Hearing Loss (In a Page: Signs and Symptoms)
Hearing Loss
Hearing loss affects about 10% of the U.S. population. Two broad categories of hearing loss exist, conductive and sensorineural. Conductive hearing loss results from any process that prevents sound from reaching the inner ear. Sensorineural hearing loss refers to nerve-type hearing loss in either the inner ear or the auditory nerve. Early diagnosis allows early intervention, which has important implications in speech and language development in children.
Differential Diagnosis
Conductive hearing loss: Results from any process preventing sound from reaching the inner ear
–Obstruction of the ear canal, usually due to cerumen impaction or foreign body
–Otitis media with middle ear effusion (most common in children but also occurs in adults)
–Chronic otitis media: Permanent change in the ear (e.g., tympanic membrane perforation, ossicular chain discontinuity and fixation, cholesteatoma) secondary to otitis media
–Congenital atresia of the external auditory canal
- Sensorineural hearing loss: Nerve type hearing loss, either in the inner ear or the auditory nerve
–Presbycusis is the most common form
–Noise-induced hearing (occupational or nonoccupational)
–Hereditary sensorineural hearing loss, usually autosomal recessive heritance
–Medications (e.g., aminoglycosides, chemotherapeutics, diuretics)
–Ménie're's disease: Hearing loss, tinnitus, vertigo, and aural fullness
–Acoustic neuroma: Results in unilateral hearing loss and tinnitus as the initial symptoms in 90% of patients
–Alport's syndrome: Hereditary nephritis, sensorineural deafness, ocular abnormalities)
- Mixed hearing loss (both conductive and sensorineural hearing loss)
–Wardenberg's syndrome
–Prolonged QT syndrome variant
–Other causes of congenital deafness
–Meningitis
–Vascular (e.g., embolism, thrombosis,
hemorrhage)
–Viral (e.g., mumps, measles, influenza, varicella, adenovirus, EBV)
Workup and Diagnosis
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Otologic history should include duration of hearing loss, laterality, otorrhea, tinnitus, associated dizziness, family history, and a focused medical history (e.g., exposure to gentamicin, history of infections)
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Weber's and Rinne's tuning fork testing may be used to determine conductive hearing loss versus sensorineural; however, audiogram is the definitive test
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Otoacoustic emission and auditory brainstem response are objective tests of nerve function; these are increasingly being used to screen for hearing loss in newborns
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CT scan of the temporal bones may be helpful in evaluating conductive hearing loss
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MRI with gadolinium is indicated for all patients with unilateral sensorineural hearing loss or tinnitus to evaluate for acoustic neuroma
Treatment
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In many cases, the physical exam is therapeutic, because it involves cleaning the ear canal
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For middle ear effusions, a course of antibiotics and observation is usually sufficient; if symptoms persist, myringotomy and tube placement may be indicated
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Hearing aids are helpful for most cases of conductive or sensorineural hearing loss
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Middle ear implantable devices for moderate to severe sensorineural hearing loss
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Cochlear implants may be indicated for severe to profound sensorineural hearing loss if hearing aids are of minimal or no benefit
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Reconstructive middle ear surgery may be necessary, and includes tympanoplasty and stapedectomy
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Prevention of additional hearing loss by ear protection
Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
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More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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