Exam 2: Treatments etc Flashcards
(32 cards)
Ototoxic drugs: the basics and the 4 classes
- Certain medications and chemical substances cause hearing loss through sensory cell damage and interference with inner ear metabolism
- Changes can be permanent and severe or may be reversed once use of the medication has stopped
- 4 classes of drugs in this category:
- -Antineoplastic drugs
- -Aminoglycoside antibiotics
- -Loop diuretics
- -Analgesics and Antimalarials
Ototoxic drugs: Antineoplastics
-cisplatinum: used in chemotherapy to reduce/inhibit the growth of cancer cells and tumors
Ototoxic drugs: Aminoglycoside antibiotic drugs
- streptomycin: used to fight tuberculosis
- gentamycin or amikacin: combats bacterial infection
Ototoxic drugs: analgesics and antimalarials
- aspirin and other salicylates: used for pain and fever reduction
- quinine: treats malaria and blood-related leg cramps
How is atresia treated?
-bone conduction hearing aids
What is asked while gathering a case history? (5 questions, know generally)
1: Hearing history
- how long has this problem lasted?
- sudden or gradual onset?
- specific environments that make the hearing loss less noticeable
- unilateral or bilateral?
2: Medical history
- history of ear infections?
- past medical or surgical treatment on ears?
- medications taken for dizziness or ear issues?
- dizziness, tinnitus, facial numbness?
3: History of noise trauma
- recent acoustic trauma?
- military service?
- hobby or employment exposure over time?
4: Family history
- are there hereditary factors?
- those w/ presbycusis and noise exposure don’t apply
5: Rehabilitation/academic history
- hearing aid experience?
- aural rehab?
- SLP therapy?
How is sudden sensorineural hearing loss treated?
- because the cause is unknown, the treatment is multimodal:
- antibiotic drug
- antiinflammatory drug
- antiviral therapy
What are the 4 Parameters of HL?
- Degree: severity of the impairment
- configuration: shape of the hearing loss (flat, sloping, steeply sloping etc)
- type of hearing loss: conductive, sensorineural, or mixed
- symmetry: comparison of results between ears
- configuration: shape of the hearing loss (flat, sloping, steeply sloping etc)
What are some reasons a person might self-refer to the audiologist? (5 things)
- difficulty understanding speech, esp in background noise
- asking for repetition during conversation
- increased volume on TV or radio
- difficulty on telephone
- problems communicating with coworkers
What are some questions that patients will want from the audiologist? (4 of them)
- Patients and their families usually have very similar questions:
- do i really have a problem?
- how serious is my problem?
- why am i having this problem/what is the cause?
- how can this problem be fixed/what is the treatment?
- Patients need answers, the audiologist’s job is the investigate their case and give them answers
Transducers: Standard / supra-oral headphones: Pros and Cons
-look like big headphones like i use
Pros:
-easiest/fastest placement on the patient
Cons:
- have to wipe them down between patients
- ear canal collapse can occur, looking like hearing loss
- require masking more frequently
- small children may not cooperate
Transducers: Insert Headphones: Pros and Cons
-tiny insertable ear plug things with a hole in the center like a churro
Pros:
-masking required less frequently
-no risk of canal collapse
-more hygienic for patient as tips are disposable
Cons: - small children may not cooperate - slightly more time consuming - more expensive for provider
Transducers: bone vibrator: Pros and cons
-headband vibratey bone thing
Pros:
-our ONLY option to test via bone conduction
Cons:
-inconsistent placement due to rounded surface of the mastoid process
-obstruction from hair can affect accuracy
Transducers: speakers in sound field: Pros and cons
Pros:
-can be used with anyone
-no cooperation needed with headphones or insert earphones
Cons:
-doesn’t provide ear specific information
Pure Tone Testing: The Order We Test (first step)
- 1000, then 2000, 4000 and 8000 (the octaves)
- retest 1000 to confirm reliability
- if 1000 has changed, take a closer look at other frequencies too
- 500, 250
Pure Tone Testing: The Order We Test (second step): When do we test the interoctave frequencies?
- 1500, 3000, 6000 are tested in the following situations:
- when difference between 2 octaves is 20db or more
- to identify the effect of noise exposure in the high frequencies
Pure Tone Testing: Familiarization
-start testing at a tone you know the patient will hear
-when they respond, confirm they have responded appropriately, then descend to their threshold
Examples:
-Start at 25 dBHL, if patient responds move down (softer) in 10 dB steps until they stop responding
-Start at 25 dBHL if patient does NOT respond move up to 50 dBHL. If still NO response, keep moving up (louder) in 5 dB steps until you achieve a response.
Once the patient responds, THEN move down in 10 dB steps until the patient no longer responds.
Pure Tone Testing: How do we find the threshold?
-use the “down ten, up 5” method (after second response, you have the threshold)
-An example:
Present at 30 dB, and patient responds
Present at 20 dB, and patient responds
Present at 10 dB, and patient responds
Present at 0 dB, and patient does NOT respond
Present at 5 dB, and patient does NOT respond
Present at 10 dB, and patient responds
10dB is your threshold for that frequency
Pure Tone Testing: why do we mask?
- from a clinical perspective, the whole purpose of masking is to rule out participation of the non-mask ear by making a masking noise (competing sound) in that ear
- masking is particularly important for bone conduction testing because the boen conductor stimulates both ears no matter where it is placed on the skull: forehead, right mastoid, left mastoid
Pure Tone Testing: What type of noise is used for masking?
- Most commonly Narrow Band Noise
- Has a particular bandwidth related to the frequency being tested
- Sometimes audiologists choose White Noise
- This sounds like static, but is less efficient because it is a random representation of ALL frequencies of equal intensity
-Speech-weighted Noise is used for masking during speech testing
It is similar to white noise, but is shaped to mirror the spectrum of speech
Audiograms: what symbols are for used for the right ear?
- AC Unmasked: O
- AC Masked: triangle
- BC Mastoid Unmasked: <
- BC Mastoid Masked: [
Audiograms: what symbols are used for the left ear?
- AC Unmasked: X
- AC Masked: square
- BC Mastoid Unmasked: >
- BC Mastoid Masked: ]
Audiograms: what symbols are examples of no response symbols?
- Right Ear: O with arrow pointing off of it, [ with arrow pointing off of it, etc
- Left Ear: X with arrow pointing off of it, > with arrow pointing off of it, etc
- Basically arrows are for no response
Family referral to audiologist and denial
- when a parent or family member is referring a patient, things can get complicated
- if the patient is an adult, you should be aware that the patient may be unwilling to accept their family member’s advice, these cases are always interesting
- patient’s denial can be interesting depending on the family dynamic
