Hearing Aids for Conductive Hearing Loss
Yes, hearing aids are highly effective for patients with conductive hearing loss and should be offered when surgical correction is not feasible or declined. 1, 2
Understanding Conductive Hearing Loss and Amplification
Conductive hearing loss occurs when sound cannot efficiently travel through the outer or middle ear to reach the inner ear. Unlike sensorineural hearing loss where the inner ear or auditory nerve is damaged, the cochlea typically remains intact in conductive hearing loss, making amplification particularly effective. 3
Treatment Algorithm
First-Line Approach: Surgical Evaluation
- Conductive hearing loss is usually amenable to surgical correction and should be evaluated by an otolaryngologist first 2
- Patients who are not surgical candidates or refuse surgery should be offered hearing aids 1, 2
Amplification Options for Conductive Hearing Loss
Conventional Air Conduction Hearing Aids:
- These are appropriate for mild to moderate conductive hearing loss (20-70 dB HL) 4
- Modern digital hearing aids with multiple microphones and digital noise reduction provide precise control for the patient's dynamic range 4
- Air conduction hearing aids may produce better audiological results for certain outcomes compared to bone conduction devices 5
Bone Conduction Hearing Aids (BCHAs):
- Traditional bone conduction hearing aids can be used when conventional air conduction devices cannot be worn (e.g., chronic ear drainage, canal abnormalities) 5, 2
- These devices bypass the outer and middle ear by transmitting sound directly through skull vibration 5
Bone-Anchored Hearing Aids (BAHAs):
- Surgically implanted titanium fixtures with detachable sound processors are suitable for conductive or mixed hearing loss when conventional hearing aids cannot provide full benefit 5
- The American Academy of Otolaryngology-Head and Neck Surgery states that osseointegrated bone conductive devices are appropriate surgical options for rehabilitation of unilateral hearing loss, particularly when conventional amplification cannot be used 6
- BAHAs show audiological benefits compared to traditional bone conduction hearing aids, with improvements in speech understanding 5
Cartilage Conduction Hearing Aids:
- A newer option for severe conduction hearing loss, particularly in patients with aural atresia 7
- Functional gains are nearly equivalent to previously used hearing aids, with most patients continuing use after trial 7
Expected Outcomes
Audiological Benefits:
- Hearing thresholds are significantly improved with amplification in conductive hearing loss 7
- Speech understanding and communication ability improve with appropriate hearing aid use 8
Quality of Life Improvements:
- Hearing aids can improve communication ability and social function for adults with hearing impairment 8
- Treatment of hearing loss reduces listening effort and fatigue, and lowers risk of depression and social isolation 8
- Improved hearing increases awareness of surroundings and ability to hear alerts and warnings, addressing safety concerns 8
Critical Pitfalls to Avoid
Do not delay amplification while waiting for surgical decision-making - patients can benefit from hearing aids immediately while considering surgical options 1, 2
Do not assume all conductive hearing loss requires surgery first - some patients prefer amplification over surgical intervention, and this is a valid choice 2
Ensure proper device selection based on ear canal status - patients with chronic drainage, canal stenosis, or aural atresia may require bone conduction devices rather than conventional air conduction hearing aids 5, 2
Address cerumen impaction before fitting - treating cerumen impaction with irrigation or curettage is potentially curative and should be done first 1
Referral Pathway
- Refer patients with conductive hearing loss to an audiologist for comprehensive audiometric testing to determine the type and severity of hearing loss 9
- Patients with conductive hearing loss should also be referred to an otolaryngologist to evaluate surgical options 1
- If hearing aids do not provide adequate benefit, re-referral to otolaryngology for surgical consideration is appropriate 1