How conductive hearing loss differs from sensorineural

In sensorineural hearing loss, the problem is in the inner ear or auditory nerve — the sensory machinery itself is damaged. In conductive hearing loss, the inner ear is typically intact, but something is physically blocking or impeding the transmission of sound waves before they reach it.

Think of it like a speaker with a working amplifier but a blocked speaker cone. The signal is fine — it just cannot get through. This distinction matters because conductive hearing loss is often reversible once the obstruction or damage is treated.

Common causes

Outer ear causes

• Earwax (cerumen) impaction: The most common cause. Excessive earwax can completely block the ear canal.
• Ear canal infection (otitis externa): Swelling and discharge can obstruct the canal.
• Foreign objects: Especially common in children.
• Exostoses: Bony growths in the ear canal, often seen in swimmers ("surfer's ear").

Middle ear causes

• Otitis media (middle ear infection): Fluid behind the eardrum reduces its ability to vibrate.
• Otitis media with effusion ("glue ear"): Thick, sticky fluid in the middle ear — very common in children.
• Perforated eardrum: A hole in the eardrum from infection, trauma, or pressure changes.
• Otosclerosis: Abnormal bone growth around the stapes (the smallest bone in the body), preventing it from vibrating freely. Often hereditary.
• Cholesteatoma: An abnormal skin growth in the middle ear that can erode the ossicles.
• Eustachian tube dysfunction: The tube that equalizes pressure in the middle ear fails to open properly.

Symptoms

Conductive hearing loss typically causes sounds to seem quieter or muffled, as if your ears are plugged. Unlike sensorineural loss, speech clarity is often preserved — sounds are just softer. Other symptoms may include:

• A feeling of fullness or pressure in the ear
• Your own voice sounding unusually loud to yourself (autophony)
• Ear pain or discharge (if infection is present)
• Tinnitus (less common than in sensorineural loss)

Diagnosis

An audiologist or ENT will conduct a physical examination of the ear canal and eardrum, followed by audiometric testing. Tympanometry — a test that measures eardrum movement and middle ear pressure — is particularly useful for identifying middle ear problems. A bone conduction test compares how well you hear sounds delivered through headphones versus through a vibrator placed on the skull, which helps confirm the conductive component.

Treatment

Treatment depends entirely on the underlying cause:

• Earwax: Removal by a professional (irrigation, microsuction, or manual removal). Never use cotton swabs.
• Ear infection: Antibiotics or antifungals, depending on the type.
• Middle ear fluid: Often resolves on its own; persistent cases may require pressure equalization (PE) tubes.
• Perforated eardrum: Many heal spontaneously; surgical repair (tympanoplasty) is available for persistent perforations.
• Otosclerosis: Surgery (stapedectomy) to replace the fixed stapes with a prosthesis, or hearing aids.
• Cholesteatoma: Surgical removal is required.

When medical treatment cannot fully restore hearing, hearing aids — including bone-anchored hearing aids (BAHA) — can be highly effective for conductive hearing loss.