Mixed Hearing Loss

Deafness caused by simultaneous involvement of the ear sound transmission and sensory systems is called mixed deafness. The patient has both conductive and sensorineural hearing loss in the same ear.

Mixed deafness refers to the coexistence of conductive deafness and sensorineural deafness, such as drug-toxic ear

Mixed deafness belongs to sensorineural deafness, and chronic suppurative otitis media belongs to conductive deafness. The treatment is treated differently as described above. For incurable sensorineural deafness and complicated otitis media, it is given While wearing hearing aids, actively treat otitis media.

Disease overview

Deafness caused by damage to the sound transmission structure of the ear (outer ear and middle ear) and sensory or nervous system (inner ear and auditory nerve) is called mixed deafness. The two parts of mixed deafness can be caused by the same disease or by two unrelated diseases. For example, in suppurative otitis media, there is a sound transmission disorder, when the toxin material penetrates into the labyrinth through the round window membrane and causes a sensory disorder, mixed deafness can occur. Viral infection can be accompanied by otitis media and can also cause cochlear damage. Otosclerosis patients with stapes fixation have transmissive deafness, and cochlear otosclerosis patients have sensory deafness. It is not uncommon for two unrelated reasons to cause mixed deafness. Can suffer from transmissive deafness first, then sensory deafness. Can also suffer from sensory deafness first, and then suffer from transmissive deafness. For example, the treatment of purulent otitis media with aminoglycoside drugs can increase the components of sensory deafness on the basis of causing transmissive deafness. Therefore, in the diagnosis of mixed deafness, in addition to hearing examination, otoscope examination should also be done, and the medical history should be comprehensively and carefully asked.

Disease classification

Otorhinolaryngology

Disease description

Deafness caused by the simultaneous involvement of ear sound and sensory systems is called mixed deafness. The reasons for the damage of the two parts can be the same or different. The former is based on conductive deafness caused by suppurative otitis media, caused by labyrinthitis, or bacterial toxins, ototoxic drugs, etc. penetrate into the inner ear through the cochlear window membrane, causing changes in the physical and chemical properties of labyrinth fluid and the structural changes of the veins and spirals. Secondary sensory deafness. The two parts of the damage caused by different causes of mixed deafness are common, such as otitis media with presbycus, noise deafness or deafness caused by systemic diseases. The hearing changes of mixed deafness are characterized by both air conduction damage and bone conduction damage. The curve is slowly descending, with air-bone conduction spacing in the low-frequency area but not obvious in the high-frequency area. Comprehensive treatment should be used to treat mixed deafness. Viral infection can be accompanied by otitis media and can also cause cochlear damage. Otosclerosis patients with stapes fixation have transmissive deafness, and cochlear otosclerosis patients have sensory deafness. It is not uncommon for two unrelated reasons to cause mixed deafness. Can suffer from transmissive deafness first, then sensory deafness. Can also suffer from sensory deafness first, and then suffer from transmissive deafness. For example, the treatment of purulent otitis media with aminoglycoside drugs can increase the components of sensory deafness on the basis of causing transmissive deafness. Therefore, for the diagnosis of mixed deafness, in addition to hearing examinations, otoscope examinations should be performed, and the medical history should be thoroughly and carefully asked.

Symptoms and signs

The hearing changes of mixed deafness are characterized by both air conduction damage and bone conduction damage. The curve is slowly descending, with air-bone conduction spacing in the low-frequency area but not obvious in the high-frequency area. The hearing changes of mixed deafness are characterized by both air conduction damage and bone conduction damage. The curve is slowly descending, with air-bone conduction spacing in the low-frequency area but not obvious in the high-frequency area. The reasons for the damage of the two parts can be the same or different. The former is based on the conductive deafness caused by suppurative otitis media, due to the combination of labyrinthitis or bacterial toxins, ototoxic drugs and other penetrating into the inner ear through the cochlear window membrane, causing the physical and chemical properties of labyrinth fluid and the structural changes of the vascular pattern and helix Secondary sensory deafness. The two parts of the damage caused by different causes of mixed deafness are common, such as otitis media with presbycus, noise deafness or deafness caused by systemic diseases.
Hearing impairment with sound transmission deafness and sensory deafness and neurological deafness. The air conduction hearing and bone conduction hearing of such patients are reduced, but relatively speaking, their bone conduction hearing is better than air conduction hearing. The disease can be caused by the same disease. It can also be caused by two diseases that are not directly related to each other. For example, chronic otitis media can not only damage the sound transmission mechanism of the middle ear, but also often affect the sensory nerve part of the auditory system, because metabolites containing inflammation can pass through the window membrane and cause cochleitis or labyrinthitis. Otosclerosis surgery, because the oval window was stabbed or the perilymph was exposed during the operation, the high-frequency hearing loss was lower than the level before the operation. Patients often complain of reduced speech recognition, even if the voice they receive is distorted. It can be equipped with bone conduction hearing aids. For those with highly perceptual deafness or complete deafness, bone conduction hearing aids can only provide a small amount of vibration information.

Cause of disease

The reasons for the damage of the two parts can be the same or different. The former is based on conductive deafness caused by suppurative otitis media, caused by labyrinthitis, or bacterial toxins, ototoxic drugs, etc. penetrate into the inner ear through the cochlear window membrane, causing changes in the physical and chemical properties of labyrinth fluid and the structural changes of the veins and spirals. Secondary sensory deafness. The two parts of the damage caused by different causes of mixed deafness are common, such as otitis media with presbycus, noise deafness or deafness caused by systemic diseases.

Pathophysiology

Prevent disease

1. A reasonable diet. Eat less sweet, salty, and thick paste to prevent inner ear ischemia caused by arteriosclerosis, leading to hearing loss.
2. Quit smoking and drink a little alcohol. Because tobacco and alcohol have a toxic effect on the auditory nerve, especially the nicotine in the smoke enters the blood, causing small blood vessels to spasm, blood is slow, and the viscosity increases, resulting in insufficient blood supply to the inner ear, which promotes deafness.
3. Avoid noise damage. Noise will make the auditory sense that has begun to decline more easily, causing the tiny blood vessels in the inner ear to spasm, reducing the blood supply to the inner ear, and causing hearing loss. Therefore, it is not advisable to set the volume too loudly when listening to music, watching TV and listening to music with headphones, generally around 85 decibels.
4. Avoid picking out your ears and often massage. Ear picking is a bad habit. It is easy to damage the ear canal, causing infection, inflammation, and even damage to the tympanic membrane. When the ear canal is itchy, use a small cotton swab to soak a little glycerin or alcohol to gently wipe the ear canal. Insist on massaging the Yifeng and Tinghui points before and after the earlobe can increase blood circulation in the inner ear and protect hearing.
5. Maintain a good mood and take part in more exercises. Excessive fatigue and mental stress can cause inner ear ischemia and affect hearing, such as anger and irritability. Participate in more exercises within your capacity, such as outings, early morning walks, Tai Chi, etc., which can promote blood circulation throughout the body, strengthen blood supply to the inner ear, and delay organ aging.

Diagnostic check

According to clinical manifestations and signs.

treatment plan

Comprehensive treatment should be used to treat mixed deafness. Deafness caused by damage to the ear’s sound transmission structure (outer ear and middle ear) and sensory or nervous system (inner ear and auditory nerve) is called mixed deafness.
The two parts of mixed deafness can be caused by the same disease or by two unrelated diseases. For example, in suppurative otitis media, there is a sound transmission disorder, when the toxin material penetrates into the labyrinth through the round window membrane and causes a sensory disorder, mixed deafness can occur. Viral infection can be accompanied by otitis media and can also cause cochlear damage. Otosclerosis patients with stapes fixation have transmissive deafness, and cochlear otosclerosis patients have sensory deafness. It is not uncommon for two unrelated reasons to cause mixed deafness. Can suffer from transmissive deafness first, then sensory deafness. Can also suffer from sensory deafness first, and then suffer from transmissive deafness. For example, the treatment of purulent otitis media with aminoglycoside drugs can increase the components of sensory deafness on the basis of causing transmissive deafness. Therefore, in the diagnosis of mixed deafness, in addition to hearing examination, otoscope examination should also be done, and the medical history should be comprehensively and carefully asked.
It solves the obstacles in communicating with others, restores self-confidence, and develops physical and mental health, which is even more important for deaf children. Hearing speech with hearing aids has been developed and used, making them deaf but not dumb, and out of the silent world. The two parts of the damage caused by different causes of mixed deafness are common, such as otitis media, presbycusis, noise deafness, or deafness caused by systemic diseases. The hearing changes of mixed deafness are characterized by both air conduction damage and bone conduction damage. The curve is slowly descending, with air-bone conduction spacing in the low-frequency area but not obvious in the high-frequency area. Comprehensive treatment should be used to treat mixed deafness. Mixed deafness refers to the coexistence of conductive deafness and sensorineural deafness. For example, drug-induced toxic deafness is sensorineural deafness, and chronic suppurative otitis media is conductive deafness. The treatment is as described above. Differentiate treatment. For patients with incurable sensorineural hearing loss and complicated otitis media, while giving hearing aids, actively treat otitis media.
The hearing changes of mixed deafness are characterized by both air conduction damage and bone conduction damage. The curve shows a slow-decreasing type, with air-bone conduction spacing in the low-frequency area but not obvious in the high-frequency area. Comprehensive treatment should be used to treat mixed deafness.

Medication safety

1. Medication: In the early stage of sensorineural hearing loss, various viral infections and the use of ototoxic drugs to cause deafness, unexplained deafness, etc., can be treated with drugs in the early stage. The relevant person reported that 20% of patients were treated early. Hearing can be restored. If the medical history is more than 2 years, the medication is invalid, and the congenital sensorineural hearing loss does not need medication.
2. Sensorineural hearing loss is mainly used with neurotrophic drugs, coenzyme A, cytochrome C, ATP, cell growth peptide, vasodilator drugs, vitamin B family, vitamin C, etc., all of which have a certain effect on the hearing recovery of such patients effect.
3. Surgical treatment: First, surgical placement of an electronic cochlear implant to allow it to listen to acoustic speech; first, surgical treatment of intracranial space-occupying lesions that cause sensorineural hearing loss, the tumor is removed by surgery to restore hearing; , Hematomas and temporal bone fractures from craniocerebral trauma compress the auditory nerve and cause sensorineural deafness. Surgery is also required to completely remove the lesion, so that the auditory nerve is not compressed to restore hearing.
4. Matching hearing aids to compensate hearing: It is the most effective and successful way to treat deaf people and deaf children with sensorineural hearing loss to wear hearing aids.

Precautions

1. If young people occasionally experience short-term tinnitus, but it will return to normal soon, it may be caused by sudden noise stimulation in the ears, or due to stress, stress, insomnia and other reasons. Pay attention to daily life and The habit of ear use will ease; if tinnitus persists for 1-2 days, you must go to the hospital for examination. Don’t think that it is just tinnitus and does not affect hearing. It is not a matter of course, because some high-frequency deafness is pure tinnitus at first, and hearing is not affected, but it will suddenly appear deaf over time.
2. In the process of taking an airplane, the atmospheric pressure drops rapidly when the airplane takes off, which will make the ears feel clogged, and a few people may have short-term hearing impairment and ear canal pain. This is because when the aircraft is ascending or descending, the air pressure in the tympanic cavity of the middle ear is abnormal due to the change of atmospheric pressure, causing the Eustachian tube to be blocked by pressure, and the tympanic cavity of the middle ear is under negative pressure, and the human body will experience ear canal blockage, tinnitus, ear Symptoms such as bloating and hearing loss. Therefore, chewing gum can be chewed during takeoff and landing of the plane. With chewing and swallowing actions, the Eustachian tube will open and close at any time, and air can freely enter and exit the middle ear cavity, so that the internal pressure of the middle ear and the external atmospheric pressure can maintain a normal balance. The discomfort will be reduced or disappeared. People who are catching a cold, have upper respiratory tract infections or have problems with the nasal cavity, it is best not to take an airplane to avoid otitis media.
3. Young parents should be aware that children, especially babies, are prone to ear inflammation and hearing loss due to upper respiratory tract infections. Especially for newborns, do not let the baby lie flat when breastfeeding, hold it diagonally as much as possible, otherwise it will be easy to choke on the milk. Once the choking is in the ears and cannot be discharged, it is easy to breed bacteria and cause ear infections.