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Causes of Hearing Loss

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Causes	Clinical Features	Investigations	Management
Conductive Hearing Loss	Otitis Media: Ear pain, discharge, reduced hearing. Otitis Externa: Ear canal pain, redness, swelling. Earwax Impaction: Feeling of fullness, difficulty hearing. Otosclerosis: Gradual hearing loss, more pronounced in low frequencies. Tympanic Membrane Perforation: History of trauma or infection, sudden hearing loss.	Otoscopy: Examination of the ear canal and tympanic membrane. Tuning Fork Tests: Rinne and Weber tests to differentiate between conductive and sensorineural hearing loss. Audiometry: Pure tone audiometry to quantify hearing loss. Imaging: CT or MRI if structural abnormalities are suspected.	Medical Treatment: Antibiotics for infections, removal of earwax, and treatment of otitis media/externa. Surgical Intervention: Tympanoplasty for perforated eardrum, stapedectomy for otosclerosis. Hearing Aids: For cases of chronic or irreversible conductive hearing loss.
Sensorineural Hearing Loss	Presbycusis: Gradual hearing loss in both ears, difficulty hearing high-pitched sounds. Noise-Induced Hearing Loss: History of exposure to loud noises, tinnitus, hearing loss. Meniere's Disease: Episodic vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness in the ear. Acoustic Neuroma: Unilateral hearing loss, tinnitus, imbalance, possibly facial numbness. Ototoxic Medications: History of using medications such as aminoglycosides, loop diuretics, or chemotherapy agents, with bilateral hearing loss.	Audiometry: Pure tone and speech audiometry to assess the degree and type of hearing loss. Otoacoustic Emissions (OAE): To assess cochlear (outer hair cell) function. Auditory Brainstem Response (ABR): To assess neural pathways from the ear to the brainstem, especially for acoustic neuroma. MRI: To detect acoustic neuroma or other central causes of hearing loss. Vestibular Testing: For patients with suspected Meniere's disease or balance issues.	Hearing Aids: For most cases of sensorineural hearing loss, especially presbycusis. Cochlear Implants: For severe or profound sensorineural hearing loss that does not benefit from hearing aids. Treatment of Meniere's Disease: Low-sodium diet, diuretics, and intratympanic steroid injections. Surgical options include endolymphatic sac decompression or vestibular nerve section. Management of Acoustic Neuroma: Observation, stereotactic radiosurgery, or microsurgical removal depending on size and symptoms. Avoidance of Ototoxic Drugs: Discontinuation or substitution of the offending medication if possible.
Mixed Hearing Loss	A combination of conductive and sensorineural hearing loss symptoms, depending on the underlying conditions contributing to both types of loss. Examples include chronic otitis media with sensorineural loss or a combination of otosclerosis and presbycusis.	Comprehensive Audiometry: To assess both conductive and sensorineural components. Imaging: CT or MRI if structural abnormalities are suspected, especially if surgical intervention is considered. Tympanometry: To assess middle ear function.	Medical and Surgical Treatment: Combination of treatments depending on the conductive and sensorineural components. For example, surgery for conductive issues like otosclerosis combined with hearing aids for sensorineural loss. Hearing Aids: May be beneficial for mixed hearing loss, particularly in mild to moderate cases. Cochlear Implants: In cases where severe sensorineural loss predominates and traditional hearing aids are ineffective.
Central Hearing Loss	Difficulty understanding speech, especially in noisy environments, despite normal or near-normal hearing on audiometric tests. May be associated with neurological symptoms such as cognitive decline, stroke, or multiple sclerosis.	Auditory Processing Tests: To evaluate central auditory processing abilities. MRI: To assess for central nervous system lesions, such as stroke, tumours, or demyelination. Neuropsychological Testing: To evaluate cognitive function, especially if cognitive decline is suspected.	Rehabilitation: Auditory training and speech therapy to improve auditory processing skills. Management of Underlying Neurological Condition: Treating the primary condition such as stroke, multiple sclerosis, or dementia. Assistive Listening Devices: Such as FM systems to improve hearing in noisy environments.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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