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American Family Physician Jul 2019More than 30 million U.S. adults have hearing loss. This condition is underrecognized, and hearing aids and other hearing enhancement technologies are underused. Hearing... (Review)
Review
More than 30 million U.S. adults have hearing loss. This condition is underrecognized, and hearing aids and other hearing enhancement technologies are underused. Hearing loss is categorized as conductive, sensorineural, or mixed. Age-related sensorineural hearing loss (i.e., presbycusis) is the most common type in adults. Several approaches can be used to screen for hearing loss, but the benefits of screening are uncertain. Patients may present with self-recognized hearing loss, or family members may observe behaviors (e.g., difficulty understanding conversations, increasing television volume) that suggest hearing loss. Patients with suspected hearing loss should undergo in-office hearing tests such as the whispered voice test or audiometry. Patients should then undergo examination for cerumen impaction, exostoses, and other abnormalities of the external canal and tympanic membrane, in addition to a neurologic examination. Sudden sensorineural hearing loss (loss of 30 dB or more within 72 hours) requires prompt otolaryngology referral. Laboratory evaluation is not indicated unless systemic illness is suspected. Computed tomography or magnetic resonance imaging is indicated in patients with asymmetrical hearing loss or sudden sensorineural hearing loss, and when ossicular chain damage is suspected. Treating cerumen impaction with irrigation or curettage is potentially curative. Other aspects of treatment include auditory rehabilitation, education, and eliminating or reducing use of ototoxic medications. Patients with sensorineural hearing loss should be referred to an audiologist for consideration of hearing aids. Patients with conductive hearing loss or sensorineural loss that does not improve with hearing aids should be referred to an otolaryngologist. Cochlear implants can be helpful for those with refractory or severe hearing loss.
Topics: Adult; Diagnosis, Differential; Hearing Loss; Hearing Tests; Humans
PubMed: 31305044
DOI: No ID Found -
American Family Physician Oct 2018Cerumen production is a normal and protective process for the ear canal. However, cerumen should be removed when it causes symptoms (e.g., hearing loss, itching, pain,...
Cerumen production is a normal and protective process for the ear canal. However, cerumen should be removed when it causes symptoms (e.g., hearing loss, itching, pain, tinnitus) or prevents assessment of the external auditory canal, the tympanic membrane, or audiovestibular system. Cerumen should also be removed when it limits examination in patients who cannot communicate their symptoms, such as those with dementia or developmental delay, nonverbal patients with behavioral changes, and young children with fever, speech delay, or parental concerns. Patients with coagulopathies, hepatic failure, thrombocytopenia, or hemophilia, and those taking antiplatelet or anticoagulant medications, should be counseled about the increased risk of bleeding in the external auditory canal when cerumen is removed. Effective treatment options include cerumenolytic agents, irrigation with or without cerumenolytic pretreatment, and manual removal. Home irrigation with a bulb syringe may be appropriate for selected adults. Cotton-tipped swabs, ear candling, and olive oil drops or sprays should be avoided. If multiple attempts to remove the impacted cerumen-including a combination of treatments-are ineffective, clinicians should refer the patient to an otolaryngologist. Persistent symptoms despite resolution of the impaction should also prompt further evaluation for an alternative diagnosis.
Topics: Cerumen; Cerumenolytic Agents; Curriculum; Education, Medical, Continuing; Hearing Loss; Humans; Practice Guidelines as Topic; Therapeutic Irrigation; Tinnitus; Treatment Outcome; United States
PubMed: 30277727
DOI: No ID Found -
The Application of Clinical Genetics 2017Maple syrup urine disease (MSUD) is an inborn error of metabolism caused by defects in the branched-chain α-ketoacid dehydrogenase complex, which results in elevations... (Review)
Review
Maple syrup urine disease (MSUD) is an inborn error of metabolism caused by defects in the branched-chain α-ketoacid dehydrogenase complex, which results in elevations of the branched-chain amino acids (BCAAs) in plasma, α-ketoacids in urine, and production of the pathognomonic disease marker, alloisoleucine. The disorder varies in severity and the clinical spectrum is quite broad with five recognized clinical variants that have no known association with genotype. The classic presentation occurs in the neonatal period with developmental delay, failure to thrive, feeding difficulties, and maple syrup odor in the cerumen and urine, and can lead to irreversible neurological complications, including stereotypical movements, metabolic decompensation, and death if left untreated. Treatment consists of dietary restriction of BCAAs and close metabolic monitoring. Clinical outcomes are generally good in patients where treatment is initiated early. Newborn screening for MSUD is now commonplace in the United States and is included on the Recommended Uniform Screening Panel (RUSP). We review this disorder including its presentation, screening and clinical diagnosis, treatment, and other relevant aspects pertaining to the care of patients.
PubMed: 28919799
DOI: 10.2147/TACG.S125962 -
Australian Family Physician Oct 2015Ear syringing is a very common practice among general practitioners (GPs). It is used by many as the treatment of choice for cerumen (ear wax), and is usually effective... (Review)
Review
BACKGROUND
Ear syringing is a very common practice among general practitioners (GPs). It is used by many as the treatment of choice for cerumen (ear wax), and is usually effective and safe. However, complications from syringing are an increasingly common reason for presentation to ear, nose and throat (ENT) specialists and medico-legal complaints against GPs.
OBJECTIVE
The aim of this article is to provide GPs with the knowledge to safely manage cerumen.
DISCUSSION
Ear wax is an important part of a normal functioning ear. It is mostly asymptomatic and requires no treatment. Softening ear drops may be necessary to help the ear fulfil its self-cleaning function, and should be considered first-line treatment. Syringing can be safely performed if this fails by taking a thorough history and examination to exclude contraindications, gaining patient consent and ensuring the appropriate use of equipment. Referral to an ENT clinic for manual removal with microsuctioning may be necessary in the event of contraindications, complications or failure.
Topics: Cerumen; Ear; Humans; Syringes; Therapeutic Irrigation
PubMed: 26484488
DOI: No ID Found -
The British Journal of General Practice... Apr 2023
Topics: Humans; Cerumen; Primary Health Care
PubMed: 36997227
DOI: 10.3399/bjgp23X732357