Hearing Flashcards
Describe the etiology/risk factors for eustachian tube disorder & middle ear effusion
- 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
Describe the clinical presentation of ETD & MEE
- plugging/fullness
- popping/crackling
- hearing loss
- tinnitus
- disequilibrium
- pain
- retracted TM in ETD
- fluid/bubbles in MEE
Describe the diagnostic testing for ETD & MEE
- 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
Describe the treatment for ETD & MEE
- 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
Describe the etiology/risk factors for cholesteatoma
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
Describe the clinical presentation of cholesteatoma
- CHL
- fullness/plugging
- drainage
- tinnitus
- pain
- imbalance
- CN7 weakness
- chronic perforation + drainage
Describe the diagnostic testing/PE for cholesteatoma
- otoscopy, CT temporal bone w/o contrast
Describe the treatment of a cholesteatoma
- MC surgery: tympanoplasty, tympanomastoidectomy, ossicular chain reconstruction
- middle ear pressure management with tubes
- address infection
- preserve hearing
Describe the etiology/risk factors for barotrauma
- trauma to middle ear from pressure change, +/- damage to tympanic membrane & ossicles
- RF: scuba, airplanes, ETD, infection, blast exposure, hyperbaric O2 treatment
Describe the clinical presentation of barotrauma
- plugging/fullness
- pain
- hearing loss
- tinnitus
- bleeding
- drainage
- injected or perforated tympanic membrane
Describe the diagnostic testing for barotrauma
- 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
Describe the treatment of barotrauma
- valsalva maneuver
- candies/gum on planes
- decongestants
- myringotomy/tubes for flying
- paper patch or tympanoplasty for persistent perforations
- spontaneously heal within 2 mos
Describe the etiology of presbycusis
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
Describe the clinical presentation of presbycusis
- progressive bilateral high frequency sensorineural hearing loss
- tinnitus
- disequilibrium
Describe the diagnostic testing for presbycusis
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
Describe the etiology/risk factors of acoustic neuroma
aka vestibular schwannoma
- benign, usually unilateral, slow growing tumor on CN8
- RF neurofibromatosis-2, childhood radiation exposure
Describe the clinical presentation of acoustic neuroma
- unilateral SNHL, tinnitus, unsteadiness, CN5 numbness/pain, CN7 weakness
Describe the diagnostic testing for acoustic neuroma
- audiogram: asymmetric SNHL
- vestibular testing +/- normal
- MRI w/wo IV contrast = gold standard
Describe the treatment for acoustic neuroma
- refer to neuro for surgical removal d/t risk of hearing loss, facial/vestibular weakness
- radiation
- observe if minor
Describe the etiology/risk factors for Meniere’s Disease
endolymphatic hydrops
- excess fluid buildup in endolymphatic space of inner ear
- RF: 20-40, F>M, fam hx, migraines
- cochlear hydrops similar without vertigo
Describe the clinical presentation of meniere’s
- hearing loss, severe tinnitus, vertigo
- spinning, n/v, ear fullness, drop attacks, fluctuating SNHL for low frequencies, tinnitus
- discomfort, nystagmus
Describe the diagnostic testing for Meniere’s
- 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
Describe the treatment for Meniere’s
- prevention: lifestyle changes (salt, caffeine, nicotine, stress)
- acute: oral/TTI steroids, vestibular rehab, zofran
- last resort: steroids, gentamicin injection, vestibular nerve section, labyrinthectomy
Describe the complications of Meniere’s
30% progress bilaterally and most have residual/permanent unilateral effects
Describe the etiology/risk factors for tinnitus
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
Describe the clinical presentation of tinnitus
- sound: ringing, hissing, buzzing, tones, water running, white noise, humming
- unilateral/bilateral, constant/intermittent
Describe the diagnostic testing for tinnitus
audiogram: usually see hearing loss (also on otoscopy)
- MRA for pulsatile tinnitus with vascular bruit on auscultation
- vestibular abnormalities are rare
Describe the treatment for tinnitus
- reassurance and education
- address underlying cause
- refer to ENT for audiogram
- masking & redirection: tinnitus retraining therapy
