Conductive, Sensorineural or Mixed: The Main Types of Hearing Loss Explained

When people hear the phrase "hearing loss", they often picture a single condition that simply turns the volume down. In practice, professionals describe hearing loss in several ways, and one of the first is by location: where along the path of sound the problem sits. That path runs from the outer ear, through the middle ear, into the inner ear and along the hearing nerve. If you'd like a refresher on those stages, see how the ear works.

Why does the location of the problem matter?

Different parts of the ear do different jobs, so a problem in each part affects sound in a different way. A blockage in the ear canal acts a bit like a finger pressed over the ear: sounds become softer, but they are still basically intact once they get through. A change in the inner ear can be quite different. Sounds may be loud enough yet less clear, and some pitches may be affected more than others.

Location also shapes what a doctor looks for next. Some causes in the outer and middle ear can be examined directly and may be treatable. Changes in the inner ear are usually longer-lasting. That's why naming the type is a starting point for the conversation, not the end of it.

Conductive and sensorineural: what is the difference?

Conductive hearing loss means sound isn't being conducted properly through the outer or middle ear. The inner ear may be working, but less sound reaches it. Possible reasons include a blocked ear canal, fluid behind the eardrum, a problem with the eardrum itself, or stiffness in the tiny middle-ear bones. People often describe a muffled or plugged feeling. Some of these causes are temporary, and some can be treated by a doctor.

Sensorineural hearing loss involves the inner ear, usually the hair cells of the cochlea, or the hearing nerve that carries signals to the brain. This is the type most often linked to ageing and to long-term noise exposure. Besides sounding quieter, speech may seem unclear, as if people are mumbling, because some pitches arrive weaker than others. In most cases this kind of change is long-term.

You may still come across the phrase "nerve deafness". It's an older, informal label for the same idea, but it can be misleading, because the cochlea is often the main part involved rather than the nerve alone.

What is mixed hearing loss, and what does the type not tell you?

Mixed hearing loss means a person has both a conductive part and a sensorineural part at the same time. For example, someone with a long-standing inner-ear change might also develop a blockage or fluid in the middle ear. A professional may then look at each part separately.

It helps to know what the type label leaves out. It doesn't describe how much hearing has changed; that's a separate description, often called the degree. It doesn't say what caused the change. And it doesn't predict how a particular person copes in daily life, which also depends on their surroundings, their work and their conversations. The tests that build up this picture are covered in hearing tests explained.

When to see a doctor

If your hearing has changed, or one ear feels blocked or dull and it doesn't settle, it is worth seeing your family doctor or an ENT doctor. They can look into the ear and arrange a hearing assessment if needed.

Other reasons to get checked include pain, discharge from the ear, dizziness, or ringing that has appeared alongside a change in hearing. This article explains concepts only and can't tell you which type, if any, applies to you.

Key takeaways

• Hearing loss is often described by where the problem sits along the path of sound.
• Conductive loss involves the outer or middle ear; sensorineural loss involves the inner ear or hearing nerve.
• Mixed loss means both are present at once.
• The type is not the same as the degree, and it doesn't reveal the cause on its own.
• Only a hearing assessment can show which type applies to a person.

Keep learning: age-related hearing loss looks at one of the most common sensorineural changes. An ENT doctor can explain what your own results mean.