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Hearing loss

Hearing loss. Overview . Not “deafness”. Deaf is a total lack of hearing Deafness has connotations of discrimination Word “deaf” frightens people. Hearing loss (HL) - classification. Conductive - any interruption of passage of acoustic energy between

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Hearing loss

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  1. Hearing loss Overview

  2. Not “deafness” • Deaf is a total lack of hearing • Deafness has connotations of discrimination • Word “deaf” frightens people

  3. Hearing loss (HL) - classification • Conductive - any interruption of passage of acoustic energy between pinna and oval window (CHL) • Sensorineural

  4. Hearing loss (HL) - classification • Conductive • Sensorineural - any damage to the organ of Corti or VIII nerve pathway or auditory cortex (SNHL)

  5. Hearing loss (HL) - classification • Can be “mixed” conductive & sensorineural

  6. Testing • Multitude of testing possibilities - clinical (in room with patient) - audiological (by audiologist or audiometrician)

  7. Testing • Clinical - tuning forks simple, quick and accurate means of differentiating between CHL & SNHL and between true HL and malingering

  8. Tuning forks • T fork large so that rate of decay is not rapid • 512 Hz (or 256 Hz) • Broad base - applied to bone • If frequency too low – felt more than heard • If frequency too high – dissipates too fast

  9. Rinne • Tests air conduction – much more efficient than BC • + Rinne • - Rinne • false - Rinne

  10. Tuning fork - Rinne

  11. Weber • Assymetrical conductive loss • Very sensitive in compliant patient • If CHL unilateral as little as 5 dB detected

  12. Tuning fork - Weber

  13. Testing • Clinical - free-field speech testing Simple, rapid, accurate to within 3 dB of true threshold of speech reception threshold

  14. Normal audiogram

  15. Conductive HL • Congenital – many syndromes affecting the development of ext. ear from 1st branchial cleft and 1st & 2nd branchial arches (eg Treacher-Collins, Pierre-Robin, Crouzon’s, Apert’s)

  16. Congenital CHL classification • Hereditary - EA or ME - present at birth (syndromes) - appearing in childhood (osteogenesis imperfecta) • Predisposing disorders - cystic fibrosis, cleft palate, Down syndrome • Miscellaneous - congenital cholesteatoma - fibrous dysplasia

  17. Congenital CHL • Minor aplasia - EAC narrow - pinna normal or minor deformity - ossicular fixation

  18. Congenital CHL • Major aplasia - microtia - EAC atresia - ossicular fixation

  19. Congenital CHL • Major aplasia / atresia - EAC atretic - tympanic cavity small - cochlear abnormal

  20. Congenital CHL - management • Congenital loss may be suspected at birth (eg family history or syndromal) • Refer to Paediatric ENT or Audiologist for: - investigation - appropriate surgery - appropriate rehabilitation

  21. Conductive HL • Acquired - OME/ effusions - foreign body / wax - perforation - ossicular damage - otitis externa / furuncle - fracture - EAC neoplasm - benign - malignant - atresia and stenosis

  22. Acquired CHL - management • From history and examination, diagnose and treat appropriately

  23. Sensorineural HL • Congenital – many syndromes involve the VIII nerve to varying degrees (eg Pendred’s, Usher’s Waardenbur’s)

  24. Congenital SNHL classification • Hereditary - HL present at birth - HL alone - syndrome + HL - HL appears in childhood - HL alone - syndrome + HL • Secondary to intrauterine event - Infections (rubella, CMV, syphilis) - Ototoxic drugs (aminoglycosides, diuretics, cytotoxics, salicylates, quinine, anticonvulsants)

  25. Congenital SNHL classification • Secondary to intrauterine event - Metabolic disorders (diabetes mellitus) - Perinatal disorders (hypoxia, hyperbilirubinaemia, premature delivery, low birth weight)

  26. Congenital SHL • Variable - uni- or bilateral - mild - moderate - severe - profound

  27. Congenital SHL - management • Prevent • Depends on cause • Depends on extent • Depends whether uni- or bilateral

  28. Congenital SHL - management • Hearing amplification - if appropriate • Alternative means of communication - lip reading - sign language • Cochlear implant - if appropriate

  29. Congenital SHL - management • Family support and advice

  30. Sensorineural HL • Acquired - trauma - sharp / blunt - acoustic – blast / noise - barotrauma – window rupture - surgery - infective labyrinthitis - syphilis - Meniere’s - presbycusis - ototoxicity - CVA

  31. Acquired SHL - management • Prevent • Depends on cause • Depends on extent • Depends whether uni- or bilateral

  32. Acquired SHL - management • Hearing amplification - if appropriate • Alternative means of communication - lip reading - sign language • Cochlear implant - if appropriate

  33. Acquired SHL - management • Family support and advice

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