Conductive hearing loss test results 2014,ear nose throat doctor edina mn used,ringing the left ear means - PDF 2016

Author: admin, 22.01.2014. Category: Tinnitus Causes And Cures

An in-vitro comparison of the disintegration of human ear wax by five cerumenolytics commonly used in general practice. Methotrexate in the management of immune mediated cochleovestibular disorders: clinical experience with 53 patients.
Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site. Evaluation of noise-induced hearing loss in young people using a web-based survey technique. MP3 players and hearing loss: adolescents' perceptions of loud music and hearing conservation.
Hearing health and care: the need for improved hearing loss prevention and hearing conservation practices.
Committee on Practice and Ambulatory Medicine and the Section on Otolaryngology and Bronchoesophagology.
Traumatic brain injury, posttraumatic stress disorder, and postconcussive symptom reporting among troops returning from Iraq. Screening for hearing loss in the elderly using distortion product otoacoustic emissions, pure tones, and a self-assessment tool. Depending on which part of the auditory chain is impaired, signs and symptoms differ greatly.
91% of all subjects reported a reduction in Tinnitusthis will be written under clinical evidence..
Download a copy of the Tinnitus Reaction Questionnaire (TRQ) and see what your score is now. The differential diagnosis of hearing loss can be simplified by considering the three major categories of loss. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Adolescents and young adults represent groups in which the prevalence of hearing loss is increasing and may therefore benefit from screening. The device comes with 4 different musical tracks fully personalized depending on individual’s hearing level and tinnitus. Conductive hearing loss occurs when sound conduction is impeded through the external ear, the middle ear, or both.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. CLEVELAND, AuD, Fort Richardson Troop Health Clinic, Joint Base Elmendorf-Richardson, AlaskaJENNY L.
If offered, screening can be performed periodically by asking the patient or family if there are perceived hearing problems, or by using clinical office tests such as whispered voice, finger rub, or audiometry. To minimize the number of false-positive results, sound levels in the test environment should not exceed American National Standards Institute (ANSI) requirements.21 A quiet booth that features sound-absorptive materials such as carpeting, acoustic foam, or tiles is considered standard practice. Bright Futures guidelines for health supervision of infants, children, and adolescents, middle childhood, 5 to 10 years. Sensorineural hearing loss occurs when there is a problem within the cochlea or the neural pathway to the auditory cortex.
Audiometry in the family medicine clinic setting is a relatively simple procedure that can be interpreted by a trained health care professional.
The ear is divided anatomically into three sections (external, middle, and inner), and pathology contributing to hearing loss may strike one or more sections. Mixed hearing loss is concomitant conductive and sensorineural loss.EvaluationA thorough history and a careful physical examination are essential to the diagnosis and treatment of hearing loss. Pure-tone testing presents tones across the speech spectrum (500 to 4,000 Hz) to determine if the patient's hearing levels fall within normal limits. The American Speech-Language-Hearing Association has a recommended procedure for pure-tone threshold search tests known as the modified Hughson-Westlake method.18 Testing begins with the ear in which the patient perceives to have better hearing.
Screening audiometers for office use, for example, generally test at frequencies in the speech range of 500 to 4,000 Hz.There are many purchase options to consider for earphones and transducers. Also searched were the Agency for Healthcare Research and Quality evidence reports, and the National Guideline Clearinghouse, and Cochrane Database of Systematic Reviews. A quiet testing environment, calibrated audiometric equipment, and appropriately trained personnel are required for in-office testing.
Leading causes of conductive hearing loss include cerumen impaction, otitis media, and otosclerosis. Pure-tone audiometry may help physicians appropriately refer patients to an audiologist or otolaryngologist. Family physicians should feel comfortable performing this testing on adults and cooperative children. After the patient responds to the pure-tone signal, the tester decreases intensity by 10 dB and presents the tone again. Department of Health and Human Services Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services.
Leading causes of sensorineural hearing loss include inherited disorders, noise exposure, and presbycusis. Unilateral or asymmetrical hearing loss can be symptomatic of a central nervous system lesion and requires additional evaluation. Supra-aural headphones sit directly on the pinna, and are the least effective headphone at attenuating background noise.
An understanding of the indications for medical management, surgical treatment, and amplification can help the family physician provide more effective care for these patients.
An otoscope should be used to examine the external auditory canal for cerumen, foreign bodies, and abnormalities of the canal skin.
This is the patient's initial ascending response.To check for accuracy, the tester should decrease the intensity of the tone by 10 dB one more time to check for no response, then increase the intensity of the signal in 5 dB increments until the patient responds again to the signal.
The mobility, color, and surface anatomy of the tympanic membrane should be determined (Figure 1).


If the patient responds consistently (minimum two out of three responses in ascending order), the tester records the dB level at which the patient responds as the air conduction threshold.
Courses leading to certification and recertification as an occupational hearing conservationist. The sound remains midline in patients with normal hearing.The Rinne test compares air conduction with bone conduction. Patients with constant, bothersome tinnitus (ringing or buzzing in the ears) often have difficulty discerning pure tones. When the patient no longer can hear the sound, the tuning fork is placed adjacent to the ear canal (air conduction). In the presence of normal hearing or sensorineural hearing loss, air conduction is better than bone conduction.
Supplemental, objective tests such as evoked otoacoustic emissions testing (stimulation of hair cells to produce sound) and patient questionnaires can assist with difficult-to-test populations.30Recent noise exposure before pure-tone testing may affect the validity of the test results.
Riding a loud motorcycle or listening to music through headphones may result in a temporary hearing threshold shift, and may not reflect the patient's true hearing thresholds. Patients should minimize or avoid exposure to loud noise for at least 14 hours before pure-tone testing.31PHYSICAL FINDINGSAudiometry results may be affected in patients with anatomic anomalies, such as narrow or collapsing ear canals (stenosis of the ear canal), complete canal occlusion, or absence of an ear canal (atresia). Audiograms objectively measure hearing levels and compare them with standards adopted by the American National Standards Institute in 1969.1 Normal hearing levels are 20 dB or better across all frequencies.
Impacted cerumen can cause a conductive hearing loss (Figure 1) that typically resolves following cerumen removal.
The audiogram measures air conduction and bone conduction and presents them graphically across the hearing frequencies. Audiographically demonstrated conductive hearing loss results in the air line falling below the bone line, creating an air-bone gap.Speech testing should be performed using standard word lists. Placing an over-the-ear headphone over already narrow or closed ear canals may add sufficient pressure to collapse the ear canals even further, resulting in a false high-frequency hearing loss. The speech reception threshold is the sound level at which 50 percent of presented words are understood. An otoscopic examination should be performed before the hearing test to ensure that the tympanic membrane is at least partially visible.Differentiating conductive hearing loss from sensorineural hearing loss requires bone conduction testing.
The speech recognition score is the percentage of words understood at 40 dB above the speech reception threshold.Conductive Hearing LossEXTERNAL EARComplete occlusion of the ear canal by cerumen is a frequent cause of conductive hearing loss.
With sensorineural hearing loss, there is no significant difference in threshold between air and bone conduction.Conventional pure-tone testing is used for adults and older children. Audiometry relies on techniques similar to the Weber and Rinne tests to compare air and bone conduction.
Bone conduction audiometry measures pure-tone thresholds using a mechanical device that transmits sounds via vibration through the forehead or mastoid bone. Warm water (body temperature) irrigation is a safe method of removing cerumen in patients who have no history of otitis media, perforation of the tympanic membrane, or otologic surgery. The distance to the tympanic membrane must be kept in mind, because otoscopes do not allow for depth perception. To prevent this crossover of sound from one ear to the other, narrow band noise is presented to the nontest ear and thresholds are recorded as masked.32 Right ear masked air conduction thresholds are manually recorded as a red triangle on the audiogram. Aqueous-based preparations, including docusate sodium, sodium bicarbonate, and hydrogen peroxide, are effective cerumenolytics.2,3Foreign bodies in the external auditory canal also can cause unilateral conductive hearing loss. Right ear masked bone conductions are manually recorded as a red square bracket (open on the right side). Left ear masked bone conduction thresholds are manually recorded as a blue square bracket (open on the left side).
If the object is not impacted or hygrostatic, warm water irrigation probably should be attempted first.
If this approach is not effective, the foreign body can be removed with an instrument if the patient is cooperative. If the patient is uncooperative, removal in an operating room may be necessary.Otitis externa is an infection of the skin of the external auditory canal. Patients with otitis externa experience pain on manipulation of the pinna or tragus, and their ear canal is edematous and filled with infectious debris. The most common pathogens in otitis externa are Pseudomonas aeruginosa and Staphylococcus aureus.4 Treatment involves debridement of the canal, followed by the application of ototopical drops. In patients with severe otitis externa, a wick is placed in the ear for two to three days to ensure delivery of the medication. The conductive hearing loss resolves after the inflammation subsides.Exostoses and osteomas are benign bony growths of the external auditory canal that interfere with normal cerumen migration, leading to occlusion and conductive hearing loss.
Osteomas are single and unilateral, and are found at the bony-cartilaginous junction (Figure 2). Sebaceous cysts, fibromas, papillomas, adenomas, sarcomas, carcinomas, and melanomas also have been reported.
If a malignancy is suspected, prompt biopsy is indicated.MIDDLE EARMiddle ear pathology may lead to conductive hearing loss. Perforations of the tympanic membrane cause hearing loss by reducing the surface area available for sound transmission to the ossicular chain (Figure 3). In patients who have had chronic otitis media with tympanic membrane perforation, otoscopic examination and debridement are essential. Ototopical antibiotics (ofloxacin [Floxin]) are necessary, and oral antibiotics may be helpful.
Small perforations (less than 2 mm) often heal spontaneously.5 In the acute setting, blood may obstruct the ear canal and prevent visualization of the membrane. If the perforation or hearing loss persists beyond two months, the patient should be referred for consideration of surgical correction. The diagnosis of otitis media can be confirmed by tympanometry and audiometry, and resolution of the effusion restores hearing.
Congenital cholesteatoma presents as a pearly white mass located behind an intact tympanic membrane in a patient with unilateral conductive hearing loss.


Acquired cholesteatoma results from a retracted or perforated tympanic membrane with an ingrowth of epithelium.
Conductive hearing loss caused by ossicular erosion is present in 90 percent of patients with cholesteatomas.8 Longstanding cholesteatomas expand to involve the mastoid, inner ear, and facial nerve.
Suspicion of cholesteatoma warrants surgical consultation.Myringosclerosis of the tympanic membrane develops in response to infection or inflammation (Figure 3). Irregular white patches consisting of calcium are visible on the membrane.9 Isolated myringosclerosis of the tympanic membrane rarely causes significant conductive hearing loss.
However, extensive myringosclerosis, referred to as tympanosclerosis, involves the tympanic membrane, ossicular chain, and middle ear mucosa, and causes significant conductive hearing loss by stiffening the entire system.Otosclerosis is characterized by abnormal bone deposition at the footplate (base of stapes). This bone deposition leads to fixation of the stapes at the oval window, preventing normal vibration. Otosclerosis typically presents as progressive bilateral conductive hearing loss in middle-aged white women.
It is the leading cause of conductive hearing loss in adults who do not have a middle ear effusion or a history of otitis media.10 There is usually a positive family history. These neuroendocrine tumors arise from the adventitia of the jugular bulb or the neural plexus within the middle ear space.
Characteristically, patients presenting with glomus tumors are women 40 to 50 years of age who report pulsatile tinnitus and hearing loss. On examination, a pulsating reddish-blue mass may be seen behind an intact tympanic membrane. However, diagnosis of these tumors is difficult, and computed tomography of the temporal bones is required.
Although most patients with this type of hearing loss are adults, children also can be affected. Hereditary and non-hereditary congenital hearing loss are the two major pediatric classifications.
The majority of hereditary losses are autosomal recessive and are frequently associated with other systemic findings. More than 100 congenital syndromes are associated with sensorineural hearing loss.The consequences of delayed detection can be significant. Neonates considered at high risk for congenital hearing loss (Table 3)11 traditionally have been screened, and 30 states now require universal newborn auditory screening.12 The American Academy of Pediatrics and several other organizations endorse universal auditory screening. Year 2000 position statement: principles and guidelines for early hearing detection and intervention programs.
The etiology is a combination of inherited and environmental factors, including lifetime noise exposure and tobacco use. High frequencies are affected first, typically at 4,000 Hz, followed by middle and lower frequencies. The use of foam-insert earplugs decreases noise exposure by 30 dB.A less common cause of hearing loss is ototoxin exposure, typically from diuretics, salicylates, aminoglycosides, and many chemotheraupetic agents. These medications must be administered carefully in patients who are elderly, have poor renal function, require a prolonged course of medication, or require simultaneous administration of multiple ototoxic agents.
Patients with ototoxin exposure may experience hearing loss or dizziness.Autoimmune hearing loss has been diagnosed with increasing frequency since the 1980s. Patients present with rapidly progressive bilateral sensorineural hearing loss and poor speech discrimination scores, and they also may have vertigo or disequilibrium. Hearing loss progresses over three to four months, and an associated autoimmune disorder may be present. Symptoms usually improve with the administration of oral prednisone, and response to this steroid is currently the best way to make the diagnosis. Low-dose methotrexate therapy is becoming an accepted alternative to long-term prednisone therapy.14UNILATERAL HEARING LOSSTemporal bone fractures can cause unilateral sensorineural and conductive hearing loss. When the fracture line involves the bony labyrinth (cochlea or vestibule), sensorineural hearing loss occurs. Temporal bone injuries are associated with facial nerve paralysis, cerebrospinal fluid leakage, and other intracranial injuries.
Early consultation is essential, and prompt surgical intervention may be required.Trauma may cause rupture of the round or oval window membranes, with perilymph leaking into the middle ear (fistula). Perilymph fistulas also may occur after straining, lifting, coughing, or sneezing, and are managed with three to six weeks of bed rest, followed by surgical repair if symptoms do not improve.15Meniere's disease is another cause of sensorineural hearing loss. Patients report unilateral fluctuating hearing loss with aural fullness, tinnitus, and episodic vertigo. Initially, the hearing loss is in the low frequencies, but higher frequencies are affected as the disease progresses.
The etiology of Meniere's disease remains unclear, but endolymphatic hydrops (increased fluid pressure within the inner ear) has been identified. The work-up consists of serial audiometry to document a fluctuating loss, vestibular testing to verify the diseased ear, and radiographic imaging to rule out an acoustic tumor. Hearing aids are often ineffective because patients suffer from poor speech discrimination, as well as diminished tolerance to amplified sound. A history of upper respiratory infection within a month of the hearing loss is often described in patients who have a viral etiology.
The work-up includes audiometry, followed by radiographic imaging to rule out an acoustic tumor. One study found that patients with minimal hearing loss, no vestibular symptoms, and early treatment have better outcomes.18Patients with acoustic neuromas present with unilateral sensorineural hearing loss approximately 10 to 22 percent of the time19 (Figure 6). Patients with asymmetric sensorineural hearing loss require evaluation for a retrocochlear tumor.



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