Your audiologist just told you that you have "sensorineural hearing loss." You nodded, trying to absorb the information, but as you left the office, you realized: What does that actually mean? Why does the type of hearing loss matter? And what does this mean for what comes next?
You're not alone in feeling confused. Most people understand they have hearing loss—they've been living with it—but the classification into types feels abstract until you understand what it means for your treatment options and outcomes.
Here's what matters: where your hearing loss occurs in your auditory system determines what can be done to help you hear better. Conductive hearing loss (problems with sound transmission) often responds to medical or surgical treatment. Sensorineural hearing loss (problems with the inner ear or nerve) typically requires amplification through devices. Mixed hearing loss needs both approaches. Understanding your type isn't just academic—it's the first step toward effective treatment.
Why Classification Matters: Treatment Follows Type
Your hearing system has three main sections: the outer ear (ear canal), the middle ear (eardrum and tiny bones), and the inner ear (cochlea and auditory nerve). Sound travels through all three sections before reaching your brain. Problems can occur anywhere along this path, and where the problem occurs determines what treatment will work.
[Image of ear anatomy showing outer, middle, and inner ear sections]Think of it like a plumbing system. If water isn't reaching your sink, the solution depends on where the blockage is. A clogged pipe (like a blocked ear canal) can be cleared. A broken pump (like damaged inner ear hair cells) might need replacement or bypass. Your audiologist isn't just diagnosing hearing loss—they're pinpointing where in the system things have gone wrong so they can recommend the right fix.
Your hearing test measures sound through two pathways: air conduction (through your ear canal and middle ear) and bone conduction (bypassing those structures to test your inner ear directly). Comparing these two measurements tells your audiologist exactly where the problem is. An air-bone gap indicates conductive loss. Both measures showing loss indicates sensorineural loss. Want to understand what your test shows? Learn to read your audiogram here.
Conductive Hearing Loss: When Sound Can't Reach Your Inner Ear
Conductive hearing loss occurs when something blocks or reduces sound waves from traveling efficiently through your outer or middle ear to reach your inner ear. Your inner ear (cochlea) and auditory nerve work fine—sound just isn't reaching them effectively enough.
How It Feels
People with conductive hearing loss often describe sounds as muffled or quiet, like listening through a barrier or with earplugs in. Once sounds are made loud enough, they're usually clear—you just need more volume. Many people notice fluctuations in their hearing, especially with ear infections or fluid buildup that comes and goes.
Common Causes
- Earwax buildup blocking the ear canal completely
- Ear infections causing fluid to accumulate behind the eardrum
- Perforated eardrum from trauma, infection, or pressure changes
- Otosclerosis—abnormal bone growth that prevents the stapes bone from moving properly
- Damage to the ossicles (the three tiny bones in your middle ear) from infection or injury
- Foreign objects in the ear canal
- Cholesteatoma—abnormal skin growth in the middle ear
- Eustachian tube dysfunction preventing proper pressure equalization
How It Shows on an Audiogram
Conductive hearing loss creates an "air-bone gap" on your audiogram. Bone conduction testing (which bypasses your outer and middle ear) shows normal or near-normal hearing, but air conduction testing (sound traveling through your ear canal and middle ear) shows hearing loss. This gap between the two measurements tells your audiologist that the problem is in sound transmission, not in your inner ear's ability to process sound.
Treatment Options and Prognosis
The encouraging news: conductive hearing loss can often be medically or surgically corrected. Because the inner ear works fine, removing the blockage or repairing the mechanical problem can restore hearing—sometimes completely.
Common treatments include:
- Earwax removal by your doctor (don't try to dig it out yourself—you'll likely push it deeper)
- Antibiotics or antifungal medications for infections
- Surgery to repair a perforated eardrum (tympanoplasty), with success rates over 90%
- Stapedectomy for otosclerosis—replacing the fixed stapes bone with a prosthesis, successful in improving hearing for 90%+ of patients
- Removal of cholesteatoma through surgical intervention
- Hearing aids if medical treatment isn't possible or doesn't fully resolve the loss
- Bone-anchored hearing aids for chronic conductive problems that can't be surgically corrected
Prognosis: Generally excellent when treated appropriately. Many causes of conductive hearing loss are temporary or reversible. Even when permanent, hearing aids or bone-conduction devices work exceptionally well because your inner ear processes sound normally once it gets there.
Sensorineural Hearing Loss: When the Inner Ear or Nerve Is Damaged
Sensorineural hearing loss (SNHL) involves damage to the inner ear—usually the hair cells in your cochlea—or to the auditory nerve that carries signals to your brain. Sound reaches your inner ear fine through normal mechanical transmission, but the system that converts sound vibrations into neural signals (or transmits those signals) doesn't work properly.
How It Feels
People with sensorineural hearing loss don't just hear things more quietly—they hear them less clearly. You might say, "I can hear that people are talking, but I can't understand what they're saying." Sounds may seem distorted or garbled. Background noise makes understanding speech extremely difficult because your brain can't filter out what it needs to hear. Many people notice they hear fine in quiet but struggle significantly in restaurants, parties, or anywhere with competing sounds.
High-frequency consonants (s, f, th, sh, ch) are typically affected first, making words sound similar—"cat," "cap," and "cash" all blur together.
Common Causes
- Age-related hearing loss (presbycusis)—natural deterioration of hair cells over time
- Noise exposure—damage from loud sounds, either sudden (explosions) or cumulative (years in noisy environments)
- Genetic factors—inherited conditions affecting inner ear structure or function
- Ototoxic medications—certain antibiotics, chemotherapy drugs, or high-dose aspirin
- Viral infections affecting the inner ear (meningitis, mumps, measles)
- Ménière's disease—inner ear disorder causing episodes of vertigo and hearing loss
- Acoustic neuroma—benign tumor on the hearing nerve
- Head trauma damaging the cochlea or auditory nerve
- Autoimmune inner ear disease
How It Shows on an Audiogram
Sensorineural hearing loss shows equally reduced air and bone conduction thresholds with no air-bone gap. Both testing methods show hearing loss because the problem is beyond the middle ear—in your inner ear or auditory nerve. The hearing loss can range from mild to profound and often affects both ears, though not always symmetrically.
Treatment Options and Prognosis
The reality: sensorineural hearing loss is usually permanent because we cannot regenerate damaged hair cells or repair nerve damage (though scientists are actively researching regenerative approaches). However, permanent doesn't mean untreatable.
Treatment options include:
- Hearing aids—amplify sound to stimulate remaining healthy hair cells more effectively, with excellent outcomes for mild-to-severe SNHL
- Cochlear implants—for severe-to-profound SNHL when hearing aids don't provide enough benefit; bypass damaged hair cells by directly stimulating the auditory nerve with electrical signals
- Assistive listening devices—FM systems, captioning, amplified phones
- Communication strategies—learning techniques to optimize understanding
- Prompt treatment for sudden SNHL—steroids within 72 hours can sometimes recover hearing if caught early
Prognosis: Depends on severity and cause. Most sensorineural hearing loss progresses slowly and responds well to hearing aids. Between 32-65% of sudden sensorineural hearing loss cases resolve spontaneously or with treatment, especially when treated early. Severe-to-profound SNHL that doesn't benefit from hearing aids often responds dramatically to cochlear implants, with users improving from understanding 8% of words to 54% on average.
Your brain needs regular sound input to maintain its ability to process speech effectively. When you have untreated sensorineural hearing loss, your auditory cortex receives degraded signals for months or years. Research shows that people who address hearing loss sooner—using hearing aids or cochlear implants when first appropriate—generally achieve better speech understanding outcomes than those who wait. Your brain's plasticity works in your favor when you act promptly.
Mixed Hearing Loss: Both Types Together
Mixed hearing loss means you have both conductive and sensorineural components—there are problems with both sound transmission (outer/middle ear) AND signal processing (inner ear/nerve). For example, you might have age-related inner ear damage (sensorineural) plus chronic ear infections causing fluid buildup (conductive).
Treatment Approach
Mixed hearing loss typically requires a combined treatment strategy that addresses both components:
- Address the conductive component first: Medical or surgical treatment to remove blockages, repair eardrums, treat infections, or correct structural problems. This often improves hearing even though the sensorineural component remains.
- Manage the sensorineural component: After optimizing the conductive portion, hearing aids or other amplification devices compensate for the permanent inner ear damage.
Quick Comparison: Which Type Do You Have?
| Feature | Conductive | Sensorineural | Mixed |
|---|---|---|---|
| Where Problem Is | Outer or middle ear | Inner ear or auditory nerve | Both locations |
| How It Feels | Muffled, quiet; clear when loud enough | Distorted, garbled; hard to understand even when loud | Both muffled AND distorted |
| Audiogram Pattern | Air-bone gap present | No air-bone gap; both measures show loss | Air-bone gap PLUS bone conduction loss |
| Can Be Reversed? | Often yes, with medical/surgical treatment | Usually no (permanent) | Conductive part often reversible |
| Primary Treatment | Remove blockage, repair damage, or use bone-conduction devices | Hearing aids or cochlear implants | Treat conductive part + amplification for sensorineural part |
Asymmetric hearing loss (one ear significantly worse than the other) or sudden hearing loss (developing over hours or days) warrants prompt medical evaluation—within 72 hours if possible. These patterns can indicate acoustic neuroma, sudden sensorineural hearing loss requiring urgent steroid treatment, or other conditions needing immediate attention.
Common Questions
A comprehensive hearing evaluation by an audiologist can definitively identify your type through comparing air conduction and bone conduction testing. Simple bedside tests can suggest the type, but formal audiometry is essential for accurate diagnosis. Learn what to expect at your first audiology appointment.
Yes. You might develop a temporary conductive loss (like an ear infection) on top of existing sensorineural loss, creating mixed hearing loss. Or progressive conditions like otosclerosis might start as purely conductive but later affect the inner ear.
Often, but not always. Stapedectomy for otosclerosis successfully improves hearing in over 90% of cases. Eardrum repair succeeds in closing the air-bone gap in 85-90% of patients. Your surgeon can discuss realistic expectations for your specific situation.
The Bottom Line
Knowing whether your hearing loss is conductive, sensorineural, or mixed is the key to understanding what treatments will actually help. Conductive loss often improves with medical or surgical care; sensorineural loss usually needs amplification; mixed loss benefits from addressing both issues.
Accurate diagnosis through a complete hearing evaluation is essential. Once you understand your type, you and your audiologist can map out a plan that matches your hearing, lifestyle, and goals.
Next Steps
If you’re unsure how your diagnosis fits into treatment, these tools can help you understand your audiogram, explore causes, and plan what to do next.