A Family Doctor's Tale - DEAFNESS

DOC I HAVE HEARING LOSS
Deafness or hearing loss is the inability to hear.

The causes of Deafness are:

A.Conductive hearing loss
Here sound waves cannot be transmitted from the external environment to the cochlea.
The problem may lie in
1.the external ear canal
a.obstruction caused by wax
b.obstruction caused by foreign body
c.obstruction caused by infection (otitis externa)
d.obstruction caused by ear polyps

2.eardrum
a.perforation caused by trauma
b.perforation caused by infection
c.scarred eardrum from injury or infection

3.middle ear bones
a.dislocation of the bones from injury or infection
b.damage to the bones from injury or infection
c.fixed bones or osteosclerosis (hardening of the bones from aging)

4.middle ear infection
infection of the middle ear occurs with fluid in the middle ear cavity preventing sound from passing through

B.Sensorineural Hearing Loss
a.damage to hearing organ or cochlea which send nerve impulse to the hearing nerve and on to the brain
b.damage to the hearing nerve (auditory nerve)from loud sounds, infection or injury

Common causes of hearing loss are:
1.aging (presbycusis)
2,acute or chronic exposure to loud noise can cause damage to sensory cells of cochlea
3.infection of the inner ear by viruses and bacteria such as mumps, measles or influenza
4.Meniere's disease - a disease with tinnitus, deafness and dizziness
5.Acoustic neuroma - tumour of the vestibular nerve which lies near to the auditory nerve and affects its function
6.Ototoxic drugs which can damage the nerves involved in hearing or sensory cells in the cochlea such as:
a.antibiotics especially gentamycin and vancomycin
b.diuretics such as frusemide
c.chemotherapy drugs

The symptoms of Deafness are:
1.Deafness is a lack of hearing.

The hearing loss is gradual or sudden and can affect one or both ears.

There is difficulty in holding a normal conversation in a noisy environment.

People may complin the affected person does not respond when called or speak louder than usual

2.tinnitus (ringing in the ear) may be present

3.vertigo (spinning sensation) may be associated with it

4.pain and discharge from ear is associated with ear infections

Diagnosis:
1.complete history, ENT examination

2.examination of ear canal and eardrum

3.endoscopy examination of nose and nasopharynx

4.neurological examination

5.hearing test (audiogram) can confirm the presence and severity and type of hearing loss

6.Tympanogram may be performed to detect problems of eardrum and middle ear.

7.X-rays, CT scan or MRI may used to exclude acoustic neuroma or brain tumors.

Treatment
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Medical treatment depends on the underlying problem.
1.Removal of wax and foreign body in the ear
Ear polyps can be dissolved away with medicines.

2.Antibiotics oral and topical may be necessary in severe external ear infections.

3.In the case of eardrum perforation, once the underlying infection is cleared and the perforation still do not close after 3 months, then surgical repair of the perforation may be needed.

4.If the cause of deafness is due to medication, then the medication should be stopped or changed.

5.If the cause is prebycusis (due to aging) no medical treatment is needed.
The deaf person is assessed to see whether hearing aids will help.

Hearing Aids:
1.hearing aids can amplify the external sound and help the hearing process.
2.They are useful for both conductive as well as sensorineural hearing loss.
3.The side effects from wearing hearing aids include:
obstruction effect
sound feedback
tendency to ear infections

Hearing implants:
Surgical hearing implants are of 2 types:
1.middle ear implants are used for those with sensorineural and conductive hearing loss.
It consists of a transducer that is attached to the middle ear ossicles or directly to the round window of the cochlea.
It vibrates the middle ear structures and amplifies the transmission of sound.

2.Cochlear implants are used in people with moderate to severe sensorineural hearing loss.
The electical electrode of the implant is inserted directly into the cochlea and stimulates the neve endings in the cochlea to bypass any problem in the cochlea.
They can be used in both children and adults.

Prevention of Deafness
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1.Avoid loud sounds especially at concerts or construction sites

2.Avoid toys with sharp points, shafts, spikes, rods and sharp edges to prevent eardrum injuries in children.

3.Avoid medicines which cause cause damage to the hearing nerve.

A Simple Guide to Cytomegalovirus

A Simple Guide to Cytomegalovirus
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What is Cytomegalovirus?
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Cytomegalovirus is an acute viral disease of all ages which can be transmitted to the fetus before birth.

It affects people at all ages but seldom causes any symptoms in adults.


What are the causes of Cytomegalovirus?
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Cytomegalovirus is a virus of the herpes group characterised by its ability to stay dormant in the body over a long period.

It is transmited in body fluid (urine, saliva ,blood, semen, tears and breast milk)


What are Signs and symptoms of Cytomegalovirus?
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Adult and children Cytomegalovirus infection do not normally give rise to symptoms except for mild fever and a mononucleosis-like illness.

Congenital Cytomegalovirus infections presents itself at birth:

1.Microcephaly

2.Hepatosplenomegaly with jaundice

3.Hearing impairment

4.Blindness

5.Chorioretinitis

6.Hemolytic anemia with petechiae

7.Seizures

8.Respiratory distress


How is the diagnosis of Cytomegalovirus made?
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1.blood tests for igG or igM for Cytomegalovirus are positive within 3 weeks of birth

2.Usually appears normal at birth

3.Ultrasound during pregnancy to dentify any brain abnormalities .

4.Saliva , urine may be taken to test if there is presence of the Cytomegalovirus.


What are the complications of Cytomegalovirus?
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1.Respiratory distress

2.Mental retardation

3.Hemolytic anemia

4.Blindness

5.Deafness


What is the treatment of Cytomegalovirus?
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There is no effective treatment of Cytomegalovirus at the present moment.

A antiviral drug ganciclovir which is used to treat AIDS may help babies with Cytomegalovirus infection.

A vacine is also being developed for prevention.


What is the prognosis of Cytomegalovirus ?
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Prognosis for congenital Cytomegalovirus infection is poor.

Adult Cytomegalovirus infection do not have any problem.


What are the Preventive measures taken for Cytomegalovirus ?
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There is no vaccine at the present moment for Cytomegalovirus.

Transmission of Cytomegalovirus infection is always preventable because it is transmitted through body fluid from hand,nose and mouth of a suseceptible person.

People who interacts with children and pregnant mothers shuold practice good safe hygiene methods such as washing of hand and wearing of clothes when changing diapers.

Pregnant women are also advised to practice safe hygiene methods and to seek advice in the presence of a mononucleosis-like illness.

A Simple Guide to Meniere's Disease

A Simple Guide to Meniere's Disease
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What is Meniere's Disease?
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Meniere's Disease is a disease of the inner ear which is characterised by the triad of episodic vertigo(giddiness), tinnitus(buzzing sound in ear) and progressive hearing loss.

It is more common in adults between 30-60years of age and in men more than women.

It usually occurs more in one ear.

What are the causes of Meniere's Disease?
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The exact cause of Meniere's Disease is unknown.

It is believed to be due to distension of the membranous labyrinth with increased pressure and fluid in the endolymph of the inner ear.

As a result the balance in one ear is affected leading to dizzines

The possible triggers of this condition may be:

1.middle ear infection,
2.head injury
3.upper respiratory tract infection
4.the effect of aspirin,
5.smoking
6.alcohol
7.caffeine
8.salt

Some invetigators believed that there is a link with the herpes zoster virus which is activated when the immune system is low, resulting in inflammation of the eight nerve(hearing).

What are the symptoms and signs of Meniere's Disease?
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Symptoms:
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The classical triad of symptoms are:

1.recurrent bouts of vertigo of varying degrees which may last from hours to days.
Recurrences may be as often as 1 week to several years.

2.Slow progressive loss of hearing in one ear or rarely in both ears starting at low pitch sounds first.

3.Unilateral tinnitus (buzzing sound in one ear), sometimes in both ears

Beides these symptoms, there is also :

4.feeling of pressure9fullness) in one or both ears.

5.Nausea and vomiting sometimes occur with the vertigo

6.hypersensitivity to sound

7.nystagmus(uncotrollable jerky eye movements)

8.cognitive performance

How is the diagnosis of Meniere's Disease established?
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1.classical history

2.audiometry shows impairment of hearing

3.MRI scan of the head - to exclude a tumour of the eighth cranial nerve (vestibulocochlear nerve)

What is the Treatment of Meniere's Disease?
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Initial treatment:

1.Acute attacks are treated symptomatically with injections of stemetil, maxolon, dimenhydrinate


Other treatments:
1. Oral stemetil, maxolon, dimenhydrinate

2. mild diuretic

3.vitamin B6

4.antihistamines,

5.anticholinergics,

6.corticosteroids orally or injection of steroid medication behind the eardrum

7.Bed rest

8.stress reduction.

9.low-sodium diet.

10.avoid caffeine, alcohol and cigarettes



Surgery :
is only required if the above treatment does not control the vertigo

1.Decompression of the endolymphatic sac may help to relieve symptoms.

2.Permanent surgical destruction of the balance part of one ear may be done where the disease is severe and affects one ear.
This usually causes permanent deafness.

a.chemical labyrinthectomy: a drug (such as gentamicin) that can cause destruction of the balance portion of the inner ear is injected into the middle ear.

b.vestibular neurectomy where section of the nerve to the balance portion of the inner ear is done surgically

c.surgical removal of the inner ear (labyrinthectomy).

Usually balance returns to normal after sugery but hearing may be permanently damaged in one ear.

3.In the belief that Meniere's disease is caused by herpes virus, acyclovir an antiviral drug is given and has been found to relieve symptoms.

What is the prognosis of Meniere's Disease?
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Symptoms may remain the same, worsen or disappear spontaneously.

1.Vertigo symptoms may be worse and more frequent but sometimes disappear spontaneously.

2.Hearing symptoms usually become worse and patients may become deaf in the affected ear.

3.Tinnitus usually is more pronounced with time.