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ENT > Examination of the auditory system > Flashcards

Examination of the auditory system Flashcards

1
Q

what does the question examination of the auditory system involve?

A

-classification of hearing disorders
-clinical examination of hearing by speech test and tuning fork
-pure tone threshold audiometry
-speech audiometry

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2
Q

how are hearing disorders classified ?

A

-sensorineural deafness
-conductive hearing loss
-mixed hearing loss

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3
Q

what are the results in sensorineural hearing loss?

A

-webber test is unto the better hearing ear
rinne test positive
schwabach test shortened

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4
Q

what are the results in conductive hearing loss?

A

weber unto the worse hearing ear
rinne test negative
schwabach test longer

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5
Q

what are the results in mixed hearing loss?

A

schwabach test is shorter
rinne test negative

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6
Q

what are the symptoms of conductive hearing loss

A

short duration hearing loss
it can be treated
usually a mild/moderate hearing deficiency
rinne test negative
any kind of blockage in outer ear preventing conduction of sound into the inner ear
absolute bone conduction is normal

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7
Q

what are the symptoms of sensorineural hearing loss?

A

permanent hearing loss
cannot be treated by or managed by hearing aids
absence or damage of sensory heair cells in the middle ear
rinne test is positive
can be mild, moderate profound and severe
absolute bone conduction

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8
Q

what is the theory behind sensorineural hearing loss?

A

-there is a problem either in the inner ear or the auditory nerve which delivers sound to the brain
-sound heard but not perceived

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9
Q

what is the theory behind conductive hearing loss?

A

-sound is not reaching the inner ear usually due to an obstruction or trauma
-sound not heard but perceived

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10
Q

what are the conditions that display conductive hearing loss?

A

-otitis media with effusion
acute otitis media
perforated ear drum
cholesteatoma
wax
otitis externa
disease of ossicles
others

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11
Q

Otitis media with effusion

A

-also know as glue ear

-most common cause of pediatric deafness
bilateral and self limiting usually
watchful waiting to allow resolution
grommets or hearing aids useful

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12
Q

acute otitis media with effusion

A

common pediatric infection
pain fever , otalgia followed by discharge and resolution
viral then bacterial
self limiting
amoxicillin after 3 days

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13
Q

cholesteatoma

A

-skin growing into the ear
benign but destructive
scanty foul discharge
later: CN VII palsy, meningitis , brain abscess
treated by mastoid surgery

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14
Q

otosclerosis

A

-fuses the stapes
infections are trauma break them apart

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15
Q

what conditions are associated with sensorineural hearing loss?

A

presbyacusis
noise induced hearing loss
acoustic neuroma
ototoxicity
trauma
merniers disease

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16
Q

presbysacusis

A

increases with age
high frequency
bilateral and symmetrical

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17
Q

acoustic neuroma

A

vestibular schwannoma
unilateral sensorineural loss
unilateral tinnitus
mid imbalance

18
Q

otoxicity

A

aminoglycosides
loop diuretics
asprin
erythromycin

19
Q

mernieres disease

A

low frequency loss
deafness, vertigo, tinnitus
bilateral in 40%

20
Q

what is involved in the clinical examination of hearing by speech test and tuning fork?

A

-conversation with patient
-whispered voice test
tunining fork tests (webber, rinnes schwabach’s)

21
Q

what do we identify in a conversation with a patient ?

A

-patient history and conversation
there are 4 different degrees:

  1. pt doesn’t understand loud speech with lip reading
    patient understands loud speech with lip reading
    patient understands loud speech without lip reading
    patient understands silent speech with lip reading
22
Q

how is the whispered voice test carried out?

A

2 syllable words are whispered at a decreasing distance from the patient until the test words can be repeated correctly

the examiner can say numbers/words at a fixed distance with decreasing volume

each ear is tested separately thus it is neccessary to cover the contralateral ear

patient should not read the lips of the examiner

23
Q

what are the different tuning fork tests?

A

-weber
-rinnes
-schwabach

24
Q

what is the purpose of the weber test?

A

-compares the bone conduction on both ears

25
Q

how is the weber test carried out ?

A

the tuning fork is placed in the centre of the skull at the hairline

26
Q

what is the normal result of the weber test?

A

-a pt with normal hearing or symmetrical hearing loss localises the tone either in the centre of the head or EQUALLY IN BOTH EARS

27
Q

what occurs in the weber test in unilateral conductive hearing loss ?

A

localised sound in the affected ear

-because the ear with the conductive hearing loss is only receiving input from the bone conduction and no air conduction

28
Q

why in conductive hearing loss is tone localised in the affected ear?

A

conduction problem of the middle ear masks the ambient noise in the room

the inner ear however works fine so it picks up the sound by the bones of the skull.

This causes the sound from the bone to be perceived louder than normal in the affected ear

29
Q

what occurs in the weber test in unilateral sensory hearing loss ?

A

-sound is localised in the healthy unaffected ear
because the sensory
-sensory organ in the affected ear cannot pick up any sound

30
Q

what is the principle of the rinnes test ?

A

-Rinnes test is based on the comparison of air conduction and bone conduction within one ear

31
Q

how is the rinnes test carried out ?

A

-first the tuning fork is pressed against the mastoid process seconds after it is held next to the ear

-the patient is then asked which one he/she perceived as the loudest

32
Q

what is found in a positive rinnes test ?

A

-the sound is loudest when the tuning fork is held next to the ear

-air conduction is better than bone conduction-> found in normal hearing loss or in sensorineural hearing loss (inner ear)

-in sensorineural hearing loss-> air conduction is perceived louder or longer than bone conduction.
the duration is shorter than in normal hearing

33
Q

what is found in a negative rinnes test?

A

the sound is loudest when pressed against the mastoid process

-bone conduction is better than air conduction

-found in conductive hearing loss (middle ear)

34
Q

what is the principle of schwabach’s test?

A

compares the patients bone conductivity the the examiners

uses the tuning fork to compare the hearing between the doctor and the patient

-the test is dependent on the examiner having normal hearing

35
Q

what do the results of the schwabah test indicate?

A

if patient stops hearing before the examiner -> this implies a sensorineural hearing loss

if patient hears for longer than the examiner->. this implies a conductive loss

this all depends on the examiner having a normal hearing

36
Q

what is the procedure of schwabach test ?

A

the examiner pinches prongs or taps it against knucles too set off lightweight vibrations

the ear that is not being tested is covered from being examined by providing a sound stimulant throughout the test

-the tuning fork is held by its stem on the mastoid bone of the client who is taught to point whether or not the tone is detected

-when they hear the tone the fork is then transferred to the mastoid bone of the examiner who listens for the tone

the method continues back and forth between the client and also the examiner until the tone is no longer detected by one in each of them

-the results are recorded and the method is then continued within the different ear

37
Q

what is the principle of pure tone audiometry ?

A

an audiometer is an electric tone generator used to determine the hearing threshold for pure tones

the patient presses a button each time they think they hear a sound

the hearing threshold is measured for both air (headphones) and bone (bone vibrator placed on mastoid process conduction in db steps

38
Q

what is the normal hearing threshold ?

A

hearing loss threshold is indicated by range between 0-20dB

normal hearing loss threshold is indicated by a straight line at 0dB

Hearing loss is measured in decibels relative to this threshold for all frequencies and is recorded on an audiogram

39
Q

what is the principle of speech audiometry?

A

-very similar to tone audiometry but instead of pure tones, speech is used instead
ability to understand speech is more important in human communication than pure tones

40
Q

how is speech tone audiometry carried out?

A
  • the test is similar to pure tone audiometry but the tones are replaced by 2 syllable words with varying levels of loudness
41
Q

what is the vocal frequency for men and women?

A

is between 125Hz for Men and 250Ha for women

ENT (11 decks)

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