Hearing loss

Question 1

2 types of hearing loss

Answer 1

Conductive hearing loss

Sensorineural hearing loss

Question 2

Conductive hearing loss

Answer 2

Problems with the outer and middle ear

Question 3

Causes of conductive hearing loss

Answer 3

Ear wax
Foreign body 
Otitis media or externa 
Perforated tympanic membrane 
Otosclerosis 
Cholesteatoma

Question 4

Causes of sensorineural hearing loss

Answer 4

Presbycusis 
Noise exposure
Ménière’s disease
Labyrinthitis
Acoustic neuroma
Neurological conditions (e.g., stroke, multiple sclerosis or brain tumours)
Infections (e.g., meningitis)
Medications

Question 5

Which medications cause sensorineural hearing loss

Answer 5

Loop diuretics - furosemide

Aminoglycoside antibiotics - gentamicin

Chemotherapy drugs (e.g., cisplatin)

Question 6

Associated symptoms with hearing loss

Answer 6

Tinnitus
Vertigo 
Pain 
Discharge 
Neurological symptoms

Question 7

How to perform a Weber’s test

Answer 7

1. Strike the tuning fork to make it vibrate
2. Place it in the centre of the patient’s forehead
3. Ask the patient if they can hear the sound and which ear it is loudest in

Question 8

Weber’s test results

Answer 8

Normal - both sides equal

If one side is louder:

• either conductive hearing loss to that ear
• sensorineural hearing loss to the other ear

Question 9

How to perform Rinne’s test

Answer 9

1. Strike the tuning fork to make it vibrate
2. Place the flat end on the mastoid process
3. Ask the patient to tell you when they can no longer hear the humming noise
4. When they can no longer hear the noise, remove the tuning fork (still vibrating) and hover it 1cm from the same ear
5. Ask the patient if they can hear the sound now – this tests air conduction
6. Repeat the process on the other side

Question 10

Rinne’s test result

Answer 10

Normal - can hear sound again when near ear canal

If can’t (BC > AC):
- disrupted conductive hearing loss in that ear

Question 11

What is ear wax

Answer 11

Cerumen

Normally produced in small amounts in the external ear canal.

Created from a combination of secretions, dead skin cells and any substances that enter the ear

Question 12

Impacted ear wax presentation

Answer 12

Conductive hearing loss 
Discomfort in the ear
A feeling of fullness
Pain
Tinnitus

Question 13

Investigations for impacted ear wax

Answer 13

Otoscopy

Question 14

Management of impacted ear wax

Answer 14

Ear drops – usually olive oil or sodium bicarbonate 5%

Ear irrigation – squirting water in the ears to clean away the wax

Microsuction – using a tiny suction device to suck out the wax

Question 15

Advice for ear wax

Answer 15

Do not use cotton buds

Question 16

When is microsuction used

Answer 16

When there are contraindications to ear irrigation (e.g. perforated tympanic membrane or infection)