II. Epidemiology

  1. Prevalence of Hearing Loss (of some degree) in U.S.
    1. Adults: 15% (30 Million U.S. Adults)
    2. Age >70 years old: 50%
    3. Age >85 years old: 85%
  2. Gender
    1. Males affected by Hearing Loss at an earlier age than women
  3. Age predictive of cause
    1. Older patients
      1. See Hearing Loss in Older Adults
      2. Sensorineural Hearing Loss (SNHL) more common
    2. Younger patients (<40)
      1. Conductive Hearing Loss more common

III. Precautions

  1. This topic refers to the evaluation of Hearing Loss
    1. See Hearing Impaired Person for chronic Hearing Loss management and adaptation
  2. Hearing Loss is under-evaluated
    1. Only one third of those with reported Hearing Loss are screened
  3. Hearing Loss is under-treated
    1. Only 15% of those eligible for Hearing Aids use them

IV. History

  1. Is Hearing Loss acute or chronic?
    1. Sensorineural Hearing Loss is more often chronic
  2. Is Hearing Loss in one or both ears?
  3. Is Hearing Loss stable, progressive or episodic?
  4. Is Hearing Loss associated with:
    1. Otalgia or ear fullness Sensation
    2. Otorrhea
    3. Vertigo
    4. Tinnitus (continuous or pulsatile)
  5. Have any Ototoxic Medications been used?
  6. Are there loud noise exposures in the work environment?
  7. Is there a Family History of early Hearing Loss?
  8. Have you had ear infections or ear injury?
  9. How loud is your speaking volume?
    1. Raised voice in Sensorineural Hearing Loss
  10. Is your Hearing better or worse in a noisy environment?
    1. Worse in Sensorineural Hearing Loss
    2. Better in Conductive Hearing Loss
  11. How is your understanding of words?
    1. Worse in Sensorineural Hearing Loss
  12. What chronic medical problems do you have?
    1. Diabetes Mellitus
    2. Cerebrovascular Accident
    3. Heart Disease

V. Signs

  1. Otoscopy: Abnormal in Conductive Hearing Loss
    1. Tympanic Membrane compliance is abnormal
    2. Signs of infection or canal obstruction present
  2. Tympanometry
  3. Formal Audiogram (normal 20 db at all frequencies)
  4. Speech Recognition
    1. Speech Reception Threshold (SRT)
      1. Decibel level at which 50% of words understood
    2. Speech Recognition Score (SRS)
      1. Percentage words understood at 40 db over SRT
  5. Whispered Voice Testing
    1. Patient occludes opposite ear
    2. Examiner whispers questions or commands
    3. Patient answers or follows commands
    4. Avoid testing with finger snapping or ticking watch
      1. Not accurate for Hearing Testing
  6. Weber Test (Tuning Fork at midline forehead)
    1. Sound radiates TO Conductive Hearing Loss ear
    2. Sound radiates AWAY from Sensorineural Hearing Loss
  7. Rinne Test (Tuning Fork at mastoid)
    1. Abnormal in Conductive Hearing Loss
      1. Air conduction better than bone conduction
  8. Hum Test (can be performed by nurse phone triage)
    1. Conductive Hearing Loss will localize to the affected ear
    2. Sensorineural Hearing Loss will localize to the unaffected ear
      1. Red Flag If Sudden Sensorineural Hearing Loss (needs urgent evaluation)

VI. Differential Diagnosis

VII. Evaluation: Triage

  1. Sudden Sensorineural Hearing Loss (SSHNL) within last 72 hours needs immediate evaluation
  2. Simple test directed by triage nurse over the phone (regarding SSHNL): Hum Test
    1. Hum Test lateralizes to the good ear suggests Sensorineural Hearing Loss
      1. Requires immediate evaluation for Sudden Sensorineural Hearing Loss (SSHNL)
    2. Hum Test lateralizes to the bad ear suggests Conductive Hearing Loss
      1. Routine evaluation is appropriate

VIII. Evaluation: Hearing Testing

IX. Management

  1. See Hearing Impaired Person
  2. Hearing Loss in Older Adults
  3. Requires immediate evaluation
    1. Rule-out Sensorineural Hearing Loss
  4. Formal Audiology Testing at various frequencies
    1. Bone Conduction Testing
    2. Air Conduction Testing

X. Prognosis: Poor prognostic indicators

XI. Prevention

  1. Limit loud sound exposure from in-ear listening devices
  2. Hearing Protection (ear plugs, ear muffs)
    1. Consistent use in loud environments (e.g. occupational, recreational)

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