Hearing Loss

Question 1

What is Conductive Hearing Loss?

Answer 1

A problem with sound travelling from the environment to the inner ear - sensory system works but the sound is not reaching it.

Question 2

What is Sensorineural Hearing Loss?

Answer 2

A problem with the sensory system or the vestibulocochlear nerve in the inner ear.

Question 3

What tests are used to investigate Hearing Loss? (2)

Answer 3

1. Weber’s Test (Forehead).

2. Rinne’s Test (Mastoid).

Question 4

Results of Weber’s Test (3).

Answer 4

1. Normal = Equal Sound Bilaterally.
2. Sensorineural = Louder in Normal Ear.
3. Conductive = Louder in Affected Ear (compensatory = becomes more sensitive).

Question 5

Results of Rinne’s Test (2).

Answer 5

1. Positive : Air Conduction > Bone Conduction (Normal).

2. Negative : Bone Conduction > Air Conduction = CONDUCTIVE CAUSE.

Question 6

Aetiology of Sensorineural Hearing Loss (9).

Answer 6

1. Sudden Sensorineural Hearing Loss (Less than 72 Hours).
2. Presbycusis (Age-Related).
3. Noise Exposure.
4. Ménière’s Disease.
5. Labyrinthitis.
6. Acoustic Neuroma.
7. Neurological Conditions e.g. Stroke, MS, Tumours.
8. Infections e.g. Meningitis.
9. Medications.

Question 7

Medications that cause Sensorineural Hearing Loss (3).

Answer 7

1. Loop Diuretics e.g. Furosemide.
2. Aminoglycoside Antibiotics e.g. Gentamicin.
3. Chemotherapy e.g. Cisplatin.

Question 8

Aetiology of Conductive Hearing Loss (9).

Answer 8

1. Ear Wax/Blockage.
2. Infection e.g. Otitis Media/Externa.
3. Effusion.
4. Eustachian tube Dysfunction.
5. Perforated Tympanic Membrane.
6. Otosclerosis.
7. Cholesteatoma.
8. Exostoses.
9. Tumours.

Question 9

What is Otosclerosis?

Answer 9

An autosomal dominant condition where there is replacement of normal bone by vascular spongy bone : onset : 20-40.

Question 10

Clinical Features of Otosclerosis (4).

Answer 10

1. Conductive Deafness.
2. Tinnitus.
3. Tympanic Membrane - Flamingo Tinge (Hyperaemia).
4. Positive Family History.

Question 11

Aetiology of Sudden-Onset Hearing Loss.

Answer 11

Majority = Idiopathic.

Question 12

Management of Sudden Onset Hearing Loss (<72 Hours) (3).

Answer 12

1. Urgent Referral to ENT : Thorough Assessment (Rivne and Weber).
2. Exclude Vestibular Schwannoma.
3. High-Dose Oral Corticosteroids.

Question 13

Audiometry Findings in Hearing Loss (2).

Answer 13

1. Presbycusis - Bilateral High-Frequency Hearing Loss.

2. Otosclerosis : Carhart’s Notch (At 2000 Hz - Bone Conduction is lost).

Question 14

Audiometry Findings : Conductive vs. Sensorineural (2).

Answer 14

1. Conductive : Bone Conduction > Air Conduction.

2. Sensorineural : Loss of Hearing at High Frequency - Symmetrical Progressive.