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Hearing Loss

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Dr Asmatullah Achakzai
Dr Asmatullah Achakzai

Hearing Imperiment Investigation management and Rehablitation ...... Presented By Dr.Asmatullah Achakzai

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Hearing Loss
Dr. Asmatullah Achakzai MBBS,DLO,MCPS,FCPS Senior registrar ENT Unit II Sandeman Provincial Hospital Quetta.
HEARING LOSS Hearing Loss is Defined as Impairment of hearing and severity vary from mild to moderate or Profound. Hearing loss is Characterized By: • Type of loss(conductive, sensory, neural) • Locations of the problem (External ear, Middle ear, Cochlea, auditory, nerve, central ) • Mode of Onset • Rate of progression • Degree on loss • The Conditions that causes it (etiology) • Bilateral and Unilateral
CLASSIFICATION Hearing Loss Organic Non-Organic Conductive Sensorineural Sensory Neural Peripheral Central (Vlllth Nerve) (Central audiotory
CONDUCTIVE HEARING LOSS 1. Negative Rinne test i.e. BC > AC. 2. Weber lateralised to poorer ear. 3. Normal absolute bone conduction. 4. Low frequencies affected more. 5. Audiometry shows bone conduction better then air conduction with air-bone gap. Greater the air-bone gap, more is the conductive loss 6. Loss is not more than 60bD. 7. Speech discrimination is good.
MANAGEMENT 1. Removal of canal obstructions. 2. Removal of fluid. 3. Removal of mass from middle ear. 4. Stapedectomy. 5. Tympanoplasty. 6. Hearing Aid.
TYMPANOPLASTY It is an Operation to Eradicate disease in the middle ear and to reconstruct hearing mechanism. Types of tympanoplasty: Type I : Defect perforation of tympanic membrane repaired with Graft. Type II : Defect perforation of tympanic membrane with erosion of malleus. Type III : Malleus and incus are absent. Graft is placed directly on the stapes head. Type IV : Only the footplate of stapes is present. It is exposed to the external ear, and Grafth is placed between the oval and round windows. Type V : Fenestration Operation.
Myringoplasty Ossicular reconstruction Repair of Occicular Chain
SENSORINEURAL HEARING LOSS  Positive Rinne test i.e. AC > BC.  Weber lateralised to better ear.  Bone conduction reduced on Schwabach and absolute bone conduction tests.  More often involving high frequencies.  No gap between air and bone conduction curve on audiometry.  Loss may exceed 60 dB.  Speech discrimination is poor.  There is difficulty in hearing in the presence of noise.
AETIOLOGY OF SNHL a) Infection of labyrinth-viral b) Trauma of labyritnth c) Noise induced Hearing loss d) Ototoxic drugs e) Presbycusis f) Meniere’s disease g) Acoustic neuroma h) Sudden hearing loss i) Familial progressive SNHL j) Systemic disorders
NOISE INDUCED HEARING LOSS NOISE Trauma Acoustic Trauma Noise Induced Temporary Prolonged Premanent
Hearing Loss
Hearing Loss
Hearing Loss
OTOTOXICITY The Drugs and Chemicals that are Ototoxic.  Aminoglycoside Anitibiotics  Cisplatan  Salicylates  Quinine  Diueritics like fursemide, bumetide  Macrolide antibiotics  Glycopeptide Antibiotics Vencomycine
CLINICAL FEATURES OF OTOTOXICITY 1. Tinnitus 2. Hearing loss 3. Balance disturbances (Disequilibrium) Investigations 1. Monitoring of the Drug concentration in the body. 2. PTA 3. Otoacoustic emission 4. BERA
MANAGEMENT OF OTOTOXICITY 1. Early recognition and discontinuation of the drug. 2. Hearing AID. 3. Tinnitus should be treated with mild hypnotics or by Tinnitus maskers. 4. Disequilibrium. Reassurance Physiotherapy Including vestibular Exercises, avoidance of walking in darkness, Unnecessary Head movements.
PRESSBYACUSIS Clinical Features: 1. Deafness 2. Tinnitus 3. Vertigo 4. Distortion of Speech 5. Recruitment may be Positive
INVESTIGATIONS OF PRESSBYACUSIS  Tuning fork test  Audiogram
TREATMENT OF PRESSBYACUSIS  Prophylaxis Avoidance of noise Avoidance of High fat diet Avoidance of cold excessive smoking and stress  Psychological Support  Hearing AID  Drugs (B1,B6,B12 & Iron) may be tried in long term to prevent deterioration of hearing
SUDDEN SNHL CAUSES  Only 10 to 15 percent of the people diagnosed with SSHL have an identifiable cause. The most common causes are:  Infectious diseases  Trauma, such as a head injury  Autoimmune diseases such as Cogan’s syndrome  Ototoxic drugs (drugs that harm the sensory cells in the inner ear)  Blood circulation problems  A tumor on the nerve that connects the ear to the brain  Neurologic diseases and disorders, such as multiple sclerosis
INVESTIGATION OF SUDDEN SNHL  Careful History & Examination  Auditory functions test  Radiological examinations of temporal bone to rule out acoustic neuroma  Serial viral antibody studies for VDRL, FTA  Blood glucose level for diabetes  ESR and circulating immune complexes to rule out autoimmune pathology.
TREATMENT  Bed rest  Sedation to relieve anxiety and associated giddiness  Steroid therapy  Inhalation of carbogen  Vasodilator drugs  Low molecular weight dextran  Hyperbaric oxygen therapy  Antiviral agents have been tried in patients with suspected viral etiology.
PROGNOSIS Onset Duration Severity
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Hearing Loss

  • 2. Dr. Asmatullah Achakzai MBBS,DLO,MCPS,FCPS Senior registrar ENT Unit II Sandeman Provincial Hospital Quetta.
  • 3. HEARING LOSS Hearing Loss is Defined as Impairment of hearing and severity vary from mild to moderate or Profound. Hearing loss is Characterized By: • Type of loss(conductive, sensory, neural) • Locations of the problem (External ear, Middle ear, Cochlea, auditory, nerve, central ) • Mode of Onset • Rate of progression • Degree on loss • The Conditions that causes it (etiology) • Bilateral and Unilateral
  • 4. CLASSIFICATION Hearing Loss Organic Non-Organic Conductive Sensorineural Sensory Neural Peripheral Central (Vlllth Nerve) (Central audiotory
  • 5. CONDUCTIVE HEARING LOSS 1. Negative Rinne test i.e. BC > AC. 2. Weber lateralised to poorer ear. 3. Normal absolute bone conduction. 4. Low frequencies affected more. 5. Audiometry shows bone conduction better then air conduction with air-bone gap. Greater the air-bone gap, more is the conductive loss 6. Loss is not more than 60bD. 7. Speech discrimination is good.
  • 6. MANAGEMENT 1. Removal of canal obstructions. 2. Removal of fluid. 3. Removal of mass from middle ear. 4. Stapedectomy. 5. Tympanoplasty. 6. Hearing Aid.
  • 7. TYMPANOPLASTY It is an Operation to Eradicate disease in the middle ear and to reconstruct hearing mechanism. Types of tympanoplasty: Type I : Defect perforation of tympanic membrane repaired with Graft. Type II : Defect perforation of tympanic membrane with erosion of malleus. Type III : Malleus and incus are absent. Graft is placed directly on the stapes head. Type IV : Only the footplate of stapes is present. It is exposed to the external ear, and Grafth is placed between the oval and round windows. Type V : Fenestration Operation.
  • 9. SENSORINEURAL HEARING LOSS  Positive Rinne test i.e. AC > BC.  Weber lateralised to better ear.  Bone conduction reduced on Schwabach and absolute bone conduction tests.  More often involving high frequencies.  No gap between air and bone conduction curve on audiometry.  Loss may exceed 60 dB.  Speech discrimination is poor.  There is difficulty in hearing in the presence of noise.
  • 10. AETIOLOGY OF SNHL a) Infection of labyrinth-viral b) Trauma of labyritnth c) Noise induced Hearing loss d) Ototoxic drugs e) Presbycusis f) Meniere’s disease g) Acoustic neuroma h) Sudden hearing loss i) Familial progressive SNHL j) Systemic disorders
  • 11. NOISE INDUCED HEARING LOSS NOISE Trauma Acoustic Trauma Noise Induced Temporary Prolonged Premanent
  • 15. OTOTOXICITY The Drugs and Chemicals that are Ototoxic.  Aminoglycoside Anitibiotics  Cisplatan  Salicylates  Quinine  Diueritics like fursemide, bumetide  Macrolide antibiotics  Glycopeptide Antibiotics Vencomycine
  • 16. CLINICAL FEATURES OF OTOTOXICITY 1. Tinnitus 2. Hearing loss 3. Balance disturbances (Disequilibrium) Investigations 1. Monitoring of the Drug concentration in the body. 2. PTA 3. Otoacoustic emission 4. BERA
  • 17. MANAGEMENT OF OTOTOXICITY 1. Early recognition and discontinuation of the drug. 2. Hearing AID. 3. Tinnitus should be treated with mild hypnotics or by Tinnitus maskers. 4. Disequilibrium. Reassurance Physiotherapy Including vestibular Exercises, avoidance of walking in darkness, Unnecessary Head movements.
  • 18. PRESSBYACUSIS Clinical Features: 1. Deafness 2. Tinnitus 3. Vertigo 4. Distortion of Speech 5. Recruitment may be Positive
  • 19. INVESTIGATIONS OF PRESSBYACUSIS  Tuning fork test  Audiogram
  • 20. TREATMENT OF PRESSBYACUSIS  Prophylaxis Avoidance of noise Avoidance of High fat diet Avoidance of cold excessive smoking and stress  Psychological Support  Hearing AID  Drugs (B1,B6,B12 & Iron) may be tried in long term to prevent deterioration of hearing
  • 21. SUDDEN SNHL CAUSES  Only 10 to 15 percent of the people diagnosed with SSHL have an identifiable cause. The most common causes are:  Infectious diseases  Trauma, such as a head injury  Autoimmune diseases such as Cogan’s syndrome  Ototoxic drugs (drugs that harm the sensory cells in the inner ear)  Blood circulation problems  A tumor on the nerve that connects the ear to the brain  Neurologic diseases and disorders, such as multiple sclerosis
  • 22. INVESTIGATION OF SUDDEN SNHL  Careful History & Examination  Auditory functions test  Radiological examinations of temporal bone to rule out acoustic neuroma  Serial viral antibody studies for VDRL, FTA  Blood glucose level for diabetes  ESR and circulating immune complexes to rule out autoimmune pathology.
  • 23. TREATMENT  Bed rest  Sedation to relieve anxiety and associated giddiness  Steroid therapy  Inhalation of carbogen  Vasodilator drugs  Low molecular weight dextran  Hyperbaric oxygen therapy  Antiviral agents have been tried in patients with suspected viral etiology.