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Most commonly - ear wax, OM, OE

''Presbycusis''
age related SN loss - difficulty following conversations
audiometry - bilat high frequency loss

''Otosclerosis''
autosomal dominant - bone replaced by vascular spongy bone
onset 20-40 years
conductive deafness, tinnitus, family history, tympanic membrane has flamingo tinge (hypereamia) in 10%

''Glue Ear'' (OM with effusion)
peaks at 2 yrs
usually presents with hearing loss but maybe with speech delay or behavioural / balance problems

''Meniere''
middle aged adults
recurrent episodes of //vertigo//, tinnitus and hearing loss (SN)
sensation of aural fullness
also nystagmus and positive rombergs (stand with closed eyes - if wobble - ?loss of vestibular function or of proprioception)
episodes last minutes to hours

''Drug ototoxicity''
eg aminoglycosides (gentamicin), furosemide, aspirin, cytotoxics

''Noise damage''
esp if works in heavy industry
bilateral and typically worse at 3000-6000Hz

''Acoustic neuroma'' (vestibular schwannoma)
cranial nerve VIII - hearing loss, vertigo, tinnitis, V - absent corneal reflex, V!! facial palsy
bilateral seen in neurofibromatosis 2