HEARING LOSS

DR BUKANU
ENT SPECIALIST
DODOMA REFFERAL HOSPITAL
Definition

 A person is said to have hearing loss if

the Thresholds of hearing are elevated
based on pure tone audiometry.
 20 – 40dB mild hearing loss
 41 – 60dB moderate hearing loss
 61 – 90 severe hearing loss
 90dB – Profound
TYPES

 (1)Conductive hearing loss

 (2) Sensor neural healing loss
 (3) Mixed hearing loss
CONDUCTIVE HL

 This may be:

 1. Congenital
 2. Acquired
CHL ctd

 CONGENITAL CONDUCTIVE HEARING LOSS

 This is due to maldevelopment of the External or
middle ear
 (1) Congenital atresia of external auditory canal
 (2) Complete atresia of middle ear cavity
 (3) Congenital absence of one or more of the
ossicles or bony
 Fussion of the middle ear ossicles
 (4) Congenital stenosis of external auditory canal
CHL ctd

 (5) Treacher – Collins syndrome

 It is characterized by:-
 Congenital meatal atresia
 Mandibulo facial anomalies e.g. hypoplastic
mandibles
CHL ctd

 ACQUIRED CONDUCTIVE HEARING LOSS

 In the Acquired CHL the lesion may be in External
ear canal or middle ear.
 External Ear
 (1) Cerumen impaction
 (This is the commonest cause of conductive
hearing loss.
 (2) Middle ear effusion (M.E.E.)
 Secretory otitis media (Glue ear) in children
 Serous otitis media
CHL ctd

 (3) External and middle ear infections

 Otitis external
 Otitis media
 (4) Trauma to the Ear
 A slap, leads to tympanic membrane perforation
 Explosions also lead to tympanic membrane
perforation
 Automobile accidents involving the temporal bones
may lead to interruption of dislocation of the
ossicular chain (in longitudinal fractures of petrous
pyramid)
CHL ctd

 (5) Tumours
 Meatal osteomas, exostoses
 Seruminoma
 Glomus jugulare or tympanicum tumour
middle ear
CHL ctd

 6) Degenerative disorders
 (a) Otoscerosis:
 abnormal new bone formation occurs around the region of
the oval window.
 This leads to fixation of the stapes.
 (b) Tymppanoclerosis:
 In this condition abnormal collagen and calcium deposits
are laid down beneath the mucosa of the tympanic cavity.
 This will lead to stiffness of the ear drum and ossicular
chain
CHL ctd

 (c) Ostietis deformans (paget’s disease);

 In this condition normal bone is replaced by
poorly mineralized bone and fibrous tissue.
 (d) Ossteogenesis imperfecta
 Abnormal bones are formed due to defective
connective tissue formation.
SENSORINEURAL HEARING LOSS

1) PERCEPTIVE HEARING LOSS

2) NEURAL HEARING LOSS
 Since it is difficult to distinguish clinically between
the two types of hearing loss the term
sensorineural hearing loss is used.
 It may be congential or acquired:
TYPES

 (1) Congenital
 Genetic
 About 50% of cases of congenital sensorineural
hearing loss are of genetic origin.
 Mode of inheritance is either autosomal
Dominant, receissive or sex linked.
 Intermarrige among close relative increase the
chance of sensorineoural deafness.
Genetic CTD

 Pendreds disease
 Non endemic goiter
 Sensorineural deafness at birth
 Michels aplasis – Total or near total aplasia of
inner ear.
 Waadenburg syndrome
 Lateral displacement of media canthi
 Iris heterochromia
 Congenital deafness
Congenital Non Genetic Hearing loss

(i)Rubella syndrome (German measles)

 Congenital deafness
 Congenital cataracts
 Congenital heart disease
 Mental retardation
(ii)Kernicterous
 Rh incompactibility is a common cause
(iii).Endemic cretinism
ACQUIRED SENSORINEURAL

 Delayed genetic sensorineural hearing loss

 These conditions are of genetic origin but
the phenotype occurs later in life.
 I. Familial progressive sensorineural hearing
loss
 ii.Alports diseases
 Progressive renal insufficiency
 Progressive sensorineural hearing loss
 Cataract formation
Acquired

 Infections
 Mumps virus
 Parotitis and hearing loss usually unilateral
 Measles symmetrical and moderately severe SNHL
 Chickenpox
 Ramsay Hunt syndrome (Herpes zoster oticus)
Vesiculur rash and facial nerve palsy .
 Meningitis
Acquired cont;

Trauma: - Accidents
 Transverse fractures of the petrous bone will
cause inner ear damage
Acquired

 d) Tumours: -
 cerrebelo pontine angle tumors
 Acoustic neuroma makes up to 10% of all intra cranial tumours.
 This tumour causes sensorineural hearing loss.Other symptoms
vertigo and tinnitus.
 (e) Ototoxicity:
(i) Aminoglycosides which includes Streptomycin, Gentamicin
and kanamycin
 (ii) Diuretic-Furusemide and Ethacrinic acid
 (iii) Anti Malarials drugs
 (iv) Cytotoxic drugs

Acquired

 (f)Noise Induced Hearing Loss

 Prolonged exposure to high intensity sound
(above 80dB)
 (g) Ageing:
 Presbyacusis is a symmetrical progressive
sensorineural hearing loss which is seen in
elderly persons
RX of HL

Conductive hearing loss

 Patients with conductive can be treated according to
the cause.
 Removal of cerumen impaction
 Repair of the tympanic membrane if perforated
 Stapes replacement surgically – for case
otosclelerosis
 Surgical removal of lesions in the nasopharynx
affecting the drainage of eustachian tube such as
adenoids or medically by use of antibiotics or
 nasal decongestants.
RX ctd

 (b) Sensorineural hearing loss:

 This is not curable.
 However Hearing may be improved by the of
hearing Aids.
 Cochlea implant.
PREVENTION OF HL

a)Vaccination e.g. Rubella

b)Councelling -Genetical counseling
-To avoid ototoxic drugs/foods
Test for Hearing

 Tuning fork test:

 Rhine Test
 Webers test.

Pure tone audiometry.

Tympanometry
end
 thnx