What You Need to Know About Conductive Hearing Loss

Earwax, infections can cause this treatable condition

Kimberly Goad,

AARP

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En español

Published December 10, 2021

woman having trouble hearing the television

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If you find that you’ve been cranking up the volume of your TV recently in order to hear it, you may think that you have age-related hearing loss and that there’s not much you can do about it. But consider this: Your hearing loss may be temporary.

It’s true that in most cases, it’s not. Around 90 percent of hearing impairment in people over 50 is classified by experts as sensorineural hearing loss, typically a permanent condition that occurs when there’s a problem with the inner ear or auditory nerve. But that leaves a minority of people who have what’s known as conductive hearing loss, which is usually temporary and treatable.

“There isn’t a clear-cut way to distinguish hearing loss as either sensorineural or conductive without a full diagnostic hearing evaluation,” says audiologist Bria Collins, associate director of audiology professional practices at the American Speech-Language-Hearing Association (ASHA). “Listeners with conductive hearing loss (CHL) predominantly will experience a loss in the volume of sound, whereas those with sensorineural hearing loss (SNHL) will more likely have both a loss of sound volume and speech clarity.”

Here’s what you need to know about conductive hearing loss.

What it is

Hearing loss can happen when any part of the ear or hearing system isn’t working the way it’s supposed to. Unlike SNHL, which occurs because of damage to the inner ear or auditory nerve (and is a result of normal aging as well as factors like noise exposure), CHL happens when sounds can’t make their way through the outer or middle ear en route to the inner ear, usually due to an infection or obstruction.

Symptoms

People with CHL struggle to hear sounds at a low volume, which is why some adapt by simply adjusting the volume on their TV, radio or computer. Symptoms can come on suddenly, with sounds — including your own voice — seeming muffled or blocked. Pain, pressure and fullness in one or both ears are also signs of CHL.

Causes

Common culprits include fluid buildup from a cold or allergies, ear infections like swimmer’s ear, benign tumors, a punctured eardrum or problems with the way the outer or middle ear is formed, explains Ishraq Alkibsi, a clinical audiologist at Next Level Hearing Care.

The most common cause? Earwax. That’s right. The very thing the body produces within the ear canal to protect and moisturize the ear can become a problem if there’s too much of it.

“Even though earwax is normal, a buildup in the ear canal can block sounds from traveling to the rest of the hearing system,” Collins says. “Sounds must travel from the outer to middle to inner ear and, ultimately, to the brain for comprehension. Earwax is a barrier, reducing the volume before it reaches the middle ear.”

Mixed hearing loss

It’s also possible to experience CHL at the same time as SNHL, resulting in what’s known as mixed hearing loss.

According to Collins, those with SNHL may have their hearing loss exacerbated by outer- or middle-ear conditions that cause CHL, such as impacted earwax or a middle-ear infection, resulting in temporary mixed hearing loss.

“When the ear infection resolves or when the earwax is removed, the hearing loss likely will return to sensorineural,” she says. “Some middle-ear conditions — such as a break in the middle-ear bones or benign bony growths of the outer or middle ear space — may result in a permanent mixed hearing loss.”

How it’s diagnosed

A physical exam can reveal problems like earwax buildup or inflammation from an infection. Hearing specialists also use several types of tests to diagnose hearing loss. These include:

Weber test: The provider will strike a 512 Hz tuning fork and place it near the midline of your scalp or on your forehead, nasal bones or teeth. If the sound is louder in your affected ear, you probably have CHL.
Rinne test: The specialist will strike a tuning fork. If you have CHL, you won’t be able to hear the sound as the fork is moved from the mastoid bone behind your ear to the pinna (the outer part of the ear).
Audiometer tests: You put on earphones and listen to sounds and words directed to each ear. Each tone is repeated at faint levels to determine your hearing threshold and the degree of hearing loss.

Treatment

Depending on the cause, medicine, surgery or other interventions (like earwax removal) can often fix CHL. “Treatment for conductive hearing loss is usually provided by physicians who specialize in conditions of the ear, such as an otologist or an otolaryngologist,” Collins says.

If the cause is earwax buildup, you may need to have it professionally removed a few times a year to keep the ear canal clear. If the culprit is fluid buildup, your doctor my prescribe antibiotics or insert what’s known as pressure-equalizing tubes, to help drain the middle ear. If your doctor discovers a problem with one or more of the middle-ear bones, surgery may be needed to replace the damaged bone with a prosthetic device, Collins says.

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Kimberly Goad is a New York-based journalist who has covered health for some of the nation’s top consumer publications. Her work has appeared in Women’s Health, Prevention, Health and Reader's Digest.