Mixed hearing loss

Mixed hearing loss happens when a person has both conductive hearing loss and sensorineural hearing loss.

Causes

• Ear infections that affect the middle ear and may also damage the inner ear
• Earwax blockage combined with existing inner ear hearing loss 
• Perforated (ruptured) eardrum along with inner ear damage 
• Otosclerosis (abnormal bone growth in the middle ear) together with sensorineural hearing loss. 
• Aging (presbycusis) combined with a conductive hearing problem
• Noise exposure that damages the inner ear, along with an outer or middle ear condition

Risk Factors

• Frequent or chronic ear infections
• Older age
• Long-term exposure to loud noise, such as from machinery, construction work or loud music
• A family history of hearing loss
• Certain medical conditions or medications that can damage the inner ear
• Previous ear injuries or surgery

Symptoms

• Difficulty listening when background noise is present
• Difficulty pinpointing the direction of a sound
• Difficulty hearing someone who is in another room or understanding what is said. Your child may be able to hear from a distance but may not always understand what is said.
• Not seeming to listen or pay attention
• Responding incorrectly to a question or request
• Getting frustrated easily and acting out

Diagnosis and Tests

A health care provider will look inside your ear with an otoscope, a small tool with a light. This helps them check for problems such as earwax buildup, infection, fluid in the ear or damaged eardrum.

Your child may need hearing tests that include:

• Tympanometry and acoustic reflex testing checks how well the middle ear is working and helps identify where the hearing problem may be located.
• Otoacoustic emissions (OAE) measures how well the inner ear (cochlea) responds to sound.
• Auditory brainstem response (ABR) checks how the hearing nerve and brain respond to sound.
• Pure tone air and bone conduction testing finds the softest sounds your child can hear at different pitches.

Treatment and Care

Treatment may include:

• Hearing aid: The type of hearing aid selected depends on your child's situation.
• An FM system, which is a type of wireless system, along with hearing aids to hear better in noisy backgrounds.

Living and Managing

Speech and language should develop as expected; however, you can help. For example:

• Repeat words and expand your child's vocabulary by introducing new words ("terrific" instead of "wonderful").
• Play listening games ("I hear the telephone ringing" or "Is that the front doorbell ringing?").

Your child could face additional educational risks due to listening challenges. You can help your child at home and at school in discussion with the teacher in ways such as:

• Learn about typical language development so you will be able to more easily notice if your child seems to be behind.
• Get your child's attention before you talk.
• Talk to your child on the side of the normal hearing ear.
• Make eye contact when talking.
• Be aware of your child's listening environment. For example, when talking, turn down the television.