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H90.8 - Combined Hearing Loss ICD-10
H90.8 is an ICD-10 diagnosis code for combined conductive and sensorineural hearing loss, unspecified, meaning both types of hearing loss are present without further laterality detail.
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H90.8 is an ICD-10 diagnosis code for combined conductive and sensorineural hearing loss, unspecified, meaning both types of hearing loss are present without further laterality detail.
Definition and Classification
H90.8 is a diagnosis code from the International Classification of Diseases, 10th Revision (ICD-10). It describes a combined conductive and sensorineural hearing loss, unspecified. This means the affected person experiences both types of hearing loss simultaneously, but without documented specification of which ear or ears are involved (no laterality assigned).
Types of Hearing Loss
To fully understand H90.8, it is helpful to distinguish the two main types of hearing loss:
- Conductive hearing loss: Impaired transmission of sound waves through the outer or middle ear. Common causes include earwax blockage, middle ear infections (otitis media), or eardrum perforations.
- Sensorineural hearing loss: Damage to the inner ear (cochlea) or the auditory nerve. Common causes include age-related hearing loss (presbycusis), noise-induced damage, or genetic conditions.
- Mixed hearing loss: When both conductive and sensorineural components are present simultaneously, this is classified as mixed hearing loss and coded as H90.8 when laterality is not specified.
Causes
Mixed hearing loss can arise from several causes, including:
- Chronic otitis media with secondary inner ear involvement
- Age-related changes combined with pre-existing middle ear disease
- Otosclerosis affecting both the middle and inner ear
- Traumatic injury to the ear
- Ototoxic medications combined with structural ear changes
- Genetic conditions affecting multiple structures of the ear
Symptoms
Typical signs and symptoms of mixed hearing loss include:
- Reduced hearing ability across different frequency ranges
- Difficulty understanding speech, especially in noisy environments
- Tinnitus (ringing or buzzing in the ears) in some cases
- A feeling of pressure or fullness in the ear
- Social withdrawal due to communication difficulties
Diagnosis
The following diagnostic tools are commonly used to assess and document H90.8 hearing loss:
- Pure tone audiometry: Measures hearing thresholds across frequencies to differentiate the conductive and sensorineural components
- Tympanometry: Evaluates middle ear function and eardrum mobility
- Tuning fork tests (e.g., Weber and Rinne tests) for initial bedside assessment
- ENT (ear, nose, and throat) examination to identify the underlying cause
Treatment
Treatment depends on the underlying cause and severity of the hearing loss:
- Conservative treatment: Management of underlying conditions such as middle ear infections with medications
- Surgical intervention: For structural middle ear problems (e.g., tympanoplasty or ossicular chain reconstruction)
- Hearing aids: The most common intervention for persistent mixed hearing loss
- Cochlear implants: Considered for severe to profound sensorineural components
- Auditory rehabilitation: Hearing training programs to improve communication skills
Clinical Relevance of Code H90.8
The ICD-10 code H90.8 is used in medical documentation, billing, and health statistics. It indicates that a more precise laterality classification has not been assigned (compare: H90.6 for bilateral, H90.7 for unilateral mixed hearing loss). Accurate coding is essential for proper reimbursement and epidemiological tracking of hearing disorders worldwide.
References
- World Health Organization (WHO): International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Geneva: WHO, 2019. Available at: https://icd.who.int/browse10
- National Institute on Deafness and Other Communication Disorders (NIDCD): Hearing Loss. U.S. Department of Health and Human Services, 2023. Available at: https://www.nidcd.nih.gov
- Boenninghaus H-G, Lenarz T: HNO. 14th edition. Springer Medizin Verlag, Heidelberg, 2012.
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