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Hearing loss

Clinical Discipline(s)/Organ System(s)
Otorhinolaryngology, Nervous System
Progress Test Topic(s)
ENT
Description
A 78 year old Samoan man visits his GP, concerned about his hearing. He is a retired baggage handler and used to work at Auckland International Airport. His family has been complaining that he watches TV with the volume too loud.
Applied Science for Medicine 
   - Anatomy of outer, middle and inner ear
   - Physiology of hearing
   - Science of sound waves, frequency, volume, generation and conduction
   - Aetiology and pathogenesis of conductive and sensorineural hearing loss
   - Pharmacology of gentamicin, chloramphenicol, penicillins with special properties, clavulanic acid
Clinical and Communication Skills 
   - History from a patient with hearing loss and associated symptoms
   - Examination of the ear, otoscopy and full ENT examination
   - Communicate with a patient through an interpreter
   - Effectively communicate with someone with hearing loss
   - Recognise signs of cerebellopontine angle tumour, conductive and sensorineural hearing loss
   - Perform otoscopy
   - Differential diagnosis of conductive and sensorineural hearing loss
   - Interpret CRP, antibiotic levels, full blood count
   - Indications for audiogram, CT head, MRI head, audio-evoked potentials
   - Management of otitis media, otitis externa (including necrotising otitis externa), tympanic membrane rupture, presbyucsis, cerumen accumulation, foreign body in external auditory canal
   - Outline management of acoustic neuroma, Meniere’s disease, cholesteatoma
   - Role of audiologists and otorhinolaryngology (ORL) surgeon
   - Prognosis for otitis media, tympanic membrane rupture, presbyucsis, Meniere’s disease, cholesteatoma, acoustic neuroma, meningioma, necrotising otitis externa
   - Complications of grommets, otitis media, necrotising otitis externa, cholesteatoma, acoustic neuroma, tympanic membrane rupture
Personal and Professional Skills 
   - Explore and empathise with the difficulties associated with hearing loss
   - Consider the legal issues relating to hearing loss and driving
Hauora Māori 
   - Ability to cater for differential health literacy needs of Māori patients and whānau
   - Acknowledgement of the impact of illness on employment/income/social roles
Population Health 
   - Common causes of conductive and sensorineural hearing loss amongst patients presenting to primary care
   - Services for those with hearing impairment
   - Prevention of noise induced hearing loss
   - Opportunities to reduce disability caused by hearing loss
Conditions to be considered relating to this scenario
Common
acute otitis media, stroke, drug induced, Ménière's disease, noise-induced hearing loss, presbyucsis, foreign body in external auditory canal, cerumen accumulation, tympanic membrane rupture, otitis externa, otosclerosis
Less common but 'important not to miss'
multiple sclerosis, systemic lupus erythematosus (SLE), cerebellopontine angle tumour, meningioma, acoustic neuroma, meningitis, cholesteatoma, necrotising otitis externa, Paget's disease
Uncommon
syphilis, mumps, measles
Related Scenarios
[Glue ear], [Congenital hearing loss]