Otology ReviewConductive Hearing Loss

Quinton Gopen , M.D.UCLA Medical Center

October 26th, 2011

Case 1• 42y.o. woman with bilateral hearing loss

– Slowly progressive– No history of ear infections, trauma– No dizziness but has tinnitus

– Exam:• Tympanic membrane is normal• Tuning fork flipped bilaterally

Audiogram

Case 1

• What is your diagnosis?

• What is Schwartze sign?

• What are your treatment options?

Audiogram

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Case 1

• How does this change your treatment options?

• What would the finding on a CT scan be?

Case 2

• 5y.o. girl fails her school screening test– Failed her newborn screen as well– No h/o ear infections– some speech and language delay– No dizziness or other complaints

• Walked at 11months

– Exam: normal ear drum

WRS100%Both ears

Case 2

What is your differential diagnosis at this point?

What other tests do you want?

Case 2

Case 2

What are your management options?

Case 2

Case 2

• What are your management options?

• How do you address malleus fixation surgically?

Case 3• A 7y.o. boy with unilateral hearing

loss– Has had many ear infections and 3 prior

sets of ear tubes– Ear exam:

Case 3Multiple ear infections and prior ear tubes

Ear Exam:

Case 4

• 12 y.o. girl with unilateral hearing loss– Ear pain and drainage for one year– Never had ear surgery– No dizziness, balance issues

Case 4

Case 4

• What are some complications of this condition?

• What is your management of this condition?

Complications• Extracranial

– Conductive hearing loss

– Sensorineural hearing loss

– Facial paralysis– Vertigo– Subperiosteal

abscess– Petrous apicitis– Labyrinthine fistula– Bezold’s abscess– Cutaneous fistula

• Intracranial

– Meningitis– Encephalocele– Epidural, subdural or

intracerebral abscess– Lateral sinus

thrombosis– Otitic hydrocephalus– Cerebrospinal fluid

leak

Case 5• A 2 year old boy has hearing loss

– Failed newborn screen– Walked at 18 months– No significant ear infection– Exam is normal

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FREQUENCY IN HERTZ (Hz)H

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Case 5

• What is your management of this condition?

• What further tests can be ordered to clinch the diagnosis?

VEMP Waveforms

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