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What is conductive hearing loss?
When sound is inadequatly conducted through the external or middle ear to the sensorineural apparatus of the inner ear.
What is sensiorineural hearing loss?
When sound is normally carried through the external and middle ear but there is a defect within the inner ear which resultsin in sound distortions.
Causes of conductive hearing loss.
- impacted cerumen
- foreign bodies
- benign tumors of the middle ear
- carcinoma of external auditory canal and/or middle ear
- eustachian tube dysfunction
- Serous OM with effusion
- TB of the temporal bone
Causes of sensorineural hearing loss.
- Congential or neonatal
- Presbycusis/vascular changes/stiffening of basilar membrane
- Meniere's dx
- acoustic tumor
- Many systemic diseases
- Drug toxicities!!
Presentation of conductive hearing loss.
- Sensitivity to sound diminished, clarity unchanged
- Volume may be increased to compenstate(hearing normal)
- Abnormal growth of bone of the middle ear
- associated with slow, progressive hearing loss beinging in the second or third decade of life; TM is normal
Presentation of sensorineural hearing loss.
- Noise-induced may be unilateral or bilateral
- Acoustic neuroma: tinnitus and unilateral unexplained hearing loss
- a lessening of hearing acuteness resulting from degenerative changes in the ear that occur especially in old age
- slowly progressive
- usually 65yo or greater
- pt's usually unaware
- decrease in speech discrimination
- tinnitus often
- hypersensitivity to noise
- Acoustic neuroma is a non-cancerous tumor that
- develops on the nerve that connects the ear to the brain. The tumor usually grows slowly. As it grows, it presses against the hearing and balance nerves. At first, you may have no symptoms or mild symptoms.
- Loss of hearing on one side
- Ringing in ears
- Dizziness and balance problems
a disorder of the membranous labyrinth of the inner ear that is marked by recurrent attacks of dizziness, tinnitus, and hearing loss
When do you refer an ENT patient?
- Acute hearing loss without a diagnosis or who do not improve. Refer to ENT.
- Hearing loss that may benefit from a hearing device. Refer to audiologist.
- For otosclerosis and congenital or acquires causes of conductive hearing loss. Refer to surgeon.
Test for tinnitus and vertigo
Test for tumors or bony lesions.
Test for acoustic neuroma.
Clinical presentation of impacted cerumen
- OFten in elderly and industrial workers
- Ear pain may be present
- sensation of fullness
- conductive hearing loss
Medication to loosen ear wax
What is otitis externa?
- Inflammation of the external auditory canal
- Predisposing factors: moisture, cleaning, trauma, allergies, skin conditions
Common bacteria of OE
- staphyloccoci coliform
Clincial presentation of OE
- Ear pain; increased with tragus pressure or pinna movement
- sensation of fullness or obstruction
- itching (usually fungal)
- purulent discharge
- conductive hearing loss
Serious complication of OE
- Malignant or necrotizing OE
- deep seated noctural pain
- foul smelling
- purulent drainage
- facial nerve paralysis
- cranial neuropathies
Differential diagnosis of OE
- cyst, furnuncle or abscess
- herpes zoster
- foreign body
Ear drops for OE from bacteria
- Polymyxin B Sulfate, neomycin, corticosporin otic
- Cipro HC
- Floxin otic
Ear drops for OE for fungal infection
- Otic Domeboro
- Severe require systemic cipro or augmentin
Follow up for OE
- mild resolves in seven days
- moderate to severe: F/u in 2-3 days
Common pathogens to cause OM
- Stretococcus pneumoniae
- haemiophilous influenze
- moraxella catarrhailis
Causes of otitis media
- eustatchian tube dysfunction
- prior infection or allergy which causes edema and congestion in the nasopharynx, eustachian tube and middle ear
Predisposing factors to OM
- active or passive smoking
- caucasion or native american
- congental disorders
- trisomy 21
- family hx
Diagnosis of OM
- Based on appearance of TM
- full or bulging TM
- absent or obscurred bony landmarks
- distorted light reflex
- decreased or absent TM mobility
- erythema (but can be inconsistent)
Differential diagnosis of OM
- external otitis
- dental abscess
- foreign body
If a healthy adult complains of ear pain and ear exam is normal, what should you consider?
- dental disorder
- nasal or pharynx issues
- cranial nerve issues
- shingles (herpes zoster)
Why should you be cautious in treating otitis media?
- 80% of cases resolve spontaneously
- 15% of cases are improved with antibiotics
- Need to modify risk factors
First line treatment for OM
Second line treatment of OM
What type of medication should not be used with OM?
When should OM follow up?
- f/u in 2-3 days if condition not improved
- f/u in 2-3 weeks from initial visit
When should OM be referred?
- Hearing loss bilaterally of 20dB or more
- chronic or persistant infection with evidence of mastoid involvement
- recurrent infections
- chronic perforation
Otitis media with effusion
Serous otitis media
accumulaitonof serous fluid in the middle ear longer than 2-3monthes without signs or symptoms of acute infection
Causes of OM with Effusion
- adeniodal hypertrophy
- recent URI
- deviated nasal septum
- post purulent otitis media
- rarely nasopharyngeal neoplasm
How should you treat OME?
Monitor. 90% resolve without antibiotics
Antibiotics for OME
- choose a beta lactamase stable antibiotic
- augmentin or biaxin
when should OME follow up?
- follow up in three months, if present need hearing check.
- refer to ENT
Primary vs referred otalgia
- Primary pain orginates in the ear
- Referred from another area
Five T's of otalgia