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EAR DISORDERS AND

HEARING LOSS

EAR DISORDERS AND HEARING LOSS

TYPES OF HEARING LOSS:

TYPES OF HEARING LOSS:  CONDUCTIVE  SENSORI-NEURAL  MIXED  NON-ORGANIC
  • CONDUCTIVE

  • SENSORI-NEURAL

  • MIXED

  • NON-ORGANIC

CONDUCTIVE HEARING

LOSS

Occurs from a dysfunction of the outer or middle ear

Can usually be treated with medicine or surgery

A deficit of

loudness only

CONDUCTIVE HEARING LOSS • Occurs from a dysfunction of the outer or middle ear • Can

Characteristics of Conductive

Loss:

  • Maintain soft speaking voice

  • Excellent speech discrimination

when speech is loud enough

  • Typically either low frequency or flat hearing loss (equal at all frequencies)

CAUSES OF CONDUCTIVE

HEARING LOSS: Outer Ear

CAUSES OF CONDUCTIVE HEARING LOSS: Outer Ear  Outer Ear:  Occlusion/foreign body  Congenital Atresia
  • Outer Ear:

    • Occlusion/foreign body

    • Congenital Atresia

    • External Otitis

CAUSES OF CONDUCTIVE HEARING LOSS: Outer Ear  Outer Ear:  Occlusion/foreign body  Congenital Atresia
CAUSES OF CONDUCTIVE HEARING LOSS: Outer Ear  Outer Ear:  Occlusion/foreign body  Congenital Atresia

Photo’s courtesy of Dr. Roy F. Sullivan, Ph.D.

CAUSES OF CONDUCTIVE HEARING LOSS: Outer Ear  Outer Ear:  Occlusion/foreign body  Congenital Atresia

Causes of Conductive Hearing Loss: Middle Ear

  • Otitis Media

  • TM Perforation

  • Cholesteatoma

  • Ossicular fixation

    • Otosclerosis

Causes of Conductive Hearing Loss: Middle Ear  Otitis Media  TM Perforation  Cholesteatoma 
  • Ossicular Disarticulation

  • Blocked Eustachian

Tube, reduced middle

ear pressure, TM retraction and eventual effusion

Causes of Conductive Hearing Loss: Middle Ear  Otitis Media  TM Perforation  Cholesteatoma 
Causes of Conductive Hearing Loss: Middle Ear  Otitis Media  TM Perforation  Cholesteatoma 
Causes of Conductive Hearing Loss: Middle Ear  Otitis Media  TM Perforation  Cholesteatoma 

Photo’s courtesy of Dr. Roy F. Sullivan, Ph.D.

TREATMENT: CONDUCTIVE HEARING LOSSES

  • Conductive hearing losses are due to problems that occur in the outer and middle ear which are usually temporary and/or treatable with antibiotics or surgery.

  • For those few people who have uncorrectable conductive hearing losses, hearing aids are of significant benefit as

sound remains clear if it is made loud

enough.

SENSORI-NEURAL HEARING LOSSES

  • Dysfunction of the inner ear or auditory nerve, usually permanent and untreatable

  • Results in loudness deficit and distorted hearing.

  • Nerve endings in cochlea or nerve pathways are

damaged.

  • Message does not effectively reach the brain.

  • Middle ear structures are intact.

SENSORI-NEURAL HEARING LOSSES  Dysfunction of the inner ear or auditory nerve, usually permanent and untreatable

Characteristics of SNHL:

  • Inappropriately loud voice

  • Tinnitus

  • High frequency loss common, but any

configuration possible

  • Speech sounds distorted

  • Background noise makes listening more difficult

  • Hearing aids may help

Characteristics of SNHL:  Inappropriately loud voice  Tinnitus  High frequency loss common, but any
Characteristics of SNHL:  Inappropriately loud voice  Tinnitus  High frequency loss common, but any

CAUSES OF SENSORI-NEURAL HEARING LOSS:

  • Genetics/Congenital

  • Disease

    • Mumps, Measles

    • Meningitis, CMV

  • Ototoxic drugs

  • Head trauma

  • Presbycusis

  • Meniere’s Disease

  • Acoustic Neuroma

  • Ototoxin Exposure

  • Noise Exposure:

    • Prolonged exposure to hazardous noise causes hearing loss by the physical destruction of

  • the hair cells in the cochlea.

    CAUSES OF SENSORI-NEURAL HEARING LOSS :  Genetics/Congenital  Disease  Mumps, Measles  Meningitis, CMV

    Characteristics of NIHL:

    (noise induced hearing loss)

    • Loss can be sudden, as with acoustic trauma from an explosion.

    • More often a gradual onset that may go unnoticed.

      • NIHL also known as noise induced permanent threshold shift (NIPTS), typically takes years of exposure, gradual erosion of hearing that

    eventually affects communication.

    Characteristics of SNHL,

    con’t
    con’t
    • Amount of loss varies from person to

    person

    • Risk of noise-induced progression

    stops if no longer in noise exposed,

    but aging invariably worsens loss

    • For most, aging effects aren’t significant before age 50+

    Classic Symptoms of NIHL:

    • A notch or drop in hearing at 4000 Hz. Generally affects 3000-6000 Hz range first, then notch becomes deeper & wider

    • Typically bilateral and symmetrical

    • Tinnitus common

    • Reduced speech comprehension, particularly in background noise. Why?

      • Vowels are low frequency sounds that carry 90% of speech energy (I can hear you talking….)

      • Consonants are higher frequency sounds that carry most of the meaning of speech. NIHL begins in high frequencies. (But I can’t understand what you are saying.)

    The “4 P’s”

    Noise induced hearing loss is:

    Painless Progressive Permanent Preventable

    The “4 P’s” Noise induced hearing loss is: • P ainless • P rogressive • P

    From Siemens Hearing Solutions

    TREATMENT:

    • Sensori-neural hearing loss is due to problems that occur in the inner ear and are almost always permanent and untreatable.

    • Hearing aids will benefit most people with

    sensori-neural loss, but results can vary.

    TREATMENT:  Sensori-neural hearing loss is due to problems that occur in the inner ear and

    MIXED HEARING LOSS:

    • Combination of conductive (outer or middle ear) disorder and sensori-neural hearing loss.

    • Treatment may be available for the conductive portion; however, the sensori-neural portion will remain.

    • Causes can be unrelated (for example, NIHL plus TM rupture), or related (for example cochlear otosclerosis).

    NON-ORGANIC HEARING LOSS

    • Non-Organic:

      • No medical or physical reason for hearing loss, may be

    voluntary or involuntary

    • Malingering:

      • Consciously faking or exaggerating a hearing impairment, often for monetary or other personal gain, to escape assignments or responsibilities, or as an anti-establishment gesture

    NON-ORGANIC HEARING LOSS  Non-Organic:  No medical or physical reason for hearing loss, may be

    NON-ORGANIC HEARING LOSS

    Symptoms that should alert you to malingering:

    • Substantial, equal hearing loss at all frequencies or no response to pure tones at all in one or both ears

    • Inconsistent results, or markedly different than prior results

      • Unilateral “deafness” without significant medical history unlikely

    • Exaggerated attention to test, may press on earphones, difficulty hearing you call them back for testing or to your directions (normal voice level is around 60 dB), but can hear

    you when your back is turned or when no visual cues

    • Patient history may provide clues to non-organic behavior if nearing retirement, or pending discipline or deployment

    • Psychogenic Hearing Loss - Unconscious development of a non-organic hearing loss a compensatory protective device, a psychogenic problem (the patient believes the impairment is real)

    CENTRAL HEARING LOSS

    • Occurring within central nervous system (cortex, brainstem, or ascending auditory pathways) as opposed to peripheral organs of hearing (cochlea and middle ear)

    CENTRAL HEARING LOSS  Occurring within central nervous system (cortex, brainstem, or ascending auditory pathways) as
    CENTRAL HEARING LOSS  Occurring within central nervous system (cortex, brainstem, or ascending auditory pathways) as
    • Often associated with other neurological disorders (multiple sclerosis, tumors)

    • Sometimes confused with non-organic hearing loss due to vague symptoms or inappropriate test behavior

    • Always requires diagnostic work-up by an audiologist, otologist, and/or neurologist; patient usually hears WNL for pure tones

    CENTRAL HEARING LOSS  Occurring within central nervous system (cortex, brainstem, or ascending auditory pathways) as

    IN SUMMARY….

    • Conductive Hearing Loss:

      • Usually low frequency or flat, affects outer and/or middle ear, usually temporary - or at least medically or surgically treatable.

    • Sensori-neural Hearing Loss:

      • Often high frequency, affects inner ear, usually permanent.

    • Mixed Hearing Loss:

      • Usually affects both high and low freqs, both conductive and sensori-neural components, but only conductive portion treatable.

    • Non-Organic Hearing Loss:

      • Typically display a flat loss or total deafness in one ear, but may exaggerate a true loss, may (rarely) be involuntary but usually malingering is involved. Prior test results are your best clue.

    • Central Hearing Loss:

      • Hearing for pure tones often normal, problem is between cochlea and cortex (receptor cells OK but a transmission or processing problem).

    Questions?

    Questions?
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    Questions?