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What is Mixed Hearing Loss? Understanding this unique type of hearing loss

Kimberley Bradshaw - Head of Online Medical Content for Hearing Aid UK
Written By:
Kimberley Bradshaw

Head of Online Medical Content

Paul Harrison - Audiology Expert at Hearing Aid UK
Medically Reviewed By:
Paul Harrison

Audiology Expert at Hearing Aid UK

Updated and medically reviewed: 9th September 2024
What is Mixed Hearing Loss?

What is Mixed Hearing Loss?

Understanding this form of hearing loss

 

Introduction    |    What is mixed hearing loss    |    Causes    |    Symptoms    |    Diagnosing    |    Treatment    |    Living with mixed hearing loss    |    Conclusion

 

Overview

Mixed hearing loss has elements of both conductive and sensorineural hearing loss.  To simplify, the outer ear is unable to conduct sound successfully to the inner ear, and the inner ear cannot process sound sent to the brain. 

Amongst the different types of hearing loss, mixed hearing loss stands out due to its unique combination of characteristics.  Managing mixed hearing loss can be challenging, as those with this condition often struggle to understand sounds and speech, and what they do hear tends to be very faint. 

In this article, we briefly look at what mixed hearing loss is, how it occurs, and what it means for those who have it.

 

What is mixed hearing loss?

Mixed hearing loss is a condition where both conductive hearing loss and sensorineural hearing loss are present.  When a person has both conductive and sensorineural hearing loss, they are diagnosed with mixed hearing loss.

This combination can make the condition more challenging to diagnose and treat because it involves issues in several parts of the auditory system.  To understand mixed hearing loss, it's essential to grasp the basics of its two components:

Conductive hearing loss:  This type of hearing loss occurs when there is an issue in the outer or middle ear that prevents sound from being conducted properly to the inner ear. Common causes include ear infections, fluid in the middle ear, earwax buildup, or abnormalities in the ear's structure.

Sensorineural hearing loss:  This type occurs when there is damage to the inner ear (cochlea) or the auditory nerve pathways. It is often permanent and can be caused by ageing, exposure to loud noises, head trauma, or certain medical conditions.

 

hearing loss types infographic

Causes of mixed hearing loss

Mixed hearing loss is caused by a combination of conductive and sensorineural hearing loss.  Therefore, the most common causes of mixed hearing loss are similar to those of conductive and sensorineural hearing loss, including:

  • Chronic ear infections:  Persistent ear infections can lead to conductive hearing loss, and if left untreated, they can also damage the inner ear, causing sensorineural hearing loss.
  • Head trauma:  An injury to the head can impact both the outer/middle ear and the inner ear at the same time, leading to mixed hearing loss.
  • Genetic factors:  Some people are genetically predisposed to hearing issues that affect both the middle and inner ear.
  • Ageing: As people age, they might experience sensorineural hearing loss due to the natural ageing process, combined with conductive issues like earwax buildup or stiffening of the middle ear bones (otosclerosis).

 

Mixed hearing loss

Mixed Hearing Loss

Symptoms and diagnosis

 

Symptoms of mixed hearing loss

The symptoms of mixed hearing loss can vary widely, but common signs include:

  • Difficulty hearing in both quiet and noisy environments.
  • A feeling of fullness or pressure in the ears.
  • Tinnitus (ringing in the ears).
  • Difficulty understanding speech, especially in noisy settings.

 

Diagnosing mixed hearing loss

Diagnosing mixed hearing loss typically involves a thorough evaluation by an audiologist. The process includes:

  • Medical history: Reviewing medical history to identify potential causes of hearing loss.
  • Physical examination: Inspecting the ear for any visible issues, such as earwax buildup or infection.
  • Audiometric tests: Conducting various hearing tests to determine the extent of hearing loss and differentiate between conductive and sensorineural components.

 

Treatment for mixed hearing loss

Treating mixed hearing loss requires many approaches that address both conductive and sensorineural hearing loss. Common treatment options include:

  • Medications: Antibiotics or other medications may be prescribed to treat infections causing conductive hearing loss.
  • Surgery:  Conductive hearing loss can sometimes be treated with surgery, especially when it is caused by a tumour or blockage.  Surgical procedures can also correct structural issues in the outer or middle ear, such as repairing a perforated eardrum or removing excess bone growth.
  • Hearing aids: Hearing aids assist those with mixed hearing loss. Behind-the-ear (BTE) hearing aids are frequently recommended, as their additional power can be necessary to manage severe-to-profound sensorineural hearing loss. 
  • Cochlear implants: In severe cases of sensorineural hearing loss, cochlear implants may be considered. These devices bypass damaged parts of the ear and directly stimulate the auditory nerve.

 

Mixed hearing loss

Mixed Hearing Loss

And how to live with it

 

Living with mixed hearing loss

Living with mixed hearing loss can be challenging, but many learn how to successfully manage their condition with the right support and strategies. Here are some basic tips for coping with mixed hearing loss:

  • Regular check-ups: Regular visits to an audiologist ensure that any changes in hearing are monitored and addressed quickly.
  • Hearing protection: Protecting the ears from loud noises can prevent further damage to hearing.
  • Communication strategies: Learning and using communication strategies, such as lip reading, can help improve understanding in conversations.
  • Support networks: Joining support groups or connecting with others who have hearing loss can provide valuable emotional support and practical advice.

 

Can mixed hearing loss be corrected?

Mixed hearing loss combines both conductive and sensorineural hearing loss. Although it can't be entirely "corrected," the quality of hearing can be improved with various treatment options. The effectiveness of these treatments depends on the severity of the loss and whether it is primarily caused by conductive or sensorineural factors.

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Mixed hearing loss conclusion

Mixed hearing loss combines conductive and sensorineural issues, affecting both the outer and inner ear.

Treatments like hearing aids, medications, or surgery can improve hearing, depending on severity and causes.

By understanding the causes, symptoms, and available treatment options, those with mixed hearing loss can improve their hearing and quality of life.

While the challenges are significant, advancements in medical technology and hearing aids continue to provide support for those with mixed hearing loss.

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Meet Kimberley Bradshaw, Head of Online Medical Content

I have collaborated and written about hearing healthcare for several online medical publications in both the UK and the US.  By working closely with Hearing Aid UK audiologists, and experts, I develop online content, so that the customer's experience is the best it can be. 

My medical representation has allowed me to focus on the importance of hearing healthcare and explore the many ways in which hearing loss and its awareness can be improved.

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Common FAQs about hearing loss and hearing aids

Is this the best model for me?

If you are looking at this page then it is likely that an audiologist has suggested that you purchase this particular hearing aid, so is this the best model for you?

In general, any audiologist will always be recommending to you the model that best suits your needs. Here is a useful check list to make sure that is the case.

  • Audiologist level of knowledge. The audiologist you have seen will hopefully have a wide knowledge of all available hearing aids, however some will only be familiar with a small number of brands and therefore may not really be in a position to know which model is the best for you. It is OK to challenge their recommendation and ask them to justify why this particular brand is the one for you.
  • Do research. Read about the hearing aid that was recommended. Does it seem like it will suit your lifestyle? Does it have more or less features than you need? 
  • Be aware of sales targets. Many high street retailers have specific tie-ins to a particular manufacturer/brand. The hearing aid they have suggested may still be the correct one for you, but do your research so that you know why they might have recommended it.

If in doubt, feel free to give us a call. That's what we're here for.

Do I need one hearing aid or two?

If you have a significant hearing loss in both ears, you should be wearing two hearing aids. Here are the audiological reasons why:

Localisation. The brain decodes information from both ears and compares and contrasts them. By analysing the miniscule time delays as well as the difference in loudness of each sound reaching the ears, the person is able to accurately locate a sound source. Simply put, if you have better hearing on one side than the other, you can't accurately tell what direction sounds are coming from.

Less amplification required. A phenomena known as “binaural summation” means that the hearing aids can be set at a lower and more natural volume setting than than if you wore only one hearing aid.

Head shadow effect. High frequencies, the part of your hearing that gives clarity and meaning to speech sounds, cannot bend around your head. Only low frequencies can. Therefore if someone is talking on your unaided side you are likely to hear that they are speaking, but be unable to tell what they have said.

Noise reduction. The brain has it’s own built in noise reduction which is only really effective when it is receiving information from both ears. If only one ear is aided, even with the best hearing aid in the world, it will be difficult for you to hear in background noise as your brain is trying to retain all of the sounds (including background noise) rather than filtering it out.

Sound quality. We are designed to hear in stereo. Only hearing from one side sounds a lot less natural to us.

What are the benefits of rechargeable hearing aids?

For most people, the main benefit of a rechargeable hearing aid is simple convenience. We are used to plugging in our phones and other devices overnight for them to charge up. 

For anybody with poor dexterity or issues with their fingers, having a rechargeable aid makes a huge difference as normal hearing aid batteries are quite small and some people find them fiddly to change.

One downside is that if you forget to charge your hearing aid, then it is a problem that can't be instantly fixed. For most a 30 minute charge will get you at least two or three hours of hearing, but if you are the type of person who is likely to forget to plug them in regularly then you're probably better off with standard batteries.

Rechargeable aids are also a little bit bigger and are only available in behind the ear models.

Finally, just like with a mobile phone, the amount of charge you get on day one is not going to be the same as you get a few years down the line. Be sure to ask what the policy is with the manufacturer warranty when it comes to replacing the battery.

 

Are behind the ear aids better than in the ear aids?

For most people, the answer is yes. But it's never that simple.

The majority of hearing problems affect the high frequencies a lot more than the low ones. Therefore open fitting hearing aids sound a lot more natural and ones that block your ears up can make your own voice sound like you are talking with your head in a bucket. Therefore in-ear aids tend to be less natural.

However the true answer is we can't tell until we have had a look in your ears to assess the size of your ear canal, and until we have tested your hearing to see which frequencies are being affected.

People with wider ear canals tend to have more flexibility, also there are open fitting modular CIC hearing aids now that do not block your ears.

There is also the age old rule to consider, that a hearing aid will not help you if it's sat in the drawer gathering dust. If the only hearing aid you would be happy wearing is one that people can't see, then that's what you should get.

Most people can adapt to any type of hearing aid, as long as they know what to expect. Have an honest conversation with your audiologist as to what your needs are.

What are channels, and how many do I need?

Generally speaking, six or more. Unless it's none at all.

The number of channels a hearing aid has is often a simplistic way an audiologist will use to explain why one hearing aid is better than another, but channels are complex and it is really not that straightforward.

Hearing aids amplify sounds of different frequencies by different amounts. Most people have lost more high frequencies than low and therefore need more amplification in the high frequencies. The range of sounds you hear are split into frequency bands or channels and the hearing aids are set to provide the right amount of hearing at each frequency level.

Less than six channels and this cannot be done with much accuracy, so six is the magic number. However, a six channel aid is typically very basic with few other features and is suitable only for hearing a single speaker in a quiet room. The number of channels is not what you should be looking at, it's more the rest of the technology that comes with them.

As a final note, different manufacturers have different approaches. One method is not necessarily better than any other. For example some manufacturers have as many as 64 channels in their top aids. Most tend to have between 17 and 20. One manufacturer has no channels at all.

Where can I get the hearing aids covered?

Hearing aids are easily lost, misplaced or damaged and typically are one of the most expensive personal possessions an individual can own. We offer hearing aid warranty cover for £80 per year per aid.  Find out more here

How much does the hearing test cost?

All our audiologists use the very latest technology and provide the full range of tests to accurately measure your hearing for free.  Find out about what we offer all our customers here

Do home visits cost extra?

Hearing Aid UK offers all their customers free home visiting services and home visits for hearing aids - Including hearing tests, fittings, maintenance, check-ups and much more in the comfort of your own home and at your convenience.  Find out more information here

How come you're much cheaper than other places?

Here, at Hearing Aid UK, we are dedicated to offering low hearing aid prices. We achieve this by having no head office and low marketing costs.   Our hearing aid prices are amongst the lowest you will find anywhere in the world.

Other pages you might find useful

Audiology Home Visits
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Best Hearing Aids 2024
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Hearing Tests at Home UK
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