Noise-induced Hearing Loss

Definition
Hearing loss caused by exposure of loud noise in a sufficient time, usually from workplace noise

Predisposing factor
High intensity noise High frequency noise Long exposure time On ototoxic drugs medication

Clinical Manifestation
Tinnitus +/ Speech discrimination deteriorate: hard to understand conversation Cocktail party deafness
adaptation: physiologic, fatigue of auditory nerve exposed to high intensity noise (70 dB SPL or less) temporary threshold shift: exposure of high intensity noise, recover in minutes to hours permanent threshold shift: exposure of high intensity noise with short (explosive) or long duration. Damage to cochlea structure

Diagnosis
Anamnesis:
noisy workplace, more than 5 years

Physical Examination:
Otoscopy: no abnormality Tuning fork: Schwabach shorten, Weber lateralization to better ear, Rinne AC>BC

 Audiometry
Pure tone: SNHL on 3000 6000 Hz, notch on 4000 Hz (specific for this disease) speech audiometry, SISI, ABLB, MLB etc.

Management
removal from exposure protector: ear plug, ear muff Hearing Aids Lip reading

 First to fail permanently are the outer hair cells (OHCs) in the basilar part of the cochlea, in the area which responds to 4 kHz and the adjacent areas of 3 and 6 kHz. This is where the ear is most sensitive, in part because of the harmonic amplification of the ear canal and in part because of an absolute sensitivity. Once hair cells degenerate they do not recover and a permanent hearing loss develops. Classically therefore, following noise exposure, hearing loss is shown as an audiometric notch, usually maximal at 4 kHz but may also be based anywhere between 3 and 6 kHz.