HEARING LOSS Yard.Doc.Dr.Müzeyyen Doğan

Learning goal and objectives of the lesson Learning goal of the lesson: The learner should know the main clinical features and investigation of the hearing loss Learning objectives of the lesson the learner will be able to: expalin the type of hearing loss. expalin the type of hearing loss. explain the acoustis trauma explain the acoustis trauma list the indications of hearing aids. list the indications of hearing aids. explain the importance of early diagnosis of hearing loss and intervention explain the importance of early diagnosis of hearing loss and intervention

TYPES OF HEARING LOSS: CONDUCTIVE CONDUCTIVE SENSORI-NEURAL SENSORI-NEURAL MIXED MIXED NON-ORGANIC NON-ORGANIC

CONDUCTIVE HEARING LOSS Occurs from a dysfunction of the outer or middle ear Occurs from a dysfunction of the outer or middle ear Can usually be treated with medicine or surgery Can usually be treated with medicine or surgery A deficit of loudness only A deficit of loudness only

Characteristics of Conductive Loss: Maintain soft speaking voice Maintain soft speaking voice Excellent speech discrimination when speech is loud enough Excellent speech discrimination when speech is loud enough Typically either low frequency or flat hearing loss (equal at all frequencies) Typically either low frequency or flat hearing loss (equal at all frequencies)

CAUSES OF CONDUCTIVE HEARING LOSS: Outer Ear Outer Ear: Outer Ear: Occlusion/foreign body Congenital Atresia External Otitis Photo’s courtesy of Dr. Roy F. Sullivan, Ph.D.

Causes of Conductive Hearing Loss: Middle Ear Otitis Media Otitis Media TM Perforation TM Perforation Cholesteatoma Cholesteatoma Ossicular fixation Ossicular fixation Otosclerosis Otosclerosis Ossicular Disarticulation Ossicular Disarticulation Blocked Eustachian Tube, reduced middle ear pressure, TM retraction and eventual effusion Blocked Eustachian Tube, reduced middle ear pressure, TM retraction and eventual effusion Photo’s courtesy of Dr. Roy F. Sullivan, Ph.D.

TREATMENT: CONDUCTIVE HEARING LOSSES Conductive hearing losses are due to problems that occur in the outer and middle ear which are usually temporary and/or treatable with antibiotics or surgery. Conductive hearing losses are due to problems that occur in the outer and middle ear which are usually temporary and/or treatable with antibiotics or surgery. For those few people who have uncorrectable conductive hearing losses, hearing aids are of significant benefit as sound remains clear if it is made loud enough. For those few people who have uncorrectable conductive hearing losses, hearing aids are of significant benefit as sound remains clear if it is made loud enough.

SENSORI-NEURAL HEARING LOSSES Dysfunction of the inner ear or auditory nerve, usually permanent and untreatable Dysfunction of the inner ear or auditory nerve, usually permanent and untreatable Results in loudness deficit and distorted hearing. Results in loudness deficit and distorted hearing. Nerve endings in cochlea or nerve pathways are damaged. Nerve endings in cochlea or nerve pathways are damaged. Message does not effectively reach the brain. Message does not effectively reach the brain. Middle ear structures are intact. Middle ear structures are intact.

Characteristics of SNHL: Inappropriately loud voice Inappropriately loud voice Tinnitus Tinnitus High frequency loss common, but any configuration possible High frequency loss common, but any configuration possible Speech sounds distorted Speech sounds distorted Background noise makes listening more difficult Background noise makes listening more difficult Hearing aids may help Hearing aids may help

CAUSES OF SENSORI-NEURAL HEARING LOSS: Genetics/Congenital Genetics/Congenital Disease Disease Mumps, Measles Mumps, Measles Meningitis, CMV Meningitis, CMV Ototoxic drugs Ototoxic drugs Head trauma Head trauma Presbycusis Presbycusis Meniere’s Disease Meniere’s Disease Acoustic Neuroma Acoustic Neuroma Ototoxin Exposure Ototoxin Exposure Noise Exposure: Noise Exposure: Prolonged exposure to hazardous noise causes hearing loss by the physical destruction of the hair cells in the cochlea.

Characteristics of NIHL: (noise induced hearing loss) Loss can be sudden, as with acoustic trauma from an explosion. Loss can be sudden, as with acoustic trauma from an explosion. More often a gradual onset that may go unnoticed. More often a gradual onset that may go unnoticed. NIHL also known as noise induced permanent threshold shift (NIPTS), typically takes years of exposure, gradual erosion of hearing that eventually affects communication. NIHL also known as noise induced permanent threshold shift (NIPTS), typically takes years of exposure, gradual erosion of hearing that eventually affects communication.

Characteristics of SNHL, con’t Amount of loss varies from person to person Amount of loss varies from person to person Risk of noise-induced progression stops if no longer in noise exposed, but aging invariably worsens loss Risk of noise-induced progression stops if no longer in noise exposed, but aging invariably worsens loss For most, aging effects aren’t significant before age 50+ For most, aging effects aren’t significant before age 50+

Classic Symptoms of NIHL: A notch or drop in hearing at 4000 Hz. Generally affects Hz range first, then notch becomes deeper & wider A notch or drop in hearing at 4000 Hz. Generally affects Hz range first, then notch becomes deeper & wider Typically bilateral and symmetrical Typically bilateral and symmetrical Tinnitus common Tinnitus common Reduced speech comprehension, particularly in background noise. Why? Reduced speech comprehension, particularly in background noise. Why? l Vowels are low frequency sounds that carry 90% of speech energy (I can hear you talking….) l Consonants are higher frequency sounds that carry most of the meaning of speech. NIHL begins in high frequencies. (But I can’t understand what you are saying.)

The “4 P’s” Noise induced hearing loss is: P ainless P rogressive P ermanent P reventable From Siemens Hearing Solutions

TREATMENT: Sensori-neural hearing loss is due to problems that occur in the inner ear and are almost always permanent and untreatable. Sensori-neural hearing loss is due to problems that occur in the inner ear and are almost always permanent and untreatable. Hearing aids will benefit most people with sensori-neural loss, but results can vary. Hearing aids will benefit most people with sensori-neural loss, but results can vary.

MIXED HEARING LOSS: Combination of conductive (outer or middle ear) disorder and sensori-neural hearing loss. Combination of conductive (outer or middle ear) disorder and sensori-neural hearing loss. Treatment may be available for the conductive portion; however, the sensori-neural portion will remain. Treatment may be available for the conductive portion; however, the sensori-neural portion will remain. Causes can be unrelated (for example, NIHL plus TM rupture), or related (for example cochlear otosclerosis). Causes can be unrelated (for example, NIHL plus TM rupture), or related (for example cochlear otosclerosis).

NON-ORGANIC HEARING LOSS Non-Organic: Non-Organic: No medical or physical reason for hearing loss, may be voluntary or involuntary Malingering: Malingering: Consciously faking or exaggerating a hearing impairment, often for monetary or other personal gain, to escape assignments or responsibilities, or as an anti-establishment gesture

NON-ORGANIC HEARING LOSS Symptoms that should alert you to malingering: Substantial, equal hearing loss at all frequencies or no response to pure tones at all in one or both ears Substantial, equal hearing loss at all frequencies or no response to pure tones at all in one or both ears Inconsistent results, or markedly different than prior results Inconsistent results, or markedly different than prior results Unilateral “deafness” without significant medical history unlikely Exaggerated attention to test, may press on earphones, difficulty hearing you call them back for testing or to your directions (normal voice level is around 60 dB), but can hear you when your back is turned or when no visual cues Exaggerated attention to test, may press on earphones, difficulty hearing you call them back for testing or to your directions (normal voice level is around 60 dB), but can hear you when your back is turned or when no visual cues Patient history may provide clues to non-organic behavior if nearing retirement, or pending discipline or deployment Patient history may provide clues to non-organic behavior if nearing retirement, or pending discipline or deployment Psychogenic Hearing Loss - Unconscious development of a non-organic hearing loss – a compensatory protective device, a psychogenic problem (the patient believes the impairment is real) Psychogenic Hearing Loss - Unconscious development of a non-organic hearing loss – a compensatory protective device, a psychogenic problem (the patient believes the impairment is real)

CENTRAL HEARING LOSS Occurring within central nervous system (cortex, brainstem, or ascending auditory pathways) as opposed to peripheral organs of hearing (cochlea and middle ear) Occurring within central nervous system (cortex, brainstem, or ascending auditory pathways) as opposed to peripheral organs of hearing (cochlea and middle ear) Often associated with other neurological disorders (multiple sclerosis, tumors) Often associated with other neurological disorders (multiple sclerosis, tumors) Sometimes confused with non-organic hearing loss due to vague symptoms or inappropriate test behavior Sometimes confused with non-organic hearing loss due to vague symptoms or inappropriate test behavior Always requires diagnostic work-up by an audiologist, otologist, and/or neurologist; patient usually hears WNL for pure tones Always requires diagnostic work-up by an audiologist, otologist, and/or neurologist; patient usually hears WNL for pure tones

IN SUMMARY…. Conductive Hearing Loss: Conductive Hearing Loss: Usually low frequency or flat, affects outer and/or middle ear, usually temporary - or at least medically or surgically treatable. Usually low frequency or flat, affects outer and/or middle ear, usually temporary - or at least medically or surgically treatable. Sensori-neural Hearing Loss: Sensori-neural Hearing Loss: Often high frequency, affects inner ear, usually permanent. Often high frequency, affects inner ear, usually permanent. Mixed Hearing Loss: Mixed Hearing Loss: Usually affects both high and low freqs, both conductive and sensori-neural components, but only conductive portion treatable. Usually affects both high and low freqs, both conductive and sensori-neural components, but only conductive portion treatable. Non-Organic Hearing Loss: Non-Organic Hearing Loss: Typically display a flat loss or total deafness in one ear, but may exaggerate a true loss, may (rarely) be involuntary but usually malingering is involved. Prior test results are your best clue. Typically display a flat loss or total deafness in one ear, but may exaggerate a true loss, may (rarely) be involuntary but usually malingering is involved. Prior test results are your best clue. Central Hearing Loss: Central Hearing Loss: Hearing for pure tones often normal, problem is between cochlea and cortex (receptor cells OK but a transmission or processing problem). Hearing for pure tones often normal, problem is between cochlea and cortex (receptor cells OK but a transmission or processing problem).

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