It takes the average person with hearing loss 5 to 7 years before getting a professional diagnosis, in spite of the fact that the signs and symptoms of hearing loss are transparent to others. But are those with hearing loss just too stubborn to get help? No, actually, and for a few specific reasons.

Maybe you know someone with hearing loss who either denies the concern or declines to seek out professional help, and while this is no doubt frustrating, it is very conceivable that the signals of hearing loss are much more obvious to you than they are to them.

Here are the reasons why:

1. Hearing loss is gradual

In most cases, hearing loss unfolds so slowly that the affected individual simply doesn’t notice the change. While you would notice an quick change from normal hearing to a 25 decibel hearing loss (characterized as moderate hearing loss), you wouldn’t detect the lesser change of a 1-2 decibel loss.

So a gradual loss of 1-2 decibels over 10-20 years, while resulting in a 20-40 total decibel loss, is not going to be perceptible at any given moment in time for those impacted. That’s why friends and family members are nearly always the first to notice hearing loss.

2. Hearing loss is often partial (high-frequency only)

The majority of hearing loss instances are classified as high-frequency hearing loss, indicating that the impacted individual can still hear low-frequency background sounds normally. Although speech, which is a high-frequency sound, is strenuous for those with hearing loss to comprehend, other sounds can usually be heard normally. This is why it’s common for those with hearing loss to say, “my hearing is fine, everyone else mumbles.”

3. Hearing loss is not attended to by the family doctor

Individuals struggling with hearing loss can attain a false sense of well-being after their yearly physical. It’s common to hear people say “if I had hearing loss, my doctor would have told me.”

This is of course not true because only 14% of physicians regularly screen for hearing loss during the yearly checkup. Not to mention that the principal symptom for the majority of cases of hearing loss — difficulty understanding speech in the presence of background noise — will not present itself in a silent office atmosphere.

4. The burden of hearing loss can be shared or passed on to others

How do you manage hearing loss when there’s no cure? The answer is easy: amplify sounds. The problem is, while hearing aids are the most effective at amplifying sounds, they are not the only way to achieve it — which those with hearing loss quickly find out.

Those with hearing loss often turn up the volume on everything, to the detriment of those around them. TVs and radios are played exceptionally loud and people are made to either scream or repeat themselves. The person with hearing loss can manage just fine with this technique, but only by transferring the burden to friends, family members, and colleagues.

5. Hearing loss is painless and invisible

Hearing loss is largely subjective: it cannot be diagnosed by visual investigation and it normally is not accompanied by any pain or discomfort. If those with hearing loss do not perceive a problem, largely due to the reasons above, then they probably won’t take action.

The only method to accurately diagnose hearing loss is through audiometry, which will determine the specific decibel level hearing loss at several sound frequencies. This is the only method to objectively determine whether hearing loss is present, but the challenging part is of course getting to that point.

How to approach those with hearing loss

Hopefully, this essay has generated some empathy. It is always frustrating when someone with hearing loss refuses to accept the problem, but remember, they may legitimately not fully grasp the magnitude of the problem. Instead of demanding that they get their hearing tested, a more productive strategy may be to educate them on the elements of hearing loss that make the condition essentially invisible.