Hearing loss is not a single condition — it's a symptom with multiple possible causes and types, each originating in a different part of the hearing system. Understanding which type you have matters enormously, because the treatment options, prognosis, and day-to-day management differ significantly between them.
Conductive Hearing Loss
✓ Often Reversible
Conductive hearing loss occurs when sound cannot efficiently travel through the outer or middle ear — from the pinna through the ear canal to the eardrum and ossicles. The inner ear (cochlea) and auditory nerve are working normally, but the sound signal isn't reaching them properly.
Common Causes
- Earwax impaction — the most common and most reversible cause
- Outer or middle ear infections (otitis externa, otitis media)
- Fluid in the middle ear (Otitis media with effusion / "glue ear")
- Perforated eardrum
- Ossicle dislocation or erosion
- Foreign objects in the ear canal
- Exostoses (surfer's ear — bony growths in the canal)
- Cholesteatoma (abnormal skin growth in the middle ear)
Typical Symptoms
- Hearing seems muffled or blocked
- Often worse in one ear than the other
- May fluctuate (better and worse on different days)
- Your own voice may sound abnormally loud to you
- Ear fullness or pressure sensation
Treatment Options
Many causes of conductive hearing loss are medically or surgically treatable. Earwax removal, antibiotics for infections, grommets for persistent fluid, and surgery for structural issues can often restore hearing. Even when full restoration isn't possible, hearing aids and OTC devices are highly effective because the inner ear is undamaged.
Sensorineural Hearing Loss
⚠️ Usually Permanent
Sensorineural hearing loss (SNHL) occurs when the delicate hair cells of the cochlea (inner ear) or the auditory nerve itself are damaged. Sound enters the ear normally, but the signal is not processed correctly by the sensory organ or transmitted properly to the brain.
Common Causes
- Age-related hearing loss (presbycusis) — the most common cause, affecting roughly 1 in 3 adults over 65
- Noise-induced hearing loss — from occupational noise, recreational firearms, loud music, or chronic headphone use
- Ototoxicity — damage from certain medications (some antibiotics, chemotherapy agents, high-dose aspirin)
- Genetic / hereditary hearing loss
- Viral infections (e.g., sudden sensorineural hearing loss, measles, mumps)
- Meniere's disease
- Acoustic neuroma
- Head trauma
Typical Symptoms
- Difficulty hearing speech, especially in noisy environments
- High-frequency sounds (women's voices, consonants like s, t, sh) are the first to go
- Sounds seem distorted rather than simply quieter
- Usually bilateral (affects both ears), though often asymmetric
- Tinnitus is very commonly present alongside
- Asking people to repeat themselves
- Turning the TV up louder than others prefer
Treatment Options
Sensorineural hearing loss cannot be reversed — hair cells in the cochlea do not regenerate. However, it's managed effectively with hearing aids (including OTC hearing aids for mild-to-moderate loss), cochlear implants (for severe-to-profound loss), and assistive listening devices. Early intervention is always better.
OTC Hearing Aids and Sensorineural Loss
The FDA's OTC hearing aid category is specifically designed for adults with mild-to-moderate sensorineural hearing loss. Most people with age-related or noise-induced hearing loss fall into this category and can benefit from OTC devices like MDHearing NEO XS or MDHearing VOLT 4.
Mixed Hearing Loss
Mixed hearing loss is exactly what it sounds like: a combination of conductive and sensorineural components. You have underlying sensorineural loss (from aging or noise exposure, for example) combined with a superimposed conductive problem (such as earwax buildup or an infection).
The conductive component may be medically treatable. The sensorineural component is permanent. Hearing aids — including OTC hearing aids — can address both components simultaneously.
Degrees of Hearing Loss
Type tells you where the problem is; degree tells you how much hearing you've lost. Hearing loss is measured in decibels (dB HL) across the speech frequency range (0.25–8 kHz).
| Degree | dB Range | Ability to Hear Speech | OTC Suitable? |
|---|---|---|---|
| Normal | −10 to 25 dB | No difficulty | No |
| Mild | 26–40 dB | Soft speech difficult | ✓ Yes |
| Moderate | 41–60 dB | Normal speech difficult | ✓ Yes |
| Severe | 61–80 dB | Loud speech needed | ⚠️ Prescription recommended |
| Profound | 81+ dB | May rely on sign language | ✗ No (cochlear implant) |
How Each Type Is Diagnosed
A proper hearing test (audiometry) performed by an audiologist can distinguish between conductive and sensorineural loss. The key test is bone conduction: a vibrating device is placed on the bone behind your ear, bypassing the outer and middle ear and sending sound directly to the cochlea.
- If sounds are heard better by bone conduction than air conduction → sensorineural loss (inner ear problem)
- If sounds are heard equally poorly by both → conductive loss (outer/middle ear problem)
- If both are reduced but bone conduction is better than air → mixed loss
→ See our full guide to hearing testing
⚠️ Medical Disclaimer
This article is for educational purposes only. If you believe you have hearing loss, consult a qualified audiologist or healthcare provider for a proper assessment. Read full disclaimer