step 2 cs hearing loss

DOC PA FAA

description of complaints

onset- when did ur hearing loss begin

constant/intermittent- does ur hearing loss constant or intermittent

Progression - was ur hearing loss sudden or slowly getting worse?

Location - does ur hearing loss involve 1 or both ears?

EAR HAT SOuNDS

exposure to loud noises?- may i know what is ur job? whar is the noise level in ur workplace/ are u exposed to any loud noises at ur workplace?

Abnormal gait/imbalance? have u noticed any difficulty in balancing urself? did anyone tell u that u have abnormal walking gait?

Ringing ear? have u beeen having ringing in ur ear?ear fullness?

Headache -do u have headache?

all sounds?- is hearing loss for all sounds or for anythings specific?

Trauma ? have u had any history of head trauma

Sounds? can u  localize the source of the sounds?

Object insert? have u had any object insert to ur ears?

Neuro- r u experiencing any neurological problem ;like numbenes/weakness/loss of sensation/ tingling in anywhr in ur body?

Distortedd speech- do words sound jumbled or distorted?

discharge- have u been having ear discharge ,pain,injury ,infection or straining to hear?

Dizzy- do u feel dizzy?

spinning- do u have sensation of room spinning around you?

THEN FRCS PUB SAW ID

PAM HUGS FOSS

PE: 

1 HEENT

head: inspect,palpate

eye: extraocular mvmt, light reflex,fundoscopy

nose;inspect

ear: otoscopy mrinne,weber,whisper test,tested hearing by speakintg with back turned

mouth : inspection

2. cv/pulmonary : auscultate

3. neuro

motor,

cerebellar heel shin tesst,findger nose test,gait,dysdiadokinesia,romberg

reflex: dtr ,babinski

sensory 

differential diagnosis of hearing loss

conductive or sensorineurol hearing loss

Differential Diagnosis and Treatment of Hearing Loss

Clues to the Diagnosis of Sensorineural Hearing Loss

History	Physical findings	Audiogram	Suggested cause of sensorineural hearing loss
Gradual hearing loss, noise exposure, tobacco use	Elderly patients with normal tympanic membrane	Bilateral, symmetric high-frequency loss	Presbycusis
Gradual hearing loss, tinnitus, noise exposure	Normal tympanic membrane	Bilateral, symmetric loss centered at 4,000 Hz	Noise-induced traumatic loss
Rapidly progressive hearing loss, possibly fluctuating, bilateral loss	Normal tympanic membrane, with possible vertigo or disequilibrium	Any abnormal configuration with poor speech discrimination	Autoimmune hearing loss
Sudden unilateral hearing loss, tinnitus, vertigo, head trauma, straining	Normal tympanic membrane; vertigo and nystagmus, with positive pneumatic pressure	Any unilateral abnormal configuration	Perilymph fistula
Sudden, fluctuating, unilateral hearing loss, tinnitus, episodic vertigo	Normal tympanic membrane	Unilateral low-frequency loss	Meniere's disese
Gradual unilateral hearing loss, tinnitus	Normal tympanic membrane, possible facial nerve weakness and unsteadiness	Any unilateral abnormal configuration	Acoustic neuroma

TABLE 2

Clues to the Diagnosis of Conductive Hearing Loss

History	Physical findings	Suggested cause of conductive hearing loss
Sudden painless loss of hearing	Cerumen	Complete canal occlusion
Sudden painful loss of hearing	Narrow canal with debris	Otitis externa
	Normal canal with red, immobile tympanic membrane	Chronic otitis media
Gradual painless loss of hearing	Immobile tympanic membrane	Middle ear effusion
	Normal mobile tympanic membrane	Otosclerosis
	Reddish-blue pulsating mass behind intact tympanic membrane	Glomus tumor or vascular anomaly
	Retracted or perforated tympanic membrane, with chronic drainage	Cholesteatoma

  source: http://www.aafp.org/afp/2003/0915/p1125.html

DIAGNOSTIC WORKUP:
audiometry tympanography brain stem auditory evoked potentials,ct-head, vdrl/rpr