Ear: Middle Ear And Beyond (Final) Flashcards
The “Big Four” Ear Complaints
- Hearing Loss
- Equilibrium or balance problems
- Dizziness, vertigo
- Tinnitus (auditory paresthesia)
Cholesteatoma
-A benign tumor near eardrum
-Appears as a white mass behind or on eardrum
Most cholesteatomas are due to repeated:
Middle ear infections
Symptoms of Cholesteatoma
Hearing loss, dizziness, pressure in ear, ear ache, drainage of pus
Treatment of Cholesteatoma
-Surgery to remove growth completely/reconstruct damaged ossicles or eardrum
-Goal: Preserve hearing and equilibrium/balance
Vestibular Schwannoma (Acoustic Neuroma)
Slow-growing, benign tumor of CN 8 Schwann cells
Vesticular Schwannoma can grow large enough to:
Compress facial nerve, leading to facial palsy
Best Diagnosis tools for Vestibular Schwannoma
-Contrast-Enhanced MRI: Gold standard of Diagnosis
-CT Scan: If MRI is contraindicated
Treatment of Vestibular Schwannoma
-Observation: Wait until symptoms are intolerable
-Microsurgical removal or reduction of tumor
-Stereotactic radiation therapy
What other ear-related symptoms can hearing loss be accompanied by?
Tinnitus, ear ache or ear pain, dizziness or problems with balance
-Others: Ear discharge, fullness in the ear, nausea
Conductive Hearing Loss is caused by:
Anything that interferes with conduction of sound waves from outer ear to oval window
Causes of Conductive Hearing Loss
-Middle ear infections (Otitis media)
-Wax or any blockage of outer ear
-Otosclerosis (growth of surrounding bone)
-Cholesteatoma (growth into the middle ear)
Sensorineural Hearing Loss is due to:
-Dysfunctional cochlea, acoustic nerve, or brain
-Usually permanent
-Usually affects both ears, but not necessarily equal
Possible Causes of Sensorineural Hearing Loss
-Presbycusis: Decline in hearing due to aging
-Acoustic Trauma: Damages hair cells of inner ear
-Drugs: Aspirin, quinine, opiods (ototoxicity)
-Vestibular Schwannoma: A benign tumor
Presbycusis
-Age-related sensorineural hearing loss
-Especially affects high frequency sounds: Difficult to hear & understand voices in a crowded situation
Diagosis of hearing loss
-Patient history, doctor suspicion
-Screening tests: Rinne, Weber Tests
Hearing Tests
-Hearing acuity: Whisper, Finger Rustle
-Hearing Loss: Weber, Rinne
Conductive Hearing Loss
-Weber: Vibration sounds heard best in bad ear
-Rinne: Bone and Air conduction are equal
Sensorineural Hearing Loss
Weber: Vibration sounds heard more in good ear
-Rinne: Air>Bone Conduction
Audiologist Tests for Hearing
-Audiometry
-Tympanometry/Impedance Tests
Tx of hearing loss
-Conductive: Removal of wax, cholesteatoma, stapedectomy, and prosthesis…
-Sensoryneural: Hearing aid, removal of vestibular schwannoma
Cochlear implants
Hearing device for people with severe sensorineural hearing loss
Tinnitus
“Paresthesia of the ear”/Ringing
Causes of Tinnitus
-Loud noises
-Underlying disease: HBP, allergies, heart disease..
-Ear infection
-Rupture/Perforation of tympanic membrane
-Earwax
-Injury to the neck or head
-Vestibular schwannoma/other tumors
-Drugs
Diagnosis in Tinnitus
-Check hearing: Auditory acuity, Weber, Rinne
-Otoscopy: Check canal and tympanic membrane
Treatment of tinnitus
-Treat the cause
-Adjust: Per PARTS findings in cervical spine/occiput
-Muscle work: SCM and suboccipital
-Self-help measures
Inputs that contribute to our sense of balance, body position, motion
Afferent information from: Ears, proprioceptors, inner ear
Labyrinthitis
-Infection/inflammation of the labyrinth
Labyrithitis is almost always caused by:
Viral infection
Symptoms of Labyrinthitis
-Vertigo, loss of balance (even longer)
-Loss of hearing in one ear
-Dizziness (lasts for days)
Treatment of Labyrinthitis
-Promote self-healing: Rest, fluids, good nutrition, adjust
-Take care regarding balance: Avoid quick movements
-Seldom recurs
Meniere’s Disease
Periods of vertigo lasting for minutes to hours
-Unknown etiology
Meniere’s Prodromals
-Visual: “Explosions of spots”
-Auditory: Tinnitus
-Head: “Feels Full”
-General: Sweating
Treatment of Meniere’s
-No known cure
-Chiro adjustments and trigger point work: Neck, schoulder and cervicothoracic regions
-Medications to: reduce anxiety
-Reduce intake of: Salt, nicotine, alcohol, caffeine
Meniere’s: Diet/Supplementation
Manganese, B Complex, Chromium picolinate, Co-Q10, Butchers Broom
Benight Paroxysmal Positional Vertigo (BPPV)
Extreme spinning sensation when patient looks up or to one side, or when lying on one side
Symptoms of BPPV typically last:
Only about a minute but are recurrent
BPPV is typically caused by:
Disruption or malposition of the otoconia/otoliths in the utricle and saccule, especially when head is moved in certain directions
-Younger: Head Injury
-Adults: Age-Related
What test would you perform for BPPV
Dix-Hallpike Test
-Others: Elecronystagmography, MRI, Rotating Stool Test
Dix-Hallpike Test would be positive for BPPV if:
- Bursts of Nystagmus: As patient turns head when supine
- Vertigo
Treatment of BPPV
-Canalith repositioning maneuvers: Epley maneuver
Cervicogenic vertigo
Vertigo due to abnormal proprioceptive input from the cervical spine
What joints/muscles are affected by Cervicogenic Vertigo?
-Joints between occiput and C3
-Muscles of the neck: SCM & suboccipital muscles
In cervicogenic vertigo, _____ and ___ are always present and _____ ROM is always found
Neck pain, trigger points and decreased ROM
Treatment of certicogenic vertigo
Chiro adjustments, stretches/neck exercises, postural hygiene, medications, surgery
Vertigo Supplementation
Niacin, DMG, B Complex, Choline, ginko biloba, zinc, butcher’s broom, ginger
Male de Debarkment Syndrome (MdDS)
Rare, usually after disembarking from a boat, ride or plane
