Hearing loss - Revision history

Rossdonaldson1: /* Sudden Sensorineural Hearing Loss ( Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., … Monjur, T. M. (2019). Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Oto...

2022-02-08T17:21:04Z

/* Sudden Sensorineural Hearing Loss ( Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., … Monjur, T. M. (2019). Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Oto...

← Revisión anterior		Revisión del 17:21 8 feb 2022
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	===Sudden Sensorineural Hearing Loss (<72 hrs)<ref> Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., … Monjur, T. M. (2019). Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Otolaryngology–Head and Neck Surgery, 161(2), 195–210. https://doi.org/10.1177/0194599819859883</ref>:===		===Sudden Sensorineural Hearing Loss (<72 hrs)<ref> Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., … Monjur, T. M. (2019). Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Otolaryngology–Head and Neck Surgery, 161(2), 195–210. https://doi.org/10.1177/0194599819859883</ref>:===
	*Every effort should be made to ensure that conductive hearing loss (eg, ruptured tympanic membrane, or congestion of the middle ear or ear canal) is not present by using a tuning fork. Tinnitus, dizziness, and vertigo are common.		*Every effort should be made to ensure that conductive hearing loss (eg, ruptured tympanic membrane, or congestion of the middle ear or ear canal) is not present by using a tuning fork. Tinnitus, dizziness, and vertigo are common.
	*Head CT not routinely necessary, but may be considered for some patients based on individual characteristics.		*[[Head CT]] not routinely necessary, but may be considered for some patients based on individual characteristics.
	*Routine laboratory tests not needed		*Routine laboratory tests not needed
	*ENT providers are encouraged to obtain MRI (outpatient)		*ENT providers are encouraged to obtain MRI (outpatient)

Rossdonaldson1: /* Management */

2022-02-08T17:20:39Z

Management

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	*Based on exam findings and imaging.		*Based on exam findings and imaging.

	===Conductive Hearing Loss===		===Acute Conductive Hearing Loss===
			*Treat mechanical factor blocking external sound
			**Remove [[ear foreign body]] if present
			**If congested, assist middle ear fluid buildup removal (e.g. from [[URI]]) with a [[decongestant]] (e.g. [[oxymetazoline]])

	===Sudden Sensorineural Hearing Loss (<72 hrs)<ref> Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., … Monjur, T. M. (2019). Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Otolaryngology–Head and Neck Surgery, 161(2), 195–210. https://doi.org/10.1177/0194599819859883</ref>:===		===Sudden Sensorineural Hearing Loss (<72 hrs)<ref> Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., … Monjur, T. M. (2019). Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Otolaryngology–Head and Neck Surgery, 161(2), 195–210. https://doi.org/10.1177/0194599819859883</ref>:===
	*Every effort should be made to ensure that conductive hearing loss (eg, ruptured tympanic membrane, or congestion of the middle ear or ear canal) is not present by using a tuning fork. Tinnitus, dizziness, and vertigo are common.		*Every effort should be made to ensure that conductive hearing loss (eg, ruptured tympanic membrane, or congestion of the middle ear or ear canal) is not present by using a tuning fork. Tinnitus, dizziness, and vertigo are common.
	*Head CT not routinely necessary, but may be considered for some patients based on individual ~~charateristics~~.		*Head CT not routinely necessary, but may be considered for some patients based on individual characteristics.
	*Routine laboratory tests not needed		*Routine laboratory tests not needed
	*ENT providers are encouraged to obtain MRI (outpatient)		*ENT providers are encouraged to obtain MRI (outpatient)

Rossdonaldson1: /* Management */

2022-02-08T17:15:17Z

Management

← Revisión anterior		Revisión del 17:15 8 feb 2022
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	==Management==		==Management==
	*Based on exam findings and imaging.		*Based on exam findings and imaging.
	*For sudden sensorineural hearing (~~less than~~ 72 hrs)<ref> Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., … Monjur, T. M. (2019). Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Otolaryngology–Head and Neck Surgery, 161(2), 195–210. https://doi.org/10.1177/0194599819859883</ref>:
	**Every effort should be made to ensure that conductive hearing loss (eg, ruptured tympanic membrane, or congestion of the middle ear or ear canal) is not present by using a tuning fork. Tinnitus, dizziness, and vertigo are common.		===Conductive Hearing Loss===
	**Head CT not routinely necessary, but may be considered for some patients based on individual charateristics.
	**Routine laboratory tests not needed		===Sudden Sensorineural Hearing Loss (<72 hrs)<ref> Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., … Monjur, T. M. (2019). Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Otolaryngology–Head and Neck Surgery, 161(2), 195–210. https://doi.org/10.1177/0194599819859883</ref>:===
	**ENT providers are encouraged to obtain MRI (outpatient)		*Every effort should be made to ensure that conductive hearing loss (eg, ruptured tympanic membrane, or congestion of the middle ear or ear canal) is not present by using a tuning fork. Tinnitus, dizziness, and vertigo are common.
	**'''Steroids should be given within 2 weeks of symptom onset (10- to 14-day treatment)'''		*Head CT not routinely necessary, but may be considered for some patients based on individual charateristics.
	**'''Do not give antivirals, thrombolytics, or vasoactive substances'''		*Routine laboratory tests not needed
			*ENT providers are encouraged to obtain MRI (outpatient)
			*'''Steroids should be given within 2 weeks of symptom onset (10- to 14-day treatment)'''
			*'''Do not give antivirals, thrombolytics, or vasoactive substances'''

	==Disposition==		==Disposition==

Rossdonaldson1: /* Diagnosis */

2020-01-11T15:17:20Z

Diagnosis

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	===Diagnosis===		===Diagnosis===
			*Differentiate between conductive and sensorineural hearing loss

	==Management==		==Management==

Rossdonaldson1: /* Evaluation */

2020-01-11T15:08:16Z

Evaluation

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	==Evaluation==		==Evaluation==
	*Whispered voice test: Stand at arm’s length behind the patient and block hearing in one ear by occluding the ear canal. Whisper a phrase and ask the patient to repeat it. Test both ears.		===Possible Testing===
			====Whispered voice test====
			Stand at arm’s length behind the patient and block hearing in one ear by occluding the ear canal. Whisper a phrase and ask the patient to repeat it. Test both ears.
	*Tone-emitting otoscope: Designed to view the ear canal and TM while emitting three different screening levels at random intervals.		*Tone-emitting otoscope: Designed to view the ear canal and TM while emitting three different screening levels at random intervals.

	===[[Eponyms_(T-Z)#Weber_test\|Weber test]]===		====[[Eponyms_(T-Z)#Weber_test\|Weber test]]====
	*Place a vibrating tuning fork on the forehead, equidistant to both ears		*Place a vibrating tuning fork on the forehead, equidistant to both ears
	*If the patient hears the sound equally in both ears, normal hearing or symmetric hearing loss is suspected.		*If the patient hears the sound equally in both ears, normal hearing or symmetric hearing loss is suspected.
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	*If sound is heard more in unaffected ear → consider sensorineural hearing loss in affected ear		*If sound is heard more in unaffected ear → consider sensorineural hearing loss in affected ear

	===[[Eponyms_(Q-S)#Rinne_test\|Rinne test]]===		====[[Eponyms_(Q-S)#Rinne_test\|Rinne test]]====
	*A vibrating turning fork is placed on the mastoid bone behind the ear. When the sound is no longer heard, the fork is held near the ear canal.		*A vibrating turning fork is placed on the mastoid bone behind the ear. When the sound is no longer heard, the fork is held near the ear canal.
	*If the sound is still present or louder at the ear canal, normal hearing is suspected. (i.e. Air conduction is greater than bone conduction)		*If the sound is still present or louder at the ear canal, normal hearing is suspected. (i.e. Air conduction is greater than bone conduction)
	*If no sound is heard near the ear canal but the sound was still heard on the mastoid bone, conductive hearing loss is suspected in that ear. (i.e. bone conduction > air conduction)		*If no sound is heard near the ear canal but the sound was still heard on the mastoid bone, conductive hearing loss is suspected in that ear. (i.e. bone conduction > air conduction)

	===Hum test===		====Hum test====
	*Hum test comparable to Weber test in diagnostic accuracy of new onset unilateral conductive hearing loss<ref>Ahmed OH et al. Validity of the Hum Test, a Simple and Reliable Alternative to the Weber Test. Ann Otol Rhinol Laryngol. 2018 Jun;127(6):402-405.</ref>		*Hum test comparable to Weber test in diagnostic accuracy of new onset unilateral conductive hearing loss<ref>Ahmed OH et al. Validity of the Hum Test, a Simple and Reliable Alternative to the Weber Test. Ann Otol Rhinol Laryngol. 2018 Jun;127(6):402-405.</ref>
	*Hum test is conducted by asking the patient to hum and tell you in which ear the humming sounds louder		*Hum test is conducted by asking the patient to hum and tell you in which ear the humming sounds louder
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	**In conductive hearing loss, humming is louder in the affected ear		**In conductive hearing loss, humming is louder in the affected ear

	===Pneumoscopy===		====Pneumoscopy====
	*To evaluate mobility of the TM.		*To evaluate mobility of the TM.
	#First, use positive pressure to force air into the EAC to push down the TM.		#First, use positive pressure to force air into the EAC to push down the TM.
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	#*Movable TM only with negative pressure = blocked Eustachian tube.		#*Movable TM only with negative pressure = blocked Eustachian tube.

	===Formal audiologic assessment===		====Formal audiologic assessment====
	*Outside scope of ED evaluation		*Outside scope of ED evaluation
	*Performed by an audiologist in a soundproof environment. Air and bone conduction are both tested.		*Performed by an audiologist in a soundproof environment. Air and bone conduction are both tested.

	===Other tests===		====Other tests====
	''Consideration for these tests should be based on history and physical''		''Consideration for these tests should be based on history and physical''
	*Blood glucose		*Blood glucose
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	*[[brain MRI\|MRI]] for sensorineural hearing loss		*[[brain MRI\|MRI]] for sensorineural hearing loss
	*ENT evaluation for presbycusis		*ENT evaluation for presbycusis

			===Diagnosis===

	==Management==		==Management==

Rossdonaldson1: /* Epidemiology */

2020-01-11T15:05:57Z

Epidemiology

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	===Epidemiology===		===Epidemiology===
	*Most common causes: presbycusis, followed by noise-induced hearing loss		*Most common causes: presbycusis (i.e. natural aging of the auditory system), followed by noise-induced hearing loss
	*90% of cases are due to Sensorineural hearing loss, 10% due to Conductive causes		*90% of cases are due to Sensorineural hearing loss, 10% due to Conductive causes
	*Most bilateral cases that present gradually are benign. Sudden onset, unilateral hearing loss is more concerning for a serious cause.		*Most bilateral cases that present gradually are benign. Sudden onset, unilateral hearing loss is more concerning for a serious cause.

Rossdonaldson1: /* Management */

2020-01-11T15:05:02Z

Management

← Revisión anterior		Revisión del 15:05 11 ene 2020
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	**Head CT not routinely necessary, but may be considered for some patients based on individual charateristics.		**Head CT not routinely necessary, but may be considered for some patients based on individual charateristics.
	**Routine laboratory tests not needed		**Routine laboratory tests not needed
	**ENT providers are encouraged to obtain MRI		**ENT providers are encouraged to obtain MRI (outpatient)
	**'''Steroids should be given within 2 weeks of symptom onset (10- to 14-day treatment)'''		**'''Steroids should be given within 2 weeks of symptom onset (10- to 14-day treatment)'''
	**'''Do not give antivirals, thrombolytics, or vasoactive substances'''		**'''Do not give antivirals, thrombolytics, or vasoactive substances'''

Rossdonaldson1: /* Management */

2020-01-11T15:04:03Z

Management

← Revisión anterior		Revisión del 15:04 11 ene 2020
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	*For sudden sensorineural hearing (less than 72 hrs)<ref> Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., … Monjur, T. M. (2019). Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Otolaryngology–Head and Neck Surgery, 161(2), 195–210. https://doi.org/10.1177/0194599819859883</ref>:		*For sudden sensorineural hearing (less than 72 hrs)<ref> Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., … Monjur, T. M. (2019). Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Otolaryngology–Head and Neck Surgery, 161(2), 195–210. https://doi.org/10.1177/0194599819859883</ref>:
	**Every effort should be made to ensure that conductive hearing loss (eg, ruptured tympanic membrane, or congestion of the middle ear or ear canal) is not present by using a tuning fork. Tinnitus, dizziness, and vertigo are common.		**Every effort should be made to ensure that conductive hearing loss (eg, ruptured tympanic membrane, or congestion of the middle ear or ear canal) is not present by using a tuning fork. Tinnitus, dizziness, and vertigo are common.
	**~~Not order routine head~~ CT but ~~does not preclude the possibility of~~ some patients ~~requiring a CT~~.		**Head CT not routinely necessary, but may be considered for some patients based on individual charateristics.
	**Routine laboratory tests ~~should~~ not ~~be ordered~~		**Routine laboratory tests not needed
	**ENT providers are encouraged to obtain MRI		**ENT providers are encouraged to obtain MRI
	**'''Steroids should be given within 2 weeks of symptom onset (10- to 14-day treatment)'''		**'''Steroids should be given within 2 weeks of symptom onset (10- to 14-day treatment)'''

Rossdonaldson1: /* Management */

2020-01-11T15:02:04Z

Management

← Revisión anterior		Revisión del 15:02 11 ene 2020
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	==Management==		==Management==
	*Based on exam findings and imaging.		*Based on exam findings and imaging.
	*For sudden sensorineural hearing (less than 72 hrs) ~~from American Academy of Otolaryngology 2019 Clinical Practice Guideline~~ <ref> Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., … Monjur, T. M. (2019). Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Otolaryngology–Head and Neck Surgery, 161(2), 195–210. https://doi.org/10.1177/0194599819859883</ref>:		*For sudden sensorineural hearing (less than 72 hrs)<ref> Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., … Monjur, T. M. (2019). Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Otolaryngology–Head and Neck Surgery, 161(2), 195–210. https://doi.org/10.1177/0194599819859883</ref>:
	**Every effort should be made to ensure that conductive hearing loss (eg, ruptured tympanic membrane, or congestion of the middle ear or ear canal) is not present by using a tuning fork. Tinnitus, dizziness, and vertigo are common.		**Every effort should be made to ensure that conductive hearing loss (eg, ruptured tympanic membrane, or congestion of the middle ear or ear canal) is not present by using a tuning fork. Tinnitus, dizziness, and vertigo are common.
	**Not order routine head CT but does not preclude the possibility of some patients requiring a CT.		**Not order routine head CT but does not preclude the possibility of some patients requiring a CT.

Hoxbox: /* Management */

2019-12-19T13:33:39Z

Management

← Revisión anterior		Revisión del 13:33 19 dic 2019
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	==Management==		==Management==
	*Based on exam findings and imaging.		*Based on exam findings and imaging.
			*For sudden sensorineural hearing (less than 72 hrs) from American Academy of Otolaryngology 2019 Clinical Practice Guideline <ref> Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., … Monjur, T. M. (2019). Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary. Otolaryngology–Head and Neck Surgery, 161(2), 195–210. https://doi.org/10.1177/0194599819859883</ref>:
			**Every effort should be made to ensure that conductive hearing loss (eg, ruptured tympanic membrane, or congestion of the middle ear or ear canal) is not present by using a tuning fork. Tinnitus, dizziness, and vertigo are common.
			**Not order routine head CT but does not preclude the possibility of some patients requiring a CT.
			**Routine laboratory tests should not be ordered
			**ENT providers are encouraged to obtain MRI
			**'''Steroids should be given within 2 weeks of symptom onset (10- to 14-day treatment)'''
			**'''Do not give antivirals, thrombolytics, or vasoactive substances'''

	==Disposition==		==Disposition==