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The Ear: Hearing Loss

Summary table for Differential Diagnosis of Sensorineural Hearing Loss

Condition	Causative agents	Features	Typical audiogram pattern	Mrs J's Pointers!
Age-related hearing loss (presbycusis)	Probably caused by the loss of elasticity of the ossicular chain (the malleus, incus and stapes) through arthritic type changes (otosclerosis) Debris or cerumen impaction in the external auditory meatus can cause a problem. This commonly exacerbates Presbycusis in older people but can be treated by having ears syringed.	Gradual onset	Bilateral high-frequency loss, "downsloping"	This you need to know - loss of high frequency perception (steeper sides to the audiogram pattern curve output) - for both ears (bilateral - on both sides!)
Congenital hearing loss	Genetic factors, prenatal infections/toxic exposures, birth trauma	Present at birth	Variable	Not on syllabus!
Noise-induced hearing loss	Noise exposure	Gradual onset, tinnitus common	Bilateral high-frequency loss, "notch" at 3,000 to 4,000 Hz	Loud music makes you 'age' as far as your hearing goes! The 'notch' at 3/4KHz relates to damage to the ear. It would show up as more dB needed to perceive at that pitch!
Sudden hearing loss	Viral infections, trauma, vascular, drugs	Sudden onset, otologic emergency	Variable; may be unilateral or bilateral	Not on syllabus!
Neoplastic	Acoustic neuroma (vestibular schwannoma), other tumors Usually gradual onset; tinnitus may be present Unilateral loss			Not on syllabus!
Meniere's disease	Unknown (may be endolymphatichydrops)	Fluctuating, progressive hearing loss, tinnitus, vertigo	Low-frequency loss, "upsloping" or flat	Not on syllabus!
Ototoxicity	Chemotherapeutic agents (cisplatin [Platinol], nitrogen mustard), aminoglycosides, furosemide (Lasix), salicylates, quinine	May be accompanied by tinnitus, vertigo, nystagmus	Usually bilateral, symmetric, high frequency (may be very high frequency)	Not on syllabus!
Other	Infections: herpes, meningitis, mumps, syphilis, tuberculosis Systemic disease: vasculitis, renal failure, head injury Genetic factors: idiopathic	Often gradual onset, associated disease	Variable	Not on syllabus!