Conductive hearing loss

Conductive hearing loss is caused by blockage or damage in your outer ear, ear canal, or middle ear, making it difficult for sounds to pass from your outer ear to your middle ear. 


Conductive hearing loss is less common, affecting only 10% of all hearing loss.

Hearing loss is a relatively common problem that can affect anyone at any age. Conductive hearing loss is a type of hearing loss that can affect one or both ears and happens when some form of blockage has occurred in the middle or outer ear. This stops sound from being able to pass properly through to the inner ear. While it’s usually only temporary, conductive hearing loss is less common than sensorineural hearing loss, only accounting for 10% of hearing loss.

If you have ever flown in a plane before, you will have likely experienced a strange feeling in your ears once you reached higher altitudes. Your hearing may feel muffled and your ears feel clogged. This is conductive hearing loss. While this is a fairly common side effect of flying, it doesn’t stop it from being frustrating and uncomfortable. The sudden change in altitude and change in air pressure affects your middle ear and Eustachian tubes which run from the back of your nose and upper throat to your middle ear. This type of pressure can also happen when you scuba dive or hike at high altitudes.

What is conductive hearing loss?

Our ears are chiefly made up of three parts – the outer ear, middle ear and inner ear – and each has an important role. The outer ear directs sounds to your eardrum and then sound vibrations are passed to your middle ear through the small bones in your ear. It then reaches the inner ear (cochlea). Conductive hearing loss happens when damage or an obstruction to the middle or outer ear is stopping sound travelling to the eardrum and the tiny bones of the inner ear. It could be that something is blocking the ear canal, such as fluid or earwax or your hearing loss is a result of an infection or perforated eardrum.

Conductive hearing loss typically makes sound volume seem lower, making it very difficult for you to hear softer sounds. Louder sounds meanwhile, can seem muffled. When you have conductive hearing loss it can feel like you have cotton wool in your ears or you are wearing earplugs. While it can be frustrating and uncomfortable and disrupts your ability to hear well, it does tend to heal itself. But medicines or surgery can also be used to help treat the problem.

Conductive and sensorineural hearing loss

The key difference between sensorineural and conductive hearing loss is that it affects different parts of your ear. While sensorineural hearing loss is caused by damage to the sensory part of the ear and often permanent, conductive hearing loss is as a result of a problem in the outer or middle ear that stops sound from conducting through the ear where it will be processed in the inner ear. It’s possible to experience both conductive and sensorineural hearing loss together – this is called mixed hearing loss.

FAQs on Conductive hearing loss

Signs of conductive hearing loss

Conductive hearing loss primarily affects your ability to be able to perceive the loudness of sounds, however, it doesn’t generally affect the clarity. If you have conductive hearing loss, then you may have some or all of these symptoms:


  • Your voice sounds different to you
  • It’s harder to hear out of one ear than the other
  • A strange odour emanating from your ears
  • Feeling of pressure in one or both ears
  • Normal day-to-day sounds seem softer
  • Struggle to follow conversations, particularly on the phone
  • Ringing in the ears (tinnitus)

Symptoms of conductive hearing can vary depending on which part of the ear is affected. You may find that you have to turn the volume up on the TV to help you hear the audio better.

What causes conductive hearing loss?

There are several different potential causes of conductive hearing loss, these may affect just one part of the ear or several. The underlying cause of conductive hearing loss is often used to classified by the affected part of the ear – the outer ear, ear canal or middle ear. Some of these causes include:


  • Impacted earwax (cerumen): This is a common cause of temporary conductive hearing loss and is when there has been a build-up of wax in the ear. It’s frequently made worse by people attempting to clear out the wax themselves with a cotton swab. Excess wax can stop sound from being able to travel to your inner ear.


  • Infection of the outer ear (otitis externa): This is an infection of the skin of the external ear canal and can lead to conductive hearing loss when the canal becomes blocked by debris and swelling.
  • Squamous cell carcinoma: Most cases of squamous cell carcinomas of the temporal bone are seen in people in their 50s and 60s. It is the most common type of cancer of the external ear canal and along with bleeding, earache and discharge it can also cause conductive hearing loss.
  • Blocked Eustachian tube: The Eustachian tube links the back of your nose to the middle ear. It can become blocked when the tube doesn’t open or close correctly or the mucosal tube lining becomes swollen. This can also be a common side effect of flying on an aeroplane when you have a head cold or swimmer’s ear (fluid in the ear).
  • Eardrum perforation: Trauma in the ear or an infection create a hole in the eardrum. This leads to reduced hearing in the affected ear. This can happen when you insert something too deep into your ear such as a cotton swab, are exposed to very loud noises (known as noise-induced hearing loss) experience head trauma or a blow to the ear. Changes in air pressure (barotrauma) often during an aeroplane flight or scuba diving can also cause a perforated eardrum.
  • Infection (otitis media): Many types of infection and inflammation can lead to conductive hearing loss such as chronic suppurative otitis media. Otitis media with effusion (fluid in the middle ear) is most frequently associated with tinnitus (ringing in the ears), earache, vertigo and hearing loss. Otitis media is more common in adults who have a lower immune system.
  • Otosclerosis: This is a rare, abnormal growth of one of the tiny bones of the middle ear (stapes bone) and stops the structures in the ear from functioning correctly. The causes are usually inflammatory, such as the measles virus and autoimmune processes, hormonal, metabolic and genetic. It’s twice as common in women, particularly those aged between 15 and 40.
  • Cholesteatoma: Generally associated with ear infections, these abnormal, non-cancerous skin growths develop behind the eardrum in your middle ear. They often develop as a cyst or sac, and as it increases in size, it can damage the delicate bones of your middle ear.
  • Paraganglioma: This is the most common primary neoplasm of the middle ear, and the second most common tumour of the temporal bone. It most often affects women in their 50s and 60s. It can cause a sensation of ringing in the ears, while the mass in the middle ear stops sound waves from passing through the middle ear to your eardrum, leading to conductive hearing loss.
  • Temporal bone trauma: Blunt head injuries can cause damage to the middle ear and eardrum, while also injuring the inner ear, facial nerves and brain, resulting in hearing loss.

How is conductive hearing loss diagnosed?

There are several ways that conductive hearing loss can be detected and diagnosed by your doctor. These include:


  • Otoscopy: The doctor will insert an otoscope in your ear to look at your eardrum and ear canal. This will show if you have an injured eardrum, foreign body in your ear canal such as impacted earwax or whether there is a problem in the middle ear. The doctor will also examine the colour, translucency and position – to see whether it’s normal, bulging or retracted.
  • Weber test: A tuning fork is struck and placed on your head. You’ll be asked to indicate when you can hear the sounds and if the sound is louder in your right ear, left ear, or the middle. If you have normal hearing, the sound should be the same in both ears. If you have conductive hearing loss in just one ear, you will hear the sound louder in that ear.
  • Tympanometry: A device similar to a probe is inserted in your ear to check for abnormal pressure, fluid or if you have a growth in the middle ear. They’ll also be able to detect if there is any scarring or perforation to your eardrum. The test is very brief but you’ll have to sit perfectly still during it.
  • Pure-tone audiometry: This test is used to assess hearing thresholds to determine if your hearing levels fall within normal limits.

How is conductive hearing loss treated?

While sensorineural hearing loss is usually permanent, conductive hearing loss tends to only be temporary and resolve itself. It can also be corrected medically or surgically. The treatment for conductive hearing loss will depend on the underlying cause.

  • Impacted earwax: Warm-water irrigation is a safe method for removal if there is no history of infection, perforation of the eardrum, or prior ear surgery and if it’s performed by a medical professional.
  • Infection of the outer ear: The ear canal is debrided, followed by application of ear drops. If the infection is severe, a wick is placed in the ear for two to three days to ensure delivery of the medication. Also, oral antibiotics may be helpful if the infection is severe. Hearing loss typically resolves after the inflammation lessens.
  • Eardrum perforation: In most cases, the hole heals on its own as long as the ear canal is kept dry. If the ear becomes infected, antibiotic ear drops or oral medication will be prescribed. If the eardrum doesn’t heal within two months, tympanoplasty may be required. This surgery involves using different types of grafts to repair the perforation. A 2015 study showed an 86.6% success rate, following this procedure.


  • Infection: Myringotomy is used to release middle ear fluid, enabling sound waves to reach your inner ear. A small incision is made through the layers of your eardrum. The fluid is suctioned from the middle ear through the incision. Ventilation tubes are often used to let the cut eardrum remain open, to allow better drainage of the fluid.

If you are worried about your hearing or your ear health in general, schedule a consultation with a hearing care professional or see your doctor. They will be able to assess your symptoms, examine your ears and determine what treatment would work best for you.

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