Deafness

Question 1

DDx for hearing loss.

Answer 1

• conductive loss - outer and middle ear loss
• sensorineural loss - inner and CN VIII disease
• Mixed conductive and sensorineural

Question 2

Define conductive hearing loss. What are it’s 4 main causes?

Answer 2

decreased transmission of sound to the cochlea via air conduction

• obstruction of the external ear canal
• perforation of the tympanic membrane - wax, oedema, debris externa, foreign bodies
• discontinuity of the ossicular chain - infection or trauma
• fixation of the ossicular chain - otosclerosis

Question 3

define sensorineural deafness. What are the 3 broad categories of causes?

Answer 3

normal sound transmission to inner ear but problem with cochlea or nerve .

• bilateral progression - drug ototoxicity, noise damage
• unilateral progression - meniere’s disease, acoustic neuroma
• Sudden loss - trauma, viral infection (mumps, measles, VZ), neuroma, barotrauma

Question 4

What are the fun ear examination test’s you do?

Answer 4

Rinnie’s behind the pinnies

Weber’s on the headers

Question 5

What does a negative Rinnie’s test tell you? How could you interpret that finding?

Answer 5

• Bone conduction is louder than air conduction

- Conductive hearing loss

Question 6

What other investigations can you do for hearing loss?

Answer 6

• pure tone audiogram

- tympanometry

Question 7

In adults what would make you 100% investigate their hearing loss?

Answer 7

• asymmetrical hearing changes

- MRI for acoustic neuroma

Question 8

What are the 2 management options for congential deafness?

Answer 8

• hearing aids

- cochlear implant

Question 9

What is the most common cause of acquired deafness?

Answer 9

otitis media with effusion

Question 10

In an acute episode of hearing loss would associated Sx would you be asking about? And why?

Answer 10

• other neuro Sx - MS/CVA
• meds Hx - loops, chemo, Abx (gentimicin), aspirin
• previous Trauma
• tinitus + aural fullness + hearing loss = meniere’s