| 👂 Conductive Hearing Loss |
- 🟤 Earwax impaction
- 🦠 Otitis externa
- 👶 Otitis media with effusion / glue ear
- 🔥 Acute otitis media
- 🕳 Tympanic membrane perforation
- 🦴 Otosclerosis
- 🧱 Cholesteatoma
- 💥 Trauma or ossicular disruption
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- Sounds are quieter or muffled.
- Ear fullness or blockage sensation.
- Ear pain or discharge if infection.
- Usually normal speech discrimination if loud enough.
- Rinne: bone conduction better than air conduction in affected ear.
- Weber: localises to affected ear.
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- 🔎 Otoscopy: wax, canal inflammation, perforation, effusion, cholesteatoma.
- 🎵 Tuning fork tests: Rinne and Weber.
- 📈 Pure tone audiometry: air–bone gap.
- 📉 Tympanometry: middle-ear pressure/effusion.
- 🖥 CT temporal bone if ossicular disease, cholesteatoma or surgical planning suspected.
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- Remove wax where appropriate.
- Treat otitis externa/media according to clinical picture.
- ENT referral for persistent perforation, cholesteatoma, recurrent infections or suspected ossicular disease.
- Hearing aids if chronic or not surgically correctable.
- Stapedotomy/stapedectomy may be considered for otosclerosis.
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| 🧠 Sensorineural Hearing Loss |
- 👵 Presbycusis
- 🔊 Noise-induced hearing loss
- 💊 Ototoxic drugs: aminoglycosides, platinum chemotherapy, loop diuretics
- 🌀 Ménière’s disease
- 🎧 Sudden sensorineural hearing loss
- 🧬 Genetic/congenital causes
- 🧠 Vestibular schwannoma
- 🦠 Viral labyrinthitis or inner-ear infection
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- Reduced clarity as well as reduced volume.
- Difficulty hearing speech in background noise.
- High-frequency loss common in presbycusis/noise damage.
- Tinnitus may occur.
- Vertigo suggests inner-ear involvement.
- Rinne: air conduction better than bone conduction.
- Weber: localises to the better ear.
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- 📈 Pure tone audiometry and speech discrimination testing.
- 🎧 Otoacoustic emissions if cochlear function assessment needed.
- 🧠 MRI internal auditory meatus if unilateral/asymmetric SNHL or unilateral tinnitus.
- 🌀 Vestibular testing if vertigo prominent.
- 💊 Medication review for ototoxic exposure.
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- Hearing aids for mild to severe persistent loss.
- Cochlear implant assessment for severe/profound loss not helped by hearing aids.
- Avoid further noise/ototoxic exposure where possible.
- Manage Ménière’s disease with specialist ENT/audiovestibular input.
- Sudden sensorineural hearing loss: urgent ENT assessment; steroids may be considered depending on timing and local pathway.
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| ⚖️ Mixed Hearing Loss |
- Chronic otitis media plus cochlear damage.
- Otosclerosis with cochlear involvement.
- Previous ear surgery or trauma.
- Presbycusis plus wax, effusion or perforation.
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- Features of both conductive and sensorineural loss.
- Reduced volume and reduced clarity.
- May have chronic ear discharge, tinnitus or vertigo depending on cause.
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- 📈 Audiometry showing both air–bone gap and raised bone-conduction thresholds.
- 🔎 Otoscopy and tympanometry.
- 🖥 CT or MRI if structural disease, cholesteatoma, tumour or surgical planning suspected.
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- Treat reversible conductive component where possible.
- Hearing aids often helpful.
- ENT referral if chronic ear disease, perforation, cholesteatoma or surgical option suspected.
- Cochlear implant assessment if severe sensorineural component predominates.
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| 🧠 Central Hearing Loss / Auditory Processing Disorder |
- Stroke
- Multiple sclerosis
- Brain tumour
- Dementia or cognitive impairment
- Traumatic brain injury
- Central auditory processing disorder
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- Difficulty understanding speech, especially in noisy environments.
- Hearing may seem “normal” on basic audiometry.
- May have neurological symptoms, cognitive change or language difficulty.
- Can be confused with dementia, aphasia or attention problems.
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- 📈 Audiology assessment including speech-in-noise testing.
- 🧠 MRI brain if focal neurological features or central lesion suspected.
- 🧩 Neuropsychological testing if cognitive impairment suspected.
- 👂 ENT/audiology and neurology input depending on presentation.
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- Manage underlying neurological condition.
- Auditory rehabilitation and communication strategies.
- Assistive listening devices, e.g. remote microphone/FM systems.
- Speech and language therapy if language processing affected.
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