{"id":351,"date":"2017-03-26T13:10:19","date_gmt":"2017-03-26T13:10:19","guid":{"rendered":"http:\/\/papergp.com\/index.php\/ent\/hearing-loss\/"},"modified":"2023-01-24T11:25:26","modified_gmt":"2023-01-24T11:25:26","slug":"hearing-loss","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/ent\/hearing-loss\/","title":{"rendered":"Hearing loss"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4>Differential diagnosis<\/h4>\n<ul>\n<li>Acoustic neuroma<\/li>\n<li>Presbyacusis (aging)<\/li>\n<li>Noise induced<\/li>\n<li>Trauma<\/li>\n<li>Wax<\/li>\n<\/ul>\n<\/div>\n<p>\u00a0<\/p>\n<div class=\"content-box-blue\">\n<h4>Data gathering<\/h4>\n<ul>\n<li>Red flags\n<ul>\n<li>Sudden onset or rapidly progressing<\/li>\n<li>Localising signs &#8211; facial weakness, facial numbness, unilateral tinnitus<\/li>\n<li>Otalgia and otorrhoea in immunocompromised<\/li>\n<li>Non-resolving otorrhoea<\/li>\n<li>A middle ear effusion unrelated to URTI in a person of Chinese or South-East Asian descent (nasopharyngeal cancer common)<\/li>\n<li>On examination: polyp, posterior or superior perforation, unexplained bleeding<\/li>\n<li>unilateral tinnitus, balance, weight loss<\/li>\n<\/ul>\n<\/li>\n<li>Others\n<ul>\n<li>family history, previous ear problems, trauma, loud sounds<\/li>\n<\/ul>\n<\/li>\n<li>Examine\n<ul>\n<li>Otoscopy<\/li>\n<li>Rinne&#8217;s + Weber&#8217;s (see table below for interpretation of Rinne\/Webers)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>\u00a0<\/p>\n<div class=\"content-box-blue\">\n<h4>Clinical management<\/h4>\n<ul>\n<li>Investigations\n<ul>\n<li>Audiometry<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Explanation\n<ul>\n<li>conductive deafness due failure of structures that conduct sound through outer ear, the eardrum and the bones of the middle ear<\/li>\n<li>sensorineural deafness is due to a problem in the inner ear either where the vibrations are converted to nerve signals or in any part of the brain that then processes these signals<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Treatment\n<ul>\n<li>Hearing aid<\/li>\n<li>ENT<\/li>\n<li>Wax\/antibiotics\/surgery\/cochlear implants<\/li>\n<\/ul>\n<\/li>\n<li>Follow-up \/ Safety net<\/li>\n<\/ul>\n<\/div>\n<p>\u00a0<\/p>\n<div class=\"content-box-blue\"><strong>How quickly should people be referred for a specialist medical opinion?<\/strong><br \/><em>Immediate referral (to be seen within 24 hours)<\/em><\/div>\n<div>\u00a0<\/div>\n<ul>\n<li class=\"content-box-blue\">Sudden hearing loss (\u22643 days) in the past 30 days\u2014Refer to on-call ENT<\/li>\n<li class=\"content-box-blue\">Acquired unilateral hearing loss with ipsilateral fifth or seventh cranial nerve symptoms and signs\u2014Refer to ENT or, if stroke is suspected, follow local stroke referral pathway.<\/li>\n<li class=\"content-box-blue\">Immunocompromised adults with hearing loss, otalgia, and otorrhoea unresponsive to treatment within 72 hours\u2014Refer to ENT.<\/li>\n<\/ul>\n<div class=\"content-box-blue\"><em>Urgent referral (to be seen within 2 weeks)<\/em><\/div>\n<ul>\n<li class=\"content-box-blue\">Sudden hearing loss &gt;30 days ago\u2014Refer to ENT<\/li>\n<li class=\"content-box-blue\">Rapid-onset hearing loss (occurring between 4 and 90 days)\u2014Refer to ENT<\/li>\n<li class=\"content-box-blue\">Middle ear effusion not associated with an upper respiratory tract infection in people of Chinese or South-East Asian family origin\u2014Consider referral to ENT.<\/li>\n<\/ul>\n<div class=\"content-box-blue\"><em>Offer proactive assessment of hearing in specific groups<\/em><\/div>\n<ul>\n<li class=\"content-box-blue\">Because of a high incidence of hearing loss and poor ability to recognise hearing difficulties, consider referring for hearing assessment every two years:\n<ul>\n<li class=\"content-box-blue\">Adults with diagnosed or suspected dementia or mild cognitive impairment.<\/li>\n<li class=\"content-box-blue\">Adults with diagnosed learning disability.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Problem<\/strong><\/td><td><strong>Rinne finding<\/strong><\/td><td><strong>Weber finding<\/strong><\/td><\/tr><tr><td>Normal<\/td><td>AC > BC<\/td><td>Localises to midline<\/td><\/tr><tr><td>Sensorineural<\/td><td>AC > BC<\/td><td><strong>Localises to NORMAL ear<\/strong><\/td><\/tr><tr><td>Conductive<\/td><td><strong>BC > AC<\/strong><\/td><td>Localises to affected ear<\/td><\/tr><\/tbody><\/table><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Differential diagnosis Acoustic neuroma Presbyacusis (aging) Noise induced Trauma Wax \u00a0 Data gathering Red flags Sudden onset or rapidly progressing Localising signs &#8211; facial weakness, facial numbness, unilateral tinnitus Otalgia and otorrhoea in immunocompromised Non-resolving otorrhoea A middle ear effusion unrelated to URTI in a person of Chinese or South-East Asian descent (nasopharyngeal cancer common) &hellip; <a href=\"https:\/\/papergp.com\/index.php\/ent\/hearing-loss\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Hearing loss<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":346,"menu_order":139,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-351","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/351","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=351"}],"version-history":[{"count":10,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/351\/revisions"}],"predecessor-version":[{"id":2533,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/351\/revisions\/2533"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/346"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=351"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}