From the Guidelines
A comprehensive hearing loss workup should begin with a thorough medical history, physical examination, and otoscopic examination to assess the ear canal and tympanic membrane, followed by audiometric testing to determine the type and severity of hearing loss, as recommended by the 2019 clinical practice guideline update on sudden hearing loss 1. The evaluation should include a focus on the onset, duration, and progression of hearing loss, as well as associated symptoms like tinnitus, vertigo, or ear pain. Key components of the workup include:
- Audiometric testing, such as pure tone audiometry, speech audiometry, and tympanometry, to determine the type and severity of hearing loss
- Tuning fork testing to distinguish between conductive and sensorineural hearing loss
- Laboratory tests, such as complete blood count, metabolic panel, thyroid function tests, and autoimmune markers, if systemic causes are suspected
- Imaging studies, like CT or MRI of the temporal bones and brain, for sudden hearing loss, asymmetric hearing loss, or when structural abnormalities are suspected. The goal of the workup is to identify the cause of hearing loss and guide appropriate treatment, which may include cerumen removal, antibiotics, surgical intervention, hearing aids, cochlear implants, or addressing underlying medical conditions, ultimately improving patient outcomes and quality of life, as emphasized in the guideline update 1.
From the Research
Hearing Loss Workup
- A comprehensive hearing loss workup typically involves a combination of audiological tests, including pure-tone air and bone conduction thresholds, speech audiometric tests, and immittance measurements 2.
- The measurement of pure-tone air and bone conduction thresholds has limitations, and objective audiometric tests should be added to confirm the diagnosis of hearing loss 2.
- The presence of otoacoustic emissions can effectively exclude a diagnosis of otosclerosis, while standard clinical immittance measurements can confirm or exclude otosclerosis 2.
- Modern middle ear analysis procedures are becoming more popular in the diagnosis of otosclerosis, and audiologic rehabilitation of otosclerosis includes fitting of hearing aids and implantable hearing devices 3.
Diagnostic Audiologic Procedures
- Diagnostic audiologic procedures for otosclerosis are effective tools in identifying this condition, and audiometric data usually demonstrate a conductive hearing loss at the early stages of otosclerosis 3.
- Mobile audiometry can serve as an effective screening tool for hearing loss, with high sensitivity and good specificity for screening hearing loss 4.
- However, limitations such as environmental noise and variability in headset quality may affect the accuracy of the results, and further research is needed to address these challenges and improve the reliability of mobile audiometry 4.
Hearing Aid Assessment
- A comprehensive hearing aid assessment is essential for adults with bilateral severe-profound sensorineural hearing loss who present for Cochlear implant evaluation 5.
- The assessment should include pure tone audiometry, aided speech understanding in quiet and in noise, and subjective scales of quality of life, hearing disability, and device use satisfaction 5.
- Individuals with bilateral, moderate sloping to profound sensorineural hearing loss who demonstrate poor aided speech understanding and dissatisfaction with hearing abilities in everyday life require timely referral to a Cochlear implant clinic for further evaluation 5.
Long-term Incidence and Degree of Sensorineural Hearing Loss
- The long-term incidence and degree of sensorineural hearing loss in patients with otosclerosis can be evaluated using retrospective audiometric database and chart review 6.
- The average long-term sensorineural hearing loss due to otosclerosis was statistically significantly more than for age alone at each frequency, but these average values were clinically insignificant 6.
- Approximately one-third of patients with otosclerosis demonstrated a clinically significant progression of the sensorineural component of hearing loss, with the average bone conduction threshold change above expected age-related changes ranging from 10.2 to 14.6 dB for tested frequencies among this subgroup 6.