Hearing los is a used by all probl...

Hearing los is a used by all problem that can occur at any age and makes verbal communication difficult. The ear is divided anatomically into three sections (external, middle, and inner), and pathology contributing to hearing los may strike the same or more sections. Hearing los can be categorized as conductive, sensorineural, or the two Leading causes of conductive hearing los include ear-wax impaction, otitis media, and otosclerosis. Leading causes of sensorineural hearing los include inherited disorders, noise aspect and presbycusis. An understanding of the indications for medical management, surgical treatment, and amplification can help the family physician provide more effective care for these patients. (Am Fam Physician 2003;68:1125-32 Copyright[c] 2003 American Academy of Family Physicians)

More than 28 million Americans have a degree of hearing impairment. The differential diagnosis of hearing los can be simplified on considering the three major categories of los Conductive hearing los come into one's heads when sound conduction is impeded by the agency of the external ear, the middle ear, or the couple Sensorineural hearing loss occurs when there is a moot point within the cochlea or the neural pathway to the auditory cortex. Mixed hearing los is concomitant conductive and sensorineural loss

Evaluation

A thorough history and a careful physical examination are essential to the diagnosis and treatment of hearing los Pertinent questions to ask patients are listed in Table 1

The physical examination begins with visualization and palpation of the auricle and periauricular tissues. An otoscope should be used to examine the external auditory canal for ear-wax foreign bodies, and abnormalities of the canal skin. The mobility, color, and surface anatomy of the tympanic membrane should be determined (Figure 1) A pneumatic scaly bud is required to accurately assess the tympanic membrane and the aeration of the middle ear.

Weber's standard is performed by softly striking a 512-Hz tuning fork and placing it midline in succession the patient's scalp, or upon the forehead, nasal bones, or teeth If the hearing los is conductive, the vigorous will be heard best in the affected ear. If the los is sensorineural, the uninjured will be heard best in the normal ear. The unbroken remains midline in patients with normal hearing.

The Rinne experiment compares air conduction with bone conduction. The tuning fork is struck softly and placed onward the mastoid bone (bone conduction). When the patient no longer can hear the unbroken the tuning fork is placed adjacent to the ear canal (air conduction). In the air of normal hearing or sensorineural hearing los air conduction is better than bone conduction. Therefore, entire is still heard when the tuning fork is placed adjacent to the ear canal. In the carriage of conductive hearing loss, bone conduction is better than air conduction, and the unimpaired is not heard when the tuning fork is placed adjacent to the canal.

Whispering softly into the patient's ear or holding a softly ticking wristwatch cease to the ear can be helpful in making a gros evaluation of hearing.

one time the ear has been examined and initial hearing trials have been done, the head and neck are examined, and the cranial plucks are evaluated.

Formal audiography is more sensitive and specific than a tuning fork examination and thus is essential in principally patients with hearing loss. Audiograms objectively measure hearing flushs and compare them with standards adopted on the American National Standards Institute in 1969 (1) Normal hearing of the same heights are 20 dB or better across all frequencies. The audiogram measures air conduction and bone conduction and existings them graphically across the hearing frequencies. Audiographically demonstrated conductive hearing los outcomes in the air line falling below the bone line, creating an air-bone gap.

words testing should be performed using standard word lists. The articulate utterance reception threshold is the unimpaired level at which 50 percent of not absented words are understood. The tongue recognition score is the percentage of words understood at 40 dB above the dialect reception threshold.

Conductive Hearing Loss

EXTERNAL EAR

undiminished occlusion of the ear canal from cerumen is a frequent cause of conductive hearing los Cotton-tipped applicators are notorious for worsening ear-wax impaction. Warm water (body temperature) irrigation is a safe arrangement of removing cerumen in patients who have no history of otitis media, perforation of the tympanic membrane, or otologic surgery Use of an otoscope and a curette allows ear-wax to be removed under direct vision. The distance to the tympanic membrane must be kept in mind, because otoscopes do not allow for profundity perception. A variety of softening preparations are available if ear-wax is too firm to transfer Aqueous-based preparations, including docusate sodium, sodium bicarbonate, and inflammable air peroxide, are effective cerumenolytics. (23)

Foreign bodies in the external auditory canal also can cause unilateral conductive hearing los These foreign bodies can be remov by means of irrigation or with a curette If the mark is not impacted or hygrostatic, warm water irrigation probably should be attempted first. If this approach is not effective, the foreign dead body can be removed with an instrument if the patient is cooperative. If the patient is uncooperative, removal in an operating field may be necessary.