De La Salle School
12A
MediLife+
Points of Interest:
Otitis
Otosclerosis
Meniere’s Disease
Congenital Hearing Loss
Presbycusis
Hearing Diseases
Otitis Media What is Otitis Media? Otitis media refers to inflammation of the middle ear. When infection occurs, the condition is called "acute otitis media." Acute otitis media occurs when a cold, allergy, or upper respiratory infection, and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the Eusta-
chian tube. This causes for weeks to many months. When a earache and swelling. discharge from the ear persists or reWhen fluid forms in peatedly returns, this is sometimes cathe middle ear, the lled chronic middle ear infection. Fluid condition is known as can remain in the ear up to three weeks "otitis media with effusion." This occurs in a recovering ear infection or when one is about to occur. Fluid can remain in the ear
Care Tips
Avoid pools
Take preventive antibiotics
Symptoms
Children
Ear pain, especially when lying down Tugging or pulling at an ear
usual
Headache
Difficulty hearing or responding to sounds
Loss of appetite
Adults
Ear pain
Drainage of fluid from the ear
Diminished hearing
Loss of balance
Difficulty sleeping
Fever of 100 F (38 C) or higher
Crying more than usual
Drainage of fluid from the ear
Acting more irritable than
Hearing Diseases
Otitis Media and Hearing Problems If not treated, chronic ear infections have potentially serious consequences such as temporary or permanent hearing loss. All children with middle ear infection or fluid have some degree of hearing loss.
level of the very softest of whispers.) Thicker fluid can cause much more loss, up to 45 decibels (the range of conversational speech).
The average hearing loss in ears with fluid is 24 decibels...equivalent to wearing ear plugs. (Twentyfour decibels is about the
unable to understand certain words and speaks louder than normal. Essentially, a child experiencing hearing loss from
Your child may have hearing loss if he or she is
middle ear infections will hear muffled sounds and misunderstand speech rather than incur a complete hearing loss. Even so, the consequences can be significant – the young patient could permanently lose the ability to consistently understand speech in a noisy environment (such as a classroom) leading to a delay in learning important speech and language skills.
Treatment and Recovery
Antibiotics
Antibiotics aren't routinely used to treat middle ear infections as there's no evidence that they speed up the healing process. Many cases are caused by viruses, which antibiotics aren't effective against. If antibiotics are needed, a five-day course of an antibiotic called amoxicillin is usually prescribed. This is often given as a liquid. Adults and children who develop a longterm middle ear infection (chronic suppurative otitis media) may benefit from short courses of antibiotic ear drops.
Grommets
For children with recurrent severe middle ear infections, tiny tubes may be inserted into the eardrum to help drain fluid. Grommets are inserted under general anaesthetic. The procedure usually only takes about 15 minutes . A grommet helps keep the eardrum open .As the eardrum starts to heal, the grommet will slowly be pushed out of the eardrum and eventually falls out. .
Testimony When I was a young child I had reocuring otitis media which lead to hearing loss at the age of 4. Medicines had a hard time dealing with the amount of pain and infection so I had surgery to deal with it. 13 years later I recoverd almost all my hearing and can live a normal life. Marie C. Diaz-G.
Hearing Diseases
Otosclerosis Otosclerosis or otospongiosis is an abnormal growth of bone near the middle ear. It can result in hearing loss. The term otosclerosis is somewhat of a misnomer. Much of the clinical course is characterised by lucent rather than sclerotic bony changes and hence why it is also known as otospongiosis.
Causes It may be that a genetic tendency to develop otosclerosis is inherited by some people. Then a trigger, such as a viral infection (like measles), actually causes the condition to develop. The disease can be considered to be hereditary, but its penetrance and the degree of expression is so highly variable that it may be difficult to detect an inheritance pattern.
Symptoms Gradual hearing loss is the most frequent symptom of otosclerosis. Often, individuals with otosclerosis will first notice that they cannot hear low-pitched sounds or whispers. Other symptoms of the disorder can include dizziness, balance problems, or a sensation of ringing, roaring, buzzing, or hissing in the ears or head known as tinnitus.
Hearing Diseases
Diagnosis Because many of the symptoms typical of otosclerosis can be caused by other medical conditions, it is important to be examined by an otolaryngologist (ear, nose and throat doctor) to eliminate these other causes. After an examination, the otolaryngologist may
order a hearing test. The typical finding on the hearing test is a conductive hearing loss in the low frequency tones. This means that the loss of hearing is due to an inability of the sound vibrations to get transferred into the inner
Treatment Falls under three heads : medical, surgical and amplification.
Medical treatment
Sodium fluoride is the preferred compound. Fluoride ions inhibit the rapid progression of disease. In the otosclerotic ear, there occurs formation of hydroxylapatite crystals which lead to stapes fixation. The adminisear. Based on the retration of fluoride replaces the sults of this test and hydroxyl radical with fluoride leading the exam findings, the to the formation of fluorapatite crysdiagnosis of otosclerotals. Hence, the progression of diseasis can be made. The se is considerably slowed down and otolaryngologist will active disease process is arrested. suggest treatment opThis treatment cannot reverse contions. ductive hearing loss, but may slow the progression of both the conductive and sensorineural components of the disease process. Otofluor, containing sodium fluoride, is one treatment.
Surgical Treatment
Stapedectomy. A stapedectomy consists of removing a portion of the
sclerotic stapes footplate and replacing it with an implant that is secured to the incus. This procedure restores continuity of ossicular movement and allows transmission of sound waves from the eardrum to the inner ear. A modern variant of this
Amplification Although hearing aids cannot prevent, cure or inhibit the progression of otosclerosis, they can help treat the largest symptom, hearing loss. Hearing aids can
surgery called a stapedotomy, is performed by drilling a small hole in the stapes footplate with a micro-drill or a laser, and the insertion of a piston-like prothesis.
by tuned to specific frequency losses. However, due to the progressive nature of this condition, use of a hearing aid is palliative at best. Without eventual surgery, deafness is likely to result.
Hearing Diseases
Meniere’s Disease Meniere's disease is a disorder of the inner ear that causes episodes in which you feel as if you're spinning (vertigo), and you have fluctuating hearing loss with a progressive, ultimately permanent loss of hearing, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear. In most cases, Meniere's disease affects only one ear. Meniere's disease can occur at any age, but it usually starts between the ages of 20 and 50. It's considered a chronic condition, but various treatments can help relieve symptoms and minimize the long-term impact on your life Care Tips During attacks you should: rest, lie down and try not to lose your balance.
Diagnosis One of the main difficulties in studying this disorder is that is no “hard” medical test, such as a blood test, for the disease. The most important data is the person’s sym-
ptoms. Meniere’s disease is usually characterized 4 symptoms:
Tinnitus
A sensation of "fullness" or pressure in the ear
Periodic episodes Meniere’s Disease is one of rotatory vertigo or of the most overdizziness. diagnosed disorders in Fluctuating, promedicine. By definition, a gressive, lowperson does not suffer frequency hearing from this disorder unless loss all of the symptom criteria are met.
Hearing Diseases
Treatments The analogy that is often applied to Meniere’s Disease is that of a twin engine airplane flying. As long as both engines are running the plane flies straight. If one engine fails the plane starts to spin until the pilot compensates and straightens the aircraft back to level flight. The problem occurs if there is a “sputtering engine” that turns on and off intermittently. The pilot does not have a chance to correct the situation and the airplane continues to rotate. The remedy is to stop the engine completely so that a stable situation is achieved. A Meniere’s ear is very similar to a sputtering engine. Normally both ears provide equal and opposite signals to the brain. A Meniere’s ear sends inconsistent (sputtering) signals to the brain. One of the main treatments for Meniere’s Disease is to weaken or shut down that sputtering engine.
Diet and drugs: Meniere’s Disease is initially treated conservatively with a salt restriction diet and diuretics. Patients are asked to main-
tain an intake of about 3gms per day of salt. The absolute number does not seem to be as important as is maintaining a steady level of intake from day to day. A diuretic such as Dyazide is routinely prescribed. Seventy five percent of all patients that are treated conservatively have a significant decrease in vertigo episodes.
Menniett Device: This is a small air pump that delivers slow puffs of air against the eardrum. The patient must use the device three to four times a day in treatments that last about five minutes. A ventilation tube must be inserted through the eardrum and maintained so that the pressure waves can act on the inner ear during treatment. The Meniette has seen some success and popularity in Europe. The exact mechanism of action has not been discovered and good placebo controlled studies have not been done to document effectiveness of the Testimony treatment.
My name is Gerry Leeper. I have Ménière’s disease. With Ménière’s you get things which I know now are called ‘drops’ where you can be walking along and you just suddenly drop and you’re dizzy and lying on the ground and you do not know how you got there.’
Hearing Diseases
Congenital Hearing Loss Congenital hearing loss is a hearing loss present at birth. It can include hereditary hearing loss or hearing loss due to other factors present either in-utero (prenatal) or at the time of birth. Congenital hearing loss can be caused by genetic or nongenetic factors.
Causes: Nongenetic factors (25% of this ring loss can be described as auhearing loss). Includes: tosomal recessive or autosomal Maternal infections, mater- dominant. A rarer type of genetic nal diabeter or toxins con- hearing loss include X-linked (related to the sex chromosome) sumed by the mother
Prematurity and low birth weight
Birth injuries
Complications associated with the Rh factor
In autosomal recessive hearing loss, both parents carry the recessive gene and pass it along to the
child (70% of all genetic hearing loss). An autosomal dominant hearing loss occurs when an ab Toxemia during pregnancy normal gene from one parent is able to cause hearing loss even Lack of oxygen (anoxia) though the matching gene from Genetic factors (more than 50% the other parent is normal. The of all hearing loss). Hearing loss parent who is carrying the domifrom genetic defects can be nant gene may also have hearing present at birth or develop laloss as well as other signs and ter on in life. Most genetic heasymptoms that make up a genetic
syndrome. The autosomal dominant pattern accounts for 15% of all genetic hearing loss cases. Genetic syndromes have a group of signs and symptoms that together indicate a specific disease. There are many genetic syndromes that include hearing loss as one of the symptoms.
Down syndrome
Usher syndrome
Treacher Collins syndrome
Crouzon syndrome
Alport syndrome
Hearing Diseases
Treatment A child with a congenital hearing loss should begin receiving treatment before 6 months of age. Children treated this early are usually able to develop communication skills that are as good as those of hearing peers. There are a number of treatment options available, and parents will need to decide which are most appropriate for their child. They will need to consider the child’s age, developmental level and personality, the severity of the hearing loss, as well as their own preferences. Treatment plans can be changed as the child gets older.
is going to communicate orally (speech), s/he may need assistance learning listening skills and lip reading skills to help her/him understand what others are saying. Many children with hearing loss also need speech or language therapy. A child also can learn to communicate using a form of sign language. There is also a visual model of spoken language called cued speech. Cued speech enables young children with hearing loss to clearly see what is being said, and learn spoken languages with normal grammar and vocabulary.
ear, or by repeated ear infections. (See Otitis Media) A device called a cochlear implant can be surgically inserted in the inner ear of children as young as 12 months of age to stimulate hearing.
The type of intervention required depends on several factors. Chief among these is the degree of impairment. When a child has a fair degree of residual hearing, the correct intervention would be fitting "optimised" hearing aids. "Optimisation" means fitting the child with a hearing aid appropriate to its degree of deafness.
Children as young as 4 weeks of age can benefit from a hearing aid. These devices amplify sound, Surgery may be recommenmaking it possible for many chil- ded if a child has a permanent condren to hear spoken words and ductive hearing loss caused by maldevelop language. However, so- formations of the outer or middle me children with severe to profound hearing loss may not be able to hear enough sound, even with a hearing aid, to make speech audible. A behind-the-ear hearing aid is often recommended for young children because it is safer and more easily fitted and adjusted as the child grows. Parents also will need to decide how their family and child are going to communicate. If the child
Testimony
Dr. Magteld Smith. Dr. Smith was born with congenital deafness and has since gone on to spend 20 years researching how to give more people with deafness and hearing loss access to a wider array of rehabilitation options. She has a Ph.D in the cost of disabling hearing impairment in South Africa, and her current research genetic testing for congenital deafness and hearing loss with associated syndromes.
Hearing Diseases
Presbycusis
Presbycusis is the loss of hearing that gradually occurs in most individuals as they grow older. Hearing loss is a common disorder associated with aging. About 30-35 percent of adults between the ages of 65 and 75 years have a hearing loss. The loss associated with presbycusis is usually greater for high-pitched sounds. For example, it may be difficult for someone to hear the nearby chirping of a bird or the ringing of a telephone. However, the same person may be able to hear clearly the low-pitched sound of a truck rumbling down the street.
Causes There are many causes of presbycusis. Most commonly it arises from changes in the inner ear of a person as they age, but presbycusis can also result from changes in the middle ear or from complex changes along the nerve pathways leading to the brain. Presbycusis most often occurs in both ears, affecting them equally. Because the process of loss is gradual, people who have presbycusis may not realize that their hearing is diminishing. Sensorineural hearing loss is caused by disorders of the inner ear or auditory nerve. Presbycusis is usually a sensorineural hearing disorder. The cumulative effects of repeated exposure to daily traffic sounds or construction work, noisy offices, equipment that produces noise, and loud music can cause sensorineural hearing loss. Sensorineural
hearing loss is most often due to a loss of hair cells This can occur as a result of hereditary factors as well as aging,
or severe.
Sometimes presbycusis is a conductive hearing disorder, meaning the loss of sound sensitivity is caused Presbycusis may be caused by abnormalities of the by changes in the blood outer ear and/or middle ear. supply to the ear because of Such abnormalities may inheart disease, high blood clude reduced function of pressure, vascular conditions the tympanic membrane or caused by diabetes, or other reduced function of the oscirculatory problems. The sicles. loss may be mild, moderate,
Hearing Diseases
What can be done? Much of the hearing loss caused by noise exposure can be prevented. Awareness of potential sources of damaging noises, such as firearms, snowmobiles, lawn mowers, leaf blowers, woodworking machinery and loud appliances is important. Ear plugs or special fluid-filled ear muffs can give protection and should be worn to help avoid the possibility of damage to hearing. Excessively loud everyday noises, both at home and at work, can pose a risk to a
person’s hearing. Avoiding loud noises and reducing the amount of time one is exposed to everyday noises may be helpful. There are many strategies to help people with presbycusis. Hearing aids may be recommended for some individuals. Assistive listening devices can provide further improvement in hearing ability in certain situations. One example of such a devi-
ce is the built-in telephone amplifier. Another example is FM systems that make sounds clearer, with or without a hearing aid, by delivering sound waves like a radio. Training in speechreading (using visual cues to determine what is being spoken) can help those with presbycusis to understand better what is being said in conversations or presentations.
Comunication Tips
Face the person
Be in a well lit area. This allows a person with a hearing impairment to observe facial expressions, gestures, and lip and body movements that provide communication clues.
Speak slightly louder than normal.
Rephrase your statement into shorter, simpler sentences if it appears you are not being understood.
Hearing Diseases
Marie Claire Diaz-Gomez Bravo #11 Oscar Luis Lopez #15
How is a hearing aid selected? Consultation with specially trained professionals who work as a team is important for evaluation of a hearing loss and selection of appropriate management. An otolaryngologist (ear, nose and throat specialist) should evaluate the individual with a hearing problem to make the diagnosis and exclude related systemic disorders that may contribute to the problem. An audiologist is a professional who measures the hearing and identifies the type of hearing loss. The audiologist conducts a complete hearing evaluation and determines if a hearing aid may be useful. The individual is counseled about how a hearing aid may improve listening situations. Then the audiologist conducts tests to find an appropriate aid, selecting one that maximizes a person’s hearing and understanding of speech. Most older adults with hearing loss can benefit from using a hearing aid, although the degree of benefit may vary according to the type and amount of hearing loss.