deafness and tinnitus - up | university of pretoria 2019... · 2019. 5. 16. · tinnitus...
TRANSCRIPT
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Deafness and Tinnitus
Asanda Makunga FCORL(SA) MMed ( L et O)
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Deafness & Tinnitus
• The two symptoms• Commonly occur together
• Determinants • Type of hearing loss
• Type of tinnitus
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Deafness (Hearing loss)
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Hearing Loss - Classification
• According to Involved subsite• Unilateral or bilateral
• Conductive Hearing Loss• Outer ear pathology
• Middle ear pathology
• Sensorineural• Inner ear pathology
• Mixed • Involvement of both systems
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Conductive Hearing Loss (CHL)
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Presentation
• Hearing loss• May be acute or chronic
• Possible associated Symptoms• Otorrhoea
• Tinnitus
• Vertigo
• Pain
• Facial nerve palsy
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Differential Diagnosis
• Outer Ear• Infection
• Trauma
• Tumor
• Systemic Disease
• Dermatologic
• Congenital
• Cerumen Impation
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Outer Ear
• Infection • Otitis externa
• Inflammation and blockage of EAC
• Pain &/or otorrhoea &/or pruritus
• Trauma• Lacerations and fractures of the EAC
• Stenosis results if not adequately treated
• Conductive hearing loss and discharge
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Outer ear
• Tumors• Chronic hearing loss• Most common is Squamous cell carcinoma• Watery to bloody otorrhoea• Red fleshy mass or ulcer in external ear• Biopsy mandatory• Refer for definitive treatment
• Exostosis• Benign bony outgrowths in EAC• Cold water exposure • Obstruction and recurrent infection (swimmers ear)• Surgery indicated when infections reduce quality of life
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Outer Ear
• Benign Polyps• Refer to specialist
• Glomus tumors
• Chronic infections (granulation)
• Meningocoele
• CT scan mandatory before biopsy and definitive treatment
• Cerumen Impaction• Usually managed in the rooms
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Outer Ear
• Systemic disease• Tuberculosis
• Other granulomatous diseases
• Dermatologic• Chronic otitis externa (eczema)
• Psoriasis
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Middle Ear
• Eustachian tube dysfunction
• Infection
• Tumors
• Trauma
• Chronic otitis media with or without Choleateatoma
• Ossicular pathology
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Middle Ear
• Eustachian tube dysfunction• Aural fullness
• Perceived hearing loss
• Usually follows URTI, allergic rhinitis
• Toynbee maneuver
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Middle Ear
• Infection• Acute otitis media
• Hearing loss (less than 3 weeks)
• Pain, fever, purulent otorrhoea
• Irritability in children
• Inflammed bulging tympanic membrane
• Analgesia
• Antibiotics for severe cases
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Middle Ear
• Infection• Chronic Otitis Media
• Ossicular Pathology• Ossiclar fixation or discontinuity
• Requires ossiculoplasty
• Tumors• Glomus Tumors
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Sensorineural Hearing Loss
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Sensorineural Hearing Loss
• Unilateral or Bilateral
• Acute or Chronic
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Pathology
• Genetic
• Infectious
• Vascular
• Neoplastic
• Traumatic
• Ototoxic
• Immunologic and Inflammatory
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Presentation
• Hearing loss• Acute or chronic
• May be fluctuating, progressive or stable
• Tinnitus (usually non pulsatile & subjective)
• Vertigo
• Otorrhoea
• Headache
• Aural fullness
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Physical Examination
• Normal outer ear
• Otoscopy usually normal
• Cranial nerve deficits are rare
• Audiology
• Further Investigations tailored to pathology
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Bilateral Sensorineural Hearing Loss
• Age Related Hearing Loss (Presbyacusis)• Irreversible degeneration of the cochlear
• Non-pulsatile subjective tinnitus
• Usually after age 60
• Bilateral and progressive
• Normal otoscopic findings
• Weber central & Rinne (+) bilaterally
• Audiogram (ski slope curve)
• Hearing aid is treatment mainstay
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Bilateral Sensori-neural Hearing Loss
• Noise-Induced Hearing Loss• Loud noise (>85dB, vacuum
cleaner) over many years
• Ussually occupation related
• Bilateral symmetrical sensori-neural loss
• Usually associated with tinnitus
• Weber central, Rinne (+) bilaterally
• Normal otoscopy
• Audiogram
• Management
• Prophylaxis• Health and safety gear
• Established cases• Hearing aid
• Compensation may be sought
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Bilateral Sensorineural Hearing Loss
• Ototoxixity• Drug related damage to cochlear
• Often a genetic predisposition
• Hearing loss & tinnitus 3 – 4 days after starting drug
• Ototoxic agents • Aminoglycosides, erythromycin, loop diuretics,salicylates, anti-depressants
• Damage is irreversible
• Prevention by monitoring serum levels
• Treatment is by Hearing aid
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Bilateral Sensori-neural Hearing Loss
• Meniere’s Disease• Fluctuating sensori-neural hearing loss
• Tinnitus, aural fullness, vertigo
• Progressive hearing loss over many years
• Vertigo is • Episodic & debilitating
• Lasts for longer than 20min to hours
• Comes in bouts
• Treatment is complex• Conservative Management
• Surgery for intractable cases
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Sensori-neural Hearing Loss
• Other causes• Autoimmune inner ear disease
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Unilateral Senorineural Hearing Loss
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Unilateral Sensorineural Hearing Loss
• Sudden Onset Sensorineural Hearing Loss• An emergency
• Onset of hours
• Presentation is often delayed
• Aetiology• Ototoxicity
• Infection (HIV, mumps, VZV, Meningitis)
• Tumors ( eg. acoustic neuroma)
• Neurological ( brainstem CVA, Multiple sclerosis)
• Temporal bone trauma
• Refer urgently to appropriate speciality including ENT
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Sensorineural Hearing Loss
• Acoustic Trauma• Louder than (180dB, rifle) = acoustic trauma
• Acute injury
• Prevetion is mainstay
• Hearing rehabilitation
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Unilateral Sensorineural Hearing Loss
• Other causes• Autoimmune inner ear disease
• Tuberculosis
• Tumors• Acoutic Neuromas
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Tinnitus
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Tinnitus
• Auditory perception of sound in the ear or head
• From the Latin “Tinnre” ( ring or tinkle)
• Up to 18% of the population
• Usually after the 4th decade
• Reduces Quality of life• Poor sleep, anxiety, depression
• Classification• Subjective & Objective
• Pulsatile & Non-pulsatile
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Tinnitus
• Subjective / Non-pulsatible• Usually bilateral
• Aetiology• Bilateral ( non life threatening)
• Most causes of sensori-neural hearing loss
• Age Related Hearing loss, Noise Induced hearing loss etc
• Hearing aid, Tinnitus masking, Pharmacology, cognitive behavioural therapy
• Unilateral• Meniere’s disease, otosclerosis, acoustic neuromas
• Sudden onset sensori-neural hearing loss (acoustic neuroma)
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Tinnitus
• Unilateral Pulsatile / Objective
• Potential life threatening• Inflammation in middle ear ( eg. Chronic Otitis Media)
• Tumors ( glomus tumors)
• Vascular ( Carotid aneurysms, High Jugular bulb, Jugular Diverticulum)
• Myoclonus (Tensor tympani syndrome, rectus muscle myoclonus)
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Tinnitus
• Bilateral Pulsatile / Objective
• Potentially life threatening
• usually systemic causes• Cardiac ( Aortic valve Regurgitation)
• Endocrine ( thyrotoxicosis)
• Haematological ( anaemia)
• Neurological (migraine, multiple sclerosis, AV malformations, Benign Intranialhypertension)
• Nutritional (Vit B1 deficiency)
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Tinnitus
• Work up can be comlplex
• Referral to specialist is appropriate
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Questions
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Thank You