Mixed hearing loss

Mixed hearing loss

Description, Causes and Risk Factors:

Mixed hearing loss is a combination of both conductive and sensorineural hearing loss at the same time. Both the middle and inner ear are involved.

A mixed hearing loss happens when there is the presence of both a conductive hearing loss (usually temporary hearing loss caused by a blockage) in the middle or outer ear, and a sensorineural hearing loss (hearing loss caused by damaged inner ear hair cells) in the inner ear involving either the cochlea or the auditory nerve.

Mixed hearing loss results from anything that causes conductive or sensorineural hearing loss. One situation where mixed hearing loss occurs is large vestibular aqueduct syndrome (LVAS). LVAS usually involves just sensorineural hearing loss, but it can also have a conductive component. One more possible cause is increased perilymphatic pressure that results from a tear in the membranes separating the middle ear from the inner ear.

Other causes may include:


  • Blockages of the ear canal by impacted wax or foreign objects.

  • Outer ear infection (sometimes the result of swimming) 'glue ear' (middle ear infection), a common problem in young children.

  • Perforated eardrum, maybe from a bad middle ear infection or an accident.

  • Otosclerosis, a hereditary condition where the bone grows around the tiny stirrup bones in the middle ear.

  • Partial or complete closure of the ear canal.

  • Head injury.

  • Excessive exposure to loud noise (music, etc).

  • Viral infections.

  • Meningitis.

  • High fever.


Usually the sensorineural is experienced first. Many patients will suffer from vertigo or tinnitus. Tinnitus is a constant sound appearing in the ear which is not really there, usually a ringing or a buzzing. Other symptoms also include struggling to cope with background noise or struggling to hear the letters z, s and f.


Diagnosis of mixed hearing loss is not difficult in the experienced hands of an audiologist or otolaryngologist. Special hearing test techniques are available to quantify the degree of the conductive hearing loss such as comparing bone-conduction thresholds with air-conduction thresholds, tympanometry and acoustic reflex measurements, and otoacoustic emissions testing. Your audiologist should use all these techniques to verify and delineate the conductive hearing. These tests are more difficult to administer to very young children and require an experienced audiologist experienced with pediatric patients.

Tests May Include:

    Whispered speech test: A combination of numbers and letters are whispered behind you.

  • Tuning fork test: Testing is done in different frequencies to determine the type of hearing loss.

  • Pure tone audiometry: An audiometer produces sounds of different volumes and frequencies.

  • Otoacoustic emissions: Measures your cochlear function and records the signals produced by the hair cells.

  • Auditory brain stem response: This measures the activity of the cochlea, cochlear nerve, and brain in response to sound.

Audiologist may also perform the following tests:

    Auditory brain stem response (ABR) test.

  • Regular (Behavioral) audiological evaluation.

  • Auditory processing.

  • Tympanometry.

  • Otoacoustic emissions (OAEs).

Laboratory studies:


  • Glucose and glycosylated hemoglobin (HbA1C).

  • Cholesterol/triglycerides.

  • T3, T4, TSH.

  • PT, PTT, serum filterability tests (if available).

  • VDRL (Venereal Disease Research Laboratory test), FTA-ABS (fluorescent treponemal antibody absorption (test)).

  • Lyme disease antibody titer (Borrelia burgdorferi antigen).

  • Acute and convalescent viral antibody titers (onset, 1 month, and 3 months).

Other Tests:

    MRI with gadolinium.

  • Electronystagmography with calorics and positional testing.


It is important that all hearing loss, not just mixed hearing loss, is diagnosed by a doctor as soon as possible. Some types are reversible through antiviral medication or surgery while others can be alleviated through devices while still many more cases can be helped by taking the hearing fix.

There are a number of treatments when it comes to hearing loss, and this form will often see the conductive hearing loss being treated first. One mixed hearing loss treatment is through the use of antibiotics to clear up infections that have been found in the ear. Another popular treatment is draining any fluid in the ear or clearing out the earwax. This can help the patient who is suffering extra discomfort in the ear due to the feeling of the fluid or wax building up.

Of course, it is very difficult to treat sensorineural hearing loss, since it is very difficult to determine the cause. There have been times that surgery has helped, if the problem has been the need to repair a nerve, but this is extremely uncommon. More often than not this hearing loss is permanent and there is nothing that can help to cure the problem. Yet, there are ways to make it easier on the patient.

One way that can help people still integrate with people is through the use of a hearing aid. With a hearing aid, sounds are taken in by a small microphone and then amplified through a speaker and into a patient's ear.

A lot of the time, this initial form of hearing loss is due to an affected cochlea nerve. Due to this, a cochlear implant is often more effective. Cochlear implants are separated in two pieces; one internal and the other external. The internal part of the device is placed under the skin and made a bed into the bone just by the cochlea nerve. This helps to send vibrations to the nerve fiber to help stimulate it, which helps with the hearing. The external part is placed behind the ear, just above the internal part. This uses a microphone to pick up all noise and then through magnets, the signals are passed to the internal half of the device so that it can do its job to help the patient hear. There are times that young children suffer from problems with the cochlea nerve and these implants have been proved to be extremely effective to help them in their school and social life. It is now common for many businesses and places that people frequently visit to have technology to assist with the use of these devices.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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