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Hearing loss

  • Common ddx

    • cerumen impaction (ear wax)
    • presbycusis (age-related, elderly)
    • acoustic trauma (exposure to loud noise)
    • otitis media
    • cholesteatoma
    • meniere's disease
    • drug toxicity
  • Serious ddx

    • acoustic neuroma
    • MS
    • ear drum rupture
  • Labs

    • ear exam, audiometry
    • CT if vestibular neuroma
    • MRI if MS
    • MRA if vertebral-basilar syndrome
  • Other ddx

    • otosclerosis, Paget's disease
  • HPI

    • onset
    • unilateral vs bilateral
    • quality
    • associated tinnitus, earache, vertigo, discharge, balance
    • severity
    • aggravates, alleviates
  • ROS

    • fever, rash
    • headache
    • chest pain, dyspnea
    • nausea, vomiting, diarrhea, abdominal pain
    • neuro: vision loss, numbness, tingling, focal weakness
    • bone pain
  • PMH

    • Paget
    • neurofibromatosis
  • FH

  • SH

    • exposure to loud noise
  • Meds

    • new meds, aminoglycosides, high dose aspirin
  • Allergies

  • Px

    • vitals
    • gen impression
    • skin: rash
    • head: trauma
    • eyes: nystagmus
    • ear (discharge, wax, whether pulling triggers pain)
    • otoscope (wax, effusion, discharge, ear drum cholesteatoma)
    • hearing: gross, conductive vs sensorineural loss
    • cardio, pulm, abd
    • gait
  • Tx

    • audiology eval

  • Print | Citations

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