In our earlier blog posts, we discussed the two most common types of hearing loss: conductive and sensorineural hearing loss. At the tip of the iceberg, we explained that both are categorized based on the area of the ear where the problem lies, with conductive hearing loss affecting the outer or middle ear and sensorineural hearing loss involving the inner ear or auditory nerve.

Mixed hearing loss is a complex condition that combines both of these types. Sometimes, conductive and sensorineural hearing loss occur simultaneously, where a person may have damage to the inner ear or nerve and then develop a conductive issue later, such as a middle ear infection.

Understanding how it develops, its symptoms, and how it’s treated can help you or your loved ones manage the condition more effectively. Here’s what you need to know.

What Is Mixed Hearing Loss?

Mixed hearing loss is a combination of both conductive and sensorineural hearing loss, meaning there are problems in both the outer and middle ear (conductive) and the inner ear or auditory nerve (sensorineural). It can be caused by various factors affecting different parts of the ear, such as middle ear infections, noise exposure, or certain medical conditions. Alternatively, a single cause could affect both the outer/middle ear and the inner ear/nerve.

Mixed hearing is sometimes referred to as single-sided deafness when it affects one ear, but mixed hearing loss can occur in both ears as well. It can range in severity from mild hearing loss to profound hearing loss, depending on the extent of the damage in each area of the ear.

How Many People Develop Mixed Hearing Loss

It’s estimated that hearing loss in general affects nearly 20% of the world’s population, with 430 million having disabling hearing loss. Mixed hearing loss is a type of hearing loss within this broader category. It isn’t as common as purely conductive or sensorineural types, but it still affects a notable portion of people experiencing hearing problems.

According to the National Institute on Deafness, roughly 15% of American adults report some trouble hearing, and a portion of these individuals experience a mixed form. In Southeast Asia and other countries in the region, mixed hearing loss affects a significant percentage of the population, particularly as people age.

Mixed hearing loss can develop at any age, although older adults are more likely to face it due to cumulative damage from age-related hearing loss, noise exposure, and chronic ear infections.

Who Is at Risk for Mixed Hearing Loss

Several risk factors increase the likelihood of developing mixed hearing loss, such as the natural process of aging. It can lead to a gradual decline in hearing due to changes in the inner ear, potentially combined with conductive issues. However, mixed hearing loss can happen to anyone at any age. Factors contributing to hearing loss include:

• Repeated ear infections and wax buildup

• Noise-induced hearing loss from loud noise or occupational noise exposure

• Head trauma

• Family history of hearing impairment

• Congenital conditions affecting the structure of the outer ear or middle ear

• Certain ototoxic medications

• Tumors or benign growth

Loud noises, especially in the workplace or from recreational activities, can damage the inner ear, contributing to sensorineural hearing loss, potentially coupled with conductive problems. Meanwhile, some individuals may have a genetic predisposition to hearing loss, which can manifest as mixed hearing loss.

Additionally, severe head injuries can damage the ear and surrounding structures, resulting in the simultaneous occurrence of conductive and severe sensorineural hearing loss. Benign tumors or growths in the ear can also contribute to conductive hearing loss, potentially in conjunction with other types of hearing loss.

Can Children Get Mixed Hearing Loss

Yes, children can develop mixed hearing loss, particularly if they have a history of chronic middle ear infections, congenital abnormalities, or genetic hearing disorders. Early diagnosis is crucial, as hearing issues can significantly impact speech, language development, and social skills.

What Are the Main Symptoms of Mixed Hearing Loss

As with any signs of hearing loss, people with mixed hearing loss may struggle to hear soft sounds and find that louder sounds are still unclear or distorted. They might have trouble following conversations, especially in loud places, frequently ask others to repeat themselves, or turn the volume up a notch on devices.

Because mixed hearing loss includes both conductive and sensorineural components, symptoms can vary. Some may notice a feeling of fullness in the ears or experience tinnitus (ringing), while others may have more permanent inner ear damage contributing to overall difficulty hearing and moderate hearing loss to severe hearing loss.

What Sounds Would You Not Be Able To Hear

Depending on the degree of hearing loss, individuals with mixed hearing loss may have challenges in hearing soft sounds and speech understanding. They may not hear:

• Soft sounds like whispers or rustling

• High-frequency sounds like birdsong or consonants in speech

• Voices in noisy environments

• Normal conversation without hearing aids

• In severe cases, only very loud sounds may be audible

There are also other potential issues. Ringing or buzzing in your ears, known as tinnitus, can be a symptom of hearing loss, including mixed hearing loss. While you might struggle to hear soft sounds, loud noises might also be uncomfortable or painful due to the conductive component of your hearing loss.

What Causes Mixed Hearing Loss

On top of what was discussed above, mixed hearing loss can stem from a variety of overlapping causes that affect both the conductive and sensorineural parts of the auditory system. These may develop over time or happen suddenly, depending on the trigger. Common causes include:

Chronic ear infections (otitis media)

Persistent fluid buildup or infection in the middle ear can damage the eardrum or ossicles (tiny bones), leading to conductive hearing loss. If inner ear structures are also affected, the result can be mixed hearing loss.

Noise exposure

Repeated exposure to loud noise, whether at work or through headphones, can damage the sensory hair cells in the inner ear, causing sensorial hearing loss. If combined with an ear blockage or damage to the outer/middle ear, mixed hearing loss may develop.

Aging (presbycusis)

Age-related inner ear deterioration can be compounded by other age-linked issues like earwax buildup, Eustachian tube dysfunction, or stiffening of middle ear bones.

Physical trauma

Blows to the head or skull fractures can simultaneously affect multiple parts of the hearing pathway, damaging the middle ear bones and the cochlea or auditory nerve.

Genetic disorders

Some congenital conditions affect both the structure of the outer/middle ear and the function of the inner ear.

Otosclerosis

This is an abnormal bone growth in the middle ear that causes conductive hearing loss. In some cases, it can also affect the cochlea and result in a mixed type.

Tumors or growths

Non-cancerous tumors like cholesteatomas or acoustic neuromas may press on the auditory nerve or interfere with middle ear mechanics.

A full hearing evaluation, such as imaging and a Toronto hearing test by an audiologist, is necessary to determine the extent and type of hearing loss involved.

What Are the Complications of Mixed Hearing Loss

Mixed hearing loss can impact daily life in different ways. Because it affects multiple parts of the ear, it may be harder to treat than one type of hearing loss alone. Here are a few common complications:

• Communication struggles leading to frustration or social withdrawal

• Delayed development in children, such as speech and language

• Tinnitus, the ringing or buzzing in the ears, makes it harder to concentrate

• Fatigue from trying to listen and understand all the time can be mentally tiring

• Safety concerns like missing important sounds/signals (alarms, doorbells, or approaching vehicles)

Early detection and treatment can reduce these problems and improve quality of life.

How Is Mixed Hearing Loss Diagnosed

Diagnosis starts with a hearing test. An audiologist or ENT specialist will check how well you hear sounds and speech. They’ll also examine your ears to look for blockages or damage. Sometimes imaging tests, like a CT or MRI, are needed to see inside the ear. These steps help figure out if both types of hearing loss are present.

Processes usually include:

• Pure-tone audiometry

• Tympanometry (to assess middle ear function)

• Speech testing

• Magnetic resonance imaging (MRI) to rule out structural issues or tumors

What Do the Results of a Mixed Hearing Loss Test Look Like

On an audiogram (a chart of your hearing test), mixed hearing loss shows signs of both sensorineural and conductive loss. You’ll see a “gap” between air conduction and bone conduction results. This gap means sound isn’t getting through well, and your inner ear also isn’t processing it fully. Test results for mixed hearing loss will also show reduced hearing across frequencies, especially in speech ranges.

How Is Mixed Hearing Loss Treated

Treatment depends on the underlying cause and severity of both hearing loss components. If there’s a blockage or infection, it may be treated with medicine or surgery. For the sensorineural component, hearing aids or other hearing devices are usually recommended. Sometimes, both treatments are used together to improve hearing on all fronts. Treatment options may include:

• Surgery to correct issues in the middle ear (e.g., tympanoplasty or stapedectomy)

• Medication for infections or inflammation

• Use of hearing aids or cochlear implants

• Sign language or communication training in severe cases

Are There Hearing Aids for Mixed Hearing Loss

Specialized hearing aids in Canada can amplify sound and compensate for both types of loss. Special hearing aids can be adjusted to handle both types of hearing loss. These devices amplify sound and can also help reduce background noise. In more serious cases, a bone-anchored hearing system (BAHAs) or cochlear implant might be suggested depending on the condition of the outer ear, ear canal, and middle ear.

How Is Mixed Hearing Loss Managed

Living with mixed hearing loss involves more than just devices. Ongoing care is key. Management includes:

• Regular check-ups with an audiologist

• Using hearing devices as recommended

• Treating any infections early

• Minimizing loud noise exposure

• Using visual cues in communication

• Adapting environments to reduce background noise

• Educating family members to improve social interactions

Some people benefit from speech therapy or listening training. Staying consistent with your treatment plan can make a big difference.

Can You Recover From Mixed Hearing Loss

Some parts of mixed hearing loss can be treated or improved, especially if there’s a fixable cause like earwax or an infection. But if there’s damage to the inner ear or nerve, that part is usually permanent. Hearing devices can help you hear better, even if full recovery isn’t possible.

How Do You Lower the Risk of Mixed Hearing Loss

You can reduce your risk by protecting your ears. Avoid loud noise or wear ear protection when needed. Treat ear infections right away. Don’t stick objects in your ears. Also, manage chronic health conditions and have regular hearing check-ups, especially as you age. Maintain overall health to support the hearing nerve and inner ear function.

Conclusion

Mixed hearing loss can feel overwhelming at first, but the good news is, it’s manageable. Knowing the signs, getting tested early, and following a treatment plan can go a long way. There are ways to stay connected and keep hearing health in check, whether through hearing aids, medical treatment, or everyday habits. If you or someone you know is experiencing hearing difficulties, don’t wait. A simple test could be the first step toward better hearing.