Download Hearing Loss and Tinnitus Presentation D Amott

Loss of Hearing and
Tinnitus
Dr Deborah Amott
ENT Surgeon
[email protected]
Core Presentations
By the end of this year, you should be able to perform a
competent medical interview, physical examination and
suggest a basic investigational plan for a patient presenting
with this symptom.
Ask 4 Questions…
 What is the most likely diagnosis?
 Could this be life-threatening?
 What information do I need to confirm my diagnosis?
 What’s my time frame?
Context of this Symptom
 Symptom itself:

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

Acuity
Duration
Severity
Fixed/Variability
Progression
Triggers/Relievers
 Associated features: what
else is changing?



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Local, adjacent structures
Regional
Distant organ dysfunction
Systemic symptoms
 Patient:
 Demographics: age, sex,
race, ethnicity
 Lifestyle: profession,
hobbies, smoking, alcohol,
other drugs, other
carcinogens, diet.
 Immune status:
Immunosuppressed/Atopic/A
utoimmune disease
 Comorbidities, previous
medical conditions or
treatment.
 Environment: season,
latitude,
humidity/temperature,
recent events.
What can an ear do?
 Otorrhoea
 Otalgia
 Hear
 Tinnitus
 Vertigo
Tinnitus: Definition
“Perception of a sound in the absence of an
environmental acoustic stimulus”
Objective OR Subjective
Unilateral OR Bilateral: Symmetrical OR Asymmetrical
Pulsatile OR Non-Pulsatile
Pitch or specific description usually not helpful
Tinnitus: Causes
?
Tinnitus: Causes
 All the causes of hearing loss can cause tinnitus, and
many commonly do
 It is possible to experience tinnitus in an ear with
 normal hearing
 no hearing at all
 everything in between.
 People who have had their inner ear surgically removed
can - and often do - experience tinnitus.
Pulsatile Tinnitus
With the pulse or not?
 Hypervascularity
 Physiological
 Pathological
 Arterial
 Arteriosclerosis
 Aneurysms
 Dissection
 Aberrant vessels
 Venous
 Benign intracranial
hypertension
 Dehiscent jugular bulb
 Both
 AVMs
 Other
 Myoclonus: stapedius,
tensor tympani, tensor veli
palatini
So, how do you investigate
pulsatile tinnitus?
Audiogram
Imaging:
Anatomy?
Vessels?
So, how do you investigate
pulsatile tinnitus?
Audiogram
Imaging:
Anatomy: CT Temporal Bones for tumours, high
riding/dehiscent jugular bulbs, abberrant vessels
Vessels: carotid doppler, MRI/MRA/MRV.
Hearing Loss
Types of Hearing Loss
Sensorineural
(Inner Ear)
Conductive
Mixed
(Outer ear/
Middle ear)
Central
General Pathological Processes
VINDICATE
V-vascular
I-infectious/inflammatory
N-neoplasia
D-drugs/degeneration
I-idiopathic
C-congenital
A-anoxia/acid-base imbalance/auto-immune
T-trauma/toxins
E-ethyl alcohol, endocrine
Genetic: too much vs. too little of an otherwise good
thing
Audiology: Nomenclature
Audiograms
Sensorineural (SNHL)
Conductive (CHL)
Mixed Hearing Loss
Causes of Hearing Loss
Conductive
Sensorineural
Causes of Hearing Loss
Conductive
 EAC: material in canal
lumen, narrowed lumen
 TM: perforation, infection,
scar, retraction
 MEC: fluid, ossicular chain
disease: discontinuity,
‘rusting tight’, scars
Sensorineural
 Aging: presbycusis
 Noise Induced HL
 Trauma
 Neoplasm
 Infection
… VINDICATE away
Asymmetrical SNHL
What’s the big deal?
 Aging
 Noise Induced HL
 Trauma
 Neoplasm
 Infection
… VINDICATE away
Weber and Rinne
You do need to know
these…
www.youtube.com/watch?v=o-QKT_o0abc
Sudden Sensorineural Hearing
Loss
• Acute sensorineural hearing loss of at least 30dB across
at least 3 frequencies, occurring within three days.
• Causes
–
–
–
–
Infection/Inflammation
Vascular
Neoplasm
Idiopathic
• Examination
• Why do you need to diagnose it?
Anatomy does not Change
Fluctuating Hearing Loss
Conductive
Sensorineural
Fluctuating Hearing Loss
Conductive
 Eustachian Tube
dysfunction
 Infections
 Effusions
 Barotrauma
Sensorineural
 Endolymphatic hydrops
 Meniere’s Disease
 Syphilis
 Sublethal injury
 Infection, trauma, vascular
 Autoimmune ear disease
 SSNHL (recurrent)
Investigations
• Know the question you want to answer.
• Only order an investigation if the result will affect your
management
• A proper initial clinical assessment and then repeated
thorough clinical assessment is always much better
than multiple non-targeted tests.
• Recruit help
So what can you do?
 Tinnitus:
 Is your patient going to top themselves?
 Treat the distress, and the tinnitus will sort itself out.
 Tinnitus Association of Victoria
 Hearing loss: whether conductive or sensorineural
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Treat reversible causes
Optimize functional hearing
Aid what needs aiding
Cochlear implantation
Learn ENT