1. Hear ye, Or 10 minutes on hearing loss

2. The ear

3. Assessment 1 History - as ever, onset and progression sudden loss may follow trauma/infection/idiopathic REFER IMMEDIATELY as can use steroids, hyperbaric O2 etc, 70% recover spontaneously Acoustic neuroma may present as sudden onset unilat in 10% Menieres, fluc loss

4. Assmt 2 Presbyacusis and otosclerosis more gradual, noise insidious Side - unilat more significant, unilat conductive in an adult may be nasopharyngeal Ca. Other sx, tinnitus - ‘sound of silence’ any cause reducing external noise may cause - common with noise exposure, head injury, drugs and radiation

5. Assmt 3 Noise hx - pattern usually high frequency around 4khz. Drug hx, chemo/radiorx Family hx Exam - wax, effns and tuning fork test Kids - preg, delivery and devlmt.

6. Normal Audiogram

7. Classification Conductive - something in outer or middle ear Sensorineural - inner ear or auditory nerve Mixed Central - lesion in brain or auditory pathway.

8. Sensorineural Includes lesions of the cochlea and neural pathways Affects kids and adults, in kids acqd or congenital - often assoc with congen syndromes Rinnes air louder than bone and Webers lateralises to less affected ear

9. Acquired Infective - rubella, congen CMV, toxo, meningitis, mumps. Neoplastic - acoustic neuroma (occipital pain, VIII nerve damage, unilat sensorineural, vertigo and tinnitus uncommon,V damage, VII unusual) Trauma - chronic noise, fracture,perilymph leak, surgery Metabolic - DM, pagets, hypothyroid, Pendreds

10. Noise exposure

12. Acquired 2 Toxic - drugs - often starts wih tinnitus,then grad hearing loss Presbyacusis - Progressive sensorineural loss with age, typically high frquency due to cochlear cell loss, words merge and shouting doesn’t help!

13. Prebyacusis

14. Acquired 3 Otosclerosis - more in conductive but can also cause sensorineural due to otosclerosis in labarynthine capsule. Menieres - usually unilat, known also as ideopathicendolymphatic hydrops., combination of vertigo, tinnitus and hearing loss episodically rare, prevalence of 43/100000 - get low frequency loss

16. A bit more on menieres In acute attck, lie down, still with eyes open on fixed object Get up slowly, use prochloperazine or cinnarizine Between attacks, restrict salt, betahisitine, adequate even fluids, no MSG. there is surgery.

17. Congenital Genetic sydromes- quite a few, e.g with retinitis pig = Ushers Chromasomal probs Downs can cause

18. Conductive causes Otitis media with effusion Acute otitis media Otitis externa Congenital or acquired stenosis Chronic middle ear disease incl cholesteatoma Otosclerosis - formation of new bone around footplates of stapes, more common in women, pregnancy worsens, rx with aids and surgery although 2% risk total hearing loss with stapedectomy.

19. Conductive causes 2 Trauma Wax Foreign body

20. A bit more on OM with effusion Commonest cause of hearing imprmt in kids, 80% kids at some point 50% resolve in 3/12 if more than 6/12 may be a problem Mild balance probs common Watchful waiting good mx for 1st 3/12 No evidence decongestants etc help Surgical mx with grommets to prevent delay Not established who. Cipro if otorrhoea Adenoidectomy recommended with grommets.

21. Eardrum of…