Approach to Tinnitus

Tinnitus can exist with a hearing loss due to any cause but may occur even
with normal hearing. However, it is most often a feature of sensorineural
losses. The noise heard is usually intrinsic (heard by the patient only) but
sometimes may be extrinsic (heard by an observer) such as a vascular
bruit.

Intrinsic Extrinsic
Peripheral Central
 Drugs  Idiopathic central  Insect in external
 Labyrinthitis tinnitus ear
 Trauma  VIII nerve tumours  Vascular causes
 Vascular  Temporal lobe e.g. AVM, glomus
 Prebycusis epilepsy jugulare tumours
 Meniere’s  Palatal myoclonus
disease/endolympha
tic hydrops
 Noise
 Otosclerosis

Approach to Hearing Loss

Causes of Conductive Hearing Loss Causes of Sensorineural Hearing

Loss
 External ear  Cochlea
- congenital atresia or stenosis - Congenital: dysplasia,
- meatal obstruction e.g. FB, perinatal hypoxia/infection,
wax, infection, keratosis syndromic
obturans, neoplasms - Presbycusis
 Middle ear  Labyrinthistis/infection
- congenital anomaly e.g of  Vascular causes
tympanic membrane,  Trauma: direct ototoxicity
ossicles, oval/round windows,  Otosclerosis
cholesteatoma  Meniere’s disease/endolymphatic
 Otitis media (acute or chronic) hydrops
 Cholesteatoma  Metabolic disorders
 Otosclerosis (haematological disorders)
 Granulomatous disorders  Retrochoclea
 Trauma - psychogenic
 Neoplasia - meningitis
 MS
 Neoplasia e.g. acoustic neuroma
 Neurological disorders
Lecture

 Use the lateral process to seewhich side the eardrum is

 Parts of ear drum and annulus (fibrocartilage ring)
 See chorda tympani in ear
 Middle ear converts sound energy to mechanical; conducts and
amplifies
 What is auditory processing disorder

Reflex – when cold water is put in

Otomycosis – hyphae in ear usu. aspergillus, candida ; quite common

because of antibiotic usage; incorrect diagnosis causes fungals to
proliferate in the absence of normal flora,

Use topical as it has the highest concentration locally

Otitis media
- bulging
- opaque because of pus behind
- seen in paeds, usually asociated with URTI
- < 6 mo give antibiotics, up to 2 yrs is iffy group – just leave it alone;
2/3 of the cases are viral
- Important complication of OM is meningitis
- Haemophilus, strep pneumococcus, moraxella (bacterial etiologies)
- Pneumococcal vaccinaitons don’t cause a drop in OM as other 2
bacteria take over

OM with effusion
- retracted ear drum (means that middle ear pressure is down)
- still a big qn of whether fluid is transudate or exudate
- air bubble in fluids
- p/w with inattentiveness/pulling behaviours in children/speech delay
if late diagnosis, in adults discomfort
- Invariably in kids with craniofacial disorders
- Gromet tube is treat – takes over function of eustachian (temporary)
and will drop out
- Ear wax forces it to drop out (allows time for tube to grow)
Cholesteatoma
- problem with pars flacida rather tha pars tensa
- skin that has gone into middle ear
- pars flacida gets the brunt of it because the membranes are less
tense, low pressure draws skin in w wax

Otosclerosis - new skin formation around the oval window that fixates the
stapes, stapedotomy or dectomy

Dimple?? Shaped hearing loss

Congenital hearing loss – AR more common than AD; AR clasically presents

at young age with very severe hearing loss