Pathophysiology
Conductive hearing loss has been attributed to result from anything that leads to a decrease in the amount of sound transmitted from the outside world into the cochlea. Possible causes include the abnormal formation of the helix or dysfunction of the ossicular chain. Sensorineural hearing loss often results from disruptions in transmission after the cochlea (Isaacson et al., 2018).
Epidemiology
Hearing loss occurs in around 5 to 10 per 1000 children in the United States. About 2 in 1000 children are born with hearing loss and 3-5 in 1000 are born with mild to moderate hearing loss. In adolescents between 12 and 19 years, hearing loss cases have significantly increased among these age groups with reported instances of around 1 in 20. Globally, hearing issues affect 9 to 27 per 1000 children (Shah, 2017).
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Physical Exam Findings
The external ear should be inspected for obstructions, infections, malformations and other lesions. Patients report difficulty in hearing sound irrespective of the hearing loss. However, depending on the condition, certain sounds can be more amplified than others.
Differential Diagnoses and Rationale
Lustig and Smith (2018) suggest the use of the Weber and Rinne tests to differentiate between conductive and sensorineural hearing loss. In the Weber test, a tuning fork at 512 Hz or 1024 Hz is placed on the midline of the head, and the patient determines which ear the tone is amplified. In conductive hearing loss, the sound is usually louder in the ear with the problem, while in the sensorineural loss, the sound is louder in the normal ear. In the Rinne test, a comparison of hearing by bone and by air conduction is compared. Bone conduction tests the integrity of the inner ear. In the sensorineural hearing loss, bone conduction is louder than air conduction.
Management Plan
In the conductive hearing loss, surgery may correct the problem. However, the use of a bone conduction hearing aid can be a solution depending on the degree of the condition. In case of an infection, antibiotics are used to clear the problem. In the sensorineural hearing loss, treatment mostly depends on the progress of the condition. However, surgery and corticosteroids are commonly used across the different cases (Hearing Loss Association of America, 2018).
References
Hearing Loss Association of America. (2018). Types, causes and treatments of hearing loss - the basics. Retrieved from http://www.hearingloss.org/hearing-help/hearing-loss- basics/types-causes-and-treatment/
Isaacson, B., Wick, C. C., Perez, C., Cantrell, S. C., & Killeen, D. E. (2018). Pathophysiology of sensorineural hearing loss in jugular foramen paraganglioma. The Laryngoscope
Lustig, L. R., & Smith, H. W. (2018). Hearing loss - Ear, nose, and throat disorders . Retrieved from https://www.msdmanuals.com/professional/ear,-nose,-and-throat-disorders/hearing- loss/hearing-loss/
Shah, K. R. (2017). Hearing impairment . Retrieved from https://emedicine.medscape.com/article/994159-overview
