Hearing Loss in ICU


Hearing Loss in ICU is an under-appreciated problem



External ear

  • obstruction (e.g. wax, blood, foreign bodies)
  • mechanical (e.g. tape, sideways turning of head, attachment devices, dressings)
  • antibiotic ear drops
  • trauma e.g. temporal bone fracture
  • edema

Middle and inner ear

  • infection (e.g. otitis media, mastoiditis)
  • effusion from blocked Eustachian tube (e.g. ETT or NGT induced)
  • hyperbaric damage
  • positive pressure ventilation


  • drugs (e.g. gentamicin, frusemide, COX inhibitors, chemotherapy such as cisplatin, salicylate toxicity and cinchonism)
  • trauma (BOS fracture, direct trauma to ear)
  • blast damage
  • meningitis/encephalitis
  • vascular event — stroke, hemorrhage, vasculitis
  • incidental tumour (e.g. acoustic schwannoma)
  • viral neuronitis of the 8th cranial nerve
  • environmental noise


  • treat potential causes
  • remove NG tube at first opportunity
  • check gentamicin levels and adjust appropriately
  • avoid large does of diuretics
  • early steroids in Haemophilus meningitis
  • reduce environmental noise

References and Links

Journal articles

  • Halpern NA, Pastores SM, Price JB, Alicea M. Hearing loss in critical care: an unappreciated phenomenon. Crit Care Med. 1999 Jan;27(1):211-9. PMID: 9934918.
  • Isaacson JE, Vora NM. Differential diagnosis and treatment of hearing loss. Am Fam Physician. 2003 Sep 15;68(6):1125-32. PMID: 14524400.

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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