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Unilateral Conductive Hearing Loss

Unilateral conductive hearing loss (UCHL) occurs when there is a problem with the middle ear that affects sound conduction to the inner ear, resulting in hearing loss in one ear.

Below are the Diagnostic Evaluation And Management Options.

Diagnostic Evaluation

Step 1: History and Physical Examination

  • Medical history

    Ask about ear infections, trauma, or previous ear surgery, any history of Epistaxis, nasal obstruction, rhinorrhea, anosmia, hyposmia, tinnitus, headache, blurring of vision or double vision, numbness on the face or teeth. Also ask about presence of cough, abdominal pains, pains in the limbs etc.

  • Physical examination

    Examine the ear canal and tympanic membrane using an otoscope. Do anterior and posterior rhinoscopy looking for nasal mass, postnasal mass, examine all cranial nerves. Examine neck looking for enlarged lymph nodes. Examine all other systems especially chest, long bones

Step 2: Audiological Evaluation

  • Pure tone audiometry

    Assess hearing thresholds in both ears.

  • Tympanometry

    To assess middle ear pressure and acoustic reflexes.

  • Speech audiometry

    Evaluate speech recognition and understanding.

  • Otoacoustic emissions (OAEs)

    Measure the sounds produced by the inner ear.

Step 3: Imaging Studies

  • Computed Tomography (CT) scan

    Evaluate the middle ear and temporal bone.

  • Magnetic Resonance Imaging (MRI)

    Assess the inner ear and auditory nerve.

Step 4: Specialized Tests

  • Electronystagmography (ENG)

    Evaluate vestibular function.

  • Electrocochleography (ECog)

    Measure the electrical activity of the inner ear.

Management

Step 1: Medical Management

  • Antibiotics

    Treat middle ear infections.

  • Nasal decongestants

    Relieve nasal congestion.

  • Ear drops

    Treat earwax buildup or outer ear infections.

Step 2: Surgical Management

  • Myringotomy and tympanostomy tube insertion

    Relieve middle ear fluid buildup.

  • Tympanoplasty

    Repair the tympanic membrane and middle ear bones.

  • Ossiculoplasty

    Repair or replace the middle ear bones.

  • Mastoidectomy

    Remove infected mastoid bone tissue.

  • Endoscopic biopsy

    Endoscopic biopsy of the postnasal space if tympanogram shows type B or C, to rule out nasopharyngeal carcinoma.

Step 3: Amplification and Rehabilitation

  • Hearing aids

    Recommend hearing aids to improve communication.

  • Bone-anchored hearing aids (BAHAs)

    Consider BAHAs for single-sided deafness.

  • Cochlear implants

    Consider cochlear implants for severe to profound hearing loss.

  • Aural rehabilitation

    Provide auditory training and speech reading instruction.

  • chemotherapy / radiotherapy

    If biopsy positive for nasopharyngeal carcinoma to refer for chemotherapy / radiotherapy

Step 4: Follow-up and Monitoring

  • Regular follow-up appointments

    Monitor hearing and adjust treatment as needed.

  • Hearing aid adjustments

    Adjust hearing aids to ensure optimal performance.

  • Surgical follow-up

    Monitor for post-surgical complications, complications of chemo radiotherapy and adjust treatment as needed.

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