Conductive Hearing Loss

What is conductive hearing loss?

Conductive hearing loss occurs when sounds can’t reach your inner ear. Several things can cause it, including ear infections, blockages and structural issues. As a result, louder sounds might be muffled, and you may not be able to hear softer sounds at all. Other names for this condition include conductive hearing impairment or conduction deafness.

Conductive hearing loss is the most common cause of hearing loss in young children. In one study, researchers found that 19% of schoolchildren from kindergarten to grade 6 had some type of hearing loss. Among these cases, 93% were due to conductive hearing impairment.

Though conductive hearing loss is most common in children, adults can get it, too. It can be temporary or permanent and range from mild to severe. In most cases, treatment can correct it.

Types of conductive hearing loss

There are two types of conductive hearing impairment:

• Unilateral conductive hearing loss: Affects one ear.
• Bilateral conductive hearing loss: Affects both ears.

What are the symptoms of conductive hearing loss?

Conductive hearing loss symptoms can include:

• Balance issues (due to problems with the vestibular system in your inner ear)
• Ear pain
• Ear pressure
• Ear popping or ringing
• Muffled hearing in one or both ears
• Noticing that your own voice sounds louder

What causes conductive hearing loss?

Conductive hearing loss happens when sound can’t reach your cochlea. Your cochlea is the part of your inner ear responsible for hearing.

There are many reasons — both simple and complex — why sounds might not reach your inner ear. Conductive hearing loss causes include:

• Blockages from stuck objects
• Ear infections (especially chronic ones)
• Ear tumors, cysts or other growths like cholesteatoma
• Earwax buildup
• Eustachian tube dysfunction
• Fluid in your middle ear from colds
• Otosclerosis (abnormal bone growth in your ear)
• Ruptured eardrum

Among children, the most common causes of conductive hearing loss include chronic ear infections and foreign objects in the ear canal.

In adults, conductive hearing loss is usually a result of an ear injury or health condition.

Risk factors

Some things increase your risk for conductive hearing loss. The following conditions could cause permanent hearing impairment if left untreated:

• Ear abnormalities. Microtia, atresia (missing or underdeveloped ear canal) and other ear abnormalities can result in conductive hearing loss.
• Chronic ear infections. Fluid buildup in your middle ear that doesn’t go away can increase your risk for conductive hearing loss.
• Structural damage. An ear injury or otosclerosis can cause damage to your ossicles (three tiny bones in your ear that help you hear).

How is conductive hearing loss diagnosed?

A healthcare provider (usually an otolaryngologist) will do a physical examination. During this visit, they’ll ask about your symptoms and medical history. They might ask you questions like:

• When did you first start to lose your hearing?
• Was it sudden or gradual?
• Is one side worse than the other?
• Do you have a history of ear infections?
• Do you have any ear pain, pressure or ringing in the ears?
• Do any of your biological family members have hearing loss?

Your healthcare provider will look at the outside of your ear and feel around the area. They’ll use a lighted instrument called an otoscope to view the inside of your ear, looking for any blockages or structural abnormalities.

What tests will be done to diagnose this condition?

After a physical exam, an otolaryngologist or audiologist will need to run some hearing tests, which may include:

• Acoustic reflex test: Measures the tightness of a small muscle in your middle ear (stapedial muscle) in response to loud sounds.
• Bone conduction test: Sends sound directly to your inner ear and helps determine which type of hearing loss you have.
• Otoacoustic emissions (OAEs): Measures sound-related vibrations from your inner ear and can show whether you have a blockage.
• Pure-tone audiometry: Determines the quietest sounds you can hear at different pitches.
• Speech audiometry: Tests your word recognition and records the softest speech you can repeat.
• Tuning fork exams: Determine whether you have conductive or sensorineural hearing loss. (Examples include the Rinne test and Weber’s test).
• Tympanometry: Shows how well your eardrum moves in response to sounds.

In addition to hearing tests, your healthcare provider may need to do a:

• Cranial nerve exam
• Head and neck exam
• MRI (magnetic resonance imaging) or CT scan (computed tomography scan)

How is conductive hearing loss treated?

The treatment that’s right for you depends on what caused your hearing loss. Depending on your situation, conductive hearing loss treatments might include:

• Active surveillance. Your healthcare provider may start with “watchful waiting.” That means they’ll monitor your hearing loss over a period of time. If hearing loss worsens, they’ll design a treatment plan.
• Hearing aids. Hearing aids and other assistive listening devices can amplify and change sounds so you can hear them better.
• Medications. You might need medication if an infection or similar condition caused conductive hearing loss. Your provider can prescribe these in ear drops or pill form.
• Surgery. If a cyst, tumor or another type of growth keeps sound from reaching your inner ear, a surgeon may need to remove the growth. Surgery can also repair damaged ossicles (the tiny bones inside your ear).

Can conductive hearing loss be prevented?

You can’t always prevent conductive hearing loss, especially when abnormal bone growth or a structural issue inside your ear causes it. But you can reduce your risk by following these guidelines:

• Don’t stick anything in your ear canal, including cotton swabs.
• If you get an ear infection, treat it promptly.
• See your healthcare provider for regular hearing tests.

What’s the outlook for people with conductive hearing loss?

The outlook is generally good with treatment. Medication, hearing aids or surgery can improve or correct most cases of conductive hearing loss.

When should I see my healthcare provider?

Tell your healthcare provider right away if you have:

• Hearing loss that gets worse
• Sudden hearing loss (especially in one ear)
• Symptoms in addition to hearing loss, like ear pain, headaches, numbness or weakness

What questions should I ask my doctor?

If you have conductive hearing loss, here are some questions you might want to ask your healthcare provider:

• What type of treatment do I need?
• What results can I expect from treatment?
• How often will I need follow-up visits?
• Could my hearing eventually get worse?
• What resources do you recommend?