Types of hearing loss

Not all hearing loss is the same. There are three main types of hearing loss, each caused by a problem in a different part of the ear. The type of hearing loss you have will determine the treatment options available to you.

A hearing care professional can diagnose the type and degree of your hearing loss through a full hearing assessment.

The three types of hearing loss

1. Sensorineural hearing loss

Sensorineural hearing loss is the most common type of permanent hearing loss. It occurs when there is damage to the inner ear (the cochlea) or the hearing nerve that carries signals to the brain.

Inside the cochlea are thousands of tiny hair cells that detect sound vibrations and convert them into electrical signals. When these hair cells are damaged or destroyed, they do not grow back. The result is permanent hearing loss.

What causes sensorineural hearing loss?

Age-related hearing loss (presbycusis) – Natural changes in the inner ear that occur gradually over time. It is the most common cause of sensorineural hearing loss.
Noise exposure – Repeated or prolonged exposure to loud sounds damages the hair cells in the cochlea. This includes loud music, power tools, firearms and industrial machinery.
Genetics – Hearing loss can be inherited. Some people are born with sensorineural hearing loss; in others, genetic factors cause hearing loss to develop over time.
Illness and infection – Certain illnesses such as meningitis, mumps and Meniere's disease can damage the inner ear.
Ototoxic medications – Some prescription drugs, including certain antibiotics, chemotherapy drugs and high-dose aspirin, can damage the inner ear.
Head or acoustic trauma – A blow to the head or exposure to an extremely loud sound (such as an explosion) can cause sudden sensorineural hearing loss.

Symptoms of sensorineural hearing loss

Sensorineural hearing loss most commonly affects the ability to hear high-pitched sounds. You may notice:

Difficulty understanding speech, especially in noisy environments
Voices sounding muffled or unclear
Trouble hearing high-pitched sounds, such as birds, children's voices or the doorbell
Ringing or buzzing in the ears (tinnitus)
Needing to turn the television volume up higher than others prefer

The onset is often gradual. Many people do not notice the change until their hearing loss has progressed significantly.

Treatment for sensorineural hearing loss

Sensorineural hearing loss is generally not reversible. However, it is highly treatable. Treatment options include:

Hearing aids – Hearing aids are the most common treatment. They amplify sounds to compensate for the loss in the inner ear. Modern hearing aids are discreet, comfortable and highly effective.
Cochlear implants – For people with severe to profound hearing loss who do not benefit sufficiently from hearing aids, cochlear implants bypass the damaged hair cells and directly stimulate the hearing nerve.
Assistive listening devices – Devices such as captioned telephones, TV streamers and FM systems can complement hearing aids in specific listening situations.

2. Conductive hearing loss

Conductive hearing loss occurs when sound cannot pass efficiently through the outer or middle ear to reach the inner ear. The inner ear itself is typically functioning normally.

Unlike sensorineural hearing loss, conductive hearing loss is often temporary and may be fully or partially reversible with treatment.

What causes conductive hearing loss?

Earwax blockage (cerumen impaction) – A build-up of earwax in the ear canal can block sound from reaching the eardrum.
Middle ear infections (otitis media) – Fluid accumulation in the middle ear due to infection reduces the movement of the eardrum and middle ear bones.
Eustachian tube dysfunction – The Eustachian tube regulates air pressure in the middle ear. When it does not open and close properly, fluid can build up.
Perforated eardrum – A hole or tear in the eardrum can be caused by infection, injury or sudden pressure changes.
Otosclerosis – Abnormal bone growth around the stapes (one of the three small bones of the middle ear) that restricts its movement.
Cholesteatoma – An abnormal skin growth in the middle ear that can damage surrounding structures.
Foreign objects – Objects lodged in the ear canal can physically block sound transmission.

Symptoms of conductive hearing loss

Sounds seem faint or muffled across all pitches
A feeling of fullness or pressure in the ear
Pain or discomfort in the ear
Drainage from the ear canal
Your own voice sounds louder than usual to you

Treatment for conductive hearing loss

Treatment depends on the cause. Many cases of conductive hearing loss can be resolved with medical treatment:

Earwax removal – A hearing care professional or doctor can safely remove earwax blockages.
Antibiotics – Bacterial middle ear infections are treated with oral antibiotics or antibiotic ear drops.
Surgery – Conditions like otosclerosis, a perforated eardrum or cholesteatoma may require surgical intervention. Ear tube surgery (myringotomy) is a common procedure for recurrent middle ear infections, particularly in children.
Hearing aids or bone-anchored hearing systems – When conductive hearing loss cannot be fully corrected medically, hearing aids or bone-conduction devices can help.

3. Mixed hearing loss

Mixed hearing loss is a combination of sensorineural and conductive hearing loss. There is damage in the inner ear or hearing nerve, as well as a problem in the outer or middle ear.

For example, a person may have age-related sensorineural hearing loss and also develop a middle ear infection. The infection adds a conductive component on top of the existing sensorineural loss, resulting in mixed hearing loss.

Treatment for mixed hearing loss

Treatment for mixed hearing loss depends on the relative contributions of each component. Your hearing care provider will:

Address any treatable conductive component first (e.g., treat an infection or remove earwax)
Reassess hearing after treating the conductive cause
Recommend hearing aids or other amplification for the remaining sensorineural component

Mixed hearing loss can be more complex to diagnose and manage. Be sure to work closely with your audiologist or otolaryngologist (ear, nose and throat specialist) to develop the right treatment plan.

How to find out what type of hearing loss you have

A full hearing assessment by an audiologist will determine the type, degree and configuration of your hearing loss. You do not need a referral to see an audiologist in Canada, and many hearing clinics offer free assessments.

Find a hearing clinic near you through Hearing Directory and take the first step toward better hearing.