Conductive hearing loss

Common causes and characteristics

Typical causes include mechanical blockages or disruptions in the ear's sound-conducting structures. Common examples are impacted earwax (cerumen), fluid or infection behind the eardrum (otitis media), perforated eardrum, eustachian tube dysfunction, abnormal bone growth such as otosclerosis, and growths like cholesteatoma. Symptoms commonly include a feeling of fullness in the ear, reduced hearing in one or both ears, and better hearing in noisy environments after treatment of the cause.

Diagnosis

Diagnosis relies on a medical history and physical ear examination with an otoscope, along with audiological tests. Pure-tone audiometry typically shows an air-bone gap (air conduction poorer than bone conduction). Tympanometry can assess middle ear pressure and eardrum mobility. In selected cases imaging (for example CT of the temporal bones) or referral to an otologist is appropriate to evaluate structural problems.

Treatment and management

Treatment depends on the underlying cause and may restore hearing fully or partially. Approaches include:

• Removal of earwax or foreign bodies;
• Medical therapy for infections or inflammation (e.g., antibiotics, nasal decongestants, or steroids when indicated);
• Placement of tympanostomy tubes to drain chronic middle ear fluid;
• Surgical repair such as tympanoplasty or stapedectomy for ossicular problems;
• Hearing amplification with conventional or bone-conduction hearing aids when surgery is not possible.

Many causes of conductive loss are treatable, and prognosis is often good when the mechanical problem is corrected. Some conditions may cause permanent conductive deficits or recur without long-term care.

Distinctions and notable points

It is important to distinguish conductive hearing loss from sensorineural and mixed losses because management differs. Sensorineural loss originates in the inner ear or auditory nerve and usually cannot be corrected surgically; mixed loss combines both patterns. Children are particularly prone to conductive problems from middle ear infections, which can affect speech and learning if persistent and should be evaluated promptly.

When in doubt, seek assessment by a primary care clinician, audiologist, or ear specialist for accurate diagnosis and appropriate treatment planning.