Chapter 19. Hearing Loss and Tinnitus without Dizziness or Vertigo Flashcards
Question 19-1: Which of the following statements are true regarding the Weber test?
- Helps to differentiate conductive from sensorineural hearing loss
- The tuning fork is placed on the skull in the midline of the forehead
- Lateralization to the side of poorer hearing indicates conductive loss
- Lateralization to the side of better hearing indicates sensorineural hearing loss on the side of the deficit
Select: A = 1.2.3. B = 1.3. C = 2.4. D = 4 only. E=AII
Answer 19-1: E. All of these are true. The Weber test uses a tuning fork applied to the midline forehead. The patient is asked on which side the sound is heard. With unilateral hearing deficit, lateralization of the Weber to the affected side indicates conductive loss whereas lateralization to the contralateral side indicates sensorineural hearing loss.
Question 19-2: Which of the following statements are true regarding the Rinne test?
- Patients with normal hearing perceive the bone conduction louder than the air conduction
- Patients with sensorineural hearing loss perceive bone conduction louder than air conduction
- Patients with conductive hearing loss perceive air conduction louder than bone conduction
- Compares bone conduction to air conduction
Select: A = I, 2, 3. B = I, 3. C = 2, 4. D = 4 only. E = All
Answer 19-2: D. The Rinne test uses a tuning fork applied to the mastoid for bone conduction and latera! to the ear for air conduction. The test compares bone conduction to air conduction. Patients with normal hearing or sensorineural hearing loss will have better air conduction than bone conduction since this is a more efficient transmission. Patients with conductive hearing loss will have better bone conduction than air conduction since the mechanisms of air • conduction in the ear are defective
Question 19-3: A patient presents with hearing loss and tinnitus affecting the left ear. Examination shows decreased hearing sensitivity across all frequencies. Speech discrimination is normal. Which is the most likely lesion?
A. Conductive hearing loss
B. Sensorineural hearing loss
C. Cannot determine on the basis of the supplied information
Answer 19-3: A. Conductive hearing loss presents with decreased hearing sensitivity which is usually across all frequencies although sometimes high frequencies are heard better than lower frequencies. Tinnitus is conwon and may be of low pitch. Speech discrimination is relatively unimpaired
Question 19-4: A patient presents with bilateral hearing loss and tinnitus. Testing shows hearing loss most severe in high frequencies, and the shows loudness recruitment. Which is the most likely lesion?
A. Conductive hearing loss
B. Cochlear dysfunction
C. Acoustic nerve dysfunction
D. Cannot be determined from these Data
Answer 19-4: B. Cochlear dysfunction presents with hearing loss and tinnitus which may be a ringing or buzzing. The pitch of the tinnitus tends to be higher than in conductive hearing loss. Cochlear lesions result in loudness recruitment, where an increase in sound intensity produces a greater than expected increase in perceived loudness.
Question 19-5: Which of the following statements are true regarding treatment of tinnitus?
A. Anticonvulsants reduce the amplitude of tinnitus
B. Masking is effective treatment for most patients with tinnitus
C. Tinnitus in the absence of other symptoms or signs is never due to serious pathology
D. There is no effective medical treatment to reduce tinnitus
Answer 19-5: D. There are no effective medical treatments for tinnitus. Anticonvulsants are occasionally used, though their benefit is unproved. Anxiolytics, antidepressants. and counseling can help the patient adapt to the tinnitus. Counseling by the physician that the tinnitus does not necessarily indicate that hearing will be totally lost or indicate some other serious disorder is probably most helpful. Masking helps a small minority of patients.
Question 19-6: Which of the following statements is true regarding word recognition?
A. Word recognition is relatively spared in sensorineural bearing loss
B. Poor word recognition with preserved hearing sensitivity suggests conversion reaction
C. Word recognition is relatively spared in conductive hearing loss
D. Word recognition is maintained in patients with cochlear hearing loss until there is severe loss of sensation
Answer 19-6: C. Word recognition is relatively spared in patients with conductive hearing loss, but is affected early in most patients with cochlear and other sensorineural causes of hearing loss. In these patients, the defect in word recognition is proportional to the degree of hearing toss.
A. Normal
B. Conductive defect
C. Sensorineural defect
D. Mixed defect
E. Cannot be determined from these data
Answer 19-7: C. Sensorineural hearing loss results in equivalent reduction in sensitivity to bone and air conduction. The loss of high frequency response in this example is typical
A. Normal
B. Conductive defect
C. Sensorineural defect
D. Mixed defect
E. Cannot be determined from these data
Answer 19-8: D. Mixed conductive and sensorineural hearing loss results in defective air conduction and bone conduction. In this example, the fall-off in response of high frequencies is typical of sensorineural hearing loss, whereas the discrepancy between bone and air conduction’ responses is due to a conductive deficit.
A. Normal
B. Conductive defect
C. Sensorineural defect
D. Mixed defect
E. Cannot be determined from these data
Answer 19-9: A. This pattern is normal. There is a flat response curve with normal air conduction bilaterally
A. Normal
B. Conductive defect
C. Sensorineural defect
D. Mixed defect
E. Cannot be determined from these data
Answer 19-10: B. Conductive hearing loss results in defect in air conduction with relative preservation of bone conduction
