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Disorders of Hearing. Pathology of the Ear. Structures of the Auditory Pathway. Outer Ear Middle Ear Pinna Tympanic Membrane External Canal Ossicles (Malleus, Incus, Stapes) Eustachian Tube Inner Ear Central Auditory Pathway Cochlea 8th Nerve Cochlear Nuclei

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disorders of hearing

Disorders of Hearing

Pathology of the Ear

slide3

Structures of the Auditory Pathway

Outer EarMiddle Ear

Pinna Tympanic Membrane

External Canal Ossicles (Malleus, Incus, Stapes)

Eustachian Tube

Inner EarCentral Auditory Pathway

Cochlea 8th Nerve

Cochlear Nuclei

Superior Olivary Complex

Lateral Lemnisci

Inferior Colliculi

Medial Geniculate Body

Auditory Cortices

conductive hearing loss
Conductive Hearing Loss
  • Abnormality or disease of the outer and/or middle ear.
  • AC scores poorer than BC -- ABG > 10 dB
  • Often abnormal tympanograms
  • Often absent or elevated acoustic reflexes
  • Once speech is loud enough to be heard, word recognition is typically good.
  • Generallycan be treated medication and/or surgery.
unilateral otitis media
Unilateral Otitis Media
  • Low frequency conductive hearing loss
  • Tympanograms may be flat or shallow with a negative pressure peak
  • Otoscopy abnormal
  • May or may not be pain
sensory or sensorineural hearing loss
Sensory or Sensorineural Hearing Loss
  • Hearing loss resulting from abnormality and/or pathology affecting the cochlea or auditory nerve.
  • AC scores equal to BC -- ABG < 10 dB
  • Often normal tympanograms
  • Often even though speech is loud enough to be detected, word recognition can be impaired.
  • Often not responsive to medical intervention.
  • Hearing aids can help alleviate communication difficulties.
slide7
Hearing WNL 250-1000 Hz steeply sloping to a profound sensorineural hearing loss above 4000 Hz bilaterally.
otitis media
Otitis Media
  • Negative pressure in middle ear space
    • often secondary to Eustachian tube dysfunction
    • can cause retraction of TM
  • Fluid can accumulate behind TM
    • May or may not be infected
    • can become very thick and adhesive
  • Untreated
    • can resolve
    • can perforate TM and recur
    • can have serious complications (e.g. meningitis, permanent hearing loss)
unilateral otitis media9
Unilateral Otitis Media
  • Low frequency conductive hearing loss
  • Tympanograms may be flat or shallow with a negative pressure peak
  • Otoscopy abnormal
  • May or may not be pain
otosclerosis
Otosclerosis
  • Progressive conductive hearing loss typically unilateral.
  • Carhart’s notch
  • Tympanogram is normal or shallow.
  • Absent or abnormally elevated acoustic reflexes
slide11

SENSORINEURAL HEARING LOSS =

LESS SENSITIVE TO SOUND

SPEECH IS UNCLEAR

slide12

Disorders of the Inner Ear

Meniere’s Disease

Endolymphatic Hydrops

Tinnitus

Vertigo

Fluctuating Hearing Loss

Ototoxicity

Induced by aminoglycosides

Induced by loop diuretics

Induced by cancer treatment

meniere s disease
Meniere’s Disease
  • Fluctuating (but often progressive), unilateral sensorineural hearing loss.
  • Tinnitus
  • Episodic vertigo
slide14

Disorders of the Inner Ear

Noise Exposure

Recreational Noise

Occupational Noise

Environmental Noise

Temporal Bone Fractures

Meningitis

Presbycusis

noise induced hearing loss
Noise Induced Hearing Loss
  • Bilateral, sensorineural loss.
  • Noise notch at 4000 Hz
  • Tympanogram and acoustic reflexes WNL
presbycusis
Presbycusis
  • Age related hearing loss
  • Bilateral sensorineural hearing loss often worse in the high frequencies and tends to progress.
  • Tympanograms normal
  • Word recognition scores often depressed.
slide17
Left: Hearing WNL.
  • Right: Moderate sloping to severe mixed loss.
slide18
Left:
    • PTA: 45 dB HL
    • SRT: 40 dB HL
    • Word Recognition: 98% at 80 dB HL
  • Right:
    • PTA: 58 dB HL
    • SRT: 50 dB HL
    • Word Recognition: 68% at 90 dB HL
slide19
Hearing WNL 250-1000 Hz steeply sloping to a profound sensorineural hearing loss above 4000 Hz bilaterally.