Types of Hearing Loss: Understanding Your Diagnosis
Your audiologist isn’t just measuring “how much” hearing loss you have. They’re also figuring out where the main bottleneck is—because treatment options depend on the type.
You’ll learn the three main types of hearing loss—conductive, sensorineural, and mixed— how your hearing test helps tell the difference, what usually helps, and when symptoms need urgent medical attention.
The big idea: Treatment follows type
Hearing is a step-by-step pathway. Sound travels through the outer ear, through the middle ear, into the inner ear (cochlea), and then along the hearing nerve into the brain.
Clean labeled illustration dividing the ear into outer ear (pinna/canal), middle ear (eardrum + ossicles), inner ear (cochlea) + auditory nerve.
When hearing changes, one key question is: Where is the main bottleneck? If the issue is mostly in the outer/middle ear, it may be treatable medically or surgically. If the issue is mostly in the inner ear or nerve, management often involves hearing technology and communication tools. Sometimes, more than one part contributes.
How audiologists identify the type (in plain English)
A standard hearing test measures hearing through two pathways:
- Air conduction: sound through the ear canal → eardrum → middle ear bones → cochlea.
- Bone conduction: gentle vibration through the skull to test the inner ear more directly (bypassing the outer/middle ear).
Comparing air and bone results helps your audiologist estimate whether the main bottleneck is in sound transmission (outer/middle ear), in inner ear/nerve processing, or both. An air–bone gap often suggests a conductive component—but your clinician interprets this in context, because rare inner-ear conditions can sometimes mimic a conductive pattern.
A simplified audiogram with a few frequencies showing air conduction symbols and bone conduction symbols, demonstrating an air–bone gap.
The three main types at a glance
| Type | Where the main bottleneck is | Common “how it feels” description | What often helps |
|---|---|---|---|
| Conductive | Outer ear or middle ear (sound doesn’t transmit efficiently) | Muffled/quiet; may sound “plugged”; clarity can be okay once loud enough | Medical treatment, procedures, or surgery (depending on cause); sometimes hearing devices |
| Sensorineural | Inner ear (cochlea) and/or hearing nerve pathway | Not just quieter—often less clear; speech in noise is hard | Hearing aids, assistive tech, communication strategies; cochlear implant evaluation for more severe cases |
| Mixed | Both (conductive + sensorineural components) | Some muffling + some distortion/clarity issues | Address the conductive part when possible + amplify/manage the sensorineural part |
Three side-by-side panels with the same ear diagram.
Conductive hearing loss
CONDUCTIVE
Conductive hearing loss happens when sound has trouble traveling through the outer or middle ear to reach the cochlea. In many cases, the inner ear and hearing nerve can still work well—sound just isn’t getting to them efficiently.
How it can feel
- Sounds seem muffled or quieter, like listening with earplugs in
- You may notice fluctuations (better some days, worse others), especially with congestion or infections
- Once sounds are loud enough, speech can be relatively clear
Common causes
- Earwax blockage or a foreign body in the ear canal
- Outer ear inflammation (otitis externa) or swelling
- Middle ear fluid (often after infection or with Eustachian tube dysfunction)
- Eardrum perforation (from infection, trauma, or pressure changes)
- Problems with the middle ear bones (ossicles), including otosclerosis
- Cholesteatoma (abnormal skin growth in the middle ear)
What often helps
Conductive hearing loss is sometimes reversible, depending on the cause. Treatment might include medications, procedures, or surgery. When medical or surgical treatment isn’t possible—or doesn’t fully fix the hearing—hearing devices can still be very effective. Your clinician will match options to your anatomy, your health, and your goals.
Cotton swabs and “digging it out” often push wax deeper and can injure the ear canal or eardrum. If you think wax is blocking your ear, ask a clinician about safe removal options.
Sensorineural hearing loss
SENSORINEURAL
Sensorineural hearing loss (SNHL) usually involves the cochlea (inner ear) and/or the nerve pathway that carries sound information to the brain. Sound can reach the cochlea normally, but the “signal” is reduced or distorted.
Cochlea spiral with a simple inset of hair cells. Show “damage” concept gently.
How it can feel
- Not just quieter—often less clear
- “I can hear people talking, but I can’t make out the words.”
- Speech in background noise is especially hard
- High-frequency consonants (like s, f, th, sh, ch) may be the first to fade
Common causes
- Age-related hearing change (presbycusis)
- Noise exposure (sudden very loud sound or long-term loud environments)
- Genetic factors
- Some medications (your clinician weighs risks/benefits and monitors when needed)
- Inner ear disorders (for example, Ménière’s disease)
- Autoimmune, infection-related, or injury-related inner ear changes
- Less commonly: growths on the hearing nerve (often benign) or other neurologic causes
What often helps
- Hearing aids (for many mild-to-severe cases)
- Assistive listening tools (captioning, remote microphones, amplified phones)
- Communication strategies (practical tools for noisy settings)
- Cochlear implant evaluation for people with severe hearing loss who get limited benefit from hearing aids
With sensorineural loss, the goal is usually not “perfect hearing.” The goal is better access to speech, less listening effort, and better day-to-day communication. Many people do very well with the right technology and support—especially when it matches their listening environments and goals.
Mixed hearing loss
MIXED
Mixed hearing loss means there is a conductive component (outer/middle ear transmission) and a sensorineural component (inner ear/nerve). A common example is an inner ear hearing change plus a temporary middle ear issue like fluid or pressure problems.
How it’s often treated
- Address the conductive part when possible (medical or surgical treatment, depending on the cause).
- Optimize hearing technology afterward to support the sensorineural part.
Seek urgent evaluation the same day (urgent care, ER, or ENT guidance) if you have: sudden hearing loss in one or both ears, a sudden major drop in one ear, or hearing change with new neurologic symptoms. Treatment decisions for sudden sensorineural hearing loss can be time-sensitive, so earlier evaluation is better.
Common questions
Can the type of hearing loss change over time?
Yes. You can develop a temporary conductive issue (like fluid) on top of a long-standing sensorineural loss, which makes the picture “mixed.” Your type can also evolve depending on the underlying condition and life events (infections, pressure changes, noise exposure, etc.).
If I have conductive hearing loss, will surgery restore my hearing?
Sometimes—but it depends on the cause, your anatomy, and what outcome you’re measuring (for example, how much the air–bone gap improves). Many middle ear procedures are often successful, but no surgery guarantees perfect hearing. Your surgeon will explain the most realistic expected benefit for your specific case.
Is an air–bone gap always a “middle ear problem”?
Often, but not always. Most air–bone gaps reflect a conductive component. Rarely, certain inner ear conditions can mimic that pattern, which is why clinicians interpret audiograms alongside your symptoms, ear exam, and sometimes additional testing.
“Type” matters because it points toward the right next step: conductive hearing loss often has medical/surgical options, sensorineural hearing loss is usually managed with hearing technology and communication tools, and mixed hearing loss often needs a combined plan.