HEARING LOSS CME TOPICS TYPES OF HEARING LOSS CAUSES OF HEARING LOSS DEGREE OF HEARING LOSS AUDIOGRAM MANAGEMENT OF A PATIENT WITH HEARING LOSS SUDDEN HEARING LOSS TYMPANIC MEMBRANE PERFORATION SEROUS OTITIS MEDIA PRESBYCUSIS OTOSCLEROSIS

GOALS and OBJECTIVES GOAL Learner will understand the different topics related to Audiology and hearing loss with the most common diagnosis. OBJECTIVES To identify the causes of hearing loss. To differentiate types of hearing loss. To diagnose and be aware of available treatments.

TYPES OF HEARING LOSS The type of hearing loss depends up on where in the ear problem occur. The three main types are Conductive hearing loss. Sensorineural hearing loss. Mixed hearing loss

TYPES OF HEARING LOSS

TYPES OF HEARING LOSS Conductive hearing loss A problem in the outer or middle ear causes conductive hearing loss. A decrease in strength of a sound is called attenuation. Conductive hearing loss involves reduction in sound level, or the ability to hear faint sounds. Persons with conductive hearing loss find that their sensitivity to sounds that are introduced by air conduction is impaired by such a blockage.

TYPES OF HEARING LOSS Conductive hearing loss If the sound is introduced by bone conduction, it passes the obstacle and goes directly to the sensorineural mechanism. The inner ear and other sensorineural structures will be unimpaired and hearing by bone conduction will be normal. This occurs when sound is not able to reach cochlea. This is due to malformation of ear canal. This problem can be fixed through simple surgical procedures. 

TYPES OF HEARING LOSS Sensorineural hearing loss A problem in the inner ear can cause sensorineural hearing loss . It is also known as nerve-related hearing loss as the damaged nerves in the inner ear can cause the loss.   These losses cannot be fixed through surgical procedures. Sensorineural hearing loss involves reduction in sound level, inability to hear sounds and  also affects speech understanding .

TYPES OF HEARING LOSS Mixed hearing loss Hearing loss which is caused by combination of conductive and sensorineural hearing loss. The problem might be both in the outer or middle ear and in the inner ear.

CAUSES OF HEARING LOSS Causes of conductive hearing loss Malformation of outer ear, ear canal or middle ear structures. Problems associated with middle ear pathology such as fluid in the middle ear from colds and allergies Poor Eustachian tube function Ear infection, perforated eardrum and benign tumors. Impacted earwax Foreign body in the ear Otosclerosis which is abnormal growth of bone of the middle ear

CAUSES OF HEARING LOSS Causes of sensorineural hearing loss There are two types of causes Prenatal or Perinatal causes Postnatal causes

CAUSES OF HEARING LOSS PRENATAL OR PERINATAL CAUSES Infections such as rubella, herpes, toxoplasmosis, syphilis and cytomegalovirus. Hearing loss that runs in family. Asphyxia or lack of oxygen at birth. Birth weight of less than 1500 grams. Defects of head and neck.

CAUSES OF HEARING LOSS POSTNATAL CAUSES Exposure to loud noise. Bacterial Meningitis Ototoxicity caused by exposure to drugs Physical damage to head or ear Hearing loss due to aging which is called as presbycusis

Other descriptors associated with hearing loss Bilateral Hearing loss in both ears. Unilateral Hearing loss in one ear and normal in other ear. Symmetrical In symmetrical hearing loss the degree and configuration are similar in both ears. Asymmetrical In asymmetrical hearing loss the degree and configuration are different in both ears.

Other descriptors associated with hearing loss Progressive versus sudden In progressive hearing loss the loss becomes worse over time where as in sudden the loss happens quickly. Fluctuating versus stable  Fluctuating hearing loss changes over time, sometimes getting better sometimes getting worse. Stable hearing loss does not change over time and remains the same.

Degree of hearing loss Degree of hearing loss refers to severity of hearing loss. According to Clark J.G. (1981) the degree of hearing loss is classified as Normal-  -10 to 20 dBHL Mild- 20 to 30 dBHL Moderate- 31 to 60 dbHL Severe- 71 to 90 dBHL Profound- 91+ dBHL

AUDIOGRAM An audiogram is a graph illustrating a person’s usable hearing and the amount of hearing loss that an individual has for each ear. The frequency or pitch of the sound is referred to in Hertz. The intensity or loudness of sound is measured in decibels.

Example of Audiograms with different degree of hearing loss

Management of a patient with hearing loss History Age ( speech delay, children, young adults, eldery…) Risk Factors (exposure to sounds, ototoxic meds, family history…) Onset of hearing loss (sudden, progressive) Circumstances of onset (cleaning ear, blast, trauma…) Progression ( fluctuating, worsening, improving) Accompanying symptoms (Nausea, vertigo, ear drainage, swimming, flu symptoms…)

Management of a patient with hearing loss Physical Exam Examination of the pinna and external auditory canal. Otoscopy:

Management of a patient with hearing loss Physical Exam Examination of the pinna and external auditory canal. Otoscopy:

Management of a patient with hearing loss Physical Exam Examination of the pinna and external auditory canal. Otoscopy:

Management of a patient with hearing loss Physical Exam Examination of the pinna and external auditory canal. Otoscopy:

Management of a patient with hearing loss Physical Exam Examination of the pinna and external auditory canal. Otoscopy:

Management of a patient with hearing loss Physical Exam Examination of the pinna and external auditory canal. Otoscopy:

Management of a patient with hearing loss Hearing tests Tuning fork Pure tone audiometry Tympanogram Oae, refelexes ABR CT scan temporal bones MRI cpa

Sudden hearing loss Sudden Sensorineural Hearing Loss** Quick diagnosis mandatory (3cons frq>30dB,TF) Early treatment initiation crucial Three main etiologies (Inflammatory, Viral, Vascular) Treatment ** Diagnostic tests* Follow-up Prognosis

Tympanic Membrane Perforation Causes Prognosis Current Condition (dry, drainage) Position * Size Audiogram Management Surgical (tympanoplasty, OCR, Mastoidectomy)

Serous Otitis Media Causes Age group Symptoms Hearing Tests Medical Treatment Surgical treatment

Presbycusis Age of onset (accompagning conditions…) Symptoms (hearing loss, tinnitus,..) Hearing Tests ( pta, srt…) Hearing aids

Otosclerosis Age of onset Gender Familial v/s sporadic Symptoms (hearing loss, tinnitus,..) Otoscopy Hearing Tests ( pta, srt…) Management (medical, aid…) Stapedectomy ( results, technique VIDEO)

Dr T. CME www.entnet.net www.ent-ad.com

References Images online http://www.dallashear.com/types-of-hearing-loss.html http://www.bcchildrens.ca/Services/ClinicalDiagnosti cFamilyServices/Audiology/Forfamilies/readaudiogra m.htm Cummings, textbook of Otolaryngology-Head & neck Surgery Entnet.net