Conductive hearing loss: symptoms, remedies and causes
Conductive hearing loss occurs when your outer ear, middle ear or ear canal has become blocked or damaged. This can make it hard for sounds to pass effectively from the outer ear to your middle ear.
10%
Conductive hearing loss is less common, affecting only 10% of all hearing loss.
Conductive hearing loss is considerably less common than sensorineural hearing loss, making up just 10% of cases of hearing loss.
Have you ever been on a flight and your ears start to feel clogged? This will have been caused by the sudden change in altitude and the air pressure outside of your body being different from that in your middle ear and Eustachian tubes. The Eustachian tubes are canals located on either side of your face that runs from the back of your nose and upper throat to your middle ear. When the change in air pressure makes your ears feel clogged and your hearing becomes muffled, this is similar to conductive hearing loss linked to Eustachian tube dysfunction. This is one of the common causes of conductive hearing loss.
What is conductive hearing loss?
The anatomy of your ear is made up of:
- The sound-conducting system (outer and middle ear)
- The sound-transducing system (the inner ear)
The outer part of your ear directs sound onto your eardrum (tympanic membrane) and then these sounds are transmitted as vibrations through your middle via small ear bones before finally reaching your inner ear (cochlea).
Conductive hearing loss is usually mild to moderate and makes sounds seem softer. However, when amplified, they can be heard more clearly. You may be able to hear better when you are in a noisy environment because conductive hearing loss reduces background noise that would otherwise interfere with the conversations you want to listen to. If you were to put cotton wool in your ears or wear earplugs, this will be similar to what conductive hearing loss can sound like.
FAQs on Conductive hearing loss
Conductive hearing loss symptoms
- Normal sounds seem softer
- Hearing is better in one ear than the other
- Difficulty following conversations, especially on the phone
- Sound quality is less sharp
- Reduction in high and low sounds
- Experience pressure in one or both ears
- Unpleasant odour coming from the ear canal
Underlying causes of conductive hearing loss
There are several causes of conductive hearing loss from something relatively common as impacted ear wax to other rarer causes such as cholesteatoma.
Impacted ear wax (cerumen): A relatively common cause of temporary conductive hearing loss, impacted earwax is the build-up of excess wax in your ear. It can be made worse if you try to dislodge the earwax from the ear canal yourself with a cotton bud. The excess wax can stop sound from reaching your inner ear from your outer ear.
Infection of the outer ear (otitis externa): This is an infection of the skin of the external ear canal. When the debris and swelling block the canal it can lead to conductive hearing loss.
Squamous cell carcinoma: Squamous cell carcinomas of the temporal bone is the most common cancer of the external ear canal and usually affects people in their 50s and 60s. Discharge from the ear is the main symptom, while earache, bleeding and conductive hearing loss are also quite common.
Blocked Eustachian tube: The Eustachian tube links the back of your nose to the middle ear. You may experience Eustachian tube dysfunction when there is swelling to the mucosal tube lining or the tube is unable to open or close correctly. It’s common to experience temporary dysfunction during flights or when you have a head cold or fluid in the ear (swimmer’s ear).
Perforated eardrum: Trauma or infection in the ear can lead to a hole developing in your eardrum. This can cause you to have reduced hearing in the affected ear. Inserting something like a cotton bud too far into your ear, exposure to very loud noises (noise-induced hearing loss), head trauma, blow to the ear or changes in air pressure (barotrauma) that occur during a flight or while scuba diving can cause a perforated eardrum.
Infection (otitis media): Inflammation can affect your middle ear. Chronic suppurative otitis media is a persistent ear infection that causes perforation or tearing of the eardrum. Otitis media with effusion (fluid in the middle ear) is the most common type associated with hearing loss, vertigo, tinnitus (ringing in the ears) and earache. Otitis media is more common in adults with weakened immune systems.
Otosclerosis: This is a rare, abnormal growth of one of the very small bones located in the middle ear (stapes bone) and stops the structures in your ear working properly. It’s supposed causes are genetic, inflammatory, hormonal and metabolic. It mainly affects peopled aged 15 to 40 and twice as likely to affect women than men. Around 20% of conductive hearing loss cases are attributed to otosclerosis, according to a 2009 study.
Cholesteatoma: More commonly linked with infections, these abnormal, noncancerous skin growths develop behind the eardrum in your middle ear. They often develop as a sac or cyst and linked to chronic ear infections. As the size of the growth increases, it can damage the very delicate bones in the middle ear.
Paraganglioma: Sometimes referred to as glomus tympanicum, this is the most common primary neoplasm of the middle ear. It’s also the second-most-common tumour of the temporal bone. It’s more common for it to affect women in their 50 and 60s. It causes tinnitus (ringing in the ears) but the mass in the middle ear can also stop sound waves passing through the middle ear to your eardrum, causing conductive hearing loss.
Temporal bone trauma: Blunt head injuries (such as from a car accident) can damage the middle ear and eardrum and injure the brain, facial nerves and inner ear. Patients who are conscious following the injury will immediately experience hearing loss and this is often the most common complaint they report after temporal bone trauma. Around 40% of people with head injuries experience hearing loss and tinnitus.
Enlarged adenoids: The obstruction caused by enlarged adenoids can disrupt the normal transmission of sound waves from the middle ear to the inner ear, especially in children. This disruption leads to conductive hearing loss, where sound vibrations are not efficiently transmitted, resulting in a decrease in hearing acuity. In fact, these glands play a crucial role in the immune system, but can sometimes become enlarged or infected. Adenoidectomy involves the complete or partial removal of these adenoids to alleviate symptoms and improve overall health.
How is conductive hearing loss diagnosed?
Several tests will diagnose conductive hearing loss. Further tests are used to diagnose any underlying diseases that could lead to conductive hearing loss.
Otoscopy: This is a common test used to diagnose conductive hearing loss. It involves your doctor gently inserting an otoscope into your ear so they can examine your ear canal and eardrum. It will help them to determine if there is an injury to your eardrum, a problem in the middle or foreign bodies in your ear canal such as impacted earwax. Your doctor will examine the colour of your eardrum, its translucency to see whether it’s opaque or transparent and its position to see whether it’s bulging, retracted or neutral.
Weber test: This test using a tuning fork which is placed on the crown of your head. You will be asked if the sound is louder in your left ear, right ear or the middle. If your hearing is normal, then you will be able to perceive the sound equally in both ears. However, if you have conductive hearing loss in just one ear, then you will likely hear the sound louder in that affected ear.
Tympanometry: This uses a probe-like device which is placed in your ear to determine if there is any abnormal pressure, fluid or a growth in your middle ear. It will also be used to see if there is any perforation or scarring to your eardrum or any issues with the small bones of your middle ear. The test is very quick and only takes two minutes for each year. However, you cannot speak, move or swallow while the test is being carried out.
Pure-tone audiometry: This test is used to assess the threshold of a person’s hearing and to determine if their hearing falls within or below normal limits.
How is conductive hearing loss treated?
While sensorineural hearing loss is permanent, conductive hearing loss is often temporary and will resolve by itself or corrected medically or surgically. The treatment for conductive hearing loss will vary depending on the underlying cause.
Impacted earwax: If there is no history of infection, a perforated eardrum or previous surgery to the ear, then warm-water irrigation by a doctor or hearing care professional is a safe method for removing impacted earwax.
Infection of the outer ear: The ear canal is first debrided, ear drops are used in the infected ear. If it is severe infection then a wick is placed in the ear for two to three days to ensure medication is delivered to the affected area. Oral antibiotics may also be prescribed. Your hearing loss should resolve once the inflammation subsides.
Eardrum perforation: If the ear canal is kept dry, then it’s normal for the hole to heal by itself. However, if the ear becomes infected, then oral medication or antibiotic ear drops will be prescribed. If the eardrum still doesn’t heal within two months, then you may require tympanoplasty. This surgery uses different types of grafts to repair the perforation. It’s common for tympanoplasty to be used when there is a chronic infection caused by a perforation.
Infection: Myringotomy is used to release middle ear fluid to allow sound waves to reach your inner ear. During this procedure, a small incision is made through the layers of your eardrum. The fluid is then suctioned from the middle ear through the incision. A sample may be sent to a lab to determine if a virus or bacteria are present. Ventilation tubes are often used to keep the incised eardrum open to help drain the fluid.
If you suspect that you may have conductive hearing loss or have any other concerns about your hearing, then you should schedule a consultation with a hearing care professional as soon as possible. The impact of untreated hearing loss can be devastating and affect all aspects of your health and wellbeing.
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Causes of conductive deafness and hearing loss
Conductive hearing loss happens when sound cannot pass efficiently through the outer or middle ear. Below is a list of common causes:
- Earwax Buildup (Cerumen Impaction): Excess earwax can block the ear canal, preventing sound waves from reaching the eardrum.
- Foreign Objects in the Ear: Often seen in children, small items lodged in the ear can obstruct sound transmission.
- Ear Infections (Otitis Media): Infections of the middle ear can lead to fluid buildup behind the eardrum, reducing its ability to vibrate properly. Repeated infections may damage the ear’s internal structures.
- Eardrum Perforation: A hole or tear in the eardrum, caused by trauma, loud noises, or pressure changes, can interfere with sound conduction.
- Otosclerosis: A hereditary condition involving abnormal bone growth in the middle ear, particularly around the stapes bone, which reduces its ability to transmit sound. It often progresses over time.
- Congenital Malformations: Birth defects affecting the outer or middle ear structures can cause conductive hearing loss from an early age.
- Middle Ear Tumours or Cysts: Benign growths, such as cholesteatomas, can block or damage parts of the middle ear, leading to hearing problems.
- Eustachian Tube Dysfunction: When the Eustachian tube fails to open properly, it can cause pressure imbalance and fluid retention in the middle ear, affecting sound conduction.
Many of these causes can be medically or surgically treated, especially if diagnosed early. Prompt management helps prevent long-term complications, particularly in children where hearing is vital for speech and language development.
Does otitis media cause conductive hearing loss?
Yes, an acute otitis media (a middle ear infection) can cause conductive hearing loss.
Here's why:
- Fluid buildup: Otitis media often leads to the accumulation of fluid behind the eardrum. This fluid prevents the eardrum and the tiny bones in the middle ear (ossicles) from vibrating properly in response to sound waves, reducing the transmission of sound to the inner ear.
- Swelling and pressure: Inflammation and swelling caused by infection can further impair the movement of structures in the middle ear.
- Temporary loss: In most cases, the hearing loss caused by otitis media is temporary and resolves once the infection is treated and the fluid drains.
- Chronic or recurrent cases: Repeated or chronic infections can cause more lasting damage to the middle ear structures, potentially leading to longer-term or even permanent conductive hearing loss if left untreated.
In summary:
- ✔️ Otitis media is a common cause of temporary conductive hearing loss, especially in children.
- ⚠️ If untreated, it can lead to more serious or permanent issues.
Does otosclerosis cause conductive hearing loss?
Yes, otosclerosis is a well-known cause of conductive hearing loss.
Here’s how it works:
- Abnormal bone growth: Otosclerosis involves abnormal bone remodeling in the middle ear, typically around the stapes bone, one of the three tiny ossicles that help transmit sound from the eardrum to the inner ear.
- Fixation of the stapes: The stapes gradually becomes fixed or immobile due to the new bone growth. When it cannot move properly, it cannot transmit sound vibrations efficiently, leading to conductive hearing loss.
- Progressive condition: Otosclerosis usually develops gradually and may worsen over time, causing increasing hearing loss.
- Sensorineural component: In some advanced cases, the abnormal bone growth can extend into the cochlea (inner ear), leading to mixed hearing loss — a combination of conductive and sensorineural hearing loss.
Summary:
- ✔️ Yes, otosclerosis causes conductive hearing loss by immobilising the stapes bone.
- ⚠️ It may progress and affect the inner ear, leading to more complex hearing issues.
- 💡 Treatment options include hearing aids or stapedectomy surgery to restore sound transmission.
Is there a Meniere's conductive hearing loss?
While Meniere’s disease is primarily associated with sensorineural hearing loss, not conductive hearing loss, it's important to understand how the condition may present and why it can be confused with conductive types.
🔹 1. Hearing Loss in Meniere’s Is Sensorineural
- Meniere’s disease affects the inner ear, specifically the cochlea and balance organs. It leads to sensorineural hearing loss, which means the damage occurs in the hair cells or auditory nerve, not in the outer or middle ear.
🔹 2. Why It’s Not Conductive Hearing Loss
- Conductive hearing loss is caused by issues in the outer or middle ear (e.g. earwax, infections, ossicle damage). Since Meniere’s involves the fluid balance of the inner ear, it does not block sound transmission in the way conductive loss does.
🔹 3. Symptoms Can Feel Conductive
- Some people with Meniere’s report a sensation of fullness or pressure in the ear and muffled hearing, which can feel similar to conductive hearing loss. However, audiometric tests reveal that the loss is sensorineural, often affecting lower frequencies in the early stages.
🔹 4. Accurate Diagnosis Is Key
- Because Meniere’s symptoms fluctuate and overlap with other ear conditions, hearing tests (audiometry, tympanometry) and a thorough evaluation by an ENT specialist are essential.
🔹 5. Treatment Focuses on Inner Ear Management
- Treatments for Meniere’s (e.g. diuretics, low-sodium diet, vestibular therapy) target inner ear fluid regulation, not the causes of conductive hearing loss.
- Meniere’s may mimic some signs of conductive loss, but it causes sensorineural hearing loss. Proper testing is essential to avoid misdiagnosis.
Otitis externa and conductive hearing loss
Otitis externa, also known as “swimmer’s ear,” is an infection or inflammation of the outer ear canal, usually caused by bacteria or fungi. While it primarily affects the skin lining the ear canal, it can also lead to conductive hearing loss when swelling, debris, or discharge physically blocks the passage of sound to the eardrum.
🔹 How It Causes Conductive Hearing Loss
In otitis externa, the ear canal becomes:
- Swollen and narrowed
- Filled with fluid, pus, or dead skin
- Painful to touch or pressure
This blockage prevents sound waves from reaching the tympanic membrane (eardrum) efficiently, resulting in a temporary reduction in hearing, typically mild to moderate in severity. Since the middle and inner ear are not involved, the inner ear structures responsible for converting sound to nerve signals remain intact—hence the hearing loss is conductive, not sensorineural.
🔹 Common Symptoms of Otitis Externa
Ear pain, especially when the ear is touched or moved
- Itching in the ear canal
- Redness and swelling of the outer ear
- Muffled or reduced hearing (conductive loss)
- Discharge or unpleasant smell from the ear
🔹 Treatment and Outlook
Treatment usually includes:
- Ear drops containing antibiotics or antifungals
- Cleaning the ear canal by a healthcare provider
- Pain relief medication
Once the infection clears and the canal opens, hearing typically returns to normal. In summary, otitis externa can cause temporary conductive hearing loss, which is usually reversible with prompt treatment.
Other decreased hearing causes to know
🔹 Sensorineural Hearing Loss Causes
This occurs when there is damage to the inner ear (cochlea) or the auditory nerve.
- Ageing (Presbycusis): Gradual hearing loss that occurs with age, typically affecting high-frequency sounds.
- Noise-induced Hearing Loss: Caused by prolonged exposure to loud noise (e.g. music, machinery), damaging hair cells in the cochlea.
- Ototoxic Medications: Certain drugs (e.g. some antibiotics, chemotherapy agents) can damage the inner ear.
- Meniere’s Disease: A disorder of the inner ear that causes vertigo, tinnitus, and fluctuating hearing loss.
- Acoustic Neuroma: A benign tumour on the auditory nerve, leading to progressive hearing loss, often in one ear.
- Sudden Sensorineural Hearing Loss (SSNHL): Rapid-onset hearing loss, often unexplained, requiring urgent medical treatment.
- Genetic Causes: Inherited conditions can lead to congenital or early-onset hearing loss.
🔹 Conductive Hearing Loss (Additional Causes)
Besides otitis media and otosclerosis:
- Tympanosclerosis
- Scarring of the eardrum or middle ear after repeated infections.
- Barotrauma
- Damage caused by pressure changes (e.g. flying, diving).
🔹 Mixed Hearing Loss
🔹 Other Contributing Factors
- Ear trauma or head injury
- Autoimmune inner ear disease
- Infections like meningitis or measles
- Neurological conditions like multiple sclerosis
Key takeaway: Decreased hearing can have many causes—identifying the type and underlying issue is essential for proper treatment and rehabilitation.
If you're experiencing sudden hearing loss and traditional remedies haven’t made a difference, you may be dealing with conductive hearing loss caused by an ear infection. Infections in the outer or middle ear—such as otitis externa or otitis media—can block or disrupt sound transmission, leading to reduced hearing that can appear quickly. While often temporary, this type of hearing loss can become long-term if left untreated. Don’t ignore the signs. If sounds seem muffled, your ears feel full, or you’re struggling to hear conversations, it’s time to take action. Schedule an appointment with one of our certified audiologists for a full evaluation. We offer a complimentary hearing test to help identify whether your hearing loss is conductive and determine the best course of treatment. Taking the next step now could make all the difference in preserving your hearing health.
Conductive vs sensorineural hearing loss: differences
Hearing loss can be broadly classified into conductive, sensorineural, or mixed types, depending on the part of the auditory system affected.
- Conductive hearing loss occurs when sound cannot efficiently pass through the outer or middle ear. Common causes include earwax buildup, ear infections, perforated eardrums, or ossicle damage. This type of loss typically reduces the loudness of sound but does not distort it.
- Sensorineural hearing loss results from damage to the inner ear (cochlea) or the auditory nerve. It is often permanent and affects both the loudness and clarity of sound. Causes include ageing (presbycusis), ototoxic drugs, and noise-induced hearing loss, which is a sensorineural type. Noise exposure damages the hair cells in the cochlea, leading to irreversible hearing damage.
- In some cases, individuals may experience mixed hearing loss, where both conductive and sensorineural components are present. For example, someone with otosclerosis (a conductive cause) and age-related inner ear damage may have mixed hearing loss.
To diagnose the type of hearing loss, clinicians use air conduction and bone conduction testing during a hearing exam.
- In conductive hearing loss, air conduction is reduced while bone conduction remains normal.
- In sensorineural hearing loss, both air and bone conduction are reduced equally.
- This distinction helps pinpoint the origin of the problem.
- Understanding the type of hearing loss is key to choosing the right treatment, whether it's medication, surgery, or hearing aids.
Rinne and Weber Tests in conductive hearing loss
The Rinne and Weber tests are quick bedside tuning fork tests used to help differentiate between conductive and sensorineural hearing loss.
🔹 Rinne Test
- How it works: A vibrating tuning fork is placed on the mastoid bone (behind the ear) to test bone conduction. Once the sound is no longer heard, the fork is moved next to the ear canal to test air conduction.
- Normal (positive Rinne): Air conduction is louder than bone conduction (AC > BC).
- Conductive hearing loss (negative Rinne): Bone conduction is louder than air conduction (BC > AC) in the affected ear. This indicates that sound is being blocked from travelling through the outer or middle ear.
🔹 Weber Test
- How it works: A vibrating tuning fork is placed on the centre of the forehead or top of the head. The patient is asked in which ear the sound is louder.
- Normal result: Sound is heard equally in both ears.
- Conductive hearing loss: Sound lateralises (is heard louder) in the affected ear. This happens because background noise is reduced in the impaired ear, making the bone-conducted sound seem louder.
- Sensorineural hearing loss: Sound lateralises to the unaffected ear.
✅ Interpretation
If a patient reports:
- BC > AC on Rinne in one ear
- Sound lateralises to that same ear on Weber
...this suggests conductive hearing loss in that ear.
These tests are useful screening tools, but should be followed by formal audiometry for accurate diagnosis.
Is conductive hearing loss permanent or temporary?
Conductive hearing loss can be temporary or permanent, depending on its cause and how it is treated. It occurs when sound is blocked or reduced as it travels through the outer or middle ear, preventing it from reaching the inner ear effectively.
- In many cases, conductive hearing loss is temporary and treatable. For example, earwax buildup, fluid from middle ear infections (otitis media), or foreign objects in the ear can cause temporary hearing loss that usually resolves once the blockage or infection is treated. Treatments may include earwax removal, antibiotics, or minor procedures like inserting ventilation tubes.
- However, some causes can lead to permanent conductive hearing loss if left untreated or if the damage is irreversible. Conditions like chronic ear infections, eardrum perforation, or otosclerosis (abnormal bone growth in the middle ear) may cause lasting damage to the ear’s sound-conducting structures. In these cases, surgical intervention, such as tympanoplasty or stapedectomy, may be required to restore hearing. When surgery is not an option or is only partially effective, hearing aids can help amplify sound.
- In summary, conductive hearing loss is often temporary and reversible, especially when caused by infections or blockages. But it can also be permanent if the underlying condition damages the ear structures. Early diagnosis and treatment are essential to prevent long-term complications and preserve hearing.
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How to tell if hearing loss is permanent or temporary
Distinguishing between temporary and permanent hearing loss depends on the cause, symptoms, and medical evaluation. Here are key signs and steps to help determine the difference:
🔹 Signs of Temporary Hearing Loss
- Sudden onset after a cold, ear infection, or loud event
- Muffled or blocked feeling in the ear
- Pain or pressure in the ear
- Recent exposure to water, wax buildup, or a foreign object
- Improves with time or treatment (e.g. antibiotics, wax removal)
- Common temporary causes:
- Earwax blockage
- Otitis media (middle ear infection)
- Eustachian tube dysfunction (e.g. after a flight)
- Temporary threshold shift from loud noise exposure
🔹 Signs of Permanent Hearing Loss
- Gradual onset over time, especially with age
- No improvement after removing blockages or treating infection
- Speech sounds unclear, even when volume is loud enough
- History of noise exposure, head trauma, or family history of hearing loss
- Tinnitus (ringing in the ears) often accompanies sensorineural loss
- Common permanent causes:
- Age-related hearing loss (presbycusis)
- Noise-induced hearing loss
- Ototoxic medications
- Inner ear or nerve damage
✅ Diagnosis: See a Hearing Specialist
- Only a qualified professional (audiologist or ENT) can confirm whether hearing loss is temporary or permanent using:
- Otoscopy (ear exam)
- Audiometry (hearing test)
- Tympanometry (middle ear function test)
- Takeaway: If hearing loss is sudden, persistent, or unexplained, seek medical evaluation promptly—some causes of permanent loss can be managed if treated early.
Diagnosis: conductive hearing loss audiogram
An audiogram is a key tool used to diagnose conductive hearing loss. It visually represents a person’s hearing ability by measuring how well they hear different sound frequencies through air conduction and bone conduction.
- In conductive hearing loss, the air conduction thresholds (sounds delivered through headphones or earphones) are elevated, meaning the person needs louder sounds to hear them. However, the bone conduction thresholds (measured by placing a vibrating device behind the ear) remain normal or near normal. This creates what is known as an air-bone gap—a distinct difference between air and bone conduction results on the audiogram.
- The size of this gap indicates the severity of the conductive component. The larger the air-bone gap, the greater the interference with sound transmission through the outer or middle ear.
- For example, if a patient has normal bone conduction but air conduction shows a 30 dB hearing loss, this strongly suggests a conductive issue like earwax blockage, fluid in the middle ear, or ossicle damage. The hearing loss is often more pronounced in lower frequencies.
- Other audiological tests, such as tympanometry, may be used alongside the audiogram to assess middle ear pressure and eardrum mobility, helping to confirm a conductive origin.
- Early diagnosis is important, as many causes of conductive hearing loss are treatable. An audiogram not only helps identify the type and severity of hearing loss but also guides appropriate medical or surgical intervention.
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What does conductive hearing loss sound like? Symptoms
Conductive hearing loss affects the transmission of sound through the outer or middle ear, making sounds seem quieter or muffled, but usually not distorted. People often describe it as similar to having a blocked or plugged ear, like when flying or having water trapped after swimming. The hallmark symptom is a reduction in loudness, especially in the low to mid frequencies. Speech may sound soft but still clear if loud enough. Many individuals can still understand what’s being said in quiet environments, but may struggle in noisy settings. Common sensory experiences of conductive hearing loss include:
- Muffled or dampened sounds
- Fullness or pressure in the ear
- Sudden or gradual hearing loss in one or both ears
- Improved hearing when speaking loudly or using headphones
- Better hearing through bone conduction, such as hearing your own voice loudly when chewing or speaking
- Pain or discomfort, if the cause is infection or inflammation
- Tinnitus (ringing) in some cases, though usually milder than in sensorineural hearing loss
Because the inner ear and auditory nerve are unaffected, sound clarity remains relatively intact once loudness is restored, such as with hearing aids or medical treatment. In children, signs may include inattentiveness, delayed speech development, or frequent requests to repeat words. If symptoms persist or worsen, a hearing test is essential for diagnosis and to determine whether the cause is temporary or requires medical intervention.
Conduction deafness and hearing disorders
Conductive hearing loss, also known as conduction deafness or conduction hearing impairment, occurs when sound waves are unable to pass efficiently through the outer or middle ear to reach the inner ear. This type of hearing loss typically results in reduced loudness of sounds but usually does not affect clarity. It can affect one or both ears and may be temporary or permanent, depending on the underlying cause.
Conduction hearing impairment is often caused by issues such as earwax buildup, middle ear infections (otitis media), perforated eardrum, Eustachian tube dysfunction, or abnormal bone growth in the middle ear, such as otosclerosis. These conditions interfere with the normal vibration and transmission of sound to the cochlea.
People with conductive hearing disorders may experience symptoms such as:
- Muffled or faint hearing
- A feeling of fullness or pressure in the ear
- Difficulty hearing in noisy environments
- Temporary hearing improvement when speaking loudly or using headphones
- Possible ear pain or discharge if infection is present
Unlike sensorineural hearing loss, which involves damage to the inner ear or auditory nerve, conductive hearing loss often has a treatable cause. Management may include medications, earwax removal, surgical repair, or the use of hearing aids that amplify sound.
Early diagnosis and treatment are important, especially in children, as prolonged conductive hearing loss can impact speech and language development. Audiometric testing helps confirm the diagnosis and guide appropriate care.
Conductive hearing loss types and disorders
Outer Ear Disorders
These involve obstructions or abnormalities in the ear canal that prevent sound from reaching the eardrum. Common examples include:
- Earwax (cerumen) impaction
- Foreign objects in the ear canal (common in children)
- External ear infections (otitis externa or "swimmer’s ear")
- Congenital malformations of the outer ear
Middle Ear Disorders
These affect the eardrum or the small bones (ossicles) responsible for conducting sound to the inner ear. Key conditions include:
- Otitis media (middle ear infection with fluid buildup)
- Tympanic membrane perforation (eardrum rupture)
- Otosclerosis (abnormal bone growth around the stapes bone
- Cholesteatoma (a benign growth in the middle ear)
- Eustachian tube dysfunction, leading to pressure imbalance and fluid retention
Symptoms of conductive hearing loss
Conductive hearing loss cures
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Mild to moderate conductive hearing loss: definition
Conductive hearing loss occurs when sound is blocked or reduced as it travels through the outer or middle ear, preventing it from reaching the inner ear. When this hearing loss is described as mild to moderate, it refers to the degree of hearing impairment measured during a hearing test (audiogram).
- Mild conductive hearing loss typically means the individual has difficulty hearing soft sounds, especially in noisy environments. On an audiogram, this usually corresponds to hearing thresholds between 26 and 40 decibels (dB).
- Moderate conductive hearing loss indicates more noticeable difficulty hearing normal conversation, with thresholds between 41 and 55 dB.
- Despite the reduced loudness, the clarity of sound is usually preserved, which distinguishes conductive hearing loss from sensorineural types.
Common causes
This level of hearing loss is often temporary and treatable, depending on the cause. Common causes include:
- Earwax buildup
- Otitis media (middle ear infection)
- Eardrum perforation
- Eustachian tube dysfunction
- Otosclerosis
Symptoms
Symptoms may include:
- A feeling of fullness or pressure in the ear
- Sounds seeming muffled or faint
- Better hearing through bone conduction (e.g., hearing one’s own voice loudly)
Diagnosis
Treatments
Bilateral conductive hearing loss in adults: signs and reasons
Signs and Symptoms
Adults with bilateral conductive hearing loss may experience:
- Muffled or soft sounds in both ears
- Difficulty following conversations, especially in group settings
- A feeling of fullness or pressure in the ears
- Frequently turning up the volume on devices
- Better hearing through bone conduction (e.g., feeling vibrations while chewing)
- Occasional ear discomfort or tinnitus (ringing in the ears), depending on the cause
Although the hearing loss is equal or similar in both ears, the individual may not notice it immediately, especially if it develops slowly
Common Causes
Bilateral conductive hearing loss in adults can result from:
- Chronic otitis media (long-standing middle ear infections with fluid buildup)
- Otosclerosis, a hereditary condition causing abnormal bone growth in the middle ear
- Eustachian tube dysfunction, often linked to allergies or sinus problems
- Earwax impaction affecting both ears
- Exposure to loud environments, leading to barotrauma or pressure-related issues
- Congenital abnormalities that persist into adulthood
Diagnosis and Treatment
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Conductive hearing impairments in kids and toddlers
Causes
Other causes include:
- Earwax impaction
- Eustachian tube dysfunction, which is more common in children due to their shorter, more horizontal tubes
- Perforated eardrum from infections or injury
- Congenital malformations of the ear canal or middle ear
Signs to Look For
Parents and caregivers may notice that the child:
- Does not respond to sounds or name
- Speaks louder than usual
- Has unclear speech or delayed language development
- Frequently asks for repetition
- Turns up the volume on devices
- Displays behavioural changes such as irritability or inattention
Diagnosis typically involves a hearing test (audiometry or tympanometry) and examination by a paediatrician or ENT specialist. Treatment may include watchful waiting, medications, or surgical options like grommet (tube) insertion. With proper care, like kids' hearing aids, most children recover full hearing and continue normal development.
Conductive hearing loss treatments and remedies
Medical Treatments
The first step in treating conductive hearing loss is identifying and addressing the underlying cause:
- Earwax removal: Excessive earwax can block the ear canal. Removal by a healthcare professional, using irrigation or suction, often restores hearing immediately.
- Antibiotics or antifungal medications: Infections such as otitis media or otitis externa (outer ear infection) may be treated with ear drops or oral medications.
- Treatment of allergies or sinus issues: These can improve Eustachian tube function, reducing middle ear fluid and pressure.
Surgical Options
When medical treatment is not effective, surgery may be recommended:
- Myringotomy with grommet (tube) insertion: Small tubes are placed in the eardrum to drain fluid and equalise pressure in cases of chronic middle ear effusion.
- Tympanoplasty: A surgical repair of a perforated eardrum.
- Ossiculoplasty: Reconstruction or replacement of damaged middle ear bones (ossicles).
- Stapedectomy: A procedure for otosclerosis, replacing the fixed stapes bone with a prosthesis to restore sound transmission.
Hearing Aids and Assistive Devices
Outlook
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Best hearing aids for conductive hearing loss
1. Bone Conduction Hearing Aids
These are among the most effective options for conductive hearing loss, especially when traditional hearing aids aren’t suitable. They work by bypassing the outer and middle ear entirely, transmitting sound vibrations directly through the skull to the inner ear. Bone conduction devices are ideal for people with:
- Chronic ear infections
- Ear canal malformations
- Conditions like atresia or microtia
Common types include bone-anchored hearing aids (BAHAs) and bone conduction headbands. BAHAs require minor surgery to implant a small titanium post behind the ear.
2. Behind-the-Ear (BTE) Hearing Aids
3. Middle Ear Implants
Choosing the best hearing aid depends on the cause and severity of the conductive loss, medical history, and personal preferences. An audiologist or ENT specialist can recommend the most effective solution after a full hearing evaluation.
Do hearing aids help conductive hearing loss?
Yes, hearing aids can help people with conductive hearing loss, especially when medical or surgical treatment is not possible or only partially effective. In conductive hearing loss, sound has difficulty reaching the inner ear due to problems in the outer or middle ear—such as fluid buildup, earwax blockage, or damage to the eardrum or ossicles. However, the inner ear (cochlea) typically functions normally. Hearing aids work by amplifying sound, making it loud enough to overcome the blockage or mechanical issue. Since the inner ear is still capable of processing sound, this amplification is often very effective.
Types of hearing aids used for conductive hearing loss:
- Conventional air conduction hearing aids: These are worn behind or in the ear and can amplify sound through the normal ear canal pathway.
- Bone conduction hearing aids: These transmit sound vibrations through the skull directly to the inner ear, bypassing the damaged outer or middle ear. They are particularly useful for chronic ear infections, malformations, or if a person cannot wear regular hearing aids.
When are hearing aids recommended?
- When surgery (e.g. for otosclerosis or eardrum repair) is not an option
- When medical treatment (e.g. for chronic otitis media) does not fully restore hearing
- For long-term conductive issues, especially congenital conditions
In summary, hearing aids are a highly effective solution for managing conductive hearing loss, improving communication and quality of life when other treatments are not suitable or successful.
Do bone conduction headphones prevent hearing loss?
Bone conduction headphones transmit sound through vibrations on the bones of the skull, bypassing the outer and middle ear and delivering sound directly to the inner ear (cochlea). Because they do not sit inside the ear canal, they leave the ears open to ambient sound and avoid pressure or blockage that traditional earphones can cause. While bone conduction headphones do not prevent hearing loss entirely, they may reduce the risk of noise-induced hearing damage compared to in-ear or over-ear headphones—especially when used at safe volumes. Since they don’t blast sound directly into the ear canal, they’re less likely to cause long-term damage from prolonged high-volume exposure.
Are bone conduction headphones better for hearing loss?
✅ When They Are Better
Bone conduction headphones are most effective for people with:
- Conductive hearing loss: Since this type of hearing loss involves problems in the outer or middle ear (e.g., earwax buildup, fluid, or ossicle damage), bone conduction headphones bypass those areas and send sound directly to the inner ear (cochlea). This makes them a helpful option.
- Single-sided deafness: They can transmit sound from the non-hearing side to the functioning cochlea, improving spatial awareness and communication.
❌ When They’re Not Ideal
Bone conduction headphones are not effective for:
- Sensorineural hearing loss, where the cochlea or auditory nerve is damaged
- People with severe or profound hearing loss
- Those needing precise amplification and clarity, as bone conduction headphones are not designed as medical hearing aids
🎧 Key Differences from Hearing Aids
🔍 Conclusion
Do bone conduction headphones work for people with hearing loss?
Yes, bone conduction headphones can work for some people with hearing loss, particularly those with conductive hearing loss or certain types of single-sided deafness. Because they bypass the outer and middle ear, they allow individuals with damaged eardrums or ossicles to hear sound through vibration. However, they are not effective for people with sensorineural hearing loss, where the cochlea or auditory nerve is damaged. In such cases, medical hearing aids or implants are more appropriate. For best results, anyone with hearing loss should consult an audiologist before choosing bone conduction devices.
Example of conductive hearing loss and deafness
- An example of conductive hearing loss is a person who experiences muffled hearing in both ears following a bad cold. The cold leads to fluid buildup in the middle ear (a condition known as otitis media with effusion), which prevents sound from passing effectively to the inner ear. The person may notice that speech sounds soft, the ears feel "full," and they struggle to hear clearly in noisy environments. In this case, the hearing loss is typically temporary and resolves once the fluid clears, either naturally or with medical treatment.
- Another example is a patient with otosclerosis, a condition where abnormal bone growth in the middle ear (often around the stapes bone) prevents sound vibrations from being transmitted properly. This leads to progressive conductive deafness, usually in both ears. Unlike fluid-related hearing loss, otosclerosis is often permanent and may require surgical treatment (e.g. stapedectomy) or hearing aids to restore hearing function.
- In both cases, the inner ear remains intact, so sound clarity can be restored with treatment or amplification. These examples highlight how conductive hearing loss can range from mild and temporary to permanent, depending on the underlying cause.
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