Sensorineural Hearing Loss

Acoustic neuroma Diabetes

Hereditary (congenital) loss Idiopathic loss Meniere's disease Multiple sclerosis Noise-induced loss Ototoxicity Perilymphatic fistula Presbycusis Syphilis ally decreasing hearing acuity, especially for higher-pitch tones (women's and children's voices) and in certain situations (with background noise). Tinnitus is common.

The cause of presbycusis is likely multifactorial, but ultimately the loss of cochlear hair cell function is thought to be the cause in most cases. Hair cell damage or loss can result from chronic noise exposure, genetic predisposition, and ototoxic medications. The hearing loss may also be caused by neurovascular injury from chronic conditions such as hypertension or diabetes, which can affect the cochlea or cochlear nerve. Hormonal conditions such as hypothyroidism should be considered, as should unusual conditions such as tertiary syphilis. Central auditory problems might be the cause, from dementia, cerebrovascular disease, or cerebrovascular accident (CVA, stroke).

Although the term "presbycusis" implies sensorineural loss, conductive hearing loss should also be considered, including cerumen impaction, chronic OME, and otosclerosis (see Box 19-6).

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