Download Hearing Loss - Barnsley VTS

Overview
Hearing Loss
By Chung Yee Kong
Aims and objectives
1. The approach to the clinical assessment of hearing
loss
2. To know common causes and the management of
conductive and sensorineural hearing loss
3. To have a have a better understanding on how we can
aid hearing
Clinical assessment
 Onset and rate of progression of hearing loss
 Unilateral or bilateral
 Associated symptoms – pain, discharge, tinnitus, imbalance
 History of noise exposure (occupational or recreational)
 Past history of ear disease, injury, surgery
 Drug history
 Family history
Examination
 Inspection and palpation of the pinna and surrounding soft tissues
 Look into the external auditory canal and tympanic membrane
 Examine the neck
 Cranial nerves
 Weber’s
 Normal = midline
 Affected ear in conductive hearing loss
 Non-affected area in sensorineural hearing loss
 Rhinne’s
 Positive – AC>BC (normal, sensorineural hearing loss)
 Negative – BC>AC (conductive hearing loss)
 Formal audiometric testing
Conductive hearing loss

Usually pathology within the external or middle ear

Earwax



5 days course of wax softener (olive oil or 5% sodium bicarbonate drops)

Ear syringing (CI: previous/ current TM perforation, current ear infection/ grommets, previous ear surgery)

Wax removal via direct vision by ENT
Glue ear

Spontaneous resolution

Persistent >3 months  Grommets

Lasts 3-12 months

Not for antibiotics/ decongesants/ steroids

Adults – unilateral middle ear effusion >3 months should be considered nasopharyngeal tumour until
proven otherwise!
Otitis externa


Steroid/ antibiotic ear drops
Tympanic membrane perforation

Is it otitis media with perforation?

Oral antibiotics

Heal spontaneously in 2 weeks

If not healed – monitor hearing loss

Consider referral to ENT for surgical repair – symptoms worsen/ persistent defect at 6 weeks
Cholesteatoma
- Accumulation of squamous epithelium within the middle ear
- Locally destructive
- Congenital vs Acquired
- Primary (accumulation within a TM retraction pocket)
- Secondary (Ingrowth of skin through TM perforation)
- Pearly white appearance
- Unilateral foul smelling discharge
- Unresponsive to treatment
- Urgent referral to ENT
Cholesteatoma
Sensorineural hearing loss
Bilateral



Presbyacusis

Symmetrical progressive deterioration of hearing with age

High pitched sounds

Hearing aids
Noise/ occupational exposure

Preventable

Occupational history

Ear protection

High frequency affected first (typically 4000 Hz)

Occupational deafness is an industrial disease – ENT opinion for specialist confirmation of diagnosis

Industrial injuries benefits
Ototoxic agents

Aminoglycosides

Diuretics

Salicylates

Chemotherapy agents

Caution in elderly and poor renal function or ototoxic drug combinations
Meniere disease

Dilatation of endolymphatic spaces of membranous labyrinth

Fluctuating unilateral hearing loss

Associated with tinnitus, aural fullness, episodic vertigo (most prominent symptom)

Lasts up to 12 hours

Attacks occur in clusters

Can progress to bilateral

Management
 Inform DVLA
 Stop driving
 Antihistamines (e.g. prochlorperazine) for symptomatic relief from acute vertigo
 Recurrent attacks – ENT referral



Possible surgical interventions
Vestibular neuronectomy (total ipsilateral deafness
Transtympanic membrane instillation of gentamicin
 Acoustic neuroma
 Unilateral sensorineural hearing loss
 Absence of external ear pathology
 Aysmmetrical sensorineural hearing loss should be referred to
exclude this
 MRI gold standard investigation
 Sudden sensorineural hearing loss




Urgent referral
60% idiopathic (spontaneous resolution 3 days-2 weeks)
Labyrinthine viral infection (CMV/ mumps)
Labyrinthine vascular compromise (hypercoagulable states or
emboli)
 Immune mediated inner ear disease
Aids to hearing
 Improve communication by:




Reduce background noise
Use short sentences
Speak clearly
Good lighting
 Environmental aids
 Changing doorbells to flashing lights
 Telephones fitted with volume controls/ converted to be
used with T induction aids
 Electronic hearing aids
 Use electromagnetic induction waves to provide sound
and cut out background noise
 Common problems:
 Acoustic feedback due to poorly fitted ear moulds
 Otorrhohea (otitis externa/ allergy to the mould)
 Non-allergic material or bone anchored hearing aids
 Cochlear implants
 Non-functioning cochlea and functioning auditory nerves
Summary
 Hearing loss is more common that we think
 Thorough clinical assessment and examination
 Conductive vs Sensorineural hearing loss
 Unilateral sensorineural hearing loss should be treated
as acoustic neuroma until proven otherwise
 There are a lot more we can do for patients with
hearing loss