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Home , Ototoxicity

Ototoxicity, Otosclerosis and in Fitting

Kath Woolley M.Sc. North West School of Audiology Definition of Ototoxicity

 Damage to the - , auditory nerve or sometimes the . Drugs

e.g. Gentamycin ‘Mycin’

 Loop Diuretics e.g.

Agents e.g. 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

 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

 > 4000 Hz  Low frequencies affected later  Profound?  Loss usually permanent Ototoxicity Process

 Poorly understood Free Radical

 Kanamycin, , toxic to the cochlea Other Ototoxicity

Lead Manganese The Risk of Noise and Chemicals Together  Noise alone- Risk factor 4.1

mixture alone- Risk factor 5.0

 Noise and - 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

, loop diuretics, chemotherapy, , – 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  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/  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

 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  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  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; ; 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

 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?