Conductive hearing loss is hearing loss that happens when sound is blocked from passing into the inner ear. This blockage occurs in either the outer or middle ear.
In this case, the inner ear is perfectly normal, but it won’t signal the brain because the sound doesn't get through to it. Without the ear transmitting impulses to the brain, the brain cannot receive any information about sound, which results in hearing loss.
If you have conductive hearing loss, the sound level that gets into the ear is reduced on its way to the cochlea in the inner ear. This results in difficulty hearing soft sounds and louder sounds becoming muffled.
Causes of Conductive Hearing Loss
Before we look at the symptoms of conductive hearing loss, let's examine some of its causes. The causes we will examine in this section are within the outer ear and middle ear.
1. Earwax Blockage
Earwax blockage is also known as cerumen impaction. It occurs when there is an accumulation of earwax in the ear canal that makes hearing difficult.
Earwax produced at a normal level is good for your ears. The body produces earwax to prevent debris, fluids, and bacteria from getting into the inner ear. The built-up wax normally works its way out of the ear naturally. When produced in excess, your ears may have a hard time getting rid of the wax.
When the ear cannot get rid of the wax, it begins to accumulate and often solidifies. This blockage affects the flow of sound transmitted into the ear.
There are two major causes of earwax blockage. The first is when earwax is pushed further into the ear canal by objects like cotton buds. The second cause of earwax blockage is the presence of solid excess wax.
Usually, conductive hearing loss caused by earwax blockage only lasts as long as the blockage exists. You can remove the earwax blockage at home or in the hospital.
When removing the ear wax blockage, sound can easily travel from the outer ear through the middle ear into the inner ear.
2. Fluid in the Ear
Otitis media refers to a group of inflammatory diseases of the middle ear. A buildup of fluid in the middle ear often triggers it.
A common type of otitis media is acute otitis media. Besides the ear inflammation, acute otitis media occurs alongside ear pain. Otitis media can cause conductive hearing loss in both adults and children.
Another type of otitis media is otitis media with effusion. This is the presence of non-infectious fluid in the ear for more than three months. It doesn't cause any infection, but there can be an occasional feeling of fullness in the ear.
3. Eustachian Tube Dysfunction
The eustachian tube is located between the middle ear and the upper throat, responsible for equalizing pressure in the ear and draining fluid from the middle ear.
The eustachian tubes usually remain closed, but they naturally open when you yawn, chew, or swallow.
The eustachian tube can get blocked for different reasons. Blockage of the eustachian tube results in eustachian tube dysfunction, which creates pain, feelings of fullness in the ears, tickling sensations in the ear, tinnitus, and hearing difficulties.
Eustachian tube blockage is often temporary, and you can resolve it with simple home remedies. However, it is important to see a doctor if you have recurring episodes of eustachian tube blockage.
4. Perforated Eardrum
A perforated eardrum, also known as a ruptured eardrum or tympanic membrane perforation, is a tear or hole in the eardrum. The eardrum is a thin tissue that separates the ear canal from the middle ear.
The eardrum plays a vital part in the transmission of sound to the middle ear. If it is perforated, conductive hearing loss may occur. The location and size of the tear can affect the degree of conductive hearing loss.
Barotrauma can cause eardrum perforation. Barotrauma is stress put on the eardrum when the air pressure in the environment and air pressure in the middle ear is out of balance.
A middle ear infection, direct blow to the ear, exposure to loud noise, severe head trauma, and foreign objects in the ear can also cause eardrum perforation.
The good news is that a perforated eardrum often heals without treatment within a few weeks. In cases when it doesn't recover, doctors can perform a patch or surgical repair. Once the tear has healed, hearing returns to normal.
Microtia is a congenital abnormality present in children. Even though the actual cause of microtia is not known, it has been linked to the use of drugs or alcohol, maintaining a diet low in carbohydrates, use of the acne medication Accutane, and genetic conditions during pregnancy.
This congenital malformation causes the outer part of a child's ear to be underdeveloped or malformed.
Microtia often develops during the first trimester of pregnancy, and it mainly affects one ear. In some rare cases, Microtia affects both ears.
Children with microtia often suffer varying degrees of conductive hearing loss. The hearing loss can be partial or total, and it can affect one or both ears. A speech impediment can also accompany this hearing loss.
Stenosis is the narrowing of the ear canal. Stenosis occurs when thick, solid fibrous tissue appears in parts of the external ear canal. The formation of this thick tissue causes conductive hearing loss.
Causes of stenosis include chronic or long-term otitis externa, chemical burns, gunshot wounds, and the build-up of thick and dry skin in the ear canal.
Most cases of stenosis are temporary, and you can treat them using ear drops.
Exostoses are also known as a bone spur. It is the formation of a new bone or bone-like protrusion on the surface of a bone. Exostoses can happen anywhere, including inside the ear.
Exostoses are also commonly known as surfer's ears. It is commonly associated with surfers because the abnormal formation of bone in the ear canal can stem from exposure to cold wind and water.
The exposure of the ear to cold wind makes the bone surrounding the ear canal develop lumps of new bony growth. This growth can constrict or block the ear canal. The blockage of the ear canal can cause water and wax to get trapped in the ear, and this can cause an infection.
When bone spurs form in the ear canal, they can cause blockages and restrict the flow of sound from the outer ear into the inner ear.
Exostoses are not particular to surfers; it also affects people who engage in activities in the cold such as diving, kayaking, jet-skiing, windsurfing, and sailing.
Tympanosclerosis is a condition that causes the thickening or calcification of the tympanic membrane. There are no obvious symptoms associated with tympanosclerosis aside from conductive hearing loss.
Without the appropriate medical attention, diagnosing tympanosclerosis can be challenging. Doctors must examine the ear before identifying tympanosclerosis. To diagnose this condition, doctors will find chalky white patches on the eardrum.
Otosclerosis is a medical term used to describe the abnormal hardening or remodeling of bones in the middle ear. Bone remodeling is a natural process in the body aimed at replacing old tissues with new ones.
A bone remodeling process that doesn't follow the natural course can affect sound travel from the middle ear to the inner ear and cause conductive hearing loss.
10. Ossicular Chain Discontinuity
Ossicular chain discontinuity is a break or a breach in the connection between the bones in the middle ear. There are three bones in the middle ear named incus, stapes, and malleus. These three bones are collectively known as ossicles.
The sound vibration collected from the outer ear moves to the eardrum through the ossicles. The stapes then carry the sound vibration into the inner ear’s fluids.
If the ossicles are not connected properly or are separated, the middle ear will not relay sound to the inner ear. This will cause conductive hearing loss.
Otosclerosis, infection, skull fracture, and trauma can cause ossicular chain discontinuity.
Conductive Hearing Loss Symptoms
The symptoms of conductive hearing loss often depend on the root cause of the hearing loss, and in some cases, the symptoms may vary.
Because the cause of conductive hearing loss is in the outer or middle ear, hearing difficulties are usually related to a sound’s volume.
This section will examine the early symptoms of conductive hearing loss, conductive hearing loss in one ear, and conductive hearing loss in children.
Early Symptoms of Conductive Hearing Loss
Here are some of the early symptoms of conductive hearing loss:
Difficulty hearing on the phone
Difficulty hearing what other people are saying, especially in crowded places
Increasing the volume of television or radio above the normal volume range
Difficulty keeping up with conversations
Constantly asking for repetition
Fatigue or stress is associated with having to concentrate on hearing what others are saying
General Symptoms of Conductive Hearing Loss
Common conductive hearing loss symptoms you will experience irrespective of the cause include the following:
Foul-smelling yellow fluid or discharge from the ear
Perception of muffled sound in the ear
Sudden hearing loss in one or both ears
Difficulty understanding words in crowded places
Better hearing in one ear than the other
Feelings of fullness in the ears
Earache and headache
Difficulty hearing both low-pitched and high-pitched soft sounds
Difficulty hearing consonants
Asking others to speak slowly or loudly
Withdrawing from conversations
Symptoms of Conductive Hearing Loss in One Ear
Conductive hearing loss can occur in one ear. This conductive hearing loss is often hard to diagnose because hearing in the unaffected ear is perfect.
Below are common symptoms of conductive hearing loss in one ear:
Poor hearing when sound is coming from one side or direction
Difficulty when trying to discover a sound’s origin
Difficulty differentiating different sounds
Inability to ignore background noise
Difficulty hearing over long distances and in noisy places
Symptoms of Conductive Hearing Loss in Children and Babies
Babies often have their hearing checked a few weeks after birth. Still, it is possible to miss hearing loss in babies and children without external abnormalities like those caused by microtia.
Also, it may be hard to notice if the hearing loss happens gradually.
Symptoms of conductive hearing loss in babies and children include:
Noticing you when they see you but not when you call their name
Inability to say any recognizable word at fifteen months
Slow to talk and speaking incoherent words
Talking very loudly
Turning up the volume of the television very high
Not getting startled by loud noises
Not turning toward your voice at four months
Not replying when you talk to them
Hearing some sounds but not others
Asking for repetition or responding inappropriately to questions
Symptoms of Conductive Hearing Loss Caused by Specific Problems
As stated earlier, the symptoms of conductive hearing loss you experience may vary based on the hearing loss’s specific cause.
For instance, the symptoms you may experience if a perforated eardrum causes the hearing loss will vary from hearing loss symptoms caused by eustachian tube dysfunction.
Below are the common symptoms associated with the specific causes of conductive hearing loss explained above.
Earwax Blockage-Related Conductive Hearing Loss Symptoms
- Feelings of fullness in the affected ear
- Severe earache
- Decreased hearing in the affected ear
- Tinnitus or noise in the ear
- Temporary sudden or partial hearing loss
- Fluid drainage or odor from the affected ear
Symptoms of Conductive Hearing Loss Caused by Fluid in the Ears
- Ear pain becomes severe when there is a change in altitude.
- The sensation that sounds are muffled
- Feelings of fullness or plugged sensations in your ears
- Tinnitus or ringing in the ears
- Behavior problems or poor performance in school
- Vertigo and loss of balance, in rare cases
Eustachian Tube Dysfunction-Related Conductive Hearing Loss Symptoms
- Feelings of fullness in the ears
- Pain in one or both ears
- Difficulty maintaining balance
- Hearing muffled sounds
- Tinnitus or noise in the ear
- Worsening symptoms when there is a change in altitude
- Popping or clicking sensations in the ears
- Children may complain of their ears tickling
Symptoms of Conductive Hearing Loss Caused by Eardrum Rupture
- Pus-like, mucus-like, or bloody drainage from the ear
- Ringing in the ear
- Vertigo or a spinning sensation
- Nausea or vomiting
- Loss of hearing in the affected ear
- Ear pain that often subsides quickly
The Difference Between Mild and Moderate Conductive Hearing Loss
Like every other type of hearing loss, conductive hearing loss is divided into various types depending on the degree or severity of the hearing loss. For the sake of this post, we will be examining mild and moderate conductive hearing loss.
Hearing loss is divided into categories based on the minimum threshold that an individual can detect. The minimum threshold is measured in decibels(dB). Decibels are the unit used to measure sound intensity.
Before examining the difference between mild and moderate conductive hearing loss, it is important to note that all hearing losses are not the same. Even if two individuals have the same type or degree of hearing loss, the impact and experiences of the two individuals are not the same.
Also, the fact that a hearing loss is referred to as mild or moderate does not mean that the hearing and communication difficulties are mild or moderate.
Mild Conductive Hearing Loss
The threshold for mild hearing loss is between 25 to 40 decibels. Adults can properly manage mild hearing loss, but children with mild hearing loss can experience impacted language development.
The feeling of mild conductive hearing loss is similar to placing fingers in your ear. A problem in the outer ear that prevents proper reception and transmission of sound to the middle and inner ear often causes this hearing loss.
Moderate Conductive Hearing Loss
People with moderate conductive hearing loss have thresholds between 41 to 55 decibels. Moderate conductive hearing loss creates difficulty hearing speech at a normal level.
In most cases, doctors prescribe hearing aids for people with moderate hearing loss. The vocabulary, language, and comprehension of children with moderate conductive hearing are often affected.
People with mild conductive hearing loss may hear vowel sounds while experiencing difficulty hearing soft consonant sounds, but people with moderate conductive hearing loss also miss consonant sounds.
Also, for most cases of mild conductive hearing loss, the difficulty in hearing seems to be associated with soft sounds. Moderate conductive hearing loss also affects comprehension.
Without hearing aids, a person with moderate hearing loss can hear speech but cannot understand what you are saying. This symptom shows the underlying cause transcends beyond the outer ear to the middle ear.
It means that the outer ear is receiving sound, but the middle ear can't pass it to the inner ear, sending the sound signal to the brain for interpretation. People with moderate conducting hearing loss cannot understand what you’re saying despite sound getting into the ear. With mild conductive hearing loss, the sound may be muffled, but comprehension is not affected.
Most people with mild conductive hearing loss can learn to manage it and live their normal lives without side effects. People with moderate conductive hearing loss will often require hearing aids to function properly.
Conductive Hearing Loss Treatments
As already stated, doctors can treat most cases of conductive hearing loss. Treatment for conductive hearing loss includes pharmaceutical treatment, surgical treatment, and supportive care. Each method is chosen based on the nature and location of the hearing loss’s causes.
There is no one-size-fits-all treatment for conductive hearing loss; instead, treatment is prescribed based on the underlying cause. For instance, treatment for conductive hearing loss caused by earwax blockage is different from conductive hearing loss caused by a ruptured eardrum.
Treatment of Conductive Hearing Loss Caused by Fluid in the Ear
In most cases, fluid in the ear does not require treatment; the fluid naturally drains on its own within a few weeks. Under certain conditions, your doctor will prescribe treatment. The treatment type depends on some factors.
If the ear’s fluid has lasted for about six weeks, they will conduct a hearing test and probably prescribe antibiotics.
Antibiotics can also treat fluid in the ear that has lasted for twelve weeks. If a hearing test is conducted and significant hearing loss, the doctor may place tubes in the ear to drain the fluid.
In severe cases where the fluid in the ear has been present for about four to six months, the doctor will need to place ear tubes surgically even in the absence of hearing loss.
In some cases, fluid in the ear may come alongside an infection. If there is no ear infection, using antibiotics is useless. Some antibiotics like antihistamines can affect the drainage of the auditory tube, and doctors do not recommend them.
If, however, there is an ear infection, your doctor will prescribe the right antibiotic for you.
Antibiotics that your doctor may recommend include:
Ciprodex (ciprofloxacin/dexamethasone) suspension
Ocuflox (ofloxacin) solution
Augmentin (amoxicillin/potassium clavulanate)
Acetal HC (hydrocortisone/acetic acid) solution
Cortisporin (neomycin/polymyxin b/hydrocortisone) suspension or solution
Ciloxan (ciprofloxacin) solution
Ciprodex (ciprofloxacin/dexamethasone) suspension
Floxin (ofloxacin) solution
Cipro HC (ciprofloxacin/hydrocortisone) suspension
If you are experiencing pain or fever due to the infection, your doctor may prescribe painkillers like ibuprofen and acetaminophen.
Children with ear fluid who have developmental delays may require early treatment. Waiting for the fluid to clear up on its own may be harmful to the child. If the child doesn't have any developmental problems, waiting for the fluid to drain on its own is not harmful.
Hearing often returns to normal when the fluid has been drained out of the ear naturally or with surgical intervention.
Treatment for Conductive Hearing Loss Caused by Ruptured Eardrum
Ruptured or perforated eardrums don't often require any treatments because they heal on their own within a few weeks. If, however, the tear in the eardrum doesn't heal by itself, your doctor may use any of the treatments listed below.
1. Eardrum Patch
This is a patch made of paper or other materials. An ENT specialist does the patching. The patch aims to speed up the healing process.
Before placing the patch, the ENT will apply a chemical to the edges of the tear. This chemical hastens the healing process. You may need more than one ear patch before the hole heals completely.
Your doctor might recommend surgery if the patch did not heal the tear. In some cases, you may not need to use a patch before the surgery. Upon examination, your doctor will be able to tell if a patch can heal the tear.
The surgical process for perforated eardrums is known as tympanoplasty. This entails grafting or patching your tissue on the eardrum to seal up the hole or tear.
The procedure is quite simple, and you will be able to go home right after.
As already stated, a ruptured eardrum can heal without any treatment.
However, there are ways you can protect your eardrum and speed up the healing process with home remedies and lifestyle changes, such as
Avoid cleaning your ears with cotton buds, Bobby pins, and other objects.
Avoid blowing your nose; the pressure in your ear when blowing your nose can open healing tears.
Keeping your ears dry always prevents any dirt or fluid from getting to the eardrum and infecting it. Keep your ears dry when bathing by placing a ball of cotton coated with petroleum jelly or a waterproof silicone earplug in your ear.
Avoid exposing your ear to loud noise.
If there is an infection alongside the perforated eardrum, your doctor will prescribe an antibiotic. Treating the infection can hasten the healing process.
Treatment for Conductive Hearing Loss Caused by Eustachian Tube Dysfunction
If you have Eustachian tube dysfunction, exercising your jaw by yawning, swallowing, and chewing your gum can help relieve the feeling of fullness in your ears. You can also take a deep breath, pinch your nostrils closed, and blow with your mouth shut.
Feeding babies or giving them a pacifier will encourage swallowing and relieve the ear’s feeling of fullness.
In some cases, these simple exercises may not be efficient in fixing the dysfunction. You will need to visit a doctor. The doctor may perform the following to improve the dysfunction:
Steroid nasal spray or an antihistamine may reduce the allergic response.
Your doctor can implant a small tube in the eardrums to drain the built-up fluid out of the middle ear. The tubes can stay in the ear for about eighteen months, then fall out naturally.
A decongestant can reduce swelling in the eustachian tube lining. The decongestant constricts blood vessels and reduces the swelling.
A doctor makes a tiny incision in the eardrum during a myringotomy, suctioning out the middle ear fluid. The incision is left open to allow the swelling to heal, which usually occurs within two to three days.
Balloon Dilation System
Your doctor will use a catheter to insert a small balloon through your nose into the eustachian tube. The inflated balloon will open a pathway for mucus and air to flow through. This restores the eustachian tube to normal.
Treatment for Conductive Hearing Loss Caused by Earwax Blockage
If you have conductive hearing loss caused by the accumulation of earwax in your ear, you shouldn't try to remove the wax by yourself. Doing this may push the earwax further in your ear canal and cause more damage.
However, with the supervision or guidance of a doctor, you may be able to get rid of the earwax blockage at home. Below are some home remedies your doctor may recommend.
Softening the Earwax
You can soften the earwax using over-the-counter wax softening drops. You can also use hydrogen peroxide, glycerin, mineral oil, baby oil, and carbamide peroxide to soften the earwax.
After softening the wax, it will flow out of the ear.
Ear irrigation is only advisable for people who do not have an ear injury. Attempting to irrigate your ear when you have a ruptured or perforated eardrum can cause an infection or worsening hearing loss. If you recently had a medical procedure done on your ear, this is also not advised.
There are over-the-counter products for ear irrigation that you can use. To get the best result, follow these steps:
Sit or stand with your head in an upright position
Hold your outer ear and pull it gently
Using a syringe, inject a stream of body-temperature water into your ear
Tip your head to allow the water to drain
If you cannot get rid of the earwax blockage by yourself, your doctor can remove the accumulated wax through irrigation, suction, or using a curette
Your hearing will return to normal after removing the earwax
Treatment for Conductive Hearing Loss Caused by Microtia
As we know, microtia is a congenital abnormality or malformation of the outer and inner ear. It is one of the causes of conductive hearing loss that may require surgery. Some parents may decide not to treat the microtia. Treatment options include the following:
1. Autologous Auricular Construction
This surgery entails taking cartilage from the child's ear and planting a new ear on the affected side. The child’s tissue helps the ear heal itself when it is injured.
This procedure is often conducted when the child is about six years old. At this age, the child is old enough to have cartilage to spare. Also, the unaffected ear would have grown to reach its adult size, and the new ear will match the adult ear’s size.
Depending on the severity of the microtia, autologous constructions require three procedures. These procedures occur six months apart to help the child heal.
During the first procedure, the doctor removes the cartilage for the new ear. The second procedure entails the refining and repositioning of the new earlobe. Finally, during the third procedure, the doctor lifts the new ear for better alignment and provides any necessary finishing. If the child needs surgery in the middle ear, it occurs after the third procedure.
Even though the new ear may not look like the unaffected ear, it will still function normally. It will also improve the child's appearance and enable them to wear sunglasses or eyeglasses.
2. Surgically Implanted Hearing Devices
Doctors can also treat conductive hearing loss caused by microtia by using a cochlear implant. They implant it into the bone above and behind the ear. When the attachment point has healed, the doctor attaches a processor that helps the child hear sounds by stimulating the nerves in the inner ear.
Aside from cochlear implants, doctors can also use vibration-inducing devices. These devices are worn on the scalp and magnetically connect to surgically placed implants. The implant connects to the middle ear and sends vibrations to the inner ear.
Even though surgically placed implants require minimal healing and do not create scar tissue, they have side effects. The side effects include tinnitus, vertigo, nerve injury, leaking of the fluid that surrounds the brain, skin infection, build-up of earwax, and worsening hearing loss.
3. Prosthetic External Ear or Ear Prosthesis
This is an artificial ear made from a synthetic material that can be attached using an adhesive or surgically implanted to the side of your child's ear. Most prosthetics look very real, and the procedure is not as invasive as the other treatment options.
Ear prosthesis is detachable and is perfect for children that are unable to undergo reconstruction. However, these prostheses need to be replaced occasionally.
Another disadvantage is that some children may have skin sensitivity to the adhesive used to attach the ear to the body. It also requires daily care.
4. Medpor Graft Surgery
This procedure is similar to autologous auricular construction. However, instead of using rib cartilage from the child, doctors implant synthetic materials. Children can undergo this procedure by age three, and only one procedure is required. Scalp tissue covers the implant.
The duration of medpor implants is unknown, so surgeons do not recommend them often. Also, because the implant is synthetic, they cannot incorporate it into surrounding tissues; this means that children can lose the implant due to trauma or injury. It also has a high risk of infection.
Treating Conductive Hearing Loss with Hearing Aids
Hearing aids are battery-powered electronic devices designed to improve hearing. Hearing aids typically are not prescribed for people with conductive hearing loss because the underlying cause is known. Once doctors treat that known cause, hearing returns to normal.
However, in some cases, treatment may not fully reverse conductive hearing loss. In such cases, the conductive hearing loss patient may benefit from a hearing aid. Also, if the cochlea’s Corti organ functions properly, a hearing aid may help transmit sound through the outer and middle ear to the inner ear.
Most hearing aids are small enough to be worn in or behind the ear, and their basic function makes sounds louder.
Hearing aids have three major components: the microphone that picks up sounds from the environment, an amplifier that makes the sound louder, and a receiver that sends the amplified sounds into the ear.
Hearing aids are medical devices and should only be fitted by an audiologist. After proper examination, the audiologist will determine what type of hearing aid you need and fit it to meet your specific hearing needs. There are no one-size-fits-all hearing aids. All hearing aids are customized.
Hearing aids come in different styles and can ft\it in different places. Below are some common hearing aid styles.
Ear Canal Hearing Aids
These hearing aids fit inside the ear canal. Completely-in-Canal hearing aids fall under this category. They are very small and hidden in the ear canal. Because of how small they are, canal hearing aids are hard to adjust or remove and are not ideal for children.
In-The-Ear (ITE) Hearing Aids
These aids fit inside the ear. They are ideal for people with mild to severe conductive hearing loss. In-the-ear hearing aids are not ideal for children whose ears are still growing.
Behind-The-Ear (BTE) Hearing Aids
These types fit behind the ear. External sound moves to the ear through a narrow tube that goes into the ear canal.
Receiver-In-Canal or Receiver-In-The-Ear Hearing Aids
These hearing aids fit behind the ear and connect to a receiver in the ear canal through a tiny wire. With this type of hearing aid, low-frequency sounds can enter the ear naturally, and high-frequency sounds are amplified.
While some conductive hearing loss causes may be out of your control, try to protect your ears as much as you can.
Avoid inserting objects like bobby pins or cotton buds into your ear when trying to get rid of earwax. This can push the wax deeper into your ear canal and cause conductive hearing loss.
Also, avoid exposing your ears to loud noise. Exposure to loud noise can damage both your eardrum and the organs in your inner ear.
Hearing aids may be able to help you manage the symptoms of hearing loss.
If you notice any hearing difficulties or symptoms listed above, don't hesitate to tell your doctor.
“The good news is that most patients with conductive hearing loss can be helped. The treatment can be life-changing. Audien hearing aids can be a terrific solution when medicines, surgery, or other devices are not possible.” - Drew Sutton, MD, Board-Certified Otolaryngologist.