Mixed Hearing Loss: What You Need to Know

You may have heard the terms sensorineural and conductive hearing loss, but did you know there’s a third type? Called mixed hearing loss, it is a condition in which both types of auditory issues are present.

What is mixed hearing loss?

Mixed hearing loss happens when there is a combination of both sensorineural hearing loss (SNHL)—the most common variety—and conductive hearing loss.

“This means that there is some form of malfunction along multiple regions of the auditory pathway," noted Rosette R. Reisman, AuD, Manager of Hearing and Dispensing at Lenox Hill Hospital in New York, NY.

The conductive element of mixed hearing loss refers to damage to the outer or middle ear. Therefore, sound waves are hindered on their journey to the inner ear. The sensorineural part of mixed hearing loss relates to problems with the inner ear, or the nerve pathways from the inner ear to the brain. This means sound vibrations cannot be effectively processed.

Mixed hearing loss can be classed as mild to profound, depending on the degree of loss.

What are the causes of mixed hearing loss?

Mixed hearing loss can be caused by anything that causes a conductive or a SNHL. Common causes include:

• Aging
• A history of excessive noise exposure
• Ear infections
• Tumors on the auditory nerve
• Head trauma
• Viral infections
• Impacted earwax

Mixed hearing loss can also be caused by a combination of these issues. “For example, if a patient has underlying SNHL due to aging, and then gets an ear infection on top of that, now they will have a mixed hearing loss. Part of the hearing loss is coming from the inner ear, and part is coming from the ear infection,” Reisman said. In this example, the mixed hearing loss may be temporary, or at least a portion of it, as the conductive part of the hearing loss—the ear infection—is medically treatable.

Sometimes however, there is a single cause for the mixed hearing loss. Examples include:

• When a head trauma such as a blast injury damages different parts of the ear.
• Conditions that affect multiple parts of the ear, such as semicircular canal dehiscence or advanced otosclerosis.

What are some common symptoms of mixed hearing loss?

The symptoms of mixed hearing loss are typically a combination of symptoms for both SNHL and conductive hearing loss. Those affected may notice their symptoms only in one ear (unilateral hearing loss) or both ears (bilateral hearing loss).

Generally, the main symptom of mixed hearing loss is difficulty hearing, especially soft sounds. “Individuals will have difficulty with this, and maybe some tinnitus (ringing of other sounds in the ear) as well as dizziness. A sudden mixed hearing loss is noted when a patient acutely reports a decline in their hearing,” explained Reisman.

What treatments are there for mixed hearing loss?

Treatment for mixed hearing loss depends on professional evaluation to determine the cause of the loss and what its impact is.

“The best way to diagnose the mixed component is with a diagnostic hearing test. To determine the course of treatment, the hearing evaluation – along with a medical and possibly surgical evaluation – is key. Together, the audiologist and the physician will determine the best treatment plan for the patient,” Reisman told HearingTracker.

The conductive element of the hearing loss can often be treated with medication or surgery, while sensorineural hearing loss is typically treated with hearing aids or implants. A combination of treatments may be required to treat both the conductive and sensorineural damage.

When to see a doctor

Since any kind of hearing loss can interfere with quality of life, if you think you may have hearing loss, contact a hearing professional. Once you have your hearing evaluated, you and your healthcare professional can determine the best treatment plan for your needs.