Pathology of Hearing

Question 1

_____is the strongest predictor of hearing loss among adults aged 20-69

Answer 1

age

Question 2

common complaints (5)

Answer 2

1) tinnitus
2) HL
3) otalgia
4) otorrhea
5) vertigo

Question 3

sound that appears to be coming from one or both ears, internally generated

Answer 3

tinnitus

Question 4

T/F Most american habituate to tinnitus and say they do not suffer from the condition

Answer 4

True

Question 5

______ % of tinnitus patients hear the sound constantly, without intermission

Answer 5

83%

Question 6

what is the primary cause of tinnitus?
- what other known causes are there?

Answer 6

primary: exposure to loud noise
secondary: stress, BP, meds, infections, head trauma

Question 7

______ tinnitus is usually related to blood vessel or muscle spasm
- the sound can also be heard by an observer

Answer 7

pulsatile

Question 8

tinnitus is more prevalent in adults but can be the first sign of _____ in children

Answer 8

HL

Question 9

the source of tinnitus is difficult to determine but is likely associated with damage to __________

Answer 9

nerve endings at hair cells

Question 10

what are some tinnitus treatments? (3)

Answer 10

masking devices, biofeedback, and relaxation exercises (wellness approach)

Question 11

common complain: HL may arise due to ___________ (5)

Answer 11

noise exposure, meds, genetic predisposition, ototoxicity, or aging

Question 12

two ototoxic exposure may interact to provide a _________ HL, which compounds risk of certain professions

Answer 12

syngergistic HL

Question 13

common complaints: otalgia is what?

Answer 13

ear pain

Question 14

T/F most otalgia is related to structures of the ear

Answer 14

false; most otalgia is not related to structures of the
ear, but more structures of larynx, pharynx, tonsils, muscles of mastication, TMJ, orthodonture

Question 15

T/F Many of the most common and important otologic diseases are associated with any level of pain

Answer 15

False; they are NOT associated with pain

Question 16

T/F Most otogenic pain is caused by infection or cerumen impaction

Answer 16

True

Question 17

common complaints: what is otorrhea

Answer 17

fluid drainage from the ear

Question 18

what is otorrhea most always due to?

Answer 18

infection, with the rare exception of a CSF leak

Question 19

_________ drainage likely due to chronic otitis media or cholesteatoma

Answer 19

painless

Question 20

__________ drainage likely due to acute otitis media and TM rupture

Answer 20

Painful

Question 21

present with the principle component of “illusion of motion”

Answer 21

vertigo

Question 22

vertigo is a condition of the _________ system, or peripheral or central

Answer 22

Vestibular

Question 23

displaced otoconia from saccule entering and stimulating the lateral semicircular canal can cause ___________

Answer 23

BPPV (benign paroxysmal positional vertigo)

Question 24

what is another cause of otoconial displacement

Answer 24

head trauma

Question 25

how do ME disorder interfere with ME's ability to act as impedance matching device

Answer 25

interfering with the mobility of ME structures

Question 26

Otitis media

Answer 26

- common feature: eustachian tube malfunction (allowing for bacteria secretion from nasopharynx to enter ME space) - kiddos more prone bc of shorter, wider, and more horizontal ETs

Question 27

how can the blockage of the eustachian tube perpetuate otitis media

Answer 27

not allow effusions (fluid collections) to drain

Question 28

OM blockage can be perpetuated at the nasal end by ___________

Answer 28

inflammation - allergies, cigs, pool water chlorine

Question 29

pus infection exhibiting swelling, increased blood flow, bleeding, and fever

Answer 29

acute otitis media

Question 30

what is the idea of AOM

Answer 30

pus collects in the middle ear space until the TM ruptures, resulting in a sudden relief of symptoms - can hear instantly - effusion clears within month but can persist indefinitely & may be asymptomatic - tubes are recommended for kiddos with 15dB loss / unresponsive to antibiotics

Question 31

low grade or recurrent infections - may be only intermittently response to antibiotics

Answer 31

chronic otitis media

Question 32

collection of dead cells accumulates, incites growth on medial side of TM

Answer 32

cholesteatoma

Question 33

what do the dead skin components provide at the center of the cholesteatoma

Answer 33

provide an excellent medium for bacterial growth and chronic infections are a consistent feature of cholesteatomas

Question 34

T/F The growing mass induces bone erosion of any contacted bony structures

Answer 34

true

Question 35

What some structures that can be affected by cholesteatoma (3)

Answer 35

ossicles, labyrinth, temporal bone

Question 36

what can cholesteatoma present as

Answer 36

significant hL and vertigo

Question 37

when encountered in _________, cholesteatomas are aggressive (fast growing)

Answer 37

kiddos

Question 38

what is the intervention for cholesteatoma

Answer 38

surgical eradication - will under many surgeries antibiotic is ineffective

Question 39

disease where normal head labyrinthine bone is replaced by vascular spongy bone

Answer 39

otosclerosis

Question 40

what does otosclerosis most frequently affect?

Answer 40

the oval window, extending to the footplate of the stapes by freezing (immobile chain of ossicles) - can sometimes primarly affect cochlea

Question 41

genetic condition that can develop in both ears ossicular chain becomes poor conduction apparatus &. sign. conductive HL results

Answer 41

otoscleorisis

Question 42

otosclerosis intervention includes the _________ to be surgically replaced in part or in whole by graft tissues or manufactured substitutes such as small pistons which reconnect remnant structures with the oval window

Answer 42

ossicular chain

Question 43

bacterial biofilms are colonies/bacteria that exist in what two forms

Answer 43

sessile form (hibernating) planktonic form (active)

Question 44

where are biofilms commonly found

Answer 44

on living/non living areas (slime, ponds, etc.)

Question 45

why are biofilms clinically relevant

Answer 45

- bacteria changes phenotype (making it easier to reject antibiotics) - biofilm helps protect bacteria

Question 46

what are some otolaryngologic diseases presumed to be mediated by biofilms

Answer 46

- chronic sinusitis - chronic otitis media - cholesteatoma - tonsilitis (chronicity is the common denominator)

Question 47

biofilms can grow on implanted substrates (including CIs) and these are often the initial sites of _________

Answer 47

colonization

Question 48

any drug/chemical that can damage OE, ME, IE

Answer 48

ototoxic

Question 49

what are some common ototoxic drugs

Answer 49

cisplatin (cancer drugs) antibiotics aspirin antidepressants etc.

Question 50

what are some ototoxic chemicals

Answer 50

1) organic solvents 2) heavy metals 3) in the home

Question 51

how does an ototoxin like aspirin affect the neuron tuning curve (3)

Answer 51

1) elevated threshold 2) widened bandwidth 3) shifts CF toward lower frequency

Question 52

diagram of the neuron tuning curve

Answer 52

Question 53

any age related hearing loss

Answer 53

presbycusis

Question 54

what is presbycusis characterized by (4)

Answer 54

1) reduced hearing sensitivity 2) reduced speech discrimination in noise 3) slowed central processing 4) impaired localization of sound sources

Question 55

what should presbycusis be considered as

Answer 55

an accumulation of acquired auditory stresses, traumas, otologic diseases and drug/chemical exposures all superimposed on an intrinsic, genetically regulated ageing process

Question 56

loss of hair cells, outer (mostly) or inner - aging alone does not cause the loss of OHCs

Answer 56

sensory presbycusis

Question 57

also called metabolic degeneration of stria vascularis leading to disruption or reduction in EP

Answer 57

strial presbycusis

Question 58

loss of SGN or changes in synaptic density further up the pathway prior to loss of hair cells - may require huge losses before HL is noticed - reduced OAEs may suggest weaknesses in MOC feedback before HL is noticed

Answer 58

neural presbycusis

Question 59

changes in stiffness of BM - may indicate damage to: spiral ligament, limbus, BM, or supporting cells

Answer 59

conductive presbycusis

Question 60

any combination of other presbycusis'

Answer 60

mixed presbycusis

Question 61

obvious due to the wide variety of potentiating exposures & genetic variances

Answer 61

intermediate presbycusis

Question 62

NIHL can cause _____ or __________ hearing loss depending on the level of sound exposure

Answer 62

temporary (reversible) or permanent (irreversible)

Question 63

results from moderately intense sounds such as a rock concert

Answer 63

TTs

Question 64

results from 2 types of exposure a) acoustic trauma (such as gun shot) that is sudden and usually painful [greater than 140 dB] b) classical NIHL results from chronic exposure [workday durations of greater than 85 dB]

Answer 64

PTS

Question 65

how can a permanent SNHL be determined

Answer 65

detected clinically by finding that bone conduction is NOT better than air conduction.

Question 66

what are some other symptoms/findings that could determine NIHL

Answer 66

- hx of long term exposure to dangerous noise levels - HL involving high freq - SRT consistent with audiometric loss - HL stabilizes one noise exposure is terminated

Question 67

- trauma noise that is usually short exposures greater than 140 dB - stretch inner ear tissues / organ of corti may detach from BM / tectorial membrane becomes detached from sterociliary buncles

Answer 67

direct mechanical stress (trauma noise)

Question 68

- metabolic exhaustion of activated (stimulated) cells - activity induced vascular narrowing that leads to ischemia - ionic poisioning, oxygen/nitrogen free radical, enzymes

Answer 68

induced metabolic activity (sub-traumatic noise)

Question 69

what are the mechanisms of protection from NIHL

Answer 69

1) middle ear muscles 2) pillar cell buckling - removing stereocilia from embedment which reduces likelihood of physical trauma to these hair cells 3) antioxidants - Vitamincs A,C,E, etc.