Sensorineural H/LDefination

hearing loss when the cause isCochlea or Auditory nerve

Diagnosis: History/audiological tests

Disability is more with S/N deafness than

conductive deafness WHY. (recruitment and reduce discrimination

Causes:Infections: Viral(Mumps and Measles.Ramsy hunt syndrome.

Bacterial: Supporative Labyrinthitis.(Serous c/f). Syphilis congenital and acquired,progressive hearing loss with very loud Tinitus.VDRL

Presbycusis:degenerative changes in cochlea at basal turn first and neural.

difficulty in understanding speech even loud(loss of high frequency..consonants), in background noise,Recruitment..distortion.poor discrimination and lack of concentration.

Ototoxicity. Aminoglycosides,Aspirin,Diuretics,and cytotoxic drugs,

Ear drops,

Trauma: Perilymph fistula

Noise induced deafness

Acoustic neuroma:

Incidence:common 80% of all CP angle tumor.10% of brain tumor.

Origin Scwan cells of vestibular nerve with in IAM. Growth very slow 1-2 mm/yr..

Classification:a/ Intracanalicular

b/ Small up to 1.5 cm

c/ Medium 1.5 to 4 cm

d/ large over 4 cm

Clinical features:

Age/Sex 40-60 yrs.. male and females

2/Unilateral SNHL +Tinnitus due to pressure on 8th nerve in the canal

3/ Vth Nerve Corneal Reflex

VII Th. nerve Sensory fibers first loss of taste and reduced lacrimation.

IX and X nerve dysphagia and hoarseness Its should be very large tumor ,rare to reach to that size before diagnosis.

Treatment: depend on size of tumor.

Intracanalicular and small 1.5 cm-and in some case Medium can be left alone and observed by yearly MRI , Large needs SURGERY.

Investigation and Management Of SNHL.

History: detailed.

Clinical examination, Otoscope

Cranial nerve :5th Corneal reflex,7th,..

Contd ; Cerebelar function tests,

Unterberger test

Tuning fork tests

PTA.

MRI

Blood investigation

1/ CP and ESR 2/ Random Glucose.3/ Lipid profile.4/ Immune complexes.5/Thyroid function test.6/ VDRL.

Treatment: explain to patient the probable cause of deafness. prognosis

Hearing Aid.

Sudden SNHL: It has been defined for research purposes and has been accepted by most authorities as 30 dB or more sensorineural hearing loss over at least three contiguous audiometric frequencies occurring within 3 days or less.

Etiology 1/ Vascular 2/ Trauma,head injury, 3/barotrauma 4/ perilymph fistula5/ Viral 6/ immune complexes

Treatment: 1/ admit to hospital

2/ investigations

3/ steroid 40-60mg prednisolone, intrtympanic injections

4/inhalation Carbogen.

Question, Define Meniers disease

1/ describe etiology

2/ symptoms

3/ investigation

4/ treatment of Meniers disease.