HEARING DISORDERS

HEARING LOSS

CONDUCTIVE HL
Occurs when auditory stimuli are not adequately transmitted through canal, TM, middle ear or ossicle chain to inner ear
Ear obstruction Infection Otosclerosis Trauma to TM

SENSORINEURAL HL
Sound waves conducted to inner ear but abnormalities to cochlear apparatus/auditory nerve decrease/distort the transfer of info to the brain
Presbycusis
Menieres dss. Congenital HL

Noise-induced HL
Benign to malignant tumors Central auditory dysfxn

Diagnostics
PE History Tuning fork test Audioscopy Audiogram

Management
Restore HL
Antibiotics, acyclovir, oral corticosteroids X ototoxic drugs

Surgery

Assist hearing
Hearing aids

Manage tinnitus Rehab

Lip reading, sign language

INFECTION OF THE EAR

OTITIS EXTERNA
Damaged by dryness, moisture or treatment Leads to edema

Itching, redness, tenderness, narrowing of ear canal, pain in pinna/canal

Watery/purulent discharge & intermittent HL

Tx
Antibiotics X trauma

Swimmers: dilute alcohol, acetic acid, Burrows solution

OTITIS MEDIA
Acute suppurative sudden onset, short duration Chronic repeated infxn w/ drainage & perforation

ACUTE OM
Pressure of fluid in middle ear in combi w/ s/sx of acute/systemic infxn Follows URTI present for several days

Cause:
Bacteria, virus

s/sx
Otalgia Fever HL

Dx
PE Otoscopic exam = pneumatic otoscopy

Tympanometry
Tympanogram Acoustic reflectometry Tympanocentesis

Tx
Myringotomy

ROM
3 new AOM episodes w/in 6mos or 4 episodes in 1yr that occurs w/ URTI

OM w/ EFFUSION
TM is intact & fluid accumulation in middle ear w/o s/sx of infection 3wks to 3mos Sx via dx:
TM clear yellow/bluish fluid or air-filled level or bubbles or both

Mgt
Promote healing
Ear irrigation
Antibiotics
Suppurative: systemic, topical antiB, analgesics

Chronic: myringotomy

TRAUMA

BAROTRAUMA
Injury from inability to equalize barometric stress/middle ear imposed by air travel/underwater diving From persons travelling w/ URTI Mgt
Autoinflation

Intranasal (phenylephrine HCl) & systemic decongestants

Myringotomy

TM TRAUMA
MGT to infection Myringoplasty

Tympanoplasty

MENIERES DISEASE

Disorder of inner ear due to distention of endolymphatic compartment (excess endolymph) of inner ear (vestibular/semicircular canals) Triad of sx
Rotary vertigo
Unilateral HL Tinnitus

Lesion in the EL sac

EL filtration & excretion

Decrease perilymph prod.

Increase endolymph prod.

Malfxn & blockage

Increase vol. of EL sac

Decrease absorption of endolymph

Cause
Idiopathic

Dx
Audiogram Electronystamography

Admin. Of hyperosmolar substances

Management
Suppressant drugs Diuretics Histamine analogs Low Na diet Steroid hormone Prednisone

Gentamicin therapy
Surgery
EL shunt Vestibular nerve section