The document discusses different types and causes of deafness, including: - Congenital deafness, which can be detected at birth and is often genetic or due to infections or drugs during pregnancy. - Childhood deafness, which can be temporary from ear infections or permanent from hereditary causes, meningitis, or complications at birth. - Adult deafness, which develops gradually, making it hard to understand speech in noise. Causes include presbycusis (age-related), otosclerosis, and noise exposure. - Tests to evaluate deafness include the Weber test to determine lateralization and the Rinne test to compare air and bone conduction.

1. DEAFNESS
MUSTAFA MANHAL ALWARD

2. EAR EXAMINATION
1- Auricle:
Inspect for deformities, lumps, skin lesions
if there’s ear pain or discharge then move the auricle up and down, press the targus and behind the ear
<< Tug test: painful only in otitis externa
2-Ear Canal and Drum: by the use of Otoscope
Inspect the eardrum, noting its color and contour. The cone of light to orient you.
Identify the handle of the malleus, noting its position, and inspect the short process of the malleus

4. 3- Auditory Acuity: Close one ear and talk, do it for both ears
4- Test Air and Bone Conduction: If auditory acuity is impaired
1-
2-
1- Weber test (Test for
lateralization ):
Place the base of the
vibrating tuning fork firmly on
top of the patient’s head or
on the midforehead.
Ask where the patient hears
it: on one or both sides.
Normally the sound
is heard in the midline or
equally in both ears. If
nothing is heard, try
again, pressing the fork
more firmly on the head.
2-Rinne Test {Compare air conduction (AC) and bone conduction
(BC)}:
Place the base of the vibrating fork on the mastoid bone, behind
the ear and level with the canal. >> When the patient can no longer
hear
the sound, quickly place the fork close to the ear canal, Here the “U”
of the fork should face forward.
Normally the sound is heard longer through air than through bone
(AC > BC).

7. Congenital deafness
Usually detected on neonatal Screening
Causes:
Genetic
Intrauterine infection, e.g. rubella
Drugs given in pregnancy, e.g. streptomycin
Birth asphyxia
Meningitis
Severe neonatal jaundice

8. Childhood-onset deafness
Temporary deafness due to middle ear infections.
Decrease hearing, noticed by parents or teachers—take it seriously
Deafness causes long-term speech, language, behavioural problems.
Causes:
If no earache Bilateral glue ear, impacted wax; hereditary cause; sequel of meningitis, head injury, or birth complications
If earache Acute otitis media, impacted wax
Management:
History, examination, assess development (including speech and language), consider referral to ENT.

9. Adult-onset deafness
Presentation hearing loss develops with increasing
Problems in understanding others when there is background noise. Tinnitus
may be the presenting problem(Depends on the cause)
Useful screening questions
• Do other people mumble a lot?
• Do you find yourself frequently saying ‘pardon’?
• Does the family say the TV is too loud?
• Do you miss hearing the doorbell or ‘phone?
• Do you occasionally get the wrong end of the stick in a conversation?
Management Examine the drum; exclude wax; consider post-nasal space
tumour. If no self-limiting cause is found, refer for a hearing test to quantify
hearing loss and assess suitability for hearing aid.

11. Presbyacusis
bilateral symmetrical sensorineural deafness in the over 50s.
Deafness is gradual in onset.
High frequencies are more severely affected, so speech discrimination, particularly of high-pitched voices,
is lost first.
Examination is normal. Refer for an audiogram to confirm diagnosis and then for a hearing aid if
appropriate.
Otosclerosis
Bilateral conductive deafness due to adherence of the
stapes footplate to the bone around the oval window.
If deteriorates in pregnancy, avoid prescribing combined contraceptives.?
Refer to ENT for assessment to replace the stapes with an implant.

12. Noise-induced deafness
Caused by exposure to noise >85dB.
May occur in work or non-work settings (e.g. firearm sports).
Immediate indications are ringing in the ears/muffling of hearing after exposure.
Management
Refer to audiology.
Avoid further excessive noise exposure.
Hearing aids may help.

13. A 37-year-old woman comes to your office for assessment of hearing loss. She has
had problems intermittently for the past 12 months.
On examination, the Weber tuning fork test lateralizes to the right ear, and the Rinne
tuning fork test is negative in the right ear (bone conduction is greater than air
conduction [BC > AC]).
This suggests which of the following?
a. a right-sided conductive hearing loss
b. a left-sided conductive hearing loss
c. a right-sided sensorineural hearing loss
d. a left-sided sensorineural hearing loss
e. a or d

14. A 43-year-old man comes to your office for assessment of hearing loss. He has had hearing difficulties for
the past 4 years.
On examination, the Weber tuning fork test lateralizes to the left ear. The Rinne tuning fork test is
normal bilaterally (AC > BC).
This suggests which of the following?
a. a right-sided conductive hearing loss
b. a left-sided conductive hearing loss
c. a right-sided sensorineural hearing loss
d. a left-sided sensorineural hearing loss
e. b or c