Beyond the Audiogram: Current Advances in the Diagnosis and Clinical Understanding of Hidden Hearing Loss
DOI:
https://doi.org/10.64784/258Palabras clave:
Hidden Hearing Loss, Cochlear Synaptopathy, Audiology, Otolaryngology, Neurology, Speech-in-Noise Perception, Auditory Brainstem Response, Electrophysiology, Hearing Disorders, Hearing Conservation, Auditory Neuroscience, Diagnostic Biomarkers, Artificial IntelligenceResumen
Hidden Hearing Loss (HHL) has emerged as a significant challenge in contemporary hearing healthcare because individuals may experience substantial communication difficulties despite presenting normal hearing thresholds during conventional pure-tone audiometry. This review analyzes current scientific evidence regarding the biological mechanisms, epidemiology, clinical manifestations, diagnostic strategies, and emerging therapeutic perspectives associated with HHL from an international viewpoint while considering the current situation in Latin America. A narrative literature review was conducted following the Scientific Method using publications retrieved from PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, and Google Scholar. Twenty peer-reviewed publications were selected according to predefined eligibility criteria and critically analyzed. The reviewed evidence identifies cochlear synaptopathy as one of the principal mechanisms underlying HHL, although aging, metabolic disorders, cardiovascular disease, ototoxic medications, and genetic susceptibility may also contribute to auditory neural dysfunction. Speech-in-noise difficulty, increased listening effort, tinnitus, and auditory fatigue were the most frequently reported clinical manifestations. No single diagnostic method demonstrated sufficient accuracy to independently confirm the condition; instead, the literature supports combining behavioral assessments with electrophysiological and cochlear function tests. Current management remains focused on hearing conservation, early recognition, and individualized auditory rehabilitation, while regenerative medicine and artificial intelligence represent promising future directions. The available evidence supports the importance of adopting comprehensive diagnostic approaches that extend beyond conventional audiometry to improve early detection and optimize hearing healthcare.
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