Hearing loss
| Approach to acute hearing loss | |
|---|---|
| History | RED FLAGS: sudden unilateral hearing loss ➥ Sensorineural or conductive? ➥ Associated s/s: ear pain, otorrhea, tinnitus, vertigo, focal neurology ➥ Underlying disease e.g. Mumps, meningitis, immunocompromise ➥ DHx: ototoxic drugs - gentamicin, NSAIDs, aspirin, quinine... |
| Examination | ➥ Otoscopy; signs of Head injury ➥ Inattention, cognitive difficulty ➥ "Tuning fork tests should not be interpreted in isolation" lol |
| Diagnostic investigations | audiology, MRI internal auditory meatus for sensorineural hearing loss; autoimmune screen for sudden sensorineural |
| Differentials | Exclude central cause, acoustic neuroma (cerebellopontine lesion) ➥ Otitis externa ➥ children: glue ear, aka Otitis media ➥ Meniere’s ➥ Eustachian tube dysfunction ➥ tympanic membrane perforation ➥ Basal skull # |
| Immediate management | See differentials. CKS suggests urgent ENT referral for: - Sudden-onset (developing within 72 hours) unilateral or bilateral hearing loss, which has occurred within the past 30 days and cannot be explained by external or middle ear causes. - Hearing loss associated with head/neck injury 2ww if: - hearing loss/middle ear effusion not associated with URTI, and Chinese or SEA family origin Routine ENT if: - Fluctuating and not associated with a URTI. - Associated with hyperacusis (reduced tolerance to sound causing significant distress). - Associated with persistent tinnitus which is unilateral, pulsatile, has significantly changed over the past 6 months, or is causing significant distress. |