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Deafness
Dr. Abdulrahman AlsanosiAssociate professor
King Saud University Otolaryngology consultant
Otologist , Neurotologist &Skull Base Surgeon
Head of otology and neurotology unit Director of cochlear implant program
King Abdulaziz University Hospital
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Questions you should be able to answer at the end of lecture
What is deafness ?
How common is the problem ?
What is the impact of deafness on the patient ?
Who is at risk for developing deafness ?
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What is the definition of deafness on pure tone audiogram ?
What are the classifications of deafness?
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What are the causes of conductive hearing loss ?
What are the causes of sensorineural hearing loss ?
What are the findings in the clinical examination you may see in patient with deafness ?
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How would you confirm hearing loss clinically ?
What are the tests you request to confirm deafness ?
How would you manage patient with deafness ?
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INTRODUCTION
Definition :
Hearing impairment refers to complete or partial loss of the ability to hear from one or both ears.
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FACTS ABOUT AND DEAFNESS
50% of deafness and hearing is avoidable through prevention, early diagnosis, and management
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In Saudi Arabia ?
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In last study done 10years ago
1.7% had profound SNHL
7.7 % (2months -12years )had hearing loss
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Prevalence figures for permanent congenital sensorineural hearing loss are 1.5 to 2.2 per 1000 live birth for developed countries
In Saudi Arabia it is 0.9 to 1.5 percent i.e.: 9 to 15 per 1000, in developing countries, making it the most frequently occurring birth defect
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The impact of hearing impairment:
- Speech,
- Language,
- Education
- Social
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High Risk Criteria For Hearing Loss in Infants
Family history of hereditary childhood sensorineural hearing loss
Hyperbilirubinemia
Ototoxic medications
Bacterial meningitis
Birth weight less than 1500 grams
In utero infections (cytomegalovirus, rubella, syphilis, herpes, and toxoplasmosis)
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High Risk Criteria For Hearing Loss in Infants
Craniofacial anomalies (including pinna and ear canal)
Birth asphexia
Mechanical ventilation lasting 5 days or longer
Stigmata or other findings associated with a syndrome known to include a sensorineural and/or conductive hearing loss
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Definitions
Impairment of sound perception more than 20 decibel on pure tone audiogram.
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Hearing loss
Types:
Conductive hearing loss
1. Concha
2. Ear Canal
3. Drum
4. Ossicular Chain
5. Eustachian Tube
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Conductive hearing loss
Exteranal canal pathology :
Artesia
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Inflammatory
Acute otitis externa
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External canal pathology
Wax
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External canal pathology
Foreign body
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External canal pathology
Tumors:
Osteoma
exostosis
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Conductive hearing loss
Tympanic membrane: Absent Perforated
Too thick tympansclerosis
Too thin SOM
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Conductive hearing loss
Ossicular chains
Absent &erosion
Fixation (otosclerosis
Disrupted trauma
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Conductive hearing loss
EustachianTube dysfunction:
Retraction
Effusion
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Sensorineural hearing loss
Two types :
Sensory (the pathology is within hair cells in cochlea)
Neural (the pathology is with in the auditory nerve and it’s
connection
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Etiologies
Congenital :
Inherited
(syndromic less common
Non- syndromic common
Congenital infection (TORCH)
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Sensorineural hearing loss Acquired : Inflammatory
-labyrinthitis ,meningitis
-
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1.What is noise-induced hearing loss ?
2.what is the typical finding ?
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Noise exposure
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Autoimmune
-Cogan syndrome
Ototoxic drugs
-Aminoglycosides groups ,diruiti,….
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1.What are the types of temporal bone fractures?
2. How does patient present clinically ?
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Trauma Temporal bone fracture
1.Longitudinal fracture
2.Transeverse fracture
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Longitudinal fracture
Bleeding from ear
Conductive hearing loss
Uncommon facial nerve paralysis
CSF
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Transverse fracture
SNHL
Facial nerve paralysis common
CSF
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Examination
General look ( syndromic )
Complete head and neck exam
Otoscopic / microscopic ear exam of both ears
Tuning fork test
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What is tunning fork test ?
How to conduct the test ?
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What tests you want to request in patient with hearing loss and why?
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Clinical testing of hearing
Audiogram battery:
Pure tone audiogramSpeech audiogram
Impedance
1. Acoustic reflex
2. Tympanogram3. Volume
4. Acoustic reflex decay
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pure tone audiogram
Normal hearing
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Conductive hearing loss
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pure tone audiogram
Sensorineural hearing loss
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Pure tone audiogram
Mixed hearing loss
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Tympanogram
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How would you classify the degree of hearing loss?
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Degree of hearing impairment
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Managemnt of deafness Medical management
Hearing aids
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Management of deafness
Surgery
A.Myringotomy and ventilation tube Otitis media with effusion
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Management of deafness Surgery
B. Myringplasty &tympanoplasty in case of CSOM
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Management of deafness
C.Ossiculoplassty
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Management of deafness(conductive )
BAHA (Bone anchored hearing aid)
-Atersia of external canal
-Chronic drainage ear not responding to surgery
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Management of SNHL
Surgery :
D. Cochlear implant
- prelingual children and postlingual adult
-it pass by the external ,middle and inner ear to stimulate auditory nerve directly
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Pre lingual deafness
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Any question
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Thank you