II. Epidemiology
-
Prevalence of Hearing Loss (of some degree) in U.S.
- Adults: 15% (30 Million U.S. Adults)
- Age >70 years old: 50%
- Age >85 years old: 85%
- Gender
- Males affected by Hearing Loss at an earlier age than women
- Age predictive of cause
- Older patients
- See Hearing Loss in Older Adults
- Sensorineural Hearing Loss (SNHL) more common
- Younger patients (<40)
- Conductive Hearing Loss more common
- Older patients
III. Precautions
- This topic refers to the evaluation of Hearing Loss
- See Hearing Impaired Person for chronic Hearing Loss management and adaptation
- Hearing Loss is under-evaluated
- Only one third of those with reported Hearing Loss are screened
- Hearing Loss is under-treated
- Only 15% of those eligible for Hearing Aids use them
IV. History
- Is Hearing Loss acute or chronic?
- Sensorineural Hearing Loss is more often chronic
- Is Hearing Loss in one or both ears?
- Is Hearing Loss stable, progressive or episodic?
- Is Hearing Loss associated with:
- Have any Ototoxic Medications been used?
- Are there loud noise exposures in the work environment?
- Is there a Family History of early Hearing Loss?
- Have you had ear infections or ear injury?
- How loud is your speaking volume?
- Raised voice in Sensorineural Hearing Loss
- Is your Hearing better or worse in a noisy environment?
- Worse in Sensorineural Hearing Loss
- Better in Conductive Hearing Loss
- How is your understanding of words?
- Worse in Sensorineural Hearing Loss
- What chronic medical problems do you have?
- Diabetes Mellitus
- Cerebrovascular Accident
- Heart Disease
V. Signs
-
Otoscopy: Abnormal in Conductive Hearing Loss
- Tympanic Membrane compliance is abnormal
- Signs of infection or canal obstruction present
- Tympanometry
- Formal Audiogram (normal 20 db at all frequencies)
- Speech Recognition
- Speech Reception Threshold (SRT)
- Decibel level at which 50% of words understood
- Speech Recognition Score (SRS)
- Percentage words understood at 40 db over SRT
- Speech Reception Threshold (SRT)
-
Whispered Voice Testing
- Patient occludes opposite ear
- Examiner whispers questions or commands
- Patient answers or follows commands
- Avoid testing with finger snapping or ticking watch
- Not accurate for Hearing Testing
-
Weber Test (Tuning Fork at midline forehead)
- Sound radiates TO Conductive Hearing Loss ear
- Sound radiates AWAY from Sensorineural Hearing Loss
-
Rinne Test (Tuning Fork at mastoid)
- Abnormal in Conductive Hearing Loss
- Air conduction better than bone conduction
- Abnormal in Conductive Hearing Loss
-
Hum Test (can be performed by nurse phone triage)
- Conductive Hearing Loss will localize to the affected ear
- Sensorineural Hearing Loss will localize to the unaffected ear
- Red Flag If Sudden Sensorineural Hearing Loss (needs urgent evaluation)
VI. Differential Diagnosis
VII. Evaluation: Triage
- Sudden Sensorineural Hearing Loss (SSHNL) within last 72 hours needs immediate evaluation
- Simple test directed by triage nurse over the phone (regarding SSHNL): Hum Test
- Hum Test lateralizes to the good ear suggests Sensorineural Hearing Loss
- Requires immediate evaluation for Sudden Sensorineural Hearing Loss (SSHNL)
- Hum Test lateralizes to the bad ear suggests Conductive Hearing Loss
- Routine evaluation is appropriate
- Hum Test lateralizes to the good ear suggests Sensorineural Hearing Loss
VIII. Evaluation: Hearing Testing
IX. Management
- See Hearing Impaired Person
- Hearing Loss in Older Adults
- Requires immediate evaluation
- Rule-out Sensorineural Hearing Loss
- Formal Audiology Testing at various frequencies
- Bone Conduction Testing
- Air Conduction Testing
XI. Prevention
- Limit loud sound exposure from in-ear listening devices
-
Hearing Protection (ear plugs, ear muffs)
- Consistent use in loud environments (e.g. occupational, recreational)