Differential Diagnosis of Otosclerosis
- Submitted by: lucylocks
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- Category: Science
- Date Submitted: 02/09/2011 11:40 AM
- Pages: 11
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Differential Diagnosis: Case Scenario 1
Differential diagnosis enables a systematic, scientific approach towards patient management, enabling the audiologist to:
- Quickly eliminate conditions, which may be life threatening
- Gain insight in to prognosis and plan effective management
- Provide information useful to future differential diagnoses
- Enable the patient to understand their condition and develop coping strategies
Audiological testing
Otoscopy:
In this patient otoscopy is reported as normal, indicating that the pinna and ear canal are clear and normal and the tympanic membrane (TM) is of normal colour- translucent pearly grey, normal malleus orientation, no perforation/surgical legacy, bright cone of light, no retraction pockets or evidence of fluid accumulation.
Tuning Fork Tests:
A positive Rinne result requires AC to be reported as louder than BC. A negative Rinne result requires BC to be reported as louder than AC, indicative of conductive hearing loss (CHL). Where AC and BC are equally depreciated (e.g. in sensorineural (SNHL)/mixed (MHL) hearing loss) a false positive result is possible.
The Weber test enables the audiologist to see whether one ear is hearing better than the other. A person with CHL or SNHL would report localisation in the affected or unaffected ear respectively. A patient with a symmetric hearing loss may report central localisation and therefore an equivocal result.
In this patient a negative Rinne is reported bilaterally suggesting bilateral CHL. The Weber provided “equivocal” results, thus providing initial support for a bilateral pathology.
Pure Tone Audiometry (PTA)
In PTA the AC threshold provides information on the sensitivity of overall hearing function. The BC threshold provides a measure of integrity of cochlea function only (reflecting SNHL). Any air bone gap (ABG) provides a measure of the magnitude of CHL.
PTA for this patient shows a “mild” CHL resulting from...
Differential diagnosis enables a systematic, scientific approach towards patient management, enabling the audiologist to:
- Quickly eliminate conditions, which may be life threatening
- Gain insight in to prognosis and plan effective management
- Provide information useful to future differential diagnoses
- Enable the patient to understand their condition and develop coping strategies
Audiological testing
Otoscopy:
In this patient otoscopy is reported as normal, indicating that the pinna and ear canal are clear and normal and the tympanic membrane (TM) is of normal colour- translucent pearly grey, normal malleus orientation, no perforation/surgical legacy, bright cone of light, no retraction pockets or evidence of fluid accumulation.
Tuning Fork Tests:
A positive Rinne result requires AC to be reported as louder than BC. A negative Rinne result requires BC to be reported as louder than AC, indicative of conductive hearing loss (CHL). Where AC and BC are equally depreciated (e.g. in sensorineural (SNHL)/mixed (MHL) hearing loss) a false positive result is possible.
The Weber test enables the audiologist to see whether one ear is hearing better than the other. A person with CHL or SNHL would report localisation in the affected or unaffected ear respectively. A patient with a symmetric hearing loss may report central localisation and therefore an equivocal result.
In this patient a negative Rinne is reported bilaterally suggesting bilateral CHL. The Weber provided “equivocal” results, thus providing initial support for a bilateral pathology.
Pure Tone Audiometry (PTA)
In PTA the AC threshold provides information on the sensitivity of overall hearing function. The BC threshold provides a measure of integrity of cochlea function only (reflecting SNHL). Any air bone gap (ABG) provides a measure of the magnitude of CHL.
PTA for this patient shows a “mild” CHL resulting from...