Hearing Impairment EXAM III

Question 1

When to engage with patients

Answer 1

-Excessive Cerumen
-Water-clogged ears
-Hearing loss (mild)
-Tinnitus (prevention)
-Motion Sickness
-Contact Dermatitis

Question 2

When to REFER

Answer 2

-External Otitis or Swimmers Ear
-Ruptured Tympanic Membrane
-Otitis Media
-Foreign body
-Physical Trauma
-Hearing loss (moderate to severe)
-Tinnitus
-Dizzines
-Children?

Question 3

What is the approximate level of db at which extended exposure can cause hearing damage?

Answer 3

85 db

Question 4

Which part of the ear is appropriate to be treated with OTC products?

Answer 4

-The outer ear (external)
Auricle
Earlobe
Auditory canal

Question 5

Parts of the ear that require REFERRAL

Answer 5

-Middle ear
Ossicles: Stapes, Inculs, Malleus
Eardrum
Tympanic cavity

-Inner ear (often damaged by chronic hearing loss)
Vestibular nerve
Cochlear nerve, Cochlea
Auditory tube

Question 6

Tool to assess Consumer’s risk for hearing impairment

Answer 6

CEDRA

-Survey developed to assist providers of patients with hearing loss

-prioritizes 104 differential diagnosis

Question 7

What are the symptoms of
Mild to Moderate Hearing Loss?

Answer 7

-Trouble hearing speech in noisy places
-Hard to follow speech in groups
-Trouble hearing on the phone
-Listening makes you tired
-Needing to turn up the volume on the TV or radio

Question 8

Exclusion from Self-care

Answer 8

-Visible congenital or traumatic deformity of
the ear
-History of active drainage from the ear (liquid)
-Acute or chronic dizziness
-History of sudden or rapidly progressive
hearing loss

-Unilateral hearing loss of sudden or recent
onset
-Visible evidence of significant cerumen
accumulation or a foreign body in the ear
canal
-Pain or discomfort in the ear

Question 9

Which drugs are associated with hearing loss?
Ototoxic

Answer 9

-Aspirin, NSAIDs (pt on high dose, short term -> improves when they discontinue the drug)

-Aminoglycoside - may be permanent
-Chemotherapy - may be permanent
-Loop diuretics
-Long-term hormone therapy

Question 10

Tinnitus associated drugs

Answer 10

NSAIDS (seen often)
Aspirin (ssen often)
APAP
Aminoglycosides
Cisplatin chemotherapy related agents
Loop - Furosemide, torsemide
Hydroxychloroquine
Sertraline, escitalopram, fluoxetine
TCAs, Bupropion (seen often)
Benzodiazepines
Isotretinoin
Carvedilol
ACE-I, lisinopril, ramipril, enalapril

change the drug or reduce the dose

Question 11

What is the most common cause of hearing loss in all ages?

Answer 11

Excessive cerumen

-Cerumen impaction affects up to 10% of children and more than 50% of adults

Question 12

Patient presentation - Excessive cerumen

Answer 12

-Vertigo
-Tinnitus
-Chronic cough

-Sense of fullness or pressure
-Gradual hearing loss
-Dull pain

Question 13

Drug for Self-treat Excessive cerumen

Answer 13

-soften and remove the cerumen with otic bulbs or syringes

-Carbamide Peroxide 6.5% in anhydrous glycerin
or hydrogen peroxide and docusate

-MOA: when exposed to moisture, oxygen is released slowly -> remaining cerumen is removed with an otic bulb

Question 14

Direction for Carbamide Peroxide

Answer 14

Instruct patients to use 5-10 drops in the affected ear, leave in for 15 minutes and irrigate, up to twice daily

Question 16

Water-clogged ears

Answer 16

-often water clogged behind the wax after swimming
-water creates a soft and moisture environment leading to bacterial or fungal infection

-removal of moisture from ears may prevent maceration (wet environment)

Question 17

Treatment Water-clogged ears

Answer 17

-Isopropyl alcohol 95% in anhydrous glycerin
5% is the only FDA-approved agent

-A 50:50 mixture of acetic acid 5% and
isopropyl alcohol 95% has also been used

-agents can be used whenever ears are
exposed to water