Sense of hearing connects people socially. Any impairment in this
sense results in significant social handicap and reduces quality of life of
individuals. It is a common problem affecting the young and the old. Hence
it is essential to promptly and correctly evaluate patients in all age groups
with suspected hearing loss and provide them with the best treatment
available.
Hearing loss can be conductive when there is obstruction in
conduction of sound from external environment to inner ear. It can be due
to problems in external ear like anotia, microtia, external auditory canal
stenosis, atresia, impacted cerumen, wax keratosis and myringosclerosis.
Hearing loss can also be due to conditions of middle ear like otitis media
with effusion, chronic otitis media with ossicular erosions, otosclerosis and
ossicular discontinuity secondary to causes like trauma.
Hearing loss can
also be sensorineural as in presbycusis, Meniere's disease, post traumatic
and noise induced hearing loss, ototoxicity and vestibular schwannomas,
post infectious viral cause and idiopathic causes, which are not well defined.
Such types of hearing loss may be associated with disturbing symptom of
tinnitus, which also needs careful understanding, evaluation and treatment
or rehabilitation. Hearing loss can also be secondary to tumours occluding
external ear or middle ear like glomus tympanicus, which is accompanied
by symptom of pulsatile tinnitus, and other rare temporal bone
malignancies
Hearing loss should be evaluated in a well-planned manner giving
significance to the age of the patient. In a young child early recognition of
hearing loss is very important since it provides means for speech and
communication in future life. The main concern in a child with delayed
speech development is the presence of good hearing.
Hearing loss in a child
that needs immediate treatment is otherwise called permanent childhood
hearing impairment which needs surgery/ auditory rehabilitation at the
earliest. It can be congenital or can be secondary to infections immediate
post partum or ototoxicity. Thorough evaluation of childhood hearing loss
should be done by otoendoscopy and audiologic test battery which includes
universal screening by OAE, impedance audiometry and confirmation of
hearing loss by BERA and advanced audiometric analysis by ASSR.
Audiometric testing by trained personnel in suitable test environments is
essential to pick up the cause of hearing loss
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