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TOPIC 2. CAUSES OF HEARING IMPAIRMENT. Outer and Middle Ear Disorders. Structural defects due to embryologic malformations Structural changes secondary to infection or trauma. Outer Ear Disorders. Microtia and atresia. Microtia. “an abnormal smallness of the auricle”. Atresia.

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TOPIC 2

CAUSES OF HEARING

IMPAIRMENT


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Outer and Middle Ear Disorders

  • Structural defects due to embryologic malformations

  • Structural changes secondary to infection or trauma


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Outer Ear Disorders

  • Microtia and atresia


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Microtia

“an abnormal smallness of the auricle”


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Atresia

“the absence of an opening of the external canal”


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Outer Ear Disorders

  • Microtia and atresia

  • Impacted cerumen

  • Perforation of the tympanic membrane


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Perforation of the TM

  • An example of the audiogram illustrating the flat, mild, conductive hearing loss that can occur with a perforated tympanic membrane


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Outer Ear Disorders

  • Microtia and atresia

  • Impacted cerumen

  • Perforation of the tympanic membrane

  • Other


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Otitis Media

Most common cause of transient conductive hearing loss in children

Inflamation of the middle ear

Caused by eustachian tube failure

Middle Ear Disorders


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Otitis Media

  • Three examples of the usual characteristics of a conductive hearing loss arising from otitis media


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Ways to Classify Otitis Media

  • With or without effusion

  • Fluid type

    • Serous

    • Suppurative

    • Mucoid


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Ways to Classify Otitis Media

  • With or without effusion

  • Fluid type

  • Duration

    • Acute

    • Chronic

    • Subacute

    • Persistent

    • Recurrent


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Otitis Media Facts

  • 76-95% of all kids will have one episode of OM by age 6

  • Prevalence is highest during the first two years of life

  • 50% of all kids with one episode before their first birthday will have 6 or more bouts within two years

  • Most episodes occur in winter and spring

  • Risk factors

    • Cleft palate

    • Down syndrome

    • Native Americans

    • Urban poor

    • Day care

    • Secondhand smoke


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Middle Ear Disorders

  • Otitis media

  • Otosclerosis


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Otosclerosis

“a bone disorder that affects the stapes and the bony labyrinth of the inner ear. The disease process is characterized by resorption of bone and new spongy formation around the stapes and oval window”


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Otosclerosis

  • Facts:

  • Hereditary

  • Women are more likely to develop the disorder

  • Usually bilateral

  • progressive


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Middle Ear Disorders

  • Otitis media

  • Otosclerosis

  • Cholesteatoma


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Cholesteatoma

“an epithelial pocket that forms on the tympanic membrane. Once the pocket forms, the normal shedding of epithelium results in growth of the tumor”


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Middle Ear Disorders

  • Otitis media

  • Otosclerosis

  • Cholesteatoma

  • Other

    • Physical trauma


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Physical Trauma of the Middle Ear

Here’s an example of an audiogram resulting from disarticulation of the ossicular chain


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Middle Ear Disorders

  • Otitis media

  • Otosclerosis

  • Cholesteatoma

  • Other

    • Physical trauma

    • Barotrauma

    • Middle ear tumors

      • Glomus tumor


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Cochlear Disorders

  • Syndromes and inherited disorders

    • Syndromic disorders

    • Nonsyndromal disorders



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Types of Nonsyndromic Disorders Hearing Loss

  • Dominant

  • Dominant progressive

  • Dominant progressive with adult onset

  • Recessive hereditary SNHL

  • X-linked


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Cochlear Disorders Hearing Loss

  • Syndromes and inherited disorders

  • Noise induced hearing loss


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Noise Induced Hearing Loss Hearing Loss

The degree of SNHL depends on

  • The intensity of the noise

  • The spectral composition of the noise

  • The duration of exposure

  • Individual susceptibility



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Noise Induced SNHL Hearing Loss

  • Noise notch

  • Cummulative

  • Progressive


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Cochlear Disorders Hearing Loss

  • Syndromes and inherited disorders

  • Noise induced hearing loss

  • Other trauma

  • Infections


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Infections Hearing Loss

  • Congenital

    • Cytomegalovirus

    • HIV

    • Rubella

    • Syphilis

    • Toxoplasmosis


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Infections Hearing Loss

  • Acquired

    • Herpes Zooster Oticus (Chicken Pox)

    • Mumps

    • Syphilis


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Cochlear Disorders Hearing Loss

  • Syndromes and inherited disorders

  • Noise induced hearing loss

  • Other trauma

  • Infections

  • Ototoxicity


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Ototoxicity Hearing Loss

  • Some antibiotics that are often ototoxic:

    • Amikacin

    • Dihydrostreptomycin

    • Garamycin

    • Gentamicin

    • Kanamycin

    • Neomycin

    • Netilmicin

    • Streptomycin

    • Tobramycin

    • Viomycin


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Ototoxicity Hearing Loss

  • Chemotherapy

    • Carboplatin

    • Cisplatin

  • Drugs that cause reversible hearing loss

    • Quinine

    • Salicylates (aspirin)

    • Loop diuretics

  • Drugs that may be harmful during pregnancy

    • Accutane

    • Dilantin

    • Quinine

    • Thalidomide


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Cochlear Disorders Hearing Loss

  • Syndromes and inherited disorders

  • Noise induced hearing loss

  • Other trauma

  • Infections

  • Ototoxicity

  • Meniere’s Disease


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Meniere’s Disease Hearing Loss

  • Symptoms

    • Tinnitus

    • Vertigo

    • Unilateral sensorineural hearing loss


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Cochlear Disorders Hearing Loss

  • Syndromes and inherited disorders

  • Noise induced hearing loss

  • Other trauma

  • Infections

  • Ototoxicity

  • Meniere’s Disease

  • Presbycusis


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Presbycusis Hearing Loss


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Central Auditory Disorders Hearing Loss

  • VIII Nerve tumors

  • Other diseases of the VIII Nerve

  • Neural disorders

    • Cochlear neuritis

    • Diabetes mellitus

  • Brain Stem disorders

    • Infarcts

    • Gliomas

    • Multiple sclerosis

  • Temporal Lobe disorders


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