Chapter 22: Hearing and Balance Disorders

Hearing loss is classified into two primary categories based on the anatomical site of dysfunction: conductive hearing loss occurs when sound transmission through the external ear, tympanic membrane, or middle ear structures is obstructed, with cerumen impaction being the most prevalent cause, while sensorineural hearing loss results from damage to cochlear hair cells or the vestibulocochlear nerve and includes age-related presbycusis as the leading cause. Diagnostic differentiation relies on physical examination techniques including otoscopy and tuning fork tests such as Weber and Rinne maneuvers, with audiography serving as the gold standard for quantifying hearing deficits. Tinnitus, the persistent perception of sound without external stimulus, represents a common symptom associated with hearing loss and noise exposure that may warrant imaging to exclude structural lesions like acoustic neuromas. The chapter provides comprehensive coverage of vestibular disorders affecting balance and spatial orientation, beginning with the distinction between dizziness and vertigo as fundamentally different sensory experiences. Benign paroxysmal positional vertigo, the most prevalent peripheral vestibular condition, results from otoconia displacement within semicircular canals and responds exceptionally well to canalith repositioning procedures including the Epley maneuver. Ménière's disease, characterized by endolymphatic hydrops, presents with episodic vertigo, fluctuating hearing loss, and tinnitus requiring dietary management and pharmacological intervention in severe cases. Vestibular neuritis and labyrinthitis, typically viral in origin, present with acute-onset vertigo and require differentiation from central causes using clinical testing such as the Head Impulse Test and HINTS examination. The chapter emphasizes the importance of rapid diagnosis and intervention in sudden sensorineural hearing loss and acute vestibular dysfunction to prevent permanent sensory deficits and facilitate recovery through vestibular rehabilitation.