Lecture 21: Ear disease and hearing loss

Question 1

Why are kids more likely to get middle ear infections and effusions of the middle ear?

Answer 1

Their eustachain tube is at about 10˚ where as adults have tubes at closer to 45˚ and a bit longer as well.

Question 2

Types of hearing loss?

Answer 2

Conductive (outer and middle ear)

Sensorineural (inner ear)

Mixed (both)

Central disorders -(auditory processing)

Question 3

Hearing loss categories?

Answer 3

1. normal
2. mild
3. moderate
4. severe
5. profound

Question 4

History?

Answer 4

age, severity, duration

Onset, consistency, precipitating factors

family history -(tinnitus, vertigo, fullness, headaches)

Question 5

Investigations?

Answer 5

Audiogram done in adults always

otoacoustic emissions - idea of inner ear function in children

ABR- auditory brainstem response

CT/MRI

Question 6

Examination?

Answer 6

Clinical test of hearing (whisper test)

Question 7

Webber and rinne test?

Answer 7

Both use a 512Hz tuning fork

Rinne’s compares air conduction with bone conduction with the fork either next to the pinna or hard against the skull.

Webber’s test holds the fork on the top of the head as looks to see if it is heard in the middle or louder on one side. Louder in bad ear if conduction and good ear if sensorineural.

Question 8

Conductive hearing loss - differential diagnosis?

Answer 8

Middle ear

• Inflammatory (otitis media w. effusion, chronic otitis media)
• Metabolic (otosclerosis, arthritis)
• Congenital
• tumour (glomus)
• trauma

Ear canal

• Congeital (microtia/atresia, stenosis)
• Aquired (exostoses = bone formation, stenosis)

Question 9

otitis media with effusion? Treatment?

Answer 9

Common in children 1-4 years

Eustchian tube dysfunction

infection/inflammation - effusion

negative pressure

TREATED with GROMITS to allow air into middle ear

Question 10

Mastoiditis?

Answer 10

Puss build up in the mastoid area behind the ear as a result of otitis media and is a medical emergency

Question 11

Sensorineural hearing loss differential diagnosis?

Answer 11

Congenital

Hereditary

Heredity with delayed onset

Aquired

Aquired

Noise induced

Temporal bone trauma

Ototoxicity (eg aminoglycoside, gentamicin, cisplatin)

Infection (syphillis, post meningitis, viral)

Vestibular schwannoma (or other tumours)