Sensorineural vs. Conductive Hearing Loss: What's the Difference?

Hearing loss is a fact of life for around 37.5 million adults in the United States, but did you know that not all hearing loss is created equal?¹ There are several types of hearing loss, and the main ones are sensorineural and conductive hearing loss.²

Read on about the difference between these two types of hearing loss and how to diagnosis and treat them for your hearing health.

Sensorineural vs. Conductive Hearing Loss Overview

Sensorineural loss stems from damage to either the inner ear or auditory nerve, while conductive hearing loss is caused by an issue with the middle or outer ear.²

• Sensorineural hearing loss (SNHL) is the most common type of permanent hearing loss, resulting from problems with the inner ear (cochlea and vestibular system) or damage to the auditory pathway, which connects the auditory nerve with the brain.³ Approximately 1 in 5,000 people in the U.S. have some form of SNHL.⁴
• Conductive hearing loss is when there is an issue with the middle or outer ear that doesn’t let sound travel to the inner ear or along the auditory pathway to the brain.² The outer and middle ear consists of the pinna (outer soft tissue and cartilage), the ear canal and the eardrum.⁵ Conductive hearing loss is usually temporary and corrects itself once the underlying cause is treated.²

Common Causes

Sensorineural hearing loss

Sensorineural hearing loss can develop before birth (congenital) or be acquired after birth. While congenital SNHL is rare, its causes typically include:⁶

• Acquired infection passed from mother to child in the womb
• Gestational diabetes
• Genetics
• Lack of oxygen during birth
• Prematurity

Due to newborn screening programs, most infants born with hearing loss are identified and treated promptly.⁷

Most cases of SNHL are acquired after birth, usually from damage to the tiny hair cells in the cochlea, which can be caused by a variety of reasons, including:⁶

• Aging (presbycusis)
• Extremely loud noises such as live concerts, gunshots and explosions
• Infections, including measles, meningitis and certain autoimmune disorders
• Medications, including certain antibiotics, chemotherapy drugs and large doses of pain medication
• Trauma to the head, which can damage the inner ear's structures or the auditory pathways
• Tumors such as acoustic neuroma

Conductive hearing loss

A variety of issues can cause a blockage in the outer and middle ear, resulting in conductive hearing loss. Some common causes are:⁸

• Benign tumor blocking the outer or middle ear
• Ear wax buildup
• Damage to the middle ear bone
• Fluid in the middle ear
• Malformation of the outer or middle ear at birth
• Object stuck in the outer ear or ear canal
• Otitis media (infection of the middle ear)
• Problem with the eustachian tube that connects the middle ear and the nose
• Ruptured eardrum²
• Swimmer's ear (infection in the ear canal)

Common Symptoms

Sensorineural hearing loss

Typically, SNHL develops over time.⁹ It can also happen suddenly to only one ear (unilateral hearing loss).⁴ Common symptoms to look out for may include:⁹

• Difficulty understanding speech
• Dizziness
• Ear feels clogged
• Noises sound muffled
• Ringing in the ear (tinnitus)
• Sudden or steady loss of hearing

Conductive hearing loss

Conductive hearing loss can make it harder to hear softer sounds, and conversation may sound muffled.⁸ Other common symptoms of conductive hearing loss can include:¹⁰

• Difficulty hearing conversations²
• Dizziness
• Feeling of fullness or pressure in the ear
• Muffled speech
• Pain or tenderness in the ear
• Tinnitus (ringing in the ear)

Diagnosis

Sensorineural hearing loss

To diagnose SNHL, a doctor can use a variety of tools and tests to help confirm the presence of hearing loss and better understand its underlying cause. This typically starts with a physical exam and a thorough medical history.¹¹

Diagnostic tests used for SNHL can include:¹¹

• Electrophysiological tests to evaluate the auditory brainstem
• Head computed tomographic scans, or brain scans like MRI/CT, to check for structural causes
• Laboratory tests to check for infection or markers for autoimmune disease
• Pure tone audiometry to test hearing at certain frequencies
• Speech audiometry to determine the impact of hearing on speech communication
• Tuning fork tests to help determine bilateral vs. unilateral hearing loss
• Tympanometry to look at the movement of the eardrum and middle ear

Conductive hearing loss

Conductive hearing loss is diagnosed by a doctor after a physical exam, including a visual inspection of the ear using an otoscope, and obtaining a thorough medical history. Many of the same tests used to diagnose SNHL are also used to diagnose conductive hearing loss.¹²

These tests may include:¹²

• Head computed tomographic scans, or brain scans like MRI/CT, to check for structural causes
• Laboratory tests to check for signs of infection
• Pure tone audiometry to determine hearing at certain frequencies
• Tuning fork tests to help determine bilateral vs. unilateral hearing loss
• Tympanometry to look at the movement of the eardrum and middle ear

Treatments

Sensorineural hearing loss

Hearing loss is treated by first identifying the underlying cause. Acute cases of hearing loss can typically be reversed. However, hearing loss caused by age is usually permanent because of irreversible inner ear damage.¹¹

Hearing aids are the most common treatment for permanent SNHL. A doctor will prescribe and fit hearing aids based on the type of hearing loss. Hearing aids work by amplifying vibrations in the inner ear and improving the clarity of speech.¹³

Other possible treatment options for SNHL include:¹¹

• Cochlear implant (for severe cases of hearing loss)
• Continued monitoring with follow-up hearing tests
• Medication (if SNHL is caused by infection or swelling)

Conductive hearing loss

Treatment for conductive hearing loss will depend on the underlying cause and can include medication, surgery or other interventions.¹²

For conductive hearing loss, typically, the hearing can be restored after eliminating the underlying condition.²

Common treatments for conductive hearing loss can include:¹²

• Antibiotics to treat infection
• Draining fluid from the ear
• Fitting of hearing aids if there is a blockage or malformation of the middle ear
• Removal of impacted ear wax
• Surgery to repair a ruptured eardrum if it hasn’t healed on its own
• Surgically removing benign tumors

The Bottom Line

If you are experiencing hearing loss, visit your doctor to determine the type and to discuss the devices or treatments that might work best for you. While many cases of hearing loss are temporary and can be treated with medication or other interventions, understanding the type of hearing loss affecting you can help you figure out your next steps.

Frequently Asked Questions About Hearing Loss

Do you still have questions about sensorineural and conductive hearing loss? Here are answers to some commonly asked questions.

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Author Bio

Amy Isler, M.S.N., R.N., has more than a decade of nursing expertise. She combines her nursing experience and journalism background to create engaging and educational healthcare content for leading brands and publications, including GoodRx, Verywell Health, Vision Center and more. Her mission in writing is to provide positive, accurate and informative articles for consumers.