Hearing impairment medical therapy: Difference between revisions

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Latest revision as of 09:21, 10 May 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

Medical therapy includes removal of impacted cerumen via irrigation, manually, cerumenolytics, and under microscopy. Sudden onset SNHL can be treated with a single dose of steroids.

Medical Therapy^[1]

Medical treatment includes the use of antivirals, steroids, and antibiotics. Antivirals have been used in cases caused by viral infection.


Virus	Medical Therapy
Congenital CMV infection	Ganciclovir (administered intravenously)
HSV-1	Acyclovir

antibiotics should be considered if symptoms of Otitis media in patients, do not improve in 3 days and/or they experience severe symptoms with high grade fever.

Cerumen impaction

Method 1. Cerumenolytics^[2]

3-5 drops of cerumenolytics are used 3 times/day to decrease impaction by lubrication and softening of earwax (oil-based) and/or fragmentation of skin cells within cerumen (water-based). It is a cheap and effective way to remove wax with minimal side effects.
Cerumenolytics must be cautiously used in patients with tympanic membrane perforation, rupture, or any active infections of the ear canal and eardrum.


Water-based cerumenolytics	Oil-based cerumenolytics
Acetic acid,	Mineral oil
Hydrogen peroxide,	Debrox
Cerumenex
Murine

Method 2. Irrigation

Aural irrigation with water in patients is another effective method for wax removal. Irrigation with water is avoided in diabetic patients or use acidifying solutions after water irrigation.

Method 3. Manual extraction

An otolaryngologist manually extracts wax from the ear canal under otoscopic observation. A Stenosed ear canal due to a history of radiations to the head and neck or any trauma to the head can complicate the procedure.

Method 4. Vacuum extraction

Method 5. Extraction under binocular microscopy

Idiopathic sudden sensorineural hearing loss:^[3]^[4]

Sudden hearing loss is a serious symptom that often requires an urgent visit to the hospital.
Firstly address distinguishing sensorineural hearing loss from conductive hearing loss at the time of presentation with hearing loss in a hospital setting. It can be done through weber and/or Rinne test or audiometry.

First-line treatment with oral steroids like Prednisone should be started within 14 days of symptoms onset.
Prednisone prescribed at 1 mg/kg of body weight per day at a maximum dose of 60 mg/d for 7–14 days, followed by tapering over a similar period. Prednisone has an anti-inflammatory effect and must be used cautiously in diabetic patients because of its effect on blood glucose. The time to treatment is definite and emphasized.
Another option for patients experiencing side effects with oral steroids is intratympanic steroids injections like dexamethasone but there's a risk for tympanic membrane perforation.
Hyperbaric oxygen therapy remains an option but only when combined with steroid therapy for oral or intratympanic initial treatment.
Antioxidants were removed from the list of treatments as they carry no clear-cut benefit.
Follow-up audiometry at end of treatment and also within 6 months posttreatment is added to reassess any residual or reoccurrence of hearing loss.

References

↑ Nieman CL, Oh ES (2020). "Hearing Loss". Ann Intern Med. 173 (11): ITC81–ITC96. doi:10.7326/AITC202012010. PMID 33253610 Check |pmid= value (help).
↑ Schwartz SR, Magit AE, Rosenfeld RM, Ballachanda BB, Hackell JM, Krouse HJ; et al. (2017). "Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)". Otolaryngol Head Neck Surg. 156 (1_suppl): S1–S29. doi:10.1177/0194599816671491. PMID 28045591.
↑ Nieman CL, Oh ES (2020). "Hearing Loss". Ann Intern Med. 173 (11): ITC81–ITC96. doi:10.7326/AITC202012010. PMID 33253610 Check |pmid= value (help).
↑ Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA; et al. (2019). "Clinical Practice Guideline: Sudden Hearing Loss (Update)". Otolaryngol Head Neck Surg. 161 (1_suppl): S1–S45. doi:10.1177/0194599819859885. PMID 31369359.

[pmid33253610-1] Nieman CL, Oh ES (2020). "Hearing Loss". Ann Intern Med. 173 (11): ITC81–ITC96. doi:10.7326/AITC202012010. PMID 33253610 Check |pmid= value (help).

[pmid28045591-2] Schwartz SR, Magit AE, Rosenfeld RM, Ballachanda BB, Hackell JM, Krouse HJ; et al. (2017). "Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)". Otolaryngol Head Neck Surg. 156 (1_suppl): S1–S29. doi:10.1177/0194599816671491. PMID 28045591.

[pmid332536102-3] Nieman CL, Oh ES (2020). "Hearing Loss". Ann Intern Med. 173 (11): ITC81–ITC96. doi:10.7326/AITC202012010. PMID 33253610 Check |pmid= value (help).

[pmid31369359-4] Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA; et al. (2019). "Clinical Practice Guideline: Sudden Hearing Loss (Update)". Otolaryngol Head Neck Surg. 161 (1_suppl): S1–S45. doi:10.1177/0194599819859885. PMID 31369359.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-Please help WikiDoc by adding more content here.  It's easy!  Click  [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
-{{AB}}
 {{Hearing impairment}}
+{{CMG}} {{AE}}
+==Overview==
+Medical therapy includes removal of impacted [[cerumen]] via [[Irrigation tank|irrigation]], [[Manual vacuum aspiration|manually]], [[cerumenolytics]], and under [[microscopy]]. Sudden onset SNHL can be treated with a single dose of [[steroids]].
-==Medical Therapy==
+==Medical Therapy<ref name="pmid33253610">{{cite journal| author=Nieman CL, Oh ES| title=Hearing Loss. | journal=Ann Intern Med | year= 2020 | volume= 173 | issue= 11 | pages= ITC81-ITC96 | pmid=33253610 | doi=10.7326/AITC202012010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33253610  }}</ref>==
-===Approaches===
+Medical treatment includes the use of [[Antiviral drug (patient information)|antivirals]], [[steroids]], and [[antibiotics]]. [[Antivirals]] have been used in cases caused by [[viral infection]].
-Cleaning of ear canal (usually occurs during physical exam) to remove cerumen or a foreign body can restore hearing.
+{| class="wikitable"
+|+
-In addition to [[hearing aids]] there exist [[cochlear implant]]s of increasing complexity and effectiveness. These are useful in treating the mild to profound hearing impairment when the onset follows the acquisitions of language and in some cases in children whose hearing loss came before language was acquired. Recent research shows variations in effacacy but some promising studies[http://www.cid.wustl.edu/research/PPR/Geers/Geersppr.htm] show that if implanted at a very young age, some profoundly impaired children can acquire effective hearing and speech.
+!Virus
+!Medical Therapy
-Ear protection can be used for the prevention of additional hearing loss.
+|-
+|[[Congenital CMV infection]]
-===Treatment depends upon the following factors===
+|[[Ganciclovir]] (administered intravenously)
+|-
+|[[HSV-1]]
+|[[Acyclovir]]
+|}
+[[antibiotics]] should be considered if symptoms of [[Otitis media]] in patients, do not improve in 3 days and/or they experience severe symptoms with high grade fever.
-* '''Age of onset of hearing impairment'''
+===[[Cerumen impaction]]===
-The age at which the hearing impairment develops is crucial to spoken language acquisition. Post-lingual hearing impairments are far more common than pre-lingual impairments.
+====Method 1.  Cerumenolytics<ref name="pmid28045591">{{cite journal| author=Schwartz SR, Magit AE, Rosenfeld RM, Ballachanda BB, Hackell JM, Krouse HJ | display-authors=etal| title=Clinical Practice Guideline (Update): Earwax (Cerumen Impaction) | journal=Otolaryngol Head Neck Surg | year= 2017 | volume= 156 | issue= 1_suppl | pages= S1-S29 | pmid=28045591 | doi=10.1177/0194599816671491 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28045591  }}</ref>====
-If the hearing loss occurs at a young age, interference with the acquisition of [[spoken language]] and [[social skills]] may occur. [[Hearing aid]]s, which amplify the incoming sound, may alleviate some of the problems caused by hearing impairment, but are often insufficient. [[Cochlear implants]] artificially stimulate the VIIIth Nerve by providing an electric impulse substitution for the firing of hair cells. [[Cochlear implants]] are not only expensive, but require sophisticated programming in conjunction with patient training for effectiveness. People who have hearing impairments, especially those who develop a hearing problem in childhood or old age, require support and technical adaptations as part of the rehabilitation process.
+*3-5 drops of cerumenolytics are used 3 times/day to decrease [[impaction]] by [[lubrication]] and softening of [[earwax]] (oil-based) and/or fragmentation of skin cells within [[cerumen]] (water-based). It is a cheap and effective way to remove wax with minimal side effects.
+*Cerumenolytics must be cautiously used in patients with tympanic membrane perforation, rupture, or any active infections of the ear canal and eardrum.
-* '''Pre-lingual deafness'''
+{| class="wikitable"
-:''Main article: [[Prelingual deafness]]''
+|+
-''Prelingual hearing impairment'' exists when the impairment is [[congenital]] or otherwise acquired before the individual has acquired [[Speech communication|speech]] and [[language]], thus rendering the disadvantages more difficult to treat because the child is unable to access audible /spoken communication from the outset.  It is important to note that those children born into signing families have no delay in language development and communication. Most pre-lingual hearing impairment is due to an acquired condition, usually either disease or trauma; therefore, families commonly have no prior knowledge of deafness.
+!Water-based cerumenolytics
+!Oil-based cerumenolytics
+|-
+|[[Acetic acid]],<br />
+|[[Mineral oil]]<br />
+|-
+|[[Hydrogen peroxide,]]<br />
+|Debrox
+|-
+|Cerumenex
+|
+|-
+|Murine
+|
+|}
+====Method 2. Irrigation====
-* '''Post-lingual hearing impairment'''
+*Aural irrigation with water in patients is another effective method for wax removal. Irrigation with water is avoided in [[diabetic]] patients or use acidifying solutions after water irrigation.
-:''Main article: [[Post-lingual hearing impairment]]''
-''Post-lingual hearing impairment'' where hearing loss is adventitious after the acquisition of speech and language, usually after the age of six. It may develop due to [[disease]], [[Physical trauma|trauma]], or as a side-effect of a medicine. Typically, hearing loss is gradual, and often detected by family and friends of the people so affected long before the patients  themselves will acknowledge the disability. Common treatments includes hearing aids and learning lip reading. Loneliness and depression can arise as a result of isolation (from the inability to communicate with friends and loved ones) and difficulty in accepting their disability.
-* '''Hard-of-hearing'''
+====Method  3. ''Manual extraction''====
-People who are ''hard of hearing'' have varying amounts of hearing loss but usually not enough to be considered deaf.  Many people who are deaf consider spoken language their primary language and consider themselves "hard of hearing".  How one classifies themselves relative to hearing loss or deafness is a very personal decision and reflects much more than just their ability to hear.
-The phrase ''hard of hearing'', normally used as an adjective or adverb, can also be used as a noun, referring to people with hearing impairment as the ''hard of hearing''. People who consider themselves [[deaf culture|culturally deaf]], prefer the term "hard of hearing" or "deaf", and perceive "hearing impaired" as an insult.
+*An [[Otolaryngologists|otolaryngologist]] manually extracts wax from the ear canal under otoscopic observation. A [[Stenosed]] ear canal due to a history of radiations to the head and neck or any trauma to the head can complicate the procedure.
-Hearing impaired persons with partial loss of hearing may find that the quality of their hearing varies from day to day, or from one situation to another or not at all. They may also, to a greater or lesser extent, depend on both hearing-aids and lip-reading. They may perhaps not always be aware of it, but they do admit to it being important to see the speaker's face in conversation.
+====Method 4. Vacuum extraction====
-Many people with hearing loss have better hearing in the lower frequency ranges (low tones), and cannot hear as well or at all in the higher frequencies.  Some people may merely find it difficult to differentiate between words that  begin with consonantal sounds such as the fricatives or sibilants, z, or th, or the plosives d, t, b, or p. They may be unable to hear thin, high-pitched or metallic noises, such as birds chirping or singing, clocks ticking, etc. Often, they are able to hear and understand men's voices better than women's.
+====Method 5. Extraction under binocular microscopy====
-Others will find their condition so much worse if circumstances in their immediate environment affect the way they are able to use their hearing aids, or prevent them from employing their speech reading skills. A room with a high ceiling and a lot of [[reverberation]] will affect the sound of a speaker's voice adversely. The position of the listener, too, sitting at a right angle to the speaker at a long seminar table, thus being able to hear only with one, maybe the ineffectual ear, can make a difference.  Difficulties can also arise for the listener trying to lip-read, if the speaker is sitting with his back against the light-source and is in this way obscuring his face. A rule of thumb is that bright lighting is to the hearing-impaired what noise is to the hearing; a source of distraction.
+===Idiopathic sudden sensorineural hearing loss:<ref name="pmid332536102">{{cite journal| author=Nieman CL, Oh ES| title=Hearing Loss. | journal=Ann Intern Med | year= 2020 | volume= 173 | issue= 11 | pages= ITC81-ITC96 | pmid=33253610 | doi=10.7326/AITC202012010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33253610  }}</ref><ref name="pmid31369359">{{cite journal| author=Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, Faucett EA, Finestone SA | display-authors=etal| title=Clinical Practice Guideline: Sudden Hearing Loss (Update). | journal=Otolaryngol Head Neck Surg | year= 2019 | volume= 161 | issue= 1_suppl | pages= S1-S45 | pmid=31369359 | doi=10.1177/0194599819859885 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31369359  }}</ref>===
-The speaker's accent; the topic under discussion, possibly with many unfamiliar words; the softness of his voice; possibly his having a [[speech impediment]]; a habit of holding a hand in front of his mouth or turning his face away at times: all these tendencies cause problems to the hard-of-hearing, especially when they have to rely on lip-reading. The rustling of papers, and notebook pages being turned are precisely the noises that will be the first thing hearing-aids pick up.
+*Sudden hearing loss is a serious symptom that often requires an urgent visit to the hospital.
+*Firstly address distinguishing sensorineural hearing loss from conductive hearing loss at the time of presentation with hearing loss in a hospital setting. It can be done through weber and/or Rinne test or audiometry.
-Noisy situations are especially difficult, because hearing loss not only affects the ability to hear sounds, but also to localize and filter out background noise.
+*First-line treatment with oral [[steroids]] like [[Prednisone]] should be started within 14 days of symptoms onset.
+*Prednisone prescribed at 1 mg/kg of body weight per day at a maximum dose of 60 mg/d for 7–14 days, followed by tapering over a similar period. Prednisone has an [[Anti inflammatory medications|anti-inflammatory]] effect and must be used cautiously in [[diabetic]] patients because of its effect on blood glucose. The time to treatment is definite and emphasized.
-* '''Unilateral hearing loss'''
+*Another option for patients experiencing side effects with oral steroids is intratympanic steroids injections like [[dexamethasone]] but there's a risk for tympanic membrane perforation.
-People with [[unilateral hearing loss]] (single sided deafness/SSD) can hear normally in one ear, but have trouble hearing out of the other ear.
+*[[Hyperbaric medicine|Hyperbaric oxygen]] therapy remains an option but only when combined with steroid therapy for oral or intratympanic initial treatment.
-Problems with this type of deficit is inability to localize sounds (ie. unable to tell where traffic is coming from)
+*[[Antioxidants]] were removed from the list of treatments as they carry no clear-cut benefit.
-and inability to process out background noise in a noisy environment, such as in a restaurant.
+*Follow-up [[audiometry]] at end of treatment and also within 6 months posttreatment is added to reassess any residual or reoccurrence of hearing loss.
-===Views of treatments===
-There is controversy in the culturally deaf community as to whether cochlear implants address wellness concerns, the overall health and psycho-emotional well-being of prelingually deaf children at all.
 ==References==
 {{Reflist|2}}
-{{WH}}
-{{WS}}
-[[Category:Needs content]]
-[[Category:Needs overview]]
 [[Category:Geriatrics]]
 [[Category:Communication disorders]]