There are three main types of hearing losses. They are conductive, sensorineural, and mixed. The type of hearing loss depends upon where in the ear the problem occurs. With conductive hearing loss there is a problem in the external or middle ear that prevents sound from reaching the nerves in the inner ear. External otitis; also known as swimmers ear can also be a cause of conductive hearing loss. Other causes include excessive cerumen or presence of a foreign body in the ear canal. Infections involving a hair follicle called furuncle or involving multiple hair follicles called carbuncle where an abscess may form can also be a cause. Benign masses may also be found in the external ear causing the ear to become red and inflamed. Your patient will be complaining of pain radiating inward on the affected side. Absence of or malformation of the outer ear, ear canal, or middle ear may also cause conductive hearing loss. Otitis media is the most common cause of hearing loss in the middle ear and usually follows an upper respiratory infection. The patient would be experiencing fever, earache and feeling of fullness in the affected ear. A perforated or ruptured tympanic membrane resulting from trauma or exposure to loud noise or repeated infections causing pressure on the membrane can also cause conductive hearing loss. The stapes in the middle ear can develop ostosclerosis preventing it from vibrating which will prevent sound from getting to the inner ear. This begins progressively mainly in women after the age of forty. If prompt medical or surgical treatments are done, permanent hearing loss may be avoided. Treatments for conductive hearing loss include removal of cerumen build up by irrigating the ear canal. If there is fluid trapped in the ear; procedures such as paracentesis using a needle or a myringtomy which makes an incisionis in the tympanic membrane will allow fluid to drain or be suctioned out of the middle ear. A surgery called a myringoplasty can also be done to repair a damaged tympanic membrane. A stapedectomy can also be done to remove a damaged stapes and replace it with prosthesis. Hearing aids are also another treatment commonly used to assist your patient with their hearing loss. Another type of hearing loss known as sensorineural hearing loss; also known as nerve hearing loss occurs in the inner part of the ear. The damaged nerves of the inner ear do not properly transmit the signals to the auditory centers of the brain. There are many causes, differing by age of onset. They can occur before or during birth from perinatal infections, heredity, and asphyxia at birth, low birth weight, or defects of the head and neck. Other causes can be from an infection or inflammation of the inner ear known as a labyrinthitis. This can also be caused by drug toxicity from some antibiotics, as well as some diuretics. Overindulgence of alcohol or some allergies have also been related to hearing loss. A couple of the most common signs of an inner ear infection are vertigo and tinnitus. Other symptoms include pain, fever, ataxia, nausea, and vomiting. The natural degeneration of the organ of Corti known as Presbycusis; or Neoplastic disorders such as inner ear tumors can also causes sensorineural hearing loss. Acoustic neuroma, a tumor of the eighth cranial nerve, is the most common benign tumor. Symptoms include unilateral loss of high pitched sounds, unilateral tinnitus as well as intermediate vertigo. Headache and balance disorders may also be present. A balance disorder called Meniere’s disease involves a group of symptoms including deafness, tinnitus, vertigo, and sensation of fullness or pressure in the ears. Acute episodes can last 2 to4 hours at a time. The symptoms will resolve after several weeks but the hearing loss in the affected ear remain and your patient will experience some degree of permanent hearing loss. Normal conversation levels occur at about 60 decibels. Prolonged exposure to loud noises above 90