Conductive vs sensorineural hearing loss: causes, signs and treatment compared

Sound travels through the outer ear and ear canal, vibrates the eardrum, passes through the three tiny hearing bones of the middle ear, and then reaches the inner ear (the cochlea), where hair cells convert it into nerve signals for the brain. Hearing loss happens when sound signals do not reach the brain. NHS inform divides it into two main types according to where the problem lies.

In conductive hearing loss, the sound is held up before it reaches the inner ear. In sensorineural hearing loss, the inner ear or the hearing nerve is not working as it should. The practical difference is that conductive loss is often treatable or reversible, while sensorineural loss is generally permanent and managed with hearing aids or implants. Some people have both at once, called mixed hearing loss.

The details below come from RNID, NHS inform and the NHS hearing loss page. A hearing assessment is needed to know which type is present.

The NHS offers a useful guide to which symptoms may point to which cause, while stressing that you should not self-diagnose. Difficulty hearing in one ear with itchiness or a blocked feeling suggests earwax build-up. Difficulty hearing in one ear with earache, a high temperature, itching, pressure or discharge suggests an ear infection. Sudden hearing loss after an ear infection, a very loud noise or a change in air pressure, for example from flying, can suggest a perforated eardrum. All of these are conductive causes.

Gradual loss in both ears from ageing or years of loud noise is the classic sensorineural pattern. Sudden hearing loss alongside dizziness, a spinning sensation (vertigo) or ringing in the ears (tinnitus) may be labyrinthitis or Ménière's disease, according to the NHS. NHS inform adds that some people are born with hearing loss, although most cases develop as you get older.

Because the ear can be affected at more than one level, the two types are not mutually exclusive. NHS inform notes that it is also possible to have both, known as mixed hearing loss, for example age-related change in the inner ear on top of earwax blockage in the canal.

Neither type has a single giveaway symptom. The NHS lists common signs of hearing loss, whatever the type: difficulty hearing other people clearly and misunderstanding what they say, especially in noisy places; needing to ask people to repeat themselves; turning the TV or music louder than others need; trouble on the phone; struggling to keep up with a conversation; and feeling tired or stressed from concentrating while listening.

NHS inform adds early signs such as difficulty hearing the doorbell and finding it hard to tell which direction noise is coming from. It also lists signs in babies and children, including not being startled by loud noises, being slow to learn to talk and often turning the TV volume up. Hearing loss can affect a child's speech development and progress at school, so concerns about a child should be raised early.

NHS inform says your GP can check for problems and may refer you to an audiologist or an ear, nose and throat (ENT) specialist for further tests. The GP may be able to treat the cause directly. According to the NHS, an ear infection might be treated with antibiotics and earwax with ear drops or removal. If hearing loss is not caused by something a GP can treat, referral to a hearing specialist follows.

For permanent loss, the NHS says a specialist will often recommend hearing aids, which will not make hearing perfect but make sounds louder and clearer, and some people may need a hearing implant attached to the skull or placed deep inside the ear. NHS inform lists digital hearing aids available through the NHS, bone anchored implants, middle ear implants, cochlear implants, and lip reading or British Sign Language for sensorineural loss. For conductive loss it notes that the problem is sometimes temporary and can be treated with medication or minor surgery, while more major surgery may be needed to repair the eardrum or the hearing bones.

See a GP if your hearing is getting gradually worse, or if you have had treatment for an ear infection or earwax but your hearing has not returned. Ask for an urgent GP appointment or call NHS 111 if you lose hearing suddenly in one or both ears, if your hearing has worsened over the last few days or weeks, or if hearing loss comes with other symptoms such as earache or discharge. The NHS notes it might not be anything serious, but it is best to get help because it may need treatment quickly.

Protection matters whichever type you have. The NHS advises ear protection around loud noise, keeping music at a comfortable volume, and not putting fingers or objects such as cotton buds into the ears.