II. Epidemiology

  1. Gender
    1. Males affected by Hearing Loss at an earlier age than women
  2. Age predictive of cause
    1. Older patients
      1. See Hearing Loss in Older Adults
      2. Sensorineural Hearing Loss (SNHL) more common
    2. Younger patients (<40)
      1. Conductive Hearing Loss more common

III. 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

IV. 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

V. 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

VI. 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

VII. Prognosis: Poor prognostic indicators

VIII. 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

Images: Related links to external sites (from Google)

Ontology: hearing impairment (C1384666)

Definition (NCI) Partial or complete loss of the ability to detect or understand sounds resulting from damage to the outer, middle, or inner ear structures. Causes include exposure to loud noise, ear infections, injuries to the ear, genetic, and congenital disorders.
Definition (NCI) A disorder characterized by partial or complete loss of the ability to detect or understand sounds resulting from damage to ear structures.
Definition (NCI) A partial or complete loss of hearing in one or both ears. It is classified as conductive, sensory, or central.
Definition (MSH) A general term for the complete or partial loss of the ability to hear from one or both ears.
Concepts Finding (T033)
MSH D034381
ICD9 389.9, 389
ICD10 H91.9
SnomedCT 155254002, 15188001, 103276001, 155242002, 194411005, 267764005, 111543003
English Unspecified hearing loss, HEARING IMPAIRED, HEARING DECREASED, HEARING REDUCED, Hearing loss, NOS, Hypoacusis, Hearing loss, unspecified, loss of hearing (symptom), hearing loss (diagnosis), hard of hearing, hearing impaired, loss of hearing, decreased hearing, hearing loss, Hearing decreased, Hearing reduced, Hearing Impairment, Hearing Loss, Loss, Hearing, Hypoacuses, Hearing loss NOS, LOSS OF HEARING, HEARING LOSS, IMPAIRMENT, HEARING, HEARING IMPAIRMENT, Hearing Loss [Disease/Finding], Impairment;hearing, Loss (of);hearing, Hearing losses, Hearing loss, Hearing impairment, Hearing impaired, Impaired hearing, Difficulty hearing, HI - Hearing impairment, HL - Hearing loss, HOH - Hard of hearing, Hard of hearing, Decreased hearing, Decreased hearing (finding), defect; hearing, hearing; defect, hearing; loss, loss; hearing, Loss of hearing, hearing impairment, Hearing loss (finding), Hearing loss (disorder)
German Hoerverluste, Gehoer verringert, Gehoer vermindert, schwerhoerig, Gehoerverlust, unspezifischer Hoerverlust, GEHOER EINGESCHRAENKT, GEHOER VERMINDERT, HOERVERMINDERUNG, Hoerverlust, nicht naeher bezeichnet, Hoerstoerung, Hypakusis, Hypoakusis, Hörbeeinträchtigung, Hörverlust
Italian Perdite dell'udito, Udito compromesso, Sordità non specificata, Udito diminuito, Duro di orecchi, Udito ridotto, Invalidità uditiva, Ipoacusia, Perdita dell'udito
Dutch verminderd gehoor, verlies van het gehoor, hardhorig, niet-gespecificeerd gehoorverlies, defect; gehoor, gehoor; defect, gehoor; verlies, verlies; gehoor, Gehoorverlies, niet gespecificeerd, gehoor beschadigd, gehoorverlies, hypoacusis, Gehoorstoornis, Hypoacusis, Gehoorafname
French Audition réduite, Perte auditive non précisée, Audition diminuée, Dur d'oreille, ALTERATION DE L'OUIE, DIMINUTION DE L'OUIE, REDUCTION DE L'OUIE, Hypo-acousie, Malentendant, Pertes auditives, Déficience auditive, Déficit auditif, Baisse de l'acuité auditive, Hypoacousie, Perte d'audition, Perte auditive
Portuguese Défice auditivo NE, Dificuldade auditiva, Audição reduzida, Audição diminuída, Défice auditivo, AUDICAO DIMINUIDA, INSUFICIENCIA AUDITIVA, REDUCAO DA AUDICAO, Deficiência auditiva, Perdas de audição, Hipoacusia, Deficiência Auditiva, Perda Auditiva, Perda da Audição, Perda da Capacidade Auditiva
Spanish Audición reducida, Dificultad para oír, Pérdida de audición no especificada, Audición disminuida, Pérdida de audición, pérdida auditiva (hallazgo), sordera, Loss of hearing, Hearing loss, AUDICION DETERIORADA, AUDICION DISMINUIDA, AUDICION REDUCIDA, pérdida de la audición (trastorno), pérdida auditiva (trastorno), pérdida de la audición, audición disminuida (hallazgo), audición disminuida, disminución de la audición, hipoacusia, pérdida auditiva, Audición alterada, Pérdidas de audición, sordera (hallazgo), Hipoacusia, Deficiencia Auditiva, Pérdida Auditiva, Pérdida de la Audición, Pérdida de la Capacidad Auditiva, Perdida Auditiva, Perdida de la Audicion, Perdida de la Capacidad Auditiva
Japanese 詳細不明の難聴, 聴力減退, 聴覚障害, 聴力低下, ナンチョウ, チョウリョクゲンタイ, ショウサイフメイノナンチョウ, チョウカクショウガイ, チョウリョクテイカ, 部分的聴力損失, 聴力損失-部分的, 局所的聴力損失, 聴力損失-局所的, 難聴-局所的, 聴力喪失-部分的, 聴力損失, 局所的難聴, 異聴(難聴), 難聴
Swedish Hörselnedsättning
Czech porucha sluchu, hypoakuzie, nedoslýchavost, Omezení sluchu, Hypoakuzie, Zhoršení sluchu, Nedoslýchavý, Porucha sluchu, Ztráty sluchu, Ztráta sluchu, Blíže neurčená ztráta sluchu
Finnish Huonokuuloisuus
Russian GLUKHOTA CHASTICHNAIA, SLUKHA POTERIA CHASTICHNAIA, SLUKHA POTERIA, ГЛУХОТА ЧАСТИЧНАЯ, СЛУХА ПОТЕРЯ, СЛУХА ПОТЕРЯ ЧАСТИЧНАЯ
Korean 상세불명의 난청
Croatian Not Translated[Hearing Loss]
Polish Ubytek słuchu, Niedosłuch
Hungarian Nem meghatározott hallásvesztés, hypoacusis, halláscsökkenés, csökkenthallás, Hallási nehézség, Halláscsökkenések, halláskárosodás, Hallás elvesztése