DEAFNESS
DEAFNESS: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the following questions:
- Is it unilateral or bilateral? Unilateral deafness may be due to local conditions such as wax, a foreign body, otitis media, or ruptured drum, or it may be due to neurologic conditions such as Ménière's disease, acoustic neuroma, or multiple sclerosis. Bilateral deafness is more likely due to otosclerosis, acoustic trauma, presbyacusis, or drug toxicity.
- Are there abnormalities on otoscopic examination of the ear? It is very important to do a thorough examination of the ear, as one may find wax, foreign body, otitis media, cholesteatoma, or ruptured drum.
- Is there associated vertigo? The presence of vertigo should make one think of Ménière's disease or some neurologic condition such as acoustic neuroma, multiple sclerosis, or basilar artery insufficiency.
- What are the results of the Rinne test? Normally, the Rinne test should show a 2 to 1 ratio of air to bone hearing. In otosclerosis, the ratio approaches 1 to 1, but in sensory neural deafness the ratio is preserved at 2 to 1. In unilateral deafness, the Weber test is helpful. This will lateralize to the affected ear if the problem is a conductive deafness, and it will lateralize to the good ear if the problem is a sensory neural deafness.
DIAGNOSTIC WORKUP
Audiometry and caloric testing or electronystagmography should be done in almost all cases in which the ear examination is normal. It is probably wise to consult an otolaryngologist at this point. Tympanography will be helpful in diagnosing subtle cases of serous otitis media. X-rays of the mastoids, petrous bones, and internal auditory canal should be done for chronic otitis media, cholesteatoma, and acoustic neuroma. If an acoustic neuroma is suspected, however, an MRI of the brain and auditory canals must be done. If basilar artery insufficiency is suspected, four-vessel cerebral angiography should be done. Magnetic resonance angiography is an excellent noninvasive alternative for diagnosing vertebral-basilar artery disease. If multiple sclerosis is suspected, MRI of the brain, BSEP and VEP studies, and a spinal tap for spinal fluid analysis may be done.
Rather than perform these tests, the most cost-effective approach would be to refer the patient to a neurologist if other focal neurologic findings are evident.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Medical Books Excerpts
- DEAFNESS
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- Deafness
- "A Pocket Manual of Differential Diagnosis" (1999)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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TINNITUS AND DEAFNESS (Differential Diagnosis in Primary Care)
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