Understanding How Ear Fullness Affects Hearing Thresholds
Yes, your sensation of ear fullness is directly causing difficulty hearing by elevating your hearing thresholds—meaning sounds must be louder for you to detect them. This occurs because fluid or pressure in your middle ear creates a physical barrier that blocks sound transmission to your inner ear. 1
What "Hearing Threshold" Actually Means
Hearing thresholds represent the softest sound level (measured in decibels) that you can detect at specific frequencies. Normal hearing is defined as thresholds ≤20 dB HL, meaning you can hear very soft sounds. 2
When your ears feel full, your thresholds increase (worsen)—for example, from 20 dB to 35 dB—meaning sounds must be significantly louder for you to hear them. This represents nearly an 8-fold decrease in sound intensity perception. 1
The relationship is exponential, not linear: A child with otitis media with effusion (OME) and an average hearing level of 28 dB experiences nearly an 8-fold decrease in sound intensity compared to someone with normal 20 dB thresholds. 1
Why Ear Fullness Causes This Problem
Ear fullness typically indicates middle ear effusion (fluid) or eustachian tube dysfunction, both of which cause conductive hearing loss by physically blocking sound wave transmission. 1
The fluid or pressure prevents your eardrum and middle ear bones (ossicles) from vibrating normally, creating a mechanical barrier between the outside world and your inner ear. 1
This type of hearing loss predominantly affects low-frequency sounds (250-1000 Hz), which is why speech may sound muffled or distant—these frequencies carry much of the information needed to understand vowels and voice quality. 3
Studies show that ear fullness is associated with mild hearing loss in the low-frequency region, and this association typically disappears once the underlying cause resolves and hearing thresholds stabilize. 3
The Clinical Pattern You're Experiencing
Patients with acute middle ear problems typically report both ear fullness AND difficulty hearing, with average hearing thresholds ranging from 0-55 dB, with the 50th percentile around 25 dB HL. 1
About 20% of ears with middle ear effusion exceed 35 dB HL hearing loss, which represents moderate difficulty understanding normal conversation. 1
Unilateral ear fullness with hearing loss results in overall poorer binaural hearing because your brain cannot effectively integrate sound from both ears, affecting sound localization and speech perception in noisy environments. 1
Important Distinction: Conductive vs. Sensorineural
Your ear fullness suggests conductive hearing loss (middle ear problem), NOT sensorineural hearing loss (inner ear/nerve problem)—this distinction is critical because they have completely different causes and treatments. 1
Conductive hearing loss from ear fullness is typically reversible once the underlying cause (fluid, pressure, infection) resolves. 1
You should undergo otoscopy (ear examination) and tympanometry to confirm middle ear dysfunction before assuming your hearing difficulty is permanent. 1
Weber and Rinne tuning fork tests can immediately distinguish conductive from sensorineural loss at the bedside—in conductive loss, the Weber test lateralizes to the affected (fuller) ear. 1
When to Worry vs. When to Reassure
If your ear fullness and hearing difficulty developed suddenly (within 72 hours) and affects only one ear, you need urgent evaluation within 14 days to rule out sudden sensorineural hearing loss (SSNHL), which requires different treatment. 1, 4
Common pitfall: Impacted cerumen (earwax) causes both ear fullness and conductive hearing loss—this MUST be removed before establishing any diagnosis. 1, 4
Red flags requiring immediate evaluation: 1
- Sudden onset (within 72 hours)
- Unilateral symptoms only
- Associated severe vertigo or neurologic symptoms
- No improvement after 2-3 weeks
Bottom Line for Your Situation
Your ear fullness is elevating your hearing thresholds by creating a mechanical barrier in your middle ear, requiring sounds to be 5-15 dB louder (or more) for you to detect them. 1 This explains why you're having a harder time hearing—it's not that your inner ear or hearing nerve is damaged, but rather that sound isn't efficiently reaching your inner ear due to the middle ear problem causing the fullness sensation. 1, 3