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THT 4 Blok Ss 1
THT 4 Blok Ss 1
AND
PERIPHERAL VESTIBULAR
DISORDERS
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DEFINITION
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HEARNG LOSS
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TYPE OF HEARING IMPAIRMENT
Hearing
Impairment
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CONDUCTIVE IMPAIRMENT
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CAUSE of CONDUCTIVE
HEARING LOSS
The most common in kids and teens otitis media.
A buildup of fluid or pus behind the eardrum block the
transmission of sound.
If fluid goes away hearing returns to normal.
Blockages in the ear a foreign object, impacted earwax or
dirt.
A tear or hole in the eardrum interfere vibrate properly.
Etiology : inserting an object into the ear, a sudden
explosion or other loud noise, a sudden change in air
pressure, a head injury, or repeated ear infections.
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Page 8
Normal Eardrum
Otitis Media
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Sensorineural Hearing Loss
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Sensorineural Hearing Loss
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CAUSE of SENSORI NEURAL
HEARING LOSS
Genetic disorder development of the inner ear and the
auditory nerve.
Injuries to the ear or head.
Complications during pregnancy or birth.
Infections or illnesses development of the inner
ear.
Premature babies.
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CAUSE of SENSORI NEURAL
HEARING LOSS
Infections or illnesses.
Repeated ear infections
Brain tumors
Damage the structures of the inner ear.
Medications.
Some antibiotics
Chemotherapy drugs
Loud noise.
A sudden loud noise or exposure to high noise levels over time
permanent damage to the tiny hairs in the cochlea
Can't transmit sounds effectively
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RISK FACTORS
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Mixed Hearing Loss
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Children with a hearing difficulties
may have problems with :
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SPEECH FREQUENCIES
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How Do Doctors Diagnose It?
History taking
Physical examination
Ancillary test
Hearing test
Radiology Examination
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How Do Doctors Diagnose It?
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HEARING TEST
1. Subjective
2. Objective
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SUBJECTIVE HEARING TEST
1. Whisper test
2. Tuning fork Test
3. Pure tone Audiometry
4. Special audiometry : SISI, ABLB, Tone Decay
5. Behavioral Observational Audiometry (BOA)
6. Visual Reinforcement Audiometry (VRA)
7. Play Audiometry
8. Speech Audiometry
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OBJECTIVE HEARING TEST
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AUDIOMETRY
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AUDIOGRAM
0
Hearing loss (dB)
10
20
30 left ear
right ear
40
50
125 250 500 1k 2k 4k 8k
Frequency (Hz)
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AUDIOGRAM
CONDUCTIVE HEARING LOSS
BC threshold within
normal limits (0-20 Db)
AC Threshold Increased
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AUDIOGRAM
SENSORI- NEURAL HEARING LOSS
Increased BC thresholds
Increased AC thresholds
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AUDIOGRAM
SENSORI- NEURAL HEARING LOSS
Presbikusis
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AUDIOGRAM
NOISE INDUCED HEARING LOSS
(NIHL)
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TYMPANOMETRY
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OTOACOUSTIC EMISSIONS
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AUDITORY BRAINSTEM RESPONSE
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AUDITORY BRAINSTEM RESPONSE
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How Is It Treated?
Depending upon etiology.
Treatment :
Removing wax or dirt from the ear.
Treating an underlying infection.
Hearing aid or cochlear implant problem in the
cochlea or hearing nerve.
Surgery damage or a structural problem with the
eardrum or ossicles.
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TREATMENT OF HEARING IMPAIRMENT
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TREATMENT OF HEARING IMPAIRMENT
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HEARING AIDS
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COCHLEAR IMPALNT
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Can I Prevent Hearing Impairment?
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Some ways to reduce it.
Turn down the volume on
your stereo, TV, headset on
your Walkman or CD player
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PERIPHERAL VESTIBULAR
DISORDERS
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INTRODUCTION
Millions of people present annually to their
physicians with the complaint of dizziness
Dizziness is subjective sensations that usually
result from a disease of the vestibular system
Dizziness may be caused by :
poor vision, decreased proprioception (diabetes
mellitus), cardiovascular insufficiency, cerebellar
or brainstem strokes, neurologic conditions
(migraines, multiple sclerosis), metabolic
disorders, and side effects of medications
Page 45
Probst-Grevers-Iro, Basic Otorhinolaryngology, 2006 Modul Ilmu Kesehatan THT-KL, 2008
ANATOMY - PERIPHERAL VESTIBULAR SYSTEM
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BENIGN PAROXYSMAL POSITIONAL VERTIGO
Epidemiology:
- The incidence may range from 10 to 100
cases per 100.000 persons per year.
- Men = women
- Average age presentation is in 5th decade.
Johnson J, Lalwani AK. Menieres . Ballengers Otorhinolaryngology
Chapter 20. 2003 BC Decker Inc. Page 48
BENIGN PAROXYSMAL POSITIONAL VERTIGO
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MD, Pasha, Otolaryngology-HNS, Clinical Reference, 2006
BENIGN PAROXYSMAL POSITIONAL VERTIGO
Diagnostic Evaluation
Management
Education, reassurance & observation INSTRUCTIONS FOR PATIENTS
Particle Repositioning Maneuver (Epley AFTER OFFICE TREATMENTS:
Maneuver) Wait for 10 minutes after the
Home vestibular positional exercise induce maneuver is performed before going
vertigo to stimulate vestibular compensation home
Antivertiginious medications Sleep semi-recumbent for the next two
Singular neurectomy: transection of the nights
nerve to the posterior SCC For at least one week, avoid provoking
Posterior SCC occlusion: occludes head positions
ampullated end to prevent movement of At one week after treatment, put
endolymph yourself in the position that usually
makes you dizzy
Series of head
positioning
completed in the
office, based on
repositioning
free-floating
particle in the
posterior canal
requires
patient to be
upright after
repositioning for
48 hours