Causes of Noise-Induced Hearing Loss
Noise-Induced Hearing Loss Causes: Book Excerpts
Related information on causes of Noise-Induced Hearing Loss:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Noise-Induced Hearing Loss may be found in:
Causes of Noise-Induced Hearing Loss: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the causes of Noise-Induced Hearing Loss.
Hearing Loss:
Differential Diagnosis
(In a Page: Signs and Symptoms)
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)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Tinnitus:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Acute or chronic otitis media
-
Impacted cerumen
-
Eustachian tube dysfunction
–“Ocean roar” that may wax and wane with respiration
-
Dysfunctional hearing aid
-
Presbycusis (high pitch)
-
Idiopathic (low pitch)
-
Noise-induced hearing loss (high pitch)
-
Meniere's disease
–Triad of tinnitus, hearing loss, and vertigo
-
Ototoxicity secondary to drugs
–High pitch
–May persist after medication (e.g., aminoglycosides)
–May be dose-related (e.g., aspirin)
-
Trauma
–Commonly associated with airbag, whiplash, barotrauma
–May have ruptured tympanic membrane
-
TMJ syndrome
–Nonpulsatile tinnitus (Costen's syndrome)
–Associated jaw symptoms (e.g., pain, clicking)
-
Migraine headache
-
Vascular disease (e.g., atherosclerosis, diabetic vasculopathy, arteriovenous malformation, small vessel disease, hypertension)
-
Stroke
-
Otosclerosis
–Associated with chronic otitis media or tympanic membrane trauma
-
Pseudotumor cerebri
-
Tumor
–Glomus tympanicum or jugulare: Pulsatile tinnitus with hearing loss
–Acoustic neuroma: Unilateral hearing loss and tinnitus, headache
-
Infections (e.g., meningitis, Lyme disease, rubella)
-
Less common etiologies (“zebras”) include thyroid disease, Paget's disease, myoclonus of palatal muscles, fetal insults (infections, toxins), sickle cell disease, osteogenesis imperfecta, neurosyphilis, symptomatic Chiari malformation, late onset congenital hearing loss, dissecting aneurysm, carotid cancer, and multiple sclerosis
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Tinnitus:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Impacted cerumen
-
Eustachian tube dysfunction
–“Ocean roar” that may wax and wane with respiration
-
Acute otitis media
–Red TM with poor movement, ±fluid
-
Chronic otitis media
–Persistent otitis with poor TM movement
-
Noise-induced hearing loss
–High pitch
-
Trauma
–Airbag, whiplash, barotrauma, etc.
-
Temporal-mandibular joint disorder
–Nonpulsatile tinnitus
-
Migraine
-
Ototoxicity
–High pitch
–Many drugs, including salicylates and aminoglycosides
-
Otosclerosis
-
Pseudotumor cerebri
-
Infections (meningitis, Lyme disease, rubella)
-
Acquired AVM, arterial bruit, venous hum (positional change of tinnitus)
-
Tumor
–Glomus tympanicum or jugulare (pulsatile tinnitus with hearing loss)
–Acoustic neuroma
-
Thyroid disease
-
Autoimmune inner ear disease
-
Idiopathic
–Low pitch
-
Fetal insults
–Infections, toxins, etc.
-
Sickle cell disease, anemia
-
Osteogenesis imperfecta
-
Symptomatic Chiari malformation
-
Late-onset congenital hearing loss
-
Less common causes are
–Hypertension
–Myoclonus of palatal muscles
–Multiple sclerosis
–Small vessel disease
–Presbycusis (high pitch)
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Hearing Loss – Acquired:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
Conductive (CHL)
-
Cerumen impaction
-
External auditory canal foreign body
-
Middle ear effusion (MEE)
–Frequently follows acute otitis media
-
Tympanic membrane (TM) perforation
–Usually due to trauma, chronic otitis media
-
Cholesteatoma
–Acquired cholesteatoma is accompanied by TM retraction or perforation
–Congenital cholesteatoma is usually over an intact TM
-
Ossicular erosion or fixation due to middle ear disease
-
Ossicular chain discontinuity (generally posttraumatic)
-
External auditory canal stenosis from chronic otitis externa
-
Middle ear tumor
–Paraganglioma (glomus tympanicum), facial neuroma, histiocytosis X, etc.
Sensorineural (SNHL)
-
Meningitis, especially bacterial
-
Viral, especially mumps
-
Autoimmune disease
–Vasculitis, scleroderma, Kawasaki disease
–Idiopathic
-
Acoustic trauma (noise-induced)
-
Ototoxic medications
–Aminoglycosides
–Diuretics (especially loop diuretics)
–Salicylates
–Cytotoxic (chemotherapeutic) agents, e.g., cisplatinum
-
Temporal bone fracture
–SNHL more likely with transverse than longitudinal fracture
-
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
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Hearing Loss – Congenital:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Infections
–CMV: Most common intrauterine infection
causing hearing loss
–Bacterial meningitis
–Congenital rubella: Cataracts, cardiovascular
anomalies, retinitis, mental retardation
–Congenital syphilis
–Toxoplasmosis
–Lyme disease - Metabolic
–Hyperbilirubinemia (kernicterus): Consider phototherapy or exchange transfusion if serum bilirubin >20 mg/dL in newborn
–Hypercholesterolemia
-
Ototoxic medications
–Aminoglycoside, gentamicin often needed for perinatal sepsis; >5 days risks hearing loss
-
Temporal bone anomaly
–Middle ear anomaly (results in conductive
hearing loss)
–Perilymphatic fistula
–Dilated vestibular aqueduct (±Mondini
deformity)
–Michel cochlear aplasia
–Scheibe aplasia: Membranous aplasia; bony
labyrinth normal
-
Nonsyndromic hereditary congenital deafness (connexin 26 gene mutation is responsible for half of all genetic deafness)
-
Syndromic hereditary congenital deafness
–Waardenburg: Telecanthus, confluent eyebrow, colored irides, white forlock
–Usher: Retinitis pigmentosa (totally blind by second to third decade), ataxia, vestibular dysfunction
–Alport: Progressive nephritis and hearing loss
–Apert (acrocephalosyndactyly): Craniofacial dysostosis
–Crouzon (craniofacial dysostosis): Prognathic mandibile, small maxilla
–Jervell and Lange-Neilsen: Heart disease
(prolonged QT interval)
–Pendred: Euthyroid goiter
–Oto-palatal-digital: Cleft palate, stubby
clubbed digits
–Congential aural atresia
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Hearing loss:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Acoustic neuroma
Acoustic neuroma, which is a CN VIII tumor, causes unilateral, progressive, sensorineural hearing loss The patient may also develop tinnitus, vertigo, and — with cranial nerve compression — facial paralysis.
Adenoid hypertrophy
Eustachian tube dysfunction causes gradual conductive hearing loss accompanied by intermittent ear discharge The patient also tends to breathe through his mouth and may complain of a sensation of ear fullness.
Aural polyps
If a polyp occludes the external auditory canal, partial hearing loss may occur The polyp typically bleeds easily and is covered by a purulent discharge.
Cholesteatoma
Gradual hearing loss is characteristic It can be accompanied by vertigo and, at times, facial paralysis
Examination reveals eardrum perforation, pearly white balls in the ear canal, and possible discharge.
Cyst
Ear canal obstruction by a sebaceous or dermoid cyst causes progressive conductive hearing loss On inspection, the cyst looks like a soft mass.
External ear canal tumor (malignant)
Progressive conductive hearing loss is characteristic and is accompanied by deep, boring ear pain, purulent discharge and, eventually, facial paralysis Examination may detect the granular, bleeding tumor.
Glomus jugulare tumor
Initially, this benign tumor causes mild, unilateral conductive hearing loss that becomes progressively more severe The patient may report tinnitus that sounds like his heartbeat
Associated signs and symptoms include gradual congestion in the affected ear, throbbing or pulsating discomfort, bloody otorrhea, facial nerve paralysis, and vertigo. Although the tympanic membrane is normal, a reddened mass appears behind it.
Head trauma
Sudden conductive or sensorineural hearing loss may result from ossicle disruption, ear canal fracture, tympanic membrane perforation, or cochlear fracture associated with head trauma Typically, the patient reports a headache and exhibits bleeding from his ear
Neurologic features vary and may include impaired vision and an altered level of consciousness.
Ménière’s disease
Initially, Ménière’s disease, an inner ear disorder, produces intermittent, unilateral sensorineural hearing loss that involves only low tones Later, hearing loss becomes constant and affects other tones
Associated signs and symptoms include intermittent severe vertigo, nausea and vomiting, a feeling of fullness in the ear, a roaring or hollow-seashell tinnitus, diaphoresis, and nystagmus.
Nasopharyngeal cancer
Nasopharyngeal cancer causes mild unilateral conductive hearing loss when it compresses the eustachian tube
Bone conduction is normal, and inspection reveals a retracted tympanic membrane backed by fluid. When this tumor obstructs the nasal airway, the patient may exhibit nasal speech and a bloody nasal and postnasal discharge. Cranial nerve involvement produces other findings, such as diplopia and rectus muscle paralysis.
Otitis externa
Conductive hearing loss resulting from debris in the ear canal characterizes acute and malignant otitis externa With acute otitis externa, ear canal inflammation produces pain, itching, and a foul-smelling, sticky yellow discharge
Severe tenderness is typically elicited by chewing, opening the mouth, and pressing on the tragus or mastoid. The patient may also develop a low-grade fever, regional lymphadenopathy, a headache on the affected side, and mild to moderate pain around the ear that may later intensify. Examination may reveal greenish white debris or edema in the canal.
With malignant otitis externa, debris is also visible in the canal. This life-threatening disorder, which most commonly occurs in the patient with diabetes, causes sensorineural hearing loss, pruritus, tinnitus, and severe ear pain.
Otitis media
Otitis media is a middle ear inflammation that typically produces unilateral conductive hearing loss In patients with acute suppurative otitis media, the hearing loss develops gradually over a few hours and is usually accompanied by an upper respiratory tract infection with a sore throat, cough, nasal discharge, and headache. Related signs and symptoms include dizziness, a sensation of fullness in the ear, intermittent or constant ear pain, a fever, nausea, and vomiting. Rupture of the bulging, swollen tympanic membrane relieves the pain and produces a brief, bloody, purulent discharge. Hearing returns after the infection subsides.
Hearing loss also develops gradually in patients with chronic otitis media. Assessment may reveal a perforated tympanic membrane, purulent ear drainage, an earache, nausea, and vertigo.
Commonly associated with an upper respiratory tract infection or nasopharyngeal cancer, serous otitis media commonly produces a stuffy feeling in the ear and pain that worsens at night. Examination reveals a retracted — and perhaps discolored — tympanic membrane and possibly air bubbles behind the membrane.
Otosclerosis
Otosclerosis is a hereditary disorder in which unilateral conductive hearing loss usually begins when the patient is in his early twenties and may gradually progress to bilateral mixed loss The patient may report tinnitus and an ability to hear better in a noisy environment
The deafness is usually noticed between ages 11 and 30.
Gender cue
Otosclerosis affects twice as many women as men, and the condition may worsen during pregnancy.
Skull fracture
Auditory nerve injury causes sudden unilateral sensorineural hearing loss Accompanying signs and symptoms include ringing tinnitus, blood behind the tympanic membrane, scalp wounds, and other findings.
Temporal bone fracture
Temporal bone fracture can cause sudden unilateral sensorineural hearing loss accompanied by hissing tinnitus The tympanic membrane may be perforated, depending on the fracture’s location
Loss of consciousness, Battle’s sign, and facial paralysis may also occur.
Tympanic membrane perforation
Commonly caused by trauma from sharp objects or rapid pressure changes, perforation of the tympanic membrane causes abrupt hearing loss along with ear pain, tinnitus, vertigo, and a sensation of fullness in the ear.
Other causes
Drugs
Ototoxic drugs typically produce ringing or buzzing tinnitus and a feeling of fullness in the ear Chloroquine, cisplatin, vancomycin, and aminoglycosides (especially neomycin, kanamycin, and amikacin) may cause irreversible hearing loss
Loop diuretics, such as furosemide, ethacrynic acid, and bumetanide, usually produce a brief, reversible hearing loss. Quinine, quinidine, and high doses of erythromycin or salicylates (such as aspirin) may also cause reversible hearing loss.
Radiation therapy
Irradiation of the middle ear, thyroid, face, skull, or nasopharynx may cause eustachian tube dysfunction, resulting in hearing loss
Surgery
Myringotomy, myringoplasty, simple or radical mastoidectomy, or fenestrations may cause scarring that interferes with hearing.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Tinnitus:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Acoustic neuroma
An early symptom of acoustic neuroma — an eighth cranial nerve tumor — unilateral tinnitus precedes unilateral sensorineural hearing loss and vertigo. Facial paralysis, headache, nausea, vomiting, and papilledema may also occur.
Atherosclerosis of the carotid artery
With atherosclerosis of the carotid artery, the patient has constant tinnitus that can be stopped by applying pressure over the carotid artery. Auscultation over the upper part of the neck, on the auricle, or near the ear on the affected side may detect a bruit. Palpation may reveal a weak carotid pulse.
Cervical spondylosis
With degenerative cervical spondylosis, osteophytic growths may compress the vertebral arteries, resulting in tinnitus. Typically, a stiff neck and pain aggravated by activity accompany tinnitus. Other features include brief vertigo, nystagmus, hearing loss, paresthesia, weakness, and pain that radiates down the arms.
Eustachian tube patency
Normally, the eustachian tube remains closed, except during swallowing. However, persistent patency of this tube can cause tinnitus, audible breath sounds, loud and distorted voice sounds, and a sense of fullness in the ear. Examination with a pneumatic otoscope reveals movement of the tympanic membrane with respirations. At times, breath sounds can be heard with a stethoscope placed over the auricle.
Glomus jugulare (tympanicum tumor)
A pulsating sound is usually the first symptom of this tumor. Other early features include a reddish blue mass behind the tympanic membrane and progressive conductive hearing loss. Later, total unilateral deafness is accompanied by ear pain and dizziness. Otorrhagia may also occur if the tumor breaks through the tympanic membrane.
Hypertension
Bilateral, high-pitched tinnitus may occur with severe hypertension. Diastolic blood pressure exceeding 120 mm Hg may also cause severe, throbbing headache, restlessness, nausea, vomiting, blurred vision, seizures, and decreased level of consciousness.
Labyrinthitis (suppurative)
With labyrinthitis, tinnitus may accompany sudden, severe attacks of vertigo, unilateral or bilateral sensorineural hearing loss, nystagmus, dizziness, nausea, and vomiting.
Ménière’s disease
Most common in adults — especially in men between ages 30 and 60 — Ménière’s disease is a labyrinthine disease that’s characterized by attacks of tinnitus, vertigo, a feeling of fullness or blockage in the ear, and fluctuating sensorineural hearing loss. These attacks last from 10 minutes to several hours; they occur over a few days or weeks and are followed by a remission. Severe nausea, vomiting, diaphoresis, and nystagmus may also occur during attacks.
Ossicle dislocation
Acoustic trauma, such as a slap on the ear, may dislocate the ossicle, resulting in tinnitus and sensorineural hearing loss. Bleeding from the middle ear may also occur.
Otitis externa (acute)
Although not a major complaint with otitis externa, tinnitus may result if debris in the external ear canal impinges on the tympanic membrane. More typical findings include pruritus, foul-smelling purulent discharge, and severe ear pain that’s aggravated by manipulation of the tragus or auricle, teeth clenching, mouth opening, and chewing. The external ear canal typically appears red and edematous and may be occluded by debris, causing partial hearing loss.
Otitis media
Otitis media may cause tinnitus and conductive hearing loss. However, its more typical features include ear pain, a red and bulging tympanic membrane, high fever, chills, and dizziness.
Otosclerosis
With otosclerosis, the patient may describe ringing, roaring, or whistling tinnitus or a combination of these sounds. He may also report progressive hearing loss, which may lead to bilateral deafness, and vertigo.
Presbycusis
Presbycusis is an otologic effect of aging that produces tinnitus and a progressive, symmetrical, bilateral sensorineural hearing loss, usually of high-frequency tones.
Tympanic membrane perforation
With tympanic membrane perforation, tinnitus and hearing loss go hand-in-hand. Tinnitus is usually the chief complaint in a small perforation; hearing loss is usually the chief complaint in a larger perforation. These symptoms typically develop suddenly and may be accompanied by pain, vertigo, and a feeling of fullness in the ear.
Other causes
Drugs and alcohol
An overdose of salicylates commonly causes reversible tinnitus. Quinine, alcohol, and indomethacin may also cause reversible tinnitus. Common drugs that may cause irreversible tinnitus include the aminoglycoside antibiotics (especially kanamycin, streptomycin, and gentamicin) and vancomycin.
Noise
Chronic exposure to noise, especially high-pitched sounds, can damage the ear’s hair cells, causing tinnitus and a bilateral hearing loss. These symptoms may be temporary or permanent.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Hearing loss:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Congenital hearing loss may be transmitted as a dominant, autosomal dominant, autosomal recessive, or sex-linked recessive trait. Hearing loss in neonates may also result from trauma, toxicity, or infection during pregnancy or delivery. Predisposing factors include a family history of hearing loss or known hereditary disorders (otosclerosis, for example), maternal exposure to rubella or syphilis during pregnancy, use of ototoxic drugs during pregnancy, prolonged fetal anoxia during delivery, and congenital abnormalities of the ears, nose, or throat. Premature or low-birth-weight neonates are most likely to have structural or functional hearing impairment; those with serum bilirubin levels above 20 mg/dl also risk hearing impairment from the toxic effect of high serum bilirubin levels on the brain. In addition, trauma during delivery may cause intracranial hemorrhage and may damage the cochlea or the acoustic nerve.
Sudden deafness refers to sudden hearing loss in a person with no prior hearing impairment. This condition is considered a medical emergency because prompt treatment may restore full hearing. Its causes and predisposing factors may include:
❑ acute infections, especially mumps (most common cause of unilateral sensorineural hearing loss in children), and other bacterial and viral infections, such as rubella, rubeola, influenza, herpes zoster, and infectious mononucleosis; and mycoplasma infections
❑ blood dyscrasias (leukemia, hypercoagulation)
❑ head trauma or brain tumors
❑ metabolic disorders (diabetes mellitus, hypothyroidism, hyperlipoproteinemia)
❑ neurologic disorders (multiple sclerosis, neurosyphilis)
❑ ototoxic drugs (tobramycin, streptomycin, quinine, gentamicin, furosemide, ethacrynic acid)
❑ vascular disorders (hypertension, arteriosclerosis).
Noise-induced hearing loss, which may be transient or permanent, may follow prolonged exposure to loud noise (85 to 90 dB) or brief exposure to extremely loud noise (greater than 90 dB). Such hearing loss is common in workers subjected to constant industrial noise and in military personnel, hunters, and rock musicians.
Presbycusis, an otologic effect of aging, results from a loss of hair cells in the organ of Corti. This disorder causes progressive, symmetrical, bilateral sensorineural hearing loss, usually of high-frequency tones.
Minor decreases in hearing are common after age 20. Some deafness due to nerve damage occurs in one of every five people by age 55.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Rape trauma syndrome:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Rape isn’t primarily about sex. It’s a violent crime linked to feelings of rage or hatred in the assailant. Some of the cultural, sociological, and psychological factors that contribute to rape are increased exposure to sex, permissiveness, cynicism about relationships, feelings of anger, and powerlessness amid social pressures. Many rapists have feelings of violence or hatred toward women or sexual problems, such as impotence or premature ejaculation. They may feel socially isolated and be unable to form warm, loving relationships. Some rapists may be psychopaths who need violence for physical pleasure, no matter how it affects their victims; others rape to satisfy a need for power. Some were abused as children.
In the United States, a rape is reported every 6 to 7 minutes. The incidence of reported rape is highest in large cities and continues to rise. However, many rapes — possibly even most — are never reported.
Known victims of rape range in age from 2 months to 97 years. The age group most affected is 10- to 19-year-olds; the average victim’s age is 13½". About one in seven reported rapes involves a prepubertal child; most of these cases involve manual, oral, or genital contact with the child’s genitals by a member of the child’s family. More than 50% of rapes occur in the home; about one-third of these involve a male intruder who forces his way into a home. In about half the cases, the victim has some casual acquaintance with the attacker. Most rapists are between ages 25 and 44 and have planned the attack. Alcohol is involved in one-third of cases.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Hearing loss:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acoustic neuroma
This eighth cranial nerve tumor causes unilateral, progressive, sensorineural hearing loss. The patient may also develop tinnitus, vertigo, and—with cranial nerve compression—facial paralysis.
Adenoid hypertrophy
Eustachian tube dysfunction gradually causes conductive hearing loss accompanied by intermittent ear discharge. The patient also tends to breathe through his mouth and may complain of a sensation of ear fullness.
Allergies
Conductive hearing loss may result when an allergy produces eustachian tube and middle ear congestion. Other features include ear pain or a feeling of fullness, nasal congestion, and conjunctivitis.
Aural polyps
If a polyp occludes the external auditory canal, partial hearing loss may occur. The polyp typically bleeds easily and is covered by a purulent discharge.
Cholesteatoma
Gradual hearing loss is characteristic in this disorder and may be accompanied by vertigo and, at times, facial paralysis. Examination reveals eardrum perforation, pearly white balls in the ear canal and, possibly, a discharge.
Cyst
Ear canal obstruction by a sebaceous or dermoid cyst causes progressive conductive hearing loss. On inspection, the cyst looks like a soft mass.
External ear canal tumor (malignant)
Progressive conductive hearing loss is characteristic and is accompanied by deep, boring ear pain; a purulent discharge; and eventually facial paralysis. Examination may detect the granular, bleeding tumor.
Furuncle
Reversible conductive hearing loss may occur when one of these painful, hard nodules forms in the ear. The patient may report a sense of fullness in the ear and pain on palpation of the tragus or auricle. Rupture relieves the pain and produces a purulent, necrotic discharge.
Glomus jugulare tumor
Initially, this benign tumor causes mild, unilateral conductive hearing loss that becomes progressively more severe. The patient may report tinnitus that sounds like his heartbeat. Associated signs and symptoms include gradual congestion in the affected ear, throbbing or pulsating discomfort, bloody otorrhea, facial nerve paralysis, and vertigo. Although the tympanic membrane is normal, a reddened mass appears behind it.
Glomus tympanum tumor
This cancerous middle ear tumor causes slowly progressive hearing loss and throbbing or pulsating tinnitus. It usually bleeds easily when manipulated. Late features include ear pain, dizziness, and total unilateral deafness.
Granuloma
A rare cause of conductive hearing loss, a granuloma may also produce fullness in the ear, deep-seated pain, and a bloody discharge.
Head trauma
Sudden conductive or sensorineural hearing loss may result from ossicle disruption, ear canal fracture, tympanic membrane perforation, or cochlear fracture associated with head trauma. Typically, the patient reports a headache and exhibits bleeding from his ear. Neurologic features vary and may include impaired vision and altered level of consciousness.
Herpes zoster oticus (Ramsay Hunt syndrome)
This syndrome causes sudden severe, unilateral mixed hearing loss, which may be accompanied by vesicles in the external ear, tinnitus, vertigo, ear pain, malaise, and transient ipsilateral facial paralysis.
Hypothyroidism
This disorder may produce reversible sensorineural hearing loss. Other effects include bradycardia, weight gain despite anorexia, mental dullness, cold intolerance, facial edema, brittle hair, and dry skin that’s pale, cool, and doughy.
Ménière’s disease
Initially, this inner ear disorder produces intermittent, unilateral sensorineural hearing loss that involves only low tones. Later, hearing loss becomes constant and affects other tones. Associated signs and symptoms include intermittent severe vertigo, nausea and vomiting, a feeling of fullness in the ear, a roaring or hollow-seashell tinnitus, diaphoresis, and nystagmus.
Multiple sclerosis
Rarely, this disorder causes sensorineural hearing loss associated with myelin destruction of the central auditory pathways. The hearing loss may be sudden and unilateral or intermittent and bilateral. Among other characteristics are impaired vision, paresthesia, muscle weakness, gait ataxia, intention tremor, urinary disturbances, and emotional lability.
Myringitis
Rarely, acute infectious myringitis produces conductive hearing loss when fluid accumulates in the middle ear or a large bleb totally obstructs the ear canal. Small, reddened inflamed blebs may develop in the canal, on the tympanic membrane, or in the middle ear and may produce a bloody discharge if they rupture. Associated findings may include severe ear pain, mastoid tenderness, and fever.
Chronic granular myringitis produces gradual hearing loss accompanied by pruritus and a purulent discharge.
Nasopharyngeal cancer
This type of cancer causes mild unilateral conductive hearing loss when it compresses the eustachian tube. Bone conduction is normal, and inspection reveals a retracted tympanic membrane backed by fluid. When this tumor obstructs the nasal airway, the patient may exhibit nasal speech and a bloody nasal and postnasal discharge. Cranial nerve involvement produces other findings, such as diplopia and rectus muscle paralysis.
Osteoma
Commonly affecting women and swimmers, osteoma may cause sudden or intermittent conductive hearing loss. Typically, bony projections are visible in the ear canal, but the tympanic membrane appears normal.
Otitis externa
Conductive hearing loss resulting from debris in the ear canal characterizes both acute and malignant otitis externa. In acute otitis externa, ear canal inflammation produces pain, itching, and a foul-smelling, sticky yellow discharge. Severe tenderness is typically elicited by chewing, opening the mouth, and pressing on the tragus or mastoid. The patient may also develop a low-grade fever, regional lymphadenopathy, a headache on the affected side, and mild to moderate pain around the ear that may later intensify. Examination may reveal greenish white debris or edema in the canal.
In malignant otitis externa, debris is also visible in the canal. This life-threatening disorder, which most commonly occurs in diabetics, causes sensorineural hearing loss, pruritus, tinnitus, and severe ear pain.
Otitis media
This middle ear inflammation typically produces unilateral conductive hearing loss. In acute suppurative otitis media, the hearing loss develops gradually over a few hours and is usually accompanied by an upper respiratory tract infection with sore throat, cough, nasal discharge, and headache. Related signs and symptoms include dizziness, a sensation of fullness in the ear, intermittent or constant ear pain, fever, nausea, and vomiting. Rupture of the bulging, swollen tympanic membrane relieves the pain and produces a brief bloody and purulent discharge. Hearing returns after the infection subsides.
Hearing loss also develops gradually in patients with chronic otitis media. Assessment may reveal a perforated tympanic membrane, purulent ear drainage, earache, nausea, and vertigo.
Commonly associated with an upper respiratory tract infection or nasopharyngeal cancer, serous otitis media commonly produces a stuffy feeling in the ear and pain that worsens at night. Examination reveals a retracted—and perhaps discolored—tympanic membrane and possibly air bubbles behind the membrane.
Otosclerosis
In this hereditary disorder, unilateral conductive hearing loss usually begins when the patient is in his early twenties and may gradually progress to bilateral mixed hearing loss. The patient may report tinnitus and an ability to hear better in a noisy environment.
Gender Cue: Otosclerosis affects twice as many women as men and may worsen during pregnancy.
Skull fracture
Auditory nerve injury causes sudden unilateral sensorineural hearing loss. Accompanying signs and symptoms include ringing tinnitus, blood behind the tympanic membrane, scalp wounds, and other findings.
Syphilis
In tertiary syphilis, sensorineural hearing loss may develop suddenly or gradually and usually affects one ear more than the other. It’s usually accompanied by a gumma lesion—a chronic, superficial nodule or a deep, granulomatous lesion on the skin or mucous membranes. The lesion is solitary, asymmetrical, painless, and indurated. The patient may also exhibit signs of liver, respiratory, cardiovascular, or neurologic dysfunction.
Temporal arteritis
This disorder may produce unilateral sensorineural hearing loss accompanied by throbbing unilateral facial pain, pain behind the eye, temporal or frontotemporal headache, and occasionally vision loss. The hearing loss is usually preceded by a prodrome of malaise, anorexia, weight loss, weakness, and myalgia that lasts for several days. Examination may reveal a nodular, swollen temporal artery. Low-grade fever, confusion, and disorientation may also occur.
Temporal bone fracture
This fracture can cause sudden unilateral sensorineural hearing loss accompanied by hissing tinnitus. The tympanic membrane may be perforated, depending on the fracture’s location. Loss of consciousness, Battle’s sign, and facial paralysis may also occur.
Tuberculosis
This pulmonary infection may spread to the ear, resulting in eardrum perforation, mild conductive hearing loss, and cervical lymphadenopathy.
Tympanic membrane perforation
Commonly caused by trauma from sharp objects or rapid pressure changes, perforation of the tympanic membrane causes abrupt hearing loss along with ear pain, tinnitus, vertigo, and a sensation of fullness in the ear.
Wegener’s granulomatosis
Conductive hearing loss develops slowly in this rare necrotizing, granulomatous vasculitis. This multisystem disorder may also cause cough, pleuritic chest pain, epistaxis, hemorrhagic skin lesions, oliguria, and nasal discharge.
Other causes
Drugs
Ototoxic drugs typically produce ringing or buzzing tinnitus and a feeling of fullness in the ear. Chloroquine, cisplatin, vancomycin, and aminoglycosides (especially neomycin, kanamycin, and amikacin) may cause irreversible hearing loss. Loop diuretics, such as furosemide, ethacrynic acid, and bumetanide, usually produce a brief, reversible hearing loss. Quinine, quinidine, and high doses of erythromycin or salicylates (such as aspirin) may also cause reversible hearing loss.
Radiation therapy
Irradiation of the middle ear, thyroid, face, skull, or nasopharynx may cause eustachian tube dysfunction, resulting in hearing loss.
Surgery
Myringotomy, myringoplasty, simple or radical mastoidectomy, or fenestrations may cause scarring that interferes with hearing.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Tinnitus:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acoustic neuroma
An early symptom of this eighth cranial nerve tumor, unilateral tinnitus precedes unilateral sensorineural hearing loss and vertigo. Facial paralysis, headache, nausea, vomiting, and papilledema may also occur.
Anemia
Severe anemia may produce mild, reversible tinnitus. Other common effects include pallor, weakness, fatigue, exertional dyspnea, tachycardia, bounding pulse, atrial gallop, and a systolic bruit over the carotid arteries.
Atherosclerosis of the carotid artery
In this disorder, the patient has constant tinnitus that can be stopped by applying pressure over the carotid artery. Auscultation over the upper part of the neck, on the auricle, or near the ear on the affected side may detect a bruit. Palpation may reveal a weak carotid pulse.
Cervical spondylosis
In this degenerative disorder, osteophytic growths may compress the vertebral arteries, resulting in tinnitus. Typically, a stiff neck and pain aggravated by activity accompany tinnitus. Other features include brief vertigo, nystagmus, hearing loss, paresthesia, weakness, and pain that radiates down the arms.
Ear canal obstruction
When cerumen or a foreign body blocks the ear canal, the patient may experience tinnitus, conductive hearing loss, itching, and a feeling of fullness or pain in the ear.
Eustachian tube patency
Normally, the eustachian tube remains closed, except during swallowing. However, persistent patency of this tube can cause tinnitus, audible breath sounds, loud and distorted voice sounds, and a sense of fullness in the ear. Examination with a pneumatic otoscope reveals movement of the tympanic membrane with respirations. At times, breath sounds can be heard with a stethoscope placed over the auricle.
Glomus jugulare or glomus tympanicum tumor
A pulsating sound is usually the first symptom of these tumors. Other early features include a reddish blue mass behind the tympanic membrane and progressive conductive hearing loss. Later, total unilateral deafness is accompanied by ear pain and dizziness. Otorrhagia may also occur if the tumor breaks through the tympanic membrane.
Hypertension
Severe hypertension (diastolic blood pressure exceeding 120 mm Hg) may cause bilateral high-pitched tinnitus, a severe throbbing headache, restlessness, nausea, vomiting, blurred vision, seizures, and decreased level of consciousness.
Intracranial arteriovenous malformation
A large malformation may cause pulsating tinnitus accompanied by a bruit over the mastoid process.
Labyrinthitis (suppurative)
In this disorder, tinnitus may accompany sudden, severe attacks of vertigo, unilateral or bilateral sensorineural hearing loss, nystagmus, dizziness, nausea, and vomiting.
Ménière’s disease
Most common in adults—especially in men between ages 30 and 60—this labyrinthine disease is characterized by attacks of tinnitus, vertigo, a feeling of fullness or blockage in the ear, and fluctuating sensorineural hearing loss. These attacks last from 10 minutes to several hours; they occur over a few days or weeks and are followed by a remission. Severe nausea, vomiting, diaphoresis, and nystagmus may also occur during attacks.
Ossicle dislocation
Acoustic trauma, such as a slap on the ear, may dislocate the ossicle, resulting in tinnitus and sensorineural hearing loss. Bleeding from the middle ear may also occur.
Otitis externa (acute)
Although not a major complaint in this disorder, tinnitus may result if debris in the external ear canal impinges on the tympanic membrane. More typical findings include pruritus, a foul-smelling purulent discharge, and severe ear pain that’s aggravated by manipulation of the tragus or auricle, teeth clenching, mouth opening, and chewing. The external ear canal typically appears red and edematous and may be occluded by debris, causing partial hearing loss.
Otitis media
This infection may cause tinnitus and conductive hearing loss. However, its more typical features include ear pain, a red and bulging tympanic membrane, high fever, chills, and dizziness.
Otosclerosis
In this disorder, the patient may describe ringing, roaring, or whistling tinnitus or a combination of these sounds. He may also report progressive hearing loss, which may lead to bilateral deafness, and vertigo.
Palatal myoclonus
In this disorder, muscles of the palate contract rhythmically, either intermittently or continuously, causing a clicking sound in the ear and vibratory tinnitus. The contractions are visible with a nasopharyngeal mirror.
Presbycusis
This otologic effect of aging produces tinnitus and progressive, symmetrical, bilateral sensorineural hearing loss, usually of high-frequency tones.
Tympanic membrane perforation
Tinnitus and hearing loss go hand-in-hand in this disorder. Tinnitus is usually the chief complaint in a small perforation; hearing loss, in a larger perforation. These symptoms typically develop suddenly and may be accompanied by pain, vertigo, and a feeling of fullness in the ear.
Other causes
Drugs and alcohol
An overdose of salicylates commonly causes reversible tinnitus. Quinine, alcohol, and indomethacin may also cause reversible tinnitus. Common drugs that may cause irreversible tinnitus include the aminoglycoside antibiotics (especially kanamycin, streptomycin, and gentamicin) and vancomycin.
Noise
Chronic exposure to noise, especially high-pitched sounds, can damage the ear’s hair cells, causing tinnitus and bilateral hearing loss. These symptoms may be temporary or permanent.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hearing Loss:
Differential Overview
(Field Guide to Bedside Diagnosis)
Sensorineural
❑ Presbyacusis
❑ Noise-induced loss
❑ Drugs
❑ Ménière disease
❑ Eighth nerve injury
❑ Acoustic neuroma
❑ Multiple sclerosis
Conductive
❑ Impacted cerumen
❑ Otitis media
❑ Middle ear effusion
❑ Perforation of tympanic membrane
❑ Otosclerosis
❑ Exostoses
❑ Developmental defect
❑ Glomus tumor
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Tinnitus:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Impacted cerumen
❑ Otitis media
❑ Eustachian dysfunction
❑ Presbyacusis
❑ Hypertension
❑ Drugs
❑ Ménière
❑ Arterial bruit
❑ Acoustic neuroma
❑ Vascular aneurysm
❑ Arteriovenous malformation
❑ Functional
❑ Glomus tumor
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Hearing loss:
Causes
(Handbook of Diseases)
Hearing loss may be congenital, or it may be caused by drugs, illness, loud noise, or aging.
Congenital hearing loss
Hearing loss may be transmitted as a dominant, autosomal dominant, autosomal recessive, or sex-linked recessive trait. In neonates, it may also result from trauma, toxicity, or infection during pregnancy or delivery.
Predisposing factors include a family history of hearing loss or known hereditary disorders (such as otosclerosis), maternal exposure to rubella or syphilis during pregnancy, use of ototoxic drugs during pregnancy, prolonged fetal anoxia during delivery, and congenital abnormalities of the ears, nose, or throat.
Premature or low-birth-weight infants are most likely to have structural or functional hearing impairments; those with serum bilirubin levels greater than 20 mg/dl also risk hearing impairment from the toxic effect of high serum bilirubin levels on the brain.
In addition, trauma during delivery may cause intracranial hemorrhage and damage the cochlea or acoustic nerve.
Sudden hearing loss
Sudden hearing loss may occur in a person with no prior hearing impairment. This condition is considered a medical emergency because prompt treatment may restore full hearing. Its causes and predisposing factors may include:
❑ acute infections, especially mumps (the most common cause of unilateral sensorineural hearing loss in children) and other bacterial and viral infections, such as rubella, rubeola, influenza, herpes zoster, and infectious mononucleosis, and mycoplasmal infections
❑ metabolic disorders, such as diabetes mellitus, hypothyroidism, and hyperlipoproteinemia
❑ vascular disorders, such as hypertension and arteriosclerosis
❑ head trauma or brain tumors
❑ ototoxic drugs, such as tobramycin, streptomycin, quinine, gentamicin, furosemide, and ethacrynic acid
❑ neurologic disorders, such as multiple sclerosis and neurosyphilis
❑ blood dyscrasias, such as leukemia and hypercoagulation.
Noise-induced hearing loss
Noise-induced hearing loss is caused by a loud noise and may be transient or permanent, and may follow prolonged exposure to loud noise (85 to 90 dB) or brief exposure to extremely loud noise (greater than 90 dB). Such hearing loss is common in workers subjected to constant industrial noise and in military personnel, hunters, and rock musicians.
Presbycusis
An otologic effect of aging, presbycusis results from a loss of hair cells in the organ of Corti. This disorder causes sensorineural hearing loss, usually of high-frequency tones.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Rape trauma syndrome:
Causes
(Handbook of Diseases)
Cultural, sociologic, and psychological factors that contribute to rape include increasing exposure to sex, permissiveness, cynicism about relationships, feelings of anger, and powerlessness amid social pressures.
A rapist usually has feelings of violence or hatred toward women or sexual problems, such as impotence or premature ejaculation. He may feel socially isolated and unable to form warm, loving relationships. Some rapists may be psychopaths who need violence for physical pleasure, no matter how it affects their victims; others rape to satisfy a need for power. Some were abused as children.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Hearing loss:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acoustic neuroma
An acoustic neuroma is an eighth cranial nerve tumor that causes unilateral, progressive, sensorineural hearing loss. The patient may also develop tinnitus, vertigo and, with cranial nerve compression, facial paralysis.
Adenoid hypertrophy
With adenoid hypertrophy, eustachian tube dysfunction gradually causes conductive hearing loss accompanied by intermittent ear discharge. The patient also tends to breathe through his mouth and may complain of a sensation of ear fullness.
Allergies
Conductive hearing loss may result when an allergy produces eustachian tube and middle ear congestion. Other features include ear pain or a feeling of fullness, nasal congestion, and conjunctivitis.
Cholesteatoma
Gradual hearing loss is characteristic in cholesteatoma. It can be accompanied by vertigo and, at times, facial paralysis. Examination reveals eardrum perforation, pearly white balls in the ear canal and, possibly, a discharge.
External ear canal tumor (malignant)
Progressive conductive hearing loss is characteristic of a malignant external ear canal tumor and is accompanied by deep, boring ear pain; purulent discharge; and eventually facial paralysis. Examination may detect the granular, bleeding tumor.
Furuncle
Reversible conductive hearing loss may occur when a furuncle (a painful, hard nodule) forms in the ear. The patient with a furuncle may report a sense of fullness in the ear and pain on palpation of the tragus or auricle. Boil rupture relieves the pain and produces a purulent, necrotic discharge.
Glomus jugulare tumor
Initially, glomus jugulare (a benign tumor) causes mild, unilateral conductive hearing loss that becomes progressively more severe. The patient may report tinnitus that sounds like his heartbeat. Associated signs and symptoms include gradual congestion in the affected ear, throbbing or pulsating discomfort, bloody otorrhea, facial nerve paralysis, and vertigo. Although the tympanic membrane is normal, a reddened mass appears behind it.
Head trauma
Sudden conductive or sensorineural hearing loss may result from ossicle disruption, ear canal fracture, tympanic membrane perforation, or cochlear fracture associated with head trauma. Typically, the patient reports a headache and exhibits bleeding from his ear. Neurologic features vary and may include impaired vision and altered level of consciousness.
Hypothyroidism
Hypothyroidism may produce reversible sensorineural hearing loss. Other effects include bradycardia, weight gain despite anorexia, mental dullness, cold intolerance, facial edema, brittle hair, and dry skin that’s pale, cool, and doughy.
Ménière’s disease
Initially, Ménière’s disease produces intermittent, unilateral sensorineural hearing loss that involves only low tones. Later in this inner ear disorder, hearing loss becomes constant and affects other tones. Associated signs and symptoms of Ménière’s disease include intermittent severe vertigo, nausea and vomiting, a feeling of fullness in the ear, a roaring or hollow-seashell tinnitus, diaphoresis, and nystagmus.
Osteoma
Commonly affecting women and swimmers, osteoma may cause sudden or intermittent conductive hearing loss. Typically, bony projections are visible in the ear canal, but the tympanic membrane appears normal.
Otitis externa
Conductive hearing loss resulting from debris in the ear canal characterizes both acute and malignant otitis externa. With acute otitis externa, ear canal inflammation produces pain, itching, and a foul-smelling, sticky yellow discharge. Severe tenderness is typically elicited by chewing, opening the mouth, and pressing on the tragus or mastoid. The patient may also develop a low-grade fever, regional lymphadenopathy, headache on the affected side, and mild-to-moderate pain around the ear that may later intensify. Examination may reveal greenish white debris or edema in the canal.
With malignant otitis externa, debris is also visible in the canal. This life-threatening disorder, which most commonly occurs in diabetics, causes sensorineural hearing loss, pruritus, tinnitus, and severe ear pain.
Otitis media
Otitis media is a middle ear inflammation that typically produces unilateral conductive hearing loss. In patients with acute suppurative otitis media, the hearing loss develops gradually over a few hours and is usually accompanied by an upper respiratory tract infection with sore throat, cough, nasal discharge, and headache. Related signs and symptoms include dizziness, a sensation of fullness in the ear, intermittent or constant ear pain, fever, nausea, and vomiting. Rupture of the bulging, swollen tympanic membrane relieves the pain and produces a brief, bloody, purulent discharge. Hearing returns after the infection subsides.
Hearing loss also develops gradually in patients with chronic otitis media. Assessment may reveal a perforated tympanic membrane, purulent ear drainage, earache, nausea, and vertigo.
Commonly associated with an upper respiratory tract infection or nasopharyngeal cancer, serous otitis media commonly produces a stuffy feeling in the ear and pain that worsens at night. Examination reveals a retracted — and perhaps discolored — tympanic membrane and, possibly, air bubbles behind the membrane.
Otosclerosis
In otosclerosis, a hereditary disorder, unilateral conductive hearing loss usually begins when the patient is in his early 20s and may gradually progress to bilateral mixed loss. The patient may report tinnitus and an ability to hear better in a noisy environment. The deafness is usually noticed between ages 11 and 30.
Skull fracture
Auditory nerve injury from a skull fracture causes sudden unilateral sensorineural hearing loss. Accompanying signs and symptoms include ringing tinnitus, blood behind the tympanic membrane, scalp wounds, and other findings.
Temporal arteritis
Temporal arteritis may produce unilateral sensorineural hearing loss accompanied by throbbing unilateral facial pain, pain behind the eye, temporal or frontotemporal headache and, occasionally, vision loss. The hearing loss is usually preceded by a prodrome of malaise, anorexia, weight loss, weakness, and myalgia that lasts for several days. Examination may reveal a nodular, swollen temporal artery. Low-grade fever, confusion, and disorientation may also occur.
Temporal bone fracture
Temporal bone fracture can cause sudden unilateral sensorineural hearing loss accompanied by hissing tinnitus. The tympanic membrane may be perforated, depending on the fracture’s location. Loss of consciousness, Battle’s sign, and facial paralysis may also occur.
Tuberculosis
Tuberculosis, a pulmonary infection, may spread to the ear, resulting in eardrum perforation, mild conductive hearing loss, and cervical lymphadenopathy. Other signs and symptoms include chest pain, crackles, dyspnea, fatigue, fever, and tachypnea.
Tympanic membrane perforation
Commonly caused by trauma from sharp objects or rapid pressure changes, perforation of the tympanic membrane causes abrupt hearing loss along with ear pain, tinnitus, vertigo, and a sensation of fullness in the ear.
Other causes
Drugs
Ototoxic drugs typically produce ringing or buzzing tinnitus and a feeling of fullness in the ear. Chloroquine, cisplatin, vancomycin, and aminoglycosides (especially neomycin, kanamycin, and amikacin) may cause irreversible hearing loss. Loop diuretics, such as furosemide, ethacrynic acid, and bumetanide, usually produce a brief, reversible hearing loss. Quinine, quinidine, and high doses of erythromycin or salicylates (such as aspirin) may also cause reversible hearing loss.
Radiation therapy
Irradiation of the middle ear, thyroid, face, skull, or nasopharynx may cause eustachian tube dysfunction, resulting in hearing loss.
Surgery
Myringotomy, myringoplasty, simple or radical mastoidectomy, or fenestrations may cause scarring that interferes with hearing.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Tinnitus:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acoustic neuroma
Acoustic neuroma, a tumor of the eighth cranial nerve, causes unilateral tinnitus that precedes early symptoms of unilateral sensorineural hearing loss and vertigo. Facial paralysis, headache, nausea, vomiting, and papilledema may also occur.
Anemia
Severe anemia may produce mild, reversible tinnitus. Other common effects include pallor, weakness, fatigue, exertional dyspnea, tachycardia, bounding pulse, atrial gallop, and a systolic bruit over the carotid arteries.
Atherosclerosis of the carotid artery
With atherosclerosis of the carotid artery, the patient has constant tinnitus that can be stopped by applying pressure over the carotid artery. Auscultation over the upper part of the neck, on the auricle, or near the ear on the affected side may detect a bruit. Palpation may reveal a weak carotid pulse.
Cervical spondylosis
With cervical spondylosis, a degenerative disorder, osteophytic growths may compress the vertebral arteries, resulting in tinnitus. Typically, a stiff neck and pain aggravated by activity accompany tinnitus. Other features include brief vertigo, nystagmus, hearing loss, paresthesia, weakness, and pain that radiates down the arms.
Ear canal obstruction
When cerumen or a foreign body blocks the ear canal, tinnitus may occur with conductive hearing loss, itching, blockage, and a feeling of fullness or pain in the ear.
Eustachian tube patency
Normally, the eustachian tube remains closed, except during swallowing. However, persistent patency of this tube can cause tinnitus, audible breath sounds, loud and distorted voice sounds, and a sense of fullness in the ear. Examination with a pneumatic otoscope reveals movement of the tympanic membrane with respirations. At times, breath sounds can be heard with a stethoscope placed over the auricle.
Hypertension
Bilateral, high-pitched tinnitus may occur with severe hypertension. Diastolic blood pressure exceeding 120 mm Hg may also cause severe, throbbing headache; restlessness; nausea; vomiting; blurred vision; seizures; and decreased level of consciousness.
Intracranial arteriovenous malformation
A large intracranial arteriovenous malformation may cause pulsating tinnitus accompanied by a bruit over the mastoid process. Other manifestations include severe headache, seizures, and progressive neurologic deficits.
Labyrinthitis (suppurative)
With suppurative labyrinthitis, tinnitus may accompany sudden, severe attacks of vertigo, unilateral or bilateral sensorineural hearing loss, nystagmus, dizziness, nausea, and vomiting.
Ménière’s disease
Ménière’s disease, a labyrinthine disease, is characterized by attacks of tinnitus, vertigo, a feeling of fullness or blockage in the ear, and fluctuating sensorineural hearing loss. These attacks last from 10 minutes to several hours; they occur over a few days or weeks and are followed by a remission. Severe nausea, vomiting, diaphoresis, and nystagmus may also occur during attacks.
Ossicle dislocation
Acoustic trauma, such as a slap on the ear, may dislocate the ossicle, resulting in tinnitus and sensorineural hearing loss. Bleeding from the middle ear may also occur.
Otitis externa (acute)
Although not a major complaint with otitis externa, tinnitus may result if debris in the external ear canal impinges on the tympanic membrane. More typical findings include pruritus, foul-smelling purulent discharge, and severe ear pain that’s aggravated by manipulation of the tragus or auricle, teeth clenching, mouth opening, and chewing. The external ear canal typically appears red and edematous and may be occluded by debris, causing partial hearing loss.
Otitis media
Otitis media may cause tinnitus and conductive hearing loss. However, its more typical features include ear pain, a red and bulging tympanic membrane, high fever, chills, and dizziness.
Otosclerosis
With otosclerosis, the patient may describe ringing, roaring, or whistling tinnitus or a combination of these sounds. He may also report progressive hearing loss, which may lead to bilateral deafness, and vertigo.
Presbycusis
Presbycusis, an otologic effect of aging, produces tinnitus and a progressive, symmetrical, bilateral sensorineural hearing loss, usually of high-frequency tones.
Tympanic membrane perforation
With tympanic membrane perforation, tinnitus and hearing loss go hand-in-hand. Tinnitus is usually the chief complaint in a small perforation; hearing loss, in a larger perforation. These symptoms typically develop suddenly and may be accompanied by pain, vertigo, and a feeling of fullness in the ear.
Other causes
Drugs and alcohol
An overdose of salicylates commonly causes reversible tinnitus. Quinine, alcohol, and indomethacin may also cause reversible tinnitus. Common drugs that may cause irreversible tinnitus include the aminoglycoside antibiotics (especially kanamycin, streptomycin, and gentamicin) and vancomycin.
Noise
Chronic exposure to noise, especially high-pitched sounds, can damage the ear’s hair cells, causing tinnitus and a bilateral hearing loss. These symptoms may be temporary or permanent.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Hearing Loss and Deafness:
Principal Causes of Hearing Loss and Deafness
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Conductivehearing loss
- Externalauditory canal disorders
- Atresia of external auditory canal
- Impacted cerumen
- Otitis externa
- Exostosis
- Masses
- Middle ear disorders
- Acuteand chronic otitis media
- Otitis media with effusion
- Tympanic membrane perforation
- Hemotympanum
- Tympanosclerosis
- Ossicular chain defect, disruption,or fixation
- Cholesteatoma and other middle earmasses
- Sensorineural hearing loss
- Sensorineuralhearing loss without associated abnormalities
- Sensorineural hearing loss with associatedabnormalities
- Chromosomal disorders
- Inner ear malformations
- Labyrinthineaplasia
- Common cavity malformation
- Cochlear malformations
- Large vestibular aqueduct
- Prematurity
- Hypoxic-ischemic encephalopathy
- Bilirubin encephalopathy (kernicterus)
- Infection
- Trauma
- Drugs
- Perilymph fistula
- Neoplasm
- Ménière disease
- Unknown
- Mixed hearing loss
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Hearing loss:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acoustic neuroma.Acoustic neuroma, which is a CN VIII tumor, causes unilateral, progressive, sensorineural hearing loss. The patient may also develop tinnitus, vertigo, and—with cranial nerve compression—facial paralysis.
Adenoid hypertrophy.Eustachian tube dysfunction causes gradual conductive hearing loss accompanied by intermittent ear discharge. The patient also tends to breathe through his mouth and may complain of a sensation of ear fullness.
Aural polyps.If a polyp occludes the external auditory canal, partial hearing loss may occur. The polyp typically bleeds easily and is covered by a purulent discharge.
Cholesteatoma.Gradual hearing loss is characteristic of cholesteatoma. It can be accompanied by vertigo and, at times, facial paralysis. Examination reveals eardrum perforation, pearly white balls in the ear canal, and possible discharge.
Cyst.Ear canal obstruction by a sebaceous or dermoid cyst causes progressive conductive hearing loss. On inspection, the cyst looks like a soft mass.
External ear canal tumor (malignant).Progressive conductive hearing loss is characteristic of an external ear canal tumor and is accompanied by deep, boring ear pain, purulent discharge and, eventually, facial paralysis. The patient may develop a rash in the external canal or pinna of the ear. Examination may detect the granular, bleeding tumor.
Glomus jugulare tumor.Initially, this benign tumor causes mild, unilateral conductive hearing loss that becomes progressively more severe. The patient may report tinnitus that sounds like his heartbeat. Associated signs and symptoms include gradual congestion in the affected ear, throbbing or pulsating discomfort, bloody otorrhea, facial nerve paralysis, and vertigo. Although the tympanic membrane is normal, a reddened mass appears behind it.
Head trauma.Sudden conductive or sensorineural hearing loss may result from ossicle disruption, ear canal fracture, tympanic membrane perforation, or cochlear fracture associated with head trauma. Typically, the patient reports a headache and exhibits bleeding from his ear. Neurologic features vary and may include impaired vision and an altered level of consciousness.
Ménière's disease.Initially, Ménière's disease, an inner ear disorder, produces intermittent, unilateral sensorineural hearing loss that involves only low tones. Later, hearing loss becomes constant and affects other tones. Associated signs and symptoms include intermittent severe vertigo, nausea and vomiting, a feeling of fullness in the ear, a roaring or hollow-seashell tinnitus, diaphoresis, and nystagmus.
Nasopharyngeal cancer.Nasopharyngeal cancer causes mild unilateral conductive hearing loss when it compresses the eustachian tube. Bone conduction is normal, and inspection reveals a retracted tympanic membrane backed by fluid. When this tumor obstructs the nasal airway, the patient may exhibit nasal speech and a bloody nasal and postnasal discharge. Cranial nerve involvement produces other findings, such as diplopia and rectus muscle paralysis.
Otitis externa.Conductive hearing loss resulting from debris in the ear canal characterizes acute and malignant otitis externa. With acute otitis externa, ear canal inflammation produces pain, itching, and a foul-smelling, sticky yellow discharge. Severe tenderness is typically elicited by chewing, opening the mouth, and pressing on the tragus or mastoid. The patient may also develop a low-grade fever, regional lymphadenopathy, a headache on the affected side, and mild to moderate pain around the ear that may later intensify. Examination may reveal greenish white debris or edema in the canal.
With malignant otitis externa, debris is also visible in the canal. This life-threatening disorder, which most commonly occurs in the patient with diabetes, causes sensorineural hearing loss, pruritus, tinnitus, and severe ear pain.
Otitis media.Otitis media is a middle ear inflammation that typically produces unilateral conductive hearing loss. In patients with acute suppurative otitis media, the hearing loss develops gradually over a few hours and is usually accompanied by an upper respiratory tract infection with a sore throat, cough, nasal discharge, and headache. Related signs and symptoms include dizziness, a sensation of fullness in the ear, intermittent or constant ear pain, a fever, nausea, and vomiting. Rupture of the bulging, swollen tympanic membrane relieves the pain and produces a brief, bloody, purulent discharge. Hearing returns after the infection subsides.
Hearing loss also develops gradually in patients with chronic otitis media. Assessment may reveal a perforated tympanic membrane, purulent ear drainage, an earache, nausea, and vertigo.
Commonly associated with an upper respiratory tract infection or nasopharyngeal cancer, serous otitis media commonly produces a stuffy feeling in the ear and pain that worsens at night. Examination reveals a retracted—and perhaps discolored—tympanic membrane and possibly air bubbles behind the membrane.
Otosclerosis.Otosclerosis is a hereditary disorder in which unilateral conductive hearing loss usually begins when the patient is in his early twenties and may gradually progress to bilateral mixed loss. The patient may report tinnitus and an ability to hear better in a noisy environment. The deafness is usually noticed between ages 11 and 30.
Skull fracture.With a skull fracture, auditory nerve injury causes sudden unilateral sensorineural hearing loss. Accompanying signs and symptoms include ringing tinnitus, blood behind the tympanic membrane, scalp wounds, and other findings.
Temporal bone fracture.Temporal bone fracture can cause sudden unilateral sensorineural hearing loss accompanied by hissing tinnitus. The tympanic membrane may be perforated, depending on the fracture's location. Loss of consciousness, Battle's sign, and facial paralysis may also occur.
Tympanic membrane perforation.Commonly caused by trauma from sharp objects or rapid pressure changes, perforation of the tympanic membrane causes abrupt hearing loss along with ear pain, tinnitus, vertigo, and a sensation of fullness in the ear.
Other causes
Drugs.Ototoxic drugs typically produce ringing or buzzing tinnitus and a feeling of fullness in the ear. Chloroquine, cisplatin, vancomycin, and aminoglycosides (especially neomycin, kanamycin, and amikacin) may cause irreversible hearing loss. Loop diuretics, such as furosemide, ethacrynic acid, and bumetanide, usually produce a brief, reversible hearing loss. Quinine, quinidine, and high doses of erythromycin or salicylates (such as aspirin) may also cause reversible hearing loss.
Radiation therapy.Irradiation of the middle ear, thyroid, face, skull, or nasopharynx may cause eustachian tube dysfunction, resulting in hearing loss.
Surgery.Myringotomy, myringoplasty, simple or radical mastoidectomy, or fenestrations may cause scarring that interferes with hearing.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Tinnitus:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acoustic neuroma.An early symptom of acoustic neuroma, unilateral tinnitus precedes unilateral sensorineural hearing loss and vertigo. Facial paralysis, headache, nausea, vomiting, and papilledema may also occur.
Atherosclerosis of the carotid artery.With atherosclerosis of the carotid artery, the patient has constant tinnitus that can be stopped by applying pressure over the carotid artery. Auscultation over the upper part of the neck, on the auricle, or near the ear on the affected side may detect a bruit. Palpation may reveal a weak carotid pulse.
Cervical spondylosis.With degenerative cervical spondylosis, osteophytic growths may compress the vertebral arteries, resulting in tinnitus. Typically, a stiff neck and pain aggravated by activity accompany tinnitus. Other features include brief vertigo, nystagmus, hearing loss, paresthesia, weakness, and pain that radiates down the arms.
Eustachian tube patency.Normally, the eustachian tube remains closed, except during swallowing. However, persistent patency of this tube can cause tinnitus, audible breath sounds, loud and distorted voice sounds, and a sense of fullness in the ear. Examination with a pneumatic otoscope reveals movement of the tympanic membrane with respirations. At times, breath sounds can be heard with a stethoscope placed over the auricle.
Glomus jugulare (tympanicum tumor).A pulsating sound is usually the first symptom of this tumor. Other early features include a reddish blue mass behind the tympanic membrane and progressive conductive hearing loss. Later, total unilateral deafness is accompanied by ear pain and dizziness. Otorrhagia may also occur if the tumor breaks through the tympanic membrane.
Hypertension.Bilateral, high-pitched tinnitus may occur with severe hypertension. Diastolic blood pressure exceeding 120 mm Hg may also cause a severe, throbbing headache, restlessness, nausea, vomiting, blurred vision, seizures, and decreased level of consciousness.
Labyrinthitis (suppurative).With labyrinthitis, tinnitus may accompany sudden, severe attacks of vertigo, unilateral or bilateral sensorineural hearing loss, nystagmus, dizziness, nausea, and vomiting.
Ménière's disease.Ménière's disease is characterized by attacks of tinnitus, vertigo, a feeling of fullness or blockage in the ear, and fluctuating sensorineural hearing loss. These attacks last from 10 minutes to several hours; they occur over a few days or weeks and are followed by a remission. Severe nausea, vomiting, diaphoresis, and nystagmus may also occur during attacks.
Ossicle dislocation.Acoustic trauma, such as a slap on the ear, may dislocate the ossicle, resulting in tinnitus and sensorineural hearing loss. Bleeding from the middle ear may also occur.
Otitis externa (acute).Although not a major complaint with otitis externa, tinnitus may result if debris in the external ear canal impinges on the tympanic membrane. More typical findings include pruritus, foul-smelling purulent discharge, and severe ear pain that's aggravated by manipulation of the tragus or auricle, teeth clenching, mouth opening, and chewing. The external ear canal typically appears red and edematous and may be occluded by debris, causing partial hearing loss.
Otitis media.Otitis media may cause tinnitus and conductive hearing loss. However, its more typical features include ear pain, a red and bulging tympanic membrane, high fever, chills, and dizziness.
Otosclerosis.With otosclerosis, the patient may describe ringing, roaring, or whistling tinnitus or a combination of these sounds. He may also report progressive hearing loss, which may lead to bilateral deafness, and vertigo.
Presbycusis.Presbycusis produces tinnitus and a progressive, symmetrical, bilateral sensorineural hearing loss, usually of high-frequency tones.
Tympanic membrane perforation.With tympanic membrane perforation, tinnitus and hearing loss go hand-in-hand. Tinnitus is usually the chief complaint in a small perforation; hearing loss is usually the chief complaint in a larger perforation. These symptoms typically develop suddenly and may be accompanied by pain, vertigo, and a feeling of fullness in the ear. If the patient has had otitis media, the perforation will cause drainage and relief of pain.
Other causes
Drugs and alcohol.An overdose of salicylates commonly causes reversible tinnitus. Quinine, alcohol, and indomethacin may also cause reversible tinnitus. Common drugs that may cause irreversible tinnitus include the aminoglycoside antibiotics (especially kanamycin, streptomycin, and gentamicin) and vancomycin.
Noise.Chronic exposure to noise, especially high-pitched sounds, can damage the ear's hair cells, causing tinnitus and a bilateral hearing loss. These symptoms may be temporary or permanent.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
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