Sensorineural hearing loss - Diagnosis

In acquired sensorineural hearing loss, most patients do not have any warning signs of the disease. In some cases, hearing loss may be preceded by the appearance of noise or ringing in the ears.

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Indications for consultation with other specialists

Depending on the suspected etiology of the development of hearing loss, it is advisable to involve a therapist, neurologist, ophthalmologist, traumatologist, endocrinologist, neurosurgeon, and geneticist in the examination of the patient.

Physical examination

Given the complexity of diagnosing sensorineural hearing loss, it is necessary to conduct a comprehensive general clinical examination of the patient with the participation of an otoneurologist, therapist, neurologist, ophthalmologist (to assess the condition of the fundus and retinal vessels), endocrinologist (to conduct glucose tolerance tests and thyroid function tests), and, if indicated, a consultation with a traumatologist.

Laboratory diagnostics of sensorineural hearing loss

A general clinical and biochemical blood test is required.

Instrumental study of sensorineural hearing loss

Otoscopy reveals no pathological changes. The eardrum and external auditory canal are unchanged.

A number of studies are conducted to assess the condition of the auditory analyzer. Acumetry reveals a significant decrease in the perception of whispered and spoken language compared to the norm. Tuning fork research methods: in case of sensorineural hearing loss, positive experiments of Rinne and Federici are determined, in the Weber experiment, the tuning fork C12S-C512 is lateralized to the better hearing or healthy ear. Patients with suspected sensorineural hearing loss need to undergo tonal threshold audiometry. As a rule, a descending configuration of the curves is revealed due to the deterioration of the perception of predominantly high tones, the absence of the bone-air interval: a break in the curves at the frequencies of their maximum decrease; tinnitus of the high-frequency spectrum. Suprathreshold audiometry reveals a positive phenomenon of acceleration of loudness increase. The thresholds of hearing of ultrasound are increased compared to the norm, lateralization of sound to the healthy or better hearing ear is noted.

In young children, subjective play audiometry or objective audiometry is used to register the state of the auditory function: registration of short-latency SEPs and OAEs. In children, registration of auditory evoked potentials is the main (often the only) method that allows diagnosing hearing defects. For early diagnosis of hearing loss in newborns, an audiological screening system has been developed that can be used in maternity hospitals, providing for the registration of OAEs and short-latency SEPs.

All patients with suspected sensorineural hearing loss require objective audiometry to determine the site of damage. Measuring the acoustic impedance of the middle ear allows us to assess the condition of the middle ear conduction system and exclude changes in the sound conduction system. In sensorineural hearing loss, as a rule, a type A tympanogram is recorded, which indicates a normal state of the sound conduction system of the middle ear. The values of recording acoustic reflexes largely depend on the level of damage to the auditory analyzer and the degree of hearing loss in a particular patient. Electrocochleography is an objective method that allows for differential diagnostics of sensorineural hearing loss caused by hydrops of the inner ear. Registration of OAEs allows us to assess the condition of the sensory structures of the inner ear and, in particular, the external spikelet cells of the inner ear, which ensure normal sound transformation processes in the inner ear. Short-latency SEPs in some cases allow for differential diagnostics of retrocochlear hearing loss,

To assess the state of the balance system, vestibulometric tests are carried out: cupulometry with threshold and suprathreshold stimuli, caloric test, fisturography, indirect selective otolithometry.

During a comprehensive examination, an X-ray examination of the chest organs, cervical spine in 2 projections, temporal bones in the Stenvers, Schuller and Manner projections is performed. CT and MRI are the most informative. To study cerebral hemodynamics, extracranial and transcranial ultrasound Dopplerography of the main vessels of the head or duplex scanning of the vessels of the brain are performed.

Differential diagnosis of sensorineural hearing loss

Sensorineural hearing loss should be differentiated from pathological conditions that cause hearing loss associated with dizziness. Sensorineural hearing loss is observed in the following diseases:

• acute cerebrovascular accident in vertebrobasilar insufficiency
• Meniere's disease:
• tumors in the cerebellopontine angle area;
• labyrinthine fistula;
• multiple sclerosis.

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