Question: Karen asked: What is a reverse-slope loss? I have something called a cookie bite loss. I have no idea what it is, but that is what my audiologist called it.
Answer: These terms refer to the shape your hearing loss makes on your audiogram. Each of these shapes have been given strange colloquial names such as ski-slope loss, cookie-bite loss, flat loss, reverse cookie-bite loss and reverse-slope (reverse curve) loss. Here is a quick run down on them.
Normal Hearing
Before you can appreciate what the various hearing losses look like on an audiogram, you first need to know what normal hearing looks like. “Perfect” hearing theoretically would be a straight line at the 0 dB level (Fig. 1). In actual fact, audiologists typically consider “normal” hearing to range anywhere from -10 dB (negative numbers lie above the 0 dB line) to 25 dB. Fig. 2 shows an example of “normal” hearing.
Flat Loss
A hearing loss that is approximately the same at all frequencies is more or less a straight horizontal line and is called appropriately enough a “flat loss.” or a “flat curve” (which is a bit of an oxymoron). This kind of loss is more common in people with conductive losses. Fig. 3 gives an example of a flat loss.
Ski-Slope Loss
Ski-slope losses are by far the most common kind of hearing losses. These losses get their name from the “ski-slope” shape of the hearing loss on the 
audiogram. With ski-slope hearing losses, there is little or no hearing loss in the low frequencies but considerable loss in the higher frequencies. Often the mid frequency range is severe to profound. The audiogram looks much like a ski slope—the
top of the hill is on the left and the slope drops to the right. There is an almost infinite variety of ski-slope curves—some slope down gently (Fig. 4), while others are much steeper. In extreme cases the curve is almost flat in the low frequencies and then, as Fig. 5 illustrates, just about drops straight down (really more like a ski-jump loss)!
Reverse-Slope Loss
A reverse-slope loss is the reverse of the ski-slope loss (hence its name). In reverse-slope losses, the curve is low at the low frequencies and slopes up to the right. Thus, the ski-hill is on the right and drops to the left. A person with a reverse-slope loss hears better in the high frequencies than in the low frequencies. This is a very rare kind of hearing loss. Fig 6. depicts a mild reverse-slope loss, Fig. 7 illustrates an severe
reverse-slope loss and Fig. 8 shows an extreme reverse slope loss such as I have. Notice that the high
frequency hearing extends to and incredible -30 dB. Also note that this audiogram shows the hearing curve up to 20,000 Hz, whereas the other audiograms all stop at 8,000 Hz, the highest frequency audiologists normally test.
Cookie-Bite Loss
A cookie-bite loss looks like someone took a bite out of the top of the audiogram (Fig. 9). Thus, the curve is higher at both the lower and higher frequencies and lower in the middle. People with cookie-bite losses hear low and high frequency
sounds well, but have a loss in the mid-frequencies. This kind of loss is less common than the ski-slope loss.
A notch loss is a variation of the cookie-bit loss. It looks like a narrow, steep-sided valley (Fig. 10). Notch losses typically occur around 4,000 Hz and are caused by the initial stages of noise-induced hearing loss.
Reverse Cookie-Bite Loss
The reverse cookie-bite loss looks like someone took a bite out of the bottom of the audiogram (Fig. 11). This curve is lower at both ends and higher in the middle. A person with this kind of loss hears well in the mid-frequencies but has considerable loss in both the low and the high frequencies. This is also a rare kind of loss.
Where can I find the co-relation to how the audiologists match with hearing aids available in the market, and more importantly have companies addressed this issue in design?
Hi Seshadri:
I don’t think the audiologists worry about the kind of loss you have. They assume any hearing aid can be programmed to fit that loss. And companies go where the money is–and that is ski-slope losses since 90% of the hard of hearing population have such losses. Therefore, hearing aids are optimized for that loss. The rest of us have to make do the best we can with how well a given hearing aid can be programmed for our kinds of losses.
Cordially,
Neil
Why am I hearing rumbling sounds when I walk or am driving? I have reverse cookie bite loss which is rare. My hearing aid is Resound and I have been struggling with my audiologist for a little over two months now
Hi Victoria:
Do you only hear these rumbling sounds when you wear your hearing aids? Or do you hear the same sounds when you take them off when walking or driving? That’s the first thing to find out.
Cordially,
Neil
hello sir my daughter has an toneburst abr…, her results were
right ear
500hz 35db
1000hz 45db
2000hz 50db
4000hz 45db…
left ear
500hz 30db
1000hz 35db
2000hz 50db
4000hz 50db
thanks.., is this more of a flat loss… god bless
Hi Francis:
Yes, that’s close to a flat loss, but it is still really a very mild ski-slope loss. As she gets older, her curve may become more distinctive.
I’m curious, why do you care whether it’s a flat curve or a ski-slope curve?
Cordially,
Neil
because her ent doctor said that she has a conductive hearing loss…, eardrum not vibrating…, i just wanna find out whether her configuration supports that…, thanks
maybe we should get a tympanometry test as her ent doctor advised… thanks
hello doctor what does it mean when it says conductive pathology…, mild to moderate… thank you
Hi Francis:
While conductive hearing losses tend to be flatter, the exact shape of the audiometric graph isn’t the way to diagnose a conductive loss.
Tympanometry is a much better test to help determine a conductive hearing loss. I assume your daughter is very young. The good news is that the ABR and the tympanometry don’t require any response on her part.
However, when she is older, doing both air-conduction and bone-conduction testing will show an air-bone gap on your audiogram, which together with the results of the tympanometry will give a much better diagnosis of whether she has a pure conductive loss, a mixed loss (both conductive and sensorineural) or just a sensorineural hearing loss.
Mild to moderate conductive pathology just means she has some degree of conductive hearing loss. It could be (and often is) as simple as clogged middle ears due to a cold or congestion in her Eustachian tubes, but it could indicate other middle ear conditions that cause hearing loss.
Cordially,
Neil
hi sir neil.., what does it mean when the test says mild moderate hearing loss.., flat tympanogram consider conductive pathology…, thank you
Hi Francis:
It means the hearing loss line is sloping so part of the time it is a mild loss (26-40 dB) and part of the time it is a moderate (41-55 dB) hearing loss.
A normal typmanogram (Type A) looks like a mountain peak. A flat line (Type B) indicates that the middle ear is not working well at all–and that would indicate a conductive hearing loss. This could be caused by a hole in the eardrum or the middle ear filled with fluid or congested Eustachian tube often due to a cold clogging up the ear.
Cordially,
Neil
My audiogram slopes down from .25 to 2kHz (30 db to 60 db), then stays absolutely flat all the way to 8kHz. I’m 82 with old NIHL, but my chart looks nothing like a ski slope. More like a bunny slope. I can’t find any charts that look like this.
Hi Donald:
I just listed the most common types of hearing loss. Your audiogram looks like a ski (albeit bunny) slope on the left changing to a flat loss above 2 hKz. There’s nothing wrong with being unique.
Cordially,
Neil
I have a strange pattern of hearing loss. I’m not sure if it a reverse slope or a reverse cookie bite. I go from 30 at 250 down to 50s and 60s at 500-1k then back up to 20s at 1500 through 4k then it falls again to 30s at 6k and 50 at 8k. Any ideas as to what causes this pattern of hearing loss? I would suspect a cookie bite that is starting to get age related loss as well but I am only 34. If it was noise related damage wouldn’t I have a dip at 4k instead of higher? Also are the causes for reverse cookie bite similar for ones for the revers slope? Thank you.
Hi Jennifer:
I’d say you had a cookie bite loss with a high-frequency loss from some other condition, not a reverse cookie-bite loss. Since you are too young for presbycusis, you have to look elsewhere for the high-frequency component. One good possibility is drugs and medications. Many of them can cause a high frequency loss that slowly works its way down the frequency spectrum. Have you taken any drugs or medications in the past few years?
Typically noise trauma causes a noise notch at 4K as you know, but depending on the volume and duration and frequency, it may give you a high-frequency loss instead.
How long have you had this hearing loss? Just recently, or most of your life? Some cookie-bite losses are hereditary as are reverse slope losses.
Cordially,
Neil
I am in the process of trying to retrieve a copy of a hearing test I received when I was 15. I remember at the time the Dr asking me if I had a hard time understanding any deeper male voices as I seemed to not hear well in a specific frequency. I said that I hadn’t noticed anything so it was kinda written off as an interesting note. Since then I have noticed that I don’t hear as well as others but it didn’t occur to me that I needed to do anything about it. Over the years it has gotten progressively more difficult, and I’ve gotten tired of asking people to repeat themselves multiple times.
I just received my first hearing test as an adult a little over a week ago and have been absorbing as much as I can. The hearing aid specialist that gave me my test referred me to an ENT to be evaluated before he fit me for aids. I’m seeing the ENT day after tomorrow. I also took my sister to get a test and her hearing is good, all better than 20db, but shows a reverse slope shape. she hears at 20db in the lowest frequencies up to 0 db in the highest frequencies. My mother also has some hearing loss, but has never been tested as she has adapted coping mechanisms, and her mother, I have been told, had significant hearing loss, so I suspect a genetic component. Incidentally I have all of my children scheduled for hearing exams now.
I have taken sertraline and bupropion for depression, but I read that they may cause tinnitus but not normally hearing loss. Other than that I haven’t had any other serious health conditions requiring any medications and when I take over the counter pain killers, which is rarely, I don’t exceed 2-3 pills a day. It is possible that I had hearing damage as a child as my father played extremely loud music in the room next to mine for long periods of time. (loud enough to wake the neighbors a few houses away, he had mental issues).
Thank you so much for taking the time to answering my questions. Your articles have been invaluable to me in learning about hearing loss and my type of loss in particular. Thanks again.
Hi Jennifer:
It’s certainly possible and quite likely that you have a heroditary hearing loss. Hearing losses that show up in every generation are dominant gene losses. And reverse slope hearing losses are typically passed via dominant genes. I know a number of families where they can see this for 3 or 4 or more generations, mine included.
Don’t believe everything you read about drug ototoxicity. This information is so often downplayed. For example, in the case of Sertraline, the ratio is 2:1. Two people report getting tinnitus from taking it for every person reporting hearing loss. So it is true that in causes tinnitus more than hearing loss, but that’s still a LOT of people reporting hearing loss. Hearing loss is not rare like they make it out to be.
In the case of Bupropion the ratio is almost exactly the same as for Sertraline, however the incidence is twice as often.
Pain killers can also cause hearing loss and tinnitus, etc.
Drugs typically cause hearing loss in the high frequencies first, then work down the frequency spectrum. And your father playing loud music typically would have affected your hearing at 4,000 Hz and above. So depending on the results of your audiogram, you can see where the likely culprits are.
Cordially,
Neil
My 10 week old son had two ABR tests with slightly different results:
Test 1:
Left ear
500hz- 35AC/20BC
2k- 35/20
4k-65/25
Right ear
500- 65/35
2k- 25/25
4k- 65/50
Tympanogram was fine for both ears.
Audiologist indicated conductive in left (despite normal tympanogram) and mixed in right.
Test 2:
Left ear
500- 45AC/15BC
2k- 35/35
4k- 65/45
Right ear
500- 55AC (I didnt get the BC )
2k- 25/20
4k- 65/45
They said the second test results were more thorough and concluded that he had a bilateral snhl.
The pattern for the AC looks like the reverse cookie bite, but the pattern for the BC look like a mild slope.
Shouldnt they investigate why there is a big 20-30db difference between AC and BC in some of the frequencies? My understanding is that suggests conductive issues that should be addressed. I’d like to know because a reverse cookie bite and gentle slope are very different types of hearing losses that will impact how he hears us without aids on (and help us know how to tall to him)
Also, why would the BC numbers change so much in 3 weeks?
Hi Chris:
Based on what you show, I think he has a mixed hearing loss in both ears–both conductive and sensorineural. The left ear basically has a sloping loss for both AC and BC, while the right ear has a reverse cookie-bite loss for both AC and BC.
Your son is still pretty young and testing isn’t as precise as it will be when he is older. So all you know for sure at this point is that he has hearing loss in both ears that appears to be both AC and BC.
I wouldn’t panic yet. Wait 6 months or so and have him tested again. The results should be better and will let you see if the pattern continues to change or not.
I agree they should investigate the cause of the BC loss, but there is still plenty of time. Exactly what would you expect them to do now? He is still an infant.
As for his ears hearing differently, his brain will hear what both ears hear best and put these two signal together to help him understand as well as he can. If the difference remain, when it is time to get hearing aids, they will both be programmed differently to compensate for the loss in each ear.
Cordially,
Neil
hi doc neal… , are you familiar with abr latency intensity function.., to determine type of hearing loss.., for a child…, cos my daughter is scheduled for a sedated abr test…. can an abr test detect conductive hearing loss… thank you
Hi Francis:
I’m basically ignorant of the details of ABR testing so can’t help you there.
Sorry.
Neil
hi sir neal.,
if the configuration is rather flat., is it almost always a conductive hearing loss..?? how come most sensory loss are sloping ..?? thanks for reply
Hi Francis:
The reason conductive losses tend to be reasonably flat is that the transmission of sound though the middle ear is somewhat blocked for all frequencies. However, most people have sloping sensorineural hearing losses is because the high energy damage occurs mostly at the beginning of the cochlea and that just happens to be the part of the cochlea that deals with high frequency sounds. Also, most drugs that damage ears do so beginning with the high frequencies and work down the frequency spectrum.
Cordially,
Neil
how about in cases of mix hearing loss.., what would be the usual shape in their audiogram…, thanks…
Hi Francis:
The typical characteristic of a mixed hearing loss is that the audiogram would show an air/bone gap. The air conduction line and the bone-conduction lines would be separate and not overlay each other.
The shape of these lines often depends on the cause of the hearing loss.
Cordially,
Neil
so in cases of mix hearing loss.., their air conduction threshold would be worse..??? was there a case of mild mix hearing loss..? thank you sir for reply…
Hi Francis:
Yes, the air conduction thresholds have to be worse because they have to contend with the conductive loss PLUS any sensorineural loss
I’m sure there are, but the milder the hearing loss the harder it is to have any air-bone gap separation so its harder to detect.
Cordially,
Neil
hi sir neal..,
about how many decibels is lost in the hearing of a child in cases of middle ear pathology…? a blockage…
im also wondering how can sound get through the cochlea if there is a blockage in the middle ear…? thanks for reply
Hi Francis:
If the middle ear is totally block, the sound would be reduced probably around 40 dB. or so.
The sound is transmitted via bone conduction as well as air conduction. A blocked middle ear just stops the air conduction component. Thus the sound reaches your cochlea via bone conduction, but with a loss of around 40 dB or so.
Cordially,
Neil
hi sir neal..,
how does the hair cells of the cochlea work.., i mean what is their purpose in hearing properly…,
can flat sensorineural hearing loss happen.???
thanks., god bless…
Hi Francis:
The hair cells basically the ends of the auditory nerve. They convert the mechanical motion of the sound waves in the cochlea into electrical signals that then travel up the auditory nerve to the brain.
“Flat” is a bit of a misnomer as I doubt there is a truly flat audiogram. It refers to a hearing loss that has little variation between all the frequencies, maybe up to 20 dB or so.
I have a sensorineural hearing loss and as I age it is becoming flatter and flatter, so yes you can have a “flat” sensorineural hearing loss, but it isn’t very common. (I have a very rare kind of hearing loss.)
Cordially,
Neil
so in cases of conductive hearing loss…, the sound waves barely reaches the cochlea..?? coz of the blockage..?? if it does reaches the mechanical energy is already reduced…?? is that correct sir neal., thank you…
Hi Francis:
You got it.
Cordially,
Neil
so mostly sensorineural hearing loss are sloping…, why almost always the affected are the high frequency region..?? thanks sir
Hi Francis:
I’m sure there are other reasons, but one that I hear the most is that the sound waves enter at the bottom of the cochlea–and that is where the hair cells are that process the highest frequency sounds so they bear the brunt of loud sounds.
Cordially,
Neil
I have reverse cookie bite hearing loss..bilateral..can I know causes and if there is treatment
Please..can you tell me about reverse cookie bite
Hi Madeha:
A reverse cookie-bite hearing loss is just the shape of the curve on your audiogram. It looks like someone took a bite out of the bottom of your audiogram. Thus you hear best in the mid frequencies and have greater losses in both the low frequencies and the high frequencies.
Since it is a sensorineural hearing loss, treatment is no different that for those having ski-slope, reverse-curve and cookie-bite losses. Normally, treatment for sensorineural hearing losses is getting hearing aids, or cochlear implants if the hearing loss is to severe for hearing aids to effectively help.
Typically, reverse cookie-bite losses are hereditary (genetic in nature). Not much is known about their cause as they are quite rare.
Cordially,
Neil
do you mean sir that sound waves enter first at the bottom of the cochlea..??? so if sound energy is lost due to conductive component..,, the hair cells wont be stimulated that well…; is that correct.??..
hi sir neal..,
in terms of conductive hearing losses.., the usual degree is mild to moderate…??
if the hearing impairment is severe to profoung isnt the audiogram for that tends to be flat..?? would it be still conductive loss..??? thanks
Hi Francis:
Yes conductive losses typically are milder, because after about 40 dB or so, bone conduction takes over. It’s just like putting your fingers in both ears and listening–you can still hear everything. It is just a lot softer and more bassy, but you can still hear as long you do not have sensorineural hearing loss.
Severe to profound hearing losses typically are ski slope losses, or almost what we call left corner losses because there is no hearing in the mid and high frequencies. It’s just that the ski slope is not very steep because you don’t have much hearing left to lose.
The severity of the overall loss has nothing to do whether it’s conductive or sensorineural. For example, you could have both kinds of losses, but if you had a severe to profound overall loss obviously the sensorineural component would be the major component.
Cordially,
Neil
what does it mean sir that after 40db bone conduction takes over..??? how is that.?? thanks
Hi Francis:
If you only have conductive loss and no sensorineural hearing loss, you could totally block your ears and only have a 40 dB loss or so, because you’d hear via bone conduction through your skull.
Cordially,
Neil
hi sir neal how can sound go in the skull.?? as you said..,, thanks
Hi Francis:
The sound waves in the air bump up against your skull and vibrate it. These sound vibrations vibrate the structures in your cochlea, and thus send the sound signals to your brain. It doesn’t matter to your cochlea whether the vibrations it gets go through the middle ear and into the inner ear via the oval window, or whether they vibrate the skull directly. Sound is sound no matter how it reaches your inner ear.
Cordially,
Neil
can sound waves energy be that strong so that it can vibrate the skull..???
hi sir neal so what then is the purpose of the outer and middle ear…?? if sound can travel through the skull…,, thanks sir neal for your patience…
hi sir neal
do you know what the is the function of the middle ear..? they say its an impedance mismatcher when sound waves transfer from air to fluid??? it provides a boost in intensity to the sound…? thanks
Hi Francis:
The main function of the middle ear is to conduct sound waves from the outer ear to the inner ear as efficiently as possible. A secondary function is to amplify the sound signals. Another secondary function is to dampen loud sounds so they don’t damage your inner ear structures.
It’s not an impedance mismatcher. It’s just the opposite. It’s an impedance matcher to more closely match the impedance of the sound waves in air to sound waves in fluid so the sound signal is efficiently transferred and not lost in the process.
Cordially,
Neil
so if there is fluid in the middle ear or some blockage.., this function is that it the middle is suppose to do is lost..??? thanks
Hi Francis:
If the middle ear is filled with fluid, much, but not all function of the middle ear is lost. It’s like trying to clap your hands underwater. You can do it but it’s much harder and you certainly don’t make much noise.
Cordially,
Neil
so sir neal if the middle ear is functioning normally…,, by how much decibels is amplified by it to the sound waves passing through it..,,,
thanks
Hi Francis:
The middle ear doesn’t so much amplify sound as concentrate sound which gives the same effect as if it was a pure amplifier. Typically your middle ear increases the intensity of the sound signal by about 20 to 25 dB.
Cordially,
Neil
so technically if there is a middle ear dusfunction.., this 20 to 25 db is lost in the process..???
helo sir neal.,
in case of middle ear dysfunction this 20 to 25db increase is lost.., thus a conductive hearing loss… thanks.???
hi sir neal…,
is it true that sounds is everywhere..? that is the reason why one can still hear even the ears are completely blocked..? it can travel another way to tha cochlea… thanks again for reply…
helo sir neal…
about the hair cells in the cochlea.., they say there is the outer hair cells and the inner hair cells., are they one in the same..?
what are their functions.? the outer / inner hair cells..?? thanks…
Hi Francis:
The inner and outer hair cells look the same, but they have different functions. The outer hair cells act as filters and amplifiers to the incoming sound signals. So they amplify what you want to hear and reduce the background babble of the sounds you don’t want to hear.
The inner row of hair cells actually send the sound signal to your brain. So if all of them are missing, you are totally deaf.
If all three rows of the outer hair cells were missing, you’d still hear everything, but the sounds would be mixed together and hard to understand.
Typically, when you have a hearing loss you lose more outer hair cells than inner hair cells. Of course there are three times as many of them.
Cordially,
Neil
hello sir neal..,
i would like to ask if air conduction hearing test can detect sensory hearing loss…??? as well as conductive hearing loss..?? thank you…
hi sir neal..,,
i have a this query.., about how many decibels is necessary to vibrate the skull and produce a travelling wave in the cochlea..??? if i have a complete blockage in the middle ear..???
thank you for reply…
Hi Francis:
You lose about 30 to 35 dB between air conduction and bone conduction, so you’d have to raise the sound level above 35 dB or so before you’d begin to hear it.
Cordially,
Neil
so if one has also has sensory hearing loss.., outer hair cell damage, about how many decibels will it take for them to hear.., combined with middle ear pathology..???
thank you
I have reverse cookie bite in both ears, severe to profound at the ends with the middle two being 55db at best. My right ear used to be the better one but as of the last couple of years is gotten as bad as the left. It’s progressive as both ears weren’t even like this in 2014. I was told last week that eventually I’ll need CI’s….. What genetics cause RCBHL and just how rare statistically is it?
Hi Carol:
Reverse slope cookie bite hearing losses are typically caused by genetics. You may be born with this kind of hearing loss, or you may develop it as an adult and in this case, it can progressively get worse–which is likely what has happened to you. I’m not sure if they know specifically which genes are responsible–at least I don’t know which ones.
As to its rarity, again, I don’t have any figures, but it is NOT common by any means. And the more severe the hearing loss and the greater the depth of the curve, I suspect the rarer it is. I’m sure not many people have this kind of hearing loss.
Cordially,
Neil
Thank you. I wish I could attach my most recent audiogram but basically I’m profound loss in the three lowest testing frequencies and almost profound in the top two. The two middle is moderate to severe and the rest is severe. I had normal hearing through college but my first abnormal testing was in 2007 and was nothing to what it is now……. If you could even guess on a timeline and your experience, how long maybe till I lose it to where not even aids do much? My tinnitus doesn’t help either.
Thank you for your expertise!
Hi Carol:
Since it’s taken you roughly 13 years to reach the profound level at both ends–and not doing great in the middle, if things keep on going the way they are (that’s an assumption) I’d say within 3 or so years, you probably should be looking at getting cochlear implants. You are probably eligible already.
You didn’t say what your word recognition scores are. If they are poor–less than 40%, you are likely eligible right now. You may also find that your tinnitus goes away when you wear cochlear implants and just comes back at night when you take them off.
Cordially,
Neil
Thank you. Next month I’ll be having my first baseline for eligibility process. I know the audiologist there too so she’ll keep an eye on me. Been quite some time since I had the word recognition done but I will next month.
I appreciate your help! I will let you know how that goes.
Apparently I have wide bone gaps with moderate-severe conducive loss. I had not had bone conduction testing in quite some time and that audiologist was not happy about that. Tuesday is a CT and going from there. How the heck would one effectively treat SNHL in the moderate/severe-severe-profound range but also moderate CHL? Would BAHA handle both? I received a booklet on BAHA. I definitely was derailed at the appointment. Bone gap ranged anything from 10db to 40db gaps.
Hi Carol:
You can use a regular hearing aid. You’d just need more power to push through the bone conduction component of your hearing loss.
Do you have the bone conduction loss in both ears or only one?
I think you could use a BAHA, but you’d have to check out the specs of the BAHA to see what degree of sensorineural hearing loss it accommodates. That’s a question for your audiologist.
Much depends on your audiogram. If you emailed me a copy I might be able to help you on that. I’d also like to know what the CT scan finds.
Cordially,
Neil
Thank you. I’d be glad to email you and continue correspondence. My e-mail is visible from this comment I believe as I’ll leave it here. What is yours in case it doesn’t work? Cochlear brand BAHA I have too much loss for I’m told. CT was attempted today but machine failures prevented this morning. We’ll see how the week goes if I can get it done. Bone conduction is both ears.
As to hearing aids, I wear currently but insurance won’t cover a new pair till 2023…… I’m going next month to that audiologist (my regular one, not the CI one) to see if the speech banana can get turned up again.
CT was normal. ENT said to come back in a year.
Carol, thank you for posting about your Reverse Cookie Bite hearing loss. I also have it and it is so hard to find anything about it. I have moderate loss in the low frequencies, mild to moderate in the mid, and severe in the high. I just started wearing HA this year, but I have needed them for about 20 years or so.. Have you been able to find any other information sources? Dr. Bauman, feel free to respond if you know of information sources. Thanks!
Hi Kimberly:
What kind of information are you looking for on the Reverse Cookies Bite loss?
Hearing loss is hearing loss so the kinds of strategies you use for successfully dealing with a reverse cookie bite loss are very similar to the strategies you use for the other kinds of losses. For example, you want light on the speaker’s face so you can speechread him/her. You want to be close so you can hear. You want background sounds turned off/reduced if possible so you can understand the voice and not have it buried in the background racket. Etc.
One big difference is in how your hearing aids are programmed.
Cordially,
Neil
Dr. Bauman,
I was really more curious about the genetic aspect. My audiologist said I may have had this since birth without knowing it, because I only have slight loss in the speaking range. I went back and read your responses to Carol and that pretty much answered my questions.
Thank you so much for your response. I appreciate it.
Unfortunately not a lot. There’s hardly anything out there.for us. Soon after my post here I got out in the Phonak P-90 UP aids and they have been amazing. My vent holes for my molds is pretty tiny. I have no regrets getting these.
Carol,
Thanks for your response. I read back a little further in your dialog with Dr. Bauman and got a little more information. I am going to shop around a little better next time for HAs. Mine are ok, but the programing is limited . I am glad yours are working out for you!
Following micro-suction, including a sudden loud ‘bang’ in my left ear, I seem to have lost low frequency and voices/radio/TV seem as though they are quite tuned in. All sounds appear harsh and thin. Might you have any insights please?
Hi Roger:
You’ve experienced acoustic shock/trauma. One of the results is that sounds are distorted because you have developed a degree of loudness hyperacusis. It will tend to correct itself if you protect your ears from louder sounds for a few months. For really loud sounds, wear ear protectors.
Cordially,
Neil
Neil, I note that I didn’t reply to your helpful message. Many thanks for what you said. bw Roger
I always had normal hearing test. Then in 1999 a loud fire alarm went off for like 30 minutes right next to my desk. This caused tinnitus for like two weeks. My hearing test after that showed a slight cookie cutter shape that has gotten worst over the years. I was told that my hearing lose was genetic because of the cookie bite shape. Could this have been caused by the fire alarm instead
Hi Linda:
Loud noise exposure typically shows up on an audiogram as a “notch” at around 4,000 Hz. Repeated exposure can cause the notch to widen and then it begins to look like a cookie-bite hearing loss. So I could build a case that your hearing loss could be noise-induced.
It is also true that cookie-bite and reverse-slope losses are often genetic in origin. And there is nothing to say that you can’t have both conditions at the same time–with the noise-exposure exacerbating a genetic cookie-bite loss.
After the fire-alarm incident (and since then) have you noticed that you can’t hear/understand people as well in noisy situations such as parties and conventions where a lot of people are talking at once as you once could before this happened? If so, this is another clue that your hearing loss may be noise-induced.
Cordially,
Neil
Thank you for your reply. I had normal hearing up to that point. Now my hearing is terrible. I don’t hear half of what people say. I even have trouble when wearing my hearing aids. On each hearing test the cookie bite has gotten worse. If this was genetic wouldn’t it have shown up on some of my test before that time? After the fire alarm this was my results.
R500: 5 L500: 5
R1000: 20 L1000: 20
R2000: 10 L2000: 20
R3000: 0 L3000: 5
R4000: 5 L4000: 5
I know that this is considered to be normal hearing but when you graph it out you can see that this is the first audiogram that shows a slight beginning of a cookie bite. Today my test is R1000: 55, L1000: 60, R2000: 45, L2000: 55.
Thank you so much for your site. I have been searching forever to try to find out if it was even possible that my hearing was cause by something other than genetics.
Hi Linda:
Genetic hearing losses can show up at birth, in early childhood, as a teen, or even not until middle age. But the fact your hearing loss appeared right after the fire alarm episode makes me more inclined to believe it is noise-induced.
However, if your hearing loss was due to noise, I’d expect you to have your worst hearing loss around 4,000 Hz, not at 1 and 2 kHz.
Another cause of hearing loss that you may not have considered is taking one of the many drugs that cause hearing loss.
Cordially,
Neil
Hello, Dr. Bauman,
I was born completely deaf in my left ear due to congenital CMV infection. In highschool, probably at about age 14, I had a severe onset of tinnitus in my right ear. I was sent to every specialist, checked for tumors, etc… after almost a year, the tinnitus calmed down, but I have had residual tinnitus ever since, I am now 44. My most recent audiogram prior to today showed a reverse cookie bite with excellent hearing at 2000, mild loss in low frequency and moderate loss in high frequency. I recently realized I can no longer hear thunder or my kitchen appliances, etc.. so I went in for another test. My hearing loss has progressed to slight loss in the mid range, mild to moderate in the low range and moderate to severe in the high range. My word recognition is excellent at this point. Speech so far has not troubled me much. I am also a lip-reader and have adapted well since childhood, which probably benefits me in this situation.
I am finding very little information about this kind of loss on the net, as it seems to be very rare. In my case, I am very distressed because I only have one ear, and the worsening tinnitus is causing alot of anxiety for me.
My question is, is it difficult to find a proper HA for my type of loss? The info I am finding seems to suggest that it is. My other question is, is there any way of knowing how long it will be before I am to the point where HA’s will not help me and I am completely deaf? And lastly, will a CI help me if I do become profoundly deaf in my right ear? And how does a CI differ from a HA?
I forgot to mention that my audiogram prior to today was in 2015,
Hi Erinne:
You are right that you have a relatively rare kind of hearing loss and this makes it harder to fit a hearing aid to your loss. There are no special aids for your kind of loss, but most aids have the capability to be adjusted to work reasonably well for your loss, but it will never be perfect. So you need to have it tweaked to get it the best they can, then use your hearing aid supplemented by your speechreading ability. I’ve been doing this all my life too. And I rely a lot on captions for the TV and videos/zoom on my computer, and I have captioned phones. This helps a lot.
It is highly unlikely that you will ever be completely deaf. It very seldom happens unless you have a tumor growing on your auditory nerve (acoustic neuroma). However, eventually you may find that a hearing aid doesn’t help you significantly. This depends on how fast your hearing deteriorates. It may be 5 years and it may be another 35 years. You just have to wait and see.
All things being equal, yes, a CI should help you if/when you have a profound hearing loss and your speech discrimination drops to below 60% or so. My hearing is bad enough (profound to severe) to be eligible for a CI, but my speech discrimination is still too good. Thus I still rely on hearing aids and I’m 76 now. So there is no guarantee you’ll even need a CI, but it’s nice to know that is an option if you ever need it.
The basic difference between a hearing aid and a CI is that a hearing aid amplifies sounds that go into your ear canal and your ears process the sound as well as they can in their damaged state. In contrast, a CI’s microphone picks up the sounds, processes them into digital form and connects to your auditory nerve–completely bypassing your outer, middle and inner ear. Thus the damage to your ears isn’t a problem as long as your auditory nerve is still working properly.
Because the CI is an electronic device, it often does not sound normal–especially at the start. Your brain slowly learns how to interpret the the signals it is now receiving, and in time, many people find it sounds almost normal. However, typically music is a problem. This is basically because of the limitation on the number of electrodes a CI (20 or so) has as compared to the thousands that your ears normally have. Think of playing a piano that just has 20 keys instead of a full complement.
Cordially,
Neil