It takes the average person with hearing loss 5 to 7 years before getting a qualified professional diagnosis, despite the reality that the warning signs of hearing loss are clear to others. But are those with hearing loss merely too stubborn to get help? No, actually, and for a few specific reasons.

Perhaps you know someone with hearing loss who either denies the difficulties or declines to seek professional help, and even though this is without a doubt frustrating, it is very feasible that the signs of hearing loss are much more conspicuous to you than they are to them.

Here are the reasons why:

1. Hearing loss is gradual

In most scenarios, hearing loss develops so gradually over time that the affected individual simply doesn’t experience the change. While you would recognize an rapid change from normal hearing to a 25 decibel hearing loss (described as moderate hearing loss), you wouldn’t perceive the lesser change of a 1-2 decibel loss.

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

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

The majority of hearing loss cases are classified as high-frequency hearing loss, which means that the afflicted individual can still hear low-frequency background sounds normally. While speech, which is a high-frequency sound, is challenging 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 claim, “my hearing is fine, everyone else mumbles.”

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

Individuals suffering with hearing loss can get a false sense of well-being after their annual physical. It’s typical 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 test for hearing loss during the course of the annual checkup. Not to mention that the primary symptom for most cases of hearing loss — difficulty understanding speech in the presence of background noise — will not present itself in a quiet office atmosphere.

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

How do you remedy hearing loss when there’s no cure? The solution is simple: amplify sounds. The problem is, even though hearing aids are the most effective at amplifying sounds, they are not the only way to accomplish it — which those with hearing loss promptly identify.

Those with hearing loss oftentimes turn up the volume on everything, to the detriment of those around them. Television sets and radios are played excessively loud and people are made to either shout or repeat themselves. The person with hearing loss can manage just fine with this method, but only by passing on the burden to friends, family members, and co-workers.

5. Hearing loss is pain-free and invisible

Hearing loss is largely subjective: it cannot be diagnosed by visual evaluation and it usually is not accompanied by any pain or discomfort. If individuals with hearing loss do not perceive a problem, mostly because of the reasons above, then they most likely won’t take action.

The only method to appropriately diagnose hearing loss is through audiometry, which will quantify the precise decibel level hearing loss at different sound frequencies. This is the only way to objectively determine whether hearing loss is present, but the difficult part is needless to say getting to that point.

How to approach those with hearing loss

Hopefully, this article has established some empathy. It is always frustrating when someone with hearing loss refuses to recognize the problem, but remember, they may legitimately not grasp the extent of the problem. Rather than commanding that they get their hearing tested, a more reliable approach may be to educate them on the components of hearing loss that make the condition virtually invisible.