1. Deafness Dr. Abdulrahman Alsanosi Associate professor King Saud University Otolaryngology consultant Otologist, Neurotologist &Skull Base Surgeon Head of otology and neurotology unit Director of cochlear implant program King Abdulaziz University Hospital

2. Questions you should be able to answer at the end of lecture  What is deafness ?  How common is the problem ?  What is the impact of deafness on the patient ?  Who is at risk for developing deafness ?

3.  What is the definition of deafness on pure tone audiogram ?  What are the classifications of deafness?

4.  What are the causes of conductive hearing loss ?  What are the causes of sensorineural hearing loss ?  What are the findings in the clinical examination you may see in patient with deafness ?

5.  How would you confirm hearing loss clinically ?  What are the tests you request to confirm deafness ?  How would you manage patient with deafness ?

6. INTRODUCTION  Definition : Hearing impairment refers to complete or partial loss of the ability to hear from one or both ears.

7. FACTS ABOUT AND DEAFNESS  50% of deafness and hearing is avoidable through prevention, early diagnosis, and management

8. In Saudi Arabia ?

9.  In last study done 10years ago  1.7% had profound SNHL  7.7 % (2months -12years )had hearing loss

10.  Prevalence figures for permanent congenital sensorineural hearing loss are 1.5 to 2.2 per 1000 live birth for developed countries  In Saudi Arabia it is 0.9 to 1.5 percent i.e.: 9 to 15 per 1000, in developing countries, making it the most frequently occurring birth defect

11. The impact of hearing impairment: - Speech, - Language, - Education - Social

12. High Risk Criteria For Hearing Loss in Infants  Family history of hereditary childhood sensorineural hearing loss  Hyperbilirubinemia  Ototoxic medications  Bacterial meningitis  Birth weight less than 1500 grams  In utero infections (cytomegalovirus, rubella, syphilis, herpes, and toxoplasmosis)

13. High Risk Criteria For Hearing Loss in Infants  Craniofacial anomalies (including pinna and ear canal)  Birth asphexia  Mechanical ventilation lasting 5 days or longer  Stigmata or other findings associated with a syndrome known to include a sensorineural and/or conductive hearing loss

14. Definitions  Impairment of sound perception more than 20 decibel on pure tone audiogram.

15. Hearing loss Types: Conductive hearing loss 1. Concha 2. Ear Canal 3. Drum 4. Ossicular Chain 5. Eustachian Tube

16. Conductive hearing loss  Exteranal canal pathology :  Artesia

17.  Inflammatory  Acute otitis externa

18. External canal pathology  Wax

19. External canal pathology  Foreign body

20. External canal pathology Tumors:  Osteoma  exostosis

21. Conductive hearing loss  Tympanic membrane:  Absent Perforated  Too thick tympansclerosis  Too thin SOM

22. Conductive hearing loss Ossicular chains  Absent &erosion  Fixation (otosclerosis  Disrupted trauma

23. Conductive hearing loss EustachianTube dysfunction:  Retraction  Effusion

24. Sensorineural hearing loss Two types :  Sensory (the pathology is within hair cells in cochlea)  Neural (the pathology is with in the auditory nerve and it’s connection

25. Etiologies Congenital :  Inherited  (syndromic less common  Non- syndromic common  Congenital infection (TORCH)

26. Sensorineural hearing loss Acquired :  Inflammatory -labyrinthitis,meningitis -

27. 1.What is noise-induced hearing loss ? 2.what is the typical finding ?

28. Noise exposure

29.  Autoimmune - Cogan syndrome  Ototoxic drugs - Aminoglycosides groups,diruiti,….

30. 1.What are the types of temporal bone fractures? 2. How does patient present clinically ?

31. Trauma  Temporal bone fracture 1.Longitudinal fracture 2.Transeverse fracture

32. Longitudinal fracture  Bleeding from ear  Conductive hearing loss  Uncommon facial nerve paralysis  CSF

33. Transverse fracture  SNHL  Facial nerve paralysis common  CSF

34. Examination  General look ( syndromic )  Complete head and neck exam  Otoscopic / microscopic ear exam of both ears  Tuning fork test

35. What is tunning fork test ? How to conduct the test ?

38. What tests you want to request in patient with hearing loss and why?

39. Clinical testing of hearing Audiogram battery: Pure tone audiogram Speech audiogram  Impedance 1.Acoustic reflex 2.Tympanogram 3.Volume 4.Acoustic reflex decay

40. pure tone audiogram Normal hearing

41. Conductive hearing loss

42. pure tone audiogram  Sensorineural hearing loss

43. Pure tone audiogram  Mixed hearing loss

44. Tympanogram

45. How would you classify the degree of hearing loss?

46. Degree of hearing impairment

47. Managemnt of deafness  Medical management  Hearing aids

48. Management of deafness  Surgery A.Myringotomy and ventilation tube Otitis media with effusion

49. Management of deafness  Surgery B. Myringplasty &tympanoplasty in case of CSOM

50. Management of deafness C.Ossiculoplassty

51. Management of deafness(conductive )  BAHA (Bone anchored hearing aid) - Atersia of external canal -Chronic drainage ear not responding to surgery

54. Management of SNHL Surgery : D. Cochlear implant - prelingual children and postlingual adult -it pass by the external,middle and inner ear to stimulate auditory nerve directly

56. Pre lingual deafness

60. Any question

61. Thank you