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Ototoxicity, Otosclerosis and Otitis Media in Hearing Aid Fitting

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Ototoxicity, Otosclerosis and Otitis Media in Hearing Aid Fitting Ototoxicity, Otosclerosis and Otitis Media in Hearing aid Fitting Kath Woolley M.Sc. North West School of Audiology Definition of Ototoxicity Damage to the ear- cochlea, auditory nerve or sometimes the vestibular system. Drugs Aminoglycosides e.g. Gentamycin ‘Mycin’ Loop Diuretics e.g. Furosemide Chemotherapy Agents e.g. Cisplatin Platinum based Symptoms Discovery of Ototoxicity Adverse Effect of Aminoglycosides Damage to the vestibular system Headache Ear fullness Imbalance Inability to tolerate head movement Problems walking in dark Nystagmus Involuntary rhythmic shaking or wobbling of the eyes Oscillopsia Oscillo- to swing Opsis-vision Objects in sight appear to oscillate Blur Nausea Dizzy Acute Cochlear Damage Tinnitus > 4000 Hz Low frequencies affected later Profound? Loss usually permanent Ototoxicity Process Poorly understood Free Radical Kanamycin, Neomycin, Amikacin toxic to the cochlea Other Ototoxicity Lead Mercury Styrene Manganese Xylene The Risk of Noise and Chemicals Together Noise alone- Risk factor 4.1 Solvent mixture alone- Risk factor 5.0 Noise and Toluene- Risk factor 10 to 27.5 Toluene 2.6 million tons produced annually Variables in Ototoxicity Bilateral, symmetrical, asymmetrical Time of onset Single dose. After completion of course. Monitor hearing for 6 months after. Benefits vs. risks Mouth vs. injection Susceptible Genetic link Prevention of Ototoxicity Aminoglycoside, loop diuretics, chemotherapy, aspirin, quinine – infusion rates, monitor drug levels, kidney history & hearing Daily administration Lowest effective dose Other ototoxic agents High risk- alternatives Avoid noise for 6 months General Monitoring High frequencies affected first- high frequency audiometry No tinnitus monitoring Dizziness Handicap Inventory Ototoxicity and Hearing Aid Fitting Recruitment Tinnitus Frequency selectivity reduced Speech in noise unclear Dead regions Consider hearing aid output What is Otosclerosis? A disorder affecting collagen Cause? Remodelling faulty Oval window/round window Sensory, neural, mixed Gradual Progressive Incidence Hereditary in 70% cases Dominant gene Virus? Unilateral 10-15% Caucasians Present in 10% of pop. Age of onset – approx. 30 years Females Worse in pregnancy Symptoms & Diagnosis Progressive conductive hearing loss Carhart’s notch @ 2 kHz Tinnitus in 4/5 Paracusis Willisi Symptoms & Diagnosis Schwartze’s sign Dizziness in 1/ 4 Weber lateralised to affected ear Sometimes bluish cast over eye whites Difficulty hearing when chewing? Risk Factors & Treatment More common in Hearing aids White & Asian BAHA Women Surgery Age-15 – 35 years Fenestration +ve family history Stapedectomy Drinking non- Stapedotomy fluoridated water- Fluoride therapy very controversial Oestrogen blockers Biphosphonates Possible Complications of Surgery Loss of hearing in 1 in 100 Dizziness Taste disturbance Reaction to ear dressings Tinnitus Considerations of Otosclerosis and Hearing Aid Fitting Type of hearing loss Conductive = more gain REM’s and conductive- careful interpretation NAL- not for conductive losses BSA Guidance on REM’s (2007) Progressive- increase amplification Otitis Media Eustachian tube Otitis Media- inflammation of the middle ear Eustachian tube dysfunction air in middle ear absorbed -ve mep exudate fills up middle ear Acute (Suppurative) Otitis Media Acute – rapid onset following a short but severe course Suppurative- formation of pus or discharge Inflammation of mucous membrane lining middle ear cleft Bacteria Responsible Adenovirus Rhinovirus Pneumococcus Haemophilus Influenzae Streptococcus Staphylococcus Signs TM inflamed, bulging or opaque Purulent ear discharge Perforation Mastoid tenderness Symptoms Pain Temperature Earache Pressure build up Perforation Discharge containing pus escapes Antibiotics Risk Factors Age Adenoids Frequent URTI Prematurity Craniofacial abnormalities Nurseries Poor socio-economic conditions Cold weather Pre-existing middle ear effusion Chronic Suppurative Otitis Media Chronic- long-standing Suppurative – formation of pus or discharge Acute infection Irritation of lining of middle ear infection destroys bone Infection granulation Bacteria responsible Pseudomonas aeroginosa Staphylococcus aureaus Proteus species Klebsiella pneumonia Diptheroids Symptoms: hearing loss; fever; vertigo; pain ‘Safe’Ear and ‘Unsafe Ear’ Perforation in pars Perforation in attic tensa region (pars flaccida) Infection of attic, antrum, No local destruction mastoid Possible cholesteatoma Cholesteatoma Looks like an onion Produces osteolytic enzymes Complications include: Hearing loss Vertigo Headaches Facial nerve palsy Meningitis Epidural abscess Otitis Media with Effusion Effusion-seeping of watery fluid from tissue OME is thick or watery fluid in middle ear with NO infection No pain No fever Unilateral fluid in an Adult requires further investigation Considerations of Otitis Media and Hearing Aid Fitting No active infection Conductive hearing loss and fluctuating Follow up fine tuning appointments Rigidity of TM and presence of fluid increase the risk of feedback Thank you for listening Any questions?.
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