Mixed Hearing Loss Audiogram: A Simple Guide

Mixed hearing loss is when someone has two types of hearing loss: sensorineural hearing loss and conductive hearing loss. This means that both the inner ear and either the outer or middle ear are affected. To understand the level and type of hearing loss, doctors often use a tool called an audiogram. An audiogram is a chart that shows how well a person can hear different sounds at various volumes and pitches. When a person has mixed hearing loss, the audiogram shows both types of hearing problems. In this guide, we’ll explain what a Mixed Hearing Loss Audiogram is, how an audiogram works, and how it helps diagnose this condition.

What is Mixed Hearing Loss?

Mixed hearing loss is a combination of two types of hearing loss:

Sensorineural Hearing Loss: This happens when there is damage to the inner ear or the hearing nerve. It’s often caused by aging, loud noises, or certain illnesses. People with sensorineural hearing loss may struggle to hear quiet sounds and may find that even loud sounds don’t sound clear.
Conductive Hearing Loss: This type of hearing loss happens in the outer or middle ear. It blocks sound from reaching the inner ear. Causes of conductive hearing loss include ear infections, fluid in the ear, or a buildup of earwax.

When these two types of hearing loss happen at the same time, it is called mixed hearing loss. The amount of each type of hearing loss can vary, and this makes treatment a bit more complicated.

What is an Audiogram?

An audiogram is a test result chart that shows how well a person can hear. The test is done by an audiologist (a hearing specialist) who plays different sounds through headphones while the person being tested indicates when they hear the sound. These sounds vary in pitch (from low to high) and volume (from soft to loud).

The results from this test are then plotted on a graph called an audiogram. This graph helps the doctor see what types of sounds the person has trouble hearing and at what volume the person starts to hear those sounds.

How is a Mixed Hearing Loss Audiogram Different?

A mixed hearing loss audiogram shows the results for both air conduction and bone conduction tests:

Air Conduction: This test checks how well sound travels through the outer and middle ear into the inner ear. The results of this test will tell the doctor how well the outer or middle ear is working.
Bone Conduction: This test checks how well sound goes through the bones of the skull directly into the inner ear, bypassing the outer and middle ear.

In a mixed hearing loss audiogram, you will see a difference between the results for air conduction and bone conduction. This gap between the two lines on the audiogram is called the air-bone gap. It shows how much of the hearing loss is caused by problems in the outer or middle ear (conductive hearing loss), while the bone conduction line shows the amount of sensorineural hearing loss.

Key Parts of a Mixed Hearing Loss Audiogram

When you look at an audiogram, there are several important parts to understand:

Frequency (Hz): The audiogram measures the frequency, or pitch, of sounds. This is shown on the horizontal axis (from left to right). Lower frequencies are to the left (like the sound of a drum), and higher frequencies are to the right (like a whistle or bird chirping). These are measured in Hertz (Hz).
Volume (dB): The vertical axis of the audiogram shows how loud a sound needs to be before the person can hear it. Softer sounds are at the top, and louder sounds are at the bottom. This is measured in decibels (dB). The higher the number of decibels, the louder the sound.
Air-Bone Gap: In a mixed hearing loss audiogram, you will see a space between the air conduction and bone conduction lines. This space is called the air-bone gap and shows how much of the hearing loss is due to conductive problems.

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How to Read a Mixed Hearing Loss Audiogram

Here’s how to read an audiogram to understand mixed hearing loss:

Look at the Frequencies: The audiogram shows different frequencies from low to high. Look at which frequencies the person can hear clearly and which they struggle with.
Check the Volume Levels: Each ear’s ability to hear sound is tested at different volume levels. Normal hearing is usually between 0 and 20 dB. Hearing loss starts when sounds need to be louder than 20 dB for the person to hear them.
Air-Bone Gap: In a mixed hearing loss audiogram, you will see a gap between the air conduction and bone conduction lines. This gap means that there’s a conductive hearing loss on top of sensorineural hearing loss.
Type of Hearing Loss: If both air and bone conduction lines show hearing loss, but there is a gap between them, it confirms mixed hearing loss. If there’s no gap, it means the hearing loss is only sensorineural.
Severity of Hearing Loss: Based on the decibel levels, the severity can range from mild (21-40 dB) to profound (90+ dB). The further down the graph, the more severe the hearing loss.

Know more about: Mixed Hearing Loss: Understanding the Condition

Conclusion

A mixed hearing loss audiogram is an important tool for diagnosing hearing problems that affect both the outer or middle ear and the inner ear. It shows how well a person can hear at different frequencies and sound levels, helping to pinpoint the type and severity of the hearing loss.

For people experiencing symptoms of hearing loss, getting an audiogram is essential for finding the right treatment. Whether through hearing aids, surgery, or other devices, there are ways to improve hearing and enhance quality of life. A mixed hearing loss audiogram helps guide this process by providing a clear picture of what’s happening with your hearing.

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Frequently Asked Questions

What is a mixed hearing loss audiogram?

A mixed hearing loss audiogram is a hearing test result chart that helps detect both sensorineural and conductive hearing loss. It shows how well a person hears different frequencies through air conduction and bone conduction tests. The audiogram displays the difference between the two, known as the air-bone gap, which indicates how much of the hearing loss is conductive and how much is sensorineural.

How does an audiogram detect mixed hearing loss?

An audiogram detects mixed hearing loss by measuring air and bone conduction. In mixed hearing loss, the audiogram shows hearing loss in both air and bone conduction, but with a significant air-bone gap. This gap represents conductive hearing loss, while both tests showing hearing loss confirms the presence of sensorineural hearing loss as well.

What causes mixed hearing loss to appear on an audiogram?

Mixed hearing loss appears on an audiogram when there’s damage to both the inner ear (sensorineural loss) and outer or middle ear (conductive loss). Causes include ear infections, head injuries, aging, or exposure to loud sounds. The audiogram shows how these conditions affect the ability to hear across different sound frequencies.

Can an audiogram show the severity of mixed hearing loss?

Yes, an audiogram can show the severity of mixed hearing loss by measuring the degree of hearing loss at different frequencies and sound levels. Hearing levels below 20 decibels are considered normal. The further the graph dips downward, the more severe the hearing loss, which can range from mild to profound.

What is the air-bone gap on a mixed hearing loss audiogram?

The air-bone gap is the difference between air conduction and bone conduction results on the audiogram. It indicates how much of the hearing loss is caused by conductive issues in the outer or middle ear. A large gap suggests significant conductive hearing loss, which adds to the sensorineural component in mixed hearing loss.

How does bone conduction help diagnose mixed hearing loss?

Bone conduction bypasses the outer and middle ear, testing the inner ear directly. In mixed hearing loss, the bone conduction test will still show hearing loss, but the air conduction results will show even worse hearing, revealing the conductive loss in addition to the sensorineural component.

What treatment options are available for mixed hearing loss?

Treatment for mixed hearing loss depends on its cause. Hearing aids can improve both sensorineural and conductive hearing loss. Surgery may be an option if the conductive loss is caused by physical damage to the outer or middle ear. For severe cases, cochlear implants or bone-conduction hearing devices may be recommended.

How can mixed hearing loss affect daily life?

Mixed hearing loss can affect daily life by making it difficult to hear both soft and loud sounds, especially in noisy environments. Conversations may be hard to follow, and sounds can be distorted. This can impact communication, work performance, and overall quality of life, making treatment important for maintaining hearing function.

Can children have mixed hearing loss detected by audiograms?

Yes, children can have mixed hearing loss detected by audiograms. Conditions like chronic ear infections, genetic factors, or birth complications may cause both conductive and sensorineural hearing loss in children. Early detection through audiograms is important to provide timely interventions like hearing aids or surgery.

How often should you get an audiogram for mixed hearing loss?

If you have mixed hearing loss or are at risk, it’s recommended to get an audiogram every year or as advised by your audiologist. Regular hearing tests can help monitor changes in your hearing and ensure that your treatment plan remains effective, whether you use hearing aids or other devices.