Hearing Health: Mixed Hearing Loss

Sensorineural hearing loss and conductive hearing loss aren’t mutually exclusive. In fact, there is a special phrase used to refer to cases where both are present: mixed hearing loss. In these cases, treatment of both forms of hearing loss is necessary to solve the problem. This might involve surgery, earwax removal, or hearing aids — among other forms of treatment. Depending on what form of conductive hearing loss is present, the treatment can change.

If you or a loved one is suffering from mixed hearing loss, or you suspect that they might need a diagnosis, this article can fill you in on the symptoms, treatment, and causes of mixed hearing loss. From there, you can seek the professional help you need.

What is Mixed Hearing Loss?

As mentioned above, mixed hearing loss is a “double” form of hearing loss, categorized as one type. People with mixed hearing loss might experience symptoms different from those suffering from just sensorineural or conductive hearing loss  alone. Because of this, it is categorized as a type on its own.

One half of mixed hearing loss is sensorineural. This means that the cochlea, located in the inner ear, has deteriorated. The cochlea is a spiral, lined with small hairs that pick up sound. When these hairs degrade, it becomes difficult to hear sounds. Oftentimes, this hearing loss is gradual, and certain sounds or frequencies will be the first to go. This form of hearing loss is largely incurable, but it can be treated with devices like hearing aids and cochlear implants.

Conductive hearing loss is the other half. This issue is a bit more variant since many things can cause conductive hearing loss. It is largely characterized as a blockage in the middle ear, which prevents sound from the outer ear from funneling in. This blockage can be something as benign as fluid or earwax, to more serious issues like improper bone growth or tumors. Depending on what’s causing your conductive hearing loss, it’s potentially curable. Once the blockage is removed, your hearing should be improved.

Symptoms of Mixed Hearing Loss

The symptoms of mixed hearing loss can change from person to person. Depending on the severity of the issue, those suffering from mixed hearing loss can be mildly inconvenienced to profoundly deaf. While symptoms of conductive and sensorineural hearing loss can differ, both cause difficulty hearing in one or both ears.

When discussing symptoms, it’s best to attribute them to their respective causes. The sensorineural aspect of mixed hearing loss manifests as follows:

• Oftentimes, sensorineural hearing loss is bilateral, meaning it occurs in both ears.
• Speech might be impossible to parse in noisy rooms. This is called the “cocktail party” effect.
• Certain sounds, like consonants in speech, might be difficult to hear.
• Tinnitus, or ringing/buzzing/humming/roaring in the ears
• Difficulty hearing high-pitched sounds.

Meanwhile, conductive hearing loss can result in more “physical” symptoms, such as:

• Unilateral hearing loss, where you can hear out of one ear more than the other.
• Pressure, pain, or “fullness” in one of both ears.
• Strange odors or leakage from the ear canal.
• Your voice sounding different to yourself.

When left untreated, hearing loss can also cause a number of “side effect” symptoms, many of which are mental and emotional. Many people with hearing loss might not realize that these symptoms are caused by hearing loss until they receive treatment.

• Irritability, or a sense of frustration.
• Lack of enjoyment in sound (music, conversation, etc.)
• Avoidance of social situations and interactions.
• Feelings of isolation or depression.
• Mental exhaustion, or feeling unreasonably fatigued at the end of the day.

If symptoms from both the sensorineural and conductive lists are being experienced, there is a chance that both forms of hearing loss are present. In this case, treatment for mixed hearing loss should be discussed.

Causes of Mixed Hearing Loss

There is one primary cause of sensorineural hearing loss: noise exposure. Prolonged exposure to loud noise can degrade the cochlea, causing sensorineural hearing loss. For this reason, loud environments like clubs and shooting ranges can be dangerous.

Conductive hearing loss can be caused by a number of factors, including:

• Abnormal bone growth
• Punctured/ruptured eardrums
• Tumors
• Infections
• Earwax buildup
• Fluid in the middle ear
• Foreign objects 

Treatment of Mixed Hearing Loss

The treatment for mixed hearing loss is a multi-step process. Because both forms of hearing loss are present, they must be treated separately. First, you will be diagnosed using a mixed hearing loss audiogram. From there, your hearing care provider will determine what is causing your conductive hearing loss. Those suffering from tumors or earwax buildup can have procedures done to remove these blockages, and infections can be treated with antibiotics.

Sensorineural hearing loss can be more difficult to treat, as it’s often permanent. However, it can be alleviated with hearing aids. Modern hearing aids are far more advanced than their predecessors, and can offer a natural hearing experience to the wearer. Once the conductive hearing loss is treated, your hearing care provider might suggest hearing aids. Regardless of your feelings regarding them, they might be a good thing to try.

If you’re interested in learning more about hearing aids, or just want to browse our articles on aural health and hearing loss, the Signia Hearing blog is a great resource for anyone who cares about their hearing. If you’d like to be notified about future updates and articles, the Signia newsletter can keep you updated on new content.