Conductive Hearing Loss

Table of Contents

What is Conductive Hearing Loss?

Do you ever feel like you’re trying to hear someone talk on the other side of a wall? Well, it might be due to conductive hearing loss. This type of hearing loss happens when there’s a blockage in your ear canal or when your outer, middle, or inner ear can’t effectively transmit sound waves.

There are two main types of conductive hearing loss: acquired and congenital.

The acquired type is usually caused by things like earwax buildup, a burst eardrum, infections, or foreign objects in the ear.

On the other hand, congenital conductive hearing loss is present from birth and is often caused by abnormalities in the middle ear bones.

When you have conductive hearing loss, loud sounds may sound muffled and soft sounds may be difficult to hear. It’s like there’s a barrier preventing sound from reaching your inner ear.

There are many possible causes of conductive hearing loss, including impacted earwax, ear infections, surfer’s ear, or a ruptured eardrum. So if you’re experiencing any difficulty hearing, it’s worth getting checked out to see if conductive hearing loss is the culprit.

Young lady with her ear pressed against the bottom of a glass that is pressed against a wall.
Conductive hearing loss is like trying to listen to a conversation on the other side of a wall.

Signs and Symptoms

Are you wondering if you or a loved one may have conductive hearing loss? Here are some of the signs and symptoms to look for:

  • Partial or total hearing loss in one or both ears.
  • A feeling of fullness, pressure, or pain in your ear.
  • A ringing sound (tinnitus) may come and go.
  • Difficulty understanding speech clearly when there’s background noise.

If you have any of these signs or symptoms, it’s essential to consult a professional for diagnosis and treatment. Early detection is critical for effective management of the condition. Your audiologist can investigate and refer you to an otolaryngologist (ENT) for further testing and diagnosis if required. Together, you can discuss the best treatment plan for your individual needs.

How Is Conductive Hearing Loss Investigated?

Do you know what could be causing your conductive hearing loss? There are many possibilities! A comprehensive history, examination, and pure tone audiometry can help pinpoint the underlying cause. It’s crucial to confirm if the hearing loss is conductive or sensorineural, as it will determine the next steps for investigation and treatment.

Patient History

A thorough history is vital. When evaluating a child, asking about speech and language development and milestone achievements is essential.

For both kids and adults, we need to know when the hearing loss started, if there was any trauma involved, and if there are any associated symptoms like dizziness, ear discharge, earache, or facial weakness.

Nasal discharge and weight loss in older patients could indicate a tumour in the postnasal space.

Otolaryngology Examination

To further investigate conductive hearing loss, a complete otolaryngology examination is required. Both ears will be examined using an otoscope or microscope. Ear canal blockages from earwax, debris, or foreign objects will be checked.

Ear canal stenosis (narrowing of the ear canal) must also be ruled out, possibly due to congenital disabilities or recurring infections.

Lastly, eardrums are examined for infections, fluid buildup, perforations, blood in the middle ear, or cholesteatoma.

Weber and Rinne Tests

The Weber and Rinne tests quickly help determine your hearing loss type. If you suspect you have hearing loss on one side, these tests are perfect for you. But if you think it might be on both sides with a mix of sensorineural loss, you’ll want to use pure tone audiometry.

So what do these tests involve? 

For the Weber test:

Step 1: Find the perfect spot on your face – the bridge of your forehead, nose, or even your teeth. Trust us; this is where the magic happens!

Step 2: Strike the tuning fork and firmly place the base on the chosen spot. Get ready to experience something extraordinary.

Now, brace yourself for the big reveal:

In a typical result, you’ll feel the sound equally in both ears, like a symphony playing right in the middle of your head. No lateralisation here, folks.

If you have a unilateral conductive loss, the sound will slyly sneak toward the affected (blocked) ear.

Now, here’s where it gets fascinating.

If you have unilateral sensorineural loss, guess what? The sound will shift to the normal or better-hearing side.

Now, onto the Rinne test!

Another tuning fork comes into play here. First, it’s put on your mastoid until you can’t hear it anymore, and then it’s moved 1cm away from your ear.

If you can hear the sound better through the air, that’s a good sign (Rinne positive). But hearing it louder through bone conduction is a hint of conductive hearing loss (Rinne negative).

Pure Tone Audiometry

Pure tone audiometry confirms if you’re experiencing hearing loss and helps assess how severe it is and what is causing it. So this test helps distinguish between conductive and sensorineural hearing loss.

It’s a relatively simple test where you listen to sounds through headphones at various frequencies and intensities. You press a button every time you hear something in either ear. This is typically done in an audiology booth.

Pure tone audiometry results are plotted onto an audiogram. If your results show a flat line from low-frequency to high-frequency, that suggests conductive hearing loss. But if the results for one frequency are better than another (unequal), it could indicate sensorineural hearing loss.

Further Testing

Sometimes discovering the root cause of conductive hearing loss may require more tests. Let’s explore some fascinating methods experts use to illuminate this issue.

Want to see detailed images of your ear structures? CT scans and MRI scans have got you covered. These advanced procedures reveal the inner workings of your ears like never before.

But that’s not all. We also have tympanometry, a test that measures how well your eardrum moves. Doing so helps determine if the middle or outer ear is causing the trouble.

And let’s not forget about acoustic reflex testing. This type of testing measures the contraction of specific muscles in the middle ear when exposed to loud sounds. Acoustic reflex testing can help identify any abnormalities that may be going on in the ear.

Lastly, audiometric tests and static acoustic measures can assess your hearing levels across different frequencies, giving a complete picture of your unique hearing abilities.

A Rinne test is being performed with a tuning fork to evaluate loss of hearing in one ear. It compares perception of sounds transmitted by air conduction to those transmitted by bone conduction through the mastoid.
The Rinne test is used to evaluate conductive hearing loss in one ear.

11 Causes of Conductive Hearing Loss

Causes can include problems with the pinna (the outer part of the ear), the external auditory canal, the tympanic membrane (eardrum), and the ossicles (tiny bones in the middle ear).

Sometimes, congenital abnormalities can lead to problems in the external ear and auditory canal. These abnormalities, known as aural atresia, can cause the external ear to not fully develop. This happens when the first and second branchial arches and the first branchial cleft don’t develop properly.

On the other hand, it’s more common for issues to arise in the external canal due to obstructions like debris, earwax, or foreign bodies. These obstructions can block the passage of sound, resulting in conductive hearing loss.

Another cause is a perforation in the tympanic membrane. This can happen due to trauma, such as using cotton swabs to clean the ear or from barotrauma while deep water diving. It can also be a complication of otitis media, an infection in the middle ear.

In summary, here are 11 potential causes:

  1. Something stuck in your ear, like impacted earwax or a foreign object.
  2. Fluid in your middle ear, resulting from a cold or a middle ear infection (otitis media).
  3. A perforated eardrum.
  4. An infection in the ear canal, also known as swimmer’s ear.
  5. Abnormal bone growth within the ear canal, also known as surfer’s ear.
  6. Fluid build-up in the middle ear from allergies, colds, sinusitis, and other illnesses.
  7. A blocked Eustachian tube that doesn’t drain well.
  8. Otosclerosis (a genetic disorder that causes abnormal bone growth in the middle ear).
  9. Cholesteatoma (an abnormal, non-cancerous skin growth in your middle ear).
  10. Labyrinthitis (inflammation of the inner ear).
  11. Vestibular neuritis (a condition resulting from vestibular nerve inflammation).

What Are The Risk Factors?

Conductive hearing loss has multiple potential causes and an even more significant number of possible risk factors. 

Identifying every risk factor is not always possible; however, here are some of the more prevalent risks:

  • A family history of related genetic conditions or syndromes.
  • Recurrent ear infections.
  • A history of eardrum injuries or surgery.
  • A genetic predisposition to impacted earwax.
  • Head trauma.
  • Fluid build-up in the middle ear from allergies, colds, sinusitis, and other illnesses.
  • Frequent exposure to cold wind or water increases your risk of surfer’s ear.

These risk factors can help you identify potential problems early on and get prompt medical attention and treatment.

Managing conductive hearing loss starts with knowing what might cause it and recognising when a problem may arise. You can get the necessary care and support by knowing signs or symptoms that may indicate trouble.

Don’t hesitate to talk to your audiologist or doctor if you have any questions or concerns about risk factors for conductive hearing loss. 

Are There Any Possible Complications?

Did you know that conductive hearing loss in children can significantly impact their ability to speak and learn? It’s true! Untreated, this condition can cause significant speech and language development delays and may even affect a child’s education. It is vital to diagnose and treat it promptly.

In addition, cholesteatomas, a medical condition that can result in conductive hearing loss, can cause severe harm to nearby structures if not adequately addressed.

It’s important to note that if specific causes of conductive hearing loss are not addressed, they can lead to permanent hearing loss.

So, taking action and getting the necessary medical attention if you or your child are facing any of these complications is essential.

Therapies and Treatment for Conductive Hearing Loss

Conductive hearing loss caused by a blocked ear canal is easily treated with ear microsuction to remove earwax or debris.

Antibiotics or antifungal medications can treat infections of the outer ear, ear canal or middle ear and deal with middle ear fluid.

Surgery might be an option to repair the middle ear’s structures, for example, after head trauma or due to otosclerosis.

If medical or surgical treatments are ineffective for conductive hearing loss, hearing aids can be a helpful solution. Different types are available, including air conduction, bone conduction, and bone-anchored hearing aids.

Many cases of conductive hearing loss are quickly resolved and get better with treatment.

Prevention And What to Look Out For

Hearing loss, especially when it is conductive, can be treated, and you should seek medical help if you notice any symptoms.

Hearing aids can be incredibly effective when hearing loss is not treatable.

Parents and teachers should be mindful when children are inattentive or misbehaving; it could indicate conductive hearing loss. A prompt diagnosis can prevent delays in speech and language development.

A collaborative approach involving various healthcare professionals is essential to manage conductive hearing loss effectively. Otolaryngologists, audiologists, general practitioners, and specialty nurses play crucial roles in this multidisciplinary approach.

In particular, pediatricians should closely monitor patients with otitis media for recurring episodes and any potential impacts on their learning and performance at school.

Eric Andre
Eric Andre
Eric has worked at Ear Health in Canterbury and the North Island since 2019 and at a related hearing clinic in Canterbury for many years prior. He has helped clients with hearing tests, hearing aids, tinnitus, and earwax removal. Before audiology, Eric was a design engineer developing voice communications equipment. He holds a Master of Audiology (with distinction) degree from Canterbury University.

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