hear ye, or 10 minutes on hearing loss. the ear assessment 1 history - as ever, onset and...
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Hear ye, Hear ye,
Or 10 minutes on hearing loss
The ear
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Assessment 1
• History - as ever, onset and progression sudden loss may follow trauma/infection/idiopathic REFER IMMEDIATELY as can use steroids, hyperbaric O2 etc, 70% recover spontaneously
• Acoustic neuroma may present as sudden onset unilat in 10%
• Menieres, fluc loss
Assmt 2
• Presbyacusis and otosclerosis more gradual, noise insidious
• Side - unilat more significant, unilat conductive in an adult may be nasopharyngeal Ca.
• Other sx, tinnitus - ‘sound of silence’ any cause reducing external noise may cause - common with noise exposure, head injury , drugs and radiation
Assmt 3
• Noise hx - pattern usually high frequency around 4khz.
• Drug hx, chemo/radiorx
• Family hx
• Exam - wax, effns and tuning fork test
• Kids - preg, delivery and devlmt.
Normal Audiogram
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Classification
• Conductive - something in outer or middle ear
• Sensorineural - inner ear or auditory nerve
• Mixed
• Central - lesion in brain or auditory pathway.
Sensorineural
• Includes lesions of the cochlea and neural pathways
• Affects kids and adults, in kids acqd or congenital - often assoc with congen syndromes
• Rinnes air louder than bone and Webers lateralises to less affected ear
Acquired
• Infective - rubella, congen CMV, toxo, meningitis, mumps.
• Neoplastic - acoustic neuroma (occipital pain, VIII nerve damage, unilat sensorineural, vertigo and tinnitus uncommon,V damage, VII unusual)
• Trauma - chronic noise, fracture,perilymph leak, surgery
• Metabolic - DM, pagets, hypothyroid, Pendreds
Noise exposure
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Acquired 2
• Toxic - drugs - often starts wih tinnitus,then grad hearing loss
• Presbyacusis - Progressive sensorineural loss with age, typically high frquency due to cochlear cell loss, words merge and shouting doesn’t help!
Prebyacusis
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Acquired 3
• Otosclerosis - more in conductive but can also cause sensorineural due to otosclerosis in labarynthine capsule.
• Menieres - usually unilat, known also as ideopathicendolymphatic hydrops., combination of vertigo, tinnitus and hearing loss episodically rare, prevalence of 43/100000 - get low frequency loss
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A bit more on menieres
• In acute attck, lie down, still with eyes open on fixed object
• Get up slowly , use prochloperazine or cinnarizine
• Between attacks, restrict salt, betahisitine, adequate even fluids, no MSG. there is surgery.
Congenital
• Genetic sydromes- quite a few, e.g with retinitis pig = Ushers
• Chromasomal probs Downs can cause
Conductive causes
• Otitis media with effusion• Acute otitis media• Otitis externa• Congenital or acquired stenosis• Chronic middle ear disease incl cholesteatoma• Otosclerosis - formation of new bone around
footplates of stapes, more common in women, pregnancy worsens, rx with aids and surgery although 2% risk total hearing loss with stapedectomy.
Conductive causes 2
• Trauma
• Wax
• Foreign body
A bit more on OM with effusion
• Commonest cause of hearing imprmt in kids, 80% kids at some point
• 50% resolve in 3/12 if more than 6/12 may be a problem
• Mild balance probs common• Watchful waiting good mx for 1st 3/12• No evidence decongestants etc help• Surgical mx with grommets to prevent delay• Not established who. Cipro if otorrhoea• Adenoidectomy recommended with grommets.
Eardrum of…
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