Clinical guideline explainer
Severe and Profound Hearing Loss: What the 2026 Guidelines Mean for You
What the 2026 severe and profound hearing loss guidelines say, how 60/60 differs, and when to ask about a cochlear implant. Book an evaluation.
Read time: 6 min read
New guidelines on severe and profound hearing loss were published in 2026 by Turton and colleagues. Our source for them is a summary from Hearing Health Matters, and we did not find a numeric candidacy threshold in it. This page explains the loss categories, a separate rule called 60/60, and the practical step: if hearing aids no longer give you clear speech, ask about a cochlear implant evaluation.
What do severe and profound mean?
“If hearing aids no longer give you clear speech, ask about a cochlear implant evaluation.”
Audiologists group hearing loss by the softest level you hear on a hearing test. Severe loss is generally 61 to 80 dB HL, and profound loss is 81 dB HL or more. At these levels, even strong hearing aids may not make speech clear.
The thresholds and rules side by side
The table keeps three things apart that people often mix up. The loss categories describe the audiogram. The 60/60 rule is a referral guide for adults with cochlear implant candidacy. Neither replaces a candidacy test.
What is the 60/60 rule?
In a 2020 paper, Zwolan and colleagues proposed that adults with a pure-tone average of 60 dB HL or worse, or a best-aided sentence score of 60 percent or lower, should be referred for a cochlear implant evaluation. The ACI Alliance revised the 60/60 guidance in 2024. Do not confuse it with the earbud volume rule of the same name, which is about listening to music at 60 percent volume for 60 minutes.
Why does referral matter?
Published estimates suggest that only about 2 to 12 percent of adults who might benefit from a cochlear implant receive one. Many wear hearing aids for years while speech understanding keeps falling. A candidacy visit tests that gap directly.
What happens at a candidacy visit?
Dr. Caitlin Dold leads our cochlear implant work. The visit combines a hearing test, speech tests in quiet and in noise with your hearing aids on, and a medical review. If you qualify, we coordinate the surgeon referral and later handle activation and programming. We do not offer a device that lacks FDA approval.
Book an evaluation
Book a hearing evaluation at our Harrison or Somers office, or call (914) 949-0034. Read more on when hearing aids are no longer enough, our cochlear implant comparison and our page on cochlear implants.
Status and last update
Last updated November 2, 2026. Change note: this is the first version. Sources are listed at the end of this page.
Medical information notice
Common questions
What is severe hearing loss?
Severe loss is generally 61 to 80 dB HL on a hearing test. Profound loss is 81 dB HL or more. Strong hearing aids may help at the lower end, but speech can stay unclear.
What is the 60/60 rule for cochlear implants?
Zwolan and colleagues proposed in 2020 a referral guide: a pure-tone average of 60 dB HL or worse, or a best-aided sentence score of 60 percent or lower. The ACI Alliance revised it in 2024.
Is it the same as the 60/60 volume rule?
No. The volume rule tells people to listen at 60 percent volume for 60 minutes. The cochlear implant guide is about referral for evaluation.
When should I ask about a cochlear implant?
Ask when you wear hearing aids and still miss many words, especially on the phone or in groups. A candidacy test gives the answer.
Do the 2026 guidelines set a new cutoff?
We found no numeric threshold in the summary we reviewed. We will update this page if the full text states one.
Do you perform the surgery?
No. We test candidacy, coordinate referral, and provide activation and programming. An implant surgeon performs the surgery.
