Hearing Loss & Rehabilitation Oliver F. Adunka, MD Assistant Professor
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Hearing Loss & Rehabilitation Oliver F. Adunka, MD Assistant Professor based on a lecture by Craig A. Buchman, MD, FACS Overview of Hearing Loss • • • • • Anatomy and Physiology Classification Diagnosis Treatment Prevention 7/27/2016 2 Anatomy of the Ear 7/27/2016 3 Anatomy of the Temporal Bone 7/27/2016 4 Anatomy of the Temporal Bone 7/27/2016 5 Anatomy of the Skull-Base 7/27/2016 6 Tympanic Membrane 7/27/2016 7 Anatomy of the Middle Ear 7/27/2016 8 Ossicles 7/27/2016 9 Anatomy of the Inner Ear 7/27/2016 10 Anatomy of the Inner Ear 7/27/2016 11 Anatomy of the Auditory System 7/27/2016 12 Anatomy of the Inner Ear 7/27/2016 13 Anatomy of the Inner Ear 7/27/2016 14 Classification • Etiology » conductive, sensorineural, mixed » congenital, acquired » specific disease 7/27/2016 15 Classification • Severity » » » » » mild (21-40 dB) moderate (41-55 dB) moderately severe (56-70 dB) severe (71-90 dB) profound (> 91 dB) 7/27/2016 16 Classification • Conductive hearing loss » » » » » » » cerumen impaction aural atresia tympanic membrane perforation ossicular discontinuity otosclerosis otitis media Cholesteatoma 7/27/2016 17 Conductive Hearing Loss 7/27/2016 18 7/27/2016 19 7/27/2016 20 7/27/2016 21 7/27/2016 22 7/27/2016 23 Classification • Sensorineural hearing loss » » » » » » » congenital presbycusis noise-induced hearing loss ototoxicity Meniere’s disease autoimmune inner ear disease acoustic neuroma 7/27/2016 24 Sensorineural Hearing Loss 7/27/2016 25 Congenital Sensorineural Hearing Loss 7/27/2016 26 Presbycusis • • • • • Bilateral Insidious onset Slowly progressive Symmetric No other etiology 7/27/2016 27 Acoustic Neuroma 7/27/2016 28 Temporal Bone Fracture QuickTime™ and a decompressor are needed to see this picture. 7/27/2016 29 Diagnosis • • • • • History Physical examination Audiometric testing Laboratory testing Imaging 7/27/2016 30 Diagnosis • History » onset, duration, severity » preceding illness and associated symptoms » medical history and family history • Physical examination » otoscopy with pneumotoscopy » tuning forks » head and neck and neurological exam 7/27/2016 31 Pneumatic Otoscopy 7/27/2016 32 Diagnosis • Audiometric testing » » » » » » » air & bone conduction thresholds speech testing tympanometry acoustic reflex testing otoacoustic emission (OAEs) electrocochleography (ECoG) auditory brainstem response (ABR) 7/27/2016 33 Auditory Brainstem Response 7/27/2016 (ABR) 34 Diagnosis • Indications for audiometric testing » symptoms of hearing loss, tinnitus, vertigo, or aural pressure » newborn screening » temporal bone fracture » ototoxic medications » medical or family screening » otologic procedure planned 7/27/2016 35 Diagnosis • Imaging » Computed tomography (CT) • middle and inner ear • mastoid • petrous apex » Magnetic resonance imaging (MRI) • internal auditory canal nerves • brain and related structures • vascular structures 7/27/2016 36 Petrous Apicitis 7/27/2016 37 Treatment • Rationale » » » » 7/27/2016 Disease management Speech and language acquisition Improved communication skills Quality of life 38 Treatment • Conductive hearing loss » » » » » » Cerumen impaction Otosclerosis Ossicular discontinuity Otitis media Cholesteatoma Tumors 7/27/2016 39 Otosclerosis 7/27/2016 40 Stapedectomy 7/27/2016 41 Stapedotomy 7/27/2016 42 Stapedectomy 7/27/2016 43 Cholesteatoma 7/27/2016 44 Treatment • Sensorineural hearing loss » » » » » sudden sensorineural hearing loss otosyphilis autoimmune inner ear disease Meniere’s disease acoustic neuroma 7/27/2016 45 Acoustic Neuroma 7/27/2016 46 Treatment • Disease non-specific » » » » » Hearing aid(s) Vibrant Soundbridge® Bone-Anchored Hearing Aid (BAHA)® Cochlear Implant Auditory Brainstem implant (ABI) 7/27/2016 47 Hearing Aids 7/27/2016 48 Hearing Aids ITE CIC ITC BTE 7/27/2016 49 Bone Conductor Hearing Aid 7/27/2016 50 Cochlear Implants 7/27/2016 51 Cochlear Implant 7/27/2016 52 Cochlear Implant Surgery 7/27/2016 53 Positioning of ICS 7/27/2016 54 Mastoid & Facial Recess 7/27/2016 55 Cochleostomy & Electrode Insertion 7/27/2016 56 Normal Cochlear Implant 7/27/2016 57 Results - Cochlear Implantation • Open-set speech perception by roughly three years of use • Mainstream education by kindergarten 7/27/2016 • Predictive factors » » » » » » » » Residual Hearing Onset of deafness Age at implantation Associated handicaps Inner Ear Malformations Communication Mode Education setting Two parents 58 Prevention • Identification of risk factors » » » » Occupation Day-care Family history Medical condition 7/27/2016 59 Prevention • Screening » » » » 7/27/2016 Newborn (well-baby and high risk) Occupational At risk individuals Genetic testing 60 Prevention • Preventive measures » » » » » Ear plugs or muffs Vaccination Medical and surgical therapy Hearing aids Cochlear implants 7/27/2016 61
