What Does an SRT of 65 dB HL Mean?
An SRT of 65 dB HL indicates moderately severe to severe hearing loss, meaning the patient requires speech to be presented at 65 decibels above normal hearing level to understand 50% of simple two-syllable words—this represents significant functional impairment in everyday communication. 1
Understanding the SRT Value
The Speech Reception Threshold (SRT) is measured in decibels Hearing Level (dB HL) and represents the softest intensity at which a person can correctly repeat 50% of standardized two-syllable words (spondees) presented to them. 2
Clinical Interpretation of 65 dB HL
65 dB HL falls within the moderately severe hearing loss category (56-70 dB HL), approaching the severe range (71-90 dB HL). 1
At this level, the patient cannot hear normal conversational speech (typically 50-60 dB SPL) without amplification—they require speech to be significantly louder than normal to understand even half of what is said. 1
This degree of hearing loss has substantial impact on quality of life, affecting communication, safety, function, and cognition. 3
Functional Implications
Communication Impact
Patients with an SRT of 65 dB HL will miss most conversational speech without hearing aids, as normal conversation occurs at approximately 50-60 dB SPL. 1
The speech-critical frequency range (500-4000 Hz) is severely compromised at this threshold level, making understanding speech extremely difficult in both quiet and noisy environments. 1
Classification Status
According to the AAO-HNS functional classification system, an SRT of 65 dB HL may fall into Class C (serviceable hearing), which is defined as PTA >50 dB with discrimination 50-69%. 1
This classification indicates the hearing is still "usable" or "serviceable" with appropriate amplification, meaning hearing aids are appropriate and beneficial. 1
Clinical Validation
Agreement with Pure Tone Average
The SRT should agree with the pure tone average (PTA) within ±6-12 dB to confirm test validity—significant discrepancies suggest unreliable testing or functional hearing loss. 2
The PTA is calculated by averaging hearing thresholds at 500,1000, and 2000 Hz, which are the frequencies most critical for speech understanding. 1
Management Implications
Immediate Actions Required
Hearing aids are the first-line treatment for this degree of hearing loss and should be fitted promptly to prevent auditory deprivation and preserve speech understanding abilities. 3
Audiologic rehabilitation should be initiated immediately, as delays can lead to auditory deprivation and poorer long-term outcomes. 3
Further Evaluation Needed
If the hearing loss is asymmetric (>15 dB difference between ears), refer to otolaryngology to rule out retrocochlear pathology such as vestibular schwannoma. 4, 3
MRI of the brain and internal auditory canals is the imaging study of choice if asymmetric sensorineural hearing loss is present. 3
Complete audiometric assessment should include air and bone conduction thresholds (250-8000 Hz), word recognition scores, and tympanometry to determine the type of hearing loss (sensorineural vs. conductive vs. mixed). 2, 4
Advanced Intervention Considerations
When Hearing Aids Are Insufficient
Cochlear implantation should be considered if hearing aids provide insufficient benefit for severe to profound bilateral hearing loss. 3
This evaluation typically occurs after an adequate trial with appropriately fitted hearing aids demonstrates limited functional improvement. 3
Common Pitfalls to Avoid
Do not assume the hearing loss is permanent without ruling out treatable causes—sudden sensorineural hearing loss may respond to corticosteroids if treated within 2 weeks of onset. 3
Standard test-retest variability is ±5 dB, so changes <10 dB may not represent true threshold shifts and should be interpreted cautiously. 1
Do not delay amplification—early intervention with hearing aids prevents auditory deprivation and maintains better speech understanding abilities over time. 3