Hearing loss

Question 1

a defect in which part of the hearing pathway causes CHL

Answer 1

outer ear

middle ear

Question 2

a defect in which part of the hearing pathway causes SNHL

Answer 2

inner ear

Question 3

what are the different classifications of hearing loss

Answer 3

CHL
SNHL - cochlear or retrocochlear
mixed

Question 4

what feature on an audiogram would suggest CHL

Answer 4

air bone gap

Question 5

list causes of CHL in the ear canal

Answer 5

atresia
otitis externa
ear wax
stenosis

Question 6

list causes of CHL in the middle ear

Answer 6

acute otitis media 
otitis media with effusion (glue ear)
cholesteatoma 
tympanic membrane perforation 
ossicular chain abnormalities 
otosclerosis

Question 7

what is glue ear

Answer 7

otitis media with effusion

Question 8

describe features of otitis media with effusion

Answer 8

more common in children
Eustachian tube dysfunction
straw coloured fluid

Question 9

causes of otitis media with effusion in adults

Answer 9

rhinosinusitis

nasopharyngeal carcinoma / lymphoma

Question 10

management of otitis media with effusion

Answer 10

grommets

further investigations if adult presentation

Question 11

features of otitis media with effusion on tympanogram and audiogram

Answer 11

flat tympanogram

CHL - air bone gap

Question 12

clinical signs of otitis media with effusion on otoscope

Answer 12

retracted membrane

Question 13

why is myringotomy not effective for otitis media with effusion

Answer 13

the membrane would heal very quickly and fluid would reaccumulate

Question 14

how long do grommets usually last for otitis media with effusion

Answer 14

9-12 months

Question 15

acute otitis media is more common in children/adults

Answer 15

children

Question 16

what is acute otitis media associated with

Answer 16

glue ear

URTI

Question 17

acute otitis media is usually viral/bacterial

Answer 17

viral

therefore do not treat with antibiotics until after 3 days

Question 18

clinical signs of acute otitis media on otoscopy

Answer 18

bulging membrane - pars tensa

Question 19

chronic suppurative otitis media is an old term to encompass which conditions

Answer 19

cholesteatoma

perforated tympanic membrane

Question 20

what is a cholesteatoma

Answer 20

collection of keratin in the middle ear

Question 21

clinical signs of cholesteatoma on otoscopy

Answer 21

retracted membrane
perforation
keratinous debris at pars tensa or flaccida
erosion of ossicles

Question 22

complications of acute otitis media and cholesteatoma

Answer 22

medially –> SNHL, tinnitus, vertigo, facial palsy
superiorly –> meningitis, brain abscess
posteriorly –> venous sinus thrombosis

Question 23

what is otosclerosis

Answer 23

gradual onset CHL with normal examination

fixation of stapes footplate

Question 24

features of otosclerosis

Answer 24

CHL
F>M
FH - inherited
worsens during pregnancy

Question 25

management of otosclerosis

Answer 25

conservative hearing aids fixation of stapes footplate stapedectomy

Question 26

trauma can cause CHL + SNHL, true or false

Answer 26

true

Question 27

what is haemotympanum

Answer 27

blood collection behind the membrane

Question 28

what is battle's sign

Answer 28

bruising behind the ear indicative of base of skull #

Question 29

symptoms and signs of BOS #

Answer 29

``` Hearing loss CSF leak facial palsy battle sign bilateral periorbital bruising ```

Question 30

causes of acquired SNHL

Answer 30

``` presbyacusis noise induced drug induced vestibular schwannoma - CPA Menieres trauma + BOS # inflammatory autoimmune meningioma ```

Question 31

what is presbyacusis

Answer 31

age related high frequency sensorineural hearing loss

Question 32

describe features of noise induced hearing loss

Answer 32

classical dip ay 4000Hz aka Cahart's notch

Question 33

causes of drug induced hearing loss

Answer 33

aminoglycoside - gentamicin chemotherapy - cisplatin, vincristine aspirin overdose diuretics - furosemide

Question 34

peri/endolymph is found in the bony labyrinth

Answer 34

perilymph

Question 35

peri/endolymph is found in the membranous labyrinth

Answer 35

endolymph

Question 36

what happens in profound SNHL

Answer 36

loss of hair cells in the organ of corti

Question 37

list chromosomal congenital causes of SNHL

Answer 37

``` Connexin 26 GJB2 - most common deafness Waardenburg's - AD Stickler - AD Usher's - AR Pendred's - AR ```

Question 38

list non-genetic congenital causes of SNHL

Answer 38

``` rubella VZV HIV CMV Streptococcus drugs/alcohol misuse ```

Question 39

short noise exposure hearing loss is reversible, true or false

Answer 39

true

Question 40

causes of inflammatory SNHL

Answer 40

``` fibrosis of the cochlear duct from: meningitis labyrinthitis mumps, measles syphilis ```

Question 41

in CHL there is/not an air bone gap

Answer 41

there is an air bone gap

Question 42

in SNHL there is.not an air bone gap

Answer 42

there is not an air bone gap

Question 43

list autoimmune causes of SNHL

Answer 43

RA GPA sarcoidosis

Question 44

Menieres has high/low frequency hearing loss

Answer 44

low frequency

Question 45

when would you use an open fitting hearing aid

Answer 45

for milder degrees of hearing loss

Question 46

how do cochlear implants work

Answer 46

electrically stimulating neural structures in the cochlea which is then transmitted to the brain and perceived as sound

Question 47

when would you use cochlear implants

Answer 47

severe - profound SNHL

Question 48

management of ear wax build up

Answer 48

olive oil sodium bicarbonate solution ear syringing