Tag Archives: Audiometry

Management of sudden sensorineural Hearing Loss

Previous Post:- Causes and evaluation of sudden sensorineural hearing loss

Sudden sensorineural hearing loss is an otologic emergency and challenge to otolaryngologist.

Thorough history, physical examination, appropriate laboratory and radiologic investigations including gadolinium enhanced MRI, and Audiometry tests should be carried out to find out known cause such as: – Infection (bacterial-meningitis/viral-mumps, herpes), Tumor, Trauma, Acoustic trauma, Ototoxic drugs (amino glycoside antibiotics), and Systemic diseases (hypothyroidism, Diabetes mellitus).

If an etiology is apparent, appropriate treatment may be initiated such as antibiotics for infection, withdrawal of ototoxic drugs.

In most cases cause remains unknown (idiopathic) thus existent treatment aims at improving blood flow.

Optimal treatment is still under research and controversies exist but treatment versus non-treatment and early initiation of treatment is proved to give better result.

1. Antivirals– Because of common association with viral infection antiviral medication is prescribed by some clinicians.

2. Steroids- Most widely accepted treatment option studies shows improved recovery rate with use of steroid. It can be given orally, or by injection, or Trans tympanic by means of middle ear instillation or round window micro catheter which is more effective than oral administration.

3. Vasodilator to improve blood flow or oxygenation to inner ear. Clinical studies shows mixed results. Carbogen inhalation, Papaverin, Histamine, Nicotin and Niacin have been used.

4. Immunosuppressant- Wang et al etanercept in experimental animal study improves hearing result.

5. Ginkgo Biloba-

6. General measures-

  • Low salt diet,
  • Avoid caffeine, nicotine and alcohol,
  • Avoid noise exposure,
  • Avoid heavy physical activity,
  • Well balanced diet,
  • Alpha-lipoic Acid, Antioxidants, Co-enzyme Q10.
  • Zinc, Magnesium, Calcium,
  • Vitamin D, B -Complex, Vitamin C

Prognosis of sudden sensorineural hearing loss-

50-65% spontaneous recovery within first 4-6 weeks.

Symptoms of ear blockage or deceased hearing is often considered as wax or middle ear infection and person delays visit to an otolaryngologist. A delay in initiating treatment may decrease the chances of recovery.

Negative factors in prognosis-

  • Age more than 65 years or less than 15 years
  • Severe hearing loss specially affecting high frequency
  • Hearing loss in opposite ear
  • Associated vertigo
  • Elevated ESR

Treatment protocol should be carefully applied and potentially harmful treatment should be avoided. A thorough evaluation to be done on emergency basis and all efforts should be taken to find out known causes. Steroids are most widely accepted treatment options.

Sudden Sensorineural hearing loss

  • It should be regarded as an otologic emergency.
  • Patient should be evaluated by otolaryngologist.
  • A thorough history, physical examination, appropriate laboratory and radiologic investigations including gadolinium enhanced MRI, and Audiometry tests should be carried out to find out known cause.
  • A tapering course of prednisolone/methyle prednisone is prescribed.
  • Antiviral medication may be considered.
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Criteria for hearing screening of new born babies

First three years of life are critical for a child to develop speech and language skill. For effective language and communication skill development child need to hear normally. If any hearing impairment is there it should be managed at the earliest.

With modern technologies like Brain-stem evoked response audiometry it is possible to identify hearing-loss within days of birth.

There are certain criteria which needs to pay attention and newborn should be subjected to hearing evaluation:–

1. Parental concern about hearing levels or speech delay in their child

2. Family history of hearing loss

3. History of in-utero (cytomegalovirus, rubella or syphilis) or post natal infections (meningitis)

4. Low birth weight babies

5. Hyper Bilirubinemia

6. Cranio facial deformities or certain syndromes

7. Head injury

8. Recurrent or Persistent otitis media with effusion

9. Exposure to ototoxic drugs

E.N.T. clinic set up; Instruments and common terms

E.N.T. Specialist (oto-rhino-laryngologist):-

A doctor who specializes in diagnosing and managing diseases (by medicines or surgery) of Ear-Nose and throat.

Evaluation of the ear, nose and throat requires good source of light. Most important is, no doubt, skilled hands and experienced eyes.

Some instruments and common terms used in E.N.T. practice:

Head-mirror and bulls lamp: –

bulls-lamp Bulls lamp placed above and behind the patient’s shoulder has got a bulb and Plano-convex lens to send focused light to head mirror.

head mirror and ent-specialist1 Head mirror (I like to describe it as “naag-mani”), has special concave lens to reflect light from bull’s lamp. The examiner sees through the hole in the center of the mirror for binocular vision.


images1

Some professionals use Head-light in place of bull’s lamp and head mirror.



Endoscopy unit:

endoscopelight source, camera and nasal endoscope are being used in a modern

ENT set-up for video demonstration of otherwise hidden- from patient’s-cavities.


Tongue depressor: –

tongue-depressor

To depress tongue and examine oral cavity.


Nasal speculum: –

thudichum nasal_speculumHelp in viewing inside of nose, procedure to inspect nasal cavity is called anterior rhinoscopy.


Laryngeal mirrors: –

il-mirror Used to examine larynx and laryngo-pharynx. Doctor will hold your tongue and will see reflection of larynx in the mirror that is why it is called indirect laryngoscopy.

Video-laryngoscopy is routinely used now a days using telescope.

Postnasal mirror: -used to examine nasopharynx and posterior part of nasal cavity, a procedure called posterior rhinoscopy.

Ear-speculum: –

ear_specula Inserted into ear to see inside of ear canal and ear drum.


Otoscope:

otoscope

It is battery operated device with magnifying glass, gives magnified view of ear drum.

ear-exam1Otoscope is most essential tool in the hands of otolaryngologist; I often use it to inspect ear, nose and throat of infant, child or bed-ridden patients or places (like rural-camps) where an equipped E.N.T. set-up is not present.


Siegel’s speculum: – It helps to test mobility of ear drum, a very essential part of ear examination.

Jobson-Horne’s probe:

jobson-horn-and-probe1 I call it “chhoti jadu ki chhadi” (tiny magic-stick). On the one end of the probe cotton can be applied and used to clean ears of any discharge. Other end has got ring like structure to remove wax, dried secretion and foreign body.


Forceps

hartmann-forceps161noyes-forceps141 (Tilley’s or Hartman’s) for packing or grasping.

Eustachian catheter: – To see the patency of Eustachian tube.


Suction-apparatus: – To suck out discharge or blood from ear or nose for detailed examination.


Ear microscope (operating microscope): –

ent-microscope To examine the ear drum more precisely under magnification, a procedure called Examination under microscope (EUM).

It gives the doctor the freedom to use suction and other Instruments in the ear.

Microscopy is used to clean discharge, to inspect ear drum, middle ear or any pathology before surgery, and to remove impacted wax or foreign bodies from ear.


Tunning Forks:

tunning-forkTo roughly assess degree and type of hearing impairment.


Pure tone audiometer and impedance meter:-

To test degree and type of hearing-loss.


tympanometer1

pure tone audiometer

Pure tone audiometer and Tympanometer