Gradual unilateral hearing loss, tinnitus Sudden, fluctuating, unilateral hearing loss, tinnitus, episodic vertigo Normal tympanic membrane vertigo and nystagmus, with positive pneumatic pressure Sudden unilateral hearing loss, tinnitus, vertigo, head trauma, straining Normal tympanic membrane, with possible vertigo or disequilibriumĪny abnormal configuration with poor speech discrimination Rapidly progressive hearing loss, possibly fluctuating, bilateral loss Gradual hearing loss, tinnitus, noise exposureīilateral, symmetric loss centered at 4,000 Hz Gradual hearing loss, noise exposure, tobacco useĮlderly patients with normal tympanic membrane Suggested cause of sensorineural hearing loss Recurrent or persistent otitis media with effusion for at least three months Neurodegenerative disorders (e.g., Hunter's syndrome) or sensory motor neuropathies (e.g., Friedreich's ataxia, Charcot-Marie-Tooth disease) Syndromes associated with progressive hearing loss (e.g., neurofibromatosis, osteopetrosis, Usher's syndrome) Neonatal indicators: hyperbilirubinemia requiring exchange transfusion, persistent pulmonary hypertension associated with mechanical ventilation, conditions requiring extracorporeal membrane oxygenation In utero infection (e.g., toxoplasmosis, rubella, cytomegalovirus infection, herpes, syphilis) Postnatal infection associated with sensorineural hearing loss (e.g., meningitis) Physical features or other stigmata associated with a syndrome known to include sensorineural or conductive hearing loss or eustachian tube dysfunction Parental or caregiver concern about hearing, speech, language, or developmental delayįamily history of permanent hearing loss during childhood Physical features or other stigmata associated with a syndrome known to include sensorineural or conductive hearing loss Illness or condition requiring admission to neonatal intensive care unit for at least 48 hours In utero infection (e.g., toxoplasmosis, rubella, cytomegalovirus infection, herpes) Family history of permanent sensorineural hearing loss during childhood
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