ENT (Otorhinolaryngology) · MU Sofia

7. Treatment of hearing loss. Cochlear implantation.

Walks through the treatment of hearing loss by type, starting with medical and surgical options for conductive loss such as wax removal, grommets, tympanoplasty, ossiculoplasty and stapedectomy. It then covers amplification and rehabilitation for sensorineural and mixed loss, including hearing aid types, bone-anchored devices and assistive listening devices, before turning to cochlear implantation. The cochlear implant section describes components, how the device works, indications, contraindications, surgical steps, outcome factors and alternatives such as brainstem and middle ear implants.

Inside: 2 sections · 2 labelled pictures · 14 flashcards · 4 min

Topic 7 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 2 sections, about 660 words (4 min of reading), with 14 flashcards.

In this note

  1. Treatment of Hearing Loss. Cochlear Implantation
  2. II. Cochlear implantation

Treatment of Hearing Loss. Cochlear Implantation

1. Medical and Surgical Treatments - Effective for Conductive Hearing Loss (CHL), which involves the outer or middle ear.

A. Medical Management:

  • Cerumen (Wax) Removal: Simple mechanical removal, irrigation, or softening agents for earwax impaction.
  • Medication: Antibiotics or steroids for infectious or inflammatory conditions like otitis externa or otitis media
  • OME → decongestants, ventilation tube

B. Surgical Management:

  • Myringotomy and Tympanostomy Tubes (PE Tubes): Creating a small incision in the eardrum to drain fluid from the middle ear and inserting a tiny tube to ventilate the middle ear space. Common for chronic or recurrent Otitis Media with Effusion (OME).
  • Tympanoplasty: Repair of a perforated tympanic membrane (eardrum).
  • Ossiculoplasty: Surgical reconstruction or replacement of the ossicles (middle ear bones) in cases of discontinuity or damage.
  • Stapedectomy: Removal of a fixed or diseased stapes bone and replacement with a prosthetic device (piston) to treat otosclerosis.

2. Amplification and Rehabilitation - Primary treatments for Sensorineural Hearing Loss (SNHL) and Mixed Hearing Loss (MHL)

1. Medical treatment

Sudden SNHL → corticosteroids

Ménière’s disease → diet, diuretics

Infection → antivirals/antibiotics

Chronic SNHL → usually irreversible.

A. Conventional Hearing Aids:

  • Amplify sound to make it audible for individuals with mild to severe SNHL. Functioning hair cells req.
  • Types: Behind-The-Ear (BTE), Receiver-In-Canal (RIC), In-The-Ear (ITE), and Completely-In-Canal (CIC).

B. Bone Conduction/Osseointegrated Devices (BAHA/Bone-Anchored Hearing Aid):

  • Bypass the outer and middle ear to stimulate the inner ear directly through bone vibration.
  • Used for:
  • CHL/MHL when traditional hearing aids or surgery are not suitable (eg, congenital ear canal atresia, chronic draining ear).
  • Single-Sided Deafness (SSD) to route sound from the deaf side to the functioning cochlea on the better-hearing side.

C. Assistive Listening Devices (ALDs): FM systems, amplified telephones, alerting devices (flashing lights/vibration for doorbells/alarms).

D. Auditory Rehabilitation: Aural rehabilitation and auditory-verbal therapy, especially crucial for children to develop speech and language skills after receiving hearing devices.

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