Ear Disorders II

Question 1

Mechanisms of conductive hearing loss

Answer 1

• obstruction
• mass effect
• stiffness effect
• discontinuity (fracture or head trauma)

Question 2

What parts of the ear does conductive hearing loss involve?

Answer 2

external or middle

Question 3

Common causes of conductive hearing loss?

Answer 3

Most common causes:

• cerumen impaction
• ETD

Other:

• otitis media
• otitis externa
• TM perf
• trauma
• otosclerosis

Question 4

Mechanisms of Sensorineural hearing loss (hint: think about the name/what parts are affected)

Answer 4

• senory- dysfunction of inner ear (cochlea)

- Neural- dysfunction of CN VIII or brain

Question 5

Causes of sensorineural hearing loss

Answer 5

Presbycusis
Persistent noise exposure
head trauma
systemic dz
acoustic neuroma
multiple sclerosis
auditory neuropathy

Question 6

Weber test: explain conductive vs sensorineural results

Answer 6

conductive- sound lateralized to bad ear

sensorineural- lateralizes to good ear

Question 7

Rinne test: explain conductive vs sensorineural results

Answer 7

Conductive- BC > AC

sensorineural- AC > BC

Question 8

When a is having an audiogram, what is the threshold at which it is considered to be abnormal?

Answer 8

> 25 decibles (dB)

Question 9

What would you see in an audiogram of a pt with conductive loss?

Answer 9

• bone conduction nl bilaterally

- AC poorer on affected side

Question 10

What would you see in an audiogram of a pt with sensorineural loss (presbycusis)?

Answer 10

Downwards sloping (higher dB) towards higher frequencies

Question 11

In any patient with new onset hearing loss without obvious pathology what do you do and why?

Answer 11

need quick referral to audiology

**idiopathic sudden sensorineural hearing loss can be treated with corticosteroids when caught early

Question 12

What is tinnitus? What can it be a symptom of?

Answer 12

perception of abnormal ear or head noises (mild, hight-pitched sounds lasting secs to mins- ringing, buzzing, crickets)

Can be manifestation of hearing loss

Question 13

Treatment of tinnitus

Answer 13

• avoid exposure to excessive noise and ototoxic agents
• masking
• meds (oral antidepressants)

Others:

• transcranial magnetic stimulation
• deep brain stimulation

Question 14

How is Pulsatile tinnitus described/what can it indicate?

How is Staccato tinnitus described?

Answer 14

Pulsatile= listening to one’s heartbeat
can indicate vascular abnormality (gloms tumor, venous sinus stenosis, aneurysm)

Staccato= rapid series of pop or clicks w/ sensation of ear fluttering

Question 15

Another name for Labrynthitis?

Answer 15

Vestibular neuritis

Question 16

Presentation and cause Labrynthitis?

Answer 16

• acute onset, continuous, severe vertigo
• nausea common

cause:
-inflammation of inner ear-
often after viral URI

Question 17

Tx of Labrynthitis

Answer 17

• abx of pt is febrile or w/ sx of bacterial infection
• vestibular suppressants (anticholinergics/antihistamines, benzodiazepines)
• anti-emetic meds
• oral steroids

Question 18

Another name for Meniere’s disease? What is it?

Answer 18

Endolymphatic hydrops

a vertigo syndrome due to a peripheral lesion

Question 19

What happens in Meniere’s disease?

Answer 19

• distention of endolymphatic comportment of inner ear
• sx wax and wane as endolymphatic pressure rises and falls
• can permanently damage inner ear structures

Question 20

Clinical presentation of Meniere’s disease

Answer 20

• episodic vertigo w/ discrete spells lasting 20 mins-several hrs
• fluctuating sensorineural hearing loss
• Tinnitus- low tone, blowing/roaring quality)
• sensation of unilateral ear pressure (aural fullness)

Question 21

Classic triad of Meniere’s

Answer 21

vertigo + hearing loss + tinnitus

Question 22

How is Meniere’s diagnosed?

Answer 22

• referral to ENT, audiology

- Caloric testing

Question 23

What if Meniere’s treatment aimed at? How is this done?

Answer 23

aimed at decreasing endolymph fluid pressure in inner ear

• diuretics
• low salt diet
• vestibular ablation w/ gentamycin (ototoxic)
• labyrinthectomy

Question 24

What is another name for an acoustic neuroma? What is it? Where does it begin/go?

Answer 24

vestibular schwannoma

benign tumor of CN VIII

• begins in internal auditory canal
• gradually grows to compress pons and cause hydrocephalus

Question 25

Most common presentation of acoustic neuroma? Dx? Tx?

Answer 25

Unilateral hearing loss= most common - disequilibrium - tinnitus Dx: MRI w/ contrast Tx: obs, surgical excision, radiotherapy

Question 26

What is vertigo?

Answer 26

sense of motion when there is no motion - spinning - tumbling - falling backward/forward

Question 27

Key differences between central vertigo and peripheral vertigo (onset and sx)

Answer 27

Central: brain - gradual onset - no auditory sx (tinnitus) Peripheral: balance organs of inner ear - sudden onset - severe enough so pt can't walk or stand - typically a/w N/V - often a/w tinnitus - often a/w hearing loss - PE often seen horizontal nystagmus

Question 28

Causes of central vs peripheral lesions

Answer 28

Central: - brainstem vascular dz - arteriovenous malformations - tumors or brainstem or cerebellum - MS Peripheral: - Meniere's dz - Labrynthitis - Benign Paroxysmal Positional Vertigo - Perilymphatic Fistula

Question 29

Explain the Dix-Hallpike maneuver | How do you perform it and what results indicated positive?

Answer 29

quickly lowering pt to supine position w/ head extending over edge and placed 30 degrees lower than the body, turned to L or R Positive test= delayed onset fatiguable nystagmus in peripheral causes If nystagmus is non fatiguable, indicated central cause

Question 30

What is the most common vestibular disorder?

Answer 30

Benign paroxysmal positional vertigo (BPPV)

Question 31

Cause of Benign paroxysmal positional vertigo? Sx duration/onset?

Answer 31

-caused by sediment in inner ear (otoconia, otoliths) - sx last less than a few mins - appear in clusters lasting several days - brief latency period following head movement before sx occur - a/w changes in head position- rolling over in bed

Question 32

Tx of BPPV?

Answer 32

PT or OT Epley maneuver Meds- vestibular suppressants bed rest