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MIXED HEARING LOSS Whenever the hearing loss of a patient includes a mixture of both conductive and sensorineural characteristics, is said to have a mixed hearing loss.
Superior ventral cochlear nucleus (SVCN) Erythroblastosis typically causes hearing loss that centers around 3000–4000 Hz.
Central Auditory Processing Disorders (CAPD) CAPD characterized by decreased understanding of speech in the presence of background noise. FUNCTIONAL HEARING LOSS Functional or psychogenic hearing loss is the customary diagnosis when there is no organic basis for the patients apparent deafness.
Functional Overlay It is entirely possible for hearing loss of functional origin to be superimposed on true organic hearing impairment. History: A 34-year-old woman with otosclerosis and hearing loss for over 10 years Refuse to use hearing aids She often says, What? Audiometric Patterns in Functional Hearing Loss There is no characteristic audiometric pattern in functional hearing loss, but the consistent inconsistencies serve to alert the physician. Malingering Malingering is the deliberate fabrication of symptoms that the patient knows do not exist. Infection can affect the ear canal (otitis externa), the eardrum, or the middle ear (otitis media). No, in fact the nursing facility will save time and money by not needing to transport residents. Our audiologists will provide complete diagnostic hearing evaluations to your residents when prescribed by either our ear exam physician or the resident's attending physician. Our audiometric testing services include medical history, otoscopy, hearing testing and impedance audiometry. Our award-winning blog brings you insights on health, nutrition and wellness from experts you can trust. Dizziness is defined as feelings of unsteadiness, wooziness, and lightheadedness; and sensations of moving, spinning, floating, swaying, tilting, or whirling (sensations known as vertigo).
More than 4 out of 10 people experience an episode of dizziness significant enough to send them to a doctor. For the body to feel balanced, the brain requires input from the inner ear, eyes, muscles and joints. Meniere’s syndrome -- This syndrome is associated with the fluid balance-regulating system in the ear. Benign paroxysmal positional vertigo -- Benign paroxysmal positional vertigo (BPPV) results from damage to the delicate sensory units of the balance portion of the inner ear.
Vestibular neuritis (labyrinthitis) -- This condition is caused by the inflammation of the nerve cells in the inner ear that control balance. Acoustic neuroma -- This is a benign tumor that most commonly grows on the nerve in the inner ear that controls balance. Remove home hazards such as floor throw rugs, loose electrical cords, stools or other small pieces of furniture that can trip people, and all other floor clutter. If you have dizziness or vertigo, avoid activities such as driving until your doctor gives you approval.
If you are feeling dizzy, it is important to see your primary care doctor for a thorough exam. This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Hearing deficiency may have started originally as a conductive failure (otosclerosis) and later developed a superimposed sensorineural component.
In clinical practice, most cases with an original sensorineural etiology remain in that classification without an added conductive element. In chronic otitis media some toxic inflammatory metabolite produces a cochleitis or labyrinthitis. This example a warning to physicians to avoid assuring any patient that his hearing loss can be corrected merely by removing cerumen, because mixed hearing loss may be found subsequently. In every case of mixed hearing loss one should determine how much of the deficit is conductive and how much is sensorineural.
If the patient does not understand any better with a hearing aid or when the voice is raised, hearing is not improved even if the conductive portion of the mixed hearing loss is corrected.


17 The auditory pathway consists of a series of transducers that repeatedly change the speech stimulus so that it can be handled effectively by the cortex.
Characteristic Features of central hearing loss : Hearing tests do not indicate peripheral hearing impairment. This may be caused by injury to SVCN spheroid cells, the second-order neurons of the ascending auditory pathway, even in the presence of normal hair cells in the organ of Corti.
Common complaints include inability to study or read in the presence of noise, slowing of reading speed caused by noise(vacuum cleaners or air conditioners ) and suspicion by family members that the patient has a hearing loss. The inability to hear results entirely or mainly from psychological or emotional factors, and the peripheral hearing mechanism may be essentially normal. Psychogenically induced hearing loss usually is a uniform flat- tone loss in all frequencies, suggestive of a well-marked conductive impairment. Usually, the hearing impairment is bilateral, and the bone conduction level is the same as the air conduction level. Most ear injuries are caused by pressure changes during direct injury (such as a blow to the ear) or sport scuba diving, but, a persistently painful ear may signal an infection that requires treatment.
A painful ear with decreased hearing is often the result of otitis media, an middle ear infection. If infection develops, continue antibiotics for at least five days after all signs of infection have cleared. The facility will also protect itself from potential liability of accidents occuring during the transit of residents. Following the testing, appropriate recommendations are made and follow-up services are provided. Among the geriatric population this proportion escalates to more than 25% more than four out of every ten senior citizens have a communicatively disrupting hearing loss. Since mechanisms for maintaining balance are so complex, finding the exact cause of dizziness is often difficult and requires input from several medical specialties. Symptoms of BPPV include a spinning sensation, dizziness, a sense of imbalance, and lightheadedness brought on by changes in head and body position, such as tipping the head backward.
These individualized balance-retraining exercise programs teach ways to decrease dizziness, improve balance, and improve overall ability to perform activities of daily living. The difficulty may have been sensorineural in the beginning ( presbycusis ), and a conductive defect (middle-ear infection ) may have developed subsequently.
In contrast, most cases that start as conductive hearing impairment later develop some sensorineural involvement.
The sensorineural deficit may be caused by penetration of the oval window with exposure of the perilymph. Prognosis: In mixed hearing loss the prognosis depends on the relative proportion of conductive and sensorineural pathology. There is no characteristic audiometric pattern, except that the disparity between the hearing level and the speech interpretation is quite marked.
Central pathology must be included in the differential diagnosis of the hearing loss producing a 4000-cycle dip on the audiogram. If people talk to a person with CAPD while he or she is involved in auditory concentration such as listening to a television program, the person will often not hear. The basis for functional hearing loss in most patients is psychogenic, the product of emotional conflict, ( neurotic anxiety ). Hysterical blindness and paralysis are other examples of the same type of somatization or conversion reaction.
In a patient with unilateral functional deafness there may be complete absence of bone conduction on the side of the bad ear, though the good ear has normal acuity.
If the patient claims he has one good and one bad ear, and the examiner obstructs his good ear with a finger, then shouts into it loudly enough to be heard easily by bone conduction alone, the malingerer claims he hears nothing. Because an ear scope (otoscope) may not be available to examine the canal and inner ear in remote locations, starting therapy may be appropriate until a doctor can be reached. It is not uncommon for the hard of hearing residents to be labeled as a difficult person when in fact the problem may be due to a significant hearing loss. Symptoms include episodic attacks of tinnitus (ringing in the ear), ear fullness, muffled or distorted hearing, hearing loss, and severe attacks of vertigo together with nausea and vomiting.


In some cases the conductive and the sensorineural elements may have started simultaneously ( severe head injury affecting both the inner ear and the middle ear ). Despite meticulous surgical care, the inner ear also can be traumatized readily and made more susceptible to infection.
The best way to approximate the conductive and the sensorineural components of a hearing loss is to perform all possible tests for estimating the patients sensorineural potential or cochlear reserve. If the sensorineural component is slight, the surgical prognosis is good, and under favorable circumstances the hearing may approximate the level of the bone conduction. In certain cases, central hearing loss may mimic peripheral causes of deafness, including occupational deafness. However, if one gets the persons attention by calling his or her name before speaking, the first sentence will not be missed, and hearing is normal. Tinnitus is a characteristic feature of hysterical deafness, and patients often claim that the noise is unbearable. Too spectacular an improvement with a hearing aid, especially when the patient has set the controls at minimal amplification, or a sudden disproportionate improvement in hearing after a simple procedure such as drum massage or insufflating the eustachian tube.
Such a patient even may deny hearing shouts directed at the bad ear in spite of the good hearing in the opposite ear. However, it may be the result from problems associated with the inner ear, brain, or heart. In surgical trauma to the inner ear, high-frequency hearing loss often falls below the preoperative level, and the patient may complain of reduced discrimination though his pure-tone threshold is improved.
However, the discrimination is not improved much, even after correction of the conductive defect. The chief function of the auditory cortex is to interpret and to integrate these impulses and to provide the listener with the exact meaningful information intended by the speaker, or to permit the listener to react appropriately to the actual implication of the sound.
The spheroid cells of the superior ventral cochlear nucleus (SVCN) show an anatomical frequency gradient, low ventral to high dorsal. Treatment : altering the listening environment to obtain the best possible signal-to-noise ratio. Hearing acuity usually varies, depending on the patients emotional state at the time of testing.
In complete deafness the presence of cochlear nerve reflexes with loud noises indicates either malingering or hysteria. We will service instruments and perform maintenance checks of the resident’s hearing devices when we are at the facility and will handle repairs sent to our office. Treatment methods include changes in diet (eg, following a low-salt diet and limiting the use of alcohol and caffeine), changes in medications, and quitting smoking.
A series of simple, in-office head and body repositioning maneuvers can result in a full recovery. Significant recovery is achieved after six to eight weeks of a balance rehabilitation program.
If the patient hears and discriminates well when speech is made louder, then the conductive element probably is a major cause of the hearing difficulty, and there is a good chance that surgery will improve the hearing.
A similar adverse effect is noted in the ear opposite the tumor when certain words are interrupted periodically or accelerated. Also as a convenience to the facility, hearing aid batteries are available which can be mailed when requested through our Battery Club Program. An injection of a steroid or of gentamicin (an antibiotic) directly into the ear is another treatment method. Labyrinthitis Otosclerosis was at one time thought to retain its purely conductive character for years; today it is recognized that this condition develops sensorineural impairment in same cases.



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