Hearing Loss

1. See Also
   1. Home Modifications for Hearing Impaired Patients
2. Epidemiology: Age predictive of cause
   1. Older patients
      1. Sensorineural Hearing Loss (SNHL) more common
   2. Younger patients (<40)
      1. Conductive Hearing Loss more common
3. History
   1. Is Hearing Loss acute or chronic?
      1. Sensorineural Hearing Loss is more often chronic
   2. Is Hearing Loss in one or both ears?
   3. Is Hearing Loss stable, progressive or episodic?
   4. Is Hearing Loss associated with:
      1. Otalgia or ear fullness sensation
      2. Otorrhea
      3. Vertigo
      4. Tinnitus
   5. Have any Ototoxic Medications been used?
   6. Are there loud noise exposures in the work environment?
   7. Is there a Family History of early Hearing Loss?
   8. Have you had ear infections or ear injury?
   9. How loud is your speaking volume?
      1. Raised voice in Sensorineural Hearing Loss
   10. Is your hearing better or worse in a noisy environment?
       1. Worse in Sensorineural Hearing Loss
       2. Better in Conductive Hearing Loss
   11. How is your understanding of words?
       1. Worse in Sensorineural Hearing Loss
   12. What chronic medical problems do you have?
       1. Diabetes Mellitus
       2. Cerebrovascular Accident
       3. Heart Disease
4. Signs
   1. Otoscopy: Abnormal in Conductive Hearing Loss
      1. Tympanic Membrane compliance is abnormal
      2. Signs of infection or canal obstruction present
   2. Tympanometry
   3. Formal Audiography (normal 20 db at all frequencies)
   4. Speech Recognition
      1. Speech Reception Threshold (SRT)
         1. Decibel level at which 50% of words understood
      2. Speech Recognition Score (SRS)
         1. Percentage words understood at 40 db over SRT
   5. Whispered Voice Testing
      1. Patient occludes opposite ear
      2. Examiner whispers questions or commands
      3. Patient answers or follows commands
      4. Avoid testing with finger snapping or ticking watch
         1. Not accurate for Hearing Testing
   6. Weber Test (Tuning Fork at midline forehead)
      1. Sound radiates TO Conductive Hearing Loss ear
      2. Sound radiates AWAY from Sensorineural Hearing Loss
   7. Rinne Test (Tuning Fork at mastoid)
      1. Abnormal in Conductive Hearing Loss
         1. Air conduction better than bone conduction
5. Evaluation: Triage
   1. Sudden Sensorineural Hearing Loss (SSHNL) within last 72 hours needs immediate evaluation
   2. Simple test directed by triage nurse over the phone (regarding SSHNL): Hum Test
      1. Hum Test lateralizes to the good ear suggests Sensorineural Hearing Loss
         1. Requires immediate evaluation for Sudden Sensorineural Hearing Loss (SSHNL)
      2. Hum Test lateralizes to the bad ear suggests Conductive Hearing Loss
         1. Routine evaluation is appropriate
6. Management
   1. Requires immediate evaluation
      1. Rule-out Sensorineural Hearing Loss
   2. Formal Audiology Testing at various frequencies
      1. Bone Conduction Testing
      2. Air Conduction Testing
7. Prognosis: Poor prognostic indicators
   1. Vertigo
   2. Tinnitus
   3. Otalgia
8. Pearls: Hearing impaired patients at clinic visits
   1. Use the stethoscope as an amplifier
   2. Place the ear tips in the patients ears
   3. Speak into the diaphragm of the stethoscope
   4. References
      1. From email communication with D. Nagase, MD
9. Prevention
   1. See Home Modifications for Hearing Impaired Patients