Historically, severe loss refers to auditory thresholds between 70 and 90dB HL. The obvious problem caused by severe loss is difficulty hearing soft sounds, and most individuals with severe loss can make out little if any conversation unless the speech is amplified. The problem is even worse if there is background noise, or if visual cues are not available. For example, many patients with unaided severe loss do not use the telephone, attend movies or enjoy meeting friends in restaurants. Unfortunately, amplifying speech offers only a partial solution to this problem. Patients with severe hearing loss complain that amplified speech is louder, but unclear. Recent studies of auditory physiology and perception suggest that these individuals have significant damage to both outer and inner auditory hair cells which results in broadened auditory filters.3 Simply put, the patient’s auditory system cannot detect a difference between two sounds that differ in frequency (pitch). The ability to make that distinction is necessary for almost every aspect of hearing. Without good frequency selectivity, we cannot hear the difference between ‘me’ and ‘knee’; distinguish speech from unwanted background noise; ignore interfering environmental sounds; or listen to music without distortion.