quiz 3 Flashcards
(40 cards)
What are the two types of hearing loss?
sensorineural and conductive
Describe the structures involved in sensorineural hearing loss and some potential etiologies.
The inner ear and the brain hair cells and nerves ETIOLOGIES acoustic trauma barotrauma head trauma atotoxic drugs infection aging acousitc neuroma sudden SSNHL Meniere dz vascular dz Multiple sclerosis
Conductive hearing loss- structures involved and examples of etiologies
external and middle ear obstructed ear canal perforated TM dislocated ossicle otitis media otitis externa otosclerosis congenital abnormality cholesteatoma
What is Mixed hearing loss
a combination of both conductive and sensorineural loss
What are two main categories of tinnitus?
subjective
objective
Describe subbjective tinnitus and list some of its etiologies
audible only to pt, high frequency, damage done to hair cells etiologies: acoustic trauma barotrauma eustacian tube dysfunction Meniere disease Drugs Presbycusis CNS tumor infection ear canal obstruction
Describe objective tinnitus and list some etiologies
rare, can be heard by listening directly over pts ear.
Etiology:
AV malfunction
Turbulent blood flow in carotid a or jugular v
vascualr middle ear tumor
What are some “other” causes of tinnitus?
diabetes, hyperlipidemia, allergies, HTN, hypotension ,TMJ, etc
What should you ask for HX on pt work up for someone with Tinnitus?
Description of sound noise exposure head trauma hearing problems dizziness los of balance recent dental work/problems bruxism stress ototoxic drug use smoking caffeine HTN anxiety insomnia
What would you do/check on a PE for a pt with Tinnitus?
otoscopic exam
CN VIII function and hearing (whisper, tuning fork)
check for: carotid artery bruits(turbulent noise in carotid) HTN oral exam neck and jaw hypertonicity TMJ dysfunction
What are the two types of Vertigo?
subjective- pt feels that they are moving in space
objective- pt feels that objects are moving around them
What causes true vertigo? (sensations of movement)
caused by assymetry in the vestibular system (CN8, inner ear, cerebellum)
What are the symptoms of true vertigo?
either surroundings move or pt moves in surroundings postural instabuility nausea vomiting sweating vertigo worsens when moving head Nystagmus is common
What structures are involved in peripheral vs central vertigo?
peripheral- labyrinth or CN8
central- cerebellum, vestibular cortex in temporal lobe
Describe lightheadedness non-vertigo and what can cause it
“graying out of vision”, pallor, roaring noise in ears
hypoperfusion of the brain from: hypotension shock drugs dehydration decrease cardiac output sever anemia hypoglycemia cardiac arrythmias
Describe disequilibrium in non-vertigo
occurs only while standing or walking, unsteady without any dizziness
source of problem may be: cerebellum frontal lobe tumor basal ganglia stroke cervical spondylosis motor neuron diseases
What can cause miscellaneous non-vertigo?
chronic hyperventilation syndrome
new eyewear and diplopia
phobias- agoraphobia, acrophobia
extra-ocular muscular palsy reults in diplopia
What do you ask about onset on a hx of vertigo?
Onset sudden or gradual?
- sudden and vivid memories are dt inner-ear dz - gradual and ill-defined are most common in CNS, cardiac, and systemic diseases
What can different durations of vertigo on a hx point to?
1Episodic true vertigo that lasts for seconds, associated with head or body position changes likely benign paroxysmal positional vertigo (BPPV)
- Sudden onset that lasts for minutes can be dt brain or vascular disease
- vertigo that lasts for hours or days probably caused by Meniere dz or vestibular neuronitis
What do you do in a general examination in a PE for Vertigo?
check vital signs, supine and standing BP, orthostatic BP, CVS
PE for vertigo- otological exam description
examine ears for cerumen, discharge, foreign body, TM perforation
Extraocular movements in a PE for Vertigo
"H in space"
a. check for nystagmus
1. horizontal plane- most common form
2. vertical plane- always abN, brain
stem function disorder
3. pendular- often congenitalor after prolonged period of blindnessHearing test- PE for Vertigo
gross hearing- whispered voice test
Weber/Rhine to asses conductive or sensorineural loss
Vestibular imbalance- PE for Vertigo
past-pointing with eyes closed, repeat
Romberg test: tend to fall toward the vestibular lesion
