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Hearing Loss: Types, Causes and What to Do
Some hearing loss reverses completely in an afternoon. Some is permanent but very manageable. A small amount is an emergency. Knowing which you have is the whole point of getting it checked.
The three types, and why the distinction matters
Nearly all hearing loss falls into one of three categories, and they have genuinely different implications. This is the first thing a hearing test establishes.
Conductive
Sound cannot get through the outer or middle ear. Impacted wax, fluid, a perforation, otosclerosis. Frequently treatable and often completely reversible — this is the kind worth ruling out first.
Sensorineural
The inner ear or hearing nerve is damaged. Age, noise, genetics, certain medications. Permanent, and the most common by a wide margin — but the kind hearing aids are designed for.
Mixed
Both at once, such as long-standing noise damage in an ear that also has wax or fluid. Treating the conductive part still helps, which is why it is worth separating them.
What causes it
Age and noise account for most permanent hearing loss, and noise is the part you can still do something about.
Age-related loss usually starts in the high frequencies, which is why the first complaint is almost never "everything is quiet" — it is "I can hear you, I just cannot understand you", and it is worse in restaurants. Consonants like s, f, th and k live in those high frequencies and carry most of the meaning. Vowels are lower and louder, so speech still sounds present while becoming mush.
Noise damage does the same thing faster, and it is cumulative and permanent. Around here that means firearms, farm and oilfield equipment, shop tools, and years on a tractor without protection. It is worth knowing that a single unprotected gunshot can do permanent damage in the time it takes to hear it.
Less common causes matter too: certain antibiotics and chemotherapy agents, head injury, genetics, diabetes and cardiovascular disease, and Meniere’s disease. Untreated hearing loss is also associated with faster cognitive decline and higher fall risk, which is a large part of why "just living with it" is a worse plan than it sounds.
Degrees: what mild, moderate and severe actually mean
Hearing loss is measured in decibels of hearing level — the quietest sound you can detect at each pitch — and plotted on an audiogram. Normal adult hearing runs to about 25 dB HL. Mild is roughly 26 to 40, moderate 41 to 70, severe 71 to 90, and profound beyond that.
Two things about those labels are worth knowing. First, "mild" is misleading: a mild high-frequency loss is enough to make group conversation genuinely difficult, and people routinely go a decade before acting on one. Second, the degree matters less than the shape. A steeply sloping loss and a flat loss at the same average behave completely differently in real life and need completely different fittings — which is why the number on its own tells you less than people expect.
Signs it is time to get checked
Hearing loss is gradual enough that the people around you usually notice before you do. The common tells: you follow one-to-one conversation fine but lose the thread in restaurants or groups; the television is louder than others want it; you ask people to repeat themselves, or find yourself guessing and nodding; consonants blur so words like "fifty" and "fifteen" become interchangeable; phone calls are harder than in-person; you are tired after a day of listening.
That last one is underrated. Straining to decode speech is real cognitive work, and listening fatigue is often the first thing people notice improving once a loss is treated.
When hearing loss is an emergency
Sudden sensorineural hearing loss — hearing that drops in one ear over hours or a few days, often noticed on waking — is a medical emergency, and it is very commonly mistaken for wax or a cold. Treatment with steroids works considerably better when it starts within days, and the odds fall off sharply after two weeks.
If your hearing drops suddenly in one ear, do not wait for a routine appointment and do not wait to see whether it clears. Contact a physician or get to urgent care the same day. The same urgency applies to hearing loss with severe vertigo, facial weakness, or following a head injury. We would far rather you were sent to a doctor and turned out to have a wax plug than the reverse.
Common Questions
Can hearing loss be reversed?+
How do I know if I have hearing loss or just wax?+
At what point should I do something about it?+
Is hearing loss hereditary?+
Does hearing loss cause dementia?+
Can I test my hearing at home?+
Keep reading
Hearing tests in Wichita Falls
What a full diagnostic evaluation actually involves, and what the results mean.
Take the online hearing check
A free screening to find out whether a full test is worth your time.
Hearing aids in Wichita Falls
What treatment looks like when the loss is permanent.
Untreated hearing loss and your health
The knock-on effects that make waiting a worse plan than it sounds.
Specialist, audiologist or ENT?
Who you actually need for what — including the cases where it is not us.
Find out where your hearing stands
A full evaluation tells you the type, the degree and the shape — and whether any of it is the reversible kind.