4. • .
Outer ear
Middle ear
Inner ear

5. Ability to perceive sound by detecting vibrations
through ear

7. Hearing loss???

9. Conductive
Sensori-neural
Mixed

10. Conductive Hearing Loss
Atresia
Wax
Otitis externa
Otitis media
Cholesteatoma
Otosclerosis
Ossicular
discontiunity
Glomus Tumor

11. Mixed Hearing Loss
Conductive
Sensorineural
Mixed

12. Sensorineural Hearing Loss
 Congenital birth defects
 Hereditary/genetic factors
 Noise trauma
 Head injury
 Ototoxicity

13.  Aging
 Measles
 Mumps
 Meningitis
 Meniers
 Tumors

14. uncontrollable
irreversible
independent
uncoordinated autonomous
unlimited abnormal
over growth of tissues.

15. Cancer spreads…
By invasion to
the
tissues
By metastasis to
sites

16. Malignant

19. Conductive
Hearing Loss
Sensorineural
Hearing Loss
Hearing Loss
Resulting from
Cancer

20. INDIRECT
EFFECTS
Treatment
Radiation
therapy
Chemo-
therapy

21. Radiation damages sensory hair cells of
the inner ear
Damage from radiation can affect one or
both the ears depending on the area of
radiation
Sensorineural hearing loss

23. Chemotherapy drugs used for
Head & neck cancer
Cervical carcinoma
Lung cancer
Neurologic cancer
Breast cancer
leukimia
Brain tumour
Neuroblastoma
Nasopharyngeal carcinoma

24. Nitrogen
mustard

27. Out of 32 patients
(aged 30-59yrs),
hearing loss was
confirmed in 23%of
patients
Out of 67 patients
(aged 8 months to 23
years), 61%
developed hearing
loss following onset of
treatment
[Annuals of Oncology,2002]
[Oregon health & science center,2005]

28. Glomus Tumors
• Most common benign
neoplasm of the middle
ear.
• Patients present with
conductive hearing loss,
pulsatile unilateral
tinnitus & a middle ear
mass
• A type tympanogram with
tiny saw-tooth variations
Cerebellopontine angled
Tumors
• 80% 0f tumors are
acoustic neuromas
• Patients present with a
progressive, unilateral, sen
sorineural hearing loss
• Reduced SDS scores, Roll
over will be
present,absent reflexes
• ABR will demonstrate an
increased wave I to V
interpeak latency

30. Nasopharyngeal
Cancer
 Cancer that occurs in the
nasopharynx, which is
located behind the nose
and near the Eustachian
Tube
 Conductive hearing loss
is the most common
symptom
 Sometimes leads to
sensorineural hearing loss
also

31. 31

32. • It occurs in the nasopharynx, which is located behind the
nose and above the back of the throat.
• The nasopharynx is the upper portion of the pharynx — a
5-inch tube that extends from behind the nose to the top of
the windpipe and esophagus.
• NPC is the most common neoplasm to cause
unilateral ET obstruction.

33. Malignant tumors of nasopharynx
Squamous Cell Carcinoma
Lymphoma
Large Miscellaneous Group

35. Age
40-50 years

37. Well known to ENT
specialist but not
familiar to audiologist

38. 0
10
20
30
40
50
60
70
Symptom from NPC found in Siriraj hospital

39. 0
10
20
30
40
50
60
Symptom & sign of NPC frequency at diagnostic in Mayo clinic series Kuala
Lumpur 1983

40. Causes
Genetic
factors
Environmental
factors
microelement
nickel(Ni)
Epstein
barr virus

41. Ear involvement

42. A Study……
Beth McLeod & Glen
Croxson (2004 )
Subject:52 year old
manPresent
complaints
a blocked
feeling in the
left ear, &
tinnitus
Test results
PTA :
Rt ear-normal
Lt ear-38 dB
Lt ear:-Flat
tympanogram
with absent
reflexes
Rt ear:- normal
Diagnosed as mild to
moderate conductive
HL for the left ear
On further evaluation
the case was
diagnosed as NPC
Post treatment
assessment
Both PTA &
tympanometry
indicated
symmetrical
normal hearing

43. The case study is offered to illustrate the
necessity for audiologists to be aware that
unilateral effusions are associated with NPC

45. Treatment
First by radiation
therapy
Chemotherapy

46. Pathophysiology of hearing loss from
treatment..
Chemo
therapy and
radiation
Produce
free radicals
Results in
ototoxicity
Sensorineural
hearing loss

47. Free radicals
•They are very reactive & unstable
substances which cause damage to the cell
walls

48. How are free radicals produced??
They are formed from exposure to elements in
chemotherapy & radiation therapy.

49. How are they harmful???

50. Other Studies
• Clinicians should inform patients of the risk of hearing loss, particularly the treatment
with cisplatin.
• Hearing test should be a routine test after chemotherapy.
Yupa &Vasana,2007
• The pre- and post-therapeutic hearing levels were recorded in a previously published
study of 20 patients receiving radiotherapy for NPC
• The incidence of SNHL increased significantly with increasing dose of radiation.
Ling, Wen-Rei Kuo, Kuen-Yao Ho, Ka-Wo Lee,2003
• After RT, at least a 10 dB loss in bone conduction threshold at speech frequency
• effect of radiation on hearing tended to be chronic and progressive.
Henriette B. Honore, Soren M. Bentzenb, Kitty Mollerc, Cai Graud,2002
• BC Thresholds at 0.5,1,2,4 kHz kHz were compared with pretreatment thresholds at
respective frequencies.
• SNHL occurred after radiotherapy, more commonly affecting high frequency.
KWONG,WEI&YUEN,1996

52. Present Complaints..
Came on
09-07-2011
Reduced hearing
since 2 years
C/O Tinnitus
(continous low
frequency)
H/o ear discharge
from both ears for
the past 6 months
Case name: X
Age/sex: 42yrs/F

53. R/O progress in
hearing
sensitivity
No C/o vertigo
No C/o Speech
discrimination in
noisy situations
Giddiness while
hearing loud
sounds

54. Nasopharyngeal
Tumor
Underwent
Medication
for 4 Months
Took 33
Radiation and
5 Chemo-
therapy
Follow-up in
every 3
months

55. Test Results

56. PTA
Immittance
Audiometry
• Bilateral ‘B’ type tympanogram with
absent reflex
Speech
Audiometry
Ear SAT SRT SDS
Right 55 dB HL 75 dB HL 90%
Left 55 dB HL 70 dB HL 100%

58. • Bilateral moderately
severe conductive
hearing loss
Audiological
Interpretation
• ENT Consultation
• Re-evaluation after ENT
Consultation
• Follow Up
Recommendations

59. Through telephonic
conversation the
patient reported that
she is not having the
ear discharge after
the treatment
But reported of
having difficulty in
hearing and
tinnitus in both
ear

60. • Nasopharyngeal cancer results in hearing loss
which can be conductive or sensorineural
hearing loss..
• Unilateral conductive hearing loss with a flat
tympanogram indicates a middle ear effusion
which can be one of the symptom of NPC..

62. It is important to obtain
a baseline
audiogram, prior to
beginning treatment or
soon after..
Hearing should be
monitored at regular
intervals during
treatment..

63. Researchers found that intake
of the drug NAC (N-
acetylcysteine) prior to
chemotherapy did not suffer
from ototoxicity..
Research is going on about
Proton beam therapy which
helps in reduced ototoxicity..

65. Audiometric
profile of
patient
undergoing
cancer
treatment to
be
developed..
Pre & Post
treatment
assessment
of hearing
must be
done in
clinical
practice for
future
research..

66. References
 Diseases of the ear(6th edition);Harold Ludman &
Tony Wright
 Auditory Diagnosis(2nd edition);Ross J Roeser
 Journal of Medical Association,Thai 2010; 93 (3):
324-9
 Journal of Radiotherapy and Oncology 65 (2002) 9–
16

67. • The Australian & New Zealand Journal of
audiology, vol 26, 2, 2004, 139-141)
• American Journal of Roentgenology,June 2003 vol.
180
• Journal of Clinical Oncology,1998; 16: 1310–1317.
• Journal of Clinical Oncology,2001; 19: 1105–1110.