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What the heck does 'conductivehearing loss' or 'sensori-neuralhearing loss' mean?Hearing losses are divided into two big types, conductive and sensori-neural. Conductive hearing lossConductive hearing loss is caused by the ear canal, ear drum, middle ear and all its fascinating little parts which work together to pass sound along to the cochelea. For some reason, conductive hearing loss is considered curable. Equally I know many many parents with kids with conductive losses which are ingrained in the child's ear or ears. Constant allergies, continuous colds, snot-nosed kids whose ears just cannot quite reach the high sounds of language despite constant medication of antihistamines and/or antibiotics. Some of the newer recommendations for treating middle ear infections have involved not using antibiotics due to concerns about antibiotic abuse. I am in the middle on this one, because an ear infection hurts, the middle ear is close to the brain and every once in a while the middle ear infection continues to the brain, and kills the child, not very often, but not never either. It would certainly be necessary to have a good backup emergency system to get help in the middle of the night if the child took a turn for the worse. Plus it is easy for a parent to see a sick child getting better, but it is very difficult to tell that an already sick child is getting worse. We used three months of alternate antibiotics and constant antihistamines, but by the time three months has gone by, the child has had three colds, the flu, and ate too much pizza...The change of season from winter to summer usually gave the burst of health to get rid of the clogged middle ear, except when playing in the hay loft next door full of hay or visiting people with indoor cats.
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( note scaring from ventilation tubes) Photo by Shane Moodie, audiologist.
A tympanogram tests the ear drum. When my son was little he would go to the audiologist, have a tympanogram and be sent to the doctor to clear up conductive loss before proceeding with audiology for his sensorineural hearing loss. One day the whole family went, and had exactly the same tympanograms. The audiologist was perplexed, and I was perplexed. On the way home our ears popped several times going up from the 350 feet above sea level where the audiologist is to 1400 feet above sea level where our house is. That is the perfect functioning of the eustachian tubes to equalize the pressure in the middle ear with the outside pressure.
The middle ear has a little tube called the eustachian tube which is supposed to drain into the sinus. The middle ear is supposed to have air in it. Many children have fluid in the middle ear, and reduced hearing ability until the fluid is gone. Some children, including mine, develop a condition called 'glue ear' which is a solid lump of garbage in the middle ear.
17 years ago, when Reid was a baby he was scheduled for a myringotomy and tubes which was surgical cleaning of the stuff in the middle ear through the ear drum, and tubes to let air in through the ear drum so gravity could work to keep the eustachian tubes draining into the sinuses.
I am not sure whether the installation of ventilation tubes through the ear drum is valid or not. For many children they work very well, and cause no problem. For other children, they fall out, and they can cause permanent scaring on the ear drum and cause a hearing loss.
When a child has a hearing aid in the ear, ventilation tubes make it much more difficult to keep the ear canal clear of irritation and infection. By the end of our time with hearing aid and ventilation tubes, we stopped going to doctors who insisted on putting in tubes.
Ear wax is another cause of conductive hearing loss. The ear thinks the hearing aid mold is a bug, and produces copious wax to protect the ears from the bug. Ear wax can build up overnight to a huge lump. I recently fired a doctor for using water and a syringe to take ear wax out of my son's ear canal. He has had a ruptured ear drum twice, and should never have his ears syringed which I was told by the head ENT at CHEO in Ottawa.
My son's ears can go from clear to impacted with earwax very quickly, in days. We had a ear wax maintenance program which involved looking in his ear canals with a good flashlight at least once a week. If ear wax was present, we used peroxide and warm water to let it soften and float up. Over the years we have tried many products to deal with ear wax.
As I get forgetful in old age, so to speak, the constant looking in my son's ears doesn't seem to happen. Several times I have taken him down for audiology and had the audiologist deem the earwax to be too significant for them to proceed, and they cannot remove earwax because they are not insured...so I have to go to a drug store, and deal with the problem using Cerumwax which is strong peroxide based product. Odd to have no equipment and HAVE TO DEAL with the problem outside in the parking lot, opposed to the professionals inside the building who have all the equipment and won't deal with the problem.
We used to have an ENT in a city not too far away. Just before Christmas
holidays I dreamt that Reid had become completely deaf after discovering his
hearing aid was not going in his ear canal. Five days earlier I had cleaned his
ear canals. On the basis of that scientific knowledge, I phoned the ENT at 6 AM
which is shortly before I have to leave the house if he says "Meet me at the
hospital at 8." The ENT was not pleased to have his rest disturbed more so as he
had been up all night with a sick patient and allowed us to come to his office,
saying that was the right way to handle this.
However if I had phoned the office, his office nurse would have told me we could not see the doctor until January. So they punished us in the waiting room for the phone call 'in the middle of the night', and he scolded me again. And then he got around to looking in Reid's ear canal which was black with ear wax, and dug in with a curette and started pulling the plug out, and he pulled, and he pulled...and he pulled, and out popped one entire bug encased in earwax, about 1 inch long. Reid immediately yells "It's a miracle. I can hear!" And the doctor took all credit for the heroics, and was grossed out himself by the size of the bug. Clearly if the bug and wax had not been removed, he would have had an abcess develop during the holidays. The next time I phoned for an appointment I was informed by the nurse that Dr.X was not accepting us as patients any more.
Children who have hearing problems can be cry babies about their ears. More
often they become absolutely stoic about pain in the ear. I have seen a doctor
pull my child's ears for ten minutes to determine whether he had a middle ear
infection based on his eyes, and my son has not flinched, indicating that he did
not have an ear infection to the doctor when he already had a burst ear drum and
fluid coming out of his ear, and most certainly had a middle ear infection.
I thought the way the doctor treated my son as a deaf child was crude. To begin with, he did not use the otoscope properly which should always be braced on the doctor's hand, not the child's head in case the child rears and reams the ear on the instrument. If our then rural GP could teach me this as he wrote a prescription for an otoscope, should I find one, then all the doctors in the teaching hospital should know this. I suggested a tympanogram, and I was told the equipment was in another department from emergency, and it was too complicated to go and use it. I suggested an ENT consult and was told it was too expensive. Sofracort ear drops were prescribed which went from the child's ear to the child's mouth, indicating the ear drum was broken. We took the child to another doctor in another province. This doctor had all the tools and used them properly. The drops which had been prescribed are otoxic, and must only be used with a pressure dressing in an ear canal. The damage which the first doctor caused was evidenced by higher threshold in his ear for a year.
Eventually my husband's grandfather died, and we inherited his otoscope, and now understand why doctors were at a lost to deal with ear problems because I see more with a bad flashlight, than with the old otoscope. The new digital otoscopes are wonderful, you can see so much.
So to sum up, a conductive hearing loss is a condition which is not necessarily permanent, or stable. Theoretically when all the parts of the outer ear, to the middle ear are working properly, a conductive hearing loss should go away. Many conductive hearing losses are in there for the long haul despite surgery and drugs. The most fascinating thing about conductive hearing losses is that they can never be higher than moderate ( which is already pretty deaf) because the mastoid bones of the skull at the back of the ear take over and provide sound to the ear nerve at a moderate level of hearing loss, even if there is no ear at all.
When you stick your fingers in your ears you are temporarily creating a moderate hearing loss for yourself. It is a good exercise to get the teachers and childcare workers to do this to understand why the child needs special equipment and consideration.
Many people think a sensori-neural hearing loss is a big deal because it has such a serious medical sounding name. Sensori-neural losses spans all across the spectrum from mild to profound, or from hard of hearing to deaf. Sensori-neural means the nerves of the ear are affected, and ,today, it is usually not curable. Tomorrow the impact of research and development of drugs, different medical techniques might mean sensori-neural deafness can be remedied too.
According to Dr. Carol Flexer of the University of Ohio the line between deaf
and hard of hearing is at 70 dB. Children and people with thresholds over 70 dB
are getting cochlear implants which is so successful at this point that most end
up with a mild hearing loss. For those who are hard of hearing the development
of cochlear implants has meant the hearing aid industry is finally making
hearing equipment for mild and moderate hearing losses. Because the hearing aids
do not have to produce a blast of loud sound, they can focus on quality sound
within a limited range. The programmable digital aids are fantastic.
references
Introduction to Audiology, 4th edition by Frederick N. Martin. New
Jersey:Prentice Hall,495 p.indexed,illus.1991
ISBN 0-13-477605-4
-PAM Candlish January 2 2002
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