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The primary cause of conductive hearing loss is indeed obstruction in the outer or middle ear. Conductive hearing loss occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones of the middle ear. This can happen due to various factors such as earwax buildup, fluid in the middle ear from infections, perforations of the eardrum, or abnormalities in the ossicles (the small bones in the middle ear).

These obstructions prevent sound waves from reaching the inner ear effectively, resulting in a reduction in sound intensity and clarity. Unlike sensorineural hearing loss, which is often caused by damage to the inner ear structures or the auditory nerve, conductive hearing loss typically has a mechanical component and can often be treated or improved with medical intervention, such as removing obstructions or repairing physical structures.

Understanding the distinction between conductive and sensorineural hearing loss is crucial in diagnosing hearing issues and determining the appropriate treatment approaches for individuals experiencing hearing difficulties. The other options do not directly indicate the mechanics of how sound transmission is impaired in conductive hearing loss.