Thursday Resident Conference

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Thursday Resident Conference

• Hau Sin Wong
• 5/11/2006

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History

• 40 year old male complaining of hearing loss

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History

• Hearing loss in the right ear
• Progressive hearing loss
• tinnitus in the right ear
• works in a factory with lost of noise
• migraines
• - vertigo or imbalance
• - otorrhea or otalgia
• - ear trauma

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• PMH no DM, Hypothyroidism, or HTN
• PSH no prior ear surgery
• FH no h/o hearing loss
• SH no tob or alcohol use

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Physical Exam

• Gen no craniofacial abnormalities
• Ear no auricular deformity, tympanic membrane
  intact and mobile bilaterally, no effusion,
  Weber-L, Rhine ACgtBC AU
• Nose wnl
• OC/OP wnl
• Neck wnl
• CN II-XII intact bilaterally

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Differential Diagnosis(Unilateral SNHL)

• Congenital Enlarged VA, abnormal labyrinth
• Infectious CMV, syphyllis, meningitis
• Idiopathic presbycusis,
• Trauma barotrauma, noise-induced hearing loss
• Toxinaminoglycosides
• Endocrinehypothyroidism, diabetes
• Neoplastic Vestibular schwannoma, CPA lesion
• Systemic functional hearing loss, stroke,
  Menieres

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Work-up

• Audiogram
• Components of the audio
• Air conduction and bone conduction
• PTA
• Speech testing- SDT, SRT, SD
• Acoustic immittence- tympanometry, stapedial
  reflex
• Stengers Test

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• Summary
• Unilateral hearing loss w/ tinnitus
• SD at 25
• Acoustic Decay Reflex is abnormal
• Any other diagnostic evaluation?

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Suspect CPA lesion

• ABR- low sensitivity than MRI, stacked ABR
  thought to increase sensitivity
• MRI-
• How do you differentiate between CPA lesions on
  MRI?

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Bilateral SNHL

• Hearing aids
• How do they work?
• Processing of hearing aids
• Analog
• Hybrid
• Digital

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Types of Hearing Aids

• BTE
• ITE
• ITC
• CIC
• Advantages and disadvantages of each and will be
  based on each individual patient

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Assessment of Hearing Aid

• What is the Acoustic gain of hearing aids?
• How is it measured?
• What is the Occlussion effect? And how can it be
  taken advantage of.
• What is acoustic feedback?

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CROS and BICROS hearing aid

• Indications
• one unaidable ear w/ a normal or hearing impaired
  ear.

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Binaural vs. Monaural amplification for bilateral
hearing loss

• Better word recognition w/ biaural amplification
• Better localization
• Prevents head shadow

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Assistive Hearing Devices

• Visual reinforcement
• Telecommunications
• Radiofrequency devices