Hearing Impairment

Question 1

Sequence of events and symptom analysis

Answer 1

Open question
Side- better or worse on one side, bilateral, which ear did it start in
Timeline- when did you first notice it, changed over time, come suddenly or gradually, if suddenly, what were you doing at the time (barotrauma eg, scuba)
Environment- any noises hard to hear, difficulty hearing background noise

Question 2

Systems review

Answer 2

Ear- vertigo, otorrhea, tinnitus, foreign bodies in ear, vertigo, balance
Sensory- numbness or tingling, discharge, throat pain or swellings
Motor- weakness or paraesthesia
Headache
Infection- felt I’ll or feverish recently
Constitutional- FWARJCNL

Question 3

Patients perspective

Answer 3

Feelings
ICE

Question 4

Background information

Answer 4

PMH- surgery, previous hearing problems, do you ever use a hearing aid, do people say you talk loud or turn TV up to loud
DH (antibiotics or chemotherapy)
FH (deafness, what age, what specifically etc.’
SH- hobbies ie. Music, rock concerts, exposure to loud noises at work, how it is affecting home life etc.

Question 5

External canal pathology

Answer 5

Conductive
Wax, foreign body, infection like otitis externa

Question 6

Nasopharyngeal tumour

Answer 6

Conductive
Eustachian tube blockage
Unilateral hearing loss, repeated infections, feeling of fullness in the ear
Local effects, headache, mandibular immobility, facial numbness, nosebleeds

Question 7

Tympanic membrane perforation

Answer 7

Conductive
Due to raised pressure changes- plane, diving, explosion, infection, trauma

Question 8

Otitis media with effusion

Answer 8

Most common cause in children

Question 9

Osteosclerosis

Answer 9

Hearing loss starting in early adult life, 85% bilateral, more females than males
Tinnitus
50% have family history
Worsens in menstruation, pregnancy, menopause, improves with background noise

Question 10

Cholestaetoma

Answer 10

Non malignant epithelial growth which often becomes infected
Commonly acquired but can be congenital
Repeated episodes of purulent discharge over months and years, progressive unilateral hearing loss
Headache, facial nerve palsy, pain, vertigo
Intracranial extension and complications

Question 11

Presbycusis

Answer 11

Sensorineural
Gradual hearing loss, starting with high pitched sounds from the 30’s
Worse with background noise or when multiple people are talking

Question 12

Ménière’s disease

Answer 12

Sensorineural
Progressive deafness
Attacks of vertigo and nausea, tinnitus, feeling of ear fullness which all appear in clusters
High salt diet, alcohol, caffeine, tobacco consumption

Question 13

Other causes of hearing loss

Answer 13

Medications
Vestibular schwannomas OR other tumours (head neck, brain etc)
Post infection
Noise induced
MS
Stroke or vasculitides (rare)

Question 14

Investigations

Answer 14

Full neurological and ENT exam with rinnes and Webers
Otoscopy
Pure tone audiometry
Bloods- FBC UE LFT CRP ESR gentamicin level (if relevant)
CT or MRI head
Biopsy of lesions if appropriate

Question 15

DVLA

Answer 15

Must tell if have Ménière’s disease
Stop driving whilst you have labyrinthitis

Question 16

Fullness in ear

Answer 16

Episodic- Ménière’s disease

Constant- acoustic neuroma, Oropharyngeal tumour etc.