Hearing Imperiment Investigation management and Rehablitation ...... Presented By Dr.Asmatullah Achakzai

2. Dr. Asmatullah Achakzai
MBBS,DLO,MCPS,FCPS
Senior registrar ENT Unit II Sandeman
Provincial Hospital Quetta.

3. HEARING LOSS
Hearing 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

4. CLASSIFICATION
Hearing Loss
Organic Non-Organic
Conductive Sensorineural
Sensory Neural
Peripheral Central
(Vlllth Nerve) (Central audiotory

5. 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.

6. MANAGEMENT
1. Removal of canal obstructions.
2. Removal of fluid.
3. Removal of mass from middle ear.
4. Stapedectomy.
5. Tympanoplasty.
6. Hearing Aid.

7. 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.

8. Myringoplasty
Ossicular reconstruction
Repair of Occicular Chain

9. 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.

10. 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

11. NOISE INDUCED HEARING LOSS
NOISE Trauma
Acoustic Trauma Noise Induced
Temporary Prolonged
Premanent

15. OTOTOXICITY
The Drugs and Chemicals that are Ototoxic.
 Aminoglycoside Anitibiotics
 Cisplatan
 Salicylates
 Quinine
 Diueritics like fursemide, bumetide
 Macrolide antibiotics
 Glycopeptide Antibiotics Vencomycine

16. CLINICAL FEATURES OF OTOTOXICITY
1. Tinnitus
2. Hearing loss
3. Balance disturbances (Disequilibrium)
Investigations
1. Monitoring of the Drug concentration in the body.
2. PTA
3. Otoacoustic emission
4. BERA

17. 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.

18. PRESSBYACUSIS
Clinical Features:
1. Deafness
2. Tinnitus
3. Vertigo
4. Distortion of Speech
5. Recruitment may be Positive

19. INVESTIGATIONS OF PRESSBYACUSIS
 Tuning fork test
 Audiogram

20. 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

21. 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

22. 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.

23. 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.

24. PROGNOSIS
Onset
Duration
Severity

25. THANK YOU