HEARING LOSS RESOURCE

What Are the Different Types of Hearing Loss?

What Are the Different Types of Hearing Loss?

Hearing loss can be surprisingly difficult to describe. You may be told that your hearing loss is “sensorineural,” see words like “moderate” or “high-frequency” on a hearing test, or hear that one ear is significantly different from the other. It can quickly start to sound like several different problems are being described at once.

Hearing loss is more specific than simply having “good” or “poor” hearing. During a hearing evaluation, an audiologist characterizes hearing loss in several ways: type, degree, configuration, which ear or ears are affected, and how the hearing loss developed. These descriptions work together rather than representing separate diagnoses.

For example, someone may have bilateral, mild-to-moderately severe, high-frequency sensorineural hearing loss. Each part of that description tells the audiologist something different about the person's auditory system and helps inform appropriate next steps.

Audiologist speaking with a patient

The Three Primary Types of Hearing Loss

Clinically, the three basic types of hearing loss are sensorineural, conductive, and mixed. The distinction is based largely on where auditory function is affected.

Sensorineural Hearing Loss

Sensorineural hearing loss (SNHL) involves dysfunction of the cochlea, the sensory organ of hearing within the inner ear, or the neural pathways that carry auditory information toward the brain. It is the most common type of permanent hearing loss and can occur with aging, noise exposure, certain medications, genetic factors, and other conditions.


Unlike hearing loss that simply makes sounds softer, sensorineural loss can also affect clarity. A person may hear that someone is speaking but have difficulty distinguishing exactly what was said, particularly in background noise.


Audiologically, sensorineural loss is identified in part by comparing air-conduction and bone-conduction thresholds. When both are reduced without a clinically significant air-bone gap, the findings are consistent with sensorineural hearing loss.

Conductive Hearing Loss

Conductive hearing loss occurs when sound is not efficiently transmitted through the outer or middle ear to the inner ear. Possible causes include excessive earwax, middle-ear fluid, eardrum abnormalities, and problems involving the middle-ear bones, or ossicles. Depending on its cause, conductive hearing loss may be medically or surgically treatable.


On an audiogram, conductive loss typically produces an air-bone gap: bone-conduction testing indicates better cochlear sensitivity than air-conduction testing because it bypasses the affected outer and middle ear. This distinction is one reason a comprehensive hearing evaluation involves more than determining the quietest sounds a person can hear.

Mixed Hearing Loss

Mixed hearing loss contains both conductive and sensorineural components. In other words, dysfunction is present in the outer or middle ear and the inner ear or auditory nerve. Someone with existing sensorineural hearing loss who subsequently develops a middle-ear problem, for example, may temporarily or permanently demonstrate mixed hearing loss.

Sensorineural Hearing Loss

Sensorineural hearing loss (SNHL) involves dysfunction of the cochlea, the sensory organ of hearing within the inner ear, or the neural pathways that carry auditory information toward the brain. It is the most common type of permanent hearing loss and can occur with aging, noise exposure, certain medications, genetic factors, and other conditions.


Unlike hearing loss that simply makes sounds softer, sensorineural loss can also affect clarity. A person may hear that someone is speaking but have difficulty distinguishing exactly what was said, particularly in background noise.


Audiologically, sensorineural loss is identified in part by comparing air-conduction and bone-conduction thresholds. When both are reduced without a clinically significant air-bone gap, the findings are consistent with sensorineural hearing loss.

Conductive Hearing Loss

Conductive hearing loss occurs when sound is not efficiently transmitted through the outer or middle ear to the inner ear. Possible causes include excessive earwax, middle-ear fluid, eardrum abnormalities, and problems involving the middle-ear bones, or ossicles. Depending on its cause, conductive hearing loss may be medically or surgically treatable.


On an audiogram, conductive loss typically produces an air-bone gap: bone-conduction testing indicates better cochlear sensitivity than air-conduction testing because it bypasses the affected outer and middle ear. This distinction is one reason a comprehensive hearing evaluation involves more than determining the quietest sounds a person can hear.

Mixed Hearing Loss

Mixed hearing loss contains both conductive and sensorineural components. In other words, dysfunction is present in the outer or middle ear and the inner ear or auditory nerve. Someone with existing sensorineural hearing loss who subsequently develops a middle-ear problem, for example, may temporarily or permanently demonstrate mixed hearing loss.

How Audiologists Further Classify Hearing Loss

Identifying sensorineural, conductive, or mixed hearing loss is only part of the picture. Audiologists further characterize hearing based on its degree, laterality, configuration, and course.

Degree: Mild to Profound Hearing Loss

The degree of hearing loss describes its severity based on hearing thresholds measured in decibels hearing level (dB HL). One commonly used classification system defines mild hearing loss as 26–40 dB HL, moderate as 41–55 dB HL, moderately severe as 56–70 dB HL, severe as 71–90 dB HL, and profound as 91+ dB HL. Classification conventions can vary.


Importantly degree alone does not describe everything a person experiences. Two people with similar pure-tone thresholds may have different speech-understanding abilities and different communication needs.

Configuration: High-Frequency, Low-Frequency, and Cookie-Bite Hearing Loss

Configuration describes the shape of hearing thresholds across frequencies, or pitches, on an audiogram. High-frequency hearing loss produces poorer thresholds for higher-pitched sounds, whereas low-frequency hearing loss primarily affects lower pitches.


A cookie-bite hearing loss is an informal name for a configuration in which hearing is poorer in the middle frequencies and better at lower and higher frequencies. These patterns matter because the same overall “degree” of hearing loss can affect access to speech sounds very differently depending on which frequencies are involved.

Laterality: Unilateral, Bilateral, and Asymmetrical Hearing Loss

Unilateral hearing loss affects one ear, while bilateral hearing loss affects both. Hearing loss may also be described as asymmetrical when its degree or configuration differs between the ears.


This distinction matters clinically. Hearing with two ears contributes to sound localization and understanding speech in challenging environments. Significant asymmetry can also influence whether additional medical evaluation is appropriate.

Onset and Course: Sudden, Progressive, and Fluctuating Hearing Loss

Hearing loss can also be described according to when it begins and how it changes. Progressive hearing loss worsens over time, while fluctuating hearing loss varies. Sudden hearing loss develops rapidly rather than gradually.

A particularly important distinction is sudden sensorineural hearing loss (SSNHL), which can occur at once or over several days and commonly affects one ear. Sudden unexplained hearing loss should be treated as a medical emergency rather than waiting for a routine hearing appointment; prompt evaluation can affect treatment options and outcomes.

Degree: Mild to Profound Hearing Loss

The degree of hearing loss describes its severity based on hearing thresholds measured in decibels hearing level (dB HL). One commonly used classification system defines mild hearing loss as 26–40 dB HL, moderate as 41–55 dB HL, moderately severe as 56–70 dB HL, severe as 71–90 dB HL, and profound as 91+ dB HL. Classification conventions can vary.


Importantly degree alone does not describe everything a person experiences. Two people with similar pure-tone thresholds may have different speech-understanding abilities and different communication needs.

Laterality: Unilateral, Bilateral, and Asymmetrical Hearing Loss

Unilateral hearing loss affects one ear, while bilateral hearing loss affects both. Hearing loss may also be described as asymmetrical when its degree or configuration differs between the ears.


This distinction matters clinically. Hearing with two ears contributes to sound localization and understanding speech in challenging environments. Significant asymmetry can also influence whether additional medical evaluation is appropriate.

Configuration: High-Frequency, Low-Frequency, and Cookie-Bite Hearing Loss

Configuration describes the shape of hearing thresholds across frequencies, or pitches, on an audiogram. High-frequency hearing loss produces poorer thresholds for higher-pitched sounds, whereas low-frequency hearing loss primarily affects lower pitches.


A cookie-bite hearing loss is an informal name for a configuration in which hearing is poorer in the middle frequencies and better at lower and higher frequencies. These patterns matter because the same overall “degree” of hearing loss can affect access to speech sounds very differently depending on which frequencies are involved.

Onset and Course: Sudden, Progressive, and Fluctuating Hearing Loss

Hearing loss can also be described according to when it begins and how it changes. Progressive hearing loss worsens over time, while fluctuating hearing loss varies. Sudden hearing loss develops rapidly rather than gradually.

A particularly important distinction is sudden sensorineural hearing loss (SSNHL), which can occur at once or over several days and commonly affects one ear. Sudden unexplained hearing loss should be treated as a medical emergency rather than waiting for a routine hearing appointment; prompt evaluation can affect treatment options and outcomes.

Where Does Neural Hearing Loss Fit?

The term neural hearing loss requires some clarification. Sensorineural hearing loss encompasses dysfunction involving either the cochlea (“sensory”) or the vestibulocochlear/auditory nerve (“neural”), so neural hearing loss is not typically presented as a fourth basic type alongside conductive, sensorineural, and mixed hearing loss.

Specific neural disorders can require testing beyond a standard audiogram. For example, auditory neuropathy spectrum disorder involves abnormal transmission of auditory information along neural pathways and is recognized separately from typical cochlear hearing loss.

How Do I Know What Type of Hearing Loss I Have?

How Do I Know What Type of Hearing Loss I Have?

You cannot reliably determine your hearing-loss classification from symptoms alone. A comprehensive audiologic evaluation brings several pieces of information together.


At Flex Audiology, our testing goes beyond identifying hearing loss. We want to understand how your hearing is affecting your everyday communication so we can help you make sense of your results and what they mean for you, including hearing aids. Depending on the individual, an evaluation may include an ear examination, pure-tone air- and bone-conduction testing, speech testing, measures of middle-ear function, and tinnitus testing. These findings allow an audiologist to determine the type, degree, configuration, and laterality of hearing loss and identify findings that may warrant additional medical evaluation.


If you have noticed changes in your hearing or have questions about terminology from a previous hearing test, schedule a hearing assessment with Flex Audiology. Understanding the complete hearing profile, and not simply whether you “passed” or “failed” a hearing test, is the foundation for making informed decisions about your hearing healthcare.

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