Mixed
Hearing Loss
A Combination of Two Types
What is Mixed Hearing Loss?
Mixed hearing loss is exactly what it sounds like — a combination of conductive hearing loss (problems in the outer or middle ear) and sensorineural hearing loss (damage in the inner ear or auditory nerve).
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This means that sound is being reduced or blocked on its way into the ear and the inner ear isn’t fully processing the signals once they arrive. Because two parts of the hearing system are involved, mixed hearing loss can be more complex to diagnose and manage.
Common Causes
Mixed hearing loss can happen gradually or suddenly. It often occurs when someone who already has sensorineural loss develops a conductive problem on top of it. For example:
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Age-related hearing loss complicated by earwax buildup
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Noise-induced hearing loss made worse by middle ear infections
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Genetic hearing loss with otosclerosis (abnormal bone growth in the middle ear)
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Longstanding conductive issues that eventually cause inner ear damage
Symptoms of Mixed Hearing Loss
People with mixed hearing loss may notice:
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Muffled hearing and lack of clarity at the same time
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Greater difficulty following speech in noisy environments
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Frequent requests for repetition
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Turning up the TV or radio louder than others prefer
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A sense that hearing fluctuates or is worse in one ear than the other
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Because both types of hearing loss are present, patients often feel like they’re “fighting two battles at once.”
Diagnosis
Mixed hearing loss is identified through a hearing test (audiogram) using both air conduction and bone conduction testing.
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If both results show loss — but bone conduction is better than air conduction — it suggests a mixed hearing loss.
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Additional exams (tympanometry, otoscopy, or imaging) may be needed to pinpoint the conductive component.
Treatment Options
Treatment usually addresses both components:
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Medical treatment (wax removal, medications, surgery) for the conductive portion
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Hearing aids or bone conduction devices for the sensorineural portion
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Ongoing monitoring to track progression, since sensorineural loss is typically permanent and may worsen over time
Why It Matters
Because mixed hearing loss involves two different parts of the auditory system, management requires a personalized approach. Treating one part without the other often leaves patients struggling. A full hearing evaluation ensures the right combination of medical care and hearing technology is used.
💡 Did You Know?
Mixed hearing loss doesn’t mean “double the volume fixes it.” Even after the conductive issue is treated, most people still need amplification to address the sensorineural portion.