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conductive hearing loss

Etiology: 1) acute otitis media: most common cause of acquired hearing loss, especially in children 2) impacted cerumen (most common in nursing home residents) 3) foreign body 4) chronic (serous) otitis media: - immobility of tympanic membrane 5) otitis externa 6) perforation of tympanic membrane (TM) - TM needed for sound transduction to mechanical impulses 7) otosclerosis a) fixation of stapes over oval window b) prevents propagation of mechanical impulse to inner ear c) present in 10% of autopsies d) conductive hearing loss (low-frequency range)[6] 8) exostoses a) bony outgrowths in the external auditory canal b) repetitive exposure to cold water 9) developmental defects a) canal atresia - Treacher Collins syndrome b) malformation of the ossicles 10) tumors - middle ear mass effect a) glomus tumors b) cholesteoma 11) Paget's disease 12) Eustachian tube obstruction [6] 13) age-related thickening of the tympanic membrane with loss of elasticity & efficiency of ossicle articulation [6] 14) osteoarthrits is a risk factor in older adults [6] Pathology: - decreased hearing acuity resulting from a mechanical defect in transmission of sound between the eardrum & oval window (tissue dividing the middle & inner ears). - thickening of tympanic membrane - described as decreased efficiency of ossicular articulations [6] - exacerbation by otosclerosis - bone conduction > air conduction - these deficits are generally reversible Clinical manifestations: - predominantly affects low frequency sounds Special laboratory: - audiography - Weber test & Rinne test Differential diagnosis: - hearing loss accompanied by ear pain & drainage is more likely to be conductive hearing loss - hearing loss associated with dizziness &/or vertigo or tinnitus is more likely to be sensorineural hearing loss [5] Management: 1) treatment of underlying disorder (deficits generally reversible) - referral to otolaryngologist for evaluation [6] 2) amplification - bone-anchored hearing aid may be appropriate [6] - referral to otolaryngologist for evaluation 1st [6]

Related

exostosis; hyperostosis; osteoma; osteoncus otitis media otosclerosis Paget's disease of the bone; osteitis deformans

General

hearing loss (hearing impairment, hard of hearing, HOH)

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 42-44
  3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 392, 407
  4. Mangione C. In: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  5. Medical Knowledge Self Assessment Program (MKSAP) 15, 18 American College of Physicians, Philadelphia 2009, 2018
  6. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  7. McColgan P, Tabrizi SJ. Huntington's disease: a clinical review. Eur J Neurol. 2018 Jan;25(1):24-34. PMID: 28817209 Review.