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ENT > 1- Ears (Sensinoural hearing loss) > Flashcards

1- Ears (Sensinoural hearing loss) Flashcards

1
Q

sensorineural hearing loss

A

Occurs due to dysfunction of the inner ear:

  • Cochlea
  • Vestibulocochlear nerve.

Causes of sensorineural hearing loss include

  • increasing age (presbycusis)
  • excessive noise exposure
  • genetic mutations
  • viral infections (e.g. cytomegalovirus)
  • ototoxic agents (e.g. gentamicin).

Conductive hearing loss
occurs when sounds cannot transmit due to problems with the outer and middle ear.

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2
Q

Sensorineural hearing loss

A
  • Sudden sensorineural hearing loss (over less than 72 hours)
  • Presbycusis (age-related)
  • Noise exposure
  • Meniere’s disease
  • Labyrinthitis
  • Acoustic neuroma
  • Neurological conditions e.g. stroke, MS, brain tumours
  • Medications
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3
Q

medications which causes sensorineural hearing loss

A
  • Loop diuretics e.g. furosemide
  • Aminoglycoside antibiotics e.g. gentamicin
  • Chemotherapy drugs e.g. cisplatin
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4
Q

Sudden sensorineural hearing loss (<72h)
Background

A
  • Sudden sensorineural hearing loss is defined as hearing loss over less than 72 hours, unexplained by other causes
  • Otological emergency and requires immediate referral to on call ENT team
  • Diagnosis made when: no conductive cause can be found
  • Usually unilateral
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5
Q

Sudden sensorineural hearing loss (<72h) Causes/risk factors

A

Most cases (90%) of SSNHL are idiopathic, meaning no specific cause is found.

Other causes of SSNHL include:

  • Infection (e.g., meningitis, HIV and mumps)
  • Meniere’s disease
  • Ototoxic medications
  • Multiple sclerosis
  • Migraine
  • Stroke
  • Acoustic neuroma
  • Cogan’s syndrome (a rare autoimmune condition causing inflammation of the eyes and inner ear)
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6
Q

Investigations for Sudden sensorineural hearing loss (<72h)

A
  • Audiometry -> SSNHL requires a loss of at least 30 decibels in three consecutive frequencies on audiogram
  • MRI or CT head to rule out stroke or acoustic neuroma
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7
Q

Sudden sensorineural hearing loss (<72h) management

A
  • Immediate referral within 24 hours of symptoms if sudden sensorineural hearing loss presenting within 30 days
  • Treat underlying cause e.g. antibiotics for infection
  • Idiopathic cause: oral or intra-tympanic (injected) steroids
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8
Q

Sudden sensorineural hearing loss (<72h) prognosis - May be permanent or resolve over days to week

A
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9
Q

Age related hearing loss- presbycusis
Background

A
  • Age-related hearing loss (presbycusis) is the loss of hearing that gradually occurs in most of us as we grow older
  • Sensorineural
  • Affects high pitched sounds first
  • Gradual and symmetrical
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10
Q

Age related hearing loss- presbycusis RF

A
  • Age
  • Male
  • Family history
  • Loud noise exposure- key
  • DM
  • HTN
  • Ototoxic medication
  • Smoking
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11
Q

causes of presbycusis

A

Complex- several mechanisms proposed
Changes in anatomical structures of the ear e.g.
- Inner ear
- Middle ear
- Vestibular cochlear nerve
- Loud noise
- Loss of hair cells
- Aging
- Ototoxic drugs

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12
Q

Presentation of presbycusis

A
  • Bilateral hearing loss
  • Gradual change and insidious
  • High-pitched noises hardest to hear e.g. speech (male voices easier)
  • Speech sounds slurred
  • Some sounds overly loud
  • Tinnitus associated
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13
Q

Investigations for presbycusis

A
  • Otoscope
  • Audiometry
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14
Q

Management of presbycusis

A
  • Hearing aids
  • Cochlear implants if hearing aids not sufficient
  • Assistive devices e.g. telephone amplifier
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15
Q

Noise related hearing loss
Background

A
  • Permanent hearing loss caused by being around loud noises over a long time or a very loud noise e.g. explosion
  • Sensorineural
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16
Q

Noise related hearing loss Pathophysiology

A

Shearing forces of sound energy impact on the stereocilia of hair cells of the basilar membrane of the cochlea

17
Q

Noise related hearing loss presentation

A
  • Bilateral hearing loss
  • Aural fullness
  • Muffled speech
  • Tinnitus
18
Q

Investigations for noise related hearing loss

A
  • Rinne’s positive (AC>BC)
  • Weber lateralises to good ear
19
Q

Management Noise related hearing loss

A
  • Hearing aids
20
Q

Labyrinthitis
Background

A

Inflammation of the bony labyrinth of the inner ear including
- Semi-circular canals
- Vestibule
- Cochlea

21
Q

Presentation of labyrinthitis

A
  • Acute onset vertigo
  • Coryzal symptoms
  • Unlike vestibular neuronitis which also presents with acute onset vertigo
    o Hearing loss
    o Tinnitus
22
Q

investigations for labyrinthitis

A
  • Clinical diagnosis
  • Head impulse tests
    –> Diagnoses peripheral cause of vertigo e.g. vestibular neuronitis or labyrinthitis
23
Q

Management of labyrinthitis

A

Management is the same as with vestibular neuronitis, with supportive care and short-term use (up to 3 days) of medication to suppress the symptoms. Options for managing symptoms are:

  • Prochlorperazine
  • Antihistamines (e.g., cyclizine, cinnarizine and promethazine)

If bacterial labyrinthitis

  • Antibiotics
24
Q

Prognosis/complications of labrynthitis

A
  • Rarely have lasting symptoms
  • If bacterial labyrinthitis more likely to have lasting symptoms

ENT (17 decks)

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