HEARING LOSS

CLASSIFICATION
CAUSES
TESTING
EVALUATION
MANAGEMENT
DEFINITION AND CLASSIFICATION

G GUNA CHAITANYA
III MBBS
 Hearing loss is “the impairment of hearing.”

DEFINITION

As per WHO(1980)
The term deaf should be applied only to those
individuals whose hearing impairment is so
severe that they are unable to benefit from any
type of amplification.
DEGREE OF HEARING LOSS
CLASSIFICATION
 ORGANIC VS NON-ORGANIC

• The basic difference lies in the presence or absence of a lesion

• If the lesion is identifiable, then it is presumed to be organic
• If the patient is found to be malingering or a lesion is unidentifiable, then it is
presumed to be inorganic.
 • Due to any disease which interferes with
conduction of sound to the cochlea.
• The lesion may be in:
• External auditory canal.
• Tympanic membrane.
CONDUCTIVE LOSS • Middle ear cavity.
• Ossicles.

To keep it simple, sound waves are unable to reach

the cochlea by whatever means possible.
 CONDUCTIVE LOSS

TEST RESULT
• Rinne test • Negative(BC>AC)
• Weber test • Lateralized to poorer ear
• Absolute bone conduction test • normal
• Schwabach test • normal
• Low frequencies vs high frequencies • Low frequencies
• Air-bone conduction gap in audiometry • Gap α conductive hearing loss
• Speech discrimination? • good

Loss doesn’t exceed beyond 60 dB

 CONDUCTIVE LOSS

AUDIOMETRY WITH AIR-BONE

GAP WEBER TEST
 CONDUCTIVE LOSS

Why lower frequencies are affected more in conductive loss?

• The lower frequencies of sound are affected more in conductive hearing loss
because they require more energy to vibrate the eardrum and middle ear bones
(ossicles) than higher frequencies.
• The outer ear and the ear canal act as natural amplifiers for high-frequency
sounds, allowing them to be heard with less energy. In contrast, the low-
frequency sounds require more energy to vibrate the eardrum and the ossicles,
which are responsible for transmitting the sound waves to the inner ear.
 CONDUCTIVE LOSS

• Why is speech discrimination good

Because speech discrimination is a function of inner ear i.e. cochlea, which is normal in
conductive hearing loss.
 • Results from lesions of
• Cochlea
• Cranial nerve VIII
• Central auditory pathways

SENSORINEURAL LOSS
 SENSORINEURAL LOSS

• Could be either
• Congenital
• Due to developmental anomalies
• Acquired during lifetime
• Labyrinthitis
• Noise induced trauma
• Drugs
• Presbycusis
• Meniere’s disease and many more (will be discussed further)
 SENSORINEURAL LOSS

TEST RESULT
• Rinne test • Positive(AC>BC)
• Weber test • Lateralized to better ear
• Absolute bone conduction test • Reduced
• Schwabach test • Reduced
• Low frequencies vs high frequencies • High frequencies
• Air-bone conduction gap in audiometry • No gap
• Speech discrimination? • poor

Loss does exceed beyond 60 dB

 • No organic defect found on examination
• Unexplained by anatomic and physiologic
abnormalities
• Could be Malingering
• Involves faking their hearing loss
NON-ORGANIC LOSS • Could also be psychogenic

Then, how does a patient with non-organic

hearing loss presents?
 NON ORGANIC LOSS

• Then, how does a patient with non-organic lesion presents?

• Total hearing loss in both ears
• Total loss in only one ear
• Exaggerated loss in one or both ears

If the patient is malinger, then how would you differentiate him?

 NON ORGANIC LOSS

How to identify a malinger?

• General suspicion
• Results will be inconsistent on repeated audiometry testing
• Stenger test
• Acoustic reflex threshold
• Electronic audiometry