Ear Disorders 1 Flashcards
1
Q
what landmark separates the inner and outer ear?
A
typmanic membrane
2
Q
Ear Anatomy
Purpose of Pinna/Auricle
A
funnels sound down auditory canal
3
Q
Ear Anatomy
purpose of auditory canal or external auditory meatus
A
carries sound to the TM
4
Q
Ear Anatomy
purpose of TM
A
vibrates from sound waves and transfers the movement to the ossicles
5
Q
Ear Anatomy
purpose of the malleus, incus, stapes
A
pass sound vibrations into the fluid of the cochlea through the oval window
6
Q
Ear Anatomy
purpose of the cochlea
A
part of auditory labyrinth which connects to vestibulocochlear nerve CN VIII
7
Q
Ear Anatomy
purpose of eustachian tubes
A
links the cavity of the middle ear to the nasal cavity and provides a route to equalize air pressure between the middle ear and the atmosphere
8
Q
Audiometry
purpose
A
to test for hearing loss
9
Q
Audiometry
how is intensity measured
A
decibles
whisper = 20 dB
concert= 120 dB
10
Q
Audiometry
how is tone measured
A
cycles per sec (cps) or Hertz (Hz)
high pitched tones = high Hz values
11
Q
Audiometry
normal range of human hearing (Hz)
A
20 to 20,000 Hz
12
Q
Tympanometry
purpose
A
- compliance (movement) ofear structures
- measures mobility of the ear drum and small bones in the middle ear
13
Q
Tympanometry
absolute contraindications
3
A
- base skull fracture
- head trauma
- recent ear surgery
14
Q
Hearing Loss
Describe weber test and results
A
- place 512 Hz tuning fork midline
- Conductive: sound radiates to bad ear
- Sensorineural: sound radiates to good ear
15
Q
Hearing Loss
describe rinne test and results
A
- alternate 512 Hz on mastoid bone and in front of ear
- conductive loss: BC > AC
- sensorineural loss: AC > BC
16
Q
Hearing Loss
what causes conductive hearing loss?
A
results from external or middle ear dysfunction
17
Q
Hearing Loss
4 mechanisms of conductive impairment
A
- obstruction
- mass loading
- stiffness
- discontinuity
18
Q
Hearing Loss
risk factors for conductive loss
5
A
- cerumen impaction
- transient eustachian tube dysfunction
- chronic ear infections
- trauma
- otosclerosis
19
Q
Hearing Loss
which type of loss can be treated w/ meds or surgery?
A
conductive
20
Q
Hearing Loss
describe sensorineural loss
A
- deterioration of cochlea usually due to loss of hair cells from the organ of Corti
21
Q
Hearing Loss
most common type of sensorineural hearing loss
A
Presbycusis
22
Q
Hearing Loss
Risk Factors for Sensorineural Loss
4
A
- excessive noise exposure
- head trauma
- systemic diseases
- family hx/genetics
23
Q
Presbycusis
describe
A
gradually progressing high frequency loss w/ advanced age
24
Q
Presbycusis
type of loss
A
sensorineural
25
# Presbycusis
diagnostic testing
* weber test
* rinne test
* audiometry
26
# Presbycusis
tx
| 3 components
* not correctable w/ medical therapy (prevention is key)
* hearing amplification
* cochlear implant
27
# Presbycusis
screening recommendations
| 3 components
* age > 65 yo
* prior exposure to high noise levels
* repeat every few years
28
# Presbycusis
when to refer?
refer any new sensorineural hearing loss to audiologist unless it is easily treatable (i.e. OM)
29
# Noise Trauma Induced Hearing Loss
what must prolonged sound exposure be above?
typically > 85 dB
30
# Noise Trauma Induced Hearing Loss
what type of hearing is first to be lost? what about with prolonged exposures?
1. high frequency
2. speech frequencies
31
# Noise Trauma Induced Hearing Loss
Examples of noise trauma
| 3
1. heavy machinery
2. weapons
3. excessively loud music
32
# Noise Trauma Induced Hearing Loss
prevention
| 3
1. monitoring workplace noise levels
2. ear plugs
3. customized earmuffs
33
# Physical Trauma Induced Hearing Loss
what part of ear is impacted?
inner ear
34
# Physical Trauma Induced Hearing Loss
Examples of things that could cause?
| 3
1. airbag deployment
2. Concussion
3. Skull fracture
35
# Ototoxicity
describe
* hearing loss from ototoxic substances which affect auditory and vestibular systems
36
# Ototoxicity
most common meds
| 3
1. aminoglycosides
2. loop diuretics
3. neoplasm meds (cisplatin)
37
# Ototoxicity
what to do with pts who have existing hearing loss and need ototoxic meds?
| 2
* monitor closely
* weigh risks/beneifts of drug choice
38
# Sudden Sensory Hearing Loss
describe
idiopathic sudden **unilateral** hearing loss
39
# Sudden Sensory Hearing Loss
typical age of onset?
> 20 y/o
40
# Sudden Sensory Hearing Loss
tx
* corticosteroid use increases chances of recovery
* prednisone 1 mg/kg/day then taper for 10d
41
# Systemic Disorders Inducing Hearing Loss
describe
* bilateral loss
* hearing level can fluctuate (recovery/deterioration/remission/relapse)
* gradual progression
42
# Systemic Disorders Inducing Hearing Loss
can have what in addition to hearing loss?
| 2
vestibular dysfunction (disequilibrium, postural instability)
43
# Systemic Disorders Inducing Hearing Loss
Examples of conditions
| 3
1. Systemic Lupus Erythematosus
2. Granulomatosis w/ polyangitis
3. Cogan syndrome
44
# Systemic Disorders Inducing Hearing Loss
tx
corticosteroids w/ taper
45
# Tinnitus
can accompany?
hearing loss
46
# Tinnitus
sensation of sound in the absence of?
exogenous sound source
47
# Tinnitus
etiology
| 4
* can be idiopathic
* from meds (ASA, NSAIDs)
* vascular lesions
* cochlear lesions
48
# Tinnitus
describe bilateral damage
| 3 components
* more common
* damage to conductive hearing system
* can be environmental or systemic
49
# Tinnitus
describe unilateral tinnitus
| 4
* tympanic membrane damage
* recurrent unilateral ear infections
* ossicle damage
* trauma
50
# Tinnitus
describe sx
| 2
* ringing in ears
* difficulty hearing in social situations
51
# Tinnitus
severe sx
| 3 components
* insomnia
* inability to concentrate
* psychological distress (anxiety, annoyance, frustration, loss of control)
52
# Tinnitus
describe pulsatile tinnitus
can hear own heartbeat
53
# Tinnitus
etiologies of pulsatile tinnitus
| 2
* conductive hearing loss
* vascular abnormalities (glomus tumor, venous sinus stenosis, varotid vaso-occlusive disease, AV malformation, aneurysm)
54
# Tinnitus
dx non-pulsatile
| 2 components
* audiometry to r/o hearing loss
* if unilateral hearing loss w/out cause: MRI to assess for cochlear lesion (vestibular schwannoma)
55
# Tinnitus
dx pulsatile
| 2 components
* MRA/MRV
* temporal bone CT
56
# Tinnitus
tx
| 4 components
* avoidance of exposure to excessive noise, ototoxic agents, and other factors causing cochlear damage
* masking tinnitus w/ music or amplification of other sounds
* habituation techniques (tinnitus retraining therapy)
* PO anti-depressants (nortriptyline 50mg PO at bedtime)
57
# Tinnitus
why give nortriptyline at night?
to help with insomnia
58
# Hyperacusis
describe
excessive sensitivity to sound
59
# Hyperacusis
Risk factors
| 4
1. ear disease
2. noise trauma
3. migraines
4. underlying psychological disease
60
# Hyperacusis
describe recruitment as it pertains to hyperacusis
abnormal senstivity to loud sounds despite reduced sensitivity to soft sounds
61
# Hyperacusis
tx in pts w/ normal hearing
* earplugs in noisy environments
* habituation (slowly introduce to noise)
62
# Hyperacusis
tx in pts w/ hearing devices
compression circuitry to avoid overamplification
63
# Vertigo
cardinal sx of which type of disease state?
vestibular disease
64
# Vertigo
sx
* spinning sensation
* sensation of tumbling/falling forward/backward
* sensation of motion when there is no motion
65
# Vertigo
important to distinguish this from?
* imbalance
* syncope
* light-headedness
66
# Vertigo
describe peripheral disease
| 4 components
* onset is sudden
* associated w/ tinnitus & hearing loss
* +/- horizontal nystagmus
* vertigo may be more intense
67
# Vertigo
describe central vertigo
| 3 components
* onset is gradual
* no associated auditory sx
* vertigo is not as intense
68
# Vertigo
how to evaluate
| 4
* audiogram
* electronystamography (ENG)
* videonystagmography (VNG)
* MRI Head
69
# Meniere Syndrome
pathophys
excess endolymph results in increased pressure w/in the semicircular canals
70
# Meniere Syndrome
classic syndrome
episodic vertigo w/ discrete spells lasting 10 min to several hours
71
# Meniere Syndrome
additional sx
| 5
1. sx wax and wane
2. unilateral aural fullness (pressure in ear)
3. tinnitus (low tone/blowing sound)
4. fluctuating low-frequency sensorineural hearing loss
5. vertigo
72
# Meniere Syndrome
PE findings
| 2 components
1. normal
2. +/- nystagmus or induced vertigo/nausea with pneumo-otoscopy
73
# Meniere Syndrome
what would audiometry at time of attack show?
low-frequency sensorineural loss
74
# Meniere Syndrome
tx
* refer to otolaryngologist
* diuretic (acetazolamide)
* Na+ restriction
75
# Meniere Syndrome
tx for sx relief of acute attacks
| 2
* meclizine
* diazepam
76
# Meniere Syndrome
tx options for refractory disease
| 3
1. glucocorticoid or gentamicin infections into middle ear
2. non-ablative surgical options (decompression, shunting of endolymphatic sac)
3. full ablative procedure (labyrinthectomy, vestibular nerve section)
77
# Labrynthitis
cause
idiopathic, sometimes linked to recent infection (URI)
78
# Labrynthitis
hallmark of the condition
acute onset of continuous, severe vertigo lasting several days to a week accompanied by tinnitus and hearing loss
79
# Labrynthitis
sx
| 4 components
* nausea, vomiting
* desire to remain immobile
* recovery period of several wks (improving vertigo)
* hearing may return to normal or stay impaired
80
# Labrynthitis
what is this classified as if there is no associated hearing loss?
vestibular neuritis
81
# Labrynthitis
PE Exam findings
| 4 components
* nystagmus and sense of body motion to opposite side
* falling and past pointing to the affected side
* vestibular paresis unilaterally
* rapid-head-impulse test as tolerated
82
# Labrynthitis
dx
MRI w/ contrast
83
# Labrynthitis
what will MRI show
enhancement of 8th nerve or the menbranous labyrinth
84
# Labrynthitis
Tx
| 3 components
* abx if pt is febrile or has sx of bacterial infection
* vestibular suppressants during acute phase of attack (diazepam, meclizine)
* sx reduction (anti-histamines, promethazine, scopolamine)
85
# Benign Paroxysmal Positional Vertigo
pathophys
* migration of inner ear otoliths (calcific particles) to the posterior semicircular canal
* the otoliths amplify any movement in the plane of the canal, resulting in brief episodes of vertigo following changes in head position
86
# Benign Paroxysmal Positional Vertigo
common in who?
people over 60 y/o
87
# Benign Paroxysmal Positional Vertigo
classic presentation
recurrent spells of vertigo, lasting only a few minutes, associated with changes in head position
| ex: rolling over in bed, looking up
88
# Benign Paroxysmal Positional Vertigo
additional sx
| 4
1. intermittent dizziness (10-15s latency period followed by 60s of dizziness)
2. "entire room spins"
3. imbalance for several hours
4. nausea
89
# Benign Paroxysmal Positional Vertigo
pertenient negatives
| 3
no associated...
1. HAs
2. hearing loss
3. focal neurologic sx
90
# Benign Paroxysmal Positional Vertigo
only abnormal PE finding
nystagmus
91
# Benign Paroxysmal Positional Vertigo
dx studies
| 2
1. recurrent cases warrant head MRI
2. some CNS disorders can mimic BPPV
92
# Benign Paroxysmal Positional Vertigo
tx
* Epley maneuver (PT or pt can do to themselves if recurrent)
* often resolves spontaneously or does not require tx
93
# Otosclerosis
pathophys
progressive disease affecting bony otic capsule
94
# Otosclerosis
where is lesion typically located?
stapes
95
# Otosclerosis
what does the lesion cause?
* decreased passage of sound through the ossicular chain
* conductive hearing loss
96
# Otosclerosis
tx
* hearing aids
* stapedectomy (replacement of stapes w/ prosthetic)
97
# Otosclerosis
what can happen if cochlea is involved?
permanent hearing loss
98
# Middle Ear Trauma --> TM Perforation
causes of TM perf from trauma
| 6
1. barotrauma
2. acoustic trauma
3. head trauma
4. otitis media
5. eustachian tube dysfunction
6. foreign objects
99
# Middle Ear Trauma --> TM Perforation
sx
| 6
1. otorrhea (clear, bloody, purulent)
2. +/- ear pain w/ sudden relief
3. conductive hearing loss
4. tinnitus
5. vertigo
6. nausea/vomiting
100
# Middle Ear Trauma --> TM Perforation
PE Findings
conductive hearing loss confirmed w/ weber and rinne tests
101
# Middle Ear Trauma --> TM Perforation
what PE exam to avoid? why?
* pneumatic otoscopy
* can push air into otic capsule underlying the injury
102
# Middle Ear Trauma --> TM Perforation
dx
* based on otoscopic exam
* conductive hearing loss
103
# Middle Ear Trauma --> TM Perforation
tx
* small ones: heal spontaneously within 4 wks
* water precautions: cotton ball w/ jelly in ear when around water
* abx drops (ofloxacin)
* f/u with audiology
* ENT referral
104
# Middle Ear Trauma --> TM Perforation
criteria for ENT referral
| 3
* Recurrent otitis media (>2 episodes in 6 mo)
* persistent hearing loss (> 1-2 wks post infection)
* chronic tympanic membrance perforation (>4 wks)
105
# Middle Ear Trauma --> TM Perforation
complications
| 4
* persistent perforation
* cholesteatoma
* hearing loss
* recurring infections
106
# Impact Injury/Explosive Acoustic Trauma
describe
conductive hearing loss of >30 dB for 3+ mo after trauma
107
# Impact Injury/Explosive Acoustic Trauma
what should you suspect if patient has this?
ossicular chain disruption
108
# Impact Injury/Explosive Acoustic Trauma
tx
middle ear exploration w/ reconstruction of ossicular chain
