Dr. Asmatullah AchakzaiMBBS,DLO,MCPS,FCPS

Senior registrar ENT Unit II Sandeman

Provincial Hospital Quetta.

HEARING LOSSHearing Loss is Defined as Impairment of hearing and

severity vary from mild to moderate or Profound.

Hearing loss is Characterized By:• Type of loss(conductive, sensory, neural)

• Locations of the problem (External ear, Middle ear,

Cochlea, auditory, nerve, central )

• Mode of Onset

• Rate of progression

• Degree on loss

• The Conditions that causes it (etiology)

• Bilateral and Unilateral

CLASSIFICATION

Hearing Loss

Organic Non-Organic

Conductive Sensorineural

Sensory Neural

Peripheral Central(Vlllth Nerve) (Central audiotory

Pathways)

CONDUCTIVE HEARING LOSS

1. Negative Rinne test i.e. BC > AC.

2. Weber lateralised to poorer ear.

3. Normal absolute bone conduction.

4. Low frequencies affected more.

5. Audiometry shows bone conduction better then air

conduction with air-bone gap. Greater the air-bone

gap, more is the conductive loss

6. Loss is not more than 60bD.

7. Speech discrimination is good.

MANAGEMENT

1. Removal of canal obstructions.

2. Removal of fluid.

3. Removal of mass from middle ear.

4. Stapedectomy.

5. Tympanoplasty.

6. Hearing Aid.

TYMPANOPLASTY

It is an Operation to Eradicate disease in the middle ear and to reconstruct hearing mechanism.

Types of tympanoplasty:Type I : Defect perforation of tympanic membrane repaired with Graft.

Type II : Defect perforation of tympanic membrane with erosion of

malleus.

Type III : Malleus and incus are absent. Graft is placed directly on the

stapes head.

Type IV : Only the footplate of stapes is present. It is exposed to the

external ear, and Grafth is placed between the oval and round

windows.

Type V : Fenestration Operation.

Myringoplasty

Ossicular reconstruction

Repair of Occicular Chain

SENSORINEURAL HEARING LOSS

Positive Rinne test i.e. AC > BC.

Weber lateralised to better ear.

Bone conduction reduced on Schwabach and absolute

bone conduction tests.

More often involving high frequencies.

No gap between air and bone conduction curve on audiometry.

Loss may exceed 60 dB.

Speech discrimination is poor.

There is difficulty in hearing in the presence of noise.

AETIOLOGY OF SNHL

a) Infection of labyrinth-viral

b) Trauma of labyritnth

c) Noise induced Hearing loss

d) Ototoxic drugs

e) Presbycusis

f) Meniere’s disease

g) Acoustic neuroma

h) Sudden hearing loss

i) Familial progressive SNHL

j) Systemic disorders

NOISE INDUCED HEARING LOSS

NOISE Trauma

Acoustic Trauma Noise Induced

Temporary Prolonged

Premanent

OTOTOXICITY

The Drugs and Chemicals that are Ototoxic.

Aminoglycoside Anitibiotics

Cisplatan

Salicylates

Quinine

Diueritics like fursemide, bumetide

Macrolide antibiotics

Glycopeptide Antibiotics Vencomycine

CLINICAL FEATURES OF OTOTOXICITY

1. Tinnitus

2. Hearing loss

3. Balance disturbances (Disequilibrium)

Investigations1. Monitoring of the Drug concentration in the body.

2. PTA

3. Otoacoustic emission

4. BERA

MANAGEMENT OF OTOTOXICITY

1. Early recognition and discontinuation of the

drug.

2. Hearing AID.

3. Tinnitus should be treated with mild

hypnotics or by Tinnitus maskers.

4. Disequilibrium. Reassurance Physiotherapy

Including vestibular Exercises, avoidance of

walking in darkness, Unnecessary Head

movements.

PRESSBYACUSIS

Clinical Features:1. Deafness

2. Tinnitus

3. Vertigo

4. Distortion of Speech

5. Recruitment may be Positive

INVESTIGATIONS OF PRESSBYACUSIS

Tuning fork test

Audiogram

TREATMENT OF PRESSBYACUSIS

Prophylaxis

Avoidance of noise

Avoidance of High fat diet

Avoidance of cold excessive smoking and stress

Psychological Support

Hearing AID

Drugs (B1,B6,B12 & Iron) may be tried in long

term to prevent deterioration of hearing

SUDDEN SNHL CAUSES

Only 10 to 15 percent of the people diagnosed with SSHL have an identifiable cause. The most common causes are:

Infectious diseases

Trauma, such as a head injury

Autoimmune diseases such as Cogan’s syndrome

Ototoxic drugs (drugs that harm the sensory cells in the inner ear)

Blood circulation problems

A tumor on the nerve that connects the ear to the brain

Neurologic diseases and disorders, such as multiple sclerosis

Disorders of the inner ear, such as Meniere’s

INVESTIGATION OF SUDDEN SNHL

Careful History & Examination

Auditory functions test

Radiological examinations of temporal bone to rule

out acoustic neuroma

Serial viral antibody studies for VDRL, FTA

Blood glucose level for diabetes

ESR and circulating immune complexes to rule out

autoimmune pathology.

TREATMENT

Bed rest

Sedation to relieve anxiety and associated giddiness

Steroid therapy

Inhalation of carbogen

Vasodilator drugs

Low molecular weight dextran

Hyperbaric oxygen therapy

Antiviral agents have been tried in patients with suspected viral etiology.

PROGNOSIS

Onset

Duration

Severity

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