STUDY - Technical - New Dacian's Medicine
Hearing
loss (Classical / Allopathic Medicine)
Hearing loss,
which affects nearly 16 million Americans, may be temporary or
permanent and partial or complete. This common symptom may
involve the reception of low-, middle-, or high-frequency
tones. If the hearing loss doesn't affect speech frequencies,
the patient may be unaware of it.
Hearing loss can
be classified as conductive, sensorineural, mixed, or
functional. Conductive hearing loss results from external or
middle ear disorders that block sound transmission. This type
of hearing loss usually responds to medical or surgical
intervention (or in some cases, both). Sensorineural hearing
loss results from disorders of the inner ear or of the eighth
cranial nerve. Mixed hearing loss combines aspects of
conductive and sensorineural hearing loss. Functional hearing
loss results from psychological factors rather than
identifiable organic damage.
Hearing loss may
also result from trauma, infection, allergy, tumors, certain
systemic and hereditary disorders, and the effects of ototoxic
drugs and treatments. In most cases, however, it results from
presbycusis, a type of sensorineural hearing loss that
typically affects people older than age 50. Other physiologic
causes of hearing loss include cerumen impaction; barotitis
media associated with descent in an airplane or elevator,
diving, or close proximity to an explosion; and chronic
exposure to noise over 90 dB.
HISTORY:
Ask the patient to fully describe the hearing loss. Is it unilateral or bilateral? Is it continuous or intermittent?
Review the patient's medical history, noting especially chronic ear infections, ear surgery, and ear or head trauma. Ask him if he has recently had an upper respiratory tract infection. Also, ask him about a family history of hearing loss.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient to describe his occupation and work environment.
Ask the patient about associated signs and symptoms. Does he have ear pain? If so, ask him whether it's unilateral or bilateral, continuous or intermittent.
Ask the patient if he has noticed a discharge from one or both ears. If he has, ask him when it began. Also, ask him to describe the discharge's color and consistency.
Ask the patient if he hears ringing, buzzing, hissing, or other noises in one or both ears. If he does, ask him whether the noises are constant or intermittent.
Ask the patient if he gets dizzy. If he does, ask him when he first noticed it.
Ask the patient to fully describe the hearing loss. Is it unilateral or bilateral? Is it continuous or intermittent?
Review the patient's medical history, noting especially chronic ear infections, ear surgery, and ear or head trauma. Ask him if he has recently had an upper respiratory tract infection. Also, ask him about a family history of hearing loss.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient to describe his occupation and work environment.
Ask the patient about associated signs and symptoms. Does he have ear pain? If so, ask him whether it's unilateral or bilateral, continuous or intermittent.
Ask the patient if he has noticed a discharge from one or both ears. If he has, ask him when it began. Also, ask him to describe the discharge's color and consistency.
Ask the patient if he hears ringing, buzzing, hissing, or other noises in one or both ears. If he does, ask him whether the noises are constant or intermittent.
Ask the patient if he gets dizzy. If he does, ask him when he first noticed it.
PHYSICAL
ASSESSMENT:
Inspect the external ear for inflammation, boils, foreign bodies, and discharge.
Apply pressure to the tragus and mastoid to elicit tenderness.
Using an otoscope, note color change, perforation, bulging, or retraction of the tympanic membrane, which normally looks like a shiny, pearl gray cone.
Evaluate the patient's hearing acuity, using the ticking watch and whispered voice tests. Perform the Weber and Rinne tests to obtain a preliminary evaluation of the type and degree of hearing loss.
Inspect the external ear for inflammation, boils, foreign bodies, and discharge.
Apply pressure to the tragus and mastoid to elicit tenderness.
Using an otoscope, note color change, perforation, bulging, or retraction of the tympanic membrane, which normally looks like a shiny, pearl gray cone.
Evaluate the patient's hearing acuity, using the ticking watch and whispered voice tests. Perform the Weber and Rinne tests to obtain a preliminary evaluation of the type and degree of hearing loss.
SPECIAL
CONSIDERATIONS:
When talking with the patient, remember to face him and speak slowly. Don't shout, smoke, eat, or chew gum when talking.
When talking with the patient, remember to face him and speak slowly. Don't shout, smoke, eat, or chew gum when talking.
PEDIATRIC
POINTERS:
Hereditary disorders (such as Paget's disease and Alport's, Hurler's, and Klippel-Feil syndromes) cause sensorineural hearing loss at birth.
Nonhereditary disorders associated with congenital sensorineural hearing loss include Usher's syndrome, albinism, onychodystrophy syndrome, cochlear dysplasias, and Pendred's, Waardenburg's, and Jervell and Lange-Nielsen syndromes. This type of hearing loss may also result from maternal use of ototoxic drugs, birth trauma, and anoxia during or after birth.
Mumps is the most common pediatric cause of unilateral sensorineural hearing loss. Other causes are meningitis, measles, influenza, and acute febrile illness.
Disorders that may produce congenital conductive hearing loss include atresia, ossicle malformation, and other abnormalities. Serous otitis media commonly causes bilateral conductive hearing loss in children.
Conductive hearing loss may occur in children who put foreign objects in their ears.
When assessing an infant or a young child for hearing loss, remember that you can't use a tuning fork. Instead, test the startle reflex in infants younger than age 6 months, or have an audiologist test brain stem evoked response in neonates, infants, and young children. Also, obtain a gestational, perinatal, and family history from the parents.
Hereditary disorders (such as Paget's disease and Alport's, Hurler's, and Klippel-Feil syndromes) cause sensorineural hearing loss at birth.
Nonhereditary disorders associated with congenital sensorineural hearing loss include Usher's syndrome, albinism, onychodystrophy syndrome, cochlear dysplasias, and Pendred's, Waardenburg's, and Jervell and Lange-Nielsen syndromes. This type of hearing loss may also result from maternal use of ototoxic drugs, birth trauma, and anoxia during or after birth.
Mumps is the most common pediatric cause of unilateral sensorineural hearing loss. Other causes are meningitis, measles, influenza, and acute febrile illness.
Disorders that may produce congenital conductive hearing loss include atresia, ossicle malformation, and other abnormalities. Serous otitis media commonly causes bilateral conductive hearing loss in children.
Conductive hearing loss may occur in children who put foreign objects in their ears.
When assessing an infant or a young child for hearing loss, remember that you can't use a tuning fork. Instead, test the startle reflex in infants younger than age 6 months, or have an audiologist test brain stem evoked response in neonates, infants, and young children. Also, obtain a gestational, perinatal, and family history from the parents.
AGING ISSUES:
In older patients, presbycusis may be aggravated by exposure to noise as well as other factors.
In older patients, presbycusis may be aggravated by exposure to noise as well as other factors.
PATIENT
COUNSELING:
Instruct the patient to avoid exposure to loud noise and to use ear protection to arrest loss.
Instruct the patient to avoid exposure to loud noise and to use ear protection to arrest loss.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)