3 - ENT - Otology - Sensorineural deafness - Presbyacusis, Acoustic Neuroma + Sudden sensorineural hearing loss

Question 1

Presbyacusis -what is it? usually where? consider what is unilateral?

Answer 1

age related hearing loss
usually bilateral and symmetrical
if unilateral consider acoustic neuroma

Question 2

Presbyacusis - what age? which tones affected? what is difficult for patients? mgmt?

Answer 2

begins ~30y - usually >50y
affects high freq tones
speech discrimination against and noisy background is difficult

mgmt - hearing aids

Question 3

Acoustic neuroma - what is it? always consider if?

Answer 3

slow growing, benign tumour arising form cochlear nerve

if – unilateral/asymmetrical sensorineural hearing deficit

Question 4

Acoustic neuroma - presentation? investigations?

Answer 4

usually presents with neuro symptoms - cerebellar/raised ICP

Ix - MRI/CT, pure tone audiometry

Question 5

Acoustic neuroma - mgmt? complications of surgery?

Answer 5

mgmt - surgical removal , gamma knife for large tumours (>3.5m)
complications of surgery - loss of hearing, facial nerve palsy, compromise brainstem blood supply

Question 6

Sudden sensorineural hearing loss - possible causes?

Answer 6

noise exposure, barotrauma, ototoxic drugs, acoustic neuroma, mumps, TB, MS, vasculopathy

Question 7

Sudden sensorineural hearing loss - recovery rate?

Answer 7

partial spontaneous recovery in 50%

Question 8

Sudden sensorineural hearing loss - mgmt? immediate and late

Answer 8

immediate - steroids, carbogen gas (95% O2 + 5% CO2)

later - exclude acoustic neuroma

Question 9

Sudden sensorineural hearing loss - prognosis

Answer 9

low freq tones recover better
vertigo may persist
young or old = worst prog