Deafness in Adults

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Rami R. AbusalehRami R. Abusaleh


 External ear:
-auricle : Collects air vibrations .
Anatomy

Middle ear:
 Tympanic
membrane:
composed of 3
layers: skin , fibrous
tissue, and mucosa.
 pars flaccida Fibrous
tissue is absent in.

Inner Ear:
 a system of coiled tubes.
 cochlea (hearing), vestibular part (balance)

• The Utricle "leather bag“ & The Saccule
 Fx: parts of the balancing apparatus.
 Mechanism : they use small stones and a
viscous fluid to stimulate hair cells to detect
motion and orientation. The utricle detects
linear accelerations and head-tilts in the
horizontal plane.

 Parts:
1)Basilar fibers
2)Organ of corti
3)Perilymph and
endolymph
cochleacochlea


Energy transformation
Awesome Music Has Enormous Effect


-impairment of sensitivity to sounds , it encompasses
any degree of hearing impairment from mild to
profound.
Hearing lossHearing loss


 Normal
 Conductive
 Sensorineural
 Mixed
 Functional
 Central
Audiometry

 Causes:
Common causes:
wax, acute otitis media , otitis media with
effusion, chronic otitis media, barotraumas,
otosclerosis.
Less common causes:
i. traumatic ossicular translocations,
ii. congenital atresia of the external canal agenesis of
the middle ear
iii. tumors of the middle ear( glomus body tumor)
Conductive deafness


Outer ear causes Middle ear causes
Wax TM. perforation
Trauma stenting ET dysfunction
Infections Infection
Tumors (squamous cell carcinoma in EAC Otosclerosis
Osteoma
Polyps Barotrauma
Congenital (atresia) Congenital
Dermatologic

 Def : usually a hereditary disorder, causes abnormal bone to be
formed around the stapes footplate, preventing its normal
movement. It becomes fixed to the fenestra ovalis that separates
mid.ear from inn.ear, conductive deafness then results.
More rarely, the bone of the cochlea is affected and results in
sensorineural deafness.
Otosclerosis

 Clinical Features
1. Usual onset in second and third decades.
1. Two-thirds give a family history.
2. Two-thirds are female.
3. Deafness may be uni/bilateral.
4. Paracusis (patient is able to hear better in noisy surroundings)
5. Tinnitus
6. The tympanic membranes are normal.
7. Audiometry. Air conduction impaired. Bone conduction initially normal
but deteriorates as the disease progresses
8. Tuning fork tests show conductive deafness .
9. Cochlear impairment
(Rule of 2 : Age / F / Side / Sound / Exam /C )
Otosclerosis


Sensorineural deafness
• prolonged exposure to high noise
level, industrial deafness.
• maternal rubella , cmv ,hereditary deafness, anoxia,
jaundice, congenital syphilis,mumps,herpes zoster
meningitis, measles ,suppurative labyrinthitis)
• ““Man Year”Man Year”(labyrinthytis hydrops).
• Erythromycin, tetracyclin, chemo,
antimalarial chloroquine, loop dieuritcs,
cocaine, heavy metals
Common causes


less common:
1. -head injuryhead injury (trauma of petrous temporal bone [mixed] ).
2.2. metabolic diseasesmetabolic diseases: DM , hypothyroidism, Paget’s.
3.3. PsychogenicPsychogenic
4.4. CNS cancers , metastasis.CNS cancers , metastasis.
5.5. Sudden idiopathic.Sudden idiopathic.
6.6. Tumors:Tumors: glomus body tumor , acoustic neuroma (most
common) , brainstem tumors ,meningioma.((most tumors
of inner ear are bengin))
7.7. Acute neuritis.Acute neuritis.
Sensorineural deafness


 Clinical Features:
 vertigo causes vomiting (can last for hours).
 a feeling of fullness in the ear.
 deafness is sensorineural and more severe before
and during an attack
 tennitus is constant but more severe before an
attack.
 Low frequency hearing loss.
 Hearing loss that recovers within 12 to 24 h
Meniere’s disease:


 Investigations: include a complete medical drug history, use of
hearing aids ,and nature of loss(gradual continuous or intermittent)
 Examination:
1. observe patient during conversation.
2. ability to repeat spoken words at different intensities and
distances in each ear while the other ear is occluded by
pressing on the tragus.
3. if there is profound hearing loss at one side, good ear should
be masked by Barany noise box and deaf ear tested by
shouting.
4. otoscopic examination
5. tuning fork tests.
Diagnosis


 Investigations:
1. Audiogram
2. tympanogram
 upon need
1. speech audiometry
2. -vestibular tests
3. -lab tests
4. -radiology
Diagnosis

Signs & symptoms :
Conductive: Sensorineural:
 Talks in a soft voice.
 Hears speech well in noisy
places.
 tolerates high intensities of
noise.
 No tinnitus.
 good discrimination.
 Talks in a loud voice.
 can not hear speech well
in noisy places.
 hears low frequencies
and cannot tolerate high
intensities.
 tinnitus
 poor discrimination score.
 Recruitment phenomena:
slight increase in intensity
perceived as a large
increase in loudness of
voice.

Test Conductive: Sensorineural:
 Weber Test  Sound localizes to
affected ear (ear
with conductive
loss)
 Sound localizes to
normal ear
 Rinne Test  Negative Rinne;
Bone Conduction >
Air Conduction
(Bone/Air Gap)
Positive Rinne; Air
conduction > Bone
conduction (both air
and bone conduction
are decreased
equally, but the
difference between
them is unchanged).


 The Barany Box is a clockwork noise generator
that is used in audiological testing with tuning
forks and speech testing.


-Congenital::
counseling , hearing aids , speech therapy , surgery in cases of
cleft palate and atresia.
-Idiopathic otosclerosis: hearing aids, surgery.
-Sudden hearing loss: idiopathic ( viral or vascular )
corticosteroids in high risk patient .
Treatment

Hearing aid is an electroacoustic body worn apparatus which
typically fits in or behind the wearer's ear, and is designed to amplify and
modulate sound for the wearer.

BTE aids consist of a case, a tube and an earmold. The case is
small and made of plastic. It fits behind the pinna (ear). The case
contains the amplification system.

In the ear aids (ITE(
These devices fit in the outer ear (called the concha); they are sometimes
visible when standing face to face with someone. ITE hearing aids are
custom made to fit each individual's ear.


 In high risk patients:
 FH of childhood hearing loss.
 prenatal infection.
 anatomic malformation.
 birth weight less than 1500gm.
 hyperbilirubinemia >20 mg/100 ml
 bacterial meningitis,esp H.influenza.
 severe hypoxia during labor
Hearing screening

Quality of tinnitus varies according to origin:
High pitch ( inner ear )
Crackling ( middle ear )
Pulsating( vascular).
Tinnitus


Types:
Objective Subjective
 Rare
 Causes:
1. palatal myoclonus, middle ear
myoclonus.
2. vascular ( aneurysm, glomus
tumor, AV shunt , atheroma of
cranial vessels).
3. infestation of external ear by
worms
4. TMJ abnormality. .
5. acute middle ear infection
 very common
 Causes:
1. acute trauma
2. Meniere’s disease
3. ototoxicity , otosclerosis
4. acoustic neuroma
5. systemic disease: CVS
disease,blood diseases ( anemia ),
neurological ( MS, neuropathy),
drugs, fever, alcohol abuse.
6. middle ear effusion and chronic
otitis
7. psychogenic( hallucinations )
8. labyrinthitis, perilymph fistula
9. idiopathic ( majority )

Dx:
*Proper hx taking:
-localization , pitch , duration,audiological : deafness ,noise
exposure,Otological : discharge & drug hx
*Examination: ENT , neck ,TMJ, auscultation
*investigations:
-audiometry, tympanometry ,vestibulometry.
-Tinnitus test (pure tone matching)
-blood test ( T3, T4 , lipid profile,…)
-radiograms( x-ray , CT, MRA )
Tinnitus

Treatment:
1. Underlying cause
2. Drugs : muscle relaxants, Antidepressants, tranquilizers,
anticonvulsants.
3. surgery: labyrinthectomy , Acoustic neuroma resection if
tinnitus is intolerable.
4. Hearing aids.( if the patient is deaf)
5. Tinnitus maskers ( white noise instrument ), by producing quite
noise .
6. Tinnitus retraining therapy ( TRT ): a method of treating tinnitus
based around a neurophysiological model of the condition, it
embraces various techniques, including explanation ,
counselling, relaxation techniques, and sound therapy.
Tinnitus

Masking. In this graphic, masking sounds are applied at C6, the tinnitus
frequency. The result is that the sensation of tinnitus is reduced. In the
auditory cortex, this corresponds to decreased spontaneous firing rates.

Another Reason to be
Grateful. Thank God,
You Can Hear

Deafness in Adults

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