Hearing Loss Perceptions in Patients With Subjective Asymmetry: Analysis and Implications

PURPOSE: The aim of this study was to evaluate the accuracy of self-reported hearing asymmetry in predicting objectively defined asymmetric hearing loss (AHL) and identify patient factors associated with over- or underestimation of individual ear hearing loss severity. METHOD: A cross-sectional survey analysis of consecutive adult patients undergoing audiometric evaluation was conducted at the audiology and otology/neurotology clinics of a single tertiary referral center from 2020 to 2025. Fifty patients reporting hearing asymmetry who had not undergone prior audiometric testing within 5 years were included. A survey was administered to quantify subjective individual ear hearing loss severity before audiometric evaluation to determine the accuracy of self-reported AHL (≥ 15 dB interaural difference) and subjective severity estimation for each ear. RESULTS: Seventy percent of patients incorrectly identified AHL based on audiometric testing. Misclassification did not differ significantly according to age, sex, or race. Patients with lower (< 25 dB) or moderate (25-50 dB) binaural pure-tone averages were more likely to misclassify AHL than those with higher thresholds (> 50 dB). Sixty-two percent of patients misclassified the worse hearing ear, with a strong bias toward overestimation (94%). In contrast, 48% misclassified the better hearing ear, with a modest skew toward underestimation (58%). Across subgroups, worse hearing ears were significantly overestimated compared with better hearing ears. Patients with better binaural hearing and narrower interaural differences were more prone to worse hearing ear overestimation. CONCLUSIONS: It is likely that patients do not reliably estimate AHL corresponding to a 15-dB interaural difference. Better binaural hearing and lower interaural asymmetry were associated with poorer estimation of the worse hearing ear, underscoring the importance of audiometric confirmation in patients with preserved hearing.