The most common causes of hearing loss are ear wax, otitis media and otitis externa. The table below details some of the characteristic features of other causes:
| Condition | Key features |
|---|---|
| Presbycusis | Presbycusis describes age-related sensorineural hearing loss. Patients may describe difficulty following conversationsAudiometry shows bilateral high-frequency hearing loss |
| Otosclerosis | Autosomal dominant, replacement of normal bone by vascular spongy bone. Onset is usually at 20-40 years - features include: |
| • conductive deafness | |
| • tinnitus | |
| • tympanic membrane - 10% of patients may have a 'flamingo tinge', caused by hyperaemia | |
| • positive family history | |
| Glue ear | Also known as otitis media with effusion |
| • peaks at 2 years of age | |
| • hearing loss is usually the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood) | |
| • secondary problems such as speech and language delay, behavioural or balance problems may also be seen | |
| Meniere's disease | More common in middle-aged adults |
| • recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom | |
| • a sensation of aural fullness or pressure is now recognised as being common | |
| • other features include nystagmus and a positive Romberg test | |
| • episodes last minutes to hours | |
| Drug ototoxicity | Examples include aminoglycosides (e.g. Gentamicin), furosemide, aspirin and a number of cytotoxic agents |
| Noise damage | Workers in heavy industry are particularly at riskHearing loss is bilateral and typically is worse at frequencies of 3000-6000 Hz |
| Acoustic neuroma(more correctly called vestibular schwannomas) | Features can be predicted by the affected cranial nerves |
| • cranial nerve VIII: hearing loss, vertigo, tinnitus | |
| • cranial nerve V: absent corneal reflex | |
| • cranial nerve VII: facial palsyBilateral acoustic neuromas are seen in neurofibromatosis type 2 |