Hearing Loss: Dr. Timothy Gacani
Hearing Loss: Dr. Timothy Gacani
Hearing Loss: Dr. Timothy Gacani
• 'Deaf' -> profound hearing loss: very little or no hearing. often use sign language
for communication.
• extremely common medical condition.
• The affected population vast, between neonates to elderly.
• multi-disciplinary team: surgeon, speech therapists, and social
workers.
Etiology
• Normal hearing function: sound waves • Conductive hearing loss: disruption of
arriving at auricle, causing vibration of transmission of sound waves to cochlea.
tympanic membrane.
• main difference between the two kinds of hearing loss apart from
pathophysiological features is with conductive hearing loss perceive
sounds diminished, while SNHL patients perceive sounds diminished
and distorted.
• Hearing loss with problematic transmission before and after cochlea is mixed.
• In children population, genetic causes most common, accounting for > 50% of
hearing loss cases.
Genetic causes involve various syndromes that have hearing loss as one of their features.
Congenital causes
• HL present at or acquired soon after birth.
• use of certain medicines, such as those used in treatment of neonatal infections, malaria,
drug-resistant tuberculosis, and cancers;
• recreational exposure to loud sounds e.g. personal audio devices at high volumes and for
prolonged periods of time and regular attendance at concerts, nightclubs, bars and sporting
events;
• Disabling HL -> HL greater than 40 decibels (dB) in the better hearing ear in adults and a HL
greater than 30 dB in the better hearing ear in children.
• Approximately one third of people over 65 years of age affected by disabling hearing loss.
Prevalence in this age group greatest in South Asia, Asia Pacific and sub-Saharan Africa.
Pathophysiology
• HL occurs when sound stimuli transmission from outer part of ear to
the brain suffers disruption.
• questions regarding prenatal history of child, their delivery, and first days of
life as well as post-natal history up until moment of symptom presentation.
• Past medical history, as well as family history, along with work and
noise exposure.
• P/E: full otolaryngology examination, with otoscopy bilaterally to rule out any reasons for
conductive HL.
• IDn of dysmorphic and other physical findings essential, especially in young children and
infants.
facial abnormalities or asymmetry, ear, neck and skin anomalies, other organ dysfunction, or even
balance irregularities.
• Weber and Rinne (TFTs) useful to differentiate between SNHL and conductive hearing loss.
Evaluation
• Ideally, all infants should undergo a hearing evaluation to rule out any hearing
impairment by age of one month.
• Hearing loss evaluation should take place with various tests that differ according to the
age of the child.
• BAER (brainstem audio-evoked response) for early diagnosis of HL in newborns and
infants.
• Otoacoustic emissions also in newborns, easy, inexpensive technique, but less reliable
than BAER tests.
• audiometry with older children, aged 4 to 5 and older, who can respond to sound stimuli
according to instructions as well as Tympanograms.
Treatment / Management
Management of conductive HL focuses on treatment of underlying disease.
• Conservative methods e.g. removal of FB, micro-suction of cerumen or discharge
in EAC are necessary if ear canal is blocked.
• With OME, myringotomy to release middle ear fluid will allow sound wave to reach
cochlea, while ventilation/myringostomy tubes if OME is persistent, causing HL.
• Others (8%)
Some simple strategies for prevention of hearing loss include:
• immunizing children against childhood diseases, including measles, meningitis, rubella and
mumps;
• immunizing adolescent girls and women of reproductive age against rubella before
pregnancy;
• strengthening maternal and child health programmes, including promotion of safe childbirth;
• screening of children for otitis media, followed by appropriate medical or surgical interventions;
• avoiding the use of particular drugs which may be harmful to hearing, unless prescribed and
monitored by a qualified physician;
• referring infants at high risk, such as those with a family history of deafness or those born with
low birth weight, birth asphyxia, jaundice or meningitis, for early assessment of hearing, to
ensure prompt diagnosis and appropriate management, as required;
• educating young people and population in general on hearing loss, its causes, prevention and
identification.