adult hearing stuff

Question 1

most common type of age-related sensorineural hearing loss is…

Answer 1

presbycusis- gradual degeneration within the cochlea that accompanies aging

Question 2

external auditory canal

Answer 2

collects sound waves for middle ear

Question 3

middle ear

Answer 3

transfers sound waves for inner ear

Question 4

inner ear

Answer 4

converts vibrations into electrical impulses. these impulses are then processed by the brain

Question 5

hearing exams

Answer 5

-finger rub tests
-whispered voice tests
-weber and rinne testing

Question 6

rinne test

Answer 6

vibrating tuning fork is held next to the ear and the pt reports when he or she can no longer hear the sound. the still vibrating fork is then placed on the mastoid process behind the ear.

Question 7

Results of rinne test

Answer 7

normal: AC> BC
sensorineural: AC> BC
conductive hearing loss: BC> AC

Question 8

weber test

Answer 8

placing a vibrating running fork at the middle of the forehead

Question 9

weber test results

Answer 9

normal: midline
sensorineural: normal ear
conductive: affected ear

Question 10

conductive hearing loss

Answer 10

-external ear (outer): cerumen impaction, otitis externa, foreign body
-middle ear: cholesteatoma, otitis media, Eustachian tube dysfunction

Question 11

sensorineural hearing loss

Answer 11

issues related to the cochlea-> inner ear
-affected by genetics, age, vascular changes, environmental factors (noise exposure), ototoxic exposures
-need to consider autoimmune conditions, tumor or neoplasms, infections, stroke

Question 12

tinnitus

Answer 12

perception of hearing a sound when there is no sound in environment

Question 13

tinnitus s/s

Answer 13

**may be described as buzzing, rising, hissing, whistling
**important clues:
-high pitched continuous tinnitus often associated with sensorineural hearing loss: associated noise with the associated hearing loss
-low pitched tinnitus: may be associated idiopathic tinnitus or Meniere disease
-pulsating or rushing tinnitus: may be associated with vascular cause
-clicking: may be associated with TMJ dysfunction

Question 14

eval of tinnitus

Answer 14

full ear exam
assess TMJ
auscultate for bruits
complete neuro exam
review of meds

Question 15

management of tinnitus

Answer 15

referral for audiogram
refer to ENT or neurology depending on suspected cause
address insomnia associated w/ tinnitus

Question 16

cerumen impaction

Answer 16

occurs when increased amounts of hard cerumen either partially or completely occlude the external ear canal

Question 17

risk factors for cerumen impaction

Answer 17

use of q-tips, ear plugs, hearing aides, ear buds

Question 18

diagnosis of cerumen impaction

Answer 18

(1) when patient has symptoms
(2) you are unable to assess the ear as a result of cerumen

Question 19

s/s of cerumen impaction

Answer 19

may complain of:
fullness
hearing loss
ear pain
ear discomfort
tinnitus
vertigo or dizziness

Question 20

management of cerumen impaction

Answer 20

prior to considering removal, ask about hx of tympanostomy tube, surgery or ruptured TM–> contraindication to irrigation
removal can be done with:
-curette
-with carmbamide peroxide drops x3-5 days
-irrigation

Question 21

patient education

Answer 21

-clean external ear only
-avoid ear swabs/small objects into ear
-may use debris drops 1-2x per week
-individuals who use hearing aides are at increased risk for cerumen impaction

Question 22

cholesteatoma

Answer 22

collection of skin cells in middle ear or mastoid into benign tumor
could be congenital or acquired
can cause erosion and hearing loss

Question 23

cholesteatoma: primary or secondary acquired

Answer 23

primary acquired: most commonly due to Eustachian tube dysfuntion
secondary acquired: can occur after TM perforation

Question 24

s/s of cholesteatoma

Answer 24

may present with malodorous drainage, hearing loss, tinnitus, vertigo

Question 25

eval of cholesteatoma

Answer 25

complete internal/external ear exam and neuro exam

Question 26

treatment of cholesteatoma

Answer 26

treatment with an antibacterial agent if otitis media or otitis externa present
referral to ENT and for audiogram
surgery is the definitive treatment