Evaluation of the Patient with Hearing Loss Flashcards
What to look at in hearing loss?
Ext ear, auditory canal, tymp membrane…if no abnormalities, begin to shift to middle or inner ear
Most common ossicular problem
Stapes fixation (otoscelorisis)
Lateral chain fixations less common (malleus or incus()
Tuning forks and differences
Higher freq, less precise
Otoscelrosis
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
Audiogram and otosclerosis
Dip at 2000
Tx of conductive hearing loss
Hearing aids
Surgical correction
Labyrinthtis
Herpes zoster oticus
Measles
Mumps
Could result from OM or meningitis…sudden loss
SNHL and vertigo could have facial paralysis
Usually bilateral and in children
Nearly unilateral and sudden
CMV and syphilis
Progressive in children and sudden in adults…HIV
Neurosyphilis more common…may present like meniere’s
RMSF and lyme dz
Rapid progressive…serologic titers
Causes CN 7 paralysis
Trauma and SNHL
Temporal bone fractures (typically HF SNHL)…if corsses labyrinth, then total SNHL
Blut concussion could also be HF
Noise induced SNHL
Temporary threshold shift - disappears in 24-48 hrs
Permanent threshold shift - does not get better
Chronic noise exposure ajudioogram
Dip at 4000
Normally bilateral
MS
Periventricular white matter plaques and SNHL
Benign Intracranial hypertension
Could have headache with blurred vision and pulsatile tinnitus but also SHNL and vertigo
Look for papilledema and confirm with LP
Cogan’s syndrome
Interstital keratisi, SNHL, vertigo
Ts with steroids
Polyarteritis nodosa
Necrotizing vasculitis of small and medium sized arteries
Relapsing polychondritis
Arthitis and eye findings present
Wegner’s granulomatosis
Usually conductive because of middle ear involvement
Primary AI ear dz
Bilateral
Usually associated with vertigo
Reponds to steroids and cytotoxic drugs (hgih dose steroids nad intratympancic dexamethasone)
68kD protein antibody
Presbycusis
Dip around 2000 but never recovers
Typically worse in HF and in men..accelerates with age
Sudden SNHL
30dB or more SNHL occuring in at least 3 fequencies within 3 days or less
Unilateral
Vertigo or imbalance
Prognositc factors of SNHL
Severity of loss Vertigo Poor speech Over 40 or children Slope of audiogram
Most recovery in first 2 weeks
Tx of SNHL
Hearing aids
Cochlear impalantation
Cochlear implant prognositc
Post lingual onset Duration of loss Residual hearing Increased intelligence HEaring environment of recipiejent
CI candidacy
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
