If a patient presents with the complaint of impaired hearing, your investigations should start with the examination. Visible abnormalities of the structures of the ear can also be responsible for impaired hearing. Only after completing this examination should you proceed with investigating the function of the ear, namely hearing. The hearing examination is an important element in various preventative and social medicine protocols.
Hearing disorders can be caused by defects in the sound-conducting structures of the ear (the auricle, the external auditory meatus, the tympanic membrane and the middle ear). This is known as conductive hearing loss. They can also be caused by defects in the ‘sound-processing’ structures (the cochlea, the 8th cranial nerve and the auditory cortex). In such instances we speak of sensorineural hearing loss.
What is your prediagnosis?
Prediagnosis
Congenital abnormalities
Inflammation
Tumours
Vascular problems
Trauma
Degenerative disorders of the:
– auricle or pinna
– auditory meatus
– middle ear
– inner ear
Allergy
During the history-taking, the following questions should be asked:
General:
- What is the precise nature of the complaint?
In relation to conductive hearing loss:
- Inspection of external auditory meatus
- Possible obstructions by cerumen or a foreign object
- Inflammation
- The tympanic membrane
- Perforations through trauma (being hit, loud bang, cotton bud, knitting needle etc.) or infection (discharge from the ear?)
- Scarring following traumatic perforations, frequent insertion of grommets (tympanostomy tubes), frequent middle ear infections with discharge from the ear
- The middle ear
- Chronic effusions due to dysfunction of the Eustachian tube (breathing with mouth open, drooling, snoring/audible breathing, ‘crackling’ inside the ear when yawning or swallowing, having a chronic cold or allergy)
- Recent cold, perhaps accompanied by earache and fever
- Dizziness
In relation to mild sensorineural hearing loss:
- Age
- Are the symptoms worse in silent surroundings compared to noisy surroundings?
- Exposure to noise
- Use of aminoglycoside antibiotics, anti-malaria agents.
- Dizziness
- Tinnitus / hyperacusis
- Problems with facial sensation (no feeling or tingling sensation etc.)
- Asymmetry of the face that was not there before.