hearing conservation program ear disorders and hearing loss

HEARING CONSERVATION PROGRAM

EAR DISORDERS AND

HEARING LOSS

126 Jan 2013

LEARNING OBJECTIVES

1.Define the five types of hearing loss2.Describe medical and communication

symptoms that are characteristic of each type of hearing loss

3.List common causes of and basic treatment for each type of hearing loss

4.Explain how impact and continuous noise exposure affects ear structures and functions

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OHC TECHNICIAN RESPONSIBILITY

YESGeneral

Knowledge for

Referrals

NODiagnosis of Type of Hearing

Loss Ear Disease

Recommendations of Treatments

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FIVE TYPES OF HEARING LOSS

1. Conductive hearing loss2. Sensorineural hearing loss3. Mixed hearing loss4. Central hearing loss

5. Non-organic or Functional hearing loss

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Five Types of Hearing Loss cont…

Central earCONDUCTIVE CENTRAL

MIXED HEARING LOSS

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SENSORI-NEURAL

CONDUCTIVE HEARING LOSS

Symptoms

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Talks softly or reports“talking in a barrel”

Understands speech with increased volume

Congestion – coldLow pitched ringing or

crackling sounds

Low frequency or flat hearing loss

Hearing Test Results500 1000 2000 3000 4000 6000Hz 35 30 25 15 10 10 dB

Abnormalotoscopic examtympanogram

Outer &

MiddleEars

Normal Ear Canal and Eardrum

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CONDUCTIVE HEARING LOSSDiseases and Disorders

Impacted Cerumen Complete Occlusion

Outer

&Middle

Ears

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External Otitis or Infection

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Outer &

Middle

Ears

Conductive Hearing Loss:Diseases/Disorder cont…

Conductive Hearing Loss:Diseases/Disorders cont…

Dermatitis Basal Cell

Carcinoma

Outer &

Middle

Ears

Conductive Hearing Loss:Diseases/Disorders…cont…

Exotosis Bony Growths or Protrusions

Outer &

Middle

Ears

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Conductive Hearing Loss:Diseases/Disorders…cont…

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Outer &

Middle

Ears

Foreign ObjectsBall Bearing Stick Insect

Conductive Hearing Loss:Diseases/Disorders contOuter &

Middle

Ears

Ear Canal Fungus

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Conductive Hearing Loss:Diseases/Disorders contOuter &

Middle

Ears

Congenital Atresia

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Reminder: Normal Eardrum

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Outer &

Middle

Ears

Conductive Hearing Loss:Diseases/Disorders cont…

Tympanic Membrane Perforation

Outer &

Middle

Ears

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Conductive Hearing Loss:Diseases/Disorders cont…

Ossicle Related

Detached

Stiff – fixated

Eroded

Birth related

Outer

and

Middle

Ears

Conductive Hearing Loss:Diseases/Disorders

cont…

Eustachian Tube DysfunctionOuter &

Middle

Ears

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Conductive Hearing Loss:Diseases/Disorders cont…

Middle Ear Effusion Serous Otitis Media

Fluid line (7:00 to 2:00)

Outer &

Middle

Ears

Conductive Hearing Loss:Diseases/Disorders cont…Outer &

Middle

Ears

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Otitis Media or Middle Ear Infection

Conductive Hearing Loss:Diseases/Disorders cont…Outer &

Middle

Ears

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Cholesteatoma

Conductive Hearing Loss:Diseases/Disorders cont…Outer &

Middle

Ears

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Otosclerosis

CONDUCTIVE HEARING LOSSTreatment

1. Medications2. Surgery3. Good ear hygiene4. Hearing aids

Conductive a) temporaryHearing Loss b) loudness

problem

Outer

&

Middle

Ears

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SENSORINEURAL HEARING LOSS

Symptoms“Can hear but trouble

understanding “ due to distorted speech sounds

May hear well in quiet but difficulties in noise

Talks loudlyTinnitusBalance difficultiesHx: illness, head

trauma, noise exposure

High frequency hearing loss

Hearing Test Results500 1000 2000 3000 4000

6000 Hz 15 20 30 45 55 60

dB

InnerEar

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Normal otoscopic exam tympanogram

SENSORINEURAL HEARING LOSS

Diseases & DisordersBASIC PROBLEM

Organ of Corti and Hair Cells are damaged destroyedundergoing pressure

RESULT Complete sounds can’t

be detected and/or transmitted creating…

“distorted speech”

InnerEar

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Ototoxinsdrugschemicals

Head traumaAgingAuto-immune or

unknown

Diseases bacterial/viral fluid pressure

Birth related genetic (DNA) fetal or birth

Hazardous noise exposure

InnerEar

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SENSORINEURAL HEARING LOSS

Causes of Inner Ear Damage

Sensorineural Hearing Loss:Diseases & Disorders cont….

Noise Induced Hearing Loss (NIHL)prolonged exposure ≥ 85 dB HLsudden impulse/impact ≥ 140 dB Peak HL

Normal Damage Normal Damage

InnerEar

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SENSORINEURAL HEARING LOSS

Treatment1.Medications & Surgery -

limited

2.Hearing Aids

3.Adaptive Skills

Sensorineural a) permanentHearing Loss b) understanding problem

InnerEar

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Conductive + Sensorineural = Mixed HL

MIXED HEARING LOSS

ANY

COMBINATION

Symptoms

Hearing Test Results

Disease/Disorders

Treatments

MOST COMMON

Permanent Sensorineural HL

with Outer/Middle Ear disorder

ORImpacted Cerumen

(temporaryconductive HL)

Outer

Middle

Inner

Ears

CENTRAL HEARING LOSSSymptoms

Asymmetrical hearing lossTinnitus - typically constantAtypical difficulty with

understanding speech in noisy conditions

Balance difficultiesHead trauma

Auditory

Nerves

&Brain

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Central Hearing Loss:Symptoms cont…

Often hearing for tones is normal

Other neurological disorders present

Easily distracted by other sounds

May have learning difficulties

Confused with behavioral problems

Auditory

Nerves &

Brain

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CENTRAL HEARING LOSSTreatment

1. Surgery for tumors/growths

2. Educational therapy

3. Adaptive techniques

Central understanding

Hearing Loss problem

Auditory

Nerves &Brain

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NON-ORGANIC HEARING LOSS

History enlistment, deployment,

discipline, avoid work, retirement, attention, monetary compensation

Inconsistent behaviors

Testing behaviors     

Hearing test results

inconsistent with

hearing behaviors previous tests how ear functions

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Malingering

Central Hearing Loss:Symptoms cont . . .

History Traumatic event –

assault, rape, IED, war trauma

Not trying to avoid work

Not trying to obtain $$

Hearing test results

inconsistentFlat affect Emotionless facePatient believes has hearing loss

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Very rare condition

Conversion or Psychological Trauma

NON-ORGANIC HEARING LOSS“Treatment”

1. Follow regular protocols2. Give reinstruction for test3. Give person an “out”4. Refer to audiologist

• special test techniques• special tests• counseling

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SUMMARYThe five types of hearing loss

are based on the divisions and functions of the ear

1. Conductive2. Sensorineural3. Mixed4. Central

5. Non-Organic

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Q U E S TION S?