Conductive hearing loss

What is conductive hearing loss?

Conductive hearing loss involves what part of the ear?

Conductive hearing loss happens through damage or obstruction in the outer or middle ear.

Damage to these areas prevents the efficient transfer of energy from the environment to the inner ear. The term ‘transmission loss’ is often used due to a decline in the ear's ability to effectively transmit the sound to the inner ear.

The visible part of the external ear collects sound and directs it into the external auditory canal to the eardrumIn the middle ear, the eardrum is connected to the ossicles which amplify and transmit the vibrations to the inner ear

If you would like to better understand how hearing works, please head over to the article about hearing loss.

What are the differences between conductive and sensorineural hearing loss?

Unlike sensorineural hearing loss, conductive hearing loss is often treatable. With conductive hearing loss, the inner ear and hearing nerve function normally.

Those with conductive hearing loss generally have difficulty with the overall loudness of sounds, but not the clarity. Therefore, if volume can be increased sufficiently, they should be able to hear as usual.

What are the degrees of conductive hearing loss?

The degree of conductive hearing loss is a description of its severity. Conductive hearing loss has a maximum transmission loss, or loss of volume, up to 60 dB HL.

The severity falls into one of three categories, instead of the five as with sensorineural hearing loss:

  • mild hearing loss: 26 to 40 dB HL
  • moderate hearing loss: 41 to 55 dB HL
  • moderate-to-severe hearing loss: 56 to 70 dB HL.

The farther down your results are on the list, the greater the hearing loss and the more significant the impact on your hearing ability. Conductive hearing loss can affect one ear (unilateral) or both ears (bilateral).

What do the categories mean in daily life?

  • Mild hearing loss: Many of the soft daily sounds fall into this level and could be missed by someone with a mild hearing loss. Soft daily sounds include people breathing, leaves rustling, people whispering, refrigerator humming, cat purring and dripping of water. Although people with mild hearing loss can communicate well in quiet surroundings, in situations with background noise there could be word confusion for words starting with certain consonants (“s”, “f” or “th”).
  • Moderate hearing loss: People with moderate hearing loss will have more difficulty hearing and understanding speech at normal conversations levels. Following a conversation will require more effort and many of the words could be missed or misunderstood even in quiet. It may not be possible to follow a conversation at normal levels in background noise. Other sounds that could be missed include laughter, rain falling and coffee brewing.
  • Moderate-to-severe hearing loss: People with moderate-to-severe hearing loss will have difficulty understanding speech in most situations and have even more difficulty in noise. The TV or radio are not understandable at normal levels and require louder volume levels to be understood. Other daily sounds that could be missed include water running, an alarm clock, children playing, a busy street, an electric toothbrush and a washing machine.

What are the leading causes of conductive hearing loss?

The causes of conductive hearing loss might include issues within two areas: the outer ear and the middle ear.

The outer ear causes of conductive hearing loss

Outer ear causes of conductive hearing loss can include:

  • Blockage. The ear canal is a small tunnel that leads to the middle ear. Anything that blocks the ear canal can cause conductive hearing loss. A blockage can include impacted ear wax or obstruction by objects pushed into the canal.
  • Infection or disease. An infection in the ear canal, such as swimmers’ ear or exostoses (bony growths), can block the ear canal.
  • Disorders. There are some congenital (at birth) disorders such as atresia or the lack of development of the ear canal that can cause hearing loss. The ear canal can also have stenosis (meaning an abnormal narrowing of the ear canal) that can be congenital or acquired later in life. Some disorders also affect the outer ear, which you can see, and can also lead to hearing-related issues.

The middle ear causes of conductive hearing loss

Middle ear causes of conductive hearing loss can include:

  • Damage to the eardrum. Hearing loss can occur when the eardrum's movements are hindered. Many factors can cause this. These include holes in the eardrum, ear infection, thickening of the eardrum tissue, or imbalances of pressure in the middle ear (too much or too little).
  • Ear infection or fluid buildup. A buildup of fluid behind the eardrum not only prevents the eardrum from moving but reduces the movement of the middle ear bones as well. Both problems create transmission loss in the middle ear.
  • Disarticulation of the bones. The middle ear has three bones. Any damage that causes a disconnection of any of these bones from one another can cause hearing loss.
  • Disease or disorders. Several middle ear diseases can cause hearing loss, including benign tumors, otosclerosis, or cholesteatomas.
  • Eustachian tube dysfunction. The Eustachian tube connects the middle ear to the back of the throat. It opens and closes to maintain proper pressure in the middle ear or to allow fluid to drain out if needed. When your ears ‘pop’, the opening of this tube releases pressure in the middle ear. With the Eustachian tube blocked, pressure and fluid can build up in the middle ear.

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What are the symptoms of conductive hearing loss?

If you have conductive hearing loss, you may experience one or more of the following symptoms:

  • Pain. Pain in one or both ears can signify a problem in the ear and, depending on the situation, may cause hearing loss.
  • Ears feel plugged. If your ears feel plugged or have too much pressure, which cannot be equalized, it can suggest you have a middle ear problem.
  • Muffled sound. If the quality of sound you receive is muffled or you have difficulty hearing people and sounds around you, you may have hearing loss.
  • Drainage. Any liquid coming out of the ear should be evaluated, especially if it has a foul odor or color (yellow or green or pus).
  • Ringing in your ears. Also known as tinnitus.
  • Own voice sounds loud. When our ears are plugged, our voice might be perceived as louder and not sound normal.
  • Your level of hearing is better in one ear.

If you are experiencing any of these symptoms, you should see your doctor and have your hearing tested by your hearing care specialist. Before you book an appointment, you can also test your hearing with an online hearing test, which helps indicate if further steps should be taken.

Can conductive hearing loss be treated or is it permanent?

Conductive hearing loss can be permanent but, in many cases, can be treated so that hearing returns to normal or to the level it was before the conductive hearing loss occurred. Ultimately, the type of treatment depends on the cause and degree of hearing loss.

What possible treatments are available for conductive hearing loss?

Here a few possible treatment options for conductive hearing loss:

  • Extraction. Your treating physician can remove problems such as impacted ear wax or objects in the ear canal.
  • Medication. Antibiotics or other medicine can be used to treat various types of ear infections.
  • Surgical procedure. Abnormalities, tumors, or certain diseases can be treated surgically to repair the damage, such as inserting a patch on the eardrum to cover a hole or remove tumors or diseases such as a cholesteatoma.
  • Implants. Various implants can help certain types of middle ear damage. For disarticulated middle ear bones, there is a prosthesis called Total Ossicular Replacement Prosthesis (TORP). There are also bone anchored hearing aids which are implantable devices that can improve transmission loss.
  • Hearing aids. For a non-surgical solution, a conventional hearing aid can help compensate for transmission loss.

How best to prevent conductive hearing loss

Conductive hearing loss can be a temporary or permanent hearing loss.

Many of the causes of conductive hearing loss may not be preventable due to reasons beyond the person's control. Regardless of the reason for the hearing loss, there are still a few things that can help reduce or prevent further damage to your hearing.

  • Wear earplugs while swimming. For those who often have a swimmer’s ear or any tear or hole in their eardrums, earplugs will help prevent unclean water from entering the ear and causing further problems.
  • Monitor your condition. Your physician should monitor any medical condition that may result in conductive hearing loss. This should include regular hearing tests to monitor for any changes in hearing.
  • Protect your hearing with hearing protection. Loud sounds and noises can cause hearing loss when participating in activities, such as concerts or shooting. Although this is unlikely to increase conductive hearing loss, it can cause additional sensorineural hearing loss. There are many types of hearing protection which a hearing care specialist can explain to you and they can help you find what works best for your lifestyle.
  • Turn the volume down. When listening to music or other sounds via radio, streaming, or some other audio device, it is essential to keep the volume set at safe levels. Some audio devices allow you to set max limits for the volume. If you find you turn up your music because it is noisy, you can try noise-canceling headphones instead.
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