Hearing impairment medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hearing impairment}} | {{Hearing impairment}} | ||
{{CMG}} {{AE}} | |||
==Overview== | |||
==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 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 entails the use of [[steroids]], [[Antiviral drug (patient information)|antivirals]], and [[antibiotics]]. [[Antivirals]] have been used in cases caused by [[viral infection]]. | Medical treatment entails the use of [[steroids]], [[Antiviral drug (patient information)|antivirals]], and [[antibiotics]]. [[Antivirals]] have been used in cases caused by [[viral infection]]. | ||
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|[[Acyclovir]] | |[[Acyclovir]] | ||
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[[Otitis media]] in patients, [[antibiotics]] should be considered if symptoms | [[Otitis media]] in patients, [[antibiotics]] should be considered if symptoms do not improve in 3 days and/or severe symptoms. | ||
=== | ===[[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>==== | ====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>==== | ||
*3-4 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 | *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 a cheap and effective way to remove 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==== | ||
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====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 the 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==== | ||
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===<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>=== | ===<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>=== | ||
*Sudden hearing loss is a serious symptom that often requires an urgent visit to hospital. | *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. | *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. | ||
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*Another option for patients experiencing side effects with oral steroids is intratympanic steroids like [[dexamethasone]] but there's a risk for tympanic membrane perforation. | *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 medicine|Hyperbaric oxygen]] therapy remains an option but only when combined with steroid therapy for oral or intratympanic initial treatment. | *[[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 | *[[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. | *Follow-up [[audiometry]] at end of treatment and also within 6 months posttreatment is added to reassess any residual or reoccurrence of hearing loss. | ||
===<u>Hearing Aids:</u>=== | ===<u>Hearing Aids:</u>=== | ||
Hearing devices | Hearing devices are either implantable or non-implantable. These devices include: | ||
*Conventional air-conduction [[hearing aids]]: The conventional air-conduction hearing aids are used with a microphone that converts sounds into electrical signals, returned to the ear as amplified sound. They are useful for patients with mild-to-severe hearing loss. | *Conventional air-conduction [[hearing aids]]: The conventional air-conduction hearing aids are used with a microphone that converts sounds into electrical signals, returned to the ear as amplified sound. They are useful for patients with mild-to-severe hearing loss. | ||
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==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Geriatrics]] | [[Category:Geriatrics]] | ||
[[Category:Communication disorders]] | [[Category:Communication disorders]] | ||
Revision as of 04:44, 6 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[1]
Medical treatment entails the use of steroids, antivirals, and antibiotics. Antivirals have been used in cases caused by viral infection.
| Virus | Medical Therapy |
|---|---|
| Congenital CMV infection | Ganciclovir (administered intravenously) |
| HSV-1 | Acyclovir |
Otitis media in patients, antibiotics should be considered if symptoms do not improve in 3 days and/or severe symptoms.
Cerumen impaction
Method 1. Cerumenolytics[2]
- 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 a cheap and effective way to remove 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 the 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:[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 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 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.
Hearing Aids:
Hearing devices are either implantable or non-implantable. These devices include:
- Conventional air-conduction hearing aids: The conventional air-conduction hearing aids are used with a microphone that converts sounds into electrical signals, returned to the ear as amplified sound. They are useful for patients with mild-to-severe hearing loss.
- Bone-anchored hearing aids (BAHAs): BAHA devices incorporate a titanium plate that is surgically anchored to the skull on the hearing-impaired side, to directly stimulate the inner ear by conducting sound vibrations through the bone. Some of the indications for BAHA include severe conductive hearing loss, congenital ear canal atresia, SNHL, and difficulty wearing a conventional air-conduction aid with an ear fungal infection, due to recurrent ear infections.
- Cochlear implants: The cochlear implant is a biomedical device that is surgically placed into the cochlea. It converts sound energy into an electrical signal, which is then conducted to the ganglion cells in the cochlea via electrodes. This conduction ultimately produces an auditory sensation to the individual that allows the detection of sounds, especially speech sounds.
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.