What hearing loss actually is
Quick answer
Hearing loss is grouped by where the problem sits in the ear into three types: conductive, sensorineural and mixed. Presbycusis is the common age-related sensorineural pattern, and only a licensed audiologist or physician can say which type is present in a given person.
Most people who search for this have already noticed something, in themselves or in someone they love, and are trying to work out what it means before they call anyone. That is a reasonable instinct, and this page is written for exactly that moment. It explains what the words on an audiology report actually describe, not what a symptom means for any one person.
Hearing loss is not one condition. Clinicians sort it by where in the hearing system the problem originates, because that location determines what can be done about it and who treats it. The three categories below cover essentially every case, and knowing the difference is what turns a vague worry into a useful question for an appointment.
What are the three types of hearing loss?
Conductive hearing loss happens when sound is blocked or dampened on its way through the outer or middle ear, before it ever reaches the inner ear. Common causes include earwax buildup, fluid behind the eardrum, ear infections, or a punctured eardrum. Conductive loss is frequently temporary and frequently treatable by a doctor, sometimes as simply as removing wax.
Sensorineural hearing loss originates in the inner ear (the cochlea) or in the auditory nerve that carries signals to the brain. This is the type behind most adult hearing loss, including age-related and noise-related loss, and it is generally permanent because the sensory cells involved do not regenerate. Amplification, not a cure, is the usual management path.
Mixed hearing loss is a conductive component and a sensorineural component happening in the same ear at the same time. It is diagnosed, not guessed, because the two components respond to entirely different treatments.
What is presbycusis?
Presbycusis is the clinical name for the gradual, typically symmetrical, sensorineural hearing loss that tends to accompany aging. It usually affects higher frequencies first, which is why consonant sounds like s, f, and th become harder to catch in conversation well before someone would describe themselves as "not hearing" at all. It is a pattern, not a specific number, and it is diagnosed the same way any other sensorineural loss is: with a hearing evaluation, not with a checklist.
How is the severity of a hearing loss described?
A pure tone average from 26 to 40 dB HL is labelled mild; 41 to 55 dB HL is moderate; the scale runs up to profound at 91 dB HL and above.
| Category | Threshold range (dB HL) | What that band typically shows |
|---|---|---|
| Normal hearing | -10 to 25 | Recorded as normal hearing for an adult on this scale. |
| Mild | 26 to 40 | Soft speech and speech at a distance are typically harder to follow. |
| Moderate | 41 to 55 | Conversation at a normal level is typically difficult without amplification. |
| Moderately severe | 56 to 70 | Speech generally has to be raised well above normal to be followed. |
| Severe | 71 to 90 | Ordinary conversation is generally not audible without amplification. |
| Profound | 91 to 120 | Very loud sounds may be perceived, often as vibration rather than sound. |
Why does the World Health Organization describe the same loss differently?
WHO sets the boundary of unimpaired hearing at 20 dB HL, ten points lower than the common United States clinical convention, so the same threshold can be labelled differently by the two scales.
| WHO grade | Threshold range (dB HL) |
|---|---|
| No impairment | 0 to 19 |
| Mild | 20 to 34 |
| Moderate | 35 to 49 |
| Moderately severe | 50 to 64 |
| Severe | 65 to 79 |
| Profound | 80 to 94 |
| Complete or total hearing loss | 95 to 120 |
Can a hearing aid cure or reverse hearing loss?
No. This is worth stating plainly because it is the single most common misconception in the category. A hearing aid amplifies and shapes sound; it does not repair the inner ear or the auditory nerve, and sensorineural hearing loss, including presbycusis, is not reversed by wearing one. What a hearing aid can do is make more of the available sound accessible to the hearing that remains. A conductive cause is a different story: a doctor treating the underlying problem (removing wax, treating an infection, repairing an eardrum) can sometimes change the picture entirely, which is one more reason the type of loss matters before anyone buys anything.
Common questions
- What is the difference between conductive and sensorineural hearing loss?
- Conductive loss blocks or dampens sound in the outer or middle ear, before it reaches the inner ear, and is frequently temporary and treatable by a doctor. Sensorineural loss originates in the inner ear or auditory nerve itself, is generally permanent, and is the type behind most age-related and noise-related hearing loss in adults. A mixed loss has both components at once.
- What is presbycusis?
- Presbycusis is the clinical term for the gradual, usually symmetrical sensorineural hearing loss that tends to accompany aging, typically affecting higher frequencies and consonant sounds first, well before conversation itself feels difficult. It describes a pattern rather than a specific number attached to any one person, and confirming it in an individual still requires a hearing evaluation rather than a self-assessment or a checklist.
- Can hearing loss be reversed?
- It depends entirely on the type. A conductive cause, such as earwax or fluid behind the eardrum, is often treatable and can improve once a doctor addresses it. Sensorineural hearing loss, including presbycusis, is generally permanent because the sensory cells involved do not regenerate, which is why management focuses on amplification rather than a cure.
- Why do the WHO and US clinical scales disagree about the same threshold?
- They set different boundaries for normal hearing. The common United States clinical convention treats up to 25 dB HL as normal for an adult, while the WHO 2021 grades set that boundary at 19 dB HL and call 20 to 34 dB HL mild. The same measured threshold can be reported as normal on one scale and mild on the other.
- Do I need a hearing test to know which type of hearing loss I have?
- Yes. There is no reliable way to distinguish conductive, sensorineural and mixed hearing loss from symptoms alone, because they can feel similar day to day. A licensed audiologist or physician determines the type through an evaluation, and that result is what should guide any next step, including whether an over the counter device is even an appropriate option.
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Last updated 2026-09-17.