What Is Mixed Hearing Loss?

Mixed hearing loss is trouble hearing in both the middle or outer ear – known as conductive hearing loss – and the inner ear – known as sensorineural hearing loss. The primary symptoms of mixed hearing loss include difficulty hearing soft sounds and trouble understanding speech, particularly in noisy environments. Causes of mixed hearing loss can vary, but typically result from a combination of factors affecting the different parts of the ear.

Signs & Symptoms

When experiencing mixed hearing loss, you may notice certain signs and symptoms.

Common symptoms of mixed hearing loss include:

• Decreased hearing sensitivity – Difficulty hearing soft sounds or needing to turn up the volume on electronic devices.
• Difficulty understanding speech – Having a hard time making out what people are saying, especially when there's a lot of background noise or when several individuals are speaking at the same time.
• Tinnitus – You may hear sounds in the ear, which can be intermittent or constant. The sounds usually come in the form of ringing, humming, or hissing noises.
• Ear pain or pressure – If you feel pain or fullness in your ear, it could be a sign of a problem in your outer or middle ear.

Causes

Mixed hearing loss can result from a variety of factors. The most common cause of hearing loss is age.

Other mixed hearing loss causes include:

• Infections – Ear infections can cause inflammation and fluid buildup in the middle ear, leading to conductive hearing loss. Infections can also damage the inner ear.
• Trauma – Injuries to the ear or head, including skull fractures.
• Age-related hearing loss – As you get older, it is common for your hearing to gradually become worse. This is called presbycusis and it often causes sensorineural hearing loss.
• Noise exposure – Hearing loss can happen if you are around loud sounds for a long time, or if you hear a loud noise suddenly. This can damage the tiny hair cells inside the ear that help us hear.

Risk Factors

Several risk factors can increase your likelihood of developing mixed hearing loss.

Risk factors include:

• Family history – Hearing loss can run in families. Some people may be born with a higher chance of having hearing problems because of their genes.
• Occupational noise exposure – Regular exposure to loud noises in certain occupations, such as construction or factory work, can significantly increase the likelihood of developing sensorineural hearing loss.
• Recreational noise exposure – Attending concerts or using headphones at high volumes can also contribute to sensorineural hearing loss.
• Smoking – Tobacco use is linked to a higher risk of hearing loss.

Diagnosis

Diagnosing mixed hearing loss involves a thorough evaluation by an audiologist or otolaryngologist.

Diagnostic tests for mixed hearing loss:

• Audiometry – This test measures your hearing sensitivity across various frequencies, helping to determine the type and degree of hearing loss.
• Tympanometry – This test assesses the function of the middle ear by measuring how the eardrum responds to changes in air pressure.
• Otoacoustic emissions (OAE) – This is a hearing test that measures the sounds produced by the tiny hair cells in the inner ear. This test helps evaluate the function of these cells and how they respond to sound.
• Speech audiometry – This test evaluates a patient's ability to understand speech at various volume levels and in different listening conditions.
• Weber Test – This is a type of tuning fork test that checks for differences in sound perception between both ears.

Treatment

The approach your doctor takes to treating your mixed hearing loss is determined by the root cause and the extent of your condition.

Mixed hearing loss treatment options include:

• Hearing aids – These devices amplify sounds, making it easier for individuals with mixed hearing loss to hear and understand speech. Different types and styles of hearing aids are available to accommodate individual needs.
• Assistive listening devices – These devices can help you better understand speech in challenging listening situations, such as watching television, attending meetings, or talking on the phone.
• Middle ear surgery – Your doctor may perform surgery to correct structural problems in your ears.
• Cochlear implants – If someone has severe sensorineural hearing loss and hearing aids do not help, they may be able to get a cochlear implant. Cochlear implants work by sending signals directly to the hearing nerve, even if the hair cells in the inner ear are damaged. This can improve the person's ability to hear and understand sounds.

Prevention

While not all cases of mixed hearing loss can be prevented, there are several steps you can take to reduce their risk.

Prevention tips include:

• Protect your ears – Wear earplugs or earmuffs when exposed to loud noises, whether at work or during recreational activities.
• Limit exposure to loud sounds – Keep the volume on headphones and electronic devices at a moderate level and take breaks when listening for long periods.
• Maintain good ear hygiene – Avoid inserting objects into the ear canal, as this can cause injury and increase the risk of infection.
• Seek prompt medical attention – If you suspect an ear infection or notice a sudden change in your hearing, consult a healthcare professional as soon as possible to prevent complications and further hearing loss.

Complications

Untreated mixed hearing loss can lead to various complications. Prolonged hearing loss can strain personal and professional relationships, as communication becomes more challenging. Neglecting untreated hearing loss can put individuals at a higher risk of isolation, depression, and a decline in cognitive function. Delays in seeking treatment can also make it more difficult to adapt to hearing aids or other interventions, as the brain may have difficulty processing auditory information after an extended period of reduced stimulation.