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Hearing Loss

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Causes	Clinical Features	Investigations	Management
Conductive Hearing Loss	Otitis Media: Ear pain, discharge, reduced hearing. Otitis Externa: Ear canal pain, redness, swelling. Earwax Impaction: Feeling of fullness, difficulty hearing. Otosclerosis: Gradual hearing loss, more pronounced in low frequencies. Tympanic Membrane Perforation: History of trauma or infection, sudden hearing loss.	Otoscopy: Examination of the ear canal and tympanic membrane. Tuning Fork Tests: Rinne and Weber tests to differentiate between conductive and sensorineural hearing loss. Audiometry: Pure tone audiometry to quantify hearing loss. Imaging: CT or MRI if structural abnormalities are suspected.	Medical Treatment: Antibiotics for infections, removal of earwax, and treatment of otitis media/externa. Surgical Intervention: Tympanoplasty for perforated eardrum, stapedectomy for otosclerosis. Hearing Aids: For cases of chronic or irreversible conductive hearing loss.
Sensorineural Hearing Loss	Presbycusis: Gradual hearing loss in both ears, difficulty hearing high-pitched sounds. Noise-Induced Hearing Loss: History of exposure to loud noises, tinnitus, hearing loss. Meniere's Disease: Episodic vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness in the ear. Acoustic Neuroma: Unilateral hearing loss, tinnitus, imbalance, possibly facial numbness. Ototoxic Medications: History of using medications such as aminoglycosides, loop diuretics, or chemotherapy agents, with bilateral hearing loss.	Audiometry: Pure tone and speech audiometry to assess the degree and type of hearing loss. Otoacoustic Emissions (OAE): To assess cochlear (outer hair cell) function. Auditory Brainstem Response (ABR): To assess neural pathways from the ear to the brainstem, especially for acoustic neuroma. MRI: To detect acoustic neuroma or other central causes of hearing loss. Vestibular Testing: For patients with suspected Meniere's disease or balance issues.	Hearing Aids: For most cases of sensorineural hearing loss, especially presbycusis. Cochlear Implants: For severe or profound sensorineural hearing loss that does not benefit from hearing aids. Treatment of Meniere's Disease: Low-sodium diet, diuretics, and intratympanic steroid injections. Surgical options include endolymphatic sac decompression or vestibular nerve section. Management of Acoustic Neuroma: Observation, stereotactic radiosurgery, or microsurgical removal depending on size and symptoms. Avoidance of Ototoxic Drugs: Discontinuation or substitution of the offending medication if possible.
Mixed Hearing Loss	A combination of conductive and sensorineural hearing loss symptoms, depending on the underlying conditions contributing to both types of loss. Examples include chronic otitis media with sensorineural loss or a combination of otosclerosis and presbycusis.	Comprehensive Audiometry: To assess both conductive and sensorineural components. Imaging: CT or MRI if structural abnormalities are suspected, especially if surgical intervention is considered. Tympanometry: To assess middle ear function.	Medical and Surgical Treatment: Combination of treatments depending on the conductive and sensorineural components. For example, surgery for conductive issues like otosclerosis combined with hearing aids for sensorineural loss. Hearing Aids: May be beneficial for mixed hearing loss, particularly in mild to moderate cases. Cochlear Implants: In cases where severe sensorineural loss predominates and traditional hearing aids are ineffective.
Central Hearing Loss	Difficulty understanding speech, especially in noisy environments, despite normal or near-normal hearing on audiometric tests. May be associated with neurological symptoms such as cognitive decline, stroke, or multiple sclerosis.	Auditory Processing Tests: To evaluate central auditory processing abilities. MRI: To assess for central nervous system lesions, such as stroke, tumours, or demyelination. Neuropsychological Testing: To evaluate cognitive function, especially if cognitive decline is suspected.	Rehabilitation: Auditory training and speech therapy to improve auditory processing skills. Management of Underlying Neurological Condition: Treating the primary condition such as stroke, multiple sclerosis, or dementia. Assistive Listening Devices: Such as FM systems to improve hearing in noisy environments.

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