Hearing Loss – Acquired (In A Page: Pediatric Signs and Symptoms)
Hearing Loss – Acquired
All patients with suspected hearing loss require formal audiologic testing to characterize the nature (conductive, sensorineural, mixed) and extent of the loss. Early treatment is essential, as is early habilitation for those in whom the hearing loss is not reversible.
Differential Diagnosis
Conductive (CHL)
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Cerumen impaction
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External auditory canal foreign body
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Middle ear effusion (MEE)
–Frequently follows acute otitis media
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Tympanic membrane (TM) perforation
–Usually due to trauma, chronic otitis media
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Cholesteatoma
–Acquired cholesteatoma is accompanied by TM retraction or perforation
–Congenital cholesteatoma is usually over an intact TM
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Ossicular erosion or fixation due to middle ear disease
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Ossicular chain discontinuity (generally posttraumatic)
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External auditory canal stenosis from chronic otitis externa
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Middle ear tumor
–Paraganglioma (glomus tympanicum), facial neuroma, histiocytosis X, etc.
Sensorineural (SNHL)
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Meningitis, especially bacterial
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Viral, especially mumps
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Autoimmune disease
–Vasculitis, scleroderma, Kawasaki disease
–Idiopathic
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Acoustic trauma (noise-induced)
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Ototoxic medications
–Aminoglycosides
–Diuretics (especially loop diuretics)
–Salicylates
–Cytotoxic (chemotherapeutic) agents, e.g., cisplatinum
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Temporal bone fracture
–SNHL more likely with transverse than longitudinal fracture
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Perilymphatic fistula (PLF)
–Hearing loss may be progressive or
fluctuating
- Cerebellopontine angle (CPA) tumor
–Vestibular schwannoma (a.k.a. acoustic neuroma, associated with type II neurofibromatosis), meningioma, etc.
–SNHL will be unilateral - Ménière disease
–Characterized by hearing loss, vertigo, tinnitus, sensation of aural fullness
Workup and Diagnosis
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History
–Ask about risk factors for SNHL
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Physical exam
–Check external auditory canal for patency
–Check TM for perforation or cholesteatoma
- Audiometric testing
–Classifies hearing loss as conductive, sensorineural, or mixed
–Quantifies the extent of the hearing loss for the full spectrum of sound frequencies
–If too young for ear-specific behavioral testing, obtain otoacoustic emissions and/or auditory brainstem response testing
–Tympanometry to objectively assess mobility (can help with diagnosis of MEE, ossicular discontinuity, and otosclerosis)
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CT scan of temporal bones (fine cuts, axial and/or coronal, noncontrast) for CHL if cholesteatoma or trauma suspected
–Determines extent of bony erosion or involvement, and whether mastoid cavity is involved
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MRI with gadolinium of internal auditory canals for
asymmetric SNHL
–Rule out CPA tumors
Treatment
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Cerumen removal
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Tympanostomy tube placement for chronic MEE lasting >3 months if bilateral, >6 months if unilateral
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Tympanoplasty for TM perforation
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Tympanomastoidectomy for cholesteatoma
–Effort to keep external auditory canal wall intact, with second look procedure planned for 6 months later
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Ossicular chain reconstruction (OCR, ossiculoplasty) with prosthesis or incus graft for ossicular anomalies
–Including after cholesteatoma resection
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Exploratory tympanotomy for suspected PLF
–If present, seal off oval and round windows
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Resection of CPA tumor
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Steroids for autoimmune SNHL (systemic or intratympanic)
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Cochlear implants for profound pre- or postlingual deafness
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Habilitation of any post-treatment hearing loss
Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2007 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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