Disordens da audição

Question 1

Quais os objetivos da avaliação de um doente com hipoacusia?

Answer 1

(1) the nature of the hearing impairment (conductive vs. sensorineural vs. mixed), (2) the severity of the impairment (mild, moderate, severe, profound), (3) the anatomy of the impairment (external ear, middle ear, inner ear, or central auditory pathway), and (4) the etiology

Question 2

O que devo avaliar na historia de alguém com hipoacusia?

Answer 2

The history should elicit characteristics of the hearing loss, including the duration of deafness, unilateral vs. bilateral involvement, nature of onset (sudden vs. insidious), and rate of progression (rapid vs. slow). Symptoms of tinnitus, vertigo, imbalance, aural fullness, otorrhea, headache, facial nerve dysfunction, and head and neck paresthesias should be noted. Information regarding head trauma, exposure to ototoxins, occupational or recreational noise exposure, and family history of hearing impairment may also be important.

Question 3

Qual deve ser o exame físico em um doente com hipoacusia?

Answer 3

(1) Examination should include the auricle, external ear canal, and tympanic membrane.
(2) Careful inspection of the nose, nasopharynx, and upper respiratory tract is indicated
(3) Cranial nerves should be evaluated with special attention to facial and trigeminal nerves, which are commonly affected with tumors involving the cerebellopontine angle
(4) The Rinne and Weber tuning fork tests, with a 512-Hz tuning fork, are used to screen for hearing loss, differentiate conductive from sensorineural hearing losses, and to confirm the findings of audiologic evaluation

Question 4

Como tratar a hipoacusia?

Answer 4

(1) In general, conductive hearing losses are amenable to surgical correction, while sensorineural hearing losses are more difficult to manage. Likewise, conductive hearing loss associated with otosclerosis can be treated by stapedectomy, which is successful in 90–95% of cases.
(2) Patients with mild, moderate, and severe sensorineural hearing losses are regularly rehabilitated with hearing aids of varying configuration and strength. In the event that the hearing aid provides inadequate rehabilitation, cochlear implants may be appropriate
(3) Relief of the tinnitus may be obtained by masking it with background music. Hearing aids are also helpful in tinnitus suppression, as are tinnitus maskers, devices that present a sound to the affected ear that is more pleasant to listen to than the tinnitus. Antidepressants have been shown to be beneficial in helping patients cope with tinnitus.
(4) Hard-of-hearing individuals often benefit from a reduction in unnecessary noise in the environment (e.g., radio or television) to enhance the signal-to-noise ratio. Speech comprehension is aided by lip reading; therefore, the impaired listener should be seated so that the face of the speaker is well illuminated and easily seen.