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Neural hearing loss (Nerve deafness) occurs when the auditory nerve, which goes from the inner ear to the brain, fails to carry the sound information to the brain.

Nerve deafness occurs as a result of damage within the sensory cells of the inner ear and other in related areas dealing with hearing. The damage from this type of defect is usually uneven and not a loss of all hearing. Those afflicted with this type of hearing loss, may loose sensitivity to different tones (usually the higher tones). Particularly in the case of nerve deafness, a person may be able to hear normally average tones, but would have decreased sensitivity to loud or higher-pitched tones. The zone of normal hearing is greatly narrowed with this type of defect. This creates a difficulty for people with nerve deafness when distinguishing consonants, because it is the high sounds of the consonants which distinguish them from each other. This causes people with this type of nerve deafness to have difficulty hearing speech when there is background noise. The other cues which may allow better understanding of the speech are masked by the background noise.

A peculiar symptom of nerve damage is that although these patients may not be able to hear faint high tones, they are able to clearly hear really loud high tones as well as a normal person. This phenomenon is called recruitment. Recruitment is a symptom of nerve damage whereby, there is a normal hearing for loud sounds and decreased sensitivity to normal sounds. This is common among the elderly. Nerve deafness is rarely improved by medical treatment because the degenerative nerve damage is already done.

Complete or total loss of hearing is generally due to an acute form of nerve damage. Infections and pathological conditions of the vestibular system are likely to spread and cause nerve damage. Tinnitus, which is heared as a high pitched ringing in nerve disoders is usually as a result of a local irritation in the cochlea.