1. sensorineural hearing loss AHMED ALARFAJ

2. EVALUATION FOR HEARING LOSS HISTORY Character of Hearing Loss:Character of Hearing Loss: Prenatal and perinatal history:Prenatal and perinatal history: Contributing Factors:Contributing Factors: Associated Symptoms:Associated Symptoms:

3. PHYSICAL EXAMINATION Otoscopy/Microscopy/Otoscopy/Microscopy/ Pneumatoscopy: Pneumatoscopy: Inspection and Palpation:Inspection and Palpation: Other Physical Exam:Other Physical Exam:

4. HEARING TEST Objective Measures:Objective Measures: Behaviour Observation Audiometry:Behaviour Observation Audiometry: By 3 years old may consider conventional testingBy 3 years old may consider conventional testing

5. ANCILLARY TEST (may be consider for select cases) CT of Temporal Bones:CT of Temporal Bones: Complete Blood Count:Complete Blood Count: Treponemal Studies:Treponemal Studies: Perchlorate Test and Thyroid Function Tests:Perchlorate Test and Thyroid Function Tests: Lipid Profile:Lipid Profile:

6. ANCILLARY TEST (may be consider for select cases) Immune Function Tests:Immune Function Tests: Electrocardiogram:Electrocardiogram: Urine Analysis Blood Urea Nitrogen, Serum Creatinine:Urine Analysis Blood Urea Nitrogen, Serum Creatinine: TORCH Studies:TORCH Studies:

7. GENERAL MANAGEMENT CONCEPTS If suspects syndromic hearing loss consider genetic evaluation (chromosomal analysis) and counselingIf suspects syndromic hearing loss consider genetic evaluation (chromosomal analysis) and counseling Hearing amplification devices should be offered early to prevent speech and developmental delays.Hearing amplification devices should be offered early to prevent speech and developmental delays.

8. COMMON INNER EAR DYSMORPHOLOGIES Michel’s AplasiaMichel’s Aplasia Mondini AplasiaMondini Aplasia Scheibe AplasiaScheibe Aplasia Alexander AplasiaAlexander Aplasia

9. Common Differential Diagnosis of Hearing Loss: KITTENS Method Infectious & Toxins & Infectious & Toxins & CongenitalPeripheral Trauma HereditaryLabyrinthitis Ototoxic Progressive medication SNHLOtitis Media Congenital Luetic hearing loss Noise induced AuricularPresbycusis hearing loss malformations Head trauma Congenital Lead & mercury Hearing losstoxicity Hearing loss toxicity Barotrauma Barotrauma

10. Common Differential Diagnosis of Hearing Loss: KITTENS Method Tumor Systemic/ (Neoplasms) Endocrine Neurologic Psychological Temporal Hypothyroiditis Multiple Sclerosis Meniere’s Disease BoneNeoplasms Hyperlipidemia Meningitis Paget’s Disease Hyperlipidemia Meningitis Paget’s Disease Cholesteatomas Stroke Otosclerosis Central auditory Presbycusis Central auditory Presbycusis processing processing disorder Cerumen disorder Cerumen impaction impaction Pseudohypacusis Pseudohypacusis Autoimmune Autoimmune disorders disorders

11. PRESBYCUSIS Presbycusis: progressive deterioration of hearing associated with agingPresbycusis: progressive deterioration of hearing associated with aging Most common cause:Most common cause: Pathophysiology:Pathophysiology: Sign & Symptoms:Sign & Symptoms: Diagnosis:Diagnosis: Treatment:Treatment:

12. NOISE-INDUCED HEARING LOSS Temporary Threshold Shift (TTS)Temporary Threshold Shift (TTS) Permanent Threshold Shift (PTS)Permanent Threshold Shift (PTS) PathophysiologyPathophysiology Sign & SymptomsSign & Symptoms DiagnosisDiagnosis TreatmentTreatment