Attention has already been drawn to the two major categories of
deafness—conductive and sensorineural. The distinction is easily made by tuning fork tests, which should never be omitted.
CAUSES
There is no strict order in the list, because the frequency with which various causes of deafness occur varies from one community
to another and from one age group to another. Nevertheless, some
indication is given by division into ‘more common’ and ‘less common’
groups. Always try to make a diagnosis of the cause of deafness and start by deciding whether it is conductive or sensorineural.
MANAGEMENT
One of the Management is Hearing aids
In cochlear forms of sensorineural deafness, loudness recruitment is often a marked feature. This results in an intolerance of noise above a certain threshold, and makes the provision of amplification very difficult.
The choice of hearing aids is now large. Most are worn behind the ear
with a mould fitting into the meatus. If the mould does not fit well, oscillatory feedback will occur and the patient will not wear the aid. More sophisticated (and expensive) are the ‘all-in-the-ear’ aids, where the electronics are built into a mould made to fit the patient’s ear. They give good directional hearing and, because they are individually built, the output can be matched to the patient’s deafness. The current generation of hearing aids are digital, allowing more refinement in the sound processing and more control of the aid.
A recent development has been the bone-anchored hearing aid
(BAHA). A titanium screw is threaded into the temporal bone and allowed
to fuse to the bone (osseo-integration). A transcutaneous abutment then allows the attachment of a special hearing aid that transmits sound directly by bone conduction to the cochlea.The main application of BAHA is to patients with no ear canal, or chronic ear disease, who are unable to wear a conventional aid and is much more effective than the old-fashioned bone conductor aid.
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