Patel, MD Gasper, MD, James C. Johnson, MD Blood Disorders Lloyd E. Gastrointestinal Disorders Kenneth R. McQuaid, MD Friedman, MD Breast Disorders Armando E. Roberts, MD Kidney Disease Tonja C. Nervous System Disorders Vanja C. Psychiatric Disorders Kristin S. Endocrine Disorders Paul A. Fitzgerald, MD Lipid Disorders Michael J. Joseph Guglielmo, PharmD Katz, MD Shandera, MD Spirochetal Infections Susan S. Medical interviews do many things.
Used to reach. Treatment options. Interview techniques that avoid clinician domination increase patient involvement in care and patient satisfaction. Effective clinician-patient communication and increased patient involvement can improve health outcomes. Conductive hearing loss results from external or middle ear dysfunction. Four mechanisms each result in impairment of the passage of sound vibrations to the inner ear: 1 obstruction eg, cerumen impaction , 2 mass loading eg, middle ear effusion , 3 stiffness eg, otosclerosis , and 4 discontinuity eg, ossicular disruption.
Conductive losses in adults are most commonly due to cerumen impaction or transient eustachian tube dysfunction from upper respiratory tract infection. Persistent conductive losses usually result from chronic ear infection, trauma, or otosclerosis. Conductive hearing loss is often correctable with medical or surgical therapy, or both. Sensory hearing loss results from deterioration of the cochlea, usually due to loss of hair cells from the organ of Corti. The most common form is a gradually progressive, predominantly high-frequency loss with advancing age presbyacusis ; other causes include excessive noise exposure, head trauma, and systemic diseases.
Sensory hearing loss is usually not correctable with medical or surgical therapy but often may be prevented or stabilized. An exception is a sudden sensory hearing loss, which may respond to corticosteroids if delivered within several weeks of onset. Neural hearing loss lesions involve the eighth cranial nerve, auditory nuclei, ascending tracts, or auditory cortex.
Neural hearing loss is much less commonly recognized. Causes include acoustic neuroma, multiple sclerosis, and auditory neuropathy. In a quiet room, the hearing level may be estimated by having the patient repeat aloud words presented in a soft whisper, a normal spoken voice, or a shout. A Hz tuning fork is useful in differentiating conductive from sensorineural losses. In the Weber test, the tuning fork is placed on the forehead or front teeth. In conductive losses, the sound appears louder in the poorer-hearing ear, whereas in sensorineural losses it radiates to the better side.
In the Rinne test, the tuning fork is placed alternately on the mastoid bone and in front of the ear canal. In conductive losses greater than 25 dB, bone conduction exceeds air conduction; in sensorineural losses, the opposite is true. Formal audiometric studies are performed in a soundproofed room. Pure-tone thresholds in decibels dB are obtained over the range of — Hz for both air and bone conduction.
Conductive losses create a gap between the air and bone thresholds, whereas in sensorineural losses, both air and bone thresholds are equally diminished. If you feel that we have violated your copyrights, then please contact us immediately. Your email address will not be published. Save my name, email, and website in this browser for the next time I comment. Mohammad lnam Danish is one of the pioneers in the field of medical writing in Pakistan in the sophomore year of MBBS, he published a handbook on Physiology which was greatly appreciated by the students and the faculty alike.
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