41. Change in hearing Flashcards by Ailsa Jones

most common causes of hearing loss

ear wax, otitis media and otitis externa.

How well did you know this?

Not at all

Perfectly

differentials hearing loss

Conductive hearing loss
(otitis media)
Glue ear
Otosclerosis
Impacted wax
Eustachian tube dysfunction

Sensorineural hearing loss
Presbycusis - Age related
Occupational
(Meniere’s disease)
(labyrinthitis) (Meningitis → labyrinthitis)
Drug toxicity
(Acoustic neuroma)

How well did you know this?

Not at all

Perfectly

history taking hearing loss

How well did you know this?

Not at all

Perfectly

examination hearing loss

How well did you know this?

Not at all

Perfectly

causes conductive hearing loss

(otitis media)
Glue ear
Otosclerosis
Impacted wax
Eustachian tube dysfunction

How well did you know this?

Not at all

Perfectly

causes sensorineural hearing loss

Presbycusis - Age related
Occupational
(Meniere’s disease)
(labyrinthitis) (Meningitis → labyrinthitis)
Drug toxicity
(Acoustic neuroma)

How well did you know this?

Not at all

Perfectly

what is primary tinnitus

no identifiable cause and often occurs with sensorineural hearing loss

How well did you know this?

Not at all

Perfectly

what is secondary tinnitus?

identifiable cause:

Impacted ear wax
Ear infection
Ménière’s disease
Noise exposure
Medications (e.g., loop diuretics, gentamicin and chemotherapy drugs such as cisplatin)
Acoustic neuroma
Multiple sclerosis
Trauma
Depression

How well did you know this?

Not at all

Perfectly

what systemic conditions can cause tinnitus

Anaemia
Diabetes
Hypothyroidism or hyperthyroidism
Hyperlipidaemia

How well did you know this?

Not at all

Perfectly

red flags tinnitus

Unilateral tinnitus
Pulsatile tinnitus
Hyperacusis (hypersensitivity, pain or distress with environmental sounds)
Associated unilateral hearing loss
Associated sudden onset hearing loss
Associated vertigo or dizziness
Headaches or visual symptoms
Associated neurological symptoms or signs (e.g., facial nerve palsy or signs of stroke)
Suicidal ideation related to the tinnitus

How well did you know this?

Not at all

Perfectly

Invetsigation tinnitus

Full blood count (anaemia)
Glucose (diabetes)
TSH (thyroid disorders)
Lipids (hyperlipidaemia)

Audiology can be used to assess the hearing in detail and help establish the underlying cause.

Imaging (e.g., CT or MRI) may be rarely required to investigate for underlying causes such as vascular malformations or acoustic neuromas.

How well did you know this?

Not at all

Perfectly

management tinnitus

Tinnitus tends to improve or resolve over time without any interventions.

Underlying causes of tinnitus can be treated, such as impacted ear wax or infection.

Several measures can be used to help improve and manage symptoms:

Hearing aids
Sound therapy (adding background noise to mask the tinnitus)
Cognitive behavioural therapy

How well did you know this?

Not at all

Perfectly

newborn hearing test

Otoacoustic emission test

How well did you know this?

Not at all

Perfectly

what test is done if otoacoustic emission test is abnormal

Auditory Brainstem Response test

How well did you know this?

Not at all

Perfectly

hearing 6-9 months

Distraction test

How well did you know this?

Not at all

Perfectly

heairng testing > 3 years

Pure tone audiometry

How well did you know this?

Not at all

Perfectly

complications of hearing impairment/unrecognised hearing impairment in children

Poor speech development
Impaired learning
Mental health
Learning difficulties

How well did you know this?

Not at all

Perfectly

causes of hearing loss in chidlren

Congenital:
Maternal rubella or cytomegalovirus infection during pregnancy
Genetic deafness can be autosomal recessive or autosomal dominant
Associated syndromes, for example Down’s syndrome

Perinatal:
Prematurity
Hypoxia during or after birth

After birth:
Jaundice
Meningitis and encephalitis
Otitis media or glue ear
Chemotherapy

How well did you know this?

Not at all

Perfectly

audiogram interpretation

20dB
anything above the 20dB line is normal

sensioneural = bone and air impaired so both below line

conduction = only air is impaired so air below line and bone above line

what is glue ear

otitis media with effusion. The middle ear becomes full of fluid, causing a loss of hearing in that ear.

ototscopy glue ear

dull tympanic membrane with air bubbles or a visible fluid level, although it can look normal.

investigation glue ear

Referral for audiometry to help establish the diagnosis and extent of hearing loss.

management glue ear

active observation: the management for a child with a first presentation of otitis media with effusion is active observation for 3 months - no intervention is required
grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube. The majority stop functioning after about 10 months
adenoidectomy

Presentation eustachain tube dysfunction

PC: reduced or altered hearing, popping noises/sensations in ear, fullness in ear, pain/discomfort, tinnitus

pathophysiology eustachian tube dysfunction

When the Eustachian tube is not functioning correctly or becomes blocked, the air pressure cannot equalise properly and fluid cannot drain freely from the middle ear. The air pressure between the middle ear and the environment can become unequal. The middle ear can fill with fluid.

invetsigation eustachain tube dysfunction

If typical history and trigger: clinical diagnosis If persistent: Tympanometry, audiometry, nasopharyngoscopy, CT

management eustachian tube dysfunction

Will resolve spontaneously with no treatment Valsalva manoeuvre (holding the nose and blowing into it to inflate the Eustachian tube) Decongestant nasal spray Antihistamine and a steroid nasal spray for allergic rhinitis Otovent is an over the counter device where the patient blows into a balloon using a single nostril, which can help inflate the Eustachian tube, clear blockages and equalise pressure. Surgical Treating any other pathology that might be causing symptoms, for example, adenoidectomy (removal of the adenoids) Grommets Balloon dilatation Eustachian tuboplasty

what is otosclerosis

Otosclerosis describes the replacement of normal bone by vascular spongy bone. It causes a progressive conductive deafness due to fixation of the stapes at the oval window.

inheritance otosclerosis

Otosclerosis is autosomal dominant and typically affects young adults

presentation otosclerosis

Onset is usually at 20-40 years - features include: conductive deafness tinnitus tympanic membrane the majority of patients will have a normal tympanic membrane 10% of patients may have a 'flamingo tinge', caused by hyperaemia positive family history

management otosclerosis

hearing aid stapedectomy

management impacted ear wax

olive oil sodium bicarbonate 5% almond oil

how may impacted ear wax present

pain conductive hearing loss tinnitus vertigo

sudden onset sensorineural hearing loss plan

urgent referral to ENT. The majority of SSNHL cases are idiopathic. High-dose oral corticosteroids are used by ENT for ALL cases of SSNHL.

what type of HL does otosclerosis cause

conductive

what type of HL does presbycusis cause

what type of noise is difficult to hear presbycusis

high-frequency hearing is affected bilaterally, which can lead to conversational difficulties, particularly in noisy environments.

what type of noise is difficult to ehar in otoscleorsis

It tends to affect the hearing of lower-pitched sounds more than higher-pitched sounds. Female speech may be easier to hear than male speech (due to the generally higher pitch). This is the reverse of the pattern seen in presbycusis.

pathophysiology presbycusis

sensory hair cells and neurons in the cochlea atrophy over time The precise cause is unknown however is likely multifactorial Arteriosclerosis: May cause diminished perfusion and oxygenation of the cochlea, resulting in damage to inner ear structures Diabetes: Acceleration of arteriosclerosis Accumulated exposure to noise Drug exposure (Salicylates, chemotherapy agents etc.) Stress Genetic: Certain individuals may be programmed for the early ageing of the auditory system

presentation presbycusis

chronic, slowly progressing history of: Speech becoming difficult to understand Need for increased volume on the television or radio Difficulty using the telephone Loss of directionality of sound Worsening of symptoms in noisy environments Hyperacusis: Heightened sensitivity to certain frequencies of sound (Less common) Tinnitus (Uncommon)

investigations presbycusus

Audiometry

what frequencies are particualrly affected occupational hearing loss

3000-6000 Hz

what drugs are ototoxic

aminoglycosides (e.g. Gentamicin), furosemide, aspirin and a number of cytotoxic agents

What is the nerve found within the middle ear?

facial nerve