Download Hear ye, Hear ye

Hear ye, Hear ye,
Or 10 minutes on hearing loss
The ear
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Assessment 1
• History - as ever, onset and progression
sudden loss may follow
trauma/infection/idiopathic REFER
IMMEDIATELY as can use steroids,
hyperbaric O2 etc, 70% recover
spontaneously
• Acoustic neuroma may present as sudden
onset unilat in 10%
• Menieres, fluc loss
Assmt 2
• Presbyacusis and otosclerosis more gradual,
noise insidious
• Side - unilat more significant, unilat
conductive in an adult may be
nasopharyngeal Ca.
• Other sx, tinnitus - ‘sound of silence’ any
cause reducing external noise may cause common with noise exposure, head injury ,
drugs and radiation
Assmt 3
• Noise hx - pattern usually high
frequency around 4khz.
• Drug hx, chemo/radiorx
• Family hx
• Exam - wax, effns and tuning fork test
• Kids - preg, delivery and devlmt.
Normal Audiogram
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Classification
• Conductive - something in outer or
middle ear
• Sensorineural - inner ear or auditory
nerve
• Mixed
• Central - lesion in brain or auditory
pathway.
Sensorineural
• Includes lesions of the cochlea and
neural pathways
• Affects kids and adults, in kids acqd or
congenital - often assoc with congen
syndromes
• Rinnes air louder than bone and
Webers lateralises to less affected ear
Acquired
• Infective - rubella, congen CMV, toxo,
meningitis, mumps.
• Neoplastic - acoustic neuroma (occipital pain,
VIII nerve damage, unilat sensorineural,
vertigo and tinnitus uncommon,V damage, VII
unusual)
• Trauma - chronic noise, fracture,perilymph
leak, surgery
• Metabolic - DM, pagets, hypothyroid,
Pendreds
Noise exposure
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Acquired 2
• Toxic - drugs - often starts wih
tinnitus,then grad hearing loss
• Presbyacusis - Progressive
sensorineural loss with age, typically
high frquency due to cochlear cell loss,
words merge and shouting doesn’t help!
Prebyacusis
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Acquired 3
• Otosclerosis - more in conductive but can
also cause sensorineural due to otosclerosis
in labarynthine capsule.
• Menieres - usually unilat, known also as
ideopathicendolymphatic hydrops.,
combination of vertigo, tinnitus and hearing
loss episodically rare, prevalence of
43/100000 - get low frequency loss
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A bit more on menieres
• In acute attck, lie down, still with eyes
open on fixed object
• Get up slowly , use prochloperazine or
cinnarizine
• Between attacks, restrict salt,
betahisitine, adequate even fluids, no
MSG. there is surgery.
Congenital
• Genetic sydromes- quite a few, e.g with
retinitis pig = Ushers
• Chromasomal probs Downs can cause
Conductive causes
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•
•
•
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Otitis media with effusion
Acute otitis media
Otitis externa
Congenital or acquired stenosis
Chronic middle ear disease incl
cholesteatoma
• Otosclerosis - formation of new bone around
footplates of stapes, more common in women,
pregnancy worsens, rx with aids and surgery
although 2% risk total hearing loss with
stapedectomy.
Conductive causes 2
• Trauma
• Wax
• Foreign body
A bit more on OM with
effusion
• Commonest cause of hearing imprmt in kids,
80% kids at some point
• 50% resolve in 3/12 if more than 6/12 may be
a problem
• Mild balance probs common
• Watchful waiting good mx for 1st 3/12
• No evidence decongestants etc help
• Surgical mx with grommets to prevent delay
• Not established who. Cipro if otorrhoea
• Adenoidectomy recommended with
grommets.
Eardrum of…
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