Deafness
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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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Deafness

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 ?


INTRODUCTION

  • Definition :

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


FACTS ABOUT AND DEAFNESS

  • 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


Definitions

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


Hearing loss

Types:

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

Tumors:

  • 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


Etiologies

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 ?


Trauma

  • 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


Examination

  • 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


Tympanogram


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

C.Ossiculoplassty


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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