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CMT > Ear Disorders 1 > Flashcards

Ear Disorders 1 Flashcards

1
Q

what landmark separates the inner and outer ear?

A

typmanic membrane

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2
Q

Ear Anatomy

Purpose of Pinna/Auricle

A

funnels sound down auditory canal

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3
Q

Ear Anatomy

purpose of auditory canal or external auditory meatus

A

carries sound to the TM

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4
Q

Ear Anatomy

purpose of TM

A

vibrates from sound waves and transfers the movement to the ossicles

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5
Q

Ear Anatomy

purpose of the malleus, incus, stapes

A

pass sound vibrations into the fluid of the cochlea through the oval window

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6
Q

Ear Anatomy

purpose of the cochlea

A

part of auditory labyrinth which connects to vestibulocochlear nerve CN VIII

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7
Q

Ear Anatomy

purpose of eustachian tubes

A

links the cavity of the middle ear to the nasal cavity and provides a route to equalize air pressure between the middle ear and the atmosphere

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8
Q

Audiometry

purpose

A

to test for hearing loss

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9
Q

Audiometry

how is intensity measured

A

decibles
whisper = 20 dB
concert= 120 dB

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10
Q

Audiometry

how is tone measured

A

cycles per sec (cps) or Hertz (Hz)
high pitched tones = high Hz values

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11
Q

Audiometry

normal range of human hearing (Hz)

A

20 to 20,000 Hz

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12
Q

Tympanometry

purpose

A
  • compliance (movement) ofear structures
  • measures mobility of the ear drum and small bones in the middle ear
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13
Q

Tympanometry

absolute contraindications

3

A
  1. base skull fracture
  2. head trauma
  3. recent ear surgery
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14
Q

Hearing Loss

Describe weber test and results

A
  • place 512 Hz tuning fork midline
  • Conductive: sound radiates to bad ear
  • Sensorineural: sound radiates to good ear
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15
Q

Hearing Loss

describe rinne test and results

A
  • alternate 512 Hz on mastoid bone and in front of ear
  • conductive loss: BC > AC
  • sensorineural loss: AC > BC
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16
Q

Hearing Loss

what causes conductive hearing loss?

A

results from external or middle ear dysfunction

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17
Q

Hearing Loss

4 mechanisms of conductive impairment

A
  1. obstruction
  2. mass loading
  3. stiffness
  4. discontinuity
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18
Q

Hearing Loss

risk factors for conductive loss

5

A
  1. cerumen impaction
  2. transient eustachian tube dysfunction
  3. chronic ear infections
  4. trauma
  5. otosclerosis
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19
Q

Hearing Loss

which type of loss can be treated w/ meds or surgery?

A

conductive

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20
Q

Hearing Loss

describe sensorineural loss

A
  • deterioration of cochlea usually due to loss of hair cells from the organ of Corti
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21
Q

Hearing Loss

most common type of sensorineural hearing loss

A

Presbycusis

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22
Q

Hearing Loss

Risk Factors for Sensorineural Loss

4

A
  1. excessive noise exposure
  2. head trauma
  3. systemic diseases
  4. family hx/genetics
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23
Q

Presbycusis

describe

A

gradually progressing high frequency loss w/ advanced age

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24
Q

Presbycusis

type of loss

A

sensorineural

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25
Q

Presbycusis

diagnostic testing

A
  • weber test
  • rinne test
  • audiometry
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26
Q

Presbycusis

tx

3 components

A
  • not correctable w/ medical therapy (prevention is key)
  • hearing amplification
  • cochlear implant
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27
Q

Presbycusis

screening recommendations

3 components

A
  • age > 65 yo
  • prior exposure to high noise levels
  • repeat every few years
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28
Q

Presbycusis

when to refer?

A

refer any new sensorineural hearing loss to audiologist unless it is easily treatable (i.e. OM)

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29
Q

Noise Trauma Induced Hearing Loss

what must prolonged sound exposure be above?

A

typically > 85 dB

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30
Q

Noise Trauma Induced Hearing Loss

what type of hearing is first to be lost? what about with prolonged exposures?

A
  1. high frequency
  2. speech frequencies
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31
Q

Noise Trauma Induced Hearing Loss

Examples of noise trauma

3

A
  1. heavy machinery
  2. weapons
  3. excessively loud music
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32
Q

Noise Trauma Induced Hearing Loss

prevention

3

A
  1. monitoring workplace noise levels
  2. ear plugs
  3. customized earmuffs
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33
Q

Physical Trauma Induced Hearing Loss

what part of ear is impacted?

A

inner ear

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34
Q

Physical Trauma Induced Hearing Loss

Examples of things that could cause?

3

A
  1. airbag deployment
  2. Concussion
  3. Skull fracture
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35
Q

Ototoxicity

describe

A
  • hearing loss from ototoxic substances which affect auditory and vestibular systems
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36
Q

Ototoxicity

most common meds

3

A
  1. aminoglycosides
  2. loop diuretics
  3. neoplasm meds (cisplatin)
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37
Q

Ototoxicity

what to do with pts who have existing hearing loss and need ototoxic meds?

2

A
  • monitor closely
  • weigh risks/beneifts of drug choice
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38
Q

Sudden Sensory Hearing Loss

describe

A

idiopathic sudden unilateral hearing loss

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39
Q

Sudden Sensory Hearing Loss

typical age of onset?

A

> 20 y/o

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40
Q

Sudden Sensory Hearing Loss

tx

A
  • corticosteroid use increases chances of recovery
  • prednisone 1 mg/kg/day then taper for 10d
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41
Q

Systemic Disorders Inducing Hearing Loss

describe

A
  • bilateral loss
  • hearing level can fluctuate (recovery/deterioration/remission/relapse)
  • gradual progression
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42
Q

Systemic Disorders Inducing Hearing Loss

can have what in addition to hearing loss?

2

A

vestibular dysfunction (disequilibrium, postural instability)

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43
Q

Systemic Disorders Inducing Hearing Loss

Examples of conditions

3

A
  1. Systemic Lupus Erythematosus
  2. Granulomatosis w/ polyangitis
  3. Cogan syndrome
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44
Q

Systemic Disorders Inducing Hearing Loss

tx

A

corticosteroids w/ taper

45
Q

Tinnitus

can accompany?

A

hearing loss

46
Q

Tinnitus

sensation of sound in the absence of?

A

exogenous sound source

47
Q

Tinnitus

etiology

4

A
  • can be idiopathic
  • from meds (ASA, NSAIDs)
  • vascular lesions
  • cochlear lesions
48
Q

Tinnitus

describe bilateral damage

3 components

A
  • more common
  • damage to conductive hearing system
  • can be environmental or systemic
49
Q

Tinnitus

describe unilateral tinnitus

4

A
  • tympanic membrane damage
  • recurrent unilateral ear infections
  • ossicle damage
  • trauma
50
Q

Tinnitus

describe sx

2

A
  • ringing in ears
  • difficulty hearing in social situations
51
Q

Tinnitus

severe sx

3 components

A
  • insomnia
  • inability to concentrate
  • psychological distress (anxiety, annoyance, frustration, loss of control)
52
Q

Tinnitus

describe pulsatile tinnitus

A

can hear own heartbeat

53
Q

Tinnitus

etiologies of pulsatile tinnitus

2

A
  • conductive hearing loss
  • vascular abnormalities (glomus tumor, venous sinus stenosis, varotid vaso-occlusive disease, AV malformation, aneurysm)
54
Q

Tinnitus

dx non-pulsatile

2 components

A
  • audiometry to r/o hearing loss
  • if unilateral hearing loss w/out cause: MRI to assess for cochlear lesion (vestibular schwannoma)
55
Q

Tinnitus

dx pulsatile

2 components

A
  • MRA/MRV
  • temporal bone CT
56
Q

Tinnitus

tx

4 components

A
  • avoidance of exposure to excessive noise, ototoxic agents, and other factors causing cochlear damage
  • masking tinnitus w/ music or amplification of other sounds
  • habituation techniques (tinnitus retraining therapy)
  • PO anti-depressants (nortriptyline 50mg PO at bedtime)
57
Q

Tinnitus

why give nortriptyline at night?

A

to help with insomnia

58
Q

Hyperacusis

describe

A

excessive sensitivity to sound

59
Q

Hyperacusis

Risk factors

4

A
  1. ear disease
  2. noise trauma
  3. migraines
  4. underlying psychological disease
60
Q

Hyperacusis

describe recruitment as it pertains to hyperacusis

A

abnormal senstivity to loud sounds despite reduced sensitivity to soft sounds

61
Q

Hyperacusis

tx in pts w/ normal hearing

A
  • earplugs in noisy environments
  • habituation (slowly introduce to noise)
62
Q

Hyperacusis

tx in pts w/ hearing devices

A

compression circuitry to avoid overamplification

63
Q

Vertigo

cardinal sx of which type of disease state?

A

vestibular disease

64
Q

Vertigo

sx

A
  • spinning sensation
  • sensation of tumbling/falling forward/backward
  • sensation of motion when there is no motion
65
Q

Vertigo

important to distinguish this from?

A
  • imbalance
  • syncope
  • light-headedness
66
Q

Vertigo

describe peripheral disease

4 components

A
  • onset is sudden
  • associated w/ tinnitus & hearing loss
  • +/- horizontal nystagmus
  • vertigo may be more intense
67
Q

Vertigo

describe central vertigo

3 components

A
  • onset is gradual
  • no associated auditory sx
  • vertigo is not as intense
68
Q

Vertigo

how to evaluate

4

A
  • audiogram
  • electronystamography (ENG)
  • videonystagmography (VNG)
  • MRI Head
69
Q

Meniere Syndrome

pathophys

A

excess endolymph results in increased pressure w/in the semicircular canals

70
Q

Meniere Syndrome

classic syndrome

A

episodic vertigo w/ discrete spells lasting 10 min to several hours

71
Q

Meniere Syndrome

additional sx

5

A
  1. sx wax and wane
  2. unilateral aural fullness (pressure in ear)
  3. tinnitus (low tone/blowing sound)
  4. fluctuating low-frequency sensorineural hearing loss
  5. vertigo
72
Q

Meniere Syndrome

PE findings

2 components

A
  1. normal
  2. +/- nystagmus or induced vertigo/nausea with pneumo-otoscopy
73
Q

Meniere Syndrome

what would audiometry at time of attack show?

A

low-frequency sensorineural loss

74
Q

Meniere Syndrome

tx

A
  • refer to otolaryngologist
  • diuretic (acetazolamide)
  • Na+ restriction
75
Q

Meniere Syndrome

tx for sx relief of acute attacks

2

A
  • meclizine
  • diazepam
76
Q

Meniere Syndrome

tx options for refractory disease

3

A
  1. glucocorticoid or gentamicin infections into middle ear
  2. non-ablative surgical options (decompression, shunting of endolymphatic sac)
  3. full ablative procedure (labyrinthectomy, vestibular nerve section)
77
Q

Labrynthitis

cause

A

idiopathic, sometimes linked to recent infection (URI)

78
Q

Labrynthitis

hallmark of the condition

A

acute onset of continuous, severe vertigo lasting several days to a week accompanied by tinnitus and hearing loss

79
Q

Labrynthitis

sx

4 components

A
  • nausea, vomiting
  • desire to remain immobile
  • recovery period of several wks (improving vertigo)
  • hearing may return to normal or stay impaired
80
Q

Labrynthitis

what is this classified as if there is no associated hearing loss?

A

vestibular neuritis

81
Q

Labrynthitis

PE Exam findings

4 components

A
  • nystagmus and sense of body motion to opposite side
  • falling and past pointing to the affected side
  • vestibular paresis unilaterally
  • rapid-head-impulse test as tolerated
82
Q

Labrynthitis

dx

A

MRI w/ contrast

83
Q

Labrynthitis

what will MRI show

A

enhancement of 8th nerve or the menbranous labyrinth

84
Q

Labrynthitis

Tx

3 components

A
  • abx if pt is febrile or has sx of bacterial infection
  • vestibular suppressants during acute phase of attack (diazepam, meclizine)
  • sx reduction (anti-histamines, promethazine, scopolamine)
85
Q

Benign Paroxysmal Positional Vertigo

pathophys

A
  • migration of inner ear otoliths (calcific particles) to the posterior semicircular canal
  • the otoliths amplify any movement in the plane of the canal, resulting in brief episodes of vertigo following changes in head position
86
Q

Benign Paroxysmal Positional Vertigo

common in who?

A

people over 60 y/o

87
Q

Benign Paroxysmal Positional Vertigo

classic presentation

A

recurrent spells of vertigo, lasting only a few minutes, associated with changes in head position

ex: rolling over in bed, looking up

88
Q

Benign Paroxysmal Positional Vertigo

additional sx

4

A
  1. intermittent dizziness (10-15s latency period followed by 60s of dizziness)
  2. “entire room spins”
  3. imbalance for several hours
  4. nausea
89
Q

Benign Paroxysmal Positional Vertigo

pertenient negatives

3

A

no associated…
1. HAs
2. hearing loss
3. focal neurologic sx

90
Q

Benign Paroxysmal Positional Vertigo

only abnormal PE finding

A

nystagmus

91
Q

Benign Paroxysmal Positional Vertigo

dx studies

2

A
  1. recurrent cases warrant head MRI
  2. some CNS disorders can mimic BPPV
92
Q

Benign Paroxysmal Positional Vertigo

tx

A
  • Epley maneuver (PT or pt can do to themselves if recurrent)
  • often resolves spontaneously or does not require tx
93
Q

Otosclerosis

pathophys

A

progressive disease affecting bony otic capsule

94
Q

Otosclerosis

where is lesion typically located?

A

stapes

95
Q

Otosclerosis

what does the lesion cause?

A
  • decreased passage of sound through the ossicular chain
  • conductive hearing loss
96
Q

Otosclerosis

tx

A
  • hearing aids
  • stapedectomy (replacement of stapes w/ prosthetic)
97
Q

Otosclerosis

what can happen if cochlea is involved?

A

permanent hearing loss

98
Q

Middle Ear Trauma –> TM Perforation

causes of TM perf from trauma

6

A
  1. barotrauma
  2. acoustic trauma
  3. head trauma
  4. otitis media
  5. eustachian tube dysfunction
  6. foreign objects
99
Q

Middle Ear Trauma –> TM Perforation

sx

6

A
  1. otorrhea (clear, bloody, purulent)
  2. +/- ear pain w/ sudden relief
  3. conductive hearing loss
  4. tinnitus
  5. vertigo
  6. nausea/vomiting
100
Q

Middle Ear Trauma –> TM Perforation

PE Findings

A

conductive hearing loss confirmed w/ weber and rinne tests

101
Q

Middle Ear Trauma –> TM Perforation

what PE exam to avoid? why?

A
  • pneumatic otoscopy
  • can push air into otic capsule underlying the injury
102
Q

Middle Ear Trauma –> TM Perforation

dx

A
  • based on otoscopic exam
  • conductive hearing loss
103
Q

Middle Ear Trauma –> TM Perforation

tx

A
  • small ones: heal spontaneously within 4 wks
  • water precautions: cotton ball w/ jelly in ear when around water
  • abx drops (ofloxacin)
  • f/u with audiology
  • ENT referral
104
Q

Middle Ear Trauma –> TM Perforation

criteria for ENT referral

3

A
  • Recurrent otitis media (>2 episodes in 6 mo)
  • persistent hearing loss (> 1-2 wks post infection)
  • chronic tympanic membrance perforation (>4 wks)
105
Q

Middle Ear Trauma –> TM Perforation

complications

4

A
  • persistent perforation
  • cholesteatoma
  • hearing loss
  • recurring infections
106
Q

Impact Injury/Explosive Acoustic Trauma

describe

A

conductive hearing loss of >30 dB for 3+ mo after trauma

107
Q

Impact Injury/Explosive Acoustic Trauma

what should you suspect if patient has this?

A

ossicular chain disruption

108
Q

Impact Injury/Explosive Acoustic Trauma

tx

A

middle ear exploration w/ reconstruction of ossicular chain

CMT (72 decks)

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