Management Options for Conductive Hearing Loss
The management of conductive hearing loss should begin with identifying and treating the underlying cause, followed by appropriate audiologic rehabilitation if hearing does not fully recover. 1
Diagnostic Approach
Initial Assessment
- Distinguish conductive hearing loss from sensorineural hearing loss using tuning fork tests (Weber and Rinne) 2, 1
- Perform a thorough otoscopic examination to assess for:
- Cerumen impaction
- Foreign bodies
- Tympanic membrane abnormalities (perforation, retraction)
- Middle ear effusion
- Exostoses or other external canal abnormalities 3
Audiometric Evaluation
- Obtain formal audiometry as soon as possible to confirm the diagnosis and determine the degree of hearing loss 1
- Pure-tone audiometry will typically show an air-bone gap in conductive hearing loss 4
- Tympanometry to assess middle ear function and mobility of the tympanic membrane
Treatment Options Based on Etiology
Cerumen Impaction
- Irrigation or curettage is potentially curative 3
- Can result in immediate improvement in hearing once removed
Middle Ear Effusion
- Observation for 3 months if asymptomatic, as many cases resolve spontaneously
- Medical management with decongestants or antihistamines for allergic causes
- Myringotomy with tympanostomy tube placement for persistent effusions
Otitis Media
- Appropriate antibiotic therapy for acute bacterial infections
- Pain management
- Follow-up to ensure resolution
Tympanic Membrane Perforation
- Observation for small perforations, which may heal spontaneously
- Surgical repair (tympanoplasty) for persistent perforations
- Paper patch myringoplasty as a temporary measure
Ossicular Chain Abnormalities
- Surgical reconstruction (ossiculoplasty)
- Prosthetic replacement of damaged ossicles
Otosclerosis
- Surgical management with stapedectomy or stapedotomy
- Hearing aids if surgery is contraindicated or declined
Amplification and Assistive Devices
Conventional Hearing Aids
- Appropriate for most cases of conductive hearing loss with good outcomes 1
- Various styles available (behind-the-ear, in-the-ear, completely-in-canal)
Bone Conduction Devices
- Particularly effective for conductive hearing loss 1
- Options include:
- Non-surgical bone conduction headbands
- Osseointegrated bone conduction implants (e.g., BAHA, Ponto)
- Transcutaneous bone conduction systems
Middle Ear Implants
- Can be considered for moderate to severe conductive hearing loss
- Directly stimulate the ossicular chain or round window
Follow-up and Monitoring
- Audiometric evaluation should be performed after treatment completion 1
- Regular follow-up to monitor hearing status and effectiveness of interventions
- Additional evaluation if hearing deteriorates or does not improve as expected
Special Considerations
Mixed Hearing Loss
- Treat the conductive component first
- Address the sensorineural component with appropriate amplification
- May require combination of surgical intervention and hearing aids 4
Quality of Life Impact
- Assess impact on communication, social interaction, and daily activities
- Consider standardized tools such as the Hearing Handicap Inventory 1
- Provide counseling about realistic expectations from treatment
Rehabilitation and Support
- Audiologic rehabilitation including communication strategies
- Referral to consumer-based organizations for support and information 1
- Consider assistive listening devices for specific situations (telephone amplifiers, FM systems)
Pitfalls to Avoid
- Overlooking treatable causes of conductive hearing loss
- Delaying intervention, which may lead to poorer outcomes
- Neglecting the psychosocial impact of hearing loss 1
- Limiting options to conventional hearing aids when other solutions may be more appropriate
By following this structured approach to managing conductive hearing loss, clinicians can significantly improve patients' hearing outcomes and quality of life.