Hearing Loss Describe what brings you here? Rate severity? One ear or both? If one year only -> which on? Is it only for specific type of sound or for all sounds? Timing Onset Offset Duration Progression Anything like this before? Can you think of might have caused it? Any recent exposure to loud noise? Is it head position or certain movement dependent? Anything makes it worse? Anything makes it better? Associated features: Dizziness Ear pain Ear discharge Weakness Numbness Tingling Loss of coordination Nausea, vomit and recent illness. Abnormal eye movements Medications Prescription Non-prescription Past medical history Allergies Vaccinations Surgical history Family history Social history Smoking Alcohol Recreational drugs Diet Work Do you swim? Examinations to do: ENT Neurological Audiometry Differentials Otitis media Otalgia Hearing loss Fever Irritability Otitis externa Severe pain Otorrhea Itching Hearing loss Cerumen impaction Ear pain and discomfort Hearing loss Otorrhea Odor Tinnitus and vertigo Wax builds up in ear. Presbycusis Progressive and irreversible damage to hair cells of the organ of corti that impact high frequency hearing. Bilateral hearing loss -> especially at high frequency Inability to point at where sound is coming from. Noise-induced Medication induced Osteosclerosis E.g. osteopetrosis Paget’s disease Bisphosphate intoxication Hyperparathyroidism Mastoiditis Tender and oedematous mastoid Ear displaced laterally and forward. Myringitis Fever Poor appetite Hearing loss Sensation of congestion Fluid running from ears. BPPV Head positions Certain movements Sudden and recurrent movements Lasts for several minutes MS Painful eyes Visual changes Muscle weakness Altered sensations Cerebella diseases Intention tremors Dysmetria Ataxia Slow and slurred speech Post infectious E.g. post pneumococcal meningitis Blockage Labyrinthitis Inflammation of the inner ear. Usually a viral cause Vertigo Nausea Vomit Tinnitus Hearing loss. Meniere’s disease