ENT Flashcards
a down sloping, symmetric, sensorineural hearing loss
age-related hearing loss
progressive and asymmetric sensorineural hearing loss
worse in the high frequencies
indicates pathology in the 8th cranial nerve
How do you evaluate asymmetric hearing loss?
MRI of internal auditory canals without contrast
How is asymmetric sensorineural hearing loss defined
10dB difference between ears in 3 contiguous frequencies, 15dB in 2 contiguous frequencies, or 25dB in one frequency
What is the typical location for the cholesteotoma?
Pars Flaccida
Who qualifies for the Navy’s Hearing Conservation Program?
All Naval Aviation personnel meet HCP criteria and are monitored annually
Significant Threshold Shift (STS)
“resetting the baseline”
>10dB change at 2000, 3000, 4,000 Hz compred to a reference audiogram.
*Prior to confirming a baseline shift, the audiogram must be repeated to ensure at least 14 hour rest from hazardous noise environments
Fitness for Duty/270 Rule
Any individual with a sum of their hearing loss at the frequencies of 3000, 4000, and 6000 Hz in both ears equals or exceeds a sum total of 270 dB
OR
has their baseline re-established three times will not be assigned to duties involving exposure to hazardous noise w/o medical qualifying evaluation and clearance
Is asymmetric hearing loss, on its own, disqualifying if hearing remains within standards?
Nope.
What do you do if there is any suspicion or concern for sudden sensorineural hearing loss?
urgent formal audiogram
urgent ENT consult
start prednisone (60-80mg PO)
When do you refer to ENT for:
barotrauma?
unilateral middle ear effusion?
Recurring barotrauma episodes or any unilateral middle ear effusion persisting for more than 8 weeks.
ENT should evaluate the Eustachian tubes with endoscope and r/o a nasopharyngeal mass as a cause of unilateral ETD in adults
What are signs of Eustachian Tube Dysfunction in adults?
recurring barotrauma or unilateral middle ear effusion persisting for more than 8 weeks
Just remember that most acute and chronic middle ear pathologies are due to ETD
ETD is the cause of most acute and chronic MIDDLE ear pathologies
Allergic rhinitis, URI, acute (or chronic) sinusitis, nasal polyps, enlarged adenoids, nasopharyngeal neoplasms are some exacerbating conditions for ETD
TM Perforation
Treatment
TM perforation is NCD on its own.
Treatment: counsel on dry ear precautions
re-examine ear at 4-6 weeks
**DO NOT USE CORTISPORIN DROPS (NEOMYCIN/POLYMIXIN/HYDROCORTISONE)
Aminoglycosides are ototoxic and can cause SENSORINEURAL hearing loss
TM Perforation
Aeromedical disposition
down status for ~2-3 days
The perforation does not need to be healed to return to flight if asymptomatic
If the perforation was due to middle ear barotrauma, ensure the patient can equalize the contralateral ear before returning to flight and any exacerbating factors are resolved
Cholesteatoma
Most common early symptom?
The most common early symptom of Cholesteatoma is recurring, painless ear drainage
Barotrauma most commonly occurs during __________
Ear barotraumas occur most commonly on descent.
Failure of the Eustachian tube to open and allow ambient air to equalize the negative pressure in the middle ear space leads to mucosal engorgement, middle ear effusion, hemotympanum, or a TM perforation
S/S of barotrauma in the ear
- middle ear effusion (serous or bloody) resulting in conductive hearing loss
- pain or discomfort acutely
There is usually no vertigo or sensorineural hearing loss. Symptoms resolve and effusion clears in days (or weeks) w/o treatment
When do you consult ENT for barotrauma?
Consult ENT for recurring barotrauma episodes or any unilateral middle ear effusion persisting for more than 8 weeks.
The ENT should visualized the Eustachian tubes with endoscopy and a nasopharyngeal mass should be ruled out as a cause of unilateral ETD in adults
Inner ear barotrauma
Signs and Symptoms
Inner Ear Barotrauma
- sensorineural hearing loss (may also be mixed)
- vertigo
*Patient’s with a perilymphatic fistula will experience fluctuating vertigo and hearing loss persisting after the initial barotraumatic presentation. Episodes of vertigo occur with straining or valsalva and they can be reproduced by “pumping” the patient’s tragus on exam
Inner Ear Barotrauma
So you think someone has it…. what do you do?
PLF:
treatment
PLF Treatment:
- bedrest
- steroids for sensorineural hearing loss
- vestibular suppressants for vertigo (PRN)
- antiemetic (PRN)
- Stool softeners (remember vertigo occurred with straining)
*recompression treatment is contraindicated for inner ear barotrauma
Barotrauma that occurs on ascent
2 causes
- Alternobaric vertigo- self limiting. Vertigo is brief and mild
- Inner ear decompression sickness (DCS) very rare in flight. S/S include vertigo, hearing loss, and other neurologic signs and symptoms from DCS.
The Ostio-meatal complex is the common drainage pathway for ?
OCM is the common drainage pathway for the
frontal
anterior ethmoid
maxillary sinuses
