Real-Life Challenge: Sensorineural Hearing Loss
A 54-year-old retired male police officer presents with complaints that his hearing has diminished over the past few years. He is accompanied by his wife who says he does not hear what she says any more. She states that this has been getting progressively worse, but she has noted that he is turning up the sound on the television so loud that she cannot stand it. She also says that he cannot hear the phone ring. Additionally, she reports that he does not hear what she is saying and confuses that information. Upon examination, audiometry indicates a loss of hearing. The patient has difficulty hearing the examiner’s commands or questions. He also complains of ringing in his ears (tinnitus). The patient has had a few experiences of dizziness or vertigo. The physician attempts to discover a possible source of the condition and also to rule out other conditions including tumors or aneurysms. The patient confirms previous exposure to extensive gun firing on a range without adequate ear protection. He also has worked in a machine shop where presses punched out metal objects on dies. Treatment includes reducing the source of damage including reduction of noise levels. The reduction can be obtained by turning down the television volume and wearing ear plugs.
1. What is the significance of the wife’s complaints?
2. Why would an audiometric exam have been necessary?
3. What might have been some of the sources of the hearing loss?
4. What is the significance of shooting without adequate ear protection?
5. What will be the outcome if noise levels are reduced?
6. Why is it important for the physician to rule out a tumor or aneurysm?