Questions Your Doctor May Ask - and Why!
During a consultation, your doctor will use various techniques in his assesment of the symptom: Hearing impairment.
These may include a physical examination or other medical tests.
Your doctor may ask several questions when assessing
your condition. It is important to remember that your consultation is a two-way process and any extra information
you can share with your doctor may help them with their diagnosis.
Some of the questions your doctor may ask are listed below:
- How long have you had a problem with hearing impairment?
Why: to determine if acute or chronic.
- Has the hearing impairment been present since birth?
Why: congenital hearing impairment may be due to inherited defects e.g. external auditory canal atresia; to factors before the birth such as maternal intrauterine infection (e.g. rubella, CMV, toxoplasma and syphilis), drug or excess alcohol ingestion during pregnancy; or due to factors around the birth such as prematurity, lack of oxygen due to birth trauma and hemolytic disease of the newborn. Hearing impairment may be associated with hypothyroidism, Down syndrome, Waardenburg's syndrome, Klippel-Feil syndrome, Treacher Collins' syndrome and mucopolysaccharidoses. In many cases of congenital hearing impairment no cause can be found.
- Is the hearing impairment unilateral or bilateral?
Why: If unilateral, the hearing impairment may be due to local conditions such as ear wax, a foreign body, otitis media (middle ear infection) or ruptured ear drum; or it may be due to nervous system conditions such as Meniere's disease, acoustic neuroma or multiple sclerosis. Bilateral hearing impairment is more likely due to otosclerosis, acoustic trauma, presbyacusis (hearing loss as part of the aging process) or drug toxicity.
- Was there an event that preceded the hearing impairment?
Why: e.g. the often sudden onset of hearing loss in an ear following swimming or showering is suggestive of wax which swells to block the ear canal completely.
- Is the deafness getting progressively worse with time?
- What is the effect on the hearing impairment in a noisy environment?
Why: e.g. people with conductive (middle ear) hearing loss may hear better in noisy conditions because we raise our voices when there is background noise. Conversely, people with hearing impairment due to a nerve problem usually have more difficulty hearing in noise as voices become unintelligible.
- Recent or past episode of a generalized infection?
Why: e.g. a child may end up with permanent hearing impairment due to mumps and meningitis infection; otitis media (middle ear infections) often are preceded by an upper respiratory tract infection; mumps, measles or herpes zoster infection may be complicated by deafness.
- Previous noise exposure, either chronic or acute?
Why: e.g. industrial machinery, weapons and loud music - common cause of permanent sensorineural (nerve based) deafness.
- Recent history of diving?
Why: diving can cause barotrauma to ear drum if there is an occluded eustachian tube.
- Recent history of air travel?
Why: flying can cause barotrauma to ear drum if there is an occluded eustachian tube.
- Recent history of swimming?
Why: may suggest otitis externa ( outer ear infection).
- History of head injury?
Why: may cause fracture of the petrous temporal bone and injury to facial nerve.
- Past medical history?
Why: e.g. viral infections e.g. mumps, measles or herpes zoster; polycythaemia (can cause vascular obstruction to the arterial system); diabetes (may cause hearing impairment due to vascular disease); Paget's disease of the bone may cause conductive (middle ear) hearing impairment.
- Medications, both current and previous?
Why: e.g. ototoxic antibiotics such as gentamycin and streptomycin, aspirin overdose, frusemide diuretic.
- Family history?
Why: e.g. congenital hearing impairment (including Waardenburg's syndrome, Down syndrome, Klippel-Feil syndrome, Treacher Collins' syndrome and mucopolysaccharidoses);presbyacusis (hearing loss as part of the aging process); otosclerosis.
- Alcohol history?
Why: alcohol abuse may cause toxicity to the nerve and cause hearing impairment.
Questions your doctor may ask about related symptoms:
Sometimes, other symptoms may be present and may help your doctor analyse
your condition. These may include:
- Vertigo (sensation of your head or surroundings spinning)?
Why: may suggest Meniere's disease or other nervous system condition such as acoustic neuroma, multiple sclerosis, basilar artery insufficiency, drug induced ototoxicity or syphilis; may also occur in otosclerosis.
- Ear pain?
Why: may suggest otitis media, mastoiditis, otitis externa.
- Ear discharge?
Why: may suggest otitis externa, otitis media, mastoiditis, barotraumas, cholesteatoma.
- Tinnitus (noises in the ear, either ringing, whistling or booming etc.)?
Why: e.g. presbyacusis, noise induced hearing loss, otosclerosis, ear wax, head injury, Meniere's disease, acute otitis media, drug induced ototoxicity.
- Fever?
Why: may suggest otitis media, otitis externa, mastoiditis, mumps, measles.
- Symptoms of deafness in infant or child?
Why: e.g. failure to respond in expected way to sounds, preference for or response only to loud sounds, no response to normal conversation or to television, speech abnormality or delay, absence of babbling by 12 months, no single words or comprehension of simple words by 18 months, learning problems at school, disobedience and other behavioral problems.
- Symptoms of Meniere's disease?
Why: e.g. nausea, vomiting, tinnitus, vertigo, sensorineural deafness.
- Symptoms of otitis media?
Why: e.g. infection often follows upper respiratory tract infection, ear pain, fever, sensation of pressure in the ear, hearing loss, drum may perforate with subsequent relief of pain and fever.
- Symptoms of otitis externa?
Why: e.g. often occurs in ears that are itchy due to eczema, dermatitis or psoriasis or in those that swim; pain, discharge, pressure on the ear lobe causes pain.
- Symptoms of mastoiditis?
Why: e.g. pain, low grade fever, feeling unwell, hearing loss, foul smelling discharge, swelling behind the ear.
- Features of Down syndrome?
Why: e.g. flat facial profile, excess neck skin, unusually shaped ears, round head, protruding tongue, short wide hands.
- Symptoms of Waardenburg's syndrome?
Why: e.g. child with white forelock of hair and different colored eyes.
» Next page: Types of Hearing impairment
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