Hearing loss and tinnitus

Question 1

1) Conductive hearing loss relates to a problem with what?
2) What causes a sensorineural hearing loss?

Answer 1

1) Sound travelling from the environment to the inner ear - sensory system is fine but sound isn’t reaching it
2) A problem with the sensory system or vestibulocochlear nerve in the inner ear

Question 2

Name 2 potential associated symptoms alongside hearing loss

Answer 2

• Tinnitus
• Vertigo
• Pain
• Discharge
• Neurological symptoms

Question 3

Weber’s test
1) What happens in a Weber’s test
2) What is a normal result?
3) If the sound is louder in the affected ear, what is the diagnosis?
4) If the sound is louder in the healthy ear, what is the diagnosis?

Answer 3

1) Tuning fork is struck then placed on patient’s forehead. Then ask the patient if they can hear the sound and which ear it is loudest in
2) Sound the same in both ears
3) Conductive hearing loss
4) Sensorineural hearing loss

Question 4

Rinne’s test
1) When the vibrating tuning fork is placed on the mastoid process, what is it testing?
2) When the vibrating tuning fork is hovered 1cm from the same ear, what is it testing?
3) What is a normal result?
4) Why is this the case?
5) What is an abnormal result?
6) What diagnosis does an abnormal result imply?

Answer 4

1) Bone conduction
2) Air conduction
3) The patient can hear the sound again when bone conduction ceases and the tuning fork is moved next to the ear rather than on the mastoid process
4) Air conduction is more sensitive than bone conduction
5) Sound is not heard after removing the tuning fork from the mastoid process and holding it near the ear canal
6) Conductive hearing loss

Question 5

Name 2 causes of conductive hearing loss

Answer 5

• Ear wax
• Infection i.e. otitis media or otitis externa
• Fluid in the middle ear
• Eustachian tube dysfunction
• Perforated tympanic membrane
• Otosclerosis
• Cholesteatoma
• Tumours

Question 6

Name 3 causes of sensorineural hearing loss

Answer 6

• Sudden sensorineural hearing loss (over less than 72 hours)
• Presbycusis
• Noise exposure
• Ménière’s disease
• Labyrinthitis
• Acoustic neuroma
• Neurological conditions i.e. stroke, MS or brain tumours
• Infections i.e. meningitis
• Medications i.e. Loop diuretics, aminoglycoside antibiotics, cisplatin (chemotherapy drug)

Question 7

What is tinnitus?

Answer 7

Persistent addition sound that is heard but is not present in the surrounding environment

Question 8

Primary tinnitus has no identifiable cause but secondary tinnitus has a cause. Name 2 potential causes

Answer 8

• Impacted ear wax
• Ear infection
• Ménière’s disease
• Noise exposure
• Medications i.e. loop diuretics, gentamicin
• Acoustic neuroma
• MS
• Trauma
• Depression