Struggling to Hear in Some Situations but Not Others? It Could Be 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

Last Hearing Aid UK Update:  11/08/2026 

A mixture of losses

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. 

Mixed hearing loss stands out from other types because it's really two things happening at once, and that combination can make everyday listening genuinely tiring.

Picture sitting in a cafe with a friend. You can hear that they're talking, but the words come through muffled, almost as if they're speaking underwater.

Then there's the flip side: the quiet moments. A phone ringing in another room, or your partner calling you from upstairs, can pass you by completely.

That’s a bit of what life with mixed hearing loss can be like. 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?

Because more than one part of the auditory system is involved, mixed hearing loss can be trickier to pin down and to manage than either type on its own. It helps to break it down into its two parts.

Conductive hearing loss happens when something in the outer or middle ear stops sound getting through to the inner ear. Sometimes the cause is simple, a build-up of earwax, say, or fluid sitting behind the eardrum. Other times it's more involved, such as recurring ear infections or a structural difference in the ear.

Sensorineural hearing loss, on the other hand, comes from damage to the inner ear (the cochlea) or the nerve pathways that carry sound to the brain. It's usually permanent, and can be brought on by ageing, prolonged exposure to loud noise, a head injury, or certain medical conditions.

When both are present together, that's mixed hearing loss, and managing it means addressing both sides of the picture.

Causes of mixed hearing loss

Because mixed hearing loss is a combination of both conductive and sensorineural hearing loss, its causes tend to reflect both types. The most common ones include:

• Chronic ear infections: Persistent ear infections are a common culprit. Left untreated, they can start out causing conductive hearing loss and gradually do damage to the inner ear, too, at which point sensorineural hearing loss enters the picture as well.
• Head trauma: A significant head injury can affect multiple parts of the ear at once, both the outer and middle ear and the inner ear, making mixed hearing loss a real possibility in the aftermath of an accident or injury.
• Genetic factors: Some people are simply more predisposed to hearing problems that affect both the middle and inner ear. It's not always something that can be predicted or prevented, but knowing your family history can be a useful early warning.
• Ageing: As we get older, the inner ear naturally starts to decline, which is sensorineural hearing loss. But ageing can also bring conductive issues along for the ride, such as earwax building up more readily or the tiny bones in the middle ear beginning to stiffen, a condition known as otosclerosis. When both happen together, mixed hearing loss is often the result.

Age UK notes that hearing changes become more common as we get older, though the pattern and severity vary a great deal from person to person.

Mixed Hearing Loss

Symptoms and diagnosis

Symptoms of mixed hearing loss

The symptoms of mixed hearing loss can vary widely, but typical symptoms consist of:

• 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 busy surroundings.

Picture yourself in a work meeting; you can hear that people are talking, but the words feel just out of reach, as if someone has turned the clarity down. The further away someone is, or the softer their voice, the harder it gets to follow.

Take it to a busy cafe, and it's a different kind of challenge. The noise is all there, but it blurs into one continuous hum, and picking out a single voice from the mix starts to feel like hard work.

If any of this sounds familiar, it's worth mentioning to your GP first, particularly if you've noticed pain, discharge, or a sudden change in one ear. Ear infections and wax build-up are common, treatable causes of the conductive side of mixed hearing loss, and a GP is the right first port of call for these.

Diagnosing mixed hearing loss

Getting to the bottom of mixed hearing loss isn't easy, because it involves more than one part of the ear; pinning it down takes a bit more than a standard hearing check. A GP, and later an audiologist, will work through a few different stages to make sure they've got the full picture:

• Medical history: The first step is simply talking. Your audiologist will want to know about your health history, any ear problems you've had in the past, medications you're currently taking, and anything else that might help connect the dots.
• Physical examination:  Next, they'll take a quick look inside your ears, checking for anything that might be contributing, earwax, signs of an infection, or something structural.
• Tests: You'll then be taken to a soundproof room where different tones and speech are played at various volumes and frequencies, and your responses help your audiologist map out your hearing in detail.

It's completely painless and more straightforward than it sounds, but the results are incredibly useful, giving a clear picture of not just how much hearing has been affected, but which parts of the auditory system are involved. That distinction is what guides everything that comes next.

Hearing Aid UK is a hearing healthcare service, not a medical practice, so we don't diagnose or treat the underlying medical causes of conductive hearing loss, such as infections or structural issues.

If your GP has ruled out or treated a medical cause and you're still noticing changes to your hearing, a free hearing test with one of our HCPC-registered audiologists is a good next step. It's carried out at a local clinic or during a free home visit, whichever suits you best, with no obligation to buy anything afterwards.

What can help with mixed hearing loss?

Because mixed hearing loss has two components, support usually involves more than one approach. What works best will depend on which type of hearing loss is more dominant, and how severe each one is.

• Medications: Where an infection is driving the conductive hearing loss, antibiotics or other medications tend to be the first thing a doctor will try.
• Surgery: If the conductive hearing loss is coming from a blockage, tumour, or structural problem in the outer or middle ear, surgery may be an option worth considering. This is arranged through the NHS or a private ENT consultant, not through Hearing Aid UK.
• Hearing aids: A hearing aid is one of the most common tools for managing mixed hearing loss. Behind-the-ear (BTE) models are often the go-to choice, partly because they offer more power, something that can really matter when the sensorineural side is more significant.
• Cochlear implants: Where sensorineural hearing loss is profound, a cochlear implant might be needed. Unlike a hearing aid, which amplifies sound, this works by bypassing the damaged parts of the ear and stimulating the auditory nerve directly. This is an NHS-led clinical pathway, assessed and provided through a specialist audiology or ENT team.

However, a combination might work best. For instance, someone dealing with conductive hearing loss from ear infections alongside age-related sensorineural hearing loss might use a hearing aid to boost volume, while medication or surgery tackles the infections themselves.

"Mixed hearing loss is one of the more interesting cases we see in clinic, because you're often working with a moving target. If a chronic ear infection is still active, sorting that out with a GP first makes a real difference to how well a hearing aid performs afterwards. Once the conductive side is being managed medically, a well-fitted hearing aid gives the sensorineural side something solid to work with, and that's where our audiologists come in."

Paul Harrison, Audiology Expert & Founder, Hearing Aid UK

Mixed Hearing Loss

And how to live with it

Living with mixed hearing loss

Living with mixed hearing loss isn't always easy, but with the right support and a few good strategies, most people find ways to manage it really well. Here are some practical tips to help:

• Scheduled assessments: Regular visits to an audiologist ensure that any changes in hearing are monitored and addressed quickly.
• Hearing protection: Protecting the ears from loud noises helps prevent additional hearing damage.
• Ways to communicate: Learning and using communication techniques, such as lip reading, can help improve understanding in conversations.
• Support networks: Joining support groups or connecting with others who have hearing loss can offer important emotional support and practical advice.

For instance, a family member might find it helpful to adjust the volume on the TV or use subtitles when watching films together.

If you’re on the phone and struggling, don’t hesitate to ask the person on the other end to slow down or repeat themselves. These little tweaks can make a huge difference to your experience.

One thing our audiologists often mention: mixed hearing loss can change over time as the conductive side improves or fluctuates, which is why the aftercare included for life with any hearing aid we fit matters. Your settings can be reviewed and fine-tuned as your hearing changes, at no extra cost.

Can mixed hearing loss be corrected?

Mixed hearing loss involves both conductive and sensorineural hearing loss, so there's rarely a single fix that covers everything. It's worth saying that "corrected" isn't really the right word here — "improved" is closer to the truth, and the good news is there are plenty of treatment options that can make a genuine difference.

How much improvement is possible depends on how severe the loss is and which side, conductive or sensorineural, is the dominant factor. But with the right support and some small adjustments to everyday life, many people manage their symptoms really well and find their quality of life is far better than they might have expected.

Need more support?

If you've noticed changes to your hearing and a medical cause has been ruled out or treated, our HCPC-registered audiologists offer a free, no-obligation hearing test at one of our 93+ clinics or in the comfort of your own home. Call us free on 0800 567 7621, or book your free hearing test online, to get a clear picture of what's going on and what could help.