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

• 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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