3b - Diseases Of Inner Ear (hearing Loss) Flashcards
Hearing refresher?
Slide 57
Hearing loss classification
Normal - soft whisper - 0-20dB Mild - soft spoken voice - 20-40dB Moderate - normal voice - 40-60dB Severe - loud voice - 60-80dB Profound - shout - >80dB
Weber test, hearing loss?
Conductive - heard better in affected ear
Sensorineural - heard better in the unaffected ear
4 causes of dysfunction of the external or middle ear?
All cause Impairment of passage of sound vibrations
- Obstruction (cerumen impaction)
- Mass loading (middle ear infection)
- Stiffness effect (otosclerosis)
- Discontinuity (ossicular disruption)
Transient and persistent causes of CHL?
Transient conduction: cerumen impaction or ETD from URI
Persistent conduction: chronic ear infection, trauma, otosclerosis
Tx for conductive hearing loss?
Medical:
- treat infection
- fix impaction
Surgical:
- tympanoplasty
- prosthesis
Sensorineural hearing loss is often?
Bilateral
Unilateral suggests lesion proximal to the cochlea (acoustic neuroma)
What makes Sensorineural hearing loss better?
Its usually Irreversible
Causes of sensorineural hearing loss?
Presbycusuis (age related) Noise trauma Physical trauma Ototoxicity Sudden sensory Hereditary Autoimmune
Presbycusis hearing loss affects?
High-freq sounds
MC complaint of old people with presbycus?
Loss of speech discrimination in noisy environments
2nd MCC of SNHL?
Noise trauma - sounds over 85dB injure the cochlea
Progression of noise trauma hearing loss?
Begins w high freq (4000 Hz)
Progresses to speech freq
Ototoxicity is MC caused by?
Aminoglycosides - Neomycin - Gentamycin Loop diuretics Antineoplastic agents
Ototoxicity hearing loss is temporary?
Nope - Irreversible
Definition of sudden sensory hearing loss?
Sudden HL
Unilateral
Typically >20y/o
Causes of sudden HL?
Not really sure, maybe:
- Viral infection
- Vascular occlusion of internal auditory artery
Tx for sudden HL?
Prompt admin of corticosteroids (PO or intratympanic)
The faster tx the better
- not effective if started after 6 weeks
Hereditary hearing loss is associated with?
- Connexin-26 gene mutation (MC)
- Hereditary mitochondrial d/o
Age and rate of progression of hereditary HL is predicted by?
Family hx
Tx for hereditary hearing loss?
Gene therapy and stem cell stuff is in the works
Autoimmune d/o that are associated w hearing loss?
SLE
Granulomatosis w polyangiitis
Cogan syndrome
(Hearing loss, keratitis, aoritis)
The only hearing loss that involves lab tests?
Autoimmune
SNHL tx?
Not correctible but:
- hearing amplificaiton
- assistive devices (improve comprehension)
- cochlear implant
Tinnitus diagnosis?
Perception of abnormal ear or heard noises
- associated w SNHL
Pulsatile tinnitus can be?
Glomus tumor Venmous sinus stenosis Carotid vaso-occlusive disease Arteriovenous malformation Aneurysm
Pulsatile tinnitus needs?
MRA
Venography
Staccato tinnitus is?
Rapid series of popping noises
- Lasts seconds - minutes
- middle ear muscle spasm
- palatal myoclonus - rhythmic involuntary movement of soft palate
Tinnitis tx?
Avoid noises that make it worse Habituation - get over it Masking - cover w noises Antidepressant - nortriptyline Transcranial magnetic stimulation/implantable brain stimulators
Hyperacusis is?
Excessive sensitivity to sound w normal hearing
Causes of hyperacusis?
Ear disease
Noise trauma
Migraines
Psych shit
Hearing loss eval?
Determine
- nature of HL
- anatomy impairment
- etiology
Hearing loss history?
You can figure it out 79-80
Exam of HL?
Auricle EAC TM insufflation HEENT Webber and Rinne Audiologic assessment Imaging - CT/MRI
Tests that audiology can do?
Audiogram:
- Pure-tone air conduction and bone-conduction thresholds
Speech reception threshold
Tympanometry
Acoustic reflexes
Normal hearing dB?
0-20dB
What does tympanometry test?
Basically is the ear anatomy normal
- Eval the TM and middle ear status
- Mobility of TM
- Help detect middle ear fluid (if PE is unclear)
Tympanogram patterns results?
A: normal B: fluid or perf C: ETD As: ossicular fixation Ad: ossicular disarticulation
Pic on slide 97
Bob suddenly realized his wife had fallen off her horse,
Which was a relief to him, as an hour before he though he had gone deaf
