Hearing Loss

Question 1

What are external ear causes of conductive hearing loss?

Answer 1

• Impacted earwax
• Foreign bodies
• Otitis externa
• Neoplasm (squamous cell carcinoma)

Question 2

What are TM pathologies which cause conductive hearing loss?

Answer 2

• Perforation

- Cholesteatoma

Question 3

What are middle ear pathologies which cause conductive hearing loss?

Answer 3

• Effusion
• Otosclerosis
• Neoplasm (vascular glomus tumour)

Question 4

What are causes of sensorineural hearing loss?

Answer 4

• Presbycusis
• Noise exposure
• Sudden sensorineural hearing loss (SSHL)
• Meniere’s disease
• Exposure to ototoxic substances
• Labyrinthitis
• Vestibular shwannoma (acoustic neuroma)
• Neurological conditions (MS, stroke)
• Malignancy (nasopharyngeal cancer)
• Trauma
• Systemic infections

Question 5

What is otosclerosis?

How does it present?

Answer 5

Abnormal growth of the small bones of the ear (mostly the stapes)

Bilateral, gradual onset hearing loss, painless, patients aged 30-50
Family history
Normal finding on examination

Question 6

What is sudden sensorineural hearing loss?

Answer 6

• Sudden onset (<72hrs) loss of 30dB or more
• Cannot be explained by outer or middle ear pathologies
• Idiopathic
• May be temporary or permanent

Question 7

Name some ototoxic substances

Answer 7

• Aminoglycoside antibiotics (gentamicin)
• Loop diuretics (bumetanide/furosemide)
• NSAIDS
• Anti malarials
• Cytotoxic drugs

Question 8

What is an acoustic neuroma?

How does it present?

Answer 8

A benign tumour which can cause hearing loss by compressing the cochlear nerve
It can grow into the posterior cranial fossa and cause brain stem compression

Presents as gradual onset unilateral hearing loss, may be associated with tinnitus/vertigo
Neurological symptoms possibly
Ear examination normal

Question 9

How does age related hearing loss present?

Answer 9

• Slowly progressive bilateral high frequency hearing loss
• Aged 50-60
• Normal examination
• Patient usually unaware

Question 10

What is labrynthitis?

Answer 10

• Hearing loss associated with tinnitus, sensation of pressure/fullness in the ears and vertigo

Question 11

What should you ask about onset and progression of symptoms?

Answer 11

• Sudden, rapidly progressive (<90 days), slowly progressive or fluctuating
• Unilateral or bilateral

Question 12

How would you do a ear systemic review?

Answer 12

• Tinnitus (persistent, unilateral, pulsatile or recently changed)
• Vertigo
• Otorrhoea or otalgia
• Sensation of fullness/pressure in the ear
• Head/neck trauma, pain or swelling
• Neurological symptoms

Question 13

What should you ask a patient about their past?

Answer 13

• Previous chronic infections
• ENT surgery/head trauma
• Exposure to noise
• Immunosuppression
• Use of ototoxic drugs
• Family history of hearing loss

Question 14

What examinations should you undertake?

Answer 14

• Pinna and surrounding skin
• Otoscope of ear canal and tympanic membrane
• Weber and Rinne test
• Cranial nerve and cerebellar function
• Head and neck for lymphadenopathy

Question 15

How do you manage hearing loss in primary care?

Answer 15

• Exclude/treat hearing loss like impacted wax/ear infections
• Arrange an audiological assessment
• Hearing aids if idiopathic sensorineural
• Give support eg reduce competing noises, soft furnishing to improve acoustics, adequate lighting

Question 16

When should you refer to ENT within 24hrs?

Answer 16

• Sudden onset unilateral/bilateral hearing loss which cannot be explained by external/middle ear pathology
• Unilateral hearing loss associated with focal neurology
• Associated with head or neck injury
• Associated with Ramsey Hunt/necrotising otitis externa

Question 17

When should you refer to ENT within 2 weeks?

Answer 17

• Sudden onset hearing loss over 30 days ago
• Rapidly progressive hearing loss
• Suspected malignancy (bloody discharge, hearing loss and middle ear effusion without upper resp tract infection)