conductive hearing loss Flashcards
what is conductive hearing loss
deafness due to failure to adequately transmit sound from out to inner ear
name 6 causes of conductive hearing loss
- cholesteatoma
- osteosclerosis
- wax impaction (impacted cerumen) -> most common
- perforated eardrum
- otitis media with effusion
- infection (otitis externa and otitis media)
what is cholesteatoma
when skin (stratified squamous epithelium grows into the middle ear causing local destruction and inflammation
cholesteatoma most common in
5-15 years old
cholesteatoma presentation
- conductive hearing loss
- otalgia
- headache
- foul smelling, cheesy white discharge
- on examination -> pearly white tympanic membrane
cholesteatoma diagnosis
- Rinne’s: negative
- Webbers: localises to side of defect
- audiometry: air bone gap
- otoscope: pearly white tympanic membrane and attic crust on uppermost part of eardrum
cholesteatoma management
surgical removal
what is otosclerosis
hereditary autosomal dominant condition of the otic capsule that results in fixation of the footplate of stapes to the oval window
otosclerosis most common in
20-40s
what is otosclerosis worsened by
pregnancy
otosclerosis presentation
- conductive hearing loss that is better with background noise
- possible tinnitus and vertigo
- normal tympanic membrane
otosclerosis diagnosis
- Rinne’s: negative
- Webbers: localises to side of defect
- audiometry: air bone gap that narrows in the middle (Carhaarts notch)
otosclerosis management
- hearing aid
- surgical replacement of stapes, CO2 laser, cochlear implant
what is otitis media with effusion
inflammation of the middle ear in abscence of infection
name 4 risk factors for otitis media with effusion
- recurrent upper respiratory tract infection
- prematurity
- craniofacial abnormalities
- smoking household
otitis media with effusion presentation
- deafness
- speech delay
- behavioural problems
- poor or reduced school performance
- on examination -> retracted membrane with visible fluid level and possible fluid bubbles behind the membrane
- unilateral otitis media with effusion in adult -> could be nasopharyngeal cancer
otitis media with effusion diagnosis
- Rinne’s: negative
- Webbers: localises to side of defect
- audiometry: air bone gap
- flat, type B tympanogram
otitis media with effusion management
- self limiting within 3 months
- < 3 years old -> Grommets
- > 3 years old -> Grommets or Grommets and adenoidectomy
when do you refer patients with otitis media with effusion
- > 3 months
- bilateral
- significant hearing loss or impact on behaviour
