Ambulatory care topics hearing loss
Download
1 / 23

Ambulatory Care Topics: Hearing Loss - PowerPoint PPT Presentation


  • 499 Views
  • Updated On :

Ambulatory Care Topics: Hearing Loss. Gustavo R. Heudebert, MD Division of General Internal Medicine. Road Map. Physiology of hearing Topography of hearing loss Differential Diagnosis Clues from history / physical examination Evaluation. Case.

Related searches for Ambulatory Care Topics: Hearing Loss

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Ambulatory Care Topics: Hearing Loss' - Michelle


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Ambulatory care topics hearing loss l.jpg

Ambulatory Care Topics: Hearing Loss

Gustavo R. Heudebert, MD

Division of General Internal Medicine


Road map l.jpg
Road Map

  • Physiology of hearing

  • Topography of hearing loss

  • Differential Diagnosis

    • Clues from history / physical examination

  • Evaluation


Slide3 l.jpg
Case

34 yo male comes to the walk-in clinic with a 36 hour

history of hearing loss. Onset has been sudden, the the

hearing loss is associated with mild bilateral ear pain

but no drainage. There is no dizziness or tinnitus.

Patient is healthy and takes no medications. Family

history is non contributory. There is no exposure to

alcohol, tobacco, or illicit drugs. He works at a hospital.

Physical examination is unrevealing except for the

following:


Physiology of hearing l.jpg
Physiology of Hearing

  • Outer / middle ear

    • Amplifier of sound

  • Internal ear

    • Transducer

      • Liquid media

  • Neural pathways


Topography l.jpg
Topography

  • Conductive

    • Outer / middle ear

  • Sensorineural

    • Inner ear and neural pathways

  • Mixed

    • Combination of middle and inner ear


History l.jpg
History

  • Acute (< 72 hours) versus chronic

  • Unilateral versus bilateral

  • Sudden versus insidious onset

  • Rate of progression

  • Associated symptoms

    • Tinnitus, vertigo, otorrhea

  • Exposures: toxins, environment


Physical examination l.jpg
Physical Examination

  • Confirming hearing loss

    • Whisper test

    • Hum test

  • Rinne and Weber test

  • Otoscopy with insufflation


Interpretation l.jpg

Rinne test

AC > BC

If BC > AC

Conductive disorder on affected ear

Weber test

Normal test

No lateralization

Lateralizes to “good ear”

SNHL on bad ear

Lateralizes to “bad ear”

Conductive disorder of that ear

Interpretation



Laboratory testing l.jpg
Laboratory Testing

  • Audiologic assessment

    • Pure tone audiometry

    • Speech audiometry

    • Tympanometry

  • Evoked responses

  • Imaging (selective)


Slide15 l.jpg

Hearing Loss

Acute

History

Chronic

Normal

Exam

Audiologic

Evaluation

Conductive

SNHL

Abnormal

SOM / AOM

Perforation

Otitis


Conductive hearing loss l.jpg

Outer / external

Cerumen

Tumors

Osteoma

SCCA

External otitis

Middle

Otitis media

Otosclerosis

Choleastatoma

TM pathology

Perforation

Hemorrhage

Conductive Hearing Loss


Sensorineural hearing loss l.jpg

Inner Ear

Hereditary

Presbycusis

Meniere’s

Drugs

Environmental

Sound

Barotrauma

Neural Pathways

Tumors

Schwannoma

Demyelinating disorders

Vascular

CVA

Sensorineural Hearing Loss


Sudden snhl l.jpg
Sudden SNHL

  • Less than 72 hours duration

  • Uncommon: 5 to 20 / 100,000

  • Age 43 to 53 years; equal gender

  • Variable recovery

    • Old age / vestibular symptoms

  • Vestibular symptoms: 305 to 60%


Sudden snhl19 l.jpg
Sudden SNHL

  • Etiology

    • 1% “retrocochlear”: tumors, MS, CVA

    • 15% other: CTD, Lyme, syphilis

    • Remainder: idiopathic

    • Rare: decrease ICP (post tap), paraneoplastic, encephalitis, dural process.

  • Delay in diagnosis common: patient and doctors


Sudden snhl20 l.jpg
Sudden SNHL

  • Quick evaluation

    • Alternate ears during phone conversation

    • Hum test

  • If suspicious for SNHL

    • Audiometry: if confirmatory then MRI

  • Therapy: controversial

    • Prednisone 1 mg/kg then over 10 days

    • Intratympanic steroids


Summary l.jpg
Summary

  • Common problem

  • Acuteness, associated symptoms, age, physical examination

  • Occasional needs further assessment

    • SNHL: acute or chronic

    • Conductive with normal otologic examination


Pearls l.jpg
Pearls

  • Presbycusis

    • High frequency hearing loss

    • Worse in loud environments

  • Speech recognition more affected than hearing

    • Neural pathway pathology

  • Associated symptoms: neural causes


ad