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EENT Exam 2 > Hearing loss > Flashcards

Hearing loss Flashcards

1
Q

Conductive hearing loss & its mechanisms

A

Mechanical disruption of the external
auditory canal or middle ear
Mechanisms:
1. Obstruction
2. Mass loading
3. Non-compliant structures
4. Discontinuity of structures

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2
Q

Sensorineural hearing loss & its mechanisms

A

Deficit in the inner ear (sense) or central nervous system auditory pathway (neural)
Mechanisms:
1. Deterioration of cochlea – usually loss
of hair cells in Organ of Corti

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3
Q

> ____% of childhood hearing impairment is thought to be hereditary

A

50

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4
Q

Nonsyndromic vs. Syndromic hearing loss

A
  • Nonsyndromic hearing loss: hearing loss is the only clinical abnormality
  • Syndromic hearing loss: in which hearing loss is associated with anomalies in other organ systems
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5
Q

_____: retinitis pigmentosa & hearing
loss

A

Usher syndrome

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6
Q

______: pigmentary
abnormality (hair, skin, & nails) & hearing loss

A

Waardenburg syndrome

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7
Q

____ → thyroid organification
defect & hearing loss

A

Pendred syndrome

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8
Q

____ → renal disease & hearing loss

A

Alport syndrome

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9
Q

_____ → prolonged
QT interval & hearing loss

A

Jervell & Lange Nielson syndrome

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10
Q

Ototoxic Medications

A
  • Aminoglycoside antibiotics: Gentamicin, Amikacin, Neomycin, Streptomycin
  • Other antibiotics: Vancomycin, Erythromycin
  • Antimalarials: Chloroquine, Quinine
  • Platinum-based chemotherapy agents: Cisplatin, Carboplatin
  • Loop diuretics: Furosemide, Torsemide
  • Nonsteroidal anti-inflammatory drugs: Aspirin, Ketorolac, Ibuprofen
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11
Q

Hearing Loss presentation

A
  • Sudden, unexplained hearing loss
  • Gradual painless hearing loss
  • Bilateral or unilateral
  • Deficits affecting high, low, or all
    frequencies
  • Distorted sound (like “blown”
    loudspeaker)
  • Ear fullness or pressure
  • Ear feels numb or blocked
  • May be associated with ear pain
  • May also have Tinnitus or Vertigo
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12
Q

T/F Remove impacted cerumen prior to
making a Dx of hearing loss

A

T

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13
Q

Conductive hearing loss structures

A
  • Involves auditory canal, tympanic membrane, & the ossicles
  • Lesions in the auricle, external auditory canal, or middle ear
    can cause conductive hearing loss
  • Often reversible
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14
Q

Sensorineural hearing loss structures

A
  • Involves cochlea and CN VIII
  • Often permanent
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15
Q

Weber test

A
  • A 256 or 512 Hz tuning fork is placed on the mid forehead
  • Sound should be perceived equally bilaterally
  • Lateralization of sound = + test
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16
Q

Rinne test

A
  • Place the tuning fork against the mastoid process & count
  • When the patient no longer hears the sound, note the number of seconds & rapidly
    reposition the tuning fork 1-2 cm from the auditory canal, & count
  • The patient should indicate when sound is no longer heard
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17
Q

Review weber/rinne results

A

:)

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18
Q

Audiometry

A
  • Most widely accepted diagnostic test for
    hearing loss or concerns
  • Usually obtained in a sound-proof
    environment
  • Demonstrates how loud sounds need to be at
    different frequencies for you to hear them
  • “Audible threshold”
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19
Q

Most widely accepted diagnostic test for hearing loss or concerns

A

Audiometry

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20
Q

Tympanometry

A

Graph
* Relationship between air pressure in the canal and movement of
the tympanic membrane (TM)
* Provides volume measurement and pressure measurement

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21
Q

Otosclerosis

A

Overgrowth of bone in the
inner ear
* Often stapes

22
Q

Otosclerosis etiology - 3 main theories

A
  • Abnormal osteoclast & osteoblast activity of mature endochondral bone of the otic capsule
  • Genetic: Inherited in an autosomal dominant pattern
    with incomplete penetrance
  • Viral infection (likely measles)
  • Endocrine factors (hormonal): Abnormalities in PTH & estrogen contribute to
    abnormal bone turnover
23
Q

Otosclerosis clinical presentation

A
  • Gradual conductive hearing loss beginning in young adulthood
  • Typically speak quietly & report better hearing in noisy
    environments, when voices tend to be raised
  • Tinnitus ~50% of patients
  • Vertigo ~10% of patients
  • Exam is normal
24
Q

Weber test in Otosclerosis

A

lateralizes

25
Q

Otosclerosis Audiogram

A

Audiogram confirms either unilateral or
bilateral conductive hearing loss
* Conductive hearing loss (about 40-60 decibels
in lower frequencies & less in higher
frequencies) on audiometry, without tympanic
membrane abnormality
* Carhart notch at 2000 Hz

26
Q

Tx for mild hearing loss

A

observation and/or hearing aids with routine hearing tests to determine if condition is progressing
* Florical
* Bisphosphonates

27
Q

Aggressive Tx for hearing loss

A

stapedectomy with prosthesis (stapedoplasty)
* Most Successful

28
Q

Otosclerosis Complications

A
  • Progressive hearing loss
  • Conductive at early stages of disease & progresses
    to mixed or sensorineural hearing loss in later
    stages of disease
  • Severe conductive hearing loss can develop in
    patients with obliterative otosclerosis
29
Q

Most common cause of hearing loss in adults

A

Presbycusis

30
Q

4 theories of etiology in Presbycusis

A
  • Sensory presbycusis: Epithelial atrophy with loss of sensory hair
    cells & supporting cells in the organ of Corti
  • Neural presbycusis: Atrophy of nerve cells in the cochlea & central
    neural pathways; ~2100 neurons are lost every decade (of 35,000
    total)
  • Metabolic presbycusis: Atrophy of the stria vascularis
  • Mechanical presbycusis: Results from thickening & secondary stiffening of the basilar membrane of the cochlea
31
Q

Clinical presentation of presbycusis

A
  • Sensorineural hearing loss usually occurs first with high-
    frequency sounds & progresses to lower tones
  • Difficulty understanding rapidly spoken language, vocabulary
    that is less familiar or more complex, & speech within a noisy,
    distracting environment
  • Localizing sound becomes difficult
32
Q

_____ is a diagnosis of exclusion

A

Presbycusis

33
Q

Management of Presbycusis

A
  • No cure
  • ENT, audiology referral
  • Amplification devices: hearing aids
  • Lip reading:
  • Assistive listening devices:
  • Cochlear implants:
34
Q

Acoustic Neuroma

A

Intracranial, extra-axial tumors arising from the
Schwann cell sheath investing either the vestibular or cochlear nerve

35
Q

High dose ionizing radiation is the only known risk factor for _____

A

Acoustic Neuroma

36
Q

Clinical Presentation of Acoustic Neuroma

A
  • Unilateral hearing loss is the most common
    symptom
  • 50-60% of patients experience headache at
    the time of diagnosis
  • 25% of patients report facial numbness
  • Unilateral sensorineural hearing loss is an
    acoustic neuroma until proven otherwise
37
Q

Unilateral sensorineural hearing loss is ____

A

acoustic neuroma until proven otherwise

38
Q

Diagnosis of Acoustic Neuroma

A
  • Audiogram
  • Gadolinium-enhanced MRI brain with attention to IACs
39
Q

Acoustic Neuroma Management

A
  • Refer to neurotology for surgical excision of the tumor: Treatment of choice for tumor eradication
  • Stereotactic radiation therapy: Stops tumor growth
  • Serial observation
40
Q

____ Americans risk noise-induced hearing
loss (NIHL)

A

5-10 million

41
Q

Noise-Induced Hearing Loss Etiology

A
  • Several minutes after exposure to noise:
  • Edema of the stria vascularis appears, & may persist for several days
  • The cochlea also becomes inflamed in response to acoustic trauma
    Outer hair cells are more susceptible to noise exposure than inner
    hair cells → ↓ stiffness of the stereocilia of outer hair cells
  • Severe exposure → injury from a loss of adjacent supporting cells to
    complete disruption of the organ of Corti, which may be permanent
42
Q

Clinical Presentation of NIHL

A
  • History of long-term exposure (10+ years)
  • With hearing loss in the high frequencies, the patient is unlikely to report difficulty in quiet conversational situations
  • Trouble understanding speech when significant background noise is present
  • May progress to difficulty understanding high-pitched voices (women, children)-even in quiet conversational situations
43
Q

Noise-Induced Hearing Loss diagnosis

A
  • Audiometry
  • Sensorineural hearing loss
  • Almost always bilateral
  • Loss is greater with frequencies 3000-6000 Hz, less with 500-2000 Hz
44
Q

Noise-Induced Hearing Loss management

A
  • No cure
  • Reduce or eliminate exposure to noise
  • Control other factors (Smoking, DM, CVD)
45
Q

Safe noise exposure limit

A

85 decibels for 8 hours a day

46
Q

Earphones usage adjustments

A
  • 70% of max vol. should be limited to <4.6 hrs/day
  • 80% of max. volume, limit to less <1.2 hrs/day
47
Q

Sudden Sensorineural Hearing Loss

A
  • Sensorineural hearing loss of 30dB or
    greater over at least three contiguous
    audiometric frequencies occurring within
    a 72-hr period
48
Q

Reported causes of Sudden Sensorineural Hearing Loss

A
  • Infectious diseases (viral URI)
  • Otologic disease
  • Trauma
  • Vascular or hematologic conditions
  • Neoplasms (vestibular schwannoma)
49
Q

Sudden Sensorineural Hearing Loss presentation

A
  • Usually in 1 ear (< 5% of cases BL)
  • Mild to severe-profound
  • Can affect high, low, or all frequencies
  • Sound may be distorted (like “blown
    loudspeaker”)
  • Ear fullness or pressure
50
Q

Sudden Sensorineural Hearing Loss Diagnosis

A
  • Weber & Rinne
  • Audiogram
  • Evaluate for alternative diagnoses suggested
    by symptoms such as: bilateral sudden
    hearing loss, recurrent episodes of sudden
    hearing loss, or focal neurologic findings
  • Consider MRI to identify: Stroke, acoustic
    neuroma, multiple sclerosis
  • Labs to evaluate autoimmune disorders,
    syphilis, HIV, West Nile, cat scratch
51
Q

Sudden Sensorineural Hearing Loss Management

A
  • Treat specific causes
  • Idiopathic sudden sensorineural hearing
    loss
  • Oral corticosteroids tapered over 10-14
    days if within 2 weeks of onset
  • Intratympanic dexamethasone injections
  • Antiviral
52
Q

Otologic emergency, until proven
otherwise

A

Sudden Sensorineural Hearing Loss

EENT Exam 2 (5 decks)

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