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# Hearing loss (conductive and sensorineural, including sudden hearing loss)

Partial or total loss of hearing in one or both ears. It can come from blocked sound in the outer or middle ear or from damage to the inner ear or nerve.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Cochlea](https://durgical.com/en/anatomy/cochlea/)
- [Eardrum](https://durgical.com/en/anatomy/tympanic-membrane/)
- [Stapes](https://durgical.com/en/anatomy/stapes/)
- [Vestibulocochlear nerve (VIII)](https://durgical.com/en/anatomy/vestibulocochlear-nerve/)
- [Ear canal](https://durgical.com/en/anatomy/external-acoustic-meatus/)
- [Malleus](https://durgical.com/en/anatomy/malleus/)
- [Incus](https://durgical.com/en/anatomy/incus/)
- [Auditory tube](https://durgical.com/en/anatomy/auditory-tube/)
- [Internal acoustic meatus](https://durgical.com/en/anatomy/internal-acoustic-meatus/)
- [Auditory cortex](https://durgical.com/en/anatomy/transverse-temporal-gyri/)
- [Vestibule](https://durgical.com/en/anatomy/vestibule-of-vagina/)

## In embryology

- [Neural crest cells and their derivatives](https://durgical.com/en/embryology/neural-crest-cells-and-their-derivatives/)
- [Second pharyngeal arch (hyoid arch) and the facial nerve](https://durgical.com/en/embryology/second-pharyngeal-arch-and-the-facial-nerve/)
- [Pharyngeal clefts and membranes: external ear and cervical sinus](https://durgical.com/en/embryology/pharyngeal-clefts-and-membranes-external-ear-and-cervical-sinus/)
- [Cleft lip and cleft palate](https://durgical.com/en/embryology/cleft-lip-and-cleft-palate/)
- [First-arch syndromes: Treacher Collins and Pierre Robin sequence](https://durgical.com/en/embryology/first-arch-syndromes-treacher-collins-and-pierre-robin-sequence/)
- [Ear: inner, middle and external ear](https://durgical.com/en/embryology/ear-inner-middle-and-external-ear/)
- [Congenital hearing loss, microtia and preauricular pits](https://durgical.com/en/embryology/congenital-hearing-loss-microtia-and-preauricular-pits/)
- [TORCH infections: what each agent does to the embryo and fetus](https://durgical.com/en/embryology/torch-infections-what-each-agent-does-to-the-embryo-and-fetus/)
- [Congenital Zika syndrome](https://durgical.com/en/embryology/congenital-zika-syndrome/)
- [Congenital rubella syndrome](https://durgical.com/en/embryology/congenital-rubella-syndrome/)
- [Tetracyclines and aminoglycosides](https://durgical.com/en/embryology/tetracyclines-and-aminoglycosides/)

## In the clinical exam

- [Otoscopy and the Rinne and Weber tests](https://durgical.com/en/clinical-exam/otoscopy-and-the-rinne-and-weber-tests/)

## Why it happens

- [Hearing: middle ear, cochlea and auditory pathway](https://durgical.com/en/physiology/hearing-middle-ear-cochlea-and-auditory-pathway/)
- [Inner ear: the cochlea and the organ of Corti](https://durgical.com/en/histology/inner-ear-the-cochlea-and-the-organ-of-corti/)

## What it is

A reduced ability to hear in one or both ears. Conductive loss comes from problems that block sound in the ear canal, [eardrum](https://durgical.com/en/anatomy/tympanic-membrane/) or ossicles; sensorineural loss comes from damage to the [cochlea](https://durgical.com/en/anatomy/cochlea/) or the auditory nerve; mixed loss has both. Sudden sensorineural loss is an otological emergency.

## Who gets it

The WHO estimates that hundreds of millions of people live with disabling hearing loss and that the number will keep rising as populations age. Much of it is preventable: noise at work and leisure, ear infections, ototoxic drugs and infections such as congenital rubella and meningitis. Colombia includes newborn hearing screening in its child health policies.

## Causes

- Conductive: earwax impaction, otitis externa, otitis media with effusion, eardrum perforation, cholesteatoma, otosclerosis
- Sensorineural: age (presbycusis), noise exposure, ototoxic drugs (aminoglycosides, cisplatin, loop diuretics), Ménière disease, vestibular schwannoma
- Infectious: bacterial meningitis, mumps, congenital rubella and cytomegalovirus, syphilis
- Genetic and congenital causes; head trauma
- Sudden sensorineural loss: mostly idiopathic, sometimes viral, vascular or autoimmune

## Risk factors

- Prolonged exposure to loud noise at work (industry, mining, construction) or leisure (personal audio, concerts)
- Older age
- Use of ototoxic medicines
- Recurrent ear infections in childhood
- Prematurity, neonatal jaundice and family history in newborns

## Pathophysiology

In conductive loss, sound does not reach the inner ear efficiently because of a block or a stiff or broken middle ear transmission chain, while the cochlea works normally. In sensorineural loss, hair cells of the cochlea or fibres of the [vestibulocochlear nerve](https://durgical.com/en/anatomy/vestibulocochlear-nerve/) are damaged; noise and ototoxic drugs destroy outer hair cells, first affecting high frequencies. Lost cochlear hair cells do not regenerate in humans, so sensorineural loss is usually permanent.

## Classification

- Conductive, sensorineural or mixed
- By degree: mild, moderate, severe, profound
- Unilateral or bilateral; sudden or progressive
- Congenital or acquired

## Symptoms and signs

- Difficulty following conversation, especially in noisy places
- Turning up the television or asking people to repeat
- Tinnitus (ringing or buzzing)
- Ear fullness; vertigo in Ménière disease or vestibular causes
- In children: delayed speech and language, poor school performance or not reacting to sounds

## Red flags

- Sudden hearing loss in one ear over less than 72 hours: urgent referral, as treatment works best early
- Asymmetric loss or one-sided tinnitus (rule out vestibular schwannoma)
- Hearing loss with facial weakness, severe vertigo or other neurological signs
- Ear discharge with pain and fever, or a persistent foul-smelling discharge (cholesteatoma)
- Hearing loss after head trauma or during treatment with ototoxic drugs

## Diagnosis

**Clinical**
Otoscopy and tuning fork tests with a 512 Hz fork. Weber: sound lateralises to the affected ear in conductive loss and to the healthy ear in sensorineural loss. Rinne: air conduction is louder than bone conduction (positive) in normal and sensorineural ears; bone louder than air (negative) in conductive loss.

**Tests**
Pure-tone audiometry (air and bone conduction) confirms the type and degree; tympanometry, speech audiometry and acoustic reflexes. Newborn screening with otoacoustic emissions or automated auditory brainstem response. Selected blood tests (syphilis serology, for example) according to the cause.

**Imaging**
MRI of the internal auditory canals with contrast for asymmetric or sudden sensorineural loss (vestibular schwannoma); CT of the [temporal bone](https://durgical.com/en/anatomy/temporal-bone/) for cholesteatoma, malformations or trauma.

## Differential diagnosis

- Earwax impaction or otitis externa
- Otitis media with effusion or acute otitis media
- Presbycusis
- Ménière disease
- Vestibular schwannoma
- Central auditory processing problems or non-organic hearing loss

## Goal of treatment

Find and treat reversible causes, recover hearing as soon as possible in sudden loss, and restore communication with hearing aids, implants and rehabilitation, with early intervention in children to protect language development.

## Treatment

**Procedure**
Removal of earwax and treatment of [ear canal](https://durgical.com/en/anatomy/external-acoustic-meatus/) or middle ear infection; ventilation tubes for persistent middle ear effusion with hearing loss in children.

**Medical**
Sudden sensorineural hearing loss: systemic or intratympanic corticosteroids given early. Stopping or adjusting ototoxic drugs when possible.

**Surgical**
Tympanoplasty for perforations, stapedectomy for otosclerosis, removal of cholesteatoma; cochlear implant for severe to profound sensorineural loss.

**Rehabilitation**
Hearing aids, auditory and speech therapy, communication training and sign language when appropriate.

**Follow-up**
Serial audiometry; hearing tests during ototoxic treatment and in noise-exposed workers; nursing focus on clear face-to-face communication and safety.

## Complications

- Delayed speech and language and learning difficulties in children
- Social isolation, depression and lower work performance in adults
- Higher risk of cognitive decline in older adults with untreated hearing loss
- Safety risks from not hearing alarms or traffic

## Prognosis

Conductive loss is often reversible with medical or surgical treatment. Sensorineural loss is usually permanent but can be well rehabilitated; about half or more of people with idiopathic sudden hearing loss recover part or all of it, more often when treated early.

## Prevention

- Hearing protection and noise control at work; limiting volume and time with personal audio
- Vaccination against measles, mumps, rubella and meningitis-causing bacteria
- Newborn hearing screening and early treatment of ear infections
- Careful use and monitoring of ototoxic drugs

## Test yourself

Think of the answer, then tap the question to see it.

## In right conductive hearing loss, where does the Weber test lateralise?

To the right (affected) ear.

## What is the Rinne result in an ear with conductive hearing loss?

Negative: bone conduction is heard better than air conduction.

## What is the first-line treatment of idiopathic sudden sensorineural hearing loss?

Early corticosteroids, systemic or intratympanic, after urgent audiometry.

## Which tumour must be ruled out with MRI in asymmetric sensorineural hearing loss?

Vestibular schwannoma (acoustic neuroma) of the vestibulocochlear nerve.

## Which frequency is classically affected first in noise-induced hearing loss?

About 4 kHz, seen as a notch on the audiogram.

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## Related conditions

- [Presbycusis (age-related hearing loss)](https://durgical.com/en/conditions/presbycusis/)
- [Acute otitis media](https://durgical.com/en/conditions/acute-otitis-media/)
- [Otitis externa](https://durgical.com/en/conditions/otitis-externa/)
- [Otosclerosis](https://durgical.com/en/conditions/otosclerosis/)
- [Cholesteatoma](https://durgical.com/en/conditions/cholesteatoma/)
- [Ménière disease](https://durgical.com/en/conditions/meniere-disease/)
- [Vestibular schwannoma (acoustic neuroma)](https://durgical.com/en/conditions/vestibular-schwannoma/)
- [Bacterial meningitis](https://durgical.com/en/conditions/bacterial-meningitis/)
- [Mumps](https://durgical.com/en/conditions/mumps/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Hearing loss: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003044.htm) (MedlinePlus, US National Library of Medicine, 2026); [Deafness and hearing loss](https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss) (World Health Organization, 2026).

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Source: https://durgical.com/en/conditions/hearing-loss/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/hearing-loss/