- Rachel Edmiston, specialty core trainee year 1, ENT 1,
- Caroline Mitchell, general practitioner2
- 1ENT Department, Tameside General Hospital, Ashton-under-Lyne, OL6 9RW, UK
- 2Institute of General Practice and Primary Care, University of Sheffield, Community Sciences Centre, Northern General Hospital, Sheffield S5 7AU, UK
- Correspondence to: R Edmiston
- Accepted 25 January 2013
A 60 year old former steelworker mentions to his general practitioner that his family is complaining that the television is too loud.
What you should cover
Onset of symptoms: acute, chronic, fluctuating, or recurrent?
Unilateral v bilateral?
What impact is there on day to day communication (for example, hearing in groups or one to one)?
Associated ear, nose, and throat (ENT) symptoms
Vertigo: described as a sensation of dizziness likened to “room spin” associated with or without nausea
Otorrhoea: is it purulent or clear?
Otalgia: otitis media or externa (is there any associated itching or discharge?)
Head and neck: localised pain, swelling, lump
Risk factors for otological disease
Infection (adult or childhood), trauma, or previous surgery
History of exposure to noise (including occupational)
Use of ototoxic drugs: permanent damage from aminoglycosides (such as gentamicin) or chemotherapy drugs (particularly platinum based treatments such as cisplatin); reversible damage from salicylates (most common in older people); quinine toxicity; and very high dose loop diuretics.
Medical history: diabetes (doubles the risk of hearing loss); vasculitis; autoimmune inner ear disease; stroke (can lead to central loss of hearing).
Family history: common for otosclerosis, owing to autosomal dominant inheritance.
Be aware of the red flag symptoms and signs (box 1)
Box 1 Red flags
Sudden onset or rapidly progressive hearing loss
A rapid onset (over a 72 hour period) of a sensation of hearing impairment in …