ABSTRACT
Hearing loss Hearing loss is the most common symptom relating to the ear. When taking a history, the following features will be important in reaching a diagnosis:
! age – presbyacusis (age-related degeneration of the hair cells of the inner ear) is very common over the age of 65, and is the most common cause of hearing loss
! speed of onset – a hearing loss that occurs over hours or days is more likely to be due to an acute inner ear pathology such as vascular insuffi ciency or a viral insult. Glue ear may also present in this way
! laterality – are both ears equally affected? Presbyacusis most commonly affects both ears equally, but an inner ear pathology is more likely to be unilateral
! tinnitus is often present with a hearing loss, and if it is bilateral, it is rarely an indicator of any sinister aetiology
! vertigo – if the hearing loss is sudden in onset and is associated with vertigo (an illusion of movement, see below), suspect inner ear pathology.
