Common cause of conductive hearing loss in adults 20 40 50,tdk in ear noise cancelling headphones review cnet,skull earring patterns uk - Videos Download

04.12.2013
The most common cause of conductive hearing loss is chronic inflammation and fluid collection in the middle ear known as Otitis media with effusion (OME) or Glue Ear. Tympanometry testing is not a hearing test and should only be carried out if the Sweep Audiometry test has a result that is abnormal or equivocal. According to the Hearing Loss Association of America, about 20 percent of adults in the United States – or about 48 million – report some degree of hearing loss. In children, however, the most common cause of hearing loss is conductive hearing loss, which is often due to fluid in the ears from an ear infection.
Hearing loss can result from a problem with any of the three main parts to the ear: the outer ear, middle ear or inner ear. The most common signs of hearing loss include sounds or speech seeming muffled, difficulty understanding words (especially in background noise or in a group of people), frequently asking others to repeat things or to speak more clearly, and setting the television or radio louder than friends or family would prefer. Recognizing the signs of hearing loss in babies and young children, on the other hand, can be trickier than a simple test. Reducing our exposure to recreational noise is one of the most important things we can do to protect our hearing later in life. Even for people with aggressive ear disorders, a variety of treatments can help reduce their symptoms. In the majority of cases of hearing loss in adults, the most effective treatment is a hearing aid.
Those advancements are already being made by companies like Beltone, which recently introduced the Beltone First hearing aid. If you or a loved one is coping with hearing loss, organizations such as The Hearing Loss Association of America are full of resources, educational programs and support.
Regardless of the profundity of hearing loss, options exist to make life easier, and plenty of organizations are out there to support you and your loved ones. The outer ear consists of the auricle (unlabelled), the external auditory canal, and the lateral surface of the tympanic membrane (TM). There are several other audiological tests that are also commonly abnormal in persons with conductive hearing loss. Tympanometry usually is either flat (as shown below), or shows an abnormally large volume (indicating a perforation).
Other tests that may be helpful in confirming conductive hearing loss are OAE testing and temporal bone CT scan. Causes include a buildup of ear wax, a foreign body in the ear canal, otosclerosis, typanosclerosis (as shown above), superior canal dehiscence (which can also cause a conductive hyperacusis), external or middle ear infections (otitis externa or media), allergy with serous otitis media (fluid in middle ear), trauma to the ossicular chain such as temporal bone fracture, tumors of the middle ear such as a glomus tumor, erosion of the ossicular chain (cholesteatoma) and perforation of the tympanic membrane. A hole in the ear drum, which is called a tympanic membrane perforation, causes a conductive hearing loss. It is generally attributed to previous ear infections or trauma (such as a tube insertion). The last step in the chain of signal transmission between sound in the air and movement of fluid in the inner ear is the middle ear.
There are three small bones interposed between the large ear drum, and the small hole (oval window) across which sound is transmitted into the inner ear. Complete ossicular chain discontinuity usuall results in a large, flat conductive hearing loss. Characteristically, hearing aids work well for conductive hearing loss, and very good hearing results can be obtained. Surgical treatment is also generally available for conductive hearing loss as it is always due to a mechanical problem. Most surgical treatments for otosclerosis or middle ear disease involve opening of the middle ear and repair under direct vision. However, in our opinion (which is not representative of general opinion of ear surgeons), we think it is preferable to use a hearing aid until hearing becomes unservicable, and then move onto an implanted hearing aid, and skip the middle ear surgery part altogether. Objective: To determine the frequency and causes of hearing impairment in patients attending the out patient department of Civil Hospital Karachi.
Methods: This study was carried out at the ENT department of Civil Hospital Karachi from January 1998 to October 2000.
Results: Frequency of conductive hearing loss was 50%, sensorineural hearing loss 20% and mixed hearing loss in 30%. Hearing is the function of the ear which receives the sound by external ear and transmits it to the cochlea in the inner ear via middle ear acoustic impedence matching system.
The task of Cochlea is to analyze the environmental sounds and transmit the result of that analysis to the brain.1 Any pathology in this system will cause deafness or hearing impairment, which may be conductive, sensorineural or mixed. Childhood deafness is the hidden disability and leads to poor education and employments prospects.3 So, Scientific Epidemiological data is the key for preventive strategic planning.
The aim of this study was to identify the frequency and causative factors of hearing impairment and deafness in a tertiary care hospital, a major problem affecting the population resulting in communication and psychiatric problems in society.
Six hundred patients of all age groups were randomly selected in the tertiary care teaching hospital i.e. As at the time of the study there was no Ethical Review Board in Dow University, an approval could not be obtained. Incidence of conductive hearing loss in this study was 50% [300] out of which 65%[195] were unilateral and 35%[105] were bilateral. In conductive type of hearing loss discharging ear remains the most common cause in this study. Hearing impairment is a multi factorial disease and it is very difficult to find out the exact cause. In conductive type of hearing loss Chronic Suppurative Otitis Media (CSOM) is the commonest cause in this study. In this study, the second common cause of conductive hearing loss was secretary otitis media in 57 cases (19%). This journal is a member of and subscribes to the principles of the Committee on Publication Ethics.
A sensorineural hearing loss is characterized by the failure of nervous impulses to reach the brain. Age-Related Hearing Loss - Presbyacusis Age-related hearing loss is also known as presbyacusis. Noise-Induced Hearing Loss Noise-induced hearing loss is triggered by exposure to loud noises. Congenital Hearing Loss Congenital hearing loss refers to a hearing loss that is present at birth. Meniere’s Disease Meniere’s disease is an inner ear pathology that affects hearing and balance. Sudden Hearing Loss A sudden hearing loss is the rapid deterioration of hearing acuity that may continue to decline for three consecutive days. Acoustic Neuroma Acoustic neuroma is a noncancerous tumor on the auditory nerve that carries nervous impulses from the cochlea to the brain.
A conductive hearing loss is usually a temporary hearing loss the can be treated medically or surgically by an ENT specialist. Hearing aids can be used while waiting for the medical intervention or as an alternative treatment option. Eardrum PerforationEardrum perforations can be the result of head trauma, middle ear infections or from the failure to heal after a ventilation tube has fallen out. Otosclerosis Otosclerosis is a progressive disorder that results in the fixation of the stapes, the third bone of the ossicles. Ossicular Discontinuity The ossicles have an important role in the conduction of sound waves from the outer ear to the inner ear.
Cholesteatoma Cholesteatoma is a condition where dead skin is produced in the middle ear to form a cyst behind the eardrum. Impacted Earwax Cerumen or earwax is a natural secretion of glands in the outer ear canal that helps keep the ear safe and clean.
Aural Atresia Aural atresia is a congenital condition where the outer ear has not developed properly at birth. A hearing loss caused by a combination of both conductive and sensorineural hearing loss. Head trauma is the most common single cause of mixed hearing loss. Head Trauma Injuries to the head can cause damage to the delicate structures of the middle ear or the inner ear.
Retirement residence administrators, contact us today to schedule a NO CHARGE hearing awareness activity offered to your senior residents. According to US government statistics from the 60's (National Center for Health Statistics), only 8% of the entire US population has any difficulty with hearing at all. Examples of conditions that cause sensorineural hearing loss are noise and just living a long time. If you have a sensorineural hearing loss, your goal should be to find out why, if you can prevent it from getting worse, and if a hearing aid could help you in overcoming the impairments associated with hearing loss. If you have to have a hearing loss, it is best to have a conductive one, as these disorders are often fixable. If you have a conductive hearing loss, your goal should be to find out why, if you can prevent it from getting worse, and if a hearing aid, surgery, or perhaps just wax removal might help you in overcoming the impairments associated with hearing loss. MRI scan of person with central hearing loss, showing high-signal (white spots) in inferior colliculi. Figure 3a: Audiogram (hearing test) typical of early Meniere's disease on the right side (x=left, o=right). Figure 3b: Peaked Audiogram typical of middle-stage Meniere's disease, again on the right side. Figure 3c: Flat audiogram typical of late-stage Meniere's disease, again on the right side. Dawes P, Fortnum H, Moore DR, Emsley R, Norman P, Cruickshanks K, Davis A, Edmondson-Jones M, McCormack A, Lutman M, Munro K A Population Snapshot of 40- to 69-Year Olds in the United Kingdom.
Leskowitz MJ1, Caruana FF2, Siedlecki B2, Qian ZJ1, Spitzer JB2, Lalwani AK2.Asymmetric hearing loss is common and benign in patients aged 95 years and older. Otitis media is an inflammation in the middle ear (the area behind the eardrum) that is usually associated with the buildup of fluid.
The eustachian tube, a passage between the middle ear and the back of the throat, is smaller and more nearly horizontal in children than in adults. Three tiny bones in the middle ear carry sound vibrations from the eardrum to the inner ear. If a hearing loss exists, a child does not get the full benefit of language learning experiences. Otitis media without infection presents a special problem because symptoms of pain and fever are usually not present.
Genetic factors are thought to cause more than 50% of all incidents of congenital hearing loss in children (4).


In autosomal dominant hearing loss , one parent who carries the dominant gene for hearing loss and typically has a hearing loss passes it on to the child. In autosomal recessive hearing loss , both parents who typically have normal hearing, carry a recessive gene.
In X-linked hearing loss, the mother carries the recessive trait for hearing loss on the sex chromosome and passes it on to males, but not to females.
There are some genetic syndromes,in which, hearing loss is one of the known characteristics.
Other causes of congenital hearing loss that are not hereditary in nature include prenatal infections, illnesses, toxins consumed by the mother during pregnancy or other conditions occurring at the time of birth or shortly thereafter.
Acquired hearing loss is a hearing loss which appears after birth, at any time in one's life, perhaps as a result of a disease, a condition, or an injury. But on average, it takes people seven years from the time they think they might have hearing loss to actually seek treatment.
In our 50s and 60s, we often experience a gradual decrease in hearing, but there can be a genetic predisposition as well. Many problems with the outer ear and middle ear, such as earwax and infections, can be treated, but inner ear problems are typically permanent. With inner ear disorders like Meniere's disease, however, the symptoms can be more immediate. Many health fairs and physician's offices offer hearing screenings, but if you do not pass this test or want a more detailed evaluation, be sure to see an audiologist who is licensed by the state and has either a master's or doctoral degree. This is why it's a good idea to ask your physician if hearing loss is one of the possible side effects. The First hearing aid connects to your iPhone, making it simple and discreet to adjust the hearing aid's volume or other settings right from the palm of your hand. Also, programs like the Georgia Telecommunications Equipment Distribution Program (GATEDP) can provide resources and equipment to make to make elements of day-to-day life, like making a simple phone call, much easier. The middle ear includes the medial surface of the eardrum, the ossicular chain of bones, the eustachian tube. These can be immensely troublesome because their removal can be difficult, and infections are common. It is more accurate to say that there is a hearing reduction, as generally hearing is not greatly affected -- a 10 db drop is typical. There also seems to be a weak association with increased serum calcium (de Carvalho et al, 2006) . When these bones are fused (otosclerosis, or ossicular fixation) or broken (ossicular chain discontinuity), a conductive hearing loss is the inevitable result.
When combined with a sensorineural hearing loss, this pattern may look superficially like a conductive hearing loss, because there is an air-bone gap. Persons with LVAS may develop hearing loss as well as be unusually vulnerable to inner ear disease associated with head injury. Recently some groups (Kakehata et al, 2006) are using endoscopy for repair of ossicular chain disturbances -- in our opinion, this is still very investigational and somewhat unreasonable -- when working inside a tiny space, one needs as good an exposure as one can manage.
Carhart Notch 2-kHz Bone Conduction Threshold Dip: A Nondefinitive Predictor of Stapes Fixation in Conductive Hearing Loss With Normal Tympanic Membrane. Speech is intimately related to hearing as patients with impaired hearing or deafness develop speech problems and the result is poor communication between patient and environment. General information is given on Paedoaudiology for both parents and professionals.4 It evaluates the size and extent of the problem, which helps in planning for prevention. This study will highlight this problem so the measure may be taken for prevention and rehabilitation. Sensorineural type of hearing loss was found to be 20% [120] of which 87% [104] were bilateral and 13% [16] were unilateral. Before the dawn of civilization, the primitive man used such tools of communication as drawing pictures, patterns, a shriek, a yell, a shout etc to draw attention or convey a message. Hearing impairment and deafness are a common problem in our country because 52% of our population lives below the poverty line and only 38% have access to clean water and proper sanitation.
However, etiology of hearing loss was estimated as genetic, congenital non-genetic, delayed onset non-genetic and unknown.8 Identification of causative factors, timely eradication of disease and rehabilitation of the effected persons are the milestones of prevention.
According to Tantany AC, Hypoxia is the most common cause of sensorineural hearing loss in the perinatal stage.18 Noise is the commonest cause of preventable hearing loss. Causes of childhood deafness in Pukhtoonkhwa Province of Pakistan and the role of consanguinity. Prevalence and etiology of bilateral sensorineural hearing impairment in a Finnish childhood population. The ciliary beat frequency of middle ear mucosa in children with chronic secretory otitis media. Causes of deafness in British Bangladeshi children: a prevalence twice that of the UK population cannot be accounted for by consanguinity alone. This permanent hearing loss can be caused by damaged nervous cells of the cochlea or difficulties with the upper auditory pathways. Other than hereditary reasons, this is the most common cause of permanent sensorineural hearing loss. Individuals exposed to prolonged periods of excessive noise can develop this permanent sensorineural hearing loss. It is caused by dysfunctions in the outer ear or in the middle ear that prevent the sound waves travelling in the air to soundly reach the inner ear. Otitis Media is an infection in the middle ear causing fluid buildup behind the eardrum, thus limiting the movement of the middle ear’s mechanical chain .
This condition is thought to be a hereditary disorder and can be associated with tinnitus and vertigo. The eardrum is attached to the malleus; the malleus is connected to the incus which is connected to the stapes. In addition to ear pain and tinnitus, cholesteatoma may also cause the erosion of the ossicles or trigger recurrent middle ear infections and perforated eardrums. In some narrow ear canals or when the cerumen has less of a lubricating quality, the earwax can become impacted and cause a conductive hearing loss. After a hearing test, hearing care professionals will be able to find out if this is only a conductive hearing loss or a mixed hearing loss. A head trauma can therefore cause a temporary or permanent hearing loss and can be accompanied by tinnitus. It develops adapted solutions for individuals, institutions and businesses, to ensure the independence and social well-being of the hard of hearing. Furthermore, only 3% of the population had difficulty hearing anything other than faint speech. Adults with hearing loss are more likely to be unemployed and earn less wages (Jung and Bhattacharyya, 2012).
If we do the math, 90% of 8% of the population with a hearing loss works out to about 7% of the population. Persons with cochlear deficits fail OAE testing, while persons with 8th nerve deficits fail ABR testing.
If we do the math again, as only 8% of the population has a hearing loss at all, and 90% of them are sensorineural, this means that only 0.8% of the population has a conductive hearing loss.
Central hearing loss generally isn't helped to a great extent by medication or surgery, but preventing progression is important. Sudden hearing loss as well as Congenital hearing loss may be due to sensorineural, conductive or central mechanisms. Association of hearing loss with decreased employment and income among adults in the United States .Ann Otol Rhinol Laryngol. At one extreme is a single short period of thin, clear, noninfected fluid without any pain or fever but with a slight decrease in hearing ability. Therefore, it can be more easily blocked by conditions such as large adenoids and infections.
When fluid is present, the vibrations are not transmitted efficiently and sound energy is lost.
However when otitis media occurs over and over again, damage to the eardrum, the bones of the ear, or even the hearing nerve can occur and cause a permanent, sensorineural hearing loss. It can include hereditary hearing loss or hearing loss due to other factors present either in utero (prenatal) or at the time of birth.
Genetic hearing loss may be autosomal dominant, autosomal recessive, or X-linked (related to the sex chromosome).
In this case there is at least a 50% probability that the child will also have a hearing loss.
Some examples are Down syndrome (abnormality on a gene), Usher syndrome (autosomal recessive), Treacher Collins syndrome (autosomal dominant), Crouzon syndrome (autosomal dominant), and Alport syndrome (X-linked). These conditions typically cause sensorineural hearing loss ranging from mild to profound in degree. The results of this test should always be viewed in conjunction with the Audiometry screening test results and follow the clinical referral pathway. What many people don't know is that time is of the essence, and seeking professional help as soon as you notice hearing changes in yourself or a loved one can help delay or even prevent certain types of hearing loss.
Brian Herrmann, pediatric otolaryngologist at Children's Healthcare of Atlanta at Scottish Rite.
The Hearing Loss Association of America recently announced a breakthrough at The Ohio State University, where computer engineers and hearing scientists are working to solve what many experts call "the cocktail party problem," or difficulty hearing one person's voice in the midst of background noise.
Atlanta Beltone's COO, Alexandra Sims, says the device is even more sophisticated than meets the eye. With the use of amplifiers, captioning and speech assistance, this free program helps Georgia residents with any degree of hearing loss speak and understand more easily on the phone. These are most easily removed using an examining microscope, but in some instances, surgical removal is needed. It is presently thought that persons taking calcium supplements are not at increased risk, and also that there is no risk from calcium channel blocker medications.
The most common ones are cholesteatoma associated with chronic ear infection (it is not a true tumor) and glomus tumors. Patients of all age groups and both genders were included, who complained of hearing impairment in one or both ears.
In majority of cases of sensorineural hearing loss, prenatal and perinatal factors predominate.
Profound hearing impairment is more prevalent in countries where consanguineous marriages are common such as Pakistan.3No definite epidemiological figures are available in Pakistan. The prevalence of hearing impairment is estimated to about 440 million people world wide, While Griffith K.


This condition is not medically or surgically treatable, in most cases hearing aids and assistive listening devices are used to adapt to the hearing difficulties caused by a sensorineural hearing loss. Listening to music at loud volumes and motorcycle riding without hearing protection are frequent causes of noise-induced hearing loss. The eardrum and ossicles lack of mobility results in a conductive hearing loss, sound waves are not transformed into amplified vibrations like they should. It can be treated by using hearing aids to overcome the difficulties caused by the hearing loss or by undergoing a stapedectomy. When an individual endures multiple middle ear infections, a cholesteatoma or head trauma, the articulation between these fragile bones can be separated. This condition requires a surgical intervention done by the ENT specialist to remove this middle ear tumor. Sometimes referred as swimmer’s ear, this condition is often the result of water remaining in the ears after an individual has gone swimming. Impacted earwax must not be removed by cotton swabs (Q-tips) as they remove the natural ear lubricants and can push the earwax deeper in the ear canal. A bone anchored hearing aid can be used in cases where the hearing loss caused by the atresia is only a conductive one to ensure proper development of speech.
If the injury is sustained in the middle ear, the conductive hearing loss may be restored by an ENT specialist. In US data between 1988 and 2006, mild or worse unilateral hearing loss (25 db or worse), is reported in 1.8% of adolescents. If you are older, statistics say that while many of your older associates may have the same problem, it will probably get worse, so you should prepare yourself and do your best to slow down the rate that it gets worse.
At the other extreme are repeated bouts with infection, thick "glue-like" fluid and possible complications such as permanent hearing loss.
Until the eustachian tube changes in size and angle as the child grows, children are more susceptible to otitis media. During this time, the child may miss out on some of the information that can influence speech and language development. The probability is higher if both parents have the dominant gene (and typically both have a hearing loss) or if both grandparents on one side of the family have hearing loss due to genetic causes. Because both parents usually have normal hearing, and because no other family members have hearing loss, there is no prior expectation that the child may have a hearing loss. By recognizing the signs and acting early, you may benefit from the variety of new treatments and devices available today. Examples of ototoxic drugs include some over-the-counter drugs such as aspirin in high doses, some antibiotics, some chemotherapy drugs, loop diuretics and some anti-inflammatory drugs. This technology, which uses a computer algorithm to analyze speech and remove most background noise, could pave the way for the next generation of digital hearing aids. Kevin Steffy, a GATEDP coordinator, says users appreciate the independence they achieve through this equipment. Practically, this is a very uncommon situation, of much more interest to diagnosticians than patients.
Consanguinity was the most frequent factor in this study in sensorineural type of hearing loss. Prevention of prenatal and postnatal factors can decrease the frequency of sensorineural hearing loss.
However, it is estimated that prevalence of the disease is near about 10% of the population in our country.
The criteria of patient selection was hearing loss for 01 month duration or more, in one or both ears, to exclude the psychogenic and malingerer. Hypoxia, low birth weight and kernicterus can be prevented by good obstetric services while infection like mumps, measles, and meningitis can be prevented by immunization. Infection including intrauterine infection, neonatal and childhood infection is the commonest cause of SNHL.
High pitch sounds are most affected by this form of disability, individuals with presbyacusis will have noted difficulties hearing speech consonants, understanding speech in background noise and hearing high pitch sounds like a birds chirp. In cases where a noise-induced hearing loss is the result of excessive noise in the work environment, it will be referred as a professional hearing loss. This hereditary disability can be triggered at birth or develop later-on during the individual’s life. Treatment of this rare pathology requires a collaborative medical team approach that includes the expertise of a neurosurgeon and ENT specialist. Water finding its way to the middle ear can cause recurrent middle ear infections, thus the perforated eardrum cannot heal.
A stapedectomy is a surgical procedure done by the ENT specialist to replace the stapes by a piston. The Ossicular discontinuity that results will cause a conductive hearing loss often accompanied by tinnitus. One must use natural oil products or carbamide peroxide over the counter softening agents to facilitate earwax removal. In cases where it is a permanent sensorineural hearing loss, hearing aids can be used to adapt to the hearing difficulties.
There was greater risk in individuals with work exposure to loud noises, lower socioeconomic background and in ethnic minorities.
Other things that cause conductive hearing losses are fluid in the middle ear, and disorders of the small bones (ossicles) in the middle ear. Because at least one parent usually has a hearing loss, there is prior expectation that the child may have a hearing loss. These hearing aids could be a feature inside of a smartphone, which would do the computer processing and broadcast the enhanced signal to the earpieces wirelessly. In Quebec, individuals with a professional hearing loss can benefit from CSST support programs. Premature labour and lack of oxygen at birth are non-genetic factors that can cause a congenital hearing loss. It is thought that this disease is caused by excessive liquid in the inner ear and treatment plans often include the modification of dietary habits. A sudden hearing loss must be treated as an emergency and a physician must be consulted quickly. In cases where the infection persists or occurs frequently, an ENT specialist can perform a small procedure called a myringotomy. To avoid water in the ears, audiologists recommend the use of specialized hearing protection products when swimming or during bathing and showering.
The conductive hearing loss can be treated with hearing aids to amplify the incoming sound and balance out the shortcomings caused by the discontinuity. The outer ear canal becomes red and the individual might experience ear pain and high sensitivity at the infected ear. This can result from recreational noise (loud music, leaf blowers, motorcycles) or occupational noise (factory work, firefighters, military). These cilia can be damaged and die off, resulting in a hearing loss for the sounds those inner hair cells were responsible for converting. Noise-induced hearing loss can otherwise be triggered by sudden extremely loud sounds such as a gunshot.
Similarly, complications during pregnancy such as maternal viral infections, toxin consumption and maternal diabetes cause the disability.
The physician will investigate the reasons of the hearing loss and prescribe a cure when possible. A myringotomy is an incision in the eardrum to insert a ventilation tube through the eardrum to allow for the draining of the fluid in the middle ear. In most cases, a Perforated Eardrum will heal by itself while in some cases it requires medical intervention.
Otherwise, surgery can be performed by an ENT specialist to reconstruct the Ossicular chain. This infection can trigger draining of pus from the ear canal, which may also be the cause a conductive hearing loss. Individuals of all ages can be affected by this form of hearing loss, often accompanied by tinnitus. Systematic neonatal hearing screening programs are being developed nation-wide to identify hearing loss at a young age. Sudden hearing loss can be treated with steroids or antibiotics in certain cases caused by infections. The tube placed will allow for normal hearing acuity and should remain in place for 3 to 12 months.
An ENT specialist can perform a surgical procedure called a tympanoplasty to repair an eardrum perforation.
Similar to age-related hearing loss, the disability has greater impact on high pitch sounds. Early detection of congenital hearing loss will result in a prompt intervention treatment which increases the chances of normal speech and social development. For ototoxic drugs, it is recommended to immediately stop the use of the problematic medication. Middle ear infections are more frequent at a young age and can disturb proper speech development. Patients who complained of hearing impairment and did not have any positive clnical or audiological sign were excluded from the study. Unlike many other forms, noise-induced hearing loss can be prevented with proper hearing protection and by eliminating noise at the source. A visit to the audiologist and to an ENT specialist is equally important for proper treatment of a sudden hearing loss.
Bone conduction hearing aids can be used to overcome the limits caused by a middle ear infection. When using these hearing aids, sound waves find their way directly to the cochlea via the temporal bone. Consequently, the conductive hearing loss will have no effect on the person’s ability to hear sounds.



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Comments Common cause of conductive hearing loss in adults 20 40 50

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