Hearing loss (deafness)

Hamza E Ahmed, MD
Assiut University
Parts of the ear:
 The outer and middle ears:
Are responsible for sound conduction together with magnification of sound.
Problem in this part causes conductive hearing loss(CHL)
 The inner ear:
Is responsible for perception of sound and generation of action potential in the
cochlear nerve. It serves another function which is equlibrium

Types of hearing loss:

 Conductive hearing loss (CHL)
 Sensorineural hearing loss (SNHL)
 Mixed hearing loss
 Auditory neuropathy

Causes of CHL:

 External auditory canal: congenital atresia, wax, foreign body, otitis externa,
tumors like
 Osteoma, and squamous cell carcinoma
 Tympanic membrane (like perforation and infections as myringitis)
 Middle ear( AOM, CSOM, otosclerosis, ossicular disruption
hemotympanum, etc….
 Eustachian tube causes ( ET obstruction for whatever causes)

Causes of sensorineural hearing loss:

 Inner ear causes (sensory hearing loss)

 Congenital HL (Heredo-familiar-infection-low birth weight)

 Trauma to the inner ear (acoustic or surgical)
 Labyrinthitis
 Ototoxic medications
 Vascular insult
 Other causes like Meniere’s disease
  Cochlear nerve and higher center (neural causes)

 Cochleovestibular nerve
acoustic neuroma, congenital cholesteatoma, cholesterol granuloma
 CNS
aging, atherosclerosis, MS. Cerebaral hemorrhage, embolism, secondaries,
meningitis, trauma, etc….

Screening for hearing in neonates:

o Otoacoustic emission
o Auditory brain stem response (ABR)

Sudden onset hearing loss:

Definition: hearing loss of 30-dB or more occurring in 3 adjacent frequencies in

less than 72-hours
Degree: It varies from mild to total hearing loss
Aetiology:
 Viral infection Autoimmune disease
 Trauma (Fr., rupture membrane, acoustic trauma)
 Vascular insult
 Medications
 Meniere’s disease
 Other causes
 Idiopathic SSNHL

Management of sudden SNHL:

 History (trauma, noise exposure, medication, viral infection, cerebrovascular
pathology etc.)
 Physical exam
 Audiometry ( to detect type & degree of hearing loss, monitor response to
treatment)
 Investigations goes parallel with the definite treatment which includes:
 Steroid (systemic (prednisolone 1mg/kg/day for a week than gradual
withdrawal within another week.
 Intratympanic steroids are used with systemic steroids or when there is
contraindication for systemic steroids.
 Hyperbaric oxygen