Download adult_hearing_loss update_(copy05)

Adult Audiology and Adult
Hearing Loss
Lisa Caulley, MD, MPH
Otolaryngology—Head and Neck Surgery
University of Ottawa
Slides courtesy of Dr. Kristian Macdonald
Objectives
1. Major Points in History Taking for Hearing Loss
2. Components of an Audiogram
3. Distinguish between a Sensorineural (SNHL) and
Conductive hearing loss (CHL)
4. The role of noise exposure in some types of
hearing loss
5. Recognize the significant historical elements,
physical signs and audiogram findings for:
Presbycusis, Otosclerosis,
Sudden Sensorineural Hearing Loss,
Noise Induced Hearing Loss,
Vestibular Schwannoma
Adult Hearing Loss
Hearing: Perception of Sound
Conversion of sound waves into action
potentials;
mechanoelectrical transduction
Elements required for hearing:
– Intact Ear
– Intact CNS
Adult Hearing Loss
Importance of hearing:
– Communication
– Personal/Professional Isolation
Scope of the problem:
– 17% of adult population
– 36% of adults between 65 and 74 yrs
– 47% of adults over 75
Adult Hearing Loss
Intact Ear
– External ear
Pinna, Ear Canal,
Tympanic Membrane
Intact CNS
– CN VIII
– Central Tracts
– Auditory Cortex
– Middle Ear
Ossicular Chain
– Inner Ear
Cochlea
– Details in the
Physiology of Hearing
Lecture
Adult Hearing Loss
EAR
Adult Hearing Loss
Adult Hearing Loss
60 year old (yo) female. Public servant
– Periodic health assessment
– Review of Systems:
Embarrassed about asking people to repeat themselves.
Feels people mumble.
55 yo male. Carpenter.
– C.C.: Ringing in his ears. For the past 2 years
34 yo female. Stay-at-Home Mom.
– Post partum. She noted a change in her hearing during
pregnancy.
25 yo male. Semi-Pro baseball player.
– Ringing in his left ear for 3 months.
– No longer able to catch ‘Fly Balls’
Adult Hearing Loss
Cardinal Signs and Symptoms of Otologic Disease
–
–
–
–
–
Hearing Loss
Tinnitus
Vertigo
Otalgia
Otorrhea
Adult Hearing Loss
Historical elements of hearing loss
1. Can’t Hear
Pt: Repetitions
Decreased ‘Speech in Noise’
People beginning to mumble
Spouse/Family:
‘Won’t Listen’
TV/Music too loud
Answers ‘wrong’ question
Adult Hearing Loss
Historical elements of hearing loss
2. Tinnitus
Perception of sound in the absence of
acoustic stimuli (Sound/noise)
Bilateral Vs Unilateral
Constant Vs Intermittent
Bothersome Vs Non-bothersome
Adult Hearing Loss
Historical elements of hearing loss
3. Vertigo: hallucination of spinning
Indicates vestibular/otologic involvement
May be a peripheral vestibular disorder
OR
a central vestibular disorder
Vs
Lightheadedness/unsteadiness
Indicates a non-vestibular cause.
Multiple potential causes
Adult Hearing Loss
Physical examination
– Observation, including otoscopy,
– usually normal
Needs to be done to rule out ear canal
obstructions (Cerumen, foreign bodies) and
Tympanic Membrane (TM) perforations
Adult Hearing Loss
Tests of Hearing
– Tuning forks tests
A vibrating tuning fork can be placed on the skull to
quickly determine if a hearing loss is present
– Audiometry
Presentation of pure tones at specific frequencies
and set volume levels to each ear independently
Speech comprehension/discrimination
Tympanometry
Adult Hearing Loss
Tuning fork Tests
Weber
Ernst Heinrich Weber
Can detect unilateral
hearing loss. Conductive or
Sensorineural
Rinne
Heirich Adolf Rinne
compares perception of
sounds, as transmitted by
air or by bone conduction
through the mastoid
Adult Hearing Loss
Audiometry
– testing of a person's ability to hear
various sound frequencies.
– Pure Tone Audiometry
Audiometer: emits sounds or tones,
like musical notes, at various
frequencies, or pitches, and at
differing volumes or levels of
loudness
– Speech Audiometry
a series of simple recorded words
spoken at various volumes into
headphones worn by the patient
being tested.
The patient repeats each word back
to the audiologist as it is heard.
Adult Hearing Loss
Tympanometry
– measure of the stiffness of the
eardrum to evaluate middle ear
function.
Helpful in detecting fluid in the middle
ear, negative middle ear pressure,
disruption of the ossicles, tympanic
membrane perforation, and otosclerosis.
To perform the test:
– a soft probe is placed into the ear
canal and a small amount of
pressure is applied. The instrument
then measures movement of the
tympanic membrane (eardrum) in
responses to the pressure changes.
The result of the test is recorded in a
visual output, called a tympanogram.
Adult Hearing Loss
Audiogram
Elements of an audiogram
– Pure Tone
– Speech Audiometry
– Tympanometry
Adult Hearing Loss
Audiogram
Elements of an audiogram
– Pure Tone
– Speech Audiometry
– Tympanometry
Adult Hearing Loss
Normal Audiogram/Hearing
Adult Hearing Loss
Severity of Hearing Loss
Adult Hearing Loss
Types of hearing loss
– Sensorineural Hearing Loss (SNHL)
– Conductive Hearing Loss (CHL)
– Mixed Hearing Loss
Adult Hearing Loss
Sensorineural Hearing Loss
– Hearing impairment of the
inner ear resulting from
damage to the sensory
hair cells or to the nerves
that supply the inner ear.
Adult Hearing Loss
Conductive Hearing Loss
– Problem conducting
sound waves through
the outer ear,
tympanic membrane
(eardrum) or middle
ear (ossicles).
– Concept of Air-Bone
Gap
Adult Hearing Loss
Air-Bone Gap
– lag between the audiographic curves for air- and
bone-conducted stimuli, as an indication of loss of
sound conduction of the ear.
– Reflects outer and middle ear dysfunction
Adult Hearing Loss
Mixed Hearing Loss
– hearing loss that is
both conductive and
sensorineural
Adult Hearing Loss
Common Causes* of Sensorineural Hearing
Loss
–
–
–
–
–
–
–
Age
Noise
Toxicity
Trauma
Infection
Meniere’s Disease
Acoustic Neuroma
* Extensive lists and descriptions of causes for hearing loss can be found
in any otolarygology text book
Adult Hearing Loss
Age related Hearing
Loss
Presbycusis
–
–
–
–
–
–
Gradual and progressive
Bilateral
Decreased ‘Speech in Noise’
Tinnitus
No Vertigo
Familial predisposition
Adult Hearing Loss
Sudden
Sensorineural
Hearing Loss (SSHL)
– aka Idiopathic SSHL
Sudden (or rapid <3d)
loss of hearing
30dB loss in 3
consecutive
frequencies
Adult Hearing Loss
Noise Induced
Hearing Loss
– Acute Noise Exposure
(Acoustic Trauma)
Temporary Threshold
Shift (TTS)
– Chronic Noise
Exposure
Adult Hearing Loss
Other causes of SNHL (partial list)
– Ototoxicity
Antibiotics
Loop Diuretics
ASA/Quinines
Cancer/Chemotherapeutic meds
– Trauma
Temporal Bone Fracture
Perilymphatic Fistula (PLF)
Adult Hearing Loss
Conductive Hearing Loss
– Foreign Body in Ear Canal or Cerumen
– Adult, with intact TM
Otosclerosis
Ossicular Dysfunction
Trauma
Acute Otitis Media
Middle Ear Effusion
– Tympanic Membrane (TM) perforation
Traumatic
Chronic Otitis Media
Adult Hearing Loss
Otosclerosis
– disease of the otic
capsule and the ossicles
– abnormal resorption and
then deposition of bone
in the labyrinthine
capsule and middle ear
– progressive hearing loss
– Most common cause of
conductive hearing loss
with an intact TM in
adults
Adult Hearing Loss
Hearing Loss can be bilateral or unilateral
Adult Hearing Loss
Unilateral Sensorineural Hearing Loss
– Meniere’s Disease
– Vestibular Schwannoma
Adult Hearing Loss
Meniere’s Disease
(aka Endolymphatic Hydrops)
– Episodic Vertigo,
Fluctuating Hearing
Loss, Aural
Fullness/Tinnitus
– Unilateral*
* up to 30% will be bilateral
Adult Hearing Loss
Vestibular
Schwannoma
– AKA Acoustic Neuroma
– Benign Neoplasm of
the myelin sheath of
CN VIII
– 5-10% of Intracranial
Neoplasia
– NF I and NF II
Adult Hearing Loss
60 years old (yo)
female. Public servant
– Periodic health
assessment
– Review of Systems:
Embarrassed about
asking people to repeat
themselves.
Feels people mumble.
Presbycusis
Adult Hearing Loss
55 yo male.
Carpenter.
– C.C.: Ringing in his
ears. For the past 2
years
Noise Induced Hearing Loss
Adult Hearing Loss
34 yo female. Stayat-Home Mom.
– Post partum. She
noted a change in
her hearing during
pregnancy.
Otosclerosis
Adult Hearing Loss
25 yo male. SemiPro baseball
player.
– Ringing in his left
ear for 3 months.
– No longer able to
catch ‘Fly Balls’
Acoustic Neuroma
Adult Hearing Loss
Lecture Objectives Review
1. Major Points in History Taking for Hearing Loss
– Ask about: Hearing Loss, Tinnitus, Vertigo, Otalgia,
Otorrhea
2. Components of an Audiogram
– Pure Tone Audiometry, Speech Audiometry. Tympanogram.
3. Distinguish between a Sensorineural (SNHL) and
Conductive hearing loss (CHL)
– Tuning Fork Tests, Air Bone Gap
4. The role of noise exposure in some types of hearing
loss
– TTS, ‘4K notch’
Adult Hearing Loss
Lecture Objectives Review (Cont’d)
– 5. Recognize the significant historical elements,
physical signs and audiogram findings for:
Presbycusis: Age, Family Hx, Audio
Otosclerosis: Family Hx, Forks, Audio
Sudden Sensorineural Hearing Loss: Hx, Audio
Noise Induced Hearing Loss: Hx, Audio
Vestibular Schwannoma: Hx, Unilateral HL
Meniere’s Disease: Hx
Foreign Body: Hx /Px
Otitis media: Hx /Px: ?TM Status?
Adult Hearing Loss
MOST IMPORTANT.
All unilateral hearing loss and/or unilateral
tinnitus needs to be investigated.
Audiogram, MRI