Diseases, Disorders information

Conductive hearing loss: can be either acquired or inherited. Acquired is much more common. Tends to be transient and is often mild to moderate hearing loss. Most often due to things like earwax or sometimes middle ear effusion. If you see more significant loss or a more chronic loss, it’s generally caused by damage to the tympanic membrane and/or the ossicles. So things like chronic perforation, which we mentioned before, cholesteatoma, otosclerosis, or more seriously ossicular chain disruptions, will lead to serious conductive hearing losses. Some inherited forms that are worth mentioning: they generally present – and these again are conductive hearing losses – often present with major ear anomalies. Goldenhar’s is a nice syndrome to be aware of. Treacher-Collins as well, and then Down’s syndrome can have conductive hearing losses as well.
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Sensorineural hearing losses can be acquired or inherited. The acquired ones may be infectious so TORCH infections in newborns, particularly Rubella, can cause sensorineural hearing loss. Bacterial meningitis, especially H. flu can cause hearing loss. And then medications, aminoglycosides, diuretics are two of the most notorious but there are others as well. And then generally not a problem in kids but maybe later on, certainly for “baby-boomers”, is a problem of acoustic trauma from listening to loud music can eventually lead to sensorineural hearing loss. Inherited forms, many many different syndromes that will cause sensorineural hearing loss. Two that are probably worth mentioning and remembering. First is Alport’s, which is hearing loss and glomerulonephritis. Those two in combination are strongly suggestive of Alport’s, and then Waardenburg’s syndrome, which is partial albinism, sometimes just presenting as a white forelock and deafness may also be present with Waardenburg’s.
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Finally, in the last section we will talk a little about audiologic evaluation and tympanometry. Pure tone audiometry is just basically putting a pure tone through earphones and trying to hear at what decibel level a child can hear those tones. With conductive hearing loss you have a particular pattern, which is; air conduction is abnormal, bone conduction is normal. The pattern of loss that you see is usually fairly equal across frequencies, in contrast to sensorineural hearing loss which has a different pattern. Sensorineural hearing loss; air conduction is abnormal, bone conduction is abnormal and the pattern of loss is usually there are higher thresholds or greater deficits at higher frequencies. So that’s one thing that is generally suggestive of sensorineural hearing loss is that if you have significantly more loss at higher frequencies. You’ve got to be a little bit careful because some conductive loss – say with middle ear effusion – it may be a little worse at the higher frequencies but it shouldn’t be a dramatic difference.
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