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H90.4 – Bilateral Conductive Hearing Loss
H90.4 is the ICD-10 code for bilateral conductive hearing loss. It indicates impaired sound transmission through the outer or middle ear on both sides.
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H90.4 is the ICD-10 code for bilateral conductive hearing loss. It indicates impaired sound transmission through the outer or middle ear on both sides.
What Does the ICD-10 Code H90.4 Mean?
The ICD-10 code H90.4 refers to bilateral conductive hearing loss without any sensorineural component. This means that on both sides, the transmission of sound through the outer ear canal and the middle ear to the inner ear structures is impaired. The inner ear (cochlea, auditory nerve) is typically not affected in pure conductive hearing loss.
Causes
Conductive hearing loss can arise from a variety of conditions affecting the outer or middle ear:
- Earwax blockage (cerumen impaction): Accumulation of earwax in the ear canal that obstructs sound transmission.
- Otitis media (middle ear infection): Inflammation of the middle ear, often accompanied by fluid accumulation.
- Otitis media with effusion (glue ear): Fluid behind the eardrum that dampens sound transmission.
- Tympanic membrane perforation: A hole in the eardrum caused by infection, trauma, or pressure changes.
- Otosclerosis: Abnormal bone growth fixing the stapes (stirrup bone) in the middle ear.
- Malformations of the middle ear: Congenital or acquired changes to the ossicular chain.
- Foreign body in the ear canal.
Symptoms
The typical symptoms of bilateral conductive hearing loss (H90.4) include:
- Reduced hearing ability in both ears
- A sensation of pressure or fullness in the ears
- Muffled or dull perception of sounds
- Difficulty understanding speech, especially in noisy environments
- Occasional tinnitus (ringing in the ears)
Diagnosis
Diagnosis is made by an ear, nose, and throat (ENT) specialist using several assessments:
- Otoscopy: Visual examination of the ear canal and eardrum using an otoscope.
- Pure-tone audiometry: Measurement of hearing thresholds at various frequencies; typically reveals an air-bone gap characteristic of conductive hearing loss.
- Tympanometry: Assessment of eardrum mobility and middle ear function.
- Tuning fork tests (Weber and Rinne): Simple bedside tests to distinguish between conductive and sensorineural hearing loss.
Treatment
Treatment depends on the underlying cause of the conductive hearing loss:
- Earwax removal: Performed by a healthcare professional through irrigation, microsuction, or curettage.
- Medication: Antibiotics or anti-inflammatory agents for middle ear infections.
- Ventilation tubes (grommets): Small tubes inserted into the eardrum to ventilate the middle ear in cases of chronic glue ear.
- Surgical procedures: For example, tympanoplasty (eardrum reconstruction) or stapedectomy for otosclerosis.
- Hearing aids: For permanent or non-operable hearing loss, hearing aids can significantly improve hearing ability.
Distinction from Related ICD-10 Codes
Within the ICD-10 classification system, several related codes are distinguished from H90.4:
- H90.0: Conductive hearing loss, bilateral (in some classification versions)
- H90.1: Conductive hearing loss, unilateral, with unrestricted hearing on the contralateral side
- H90.2: Conductive hearing loss, unspecified
- H90.3 to H90.8: Further types of hearing loss, including mixed and sensorineural forms
References
- World Health Organization (WHO): ICD-10 Version 2019 – Chapter VIII: Diseases of the ear and mastoid process (H60-H95). Available at: https://icd.who.int/
- Lustig L.R., Limb C.J.: Disorders of the Middle Ear. In: Paparella MM, Adams GL, Levine SC (eds): Otolaryngology – Head and Neck Surgery. Elsevier, 2022.
- Dhingra P.L., Dhingra S.: Diseases of Ear, Nose and Throat. 7th edition, Elsevier India, 2018.
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