Hearing impairment medical therapy: Difference between revisions
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__NOTOC__ | |||
{{Hearing impairment}} | {{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<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>== | |||
Medical treatment includes the use of [[Antiviral drug (patient information)|antivirals]], [[steroids]], and [[antibiotics]]. [[Antivirals]] have been used in cases caused by [[viral infection]]. | |||
{| class="wikitable" | |||
|+ | |||
!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<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>==== | |||
*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. | |||
{| class="wikitable" | |||
|+ | |||
!Water-based cerumenolytics | |||
!Oil-based cerumenolytics | |||
|- | |||
|[[Acetic acid]],<br /> | |||
|[[Mineral oil]]<br /> | |||
|- | |||
|[[Hydrogen peroxide,]]<br /> | |||
|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 [[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. | |||
====Method 4. Vacuum extraction==== | |||
== | ====Method 5. Extraction under binocular microscopy==== | ||
== | |||
=== | ===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>=== | ||
*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 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. | |||
*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 medicine|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== | ||
{{Reflist|2}} | |||
[[Category:Geriatrics]] | |||
[[Category:Communication disorders]] | |||
[[Category:Audiology]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Noise pollution]] | |||
Latest revision as of 09:21, 10 May 2021
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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.