Conductive & Sensorineural Hearing Loss

The ear and the auditory system are complex indeed and so before treatment for sudden hearing loss can begin a thorough examination will take place. When you experience sudden hearing loss you can expect to get a series of questions which will include these:

What do you do for a living? What is the level of noise in the place you work?
Is there a history of ear infection, injury, and straining to hear?
Is there a history of stroke, diabetes of any kind, heart disease?
What medications are you currently taking? Have you taken in the last several months?
Did you receive any intravenous antibiotics, diuretics, salicylates, or chemotherapy?
When did first notice that a hearing loss had begun?
Did your hearing loss come on suddenly , or has your hearing slowly been getting worse?
Is your hearing loss in one or both ears as far as you can tell?
Have you been having ringing in your ear, fullness in your ear, dizziness, ear drainage, or ear pain?
Have there been occurences of hearing loss in your family?

The physical examination will include but not necessarily be limited to:

The physical examination begins palpation and visual inspection of periauricular & auricle tissues. An otoscope will be used to examine the most external auditory canal for things that can be the source cerumen, foreign bodies, and abnormalities of the canal skin. Next the mobility, color, and surface anatomy of the tympanic membrane is to be determined. Use of pneumatic bulb is will be required to accurately assess the tympanic membrane and the aeration of the middle ear.

Some routine and simple hearing tests will be performed.

The Rinne test compares air conduction to bone conduction. A tuning fork which is struck softly and then placed on the mastoid bone . When a patient is no longer able to hear the sound, the tuning fork will be placed next to the ear canal .When there is normal hearing or sensorineural hearing loss, air conduction is better than bone conduction and sound is still heard when the tuning fork is placed next to the ear canal. In the presence of conductive hearing loss, bone conduction is superior to air conduction, and the sound isn’t heard when the tuning fork is placed next to the canal.

Weber’s test is performed with the softly striking of a tuning fork and placing it midline on the patient’s scalp, the forehead, nasal bones, or teeth. If the hearing loss is conductive, the sound will be heard better in the affected ear. If the loss is sensorineural, the sound will be heard better in the normal ear. Sound will remain midline in the patient who has normal hearing.

By whispering softly into the patient’s ear or holding a softly ticking wristwatch at a close distance from the ear will be helpful in making a gross evaluation of hearing.

A close examination of the entire body area close to the region of the ears will be done including the neck, shoulders, cranial nerves and the entire head.

Audiography will be considered at this point for a better evaluation of the precise level of the hearing loss.

There are a number of further tests and observations that can and are made by the examining physician when it is deemed appropriate. At this point the doctor has a good idea of the the sudden hearing loss cause and treatment.