ENT - hearing loss

Question 1

Questions to make sure to ask in the ENT history

Answer 1

Hearing loss
Vertigo
Pain
Tinnitus
Discharge
Neurological symptoms

Exposure to loud noises

Question 2

How to perform Weber’s test?

Answer 2

Tuning fork in the centre of the forehead

Ask which ear they hear the sound the loudest in

Normal - equal in both ears

Sensorineural - louder in the normal ear

Conductive - louder in the affected ear

Question 3

How to perform Rinne’s test?

Answer 3

Tuning fork placed on the mastoid process

Ask the patient to tell you when they can no longer hear the noise

Put the tuning fork in front of their ear and ask if they can hear it again (testing air conduction)

Normal (Rinne’s positive)- can hear the air conduction sound (normal for air conduction to be better than bone conduction

Abnormal (Rinne’s negative) - when bone conduction is better than air conduction - suggests a conductive cause for the hearing loss

Repeat in the other ear

Question 4

Causes of sensorineural hearing loss

Answer 4

Sudden sensorineural hearing loss (over less than 72h)

Presbycusis (age-related)
Noise exposure

Ménière’s disease

Labyrinthitis

Acoustic neuroma

Neurological conditions (e.g., stroke, multiple sclerosis or brain tumours)

Infections (e.g., meningitis)

Medications e.g. loop diuretics e.g. furosemide, aminoglycosides (e.g. gentamicin), chemotherapy drugs e.g. cisplatin

Question 5

Causes of conductive hearing loss

Answer 5

Ear wax

Infection e.g. otitis media/externa

Effusion (fluid in the middle ear)

Otosclerosis

Cholesteatoma

Perforated tympanic membrane

Exostoses
Tumours
Eustachian tube dysfunction