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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
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.

facts about and deafness
  • 50% of deafness and hearing is avoidable through prevention, early diagnosis, and management
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
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 infants1
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
Hearing loss


Conductive hearing loss

1. Concha

2. Ear Canal

3. Drum

4. Ossicular Chain

5. Eustachian Tube

conductive hearing loss
Conductive hearing loss
  • Exteranal canal pathology :
  • Artesia
  • Acute otitis externa
external canal pathology2
External canal pathology


  • Osteoma
  • exostosis
conductive hearing loss1
Conductive hearing loss
  • Tympanic membrane:
  • Absent Perforated
  • Too thick tympansclerosis
  • Too thin SOM
conductive hearing loss2
Conductive hearing loss

Ossicular chains

  • Absent &erosion
  • Fixation (otosclerosis
  • Disruptedtrauma
conductive hearing loss3
Conductive hearing loss

EustachianTube dysfunction:

  • Retraction
  • Effusion
sensorineural hearing loss
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 loss1
Sensorineural hearing loss

Acquired :

  • Inflammatory

-labyrinthitis ,meningitis


-Cogan syndrome

  • Ototoxic drugs

-Aminoglycosides groups ,diruiti,….

  • Temporal bone fracture

1.Longitudinal fracture

2.Transeverse fracture

longitudinal fracture
Longitudinal fracture
  • Bleeding from ear
  • Conductive hearing loss
  • Uncommon facial nerve paralysis
  • CSF
transverse fracture
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
clinical testing of hearing
Clinical testing of hearing

Audiogram battery:

Pure tone audiogram

Speech audiogram

  • Impedance
  • Acoustic reflex
  • Tympanogram
  • Volume
  • Acoustic reflex decay
pure tone audiogram
pure tone audiogram
  • Sensorineural hearing loss
pure tone audiogram1
Pure tone audiogram
  • Mixed hearing loss
managemnt of deafness
Managemnt of deafness
  • Medical management
  • Hearing aids
management of deafness
Management of deafness
  • Surgery

A.Myringotomy and ventilation tube Otitis media with effusion

management of deafness1
Management of deafness
  • Surgery

B. Myringplasty &tympanoplasty in case of CSOM

management of deafness2
Management of deafness


management of deafness conductive
Management of deafness(conductive )
  • BAHA (Bone anchored hearing aid)

-Atersia of external canal

-Chronic drainage ear not responding to surgery

management of snhl
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