Ear Flashcards
Sensorineural Hearing Loss
dysfunction of cochlear sensorineural elements and/or cochlear nerve
high frequency loss (difficulty understanding words)
Rinne: AC > BC
associated w/ tinnitus
Rx can cause SHL
Presbycusis
most common cause of diminished hearing in elderly
hair cell loss and cochlear neuron degeneration
B/L symmetrical hearing loss, gradual onset beginning w/ loss of high frequency then middle then low
Noise Induced Hearing Loss
chronic exposure to sound levels in excess of 85-90 dB, frequency range 4000 Hz
reversible elevation in threshold (temporary)
if exposure persists elevated threshold can be permanent
Acoustic Trauma
single noise event (shotgun blast) that induces an immediate irreversible hearing loss
Acoustic Neuroma
benign tumor of CN 8 (Vestibulocochlear)
rare
asymmetric (U/L) sensorineural hearing loss w/ disequilibrium
If w/ neurofibromatosis II B/L
S&S:
early - midfacial and corneal hypesthesia, occipital HA, ataxia
Late - hoarseness, dysphagia, aspiration, shoulder/tongue weakness
Tx: radiotherapy, microsurgery
Meniere’s Dz
d/t excess fluid (endolymph) in the inner ear, hence the term endolymphatic hydrous
U/L, fluctuating, low frequency sensorineural hearing loss w/ tinnitus, sensation of fullness in ear, intermittent vertigo
could progress to high frequency loss = “burn out” (hair cells destroyed)
Tx: diazepam for vertigo
dietary - low Na, water, restrict caffeine/alcohol/chocolate
Conductive Hearing Loss
low frequency loss
hx of ear dz
Weber - perceived in ear w/ CHL
Rinne - BC > AC
Otosclerosis
disorder of the bony labyrinth that fixes the footplate of the stapes in the oval window
associated w/ pregnancy
Exostoses
bony excrescences of external auditory canal
associated w/ repetitive exposure to cold water
Glomus Tumors / Paragangliomas
Benign
rare
highly vascular
Sxs: CHL, spontaneous hemorrhage from canal, paralysis of CN 9, 10, 11 (jugular foramen syndrome), pulsatile tinnitus
Tympanometry
screens for middle ear dysfunction
Audiometry
measurement of frequency threshold
Finger Rub Test
if not hearing impaired
Otitis Externa
broken skin leads to inflammation of surrounding tissue
broken skin can be d/t excessive moisture and trauma allowing bacteria to infect
S&S: itching, crusting, pain (otalgia) , redness, discharge (otorrhea)
movement of pinna or tragus is painful
Tx: topical ABX and analgesics
Refer if canal is obstructed by edema or purulent material (suction aspiration of debris and insertion of a wick to promotor ABX penetration)
Malignant (Necrotizing) External Otitis
seen in immunocompromised pts and older diabetics, life threatening
Pseudomonas cellulitis of the canal and adjacent tissues
S&S: purulent discharge, granulation tissue in external auditory canal, severe pain, TMJ pain
Tx: PO ABX that includes coverage of Pseudomonas aeruginosa
Acute Otitis Media
Serous - viral
Purulent - bacteria
d/t abnormal eustachian tube reflex or obstruction that permits nasopharyngeal bacteria to infect the middle ear
Viral most common cause
S&S: serous otitis, which is generally sterile, translucent effusion, retracted TM, bony landmarks present
Tx: decongestants
Bacteria - Strep pneumonia, H influenzae, M catarrhalis
S&S: purulent otitis media, opaque effusion, bulging TM which may perforate, fever, ear pain
Tx: analgesics, decongestants, ABX (amoxicillin)
Chronic Otitis Media
d/t untreated or recurrent AOM resulting in bony destruction or sclerosis of mastoid air cells
TM may be perforated leading to purulent drainage
S&S: hearing loss, chronic foul otorrhea
Tx: acetic acid irrigation (restores pH) and topical ABX
If have otitis…When to refer?
AOM fails to respond to Tx
complication occurs such as perforation, recurrent or chronic
If have otitis…..emergency?
persistent fever, HA, facial nerve paralysis, vertigo, sensorineural hearing loss
static equilibrium
perception of head orientation
perceived by macula (saccule and utricle)
dynamic equilibrium
perception of motion or acceleration
linear acceleration perceived by macula (saccule and utricle)
angular acceleration perceived by crista (semicircular ducts)
