(Audiological Disorders) Flashcards
Autoimmune Inner Ear Disease
caused by antibodies attacking the inner ear. Symptoms include progressive hearing loss, vertigo, and balance problems.
Acoustic Neuroma
tiny tumor that affects the auditory and vestibular nerves. The tumor causes gradual hearing loss, ringing in one ear, balance problems and vertigo.
Perilymph Fistula
a hole between the middle ear and inner ear causes many disruptions. Dizziness, tinnitus, pressure sensitivity, and hearing loss are all common (and all symptoms of Meniere’s). A doctor may recommend surgery. These procedures come with varying degrees of success.
Dislodged Calcium
Vertigo and nausea sometimes result from calcium carbonate crystals that become dislodged in the ear. The symptoms are intermittent, like Meniere’s, but much shorter. This condition sometimes fixes itself. Calcium deposits on inner ear bones have similar symptoms.
Superior Canal Dehiscence Syndrome (SCDS)
is rare. The inner ear shows signs of the temporal bone thinning. Symptoms include common Meniere’s manifestations.
Vertigo has other triggers than Meniere’s Disease. It can result from
A Head Injury.
Head movements (positional vertigo affecting people over 50 years of age).
Labyrinthitis (inner ear infection).
Inflammation of the vestibular nerve caused by a viral infection.
Problems in the cerebellum like migraines, multiple sclerosis, Transient Ischemic Attack (TIA), and brain tumors.
most common congenital malformations of the pinna
microtia and atresia
what is microtia? impact on hearing?
when the outer ear is small or not formed properly (ex. abnormally small pinna), or when the outer ear is entirely missing. The opening of the ear may also be small or blocked. There is HL only if there is something secondary to it (such as an ear canal that is not intact).
what is anotia? impact on hearing?
a missing pinna/auricle. there is HL if the ear canal is not intact (or if there is something secondary to it).
microtia and anotia are both considered __ and __
craniofacial abnormalties, non-syndromic hearing losses
non-syndromic hearing losses account for __% of all forms of inhertied HL
70%
is surgery possible for microtia and anotia?
yes, can get a prosthetic
what is aural atresia? can affect __ or __ ear canals? can be in __ or __ __ __?
undeveloped or absent ear canal. can affect ONE or BOTH ear canals. can be in ISOLATION or WITH OTHER ABNORMALTIES
aural atresia impact on hearing?
conductive HL
aural atresia is common in who
people with Treacher Collins syndrome (inherited condition, issues with facial bones), people with Goldin Har syndrome (rare congenital defect where there is incomplete formation of ears, palate, mandible)
stenosis
very small or narrow ear canal
what are the disorders of the external auditory meatus (ear canal)
aural atresia, otitis externa, collapsing ear canal, impacted cerumen
what are the disorders of the auricle
MICROTIA (when outer ear is small or not formed properly or entirely missing), and ANOTIA (a missing pinna/auricle).
what is otitis externa? it can be…? what is the most common type of otitis externa? why would there be issues with performing a hearing test?
inflammation or infection of the ear canal. it can be a fungal, viral, or bacterial infection. most common type of otitis externa is Swimmer’s Ear. there would be issues with performing a hearing test because the pressure is very painful on the outside of the ear and in the ear canal
impact of otitis externa on hearing?
can cause conductive HL if the pressure is great enough to cut off the ear canal
Fluctuating conductive hearing loss nearly always occurs with all types of __ __. In fact it is the most common cause of hearing loss in young children.
otitis media
collapsing ear canals are more of a __ than a __. collapsing ear canals are very important when testing who?
condition; disorder. children under 7 and older adults
impacted cerumen:
build up of ear wax in the ear canal
who is susceptible to impacted cerumen
people who wear ear plugs all the time; people with small canals (petite adults)
impact of impacted cerumen on hearing?
varies depending on the amount of blockage
what can impact cerumen?
cleaning ears with q-tips
An acoustic neuroma is also known as
vestibular schwannoma
An acoustic neuroma (vestibular schwannoma) is a __ __ that develops on the __ __ leading from the inner ear to the brain. The pressure on the __ from the tumor may cause __ and __.
An acoustic neuroma (vestibular schwannoma) is a BENIGN TUMOR that develops on the 8TH NERVE (vestibulocochlear nerve) leading from the INNER EAR to the BRAIN. The pressure on the NERVE from the tumor may cause HL and IMBALANCE.
Meniere’s disease is a disorder of the __ __ that can lead to __ and __. In most cases, Meniere’s disease affects only __ __. Meniere’s disease can occur at any age, but it usually starts between __ and __ __.
Meniere’s disease is a disorder of the inner ear that can lead to DIZZY SPELLS (VERTIGO) and HL. In most cases, Meniere’s disease affects only ONE EAR Meniere’s disease can occur at any age, but it usually starts between YOUNG and MIDDLE-AGED ADULTHOOD.
Another name for Meniere’s is __ __ __, which essentially means __ __ in the __ __.
Another name for Meniere’s is IDIOPATHIC ENDOLYMPHATIC HYDROPS, which essentially means ABNORMAL FLUID IN THE INNER EAR.
Signs of a Weakened Immune System
High Stress Levels, Frequent Respiratory Infections, Stomach Problems, Wounds Are Slow to Heal, Frequent Fatigue
Name some causes or triggers of Meniere’s Disease
Head injury, Infection to the middle/inner ear, Allergies, Alcohol use, Stress
Side effects of certain medications, Smoking, Stress or anxiety, Fatigue, Family history of the disease, Respiratory infection, Recent viral illness, Abnormal immune response, Migraines
disorders of the tympanic membrane
TM perforation, tympanosclerosis, myringoclerosis
In myringosclerosis the __ only deposits on the __, and there are no symptoms. In tympanosclerosis, the __ deposits are not only on the __ but also on the __ of the __ __. The most common symptom of tympanosclerosis is conductive hearing loss.
In myringosclerosis the CALCIUM only deposits on the TM, and there are no symptoms. In tympanosclerosis, the CALCIUM deposits are not only on the TM but also on the STRUCTURES of the MIDDLE EAR. The most common symptom of tympanosclerosis is conductive hearing loss.
myringoclerosis
scarring of the ear drum after the ear drum is injured or after surgery – a small white scarring on the ear drum can be seen after a person has had middle ear ventilation tubes. Myringosclerosis causes no symptoms.
most common symptom of tympanosclerosis (calcium deposits are not only on the TM but also on the structures of the middle ear)
conductive hearing loss.
symptoms in myringosclerosis (scarring of the ear drum after the ear drum is injured or after surgery / calcium deposits on the TM).
No symptoms (no hearing loss). BUT IF the scaring is thick enough then it can cause a conductive hearing loss.
possible causes of a TM perforation
excessive pressure from middle ear infections, trauma (loud noises), forceful changing in air pressure (flying, diving, intense sneeze)
does a perforation heal? explain
Most perforated eardrums heal without treatment within a few weeks (tissue migrates toward the perforation). Your doctor may prescribe antibiotic drops if there’s evidence of infection. It doesn’t heal by itself, treatment will involve a surgical procedure to close the perforation.
impact of TM perforation on hearing
depending on the size of the perforation, there can be a mild to moderate conductive HL.
tympanosclerosis
scaring of the ear drum (thickens/adds mass to the ear drum, calcium plaque gives ear drum a white appearance)
disorders of the middle ear
cholesteatoma, otitis media, otosclerosis, ossicular disarticulation
most common disorder of the ME
otitis media
most common cause of otitis media in children
upper respiratory infections
in children, eustachian tube is more __. so…
in children, eustachian tube is more horizontal and angled. so a child’s eustachian tube will not drain out as easily as an adult’s eustachian tube.
otitis media can be classified in what 2 ways?
-based on duration/frequency. -based on type of fluid (effusion)
ways to classify otitis media based on duration/frequency
-acute: short period of time (less than 1 mo). -chronic: lasts longer than 2 mo. -recurrent: 3 or more acute episodes within a 6 mo period.
if a child has chronic or recurrent otitis media, make sure to look at
speech and langage development
ways to classify otitis media based on type of effusion. explain each. symptoms of otitis media…?
serous: thin, sterile fluid with no bacteria in it. purulent: contains puss, bacteria. symptoms of otitis media may include fever and conductive hearing loss (although with purulent otitis media some indivuals will have no symtoms)
difference between suppurative and nonsuppurative otitis media
Suppurative otitis media is a fluid buildup in the ear with pus formation, while nonsuppurative lacks pus formation.
Acute otitis media and blockage of a eustachian tube are among the causes of __ __ __ __. A flare-up may occur after a cold, an ear infection, or after water enters the middle ear. People usually have hearing loss and persistent drainage from the ear. Doctors __ the ear canal and give __ __.
Acute otitis media and blockage of a eustachian tube are among the causes of CHRONIC SUPPERATIVE OTITIS MEDIA. A flare-up may occur after a cold, an ear infection, or after water enters the middle ear. People usually have hearing loss and persistent drainage from the ear. Doctors CLEAN the ear canal and give EAR DROPS.
what serous and purulent fluid looks like
serous: clear and watery looking. fluid bubbles visable through TM. purulent: yellow fluid
population that is exteremly prone to otitis media
children with down syndrome
why are children more suseptible to otitis media?
adults have more verticle ET, adults have more cartilage support
% of children who will have at least 1 eps of otitis media by age 6
75%
what causes an ear ache
-negative air pressure inside the ME causes TM to retract and stretch. - earache is in ear canal…?
otitis media impact on hearing
conductive hearing loss that ranges from 15 dB HL to 45 dB HL
what else can otitis media cause?
TM perforation
is conductive HL usually permanent with otitis media?
no
greatest amount of loss with otitis media is in the __ F’s
low
degree of loss with otitis media is dependent on
amount of fluid
if left untreated, what can otitis media lead to
-ossicular erosion: ossicles erode bc they are sitting in fluid. -mastoiditis: infection of mastoid bone bc of fluid. -if left untreated, can lead to meningitis or possibly death. -cholesteatoma
children with a history of otitis media before age 2 and a HL of 26 dB or greater will have loss in
verbal ability, reading, math, language
where are pressure equalizer (PE) tubes place? how long do they stay there?
ear drum. 6-12 mo
what is a myringotomy
incision into ear drum to relieve pressure or to drain fluid
what is a cholesteatoma
a benign cyst (large white mass behind the TM)
-capable of reabsorbing bone that’s adjacent to it -foul smelling infection
what is otosclerosis? what does it result in?
fill in later
otosclerosis has a __ component. explain
GENETIC component. more common in females and usually happens in 20s and occurs bilaterally. also associated with pregnancy.
how to treat otosclerosis?
fill in later
explain the audiogram of someone with otosclerosis
fill later
symptoms of otosclerosis
fill later
ossicular disarticulation
closed head injury / trauma especially if related to temporal bone
impact of ossicular disarticulation on hearing
major conductive HL between 30 and 60 dB
ossicular discontinuity interrupts…
the normal flow of energy from the air-filled middle ear to the fluid-filled inner ear.
ossicular discontinuity often times can occur in conjunction with…
TM perforation
often see ossicular discontinuity in who?
military personnel (esp. with loud noise exposure)
surgery that helps form new ossicular chain in ossicular disarticulation
ossicular reconstruction
3 categories of disorders of the inner ear
prenatal disorders, perinatal disorders, postnatal disorders
prenatal disorders of inner ear
syndromes and inherited disorders, maternal infections
perinatal disorders of inner ear
prematurity anoxia? (check on this)
postnatal disorders of inner ear
meningitis, autoimmune diseases, meniere’s disease, ototoxicity, noise induced, presbycusis
explain major differences between conductive HL and SNHL
CONDUCTIVE HL: Hearing loss as a result of an abnormality or pathology in the outer or middle ear, usually temporary, often can be treated medically or surgically. Hearing ability through air conduction is reduced, hearing through bone conduction is normal (you will always see an air-bone-gap in conductive hearing losses, but
bone conduction thresholds will be within normal limits since the
damage is not in the inner ear). maximum hearing loss of 60 dB. SNHL: usually permanent, ranges from mild to profound, cochlear implant can be an alternative to hearing aids among those with profound SNHL (a cochlear implant bypasses the damaged hair cells by directly transmitting electrical impulses to the auditory nerve)
2 most common causes of SNHL in adults
noise exposure, aging
tinnitus is associated with
conductive HL and SNHL
is tinnitus a disorder
no, it is a symptom that can accompany hearing loss
unilateral tinnitus
red flag - could be an 8th nerve tumor (check on this)
objective tinnitus
extremely rare, docor can hear it too, caused by a blood vessel problem (check on this)
if a hearing loss is in combination with other symtpoms, it is referred to as
a syndrome (check on this)
congenital infections are often associated with
SNHL
maternal infections can result in __. most damaging time during pregnancy?
SNHL. first trimester bc cochlea is developing during 6-12 weeks.
materal infections that can cause HL
CMV (cytomegalovirus), toxoplasmosis, rubella
characteristics of CMV (cytomegalovirus)
caused by a herpes-like virus that often symptomless for mother, no vaccine (check on this)
charactersitics of toxoplasmosis
parasitic infection due to raw meats, cat feces. mom often won’t have symtoms but will affect baby
chatacterisitcs of rubella
viral cause. last epidemic was in the 60s. vaccine created in 69. people now refusing vaccinations for various reasons, so there more of an outbreak now (check on this)
some of the common acquired viral infections that can cause HL
herpes zoster oticus (what causes HL), mumps (if accompanied by encephalitis), syphillis (usually occurs in secondary or pertiary stage of disease). check on this
often prematuriry is accompanied by?
hyperbilirubemia (too much bilirubin made in body when breaks down RBCs), kernicterus (too much billirbin in blood causes brain damage which can lead to HL).
how can anoxia affect hearing
lack of oxygen, affects cells in brain and inner most often, usually related to trauma during labor or delivery
characteristics of idiopathic hearing loss
SNHL; sudden unilateral HL; no known cause; accompanied by tinnitus
meniere’s disease
oversecretion of endolymph in the scala media; reiner’s membrane ruptures, massive amount of fluid
symptoms of meniere’s disease
roaring tinnitus, vertigo, aural fullness, fluctuating unilateral SNHL, poor speech discrimination, HL in low frequencies
how do acoustic neuroma’s occur
unknown cause
what often comes with acoustic neuroma
headaches
how to diagnose an acoustic neuroma
ABR, MRI, CT
neurofibromatosis and its link to an acoustic neuroma
neurofibromatosis: genetic disorder that causes tumors to grow in the nervous system; could cause an acoustic neuroma
auditory neuropathy
OHC are fine; but IHCs 8th nv & lower auditory BS is abnormal. sound is going through but not in a correct way.
symptoms of auditory neuropathy
mild to moderate SNHL, poor SRT (speech recognition)
with auditory neuropathy, diagnostic testing will reveal
OAE’s are present (cochlea is functioning), but ABR (neural results) will be poor
why will an auditory neuropathy often go undiagnosed
because audiologists don’t typically perform ABR on children
what could help with auditory neuropathy
CI can help IF hearing loss is severe
children with auditory neuropathy will often have
speech and language issues, often need to supplement with cued speech/visuals
auditory processing disorder (APD)
breakdown in the ability to interpret speech that’s due to issues in the central auditory nervous system
site of lesion for APD (auditory processing disorder)
almost any area of the central auditory system
symptoms of APD (auditory processing disorder)
usually AC & BC normal, but cannot understand speech in noisy environment, difficulty following directions/paying attention, difficulty distinguishing between similar sounds. often confused with LPD or ADHD
is there a “pathology” with APD?
No, no tumor or anything
what diagnostic testing will show with APD
normal audiogram, excellent WRS in quiet
main area in brain for processing speech
left temporal lobe (herschl’s gyrus)
Speech that’s directed to right ear goes
directly to dominant contralateral left temporal lobe
order of transmission of sound through the nervous system
auditory nerve, cochlear nucleus, SOC, lateral lemniscus, inferior colliculus, medial geniculate body, auditory cortex
organic hearing loss
organic hearing loss has an anatomical, physiological, or metabolic etiology
functional hearing loss
not consistent with audiological evaluation
with OAE’s, it is possible to find
malingering (faking a HL)
who hypothesized about OAE’s
gold (1942), kemp (1978)
crucial for generating energy needed for outer hair cell movement
stria vascularis
OAE’s are generated by _____ auditory activity
efferent
what do outer hair cells do
their motile properties either enhance or suppress the motion of the BM. This action directly affects the amount of stimulation received by the inner hair cells (what we hear)
3 ways to measure OAE’s
spontaneous OAE’s, Distortion product OAE’s, transient evoked OAE’s
SPOAE’s
These emissions are estimated to be present in less than half of all people with normal hearing and occur without external stimulation. This type of OAE is not used clinically. Measurement in ear canal with a sensitive microphone attached to an amplifier and a computer averaging device..
SPOAE’s are more common in…? used clinically?
females, in right ear. no
explain EOAEs
the probe that’s placed in the ear canal deliver a stimulus (tone) to evoke an EMISSION from the ear. the microphone on the probe measures the emissions.
an OAE presence is defined by
at least 6 dB above the noise floor
TEOAE’s are evoked by… stimulates a… if present, indicates…? 2 cautions?
TEOAE’s are evoked by a broadband CLICK stimulus. stimulates a wide frequency range on BM. if TEOAE is present, this indicates normal middle ear functioning. hearing is NOT worse than 40 dB at the frequency of the click. caution: not a hearing test, and it is NOT frequency specific.
Why measure OAEs
OAE’s are pre-neural events from the cochlea (helps us distinguish between sensory and neural hearing loss in some cases. Can be measured objectively in less than 1 minute for each ear, non-invasive, repeatable and reliable.
DPAOE’s are evoked by
2 pure tones presented simultaneously to the ear, stimulating a specific region on the BM.
When you might have absent OAE’s
cholesteatoma, stenosis, cochlear pathology, external otitis, otosclerosis, cyst
individuals tested with OAE’s
screening for newborns and cognitively challenged individuals who can’t respond behavorially, malingerer, ototoxic monitoring (for noise-induced hearing loss or chemo therapy), for differentiation between cochlear and neural hearing losses
ABR
The auditory brainstem response test (also known as ABR or BAER) is used for two purposes: To test hearing thresholds. To assess the functional status of the auditory neural pathway, which is used to determine the cause of hearing loss and candidacy for hearing loss treatments
three different auditory evoked potentials and what activity they reflect and when they occur
- ABR reflects the activity of the 8th nerve and occurs in the first 10 milliseconds.
- Middle latency reflects activity in the thalamus and occurs in the first 50 milliseconds.
- Late latency reflects activity in the auditory cortex and occurs in the first 50-250 milliseconds.
how do we measure auditory evoked potentials
we place electrodes on the patient’s head, stimulate the ear with sound, measure the electrical activity
auditory evoked potentials (AEP’s)
measure of the electrical voltages evoked in the brain in response to acoustic stimulation
electrocochleography (ECochG)
is an Abrupt brief sound like a click. Dependent upon hearing in 1k-4kHz range. Can diagnose meniere’s disease.
second electrophysiologic measure… happens when? Comes from…
Summating potential (from cochlea). action potential (end of 8th nerve) comes from electrocochleography (ECochG)
earliest electrophysiologic measure associated with…
cochlear microphonic, hair cell activity
What are electrophysiologic measures?
Measures of electricity generated by the physiologic response of the nervous system. Place electrodes on the person’s head, stimulate the ear with sound, and measure the electrical activity that is triggered by introducing sound to the ear
for ABR, if interpeak latency between wave 3 & 5 is too long…
upper brainstem lesion
for ABR, if interpeak latency between wave 1 & 3 is too long…
lower brainstem lesion
if wave 1 has small amplitude or if it’s delayed or absent this could indicate
cochlear lesion
another application of ABR results with children?
Can be used for threshold estimation. Reduce intensity of sound and observe how long wave 5 is still measurable
slower than normal latencies should have a medical referral for
Imaging studies to investigate cause
timing or distance between 1-3-5 should be
about 2 milliseconds between each
latency __ as intensity decreases
increases
missing wave on ABR
this is where site of lesion is
major components of ABR waves
1, 3, 5
Each wave of ABR and timing of each
- Distal end of 8th nerve or spiral ganglion, less than 1 ms. 2. Proximal end of eighth nerve and cochlear nuclei, 2 ms. 3. Superior olivary complex, 3 ms. 4. Lateral lemniscus, 4 ms. 5. inferior colliculus, 5 ms
ABR stimuli presented through what type of conduction? If using clicks, tests what frequency? If using tone bursts?
Air or bone. If using clicks, tests between 2000 and 4000 Hz. If using tone bursts, tests between 500 to 4000 Hz.
ABR has __ major peaks that occur at __
5 major peaks that occur at INTERVALS (latencies)
most common auditory evoked potential
ABR
ABR is NOT a true measurement of
NOT a true measurement of threshold, only measures neural synchrony
The auditory brainstem response test (also known as ABR or BAER) is used for 3 purposes
- to estimate threshold (not to measure threshold)
- assess the functional status of the auditory neural pathway (to determine if there’s an acoustic neuroma or other retrocochlear problem)
- If a patient is faking a hearing loss (malingering), OAE’s can help to prove this
ABR is an objective test that measures theintegrity of ofthe hearing system from the level of the
from the level of the cochlea up to the lower brainstem.
Process of ABR
electrodes are placed on mastoid and two on forehead. Sound delivered to ears through earphones or oscillator. Measurement is made from 0-12 milliseconds post-stimulus and waveforms are observed that correspond to synaptic junctions along auditory pathway
