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H90.3 – Bilateral Conductive Hearing Loss
H90.3 is an ICD-10 diagnosis code for bilateral conductive hearing loss, a condition where sound transmission to the inner ear is impaired in both ears, reducing hearing ability.
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H90.3 is an ICD-10 diagnosis code for bilateral conductive hearing loss, a condition where sound transmission to the inner ear is impaired in both ears, reducing hearing ability.
Definition
H90.3 is a diagnostic code from the International Classification of Diseases (ICD-10) referring to bilateral conductive hearing loss. In this type of hearing loss, the mechanical transmission of sound through the outer ear canal, eardrum, or the ossicles (small bones) of the middle ear to the inner ear is impaired on both sides.
Causes
Conductive hearing loss can result from various factors that obstruct or disrupt the mechanical transmission of sound:
- Earwax blockage (cerumen impaction): Accumulation of earwax blocking the ear canal
- Middle ear infection (otitis media): Inflammation of the middle ear, often accompanied by fluid buildup
- Otitis media with effusion (glue ear): Fluid accumulation behind the eardrum without active infection
- Eardrum perforation: A hole or tear in the tympanic membrane
- Otosclerosis: Abnormal bone growth in the middle ear restricting ossicle mobility
- Congenital malformations: Birth defects of the outer or middle ear
- Foreign bodies: Objects lodged in the external ear canal
Symptoms
Common symptoms of bilateral conductive hearing loss include:
- Reduced perception of sound volume in both ears
- A sensation of fullness or blockage in the ears
- Difficulty understanding speech, especially in noisy environments
- Autophony (hearing one's own voice unusually loudly)
- Occasional ear pain or pressure
Diagnosis
Diagnosis of conductive hearing loss is made by an ear, nose, and throat (ENT) specialist using the following methods:
- Otoscopy: Direct visual examination of the ear canal and eardrum using an otoscope
- Tuning fork tests (Weber and Rinne tests): Simple bedside tests to differentiate conductive from sensorineural hearing loss
- Pure-tone audiometry: Measurement of hearing across different frequencies; conductive hearing loss shows an air-bone gap with preserved bone conduction
- Tympanometry: Assessment of eardrum mobility to evaluate middle ear function
Treatment
Treatment depends on the underlying cause:
- Earwax removal: Professional irrigation or microsuction of impacted cerumen by an ENT specialist
- Medical therapy: Antibiotics or decongestants for middle ear infections
- Myringotomy and tympanostomy tubes: A small incision in the eardrum to drain middle ear fluid, often with insertion of ventilation tubes
- Surgical procedures: Such as tympanoplasty (eardrum reconstruction) or stapedectomy for otosclerosis
- Hearing aids: For permanent or irreversible hearing loss when surgical correction is not possible
- Bone-anchored hearing systems (BAHA): For more severe cases or structural malformations of the ear
Prognosis
The prognosis for conductive hearing loss is generally favorable, as the underlying cause is often treatable. With timely and appropriate intervention, hearing can frequently be fully or largely restored. If left untreated, bilateral hearing loss can significantly impact daily functioning and, in children, may lead to delays in speech and language development.
References
- World Health Organization (WHO): ICD-10: International Statistical Classification of Diseases and Related Health Problems, 10th Revision. WHO, Geneva 2019. Available at: https://www.who.int/classifications/icd/
- Lalwani, A.K. (ed.): Current Diagnosis and Treatment in Otolaryngology -- Head and Neck Surgery. 3rd Edition, McGraw-Hill Medical, New York 2012.
- Bhatt, J.M.; Lin, H.W.; Bhattacharyya, N.: Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States. JAMA Otolaryngology -- Head and Neck Surgery, 2016. PubMed PMID: 27442217.
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