1、Hearing loss,prevention and managementOverview 27,800,000 hearing disability in China Incidence of hearing loss increasing Deaf-mutismHow to hear?Gyri temporales transversiAcoustic radiationMedial geniculate bodyNucleus cochlearis posteriorNucleus cochlearis anteriorSpiral organ of cortiLateral lemn
2、iscusSuperior olivary nucleusAuditory ossiclesExternal acoustic meatusVestibular fenestraWhy is hearing very important?Means to recognize the world Foundation to develop speech Affection sharing,life enjoying Important means of communicationClassification of hearing loss By nature Conductive Sensori
3、neural Mixed By birth Congenital Acquired By speech ability when deaf-Prelingual -postlingualNormal Hearing Conductive Hearing Loss Sensorineural Hearing LossMixed Hearing LossLevel of Hearing lossLeveldB HLNormal25dBHLMild2640dBHLModerate4170dBHLSevere7190dBHLProfound90dBHLCommen causes of hearing
4、lossCauseConductiveSensorineuralCongenital Ear deformityAntepartum:heritage,bastard measlesAcquiredExternal ear:cerumen otitis externa foreign bodyMiddle ear:otitis media with effusion chronic otitis media otospongiosis traumatic perforation of ear drum broken ossicular chainperinatal period:hypoxia
5、,jaundiceototoxicity:aminoglycosides,cytotoxicDegeneration:presbycusisTrauma:noise,head injury,surgeryTumor:acoustic neuromaIdiopathic:Meniere disease,sudden deafnessInflammation:meningitis,measles,parotitisCongenital hearing loss and hereditary hearing loss Congenital hearing loss:hearing disturban
6、ce when birth Hereditary hearing loss:derive from gene or chromosomal anomaly Congenital hearing loss Antenatal period,circumnatal period or perinatal period Causes Genetic factor:gene of deafness,50%Factors during pregnancy:early viral infection,drug intoxication,noise Factors during circumnatal pe
7、riod:jaundice,low birthweight infant,neonatal asphyxia,birth traumaGene of deafness 50%of congenital hearing loss Common genes of deafness GJB2 SLC26A4（PDS）-enlarged vestibular aqueduct syndrome Mutation of mitochondrial gene Universal newborn hearing screening(UNHS)To identify hearing disturbance w
8、ithin 3 monthsSignificance of UNHS Early discovery of deafness makes the deaf undumb Possibility of early discovery Registration and management for high risk family:only 50%can be identified Routine medical examination:hardly identified within 1 year old Parents awareness:hardly identified within 1
9、year old UNHS:effective method 耳声发射法 快速脑干诱发电位法Method of otoacoustic emission Method of quick brainstem evoked potentialStrategy of UNHSscreeningrescreeningBirthFollow upInterventionRigorousFollow upDiagnosis testEvaluation Clinical characteristics of Presbycusishearing of old age,the effects of agin
10、g Progressive hearing loss Bilateral symmetric sensorineural hearing loss No history of noise contact Speech discrimination score bad than pure tone testDrug-induced hearing loss,ototoxicity Mechanism unclear,possibily related to drug type,dosage,route,genetic predisposition,etc.Ototoxic drug(more t
11、han 90)Aminoglycoside antibiotics Antitumor drug-cisplatin,carboplatin Diuretic-furosemide,ethacrynic acid Salicylate-aspirin antimalarial drug-quinin Clinical characteristics of ototoxic deafness Bilateral hearing loss Hearing loss happens at high frequency Reversible or progressive With tinitus,ve
12、rtigoClinical characteristics of noise-induced hearing loss Long term exposure to noise Bilateral symmetric Evident hearing loss at high frequency:3-6kHz Reversible if separated from noise Pround hearing loss rareClinical characteristics of idiopathic sudden hearing loss Sensorineural hearing loss w
13、ithin 3days or less,more than 30 dB HL Usually unilateral With tinitus,vertigo Etiology:possible viral infection and disorder of blood supply in the inner earClinical characteristics of acoustic neuroma Unilateral progressive hearing loss,tinnitus Systematic or infectious diseases Kidney disease Dia
14、betes Meningitis Viral infectionDiagnosis of hearing loss Detailed history Age,time,symptom History of using ototoxic drug,family history of deafness,history of noise exposure Examination:aural and general Examination of auditory functionExamination of auditory function Pure tone test Speech audiome
15、try Tympanogram and acoustic reflection Auditory brainstem response Otoacoustic emissionImaging evaluation High definition CT Temporal anatomy Osseous abnormality Fracture Infectious diseases Magnetic resonance imaging(MRI)Cerebellopontine angle VIII cranial nerve LabyrinthProtective measure for dea
16、fness Prevention of congenital deafness Genetic counseling and prenatal diagnosis Pregnant women are prohibited to use ototoxic drugs To avoid viral infection when pregnant Prevention of viral and bacterial infection Measles Varicella Parotitis Epidemic meningitis Rhinitis Otitis media To keep favou
17、rable mental status and avoid over-tired To avoid exposure to noise for long time To lower level of sound source To decrease exposure time To use ear protector To protect from ototoxic deafness To understand family history and susceptivity To control suitable dosage and course of treatmentProtective
18、 measure for deafnessManagement of hearing loss Medicine-corticosteroid,peripheral vasodilator Otomicrosurgery Hearing aid Cochlear implant Speech training Aim at sudden or recent hearing loss Corticosteroids Peripheral vasodilator VitaminMedical therapy OtomicrosurgeryManagement of otitis media with effusionTympanoplasty-chronic otitis mediaStapes surgeryAcoustic neuroma surgeryHearing aid CIC ITC ITE BTE 深耳道式深耳道式 耳道式耳道式 耳甲腔式耳甲腔式 耳背式耳背式Bone anchored hearing aid(BAHA)Cochlear implant手术步骤Thanks for your attention
