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Deafness PowerPoint PPT Presentation

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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.

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Dr. Abdulrahman AlsanosiAssociate 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

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 ?

  • What is the definition of deafness on pure tone audiogram ?

  • What are the classifications of deafness?

  • 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 ?

  • How would you confirm hearing loss clinically ?

  • What are the tests you request to confirm deafness ?

  • How would you manage patient with deafness ?


  • Definition :

    Hearing impairment refers to complete or partial loss of the ability to hear from one or both ears.


  • 50% of deafness and hearing is avoidable through prevention, early diagnosis, and management

In Saudi Arabia ?

  • In last study done 10years ago

  • 1.7% had profound SNHL

  • 7.7 % (2months -12years )had hearing loss

  • 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

The impact of hearing impairment:

- Speech,

- Language,

- Education

- Social

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)

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


  • Impairment of sound perception more than 20 decibel on pure tone audiogram.

Hearing loss


Conductive hearing loss

1. Concha

2. Ear Canal

3. Drum

4. Ossicular Chain

5. Eustachian Tube

Conductive hearing loss

  • Exteranal canal pathology :

  • Artesia

  • Inflammatory

  • Acute otitis externa

External canal pathology

  • Wax

External canal pathology

  • Foreign body

External canal pathology


  • Osteoma

  • exostosis

Conductive hearing loss

  • Tympanic membrane:

  • Absent Perforated

  • Too thick tympansclerosis

  • Too thin SOM

Conductive hearing loss

Ossicular chains

  • Absent &erosion

  • Fixation (otosclerosis

  • Disruptedtrauma

Conductive hearing loss

EustachianTube dysfunction:

  • Retraction

  • Effusion

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


Congenital :

  • Inherited

  • (syndromic less common

  • Non- syndromic common

  • Congenital infection (TORCH)

Sensorineural hearing loss

Acquired :

  • Inflammatory

    -labyrinthitis ,meningitis

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

Noise exposure

  • Autoimmune

    -Cogan syndrome

  • Ototoxic drugs

    -Aminoglycosides groups ,diruiti,….

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


  • Temporal bone fracture

    1.Longitudinal fracture

    2.Transeverse fracture

Longitudinal fracture

  • Bleeding from ear

  • Conductive hearing loss

  • Uncommon facial nerve paralysis

  • CSF

Transverse fracture

  • SNHL

  • Facial nerve paralysis common

  • CSF


  • General look ( syndromic )

  • Complete head and neck exam

  • Otoscopic / microscopic ear exam of both ears

  • Tuning fork test

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

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

Clinical testing of hearing

Audiogram battery:

Pure tone audiogram

Speech audiogram

  • Impedance

  • Acoustic reflex

  • Tympanogram

  • Volume

  • Acoustic reflex decay

pure tone audiogram Normal hearing

Conductive hearing loss

pure tone audiogram

  • Sensorineural hearing loss

Pure tone audiogram

  • Mixed hearing loss


How would you classify the degree of hearing loss?

Degree of hearing impairment

Managemnt of deafness

  • Medical management

  • Hearing aids

Management of deafness

  • Surgery

    A.Myringotomy and ventilation tube Otitis media with effusion

Management of deafness

  • Surgery

    B. Myringplasty &tympanoplasty in case of CSOM

Management of deafness


Management of deafness(conductive )

  • BAHA (Bone anchored hearing aid)

    -Atersia of external canal

    -Chronic drainage ear not responding to surgery

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

Pre lingual deafness

Any question

Thank you

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