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. Hearing Loss is under-evaluated
    1. Only one third of those with reported Hearing Loss are screened
  2. 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

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. Requires immediate evaluation
    1. Rule-out Sensorineural Hearing Loss
  2. Formal Audiology Testing at various frequencies
    1. Bone Conduction Testing
    2. Air Conduction Testing

X. Prognosis: Poor prognostic indicators

XI. Pearls: Hearing impaired patients at clinic visits

  1. Use the stethoscope as an amplifier
  2. Place the ear tips in the patients ears
  3. Speak into the diaphragm of the stethoscope
  4. References
    1. From email communication with D. Nagase, MD

XIII. Complications

  1. Decreased social engagement
  2. Adverse effects on partner relationship
  3. Decreased quality of life
  4. Major Depression
  5. Decreased functional status (e.g. Activities of Daily Living)
  6. Delirium
  7. Exacerbates Dementia
  8. Increased Fall Risk
  9. Increased Mortality

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Related Studies

Ontology: Deafness (C0011053)

Definition (MSHCZE) Těžká porucha až ztráta sluchu znemožňující příjem zvukových informací. Postihuje jedno nebo obě uši. Převodní porucha sluchu – porucha převodu zvuku ze zevního ucha na ucho vnitřní, obv. ve středním uchu. Pacient slyší lépe vysoké tóny než nízké. Percepční porucha sluchu – porucha vlastního vnímání zvuku ve vnitřním uchu, sluchovém nervu nebo v příslušných oblastech mozku (poslední se někdy označuje jako centrální). Pacient slyší hůře vysoké tóny, resp. šepot ve srovnání s hlasitou řečí. Příč. vrozená onemocnění, vlivy některých toxických látek a léků (srov. ototoxický), akustické trauma (barotrauma), záněty ucha či CNS, náhlé cévní příhody v oblasti vnitřního ucha, těžké formy otosklerózy aj. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) An inherited or acquired condition characterized by a partial or complete loss of hearing in one or both ears. The level of impairment varies from a mild but important loss of sensitivity to a total loss of hearing.
Definition (CSP) lack or significant deficiency of the sense of hearing.
Definition (MSH) A general term for the complete loss of the ability to hear from both ears.
Concepts Finding (T033)
MSH D003638
ICD10 H91.9
SnomedCT 15188001, 267678002, 194432002, 155259007, 162341001, 194411005, 139613003
English Deafness, Deafness NOS, Surdity, Deafness (NOS), Unspecified deafness, No hearing, Deafness [Disease/Finding], loss hearing, ear deafness, hear loss, hearing losses, hearing loss, deafness degree, deafness (diagnosis), deafness, Deafness NOS (disorder), DEAFNESS, Deafness, NOS, Deafness NOS (finding)
French SURDITE, Surdité SAI, Pas d'audition, Surdité non précisée, Surdité totale, Surdité, Déficience auditive totale, Perte auditive totale, Perte d'audition totale, Surdité bilatérale totale
Portuguese SURDEZ, Surdez NE, Audição nula, Surdez
Spanish SORDERA, sordera total (trastorno), Sordera (NEOM), No oye, Sordera NEOM, Sordera no especificada, sordera, SAI (hallazgo), Anacusia, sordera, SAI (trastorno), sordera, SAI, Deafness NOS, Sordera
German TAUBHEIT, kein Gehoer, unspezifische Taubheit, Taubheit (NNB), Taubheit NNB, Gehörlosigkeit, Gehörverlust, vollständiger, Surditas, Taubheit
Dutch doofheid NAO, doofheid (NAO), geen gehoor, niet-gespecificeerde doofheid, surditas, doofheid, Doofheid, Slechthorendheid
Italian Sordità NAS, Sordità non specificata, Sordità (NAS), Udito assente, Perdita dell'udito, Sordità bilaterale, Perdita completa dell'udito, Sordità
Japanese 難聴, 詳細不明の難聴, ろう, 難聴(NOS), 難聴NOS, ナンチョウNOS, ショウサイフメイノナンチョウ, ナンチョウ, ロウ, 聾唖, ろうあ, 聴覚消失症, 聴覚消失,
Swedish Dövhet
Czech hluchota, Nedoslýchavost NOS, Hluchota, Hluchota NOS, Blíže neurčená hluchota, Neslyšící, anacusis, anakuze, bilaterální hluchota, celková ztráta sluchu, surditas
Finnish Kuurous
Croatian GLUHOĆA
Polish Głuchoniemota, Głuchota
Hungarian süketség, süketség (k.m.n.), süketség k.m.n., Süketség, Nem hallás, Nem meghatározott süketség
Norwegian Døvhet, begge ører, Totalt hørselstap, Døvhet, Bilateral døvhet

Ontology: hearing impairment (C1384666)

Definition (MSHCZE) Výraz pro celkovou či částečnou ztrátu schopnosti slyšet jedním nebo oběma ušima.
Definition (NCI) Partial or complete loss of the ability to detect or understand sounds resulting from damage to the outer, middle, or inner ear structures. Causes include exposure to loud noise, ear infections, injuries to the ear, genetic, and congenital disorders.
Definition (NCI) A partial or complete loss of hearing in one or both ears. It is classified as conductive, sensory, or central.
Definition (NCI_CTCAE) A disorder characterized by partial or complete loss of the ability to detect or understand sounds resulting from damage to ear structures.
Definition (MSH) A general term for the complete or partial loss of the ability to hear from one or both ears.
Concepts Finding (T033)
MSH D034381
ICD9 389.9, 389
ICD10 H91.9
SnomedCT 155254002, 267764005, 155242002, 194411005, 15188001, 103276001, 111543003
LNC LP56780-7, MTHU021608, LA17308-0, LA16989-8
English Unspecified hearing loss, HEARING IMPAIRED, HEARING DECREASED, HEARING REDUCED, Hypoacusis, Hearing loss, unspecified, loss of hearing (symptom), hearing loss (diagnosis), hard of hearing, hearing impaired, loss of hearing, hearing loss, Hearing decreased, Hearing reduced, Hearing Impairment, Hearing Loss, Loss, Hearing, Hypoacuses, Hearing deficit, Hearing loss NOS, Hearing Loss [Disease/Finding], Impairment;hearing, Loss (of);hearing, Hearing losses, Loss of hearing, Deafness, IMPAIRMENT, HEARING, HEARING IMPAIRMENT, HEARING LOSS, LOSS OF HEARING, Hearing loss, Hearing impairment, Hearing impaired, Impaired hearing, Difficulty hearing, HI - Hearing impairment, HL - Hearing loss, HOH - Hard of hearing, Hard of hearing, Decreased hearing, Decreased hearing (finding), defect; hearing, hearing; defect, hearing; loss, loss; hearing, Hearing loss, NOS, hearing impairment, Hearing loss (finding), Hearing loss (disorder)
German Hoerverluste, Gehoer verringert, Gehoer vermindert, schwerhoerig, Gehoerverlust, unspezifischer Hoerverlust, GEHOER EINGESCHRAENKT, GEHOER VERMINDERT, HOERVERMINDERUNG, Hoerverlust, nicht naeher bezeichnet, Hoerstoerung, Hypakusis, Hypoakusis, Hörbeeinträchtigung, Hörverlust
Italian Perdite dell'udito, Udito compromesso, Sordità non specificata, Udito diminuito, Duro di orecchi, Udito ridotto, Invalidità uditiva, Ipoacusia, Perdita dell'udito
Dutch verminderd gehoor, verlies van het gehoor, hardhorig, niet-gespecificeerd gehoorverlies, defect; gehoor, gehoor; defect, gehoor; verlies, verlies; gehoor, Gehoorverlies, niet gespecificeerd, gehoor beschadigd, gehoorverlies, hypoacusis, Gehoorstoornis, Hypoacusis, Gehoorafname
French Audition réduite, Perte auditive non précisée, Audition diminuée, Dur d'oreille, ALTERATION DE L'OUIE, DIMINUTION DE L'OUIE, REDUCTION DE L'OUIE, Hypo-acousie, Malentendant, Pertes auditives, Déficience auditive, Déficit auditif, Baisse de l'acuité auditive, Hypoacousie, Perte d'audition, Perte auditive
Portuguese Défice auditivo NE, Dificuldade auditiva, Audição reduzida, Audição diminuída, Défice auditivo, AUDICAO DIMINUIDA, INSUFICIENCIA AUDITIVA, REDUCAO DA AUDICAO, Perda da Audição, Perda da Capacidade Auditiva, Deficiência auditiva, Perdas de audição, Hipoacusia, Deficiência Auditiva, Perda Auditiva
Spanish Audición reducida, Dificultad para oír, Pérdida de audición no especificada, Audición disminuida, Pérdida de audición, pérdida auditiva (hallazgo), sordera, AUDICION DETERIORADA, AUDICION DISMINUIDA, AUDICION REDUCIDA, pérdida de la audición (trastorno), pérdida auditiva (trastorno), pérdida de la audición, disminución de la audición, Pérdida de la Capacidad Auditiva, Pérdida de la Audición, audición disminuida (hallazgo), audición disminuida, hipoacusia, pérdida auditiva, Audición alterada, Pérdidas de audición, sordera (hallazgo), Hipoacusia, Deficiencia Auditiva, Pérdida Auditiva
Japanese 詳細不明の難聴, 聴力減退, 聴覚障害, 聴力低下, ナンチョウ, チョウリョクゲンタイ, ショウサイフメイノナンチョウ, チョウカクショウガイ, チョウリョクテイカ, 部分的聴力損失, 聴力損失-部分的, 局所的聴力損失, 聴力損失-局所的, 難聴-局所的, 聴力喪失-部分的, 聴力損失, 局所的難聴, 異聴(難聴), 難聴
Swedish Hörselnedsättning
Czech porucha sluchu, hypoakuzie, nedoslýchavost, Omezení sluchu, Hypoakuzie, Zhoršení sluchu, Nedoslýchavý, Porucha sluchu, Ztráty sluchu, Ztráta sluchu, Blíže neurčená ztráta sluchu, ztráta sluchu, hypakuze, hypacusis, hypakuzie
Finnish Huonokuuloisuus
Korean 상세불명의 난청
Croatian Not Translated[Hearing Loss]
Polish Ubytek słuchu, Niedosłuch
Hungarian Nem meghatározott hallásvesztés, hypoacusis, halláscsökkenés, csökkenthallás, Hallási nehézség, Halláscsökkenések, halláskárosodás, Hallás elvesztése
Norwegian Hørselshemning, Nedsatt hørsel, Hørselstap, Hypakusis, Hørselshemming, Tunghørthet

Ontology: Hearing impairment (SMQ) (C2609433)

Definition (MDR) SMQ is intended to include ear disorders that may be drug related. Two sub-search SMQs created for two functions of ear: hearing and balance. Hearing may be impaired, disturbed, or accentuated. Hearing loss and abnormal hearing are not separated in this SMQ due to overlap of the these conditions in certain patients. Definition: hearing - ability to perceive sound; sensation of sound as apposed to vibration. Hearing impairment may result from: a lesion in external auditory canal or middle ear (conductive hearing loss); or a lesion in inner ear or VIIIth cranial nerve (sensorineural). Sensorineural hearing loss can be further differentiated as: sensory (cochlea); or neural (VIIIth cranial nerve)
Definition (MDRSPA) La SMQ está destinada para incluir trastornos del oído que pueden estar relacionados con fármacos. Se crearon dos SMQ de subbúsqueda para dos funciones del oído: audición y equilibrio. La audición puede perderse, alterarse o agudizarse. La pérdida auditiva y audición anormal no están separadas en esta SMQ debido a que en ciertos pacientes estas afecciones son mixtas. Definición: audición capacidad de percibir el sonido; sensación de sonido a diferencia de la vibración. El déficit auditivo puede ser resultado de: una lesión en el conducto auditivo externo o el oído medio (pérdida auditiva conductiva); o una lesión en el oído interno o en el VIII par craneal (neurosensorial).La pérdida auditiva neurosensorial puede diferenciarse más a fondo como: sensorial (cóclea); o neural (VIII par craneal)
Definition (MDRPOR) Esta SMQ destina-se a incluir perturbações do ouvido que podem estar relacionadas com fármacos. Criaram-se duas SMQ de sub-pesquisa para duas funções do ouvido: audição e equilíbrio. A audição pode diminuir, alterar-se ou acentuar-se. A perda da audição e a audição anormal não estão separadas nesta SMQ devido ao facto destas perturbações se sobreporem em certos pacientes. Definição: audição capacidade de perceber o som; sensação de som por oposição à vibração. A insuficiência auditiva pode ser o resultado de uma lesão do canal auditivo externo ou do ouvido médio (perda auditiva condutiva); ou uma lesão do ouvido interno ou do VIII nervo craniano (neurossensorial).A perda auditiva neurossensorial pode diferenciar-se mais a fundo como: sensorial (cóclea); ou neural (VIII nervo craniano).
Definition (MDRDUT) De SMQ is opgezet om ooraandoeningen te bevatten die mogelijk geneesmiddelgerelateerd zijn. Twee SMQ's met ondergeschikte zoekbewerkingen samengesteld voor twee functies van het oor: gehoor en evenwicht. Het gehoor kan verminderd, verstoord of geaccentueerd zijn. Gehoorverlies en abnormaal gehoor worden in deze SMQ niet gescheiden omdat deze aandoeningen zich bij bepaalde patiënten overlappen. Definitie: gehoor vermogen geluid waar te nemen; gewaarwording van geluid in tegenstelling tot trilling. Hardhorendheid kan het gevolg zijn van: letsel in de uitwendige gehoorgang of het middenoor (geleidingsgehoorverlies); of letsel in het binnenoor of de VIIIe hersenzenuw (sensineuraal).Sensineuraal gehoorverlies kan nader worden onderscheiden als: sensorisch (cochlea); of neuraal (VIIIe hersenzenuw)
Definition (MDRITA) Questo SMQ intende includere i disturbi dell'orecchio che possono essere farmaco-correlati. Due SMQ di sottoricerca creati per due funzioni dell'orecchio: udito ed equilibrio. L'udito può essere compromesso, disturbato o accentuato. La perdita dell'udito e l'udito anormale non sono separati in questo SMQ in quanto queste condizioni si sovrappongono in alcuni pazienti. Definizione: udito abilità di percepire suoni; sensazione di suono opposto a vibrazione. La compromissione dell'udito può essere causata da: una lesione nel canale uditivo esterno o nell'orecchio medio (perdita dell'udito conduttivo); o da una lesione dell'orecchio interno e dell'VIII nervo cranico (sensorineurale).La perdita dell'udito sensorineurale può essere ulteriormente differenziata come: sensoria (coclea) o neurale (VIII nervo cranico).
Definition (MDRFRE) Cette SMQ est destinée à inclure les troubles de l'oreille pouvant être d'origine médicamenteuse. Deux SMQ de sous-recherche créées pour deux fonctions de l'oreille : audition et équilibre. L'audition peut être entravée, perturbée ou accentuée. La perte d'audition et une audition anormale ne sont pas séparées dans cette SMQ en raison du chevauchement de ces états chez certains patients. Définition : Audition capacité à percevoir un son ; sensation du son par opposition à la vibration. Une déficience auditive peut résulter de : Une lésion du canal auditif externe ou de l'oreille moyenne (perte d'audition conductive) ; ou une lésion de l'oreille interne ou du huitième nerf crânien (neurosensorielle).La perte d'audition neurosensorielle peut être d'avantage différenciée comme : sensitive (cochlée) ou neurale (huitième nerf crânien).
Definition (MDRGER) Arzneimittelbedingte Erkrankungen des Ohrs sind absichtlich in der SMQ enthalten. Zwei SMQs der Untergruppensuchen bestehen für zwei Funktionen des Ohrs: Gehör, Gleichgewicht. Das Gehör kann beinträchtigt, gestört oder akzentuiert sein. Gehörverlust und anomales Gehör sind in dieser SMQ aufgrund einer Überlappung dieser Zustände in bestimmten Patienten nicht geteilt. Definition: Gehör Fähigkeit Töne zu erkennen; Wahrnehmung einesTons im Gegensatz zu Vibrationen. Mögliche Ursachen von Hörstörungen sind: Läsion im äußeren Hörkanal oder Mittelohr (Leitungsstörung); oder Läsion im Innenohr oder im Kranialnerv VII (sensorineural).Sensorineuraler Gehörverlust kann weiter unterschieden werden als: sensorisch (Cochlea); oder neural (Kranialnerv VII).
Definition (MDRCZE) SMQ je určeno pro poruchy sluchu, které mohou být způsobeny léky. Dvě podřízená vyhledávání SMQ vytvořená pro dvě funkce ucha: sluch a rovnováhu. Sluch může být zhoršený, narušený nebo zesílený. Porucha sluchu a abnormální sluch nejsou v SMQ Porucha sluchu odděleny vzhledem k překrývání těchto stavů u určitých pacientů. Definice: sluch schopnost vnímat zvuk na rozdíl od vibrací. Porucha sluchu může být způsobena: lézí v zevním zvukovodu nebo středním uchu (převodní ztráta sluchu) nebo lézí ve vnitřním uchu nebo VIII. hlavovém nervu (sensorineurální).Sensorineurální ztráta sluchu může být dále rozdělena jako: senzorická (kochleární) nebo neurální (VIII. hlavový nerv).
Definition (MDRJPN) 本SMQは薬剤に関連する可能性のある耳障害を包含することを目的としている。耳の2種類の機能−聴覚と平衡感覚−に対して2つのサブSMQを作成した。聴覚は低下、障害、または亢進する。本SMQでは難聴と聴覚異常を区別していない。これは一部の患者ではこれらの病態が重複するためである。定義:聴覚−音を知覚する能力;すなわち振動に対比するものとして音に対する感覚である。聴覚障害の原因は次の通りである:外耳道あるいは中耳の病変(伝音難聴)、または;内耳あるいは第8脳神経の病変(感音難聴)。感音難聴はさらに次のように区別される:感覚性(蝸牛性)、または神経性(第8脳神経性)。
Definition (MDRHUN) Az SMQ a gyógyszerek mellékhatásaként jelentkező fülbetegségeket hivatott magában foglalni. A fül két funkciójához két al-SMQ lett létrehozva: hallás és egyensúly. A hallás lehet károsodott, zavart vagy érzékeny. A hallás elvesztése és a kóros hallás ebben az SMQ-ban nincs elkülönítve, mivel ezek az állapotok bizonyos páciensekben átfedik egymást. Definíció: hallás hang érzékelésének képessége; hangérzékelés vibráció hatására. A halláskárosodás okai lehetnek: laesio a külső fülkürt csatornában vagy a belsőfülben (vezetéses hallásvesztés); vagy laesio a belső fülben vagy a VIII. agyidegben (sensoro-neuralis).A sensoro-neuralis hallásvesztés tovább osztályozható: sensoros (cochlea); vagy neuralis (VIII.. agyideg),
Concepts Classification (T185)
English Hearing impairment (SMQ)
Spanish Déficit auditivo (SMQ)
Portuguese Deficiência auditiva (SMQ)
Dutch Hardhorendheid (SMQ)
Italian Compromissione dell'udito (SMQ)
French Déficience auditive (SMQ)
German Hoerstoerung (SMQ)
Czech Porucha sluchu (SMQ)
Japanese 聴覚障害(SMQ)
Hungarian Halláskárosodás (SMQ)