Hearing impairment medical therapy: Difference between revisions
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==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>== | ||
=== <u>[[Cerumen impaction]]:</u> === | ===<u>[[Cerumen impaction]]:</u>=== | ||
==== Method 1. Cerumenolytics ==== | ====Method 1. Cerumenolytics==== | ||
* 3-4 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 cheap and effective way for removal of wax with minimal side effects. | *3-4 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 cheap and effective way for removal of wax with minimal side effects. | ||
* Cerumenolytics must be cautiously used in patients with tympanic membrane perforation or active infections of the ear canal. | *Cerumenolytics must be cautiously used in patients with tympanic membrane perforation or active infections of the ear canal. | ||
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==== Method 2. Irrigation ==== | ====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. | *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'' ==== | ====Method 3. ''Manual extraction''==== | ||
* An [[Otolaryngologists|otolaryngologist]] manually extract wax from ear canal under otoscopic observation. [[Stenosed]] ear canal due to history of radiations to head and neck or any trauma to head can complicate the procedure. | *An [[Otolaryngologists|otolaryngologist]] manually extract wax from ear canal under otoscopic observation. [[Stenosed]] ear canal due to history of radiations to head and neck or any trauma to head can complicate the procedure. | ||
==== Method 4. Vacuum extraction ==== | ====Method 4. Vacuum extraction==== | ||
==== Method 5. Extraction under binocular microscopy ==== | ====Method 5. Extraction under binocular microscopy==== | ||
=== <u>Idiopathic sudden sensorineural hearing loss:</u> === | ===<u>Idiopathic sudden sensorineural hearing loss:</u><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>=== | ||
* First-line treatment with oral [[steroids]] like [[Prednisone]] should be started within 14 days of symptoms onset. Prednisone has [[Anti inflammatory medications|anti-inflammatory]] effect and must be used cautiously in [[diabetic]] patients because of its effect on blood glucose. | * Sudden hearing loss is a serious symptom that often requires an urgent visit to hospital. | ||
* Another option for patients experiencing side effects with oral steroids is intratympanic steroids like [[dexamethasone]] but there's a risk for tympanic membrane perforation. | |||
*First-line treatment with oral [[steroids]] like [[Prednisone]] should be started within 14 days of symptoms onset. Prednisone has [[Anti inflammatory medications|anti-inflammatory]] effect and must be used cautiously in [[diabetic]] patients because of its effect on blood glucose. | |||
*Another option for patients experiencing side effects with oral steroids is intratympanic steroids like [[dexamethasone]] but there's a risk for tympanic membrane perforation. | |||
==References== | ==References== | ||
Revision as of 05:24, 19 April 2021
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Medical Therapy[1]
Cerumen impaction:
Method 1. Cerumenolytics
- 3-4 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 cheap and effective way for removal of wax with minimal side effects.
- Cerumenolytics must be cautiously used in patients with tympanic membrane perforation or active infections of the ear canal.
| 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 extract wax from ear canal under otoscopic observation. Stenosed ear canal due to history of radiations to head and neck or any trauma to head can complicate the procedure.
Method 4. Vacuum extraction
Method 5. Extraction under binocular microscopy
Idiopathic sudden sensorineural hearing loss:[2][3]
- Sudden hearing loss is a serious symptom that often requires an urgent visit to hospital.
- First-line treatment with oral steroids like Prednisone should be started within 14 days of symptoms onset. Prednisone has anti-inflammatory effect and must be used cautiously in diabetic patients because of its effect on blood glucose.
- Another option for patients experiencing side effects with oral steroids is intratympanic steroids like dexamethasone but there's a risk for tympanic membrane perforation.
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). - ↑ 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.