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EAR, NOSE AND THROAT COPY > HEARING LOSS > Flashcards

HEARING LOSS Flashcards

1
Q

What are the causes of conductive hearing loss?

A

External ear:

Congenital atresia (microtia)

Wax

Foreign body

Otitis externa

Tympanic membrane and middle ear:

Tympanic perforation

Otitis media

Eustachian tube blocking (nasopharyngeal tumour, allergic rhinitis)

Fixation of ossicles (fusion of ear bones)

Otosclerosis

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2
Q

What are the causes of sensorineural hearing loss?

A

Congenital causes:

Premature birth

Neonatal jaundice

Intrauterine infection

Traumatic or noise induced

Toxic - gentamicin, loop diuretics, aspirin, cytotoxics

Autoimmune hearing loss (AIED)

Cerebellopontine angle tumours - Vestibular schwannoma

Sudden onset hearing loss - herpes simplex

Menieres disease

Presbycusis (age related hearing loss)

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3
Q

What are the causes of acute onset hearing loss?

A

Otitis externa

Otitis media with effusion (glue ear)

Toxic causes

Traumatic causes

Infective causes

Vestibular schwannomas

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4
Q

What are the causes of more insidious onset hearing loss?

A

Presbycusis (age related hearing loss)

Noise induced hearing loss

Tumours

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5
Q

What are the causes of fluctuating hearing loss?

A

Middle ear effusions

Ménière’s disease

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6
Q

Is more copious ear discharge more associated with external ear infections or middle ear infections?

A

Middle ear infections

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7
Q

What conditions might ear discharge indicate?

A

Otitis externa or media

Perforated tympanic membrane

Cholesteatoma

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8
Q

What factors of birth and pregnancy can lead to congenital deafness?

A

Prematurity

Low birth weight

Neonatal jaundice

Rubella infection

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9
Q

What is the autosomal dominant inherited form of conductive hearing loss?

A

Otosclerosis

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10
Q

What are the medications that can cause hearing loss?

A

Loop diuretics

Gentamicin

Aspirin

Anti-neoplastic agents

Quinines

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11
Q

What are the two types of hearing loss?

A

Conductive hearing loss

Sensorineural hearing loss

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12
Q

What does Rinne’s test look for?

A

Conductive hearing loss

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13
Q

What are the two possible results from Rinne’s test?

A

Positive - normal - the tuning fork is still heard next to the ear when it is no longer heard when placed on the mastoid.

Negative - abnormal - the tuning fork is heard best when placed on the mastoid process.

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14
Q

What does Weber’s test look for?

A

Hearing loss - both conductive and sensorineural

It must be used in conjunction with Rinne’s test to work out which it is.

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15
Q

On examination of a patient with hearing loss, they have a negative result in the left ear during Rinne’s test and when Weber’s test is performed the sound lateralizes to the left. What is the likely nature of the hearing loss?

A

Conductive loss in the left

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16
Q

On examination of a patient with hearing loss, they have a negative result in the left ear during Rinne’s test and when Weber’s test is performed the sound lateralizes to the right. What is the likely nature of the hearing loss?

A

Combined (conductive and sensorineural) loss in the left ear

17
Q

On examination of a patient with hearing loss, they have a negative result in the right ear during Rinne’s test and when Weber’s test is performed the sound lateralizes to the left. What is the likely nature of the hearing loss?

A

Combined (conductive and sensorineural) loss in the right ear

18
Q

On examination of a patient with hearing loss, they have a negative result in the right ear during Rinne’s test and when Weber’s test is performed the sound lateralizes to the right. What is the likely nature of the hearing loss?

A

Conductive loss in the right

19
Q

On examination of a patient with hearing loss, they have a positive result in both ears during Rinne’s test but when Weber’s test is performed the sound lateralizes to the left. What is the likely nature of the hearing loss?

A

Sensorineural loss in the right

20
Q

On examination of a patient with hearing loss, they have a positive result in both ears during Rinne’s test but when Weber’s test is performed the sound lateralizes to the right. What is the likely nature of the hearing loss?

A

Sensorineural loss in the left

21
Q

On examination of a patient with hearing loss, they have a negative result in both ears during Rinne’s test but when Weber’s test is performed the sound lateralizes to the right. What is the likely nature of the hearing loss?

A

Combined loss in the left

Conductive loss in the right

22
Q

On examination of a patient with hearing loss, they have a negative result in both ears during Rinne’s test but when Weber’s test is performed the sound lateralizes to the left. What is the likely nature of the hearing loss?

A

Combined loss in the right

Conductive loss in the left

23
Q

On examination of a patient with hearing loss, they have a negative result in both ears during Rinne’s test but when Weber’s test is performed the sound does not lateralize. What is the likely nature of the hearing loss?

A

Conductive loss in both ears

24
Q

When you examine the tympanic membrane, what features are assessing?

A

Perforations

Bulging (middle ear fluid)

Retracted/sucked in (Eustachian tube dysfunction)

Colour

Inflammation (red)

Middle ear effusion (yellowish and serous, greyish in glue ear)

Light reflex (over-rated as a sign)

25
Q

What is the standardized hearing test that we use?

A

Pure tone audiogram

26
Q

If a patient is unable to undertake the pure tone audiogram, what are the other options available?

A

Oto-acoustic emission testing (OAEs)

Brain stem evoked response audiometry (BERA)

27
Q

What is the objective test used to assess middle ear function?

A

Tympanometry

28
Q

When might a patient who presents with hearing loss need a CT of temporal bones?

A

Cholesteatoma

Malformations of external ear

29
Q

As well as assessing hearing and examining the ear, what else must you examine in a patient with hearing loss?

A

Signs of facial nerve palsy

30
Q

What is otosclerosis?

A

Inherited disease which produces a progressive, conductive or mixed hearing loss secondary to abnormal bone metabolism in the remnants of the otic capsule in the inner ear. The most common site of attack in the ear is the fistula ante fenestra at the anterior part of the stapes footplate. The abnormal bone deposition anchors the stapes in the round window preventing normal conduction of sound.

31
Q

Are males or females more affected by otosclerosis?

A

Females are affected twice as much.

32
Q

How do patients affected by otosclerosis most often present?

A

In the third decade of life, with slowly, progressive, bilateral conductive deafness, tinnitus and occasional mild vertigo. Otoscopy shows a normal ear drum in most cases, however 10% have a ‘flamingo tinge to the tympanic membrane. This is caused by hyperaemia.

33
Q

What investigations would you order for someone in whom you suspect otosclerosis and what would the results likely show?

A

Audiogram - typically shows a conductive hearing loss. In late disease however there can be a superimposed sensorineural hearing loss.

Tympanogram - typically normal

CT scanning - may show abnormal bone deposition around the cochlea with areas of radiolucency. This is called ostiospongiosus.

34
Q

How do you manage someone with diagnosed otosclerosis?

A

Conservative - hearing aids

Surgical - stapedectomy and insertion of prosthesis

35
Q

What is presbyacusis?

A

Irreversible sensorineural hearing loss due to age related degeneration of the hair cells. Very common. Patient will report bilateral hearing loss accompanied by tinnitus. Speech discrimination is affected first, especially when there is background noise.

36
Q

How is presbyacusis diagnosed?

A

Mainly through history and audiological evidence of bilateral sensorineural hearing loss that is more marked in the higher frequencies.

37
Q

What sounds do those with presbyacusis have particular difficulty hearing?

A

Speech, especially those sounds of speech which involve the higher frequencies. Sounds include ‘th’, ‘f’, ‘s’ and ‘k’

38
Q

How are those with presbyacusis managed?

A

Provision of an appropriate hearing aid

Provision of environmental aids as well

Cochlear implantation

EAR, NOSE AND THROAT COPY (8 decks)

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