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Hearing Loss Notes

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Hearing Loss Classification
- Deafness = subjective decline in hearing acuity affecting one or both ears
- Conductive hearing loss ("Obstructive") o Pathology external or middle ear amenable to surgery
- Sensory-neural hearing loss ("failure of transmission") o Pathology affecting cochlear, auditory nerve or auditory centers in the brain o Often involves loss of hair cells from the Organ of Corti, therefore is usually permanent

Aetiology

Conductive hearing loss
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External ear occlusion e.g wax, foreign body, congenital agenesis of the ear Infection (otitis media/externa) Glue ear Trauma (direct blow, acoustic trauma) Osteosclerosis - fixation of stapes on oval window (runs in families, associated with tinnitus and mild vertigo) Iatrogenic (surgery)

Sensorineural hearing loss
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Idiopathic Presbycusis o Age-related hearing loss, usually loss of high-frequency sounds initially, because hair cells responding to high-frequency sounds are most easily damaged) Viral infections (measles, mumps, meningitis) Tumours affecting the cochlear nerve Trauma - temporal bone fractures Drugs - aminoglycosides e.g gentamycin Central - brainstem CVA

Investigations Tuning Fork Test
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o 512 Hz, middle C - so heard not felt) Rinnes o Place tuning fork on mastoid bone and acoustic meatus and ask which is loudest (normally air conduction > bone conduction =
positive Rinne's test) o Negative test = pathology where bone conduction > air conduction = conductive hearing pattern o In sensorineural loss both AC and BC are decreased therefore AC should still be > BC Webers o Place tuning fork in middle of forehead o Normal sound is equally loud in both ears o In unilateral conductive hearing loss the sound will lateralise to the affected side

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