otology review conductive hearing loss...conductive hearing loss quinton gopen , m.d. ucla medical...
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Otology ReviewConductive Hearing Loss
Quinton Gopen , M.D.UCLA Medical Center
October 26th, 2011
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Case 1• 42y.o. woman with bilateral hearing loss
– Slowly progressive– No history of ear infections, trauma– No dizziness but has tinnitus
– Exam:• Tympanic membrane is normal• Tuning fork flipped bilaterally
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Audiogram
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Case 1
• What is your diagnosis?
• What is Schwartze sign?
• What are your treatment options?
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Audiogram
23
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Case 1
• How does this change your treatment options?
• What would the finding on a CT scan be?
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Case 2
• 5y.o. girl fails her school screening test– Failed her newborn screen as well– No h/o ear infections– some speech and language delay– No dizziness or other complaints
• Walked at 11months
– Exam: normal ear drum
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WRS100%Both ears
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Case 2
What is your differential diagnosis at this point?
What other tests do you want?
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Case 2
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Case 2
What are your management options?
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Case 2
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Case 2
• What are your management options?
• How do you address malleus fixation surgically?
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Case 3• A 7y.o. boy with unilateral hearing
loss– Has had many ear infections and 3 prior
sets of ear tubes– Ear exam:
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Case 3Multiple ear infections and prior ear tubes
Ear Exam:
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Case 4
• 12 y.o. girl with unilateral hearing loss– Ear pain and drainage for one year– Never had ear surgery– No dizziness, balance issues
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Case 4
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Case 4
• What are some complications of this condition?
• What is your management of this condition?
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Complications• Extracranial
– Conductive hearing loss
– Sensorineural hearing loss
– Facial paralysis– Vertigo– Subperiosteal
abscess– Petrous apicitis– Labyrinthine fistula– Bezold’s abscess– Cutaneous fistula
• Intracranial
– Meningitis– Encephalocele– Epidural, subdural or
intracerebral abscess– Lateral sinus
thrombosis– Otitic hydrocephalus– Cerebrospinal fluid
leak
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Case 5• A 2 year old boy has hearing loss
– Failed newborn screen– Walked at 18 months– No significant ear infection– Exam is normal
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125 250 500 1000 2000 4000 8000750 1500 3000 6000
-10
0
10
20
30
40
50
60
70
80
90
100
120
FREQUENCY IN HERTZ (Hz)H
EAR
ING
LEV
EL (H
L) IN
DEC
IBEL
S (d
B)
-20
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Case 5
• What is your management of this condition?
• What further tests can be ordered to clinch the diagnosis?
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VEMP Waveforms
0 5 10 15 20 25 30 35
ms0 5 10 15 20 25 30 35
ms
90 dB nHL
80 dB nHL
70 dB nHL
60 dB nHL
50 dB nHL
45 dB nHL
90 dB nHL
80 dB nHL
75 dB nHL
70 dB nHL
P1 P1
N1
N1