Hearing loss refers to a condition that involves the inability to clearly perceive sounds and speech. It is a common issue, especially among older adults. More precisely, a decline in hearing ability typically begins around the ages of 30–40, with significant impairment occurring by the age of 80. Specifically, damage to or loss of the nerve and hair cells in the inner ear prevents the transmission of electrical signals, leading to reduced sound perception—particularly high-frequency sounds, such as female voices or children’s higher-pitched tones. However, in recent years, hearing loss has also been increasingly observed in younger individuals and children, mainly due to more frequent exposure to loud noises or improper use of ear devices.

There are several types of hearing loss: it is defined as unilateral when it affects only one ear, and bilateral when it involves both ears. It can also be progressive, if it worsens over time, or sudden, if it develops rapidly within a few days, typically within 72 hours. Considering the time of onset, we distinguish between congenital hearing loss, which is present at birth due to genetic factors or complications during pregnancy or delivery, and presbycusis, which develops with age due to degeneration of hair or nerve cells. Hearing loss can also result from physical trauma, such as head injuries or ear damage, or from diseases, mainly infectious or neurological in nature. Among the causes of hearing loss, we may find a reduction in sound perception due to obstruction of the ear canal, such as earwax buildup or infection. This condition is generally reversible if treated promptly. On the other hand, sensorineural hearing loss, caused by damage to the hair cells of the cochlea or the auditory nerve, is more commonly associated with aging, trauma, or disease, and is typically irreversible. Hearing loss may also be classified by severity:

Mild (25–39 dB): difficulty following conversations in noisy environments

Moderate (40–69 dB): hearing aids are usually required

Severe (70–89 dB): alternative communication methods, such as sign language, may be necessary

When hearing loss leads to a level of disability that significantly affects daily and work-related activities, individuals may be entitled to benefits or financial support. Assistive devices may be provided through the civil disability system, although eligibility depends on the severity, type, and onset of the condition. According to Italian Law 95/2006, children up to 12 years old with deafness are entitled to financial support due to the impact on speech and language development. After the age of 12, adults between 18 and 67 years may access a disability pension for deaf individuals, provided specific requirements are met. These include congenital hearing loss or hearing loss acquired during developmental age (up to 12 years), with an average loss equal to or greater than 75 dB in the better ear, along with economic need. However, even in cases of sudden or later-onset hearing loss, individuals may still qualify for benefits. These include enrollment in protected employment categories, work leave, access to hearing aids, tax relief, healthcare assistance, or exemption from medical fees, depending on the degree of disability. To obtain disability benefits for hearing loss, a formal application must be submitted after consultation with a specialist, who will issue a medical certificate detailing the patient’s condition and degree of hearing impairment. The process for recognizing the status of a “hearing-impaired minor” (Law 118/71, if the average hearing loss at 500–1000–2000 Hz is less than 60 dB HL) or “deaf person” (Law 381/70, if the loss is equal to or greater than 60 dB HL) requires completion of a medical certification. Based on the final assessment, the procedure for civil disability recognition and the related benefits will begin. The prescribing specialist (ENT doctor, audiologist, or phoniatrician) will perform the necessary tests, and based on the prescription, the hearing care professional will prepare a cost estimate. Subsequently, all documentation must be submitted to the Prosthetic Unit of the local health authority (ASL) to obtain authorization. Within 30 days of approval, the device will be delivered, along with instructions for proper use. Upon delivery, the patient signs a receipt, which must be returned to the ASL within 3 days. Within 20 days, the patient must return to the prescribing specialist for device testing (fitting validation). This step ensures that the device meets the prescription, evaluates patient satisfaction, and verifies correct usage. If testing is not completed within this period, the provider may proceed with billing. If discrepancies or unsatisfactory results are identified during testing, the provider must adjust or replace the device accordingly, repeating the delivery and testing process. Patients with hearing loss greater than 65 dB in the better ear are entitled to device provision. Those with less severe hearing loss may also qualify if they have additional certified conditions contributing to at least 34% disability. However, if hearing loss is the only recognized condition, it must be equal to or greater than 65 dB in the better ear to qualify for free hearing aids. If hearing loss is part of multiple conditions, it may be less than 65 dB, provided the total disability reaches at least 34%. All individuals who have completed the civil disability recognition process and have been assigned a disability level of at least 34% are entitled to free hearing aid provision. The condition “hearing loss” must be explicitly stated in the disability report; otherwise, a reassessment request is required. Individuals with total deafness (no usable hearing in either ear) are not eligible for hearing aid provision. However, those recognized as 100% disabled with assistance may still qualify if hearing loss is properly documented.

Children with hearing loss—whether mild, moderate, or severe—are entitled to exemptions and financial support from the healthcare system for devices and tools that help overcome hearing difficulties. These include hearing aids and assistive listening systems, used not only in school but also in everyday life. Cochlear implant users are entitled to repair or replacement of the external processor if it is irreparably damaged or technologically outdated. Italy, in line with the United Nations Convention on the Rights of the Child, guarantees access to education, training, and healthcare for all children, regardless of physical or social condition. Therefore, children with hearing loss have the right to receive appropriate care and tools to support their development and maximize their cognitive potential. To obtain these benefits, parents or guardians must submit an application to the INPS exclusively online. Once approved, the State provides financial support for purchasing the necessary assistive devices. Children with hearing loss also have the right to attend mainstream schools, with support teachers if needed. These rights are essential to ensure that all children, regardless of their condition, have equal opportunities for growth and development.