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Foundations II (Jess) > Ear Disorders II > Flashcards

Ear Disorders II Flashcards

1
Q

Mechanisms of conductive hearing loss

A
  • obstruction
  • mass effect
  • stiffness effect
  • discontinuity (fracture or head trauma)
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2
Q

What parts of the ear does conductive hearing loss involve?

A

external or middle

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3
Q

Common causes of conductive hearing loss?

A

Most common causes:

  • cerumen impaction
  • ETD

Other:

  • otitis media
  • otitis externa
  • TM perf
  • trauma
  • otosclerosis
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4
Q

Mechanisms of Sensorineural hearing loss (hint: think about the name/what parts are affected)

A
  • senory- dysfunction of inner ear (cochlea)

- Neural- dysfunction of CN VIII or brain

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5
Q

Causes of sensorineural hearing loss

A 
Presbycusis
Persistent noise exposure
head trauma
systemic dz
acoustic neuroma
multiple sclerosis
auditory neuropathy
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6
Q

Weber test: explain conductive vs sensorineural results

A

conductive- sound lateralized to bad ear

sensorineural- lateralizes to good ear

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7
Q

Rinne test: explain conductive vs sensorineural results

A

Conductive- BC > AC

sensorineural- AC > BC

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8
Q

When a is having an audiogram, what is the threshold at which it is considered to be abnormal?

A

> 25 decibles (dB)

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9
Q

What would you see in an audiogram of a pt with conductive loss?

A
  • bone conduction nl bilaterally

- AC poorer on affected side

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10
Q

What would you see in an audiogram of a pt with sensorineural loss (presbycusis)?

A

Downwards sloping (higher dB) towards higher frequencies

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11
Q

In any patient with new onset hearing loss without obvious pathology what do you do and why?

A

need quick referral to audiology

**idiopathic sudden sensorineural hearing loss can be treated with corticosteroids when caught early

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12
Q

What is tinnitus? What can it be a symptom of?

A

perception of abnormal ear or head noises (mild, hight-pitched sounds lasting secs to mins- ringing, buzzing, crickets)

Can be manifestation of hearing loss

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13
Q

Treatment of tinnitus

A
  • avoid exposure to excessive noise and ototoxic agents
  • masking
  • meds (oral antidepressants)

Others:

  • transcranial magnetic stimulation
  • deep brain stimulation
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14
Q

How is Pulsatile tinnitus described/what can it indicate?

How is Staccato tinnitus described?

A

Pulsatile= listening to one’s heartbeat
can indicate vascular abnormality (gloms tumor, venous sinus stenosis, aneurysm)

Staccato= rapid series of pop or clicks w/ sensation of ear fluttering

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15
Q

Another name for Labrynthitis?

A

Vestibular neuritis

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16
Q

Presentation and cause Labrynthitis?

A
  • acute onset, continuous, severe vertigo
  • nausea common

cause:
-inflammation of inner ear-
often after viral URI

17
Q

Tx of Labrynthitis

A
  • abx of pt is febrile or w/ sx of bacterial infection
  • vestibular suppressants (anticholinergics/antihistamines, benzodiazepines)
  • anti-emetic meds
  • oral steroids
18
Q

Another name for Meniere’s disease? What is it?

A

Endolymphatic hydrops

a vertigo syndrome due to a peripheral lesion

19
Q

What happens in Meniere’s disease?

A
  • distention of endolymphatic comportment of inner ear
  • sx wax and wane as endolymphatic pressure rises and falls
  • can permanently damage inner ear structures
20
Q

Clinical presentation of Meniere’s disease

A
  • episodic vertigo w/ discrete spells lasting 20 mins-several hrs
  • fluctuating sensorineural hearing loss
  • Tinnitus- low tone, blowing/roaring quality)
  • sensation of unilateral ear pressure (aural fullness)
21
Q

Classic triad of Meniere’s

A

vertigo + hearing loss + tinnitus

22
Q

How is Meniere’s diagnosed?

A
  • referral to ENT, audiology

- Caloric testing

23
Q

What if Meniere’s treatment aimed at? How is this done?

A

aimed at decreasing endolymph fluid pressure in inner ear

  • diuretics
  • low salt diet
  • vestibular ablation w/ gentamycin (ototoxic)
  • labyrinthectomy
24
Q

What is another name for an acoustic neuroma? What is it? Where does it begin/go?

A

vestibular schwannoma

benign tumor of CN VIII

  • begins in internal auditory canal
  • gradually grows to compress pons and cause hydrocephalus
25
Q

Most common presentation of acoustic neuroma?
Dx?
Tx?

A

Unilateral hearing loss= most common

  • disequilibrium
  • tinnitus

Dx: MRI w/ contrast

Tx: obs, surgical excision, radiotherapy

26
Q

What is vertigo?

A

sense of motion when there is no motion

  • spinning
  • tumbling
  • falling backward/forward
27
Q

Key differences between central vertigo and peripheral vertigo (onset and sx)

A

Central: brain

  • gradual onset
  • no auditory sx (tinnitus)

Peripheral: balance organs of inner ear

  • sudden onset
  • severe enough so pt can’t walk or stand
  • typically a/w N/V
  • often a/w tinnitus
  • often a/w hearing loss
  • PE often seen horizontal nystagmus
28
Q

Causes of central vs peripheral lesions

A

Central:

  • brainstem vascular dz
  • arteriovenous malformations
  • tumors or brainstem or cerebellum
  • MS

Peripheral:

  • Meniere’s dz
  • Labrynthitis
  • Benign Paroxysmal Positional Vertigo
  • Perilymphatic Fistula
29
Q

Explain the Dix-Hallpike maneuver

How do you perform it and what results indicated positive?

A

quickly lowering pt to supine position w/ head extending over edge and placed 30 degrees lower than the body, turned to L or R

Positive test= delayed onset fatiguable nystagmus in peripheral causes
If nystagmus is non fatiguable, indicated central cause

30
Q

What is the most common vestibular disorder?

A

Benign paroxysmal positional vertigo (BPPV)

31
Q

Cause of Benign paroxysmal positional vertigo? Sx duration/onset?

A

-caused by sediment in inner ear (otoconia, otoliths)

  • sx last less than a few mins
  • appear in clusters lasting several days
  • brief latency period following head movement before sx occur
  • a/w changes in head position- rolling over in bed
32
Q

Tx of BPPV?

A

PT or OT
Epley maneuver
Meds- vestibular suppressants
bed rest

Foundations II (Jess) (8 decks)

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