Otolaryngology Book

http://www.fpnotebook.com/

Sensorineural Hearing LossAka: Perceptive Hearing Loss

Advertisement

  1. See Also
    1. Hearing Loss
    2. Conductive Hearing Loss
  2. Epidemiology
    1. Age of onset over 40 years old
  3. Etiologies
    1. Presbycusis (bilateral)
    2. Noise induced Hearing Loss (bilateral)
    3. Cranial Nerve 8 disease
      1. Meniere's Disease
      2. Acoustic Neuroma
    4. Viral
      1. Mumps
    5. Hematologic from vascular sludging and Hypoxia
      1. Polycythemia Vera
      2. Sickle Cell Anemia
      3. Leukemia
      4. Hypercoagulable states
    6. Microvascular disease
      1. Diabetes Mellitus
      2. Hyperlipidemia
    7. Ototoxic Medications (bilateral)
    8. Infectious Causes
      1. Tertiary Syphilis
      2. Lyme Disease
    9. Endocrine Disease
      1. Hypothyroidism
    10. Autoimmune Hearing Loss
    11. Congenital deafness
    12. Trauma
      1. Temporal bone Fracture involving cochlea or vestibule
      2. Perilymph fistula
        1. Round window or oval window rupture with leak
        2. Caused by trauma, lifting, straining, coughing
  4. Symptoms
    1. Impaired word understanding often present
    2. Hearing worse in a noisy environment
    3. Loud patient's voice
    4. Tinnitus often present
  5. Signs
    1. Otoscopy
      1. Ear Canal and TM are normal
    2. Weber Test (Tuning Fork at Midline) Abnormal
      1. Sound radiates to ear with less sensorineural loss
    3. Rinne Test (Tuning Fork on Mastoid) Abnormal
      1. Both air conduction and bone conduction reduced
  6. Labs
    1. Complete Blood Count (CBC)
    2. Erythrocyte Sedimentation Rate (ESR)
    3. Thyroid Stimulating Hormone (TSH)
    4. Urinalysis
    5. Serum Glucose
    6. Renal Function,
    7. Cholesterol and Triglycerides
    8. Syphilis Serology (VDRL or RPR)
    9. Lyme Titer (if suggested by history)
  7. Imaging: MRI Head at Internal Auditory Canal (IAC)
    1. Rule-out Acoustic Neuroma
  8. Management
    1. Formal audiology testing
    2. Acute Hearing Loss (within 3 days)
      1. Urgent evaluation needed for 30 db loss
      2. High dose Steroids (1 mg/kg/d) (uncertain efficacy)
      3. Carbogen Inhalation (5% CO2 and 95% Oxygen)
        1. May increase cochlear blood flow by vasodilation
        2. Duration determined by serial Audiograms
      4. Otolaryngology evaluation
    3. Chronic
      1. See Hearing Aid
  9. Course
    1. Often no etiology identified and resolves spontaneously

Navigation Tree