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Chronic hearing loss

Definition
Chronic hearing loss is the loss of sound threshold sensitivity associated with difficulty in speech discrimination, causing social isolation and cognitive deficit.
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Pathophysiology
Chronic hearing loss is caused by degenerative processes associated with aging (presbycusis), genetic mutations, noise exposure, therapeutic drugs (aminoglycosides, cisplatin), and chronic conditions.
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Disease course
Impaired hearing may lead to social isolation due to impaired communication, and is associated with increased risk of depression, falls, hospitalizations, frailty, and dementia.
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Prognosis and risk of recurrence
Mild hearing loss and moderate/severe hearing loss in the elderly are associated with a 39% and 21% increased risk of mortality, respectively.
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Key sources
The following summarized guidelines for the evaluation and management of chronic hearing loss are prepared by our editorial team based on guidelines from the American Cochlear Implant Alliance (ACI Alliance 2022), the American College of Medical Genetics (ACMG 2014), and the U.S. Preventive Services Task Force (USPSTF 2012).
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Guidelines

1.Screening and diagnosis

Indications for screening, older adults: insufficient evidence to assess the balance of benefits and harms of screening for hearing loss in asymptomatic adults ≥ 50 years of age.
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2.Diagnostic investigations

Clinical history: perform a comprehensive evaluation in all newborns and infants with confirmed hearing loss, including:
patient-focused medical and birth histories
three-generation pedigree and family medical history
physical examination focusing on dysmorphic physical findings
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More topics in this section

  • Genetic testing in patients with syndromic features

  • Genetic testing in patients without dysmorphic features

3.Therapeutic procedures

Cochlear implants: obtain standard medical workup and monitoring in patients with sudden and/or rapid progression of single-sided deadness to determine if the hearing spontaneously improves or is recoverable with treatment. Offer cochlear implantation not earlier than 3-6 months after the sudden hearing loss to allow ample time for potential recovery of hearing.
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4.Patient education

Indications for specialist referral: refer to a multidisciplinary care center, when available.
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