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Approach to the Patient: Disorders of the Sense of Hearing The goal in the evaluation of a patient with auditory complaints is to determine (1) the nature of the hearing impairment (conductive vs. sensorineural vs. mixed), (2) the severity of the impairment (mild, moderate, severe, profound), (3) the anatomy of the impairment (external ear, middle ear, inner ear, or central auditory pathway), and (4) the etiology. The history should elicit characteristics of the hearing loss, including the duration of deafness, unilateral vs. bilateral involvement, nature of onset (sudden vs. insidious), and rate of progression (rapid vs. slow). Symptoms of. | Chapter 030. Disorders of Smell Taste and Hearing Part 11 Approach to the Patient Disorders of the Sense of Hearing The goal in the evaluation of a patient with auditory complaints is to determine 1 the nature of the hearing impairment conductive vs. sensorineural vs. mixed 2 the severity of the impairment mild moderate severe profound 3 the anatomy of the impairment external ear middle ear inner ear or central auditory pathway and 4 the etiology. The history should elicit characteristics of the hearing loss including the duration of deafness unilateral vs. bilateral involvement nature of onset sudden vs. insidious and rate of progression rapid vs. slow . Symptoms of tinnitus vertigo imbalance aural fullness otorrhea headache facial nerve dysfunction and head and neck paresthesias should be noted. Information regarding head trauma exposure to ototoxins occupational or recreational noise exposure and family history of hearing impairment may also be important. A sudden onset of unilateral hearing loss with or without tinnitus may represent a viral infection of the inner ear or a stroke. Patients with unilateral hearing loss sensory or conductive usually complain of reduced hearing poor sound localization and difficulty hearing clearly with background noise. Gradual progression of a hearing deficit is common with otosclerosis noise-induced hearing loss vestibular schwannoma or Meniere s disease. Small vestibular schwannomas typically present with asymmetric hearing impairment tinnitus and imbalance rarely vertigo cranial neuropathy in particular of the trigeminal or facial nerve may accompany larger tumors. In addition to hearing loss Meniere s disease may be associated with episodic vertigo tinnitus and aural fullness. Hearing loss with otorrhea is most likely due to chronic otitis media or cholesteatoma. Examination should include the auricle external ear canal and tympanic membrane. The external ear canal of the elderly is often dry and fragile it is preferable to
