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AAP Flashcards

1
Q

Bacterial infections of inner ear and their symptoms?

A

Labrynthitis: inflammation of the membranous membrane from otitis media.
Bacterial meningitis: bilateral SNHL usually profound. Via internal auditory Meatus
Syphilis: SNHL is common. Vertigo and tinnitus can occur at later stages

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2
Q

Viral infections of inner ear and their loss?

A

CMV: in child profound loss in mother flu. Common cause on congenital hearing loss.
Rubella: bilateral SNHL. Partial collapse of reissners membrane
Measles: bilateral mixed. Mixed loss due to middle ear erosion. 40dB to 80dB flattish loss
Mumps: unilateral sudden severe to Profound, can be reversible
Herpes zoster: sudden cochlea and retro cochlea loss. Associated with pain and vesicular rash on external ear.

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3
Q

Antibiotics causing ototoxicity of inner ear and drugs, use and damage?

A

Neomycin, gentamicin, streptomycin.
Used for bacterial disorders and they damage the OHC at basal end of the cochlea.

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4
Q

Anti cancer drugs causing ototoxicity of inner ear and use and effect

A

Cisplatin and carboplatin
Used for malignant disease. Effects hair cells, stria vascularis and spiral ganglion and is permanent

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5
Q

Diuretics that cause ototoxicity in inner ear and use and effects?

A

Frusemide and ethacrynic acid. Used to turn excess water into urine. Effects OHCS’s and Stria vascularis. Is mostly reversible.

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6
Q

Anti malarial drugs that cause ototoxicity in inner ear and use and effects?

A

Quinine. Used for malaria treatment. Effects are tinnitus and damage to organ of corti.

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7
Q

NSAID (non steroid antiflamatory drugs) that cause ototoxicity in inner ear and use and effects?

A

Salicylates - aspirin. For pain relief and effects and damage are unknown. Loss reversible.

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8
Q

What is Menieres?

A

Over production of endolymph. The endolymphatic sac becomes swollen with excess fluid. Scala media fills the scala tympani and scale vestibuli. Greatest affect at the apical end of the cochlea therefore affects low frequency and low frequency tinnitus.
It is:
idiopathic (unknown cause)
Episodic (happens in episodes)
Endolymphatic (relates to endolymph)
Hydrops (excess fluid)

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9
Q

Describe stage 1 of Menieres

A

-Disabling, rotary vertigo
-nausea and vomiting
- episodes from 20 mins to several hours
-aural fullness or pressure
- sensation in affected ear
- between attacks hearing returns to normal

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10
Q

Describe stage 2 Menieres?

A

-hearing loss is more established but still fluctuates , often unilateral
- SN, low frequency loss: reverse slope
- vertigo episodes reach maximum and then subside
- pattern of attacks is extremely variable : no 2 patients the same
- tinnitus becomes more noticeable

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11
Q

Describe stage 3 Menieres?

A
  • hearing loss becomes severe and permanent. Becomes primary disability
  • 50% of long term sufferers develop a bilateral loss
  • vertigo diminishes but unsteadiness remains
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12
Q

Medication for Menieres

A
  • anti vertiginous
  • diuretics
  • gentamicin
  • steroid injections
    Passed through cochlea via TM or through grommets
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13
Q

Surgery treatments for Menieres

A
  • endolymphatic sac shunt: drains the endolymphatic sac to reduce pressure. Usually will preserve the hearing.
  • endolymphatic sac decompression: removal of bone over the sac to allow for its expansion
  • vestibular nerve suction: severing of the vestibular nerve.
  • labrynthectomy: destruction of Labrynth : no hearing
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14
Q

Other treatments of Menieres?

A
  • vestibular rehabilitation ; head eye and neck movements. Hallpike manoeuvre
  • diet - low sodium
  • tinnitus management, hearing aids, counselling and surgical treatments if vertigo remains
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15
Q

Symptoms of Presbyacusis

A
  • bilateral
  • symmetrical
  • sloping
  • sensorineural
  • slow and progressive
  • both ears same degree
  • mainly affects high frequencies
  • cochlea + neural pathways
    There is also a generic element as some will be more susceptible than others.
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16
Q

4 different etiologies of presbyacusis

A
  • neural
  • sensory
    -metabolic
  • mechanical
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17
Q

Sensory presbyacusis

A

Hair cell degeneration within the organ of corti. Mainly at the basal end (doormat effect) therefore affects the high frequencies.

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18
Q

Neural presbyacusis

A

Degeneration of ganglion cells, reduction in synapses to the brain.
Loss of never cells that transmit the impulses along the auditory pathway. Not specific to high frequencies.

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19
Q

Metabolic presbyacusis

A

Atrophy of atria vascularis capillaries. No rich supply of potassium to feed into the inner hair cells - not specific to high frequencies.

20
Q

Mechanical presbyacusis

A

Thickening of the basilar membrane. This reduces elasticity so the normal rippling affect does not happen. Base is already taut and becomes even more which has a greater affect on the higher frequencies.

21
Q

Risk factors of presbyacusis

A

Heart disease
Noise damage
Ototoxic drugs
Diabetes
Poor diet
Stress

22
Q

Problems with sensorineural hearing loss

A

Poor speech discrimination
Loudness recruitment
Poor frequency/ temporal resolution
Upward spread of masking

23
Q

Describe Loudness recruitment

A

People with cochlea damage have reduced thresholds so when a sound is increased above this level the perceived rate of growth of loudness is greater than normal. This results from damage to the sensory cells of the cochlea as they recruit neighbour hair cells to hear the frequency.

24
Q

Describe poor temporal resolution

A

Temporal resolution is the ability to detect small gaps in sound which is important for speech discrimination. With Cochlea damage this ability is lost which makes speech sound like a continuous slur

25
Describe Frequency resolution
This is the ability to differentiate sounds of similar frequencies which produces sharper hearing. Damage to the hair cells reduces the sound getting to the brain. Increased sound levels are required. Patients report they can hear but cannot understand.
26
Describe upward spread of masking
The ability of low frequency sounds to mask out high frequency sound. When a low frequency sound enters the cochlea the whole basilar membrane is in motion so if a high frequency sound is introduced at the same time the area of the BM responsible for that frequency has already moved towards the tectorial membrane. So the low frequency activity has lessened the intensity perceived by the cochlea of that high frequency signal.
27
Hearing aids for presbyacusis must:
1. Work and change quickly to help with temporal resolution 2. Amplify loud sounds more and quiet sounds less 3. Amplify high frequencies more and low frequencies less to improve speech discrimination 4. Not over amplify low frequencies to stop upward spread of masking
28
What is a cochlear dead region?
When hearing loss is so severe in some areas that the inner hair cells and or the Neurons completely loose their function. Amplification of frequencies well inside the dead region usually will not improve speech intelligibility
29
What is localisation
The ability to pinpoint source and location or sound using input from ears and cognitive processes
30
What is ITD
interaural time difference: relates to time or arrival and relates to phase differences and wavelength of a sound. Low frequencies have a longer wavelength so by the time it has reached the opposite ear it will be out of phase - brain utilises this to obtain directional clues.
31
What is IPD
Intetaural phase difference: relates to the wave being at different phases in each ear. One ear might pick up sound whilst the wave is in compression and other ear picks it up whilst it’s in rarefaction. The phase difference from one ear to the other is further info used by brain to identify the direction of the sound.
32
What is IID?
Interaural intensity difference: sound dissipates over a distance and so is hear louder by the ear closest to the source. Head proves and obstacle to certain sounds and causes a shadow to higher frequencies as lower frequencies diffract better around the head and so are heard by opposite and at with minimal loss of intensity
33
What is headshadow?
Head acts as a barrier when sound is presented from one side. One ear is in shadow of head so their is an average of 6db in intensity difference.
34
What is vertical localisation?
Contours and folds of pinna create echoes as well as shoulder and torso reflections. Sound arrival font at TM is combo of direct and reflected sound. The brain used this info to determine position of sound source. Sound from above has a faster echo (100 microsecond) and from below is slower (300 microseconds)
35
What is front localisation?
Pinna faces forwards at an angle. High frequencies are boosted by pinna resonance when they arrive from the front. But when they come from behind the sound has to diffract around the helix to enter the eam. High frequencies above 3khz are less able to defract so the brain uses this loss of high frequencies to identify the if the sound has come from behind
36
What is a harmonic?
A harmonic is a a sound wave that has a frequency that is a whole number multiple of a fundamental tone. The lowest frequency sound that can be produced is the fundamental frequency. For example: Frequency 2 x that of fundamental tone = second harmonic (f2) Frequency 3x that of fundamental frequency = third harmonic (f3) Frequency 4x that of fundamental frequency = fourth harmonic
37
What is timbre?
It is the addition of harmonics and overtones to a wave that makes it possible to distinguish between different sounds and instruments, the timbre.
38
What is a spectrum or Fourier or frequency analysis?
It is a chart that breaks down a wave form into all of its component frequencies
39
What is the signal/noise ratio?
It is the balance of signal strength(what you want to hear) versus the noise strength (background noise)
40
What is the Lombard effect?
It is when your voice naturally raise in intensity when in noise
41
If the signal to noise ratio is +dB what does this mean?
It means it is positive so the signal is better than the noise
42
If the signal to noise ratio is -dB what does this mean?
It means the noise is louder than the signal (negative)
43
What signal to noise ratio can normal people deal with?
They can deal with it a SNR of 0dB, so signal and noise are the same.
44
What signal to noise ratio can people with a conductive loss deal with?
People with conductive loss can deal with a SNR of 0dB as long as it is above their hearing threshold
45
What signal to noise ratio can people with a sensorineural hearing loss deal with?
They will need a +dB signal to noise ratio, usually +10dB
46
What are the 4 stages of speech production?
1. Air flow from kings 2. Source of vibration from vocal chords 3. Resonators (vocal tract) 4. Speech signal

Audiology (9 decks)

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