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To evaluate the natural history of traumatic conductive hearing loss.Retrospective chart review.Otologic and audiometric evaluations of patients in the early posttraumatic phase were compared with evaluations at follow-up. Assessment included etiologies of trauma, classification of hearing loss, factors causing conductive loss, and analyses of changes in air-bone gaps, pure-tone averages and hearing loss class.There were 45 patients, representing 47 ears, with sufficient initial and follow-up documentation to analyze the natural history of traumatic conductive hearing loss. Overall, 77% of ears showed an improvement in pure-tone averages without surgical intervention. Air-bone gaps closed from an average of 24.8 ± 12.1 to 13.2 ± 11.1 dB. Only 11% of ears demonstrated a decrease in pure-tone averages, and 12% showed no change in thresholds. All forms of injury contributing to the conductive hearing loss had good outcomes. Specifically, tympanic membrane perforations showed final air-bone gaps of 14.9 ± 11.2 dB; cases of hemotympanum had final air-bone gaps of 10.0 ± 8.1 dB; and suspected ossicular chain disruptions had final air-bone gaps of 13.9 ± 12.3 dB. Only 5 of 47 ears ultimately required surgical intervention for persistent pathology.Patients with all forms of traumatic conductive hearing loss can be initially managed conservatively. Even suspected ossicular chain disruptions have a high rate of spontaneous reparation. Surgical intervention for perforation or conductive hearing loss should be undertaken in the rare cases when these conditions persist greater than 6 months.