conductive hearing loss

Question 1

what is conductive hearing loss

Answer 1

deafness due to failure to adequately transmit sound from out to inner ear

Question 2

name 6 causes of conductive hearing loss

Answer 2

• cholesteatoma
• osteosclerosis
• wax impaction (impacted cerumen) -> most common
• perforated eardrum
• otitis media with effusion
• infection (otitis externa and otitis media)

Question 3

what is cholesteatoma

Answer 3

when skin (stratified squamous epithelium grows into the middle ear causing local destruction and inflammation

Question 4

cholesteatoma most common in

Answer 4

5-15 years old

Question 5

cholesteatoma presentation

Answer 5

• conductive hearing loss
• otalgia
• headache
• foul smelling, cheesy white discharge
• on examination -> pearly white tympanic membrane

Question 6

cholesteatoma diagnosis

Answer 6

• 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

Question 7

cholesteatoma management

Answer 7

surgical removal

Question 8

what is otosclerosis

Answer 8

hereditary autosomal dominant condition of the otic capsule that results in fixation of the footplate of stapes to the oval window

Question 9

otosclerosis most common in

Answer 9

20-40s

Question 10

what is otosclerosis worsened by

Answer 10

pregnancy

Question 11

otosclerosis presentation

Answer 11

• conductive hearing loss that is better with background noise
• possible tinnitus and vertigo
• normal tympanic membrane

Question 12

otosclerosis diagnosis

Answer 12

• Rinne’s: negative
• Webbers: localises to side of defect
• audiometry: air bone gap that narrows in the middle (Carhaarts notch)

Question 13

otosclerosis management

Answer 13

• hearing aid
• surgical replacement of stapes, CO2 laser, cochlear implant

Question 14

what is otitis media with effusion

Answer 14

inflammation of the middle ear in abscence of infection

Question 15

name 4 risk factors for otitis media with effusion

Answer 15

• recurrent upper respiratory tract infection
• prematurity
• craniofacial abnormalities
• smoking household

Question 16

otitis media with effusion presentation

Answer 16

• 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

Question 17

otitis media with effusion diagnosis

Answer 17

• Rinne’s: negative
• Webbers: localises to side of defect
• audiometry: air bone gap
• flat, type B tympanogram

Question 18

otitis media with effusion management

Answer 18

• self limiting within 3 months
• < 3 years old -> Grommets
• > 3 years old -> Grommets or Grommets and adenoidectomy

Question 19

when do you refer patients with otitis media with effusion

Answer 19

• > 3 months
• bilateral
• significant hearing loss or impact on behaviour