How can I differentiate between conductive and sensorineural hearing loss during a clinical examination?

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 ¹. Initial Clinical Steps:

• For adults presenting with hearing difficulties, the first step is to exclude impacted earwax and acute infections such as otitis externa ¹.
• Otoscopy is a key part of the clinical examination for both adults and children ¹,². This allows for visual inspection of the ear canal and eardrum ¹.
• 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 ¹. These findings, especially if persistent after initial treatment of wax or infection, would prompt a referral to an ear, nose and throat (ENT) service ¹.

Further Diagnostic Assessment:

• If hearing difficulties persist after excluding impacted wax and acute infections, an audiological assessment should be arranged ¹.
• This formal audiological assessment includes pure tone audiometry and tympanometry, which are crucial for definitively differentiating between conductive and sensorineural hearing loss ¹.