Dr Kola Tytler MBBS CertHE MBA MSt MRCGPClinical Lead • iatroX
During a clinical examination, differentiating between conductive and sensorineural hearing loss primarily involves initial assessment to exclude common conductive causes and then referral for specialist audiological evaluation NICE NG98.
Initial Clinical Steps:
- For adults presenting with hearing difficulties, the first step is to exclude impacted earwax and acute infections such as otitis externa NICE NG98.
- Otoscopy is a key part of the clinical examination for both adults and children NICE NG98,NICE NG233. This allows for visual inspection of the ear canal and eardrum NICE NG98.
- Findings on otoscopy that may indicate a conductive hearing loss include inflammation, polyp formation, a perforated eardrum, abnormal bony or skin growths, swelling of the outer ear, blood in the ear canal, or a middle ear effusion NICE NG98. These findings, especially if persistent after initial treatment of wax or infection, would prompt a referral to an ear, nose and throat (ENT) service NICE NG98.
- If hearing difficulties persist after excluding impacted wax and acute infections, an audiological assessment should be arranged NICE NG98.
- This formal audiological assessment includes pure tone audiometry and tympanometry, which are crucial for definitively differentiating between conductive and sensorineural hearing loss NICE NG98.