Chart — Med-Surg
Conductive vs Sensorineural Hearing Loss Chart
One loss is a plumbing problem — sound blocked on the way in, often fixable. The other is a wiring problem — hair cells or nerve damaged, usually permanent. The tuning fork tells them apart, and the management diverges from there.
Educational use only. Tuning-fork tests screen rather than diagnose; audiometric evaluation confirms the type and degree of loss. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The Two Losses Side by Side
| Feature | Conductive | Sensorineural |
|---|---|---|
| Where the problem is | Outer or middle ear — sound is physically blocked or dampened on its way in | Inner ear (cochlear hair cells) or auditory nerve — sound arrives but isn't converted or carried |
| Common causes | Impacted cerumen (most reversible), otitis media with effusion, TM perforation, otosclerosis, foreign body | Presbycusis (aging), chronic noise exposure, ototoxic drugs, Ménière's disease, acoustic neuroma, congenital |
| Weber test (midline forehead) | Lateralizes to the AFFECTED (worse) ear | Lateralizes to the GOOD (unaffected) ear |
| Rinne test (mastoid vs air) | Bone conduction ≥ air conduction in the affected ear (negative Rinne) | Air > bone preserved, but both reduced on the affected side |
| How speech sounds | Everything is quieter — like wearing earplugs; patient may hear BETTER in noise and speak softly | Loud enough but unclear — "I hear you but can't understand you"; high frequencies/consonants go first; worse in background noise |
| Reversibility & treatment | Often fixable — cerumen removal, effusion management, TM repair, stapedectomy for otosclerosis | Usually permanent — hearing aids, cochlear implants for severe loss; prevention is the real treatment |
| Nursing care | Otoscopic check before assuming worse; never irrigate a perforated TM; post-op ear surgery precautions (no nose blowing, no straining) | Communication techniques (face patient, lower pitch), hearing aid care, ototoxic-drug vigilance, noise-protection teaching, fall-risk awareness |
Exam Traps
- ✦Weber lateralizes TOWARD the conductive loss and AWAY from the sensorineural loss — the most-tested fact in sensory nursing.
- ✦Rule out cerumen before attributing any new hearing loss to age — it's the most reversible cause.
- ✦Presbycusis takes high frequencies first: lower your pitch, don't shout (shouting raises pitch into the lost range).
- ✦Ototoxic drugs (aminoglycosides, loop diuretics, ASA, cisplatin, vancomycin) cause SENSORINEURAL loss — new tinnitus is the early warning.
- ✦Sudden sensorineural hearing loss is urgent — same-day evaluation; steroid treatment is time-sensitive.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →