Conductive Hearing Loss: Symptoms, Causes & Treatment

Conductive hearing loss is a type of hearing loss that happens when sound cannot travel normally through the outer or middle ear. This can make sounds seem softer, muffled, or harder to understand, even when the inner ear is still working.

This condition can happen due to earwax blockage, fluid behind the eardrum, ear infections, otosclerosis, problems with the small bones in the middle ear, trauma, or changes in the ear canal. Some people may also have ear fullness, ear pain, drainage, dizziness, or ringing in the ear.

Treatment depends on the cause of conductive hearing loss. Options may include removing a blockage, treating an infection, using hearing aids or bone-conduction devices, or having surgery to repair the eardrum, middle ear bones, or other structures.

Main symptoms

Conductive hearing loss can affect one or both ears, and symptoms may appear suddenly or develop slowly over time. The most common symptoms include:

• Muffled hearing

• Trouble hearing soft sounds

• A feeling of fullness or pressure in the ear

• Ear pain

• Fluid or drainage from the ear

• Ringing in the ear

• Dizziness or balance problems

• Difficulty understanding speech, especially in noisy places

• Speaking louder than usual

• Turning up the volume on the TV, phone, or radio

Symptoms may vary depending on the cause. For example, an ear infection may cause pain and drainage, while otosclerosis may cause hearing loss that slowly worsens over time.

Common causes

Conductive hearing loss can be caused by any problem that blocks or reduces the movement of sound through the outer ear, eardrum, or middle ear. Common causes include:

1. Earwax blockage

Earwax can build up in the ear canal and block sound from reaching the eardrum. This may cause muffled hearing, ear fullness, ringing in the ear, or discomfort. 

This type of hearing loss is often temporary. Hearing usually improves after the wax is safely removed by a healthcare professional .

2. Ear infections and fluid in the middle ear

Middle ear infections and fluid behind the eardrum are common causes of conductive hearing loss. Fluid can stop the eardrum and middle ear bones from moving normally, making sounds harder to hear.

This is especially common in children, but it can also happen in adults. Symptoms may include ear pain, pressure, drainage, fever, or temporary hearing loss.

3. Otosclerosis

Otosclerosis is a condition in which abnormal bone growth affects the small bones in the middle ear, especially the stapes bone. This can prevent sound vibrations from moving normally into the inner ear.

Hearing loss from otosclerosis usually develops slowly. It may affect one or both ears and can sometimes be treated with hearing devices or surgery.

4. Problems with the eardrum

A hole or tear in the eardrum can cause conductive hearing loss because the eardrum cannot vibrate normally. This can happen after an ear infection, trauma, sudden pressure changes, or injury from objects placed in the ear.

Some eardrum injuries heal on their own, while others may need medical treatment or surgery. Drainage, pain, or repeated infections may also be present.

5. Problems with the middle ear bones

The middle ear contains three tiny bones that help carry sound to the inner ear. These bones can become stiff, separated, damaged, or fixed in place.

This can happen due to trauma, chronic ear disease, otosclerosis, or previous surgery. Treatment depends on the exact problem and may involve hearing devices or middle ear reconstruction.

6. Ear canal problems

A narrow, blocked, swollen, or malformed ear canal can prevent sound from reaching the eardrum. Some people are born with ear canal atresia, which means the ear canal did not form normally.

Ear canal problems may be linked to hearing loss from birth or early childhood. Early diagnosis is important in children because hearing problems can affect speech and language development.

7. Third-window conditions

Some inner ear conditions can look like conductive hearing loss on hearing tests, even when the eardrum and middle ear appear normal. These are sometimes called third-window conditions.

One example is superior semicircular canal dehiscence, in which an abnormal opening in the inner ear changes how sound vibrations move. Imaging tests may be needed when hearing tests suggest conductive hearing loss but the ear exam looks normal.

Confirming a diagnosis

Conductive hearing loss is diagnosed by an ear, nose, and throat doctor or an audiologist. The doctor usually starts by asking about symptoms, when they began, whether one or both ears are affected, and whether there is pain, drainage, dizziness, infection, trauma, or a history of ear surgery.

An ear exam is done to check for earwax, fluid, infection, eardrum damage, or visible changes in the ear canal. Hearing tests, such as an audiogram, help confirm conductive hearing loss by comparing how well sound travels through air and through bone.

Doctors look for an air-bone gap on hearing tests, which means bone-conducted sound is heard better than air-conducted sound. In some cases, tympanometry, tuning fork tests, otoacoustic emission testing, or imaging tests such as CT scans may be used to check the eardrum, middle ear bones, or inner ear structures.

Treatment options

Treatment for conductive hearing loss depends on the cause, severity, and whether the hearing loss is temporary or long-lasting. Some causes can be corrected, while others may need long-term hearing support.

1. Earwax or foreign body removal

When conductive hearing loss is caused by earwax or an object in the ear, treatment involves safely removing the blockage. This should be done by a trained healthcare professional, especially if there is pain, drainage, or a history of eardrum problems.

Hearing often improves once the ear canal is clear. Cotton swabs or sharp objects should not be used deep inside the ear because they can push wax farther in or injure the ear.

Read more about earwax removal using different methods.

2. Medications

Medication may be used when hearing loss is related to an infection, swelling, or inflammation. Depending on the cause, treatment may include antibiotics or other medicines prescribed by a doctor.

Medication may help clear the infection and reduce fluid or swelling. However, if fluid or hearing loss lasts for a long time, other treatments may be needed.

3. Monitoring

Some cases of conductive hearing loss are temporary and improve as the underlying problem resolves. This can happen with mild fluid behind the eardrum or after some infections.

Monitoring may include repeat ear exams and hearing tests. This helps confirm that hearing is improving and that there is no ongoing damage or chronic disease.

4. Hearing aids

Hearing aids can help people with conductive hearing loss when the condition cannot be fully corrected or when surgery is not the best option. They amplify sound so it is easier to hear speech and everyday sounds.

Hearing aids may be helpful for long-term conductive or mixed hearing loss. Follow-up with an audiologist is important to adjust the device and check hearing over time.

5. Bone-conduction devices

Bone-conduction devices send sound vibrations through the bones of the skull to the inner ear. These devices can help when sound cannot pass normally through the outer or middle ear.

They may be used for people with ear canal problems, chronic ear disease, or other causes of conductive hearing loss. Some devices are worn externally, while others may be surgically implanted.

6. Surgery

Surgery may be recommended when conductive hearing loss is caused by structural problems. This may include repairing the eardrum, reconstructing the middle ear bones, treating chronic ear disease, or performing stapes surgery for otosclerosis.

Surgery can improve hearing in many cases, but results depend on the cause and the condition of the ear. Possible risks and expected benefits should be discussed with an ear, nose, and throat specialist.

When to see a doctor

A doctor should be consulted if hearing loss appears suddenly, affects only one ear, or is getting worse. Medical evaluation is also important if hearing loss occurs with ear pain, drainage, dizziness, ringing, fever, or a feeling of pressure in the ear.

Children should be evaluated if there are signs of hearing difficulty, speech delay, frequent ear infections, or lack of response to sounds. Early diagnosis and treatment can help reduce the risk of speech, learning, and communication problems.