Hearing loss

Question 1

What tuning fork to use in assessing hearing loss

Answer 1

512Hz

Question 2

Rinne’s test interpretation

Answer 2

Normal: Air conduction better than bone conduction

Abnormal (‘negative’): AC

Question 3

How to perform Rinne’s test

Answer 3

Hold 512Hz tuning fork to mastoid, and ask patient to indicate when they stop hearing it. At this point quickly move the tuning for to just in front of external auditory canal, and ask if they can hear it there.

Question 4

Interpretation of Weber’s test

Answer 4

Normal: central
SNHL: lateralises to normal ear
Conductive: lateralises to abnormal ear

Question 5

Causes of conductive hearing loss

Answer 5

Impaired conduction anywhere between auricle and round window
Canal obstruction: wax, foreign body
Tympanic membrane perforation: trauma, infection
Ossicle defects: otosclerosis, infection
Fluid in the middle ear

Question 6

Causes of sensorineural hearing loss

Answer 6

Defects of the cochlea, cochlear nerve, or brain.
Congenital: Alport’s syndrome (sensorineural hearing loss + haematuria), Jewell-Lange-Nielsen (sensorineural hearing loss + long QT).
Acquired: presbyacusis, drugs (gentamicin, vancomycin), infection (meningitis, measles), tumour (vestibular Schwannoma).