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EENT/ID > Hearing > Flashcards

Hearing Flashcards

1
Q

Describe the etiology/risk factors for eustachian tube disorder & middle ear effusion

A
  • Dilatory type: most common, ear won’t pop
  • patulus type: chronic patency
  • poorly functioning eustachian tube causing pressure, serous fluid trapping, middle ear effusion, can occur from inflammation
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2
Q

Describe the clinical presentation of ETD & MEE

A
  • plugging/fullness
  • popping/crackling
  • hearing loss
  • tinnitus
  • disequilibrium
  • pain
  • retracted TM in ETD
  • fluid/bubbles in MEE
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3
Q

Describe the diagnostic testing for ETD & MEE

A
  • insufflation: limited movement
  • tympanometry: diagnostic
  • Weber/Rinne & Audiometry: conductive loss in MEE
  • Nasal endoscopy: +/- carcinoma
    Diagnostic criteria: sxs of ETD + otoscopic evidence of retraction or fluid OR tympanogram showing B or C pattern
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4
Q

Describe the treatment for ETD & MEE

A
  • treat underlying issue, topical nasal steroids, saline rinse, decongestants
  • myringotomy, PE tube placement
  • eustachian tube dilation
  • may have lingering sx for months
  • may lead to perforation, cholesteatoma, hearing loss
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5
Q

Describe the etiology/risk factors for cholesteatoma

A

unsafe ear
benign growth of keratinized skin from middle ear d/t chronic negative pressures causing retratction pockets in tympanic membrane
- commonly acquired
- RF: chronic ETD, poor medical care, LMICs

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6
Q

Describe the clinical presentation of cholesteatoma

A

- CHL
- fullness/plugging
- drainage
- tinnitus
- pain
- imbalance
- CN7 weakness
- chronic perforation + drainage

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7
Q

Describe the diagnostic testing/PE for cholesteatoma

A
  • otoscopy, CT temporal bone w/o contrast
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8
Q

Describe the treatment of a cholesteatoma

A
  • MC surgery: tympanoplasty, tympanomastoidectomy, ossicular chain reconstruction
  • middle ear pressure management with tubes
  • address infection
  • preserve hearing
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9
Q

Describe the etiology/risk factors for barotrauma

A
  • trauma to middle ear from pressure change, +/- damage to tympanic membrane & ossicles
  • RF: scuba, airplanes, ETD, infection, blast exposure, hyperbaric O2 treatment
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10
Q

Describe the clinical presentation of barotrauma

A

- plugging/fullness
- pain
- hearing loss
- tinnitus
- bleeding
- drainage
- injected or perforated tympanic membrane

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11
Q

Describe the diagnostic testing for barotrauma

A
  • insufflation: floppy TM
  • tympanometry: hypermobile vs flat w/ large volume
  • Webber/Rinne & audiometry: CHL of TM perforated or ossicles disrupted
  • criteria: clinical hx, PE showing injury
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12
Q

Describe the treatment of barotrauma

A
  • valsalva maneuver
  • candies/gum on planes
  • decongestants
  • myringotomy/tubes for flying
  • paper patch or tympanoplasty for persistent perforations
  • spontaneously heal within 2 mos
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13
Q

Describe the etiology of presbycusis

A

age related hearing loss d/t atrophy of the outer hair cells of cochlea and cells in spiral ganglion & vestibulocochlear nerve
- RF: fam hx, white, smoking, vascular/metabolic disease, ototoxic meds, noise exposure, diet

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14
Q

Describe the clinical presentation of presbycusis

A

- progressive bilateral high frequency sensorineural hearing loss
- tinnitus
- disequilibrium

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15
Q

Describe the diagnostic testing for presbycusis

A

audiogram gold standard
- word recognition score determines benefit from hearing aids (50% or greater)
- criteria: audogram showing general symmetric SNHL sloping downward at high frequencies

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16
Q

Describe the etiology/risk factors of acoustic neuroma

A

aka vestibular schwannoma
- benign, usually unilateral, slow growing tumor on CN8
- RF neurofibromatosis-2, childhood radiation exposure

17
Q

Describe the clinical presentation of acoustic neuroma

A

- unilateral SNHL, tinnitus, unsteadiness, CN5 numbness/pain, CN7 weakness

18
Q

Describe the diagnostic testing for acoustic neuroma

A
  • audiogram: asymmetric SNHL
  • vestibular testing +/- normal
    - MRI w/wo IV contrast = gold standard
19
Q

Describe the treatment for acoustic neuroma

A
  • refer to neuro for surgical removal d/t risk of hearing loss, facial/vestibular weakness
  • radiation
  • observe if minor
20
Q

Describe the etiology/risk factors for Meniere’s Disease

A

endolymphatic hydrops
- excess fluid buildup in endolymphatic space of inner ear
- RF: 20-40, F>M, fam hx, migraines
- cochlear hydrops similar without vertigo

21
Q

Describe the clinical presentation of meniere’s

A

- hearing loss, severe tinnitus, vertigo
- spinning, n/v, ear fullness, drop attacks, fluctuating SNHL for low frequencies, tinnitus
- discomfort, nystagmus

22
Q

Describe the diagnostic testing for Meniere’s

A
  • audiogram: unilateral SNHL for low-mid frequencies
  • vestibular testing: peripheral hypofunction
  • MRI w/wo contrast WNL
  • Criteria: 2+ spontaneous episodes of vertigo 20min-12hr, audiometry showing low-mid SNHL, fluctuating aural sx of tinnitus, fullness, distorted hearing
23
Q

Describe the treatment for Meniere’s

A
  • prevention: lifestyle changes (salt, caffeine, nicotine, stress)
  • acute: oral/TTI steroids, vestibular rehab, zofran
  • last resort: steroids, gentamicin injection, vestibular nerve section, labyrinthectomy
24
Q

Describe the complications of Meniere’s

A

30% progress bilaterally and most have residual/permanent unilateral effects

25
Q

Describe the etiology/risk factors for tinnitus

A

Perception of a sound not actually there (symptom or diagnosis)
- RF: noise exposure, age, tobacco, anx, insomnia, pain, meds, neuro disorders
- can be secondary to hearing loss
Vascular = pulsatile, MSK = clicking/tapping

26
Q

Describe the clinical presentation of tinnitus

A
  • sound: ringing, hissing, buzzing, tones, water running, white noise, humming
  • unilateral/bilateral, constant/intermittent
27
Q

Describe the diagnostic testing for tinnitus

A

audiogram: usually see hearing loss (also on otoscopy)
- MRA for pulsatile tinnitus with vascular bruit on auscultation
- vestibular abnormalities are rare

28
Q

Describe the treatment for tinnitus

A
  • reassurance and education
  • address underlying cause
  • refer to ENT for audiogram
  • masking & redirection: tinnitus retraining therapy

EENT/ID (15 decks)

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