In the UK, there are 9 million people who are deaf or hard of hearing and potentially facing significant communication barriers. Hearing loss can be broadly divided into two main types—conductive and sensorineural. The former is usually caused by pathology within the external or middle ear, the latter by inner ear disease (the cochlea or neural pathway to the auditory cortex). A patient can also have a mixed picture with both conductive and sensorineural elements. This article describes the initial assessment and investigation of a patient presenting with hearing loss, outlines the more common causes of both conductive and sensorineural deafness and outlines strategies to optimize hearing.
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