Evaluation of the Patient with Hearing Loss

Question 1

What to look at in hearing loss?

Answer 1

Ext ear, auditory canal, tymp membrane…if no abnormalities, begin to shift to middle or inner ear

Question 2

Most common ossicular problem

Answer 2

Stapes fixation (otoscelorisis)

Lateral chain fixations less common (malleus or incus()

Question 3

Tuning forks and differences

Answer 3

Higher freq, less precise

Question 4

Otoscelrosis

Answer 4

Also otosongiosis

Lesions of spongy bone of toci capsule

More in women and whites…early progression rapid but later slowerq

Only 12% produce CHL by involving stapes

Question 5

Audiogram and otosclerosis

Answer 5

Dip at 2000

Question 6

Tx of conductive hearing loss

Answer 6

Hearing aids

Surgical correction

Question 7

Labyrinthtis
Herpes zoster oticus
Measles
Mumps

Answer 7

Could result from OM or meningitis…sudden loss

SNHL and vertigo could have facial paralysis

Usually bilateral and in children

Nearly unilateral and sudden

Question 8

CMV and syphilis

Answer 8

Progressive in children and sudden in adults…HIV

Neurosyphilis more common…may present like meniere’s

Question 9

RMSF and lyme dz

Answer 9

Rapid progressive…serologic titers

Causes CN 7 paralysis

Question 10

Trauma and SNHL

Answer 10

Temporal bone fractures (typically HF SNHL)…if corsses labyrinth, then total SNHL

Blut concussion could also be HF

Question 11

Noise induced SNHL

Answer 11

Temporary threshold shift - disappears in 24-48 hrs

Permanent threshold shift - does not get better

Question 12

Chronic noise exposure ajudioogram

Answer 12

Dip at 4000

Normally bilateral

Question 13

MS

Answer 13

Periventricular white matter plaques and SNHL

Question 14

Benign Intracranial hypertension

Answer 14

Could have headache with blurred vision and pulsatile tinnitus but also SHNL and vertigo

Look for papilledema and confirm with LP

Question 15

Cogan’s syndrome

Answer 15

Interstital keratisi, SNHL, vertigo

Ts with steroids

Question 16

Polyarteritis nodosa

Answer 16

Necrotizing vasculitis of small and medium sized arteries

Question 17

Relapsing polychondritis

Answer 17

Arthitis and eye findings present

Question 18

Wegner’s granulomatosis

Answer 18

Usually conductive because of middle ear involvement

Question 19

Primary AI ear dz

Answer 19

Bilateral

Usually associated with vertigo

Reponds to steroids and cytotoxic drugs (hgih dose steroids nad intratympancic dexamethasone)

68kD protein antibody

Question 20

Presbycusis

Answer 20

Dip around 2000 but never recovers

Typically worse in HF and in men..accelerates with age

Question 21

Sudden SNHL

Answer 21

30dB or more SNHL occuring in at least 3 fequencies within 3 days or less

Unilateral

Vertigo or imbalance

Question 22

Prognositc factors of SNHL

Answer 22

Severity of loss
Vertigo
Poor speech
Over 40 or children
Slope of audiogram 

Most recovery in first 2 weeks

Question 23

Tx of SNHL

Answer 23

Hearing aids

Cochlear impalantation

Question 24

Cochlear implant prognositc

Answer 24

Post lingual onset
Duration of loss
Residual hearing 
Increased intelligence 
HEaring environment of recipiejent

Question 25

CI candidacy

Answer 25

Infant - 12 months with profound SNHL…cannot progoress with normal hearing aids

Over 24 months…PTA should equal or exceed 70 dB with best fitting HA in place

Open set sentence recognition is 60% or 40% or less with best aided condition