IMPORTANCE: Audiometric evidence of hearing loss does not always relate to self-reported hearing loss. OBJECTIVE: To determine the prevalence of self-reported good hearing in a population with audiometrically defined hearing loss and identify associated factors. DESIGN, SETTING, AND PARTICIPANTS: We analyzed audiometric data from adults aged 20 to 69 years from the 1999 to 2002 cycles of the US National Health and Nutrition Examination Survey, a cross-sectional, nationally representative interview and examination survey of the civilian, noninstitutionalized population. Logistic regression was used to examine unadjusted and multivariable-adjusted relationships between demographic, hearing health, and general health factors related to self-perceived hearing status. Analysis was conducted between September 4, 2018, and November 30, 2018. INTERVENTIONS: Audiometry and questionnaires. MAIN OUTCOMES AND MEASURE: The prevalence of persons reporting good hearing among those with audiometrically defined hearing loss and the variables associated with this population. RESULTS: The mean (SD) age was 47.0 (0.4) years for hearing loss defined by any frequency >25 dB HL and 52.5 (1.1) years for hearing loss defined by PTA >25 dB HL. For the sample with hearing loss defined by any frequency >25 dB HL, 744 (56.1%) were men and 629 (43.9%) were women. For the sample with hearing loss defined by PTA >25 dB HL 251 (68.5%) were men and 114 (31.5%) were women. Of the 1373 participants who were found to have hearing loss (at least 1 individual frequency >25 dB HL in either ear) 993 (68.5%) reported good hearing. Younger age, nonwhite race, and women were all more likely to report good hearing. When the definition of hearing loss was made more stringent (pure-tone average >25 dB HL), 365 participants had audiometric hearing loss, but 174 (43%) continued to report good hearing. We observed that better self-perceived general health status (OR, 1.90; 95% CI, 1.25-2.90) and higher dietary quality (OR, 1.01; 95% CI, 1.00-1.02) were significantly associated with increased self-report of good hearing, whereas tinnitus (OR, 0.25; 95% CI, 0.14-0.44), noise exposure (OR, 0.39; 95% CI, 0.26-0.58), and several comorbid conditions were associated with decreased self-report of good hearing. CONCLUSIONS AND RELEVANCE: A significant proportion of the study population reported good hearing despite having audiometric evidence of hearing loss; the prevalence was related to how hearing loss was defined. The report of good hearing was significantly associated with demographics and general health status. The high prevalence of mild hearing loss and self-reported good hearing was associated with the low reported use of hearing aids.