Hearing impairment medical therapy
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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.
- 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 has anti-inflammatory effect and must be used cautiously in diabetic patients because of its effect on blood glucose. The time to treatment is defined and emphasized.
- Another option for patients experiencing side effects with oral steroids is intratympanic steroids 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 treatment 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). - ↑ 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.