Hearing and Balance Disorder Flashcards
approx. 2.5 cm long, lateral third: elastic cartilaginous & dense fibrous framework, medial two-thirds: bone lined with thin skin, ends at the tympanic membrane.
External auditory canal
separates middle from external ear
Typanic membrane (eardeum)
secrete a brown, waxlike substance: cerumen/ear wax
Ceruminous glands
anterior to the external auditory canal; the head of the mandible can be felt by placing a fingertip in the external auditory canal while the patient opens and closes the mouth.
Temporomandibular Joint (TMJ)
composed mainly of cartilage, except for the fat and subcutaneous tissue in the earlobe, collects the sound waves and directs vibrations into the external auditory canal.
Auricle
air-filled cavity, includes the tympanic membrane laterally and the otic capsule medially.
Middle ear
which is approximately 1 mm wide and 35 mm long, connects the middle ear to the nasopharynx.
Esutachian tube
the eustachian tube opens by the action of the ______ when the person performs a Valsalva maneuver, yawns, or swallows.
tensor veli palatini muscle
It drains normal and abnormal secretions of the middle ear and equalizes pressure in the middle ear with that of the atmosphere.
Estachian tube
about 1 cm in diameter, very thin, pearly gray, translucent; protects the middle ear and conducts sound vibrations from the external canal to the ossicles; sound pressure is magnified 22 times.
Tympanic membrane (eardrum)
Assist in the transmission of sound.
Ossicles
3 smallest bones in the ears
malleus (hammer)
incus (anvil)
stapes (stirrup)
Separate the middle from the inner
2 fenestrae (oval, round window)
sits in the oval window, transmits sound to the
inner ear
Footplate of the stapes
The footplate of the stapes is secured by the_____
Fibrous annulus
provides an exit for sound vibrations`
Round window
3 layers of the typanic membrane
Outer layer
Fibrous middle layer
Inner mucosal layer
80% composed of all three layers of the typanic membrane
Pars tensa
20% lacks the middle layer
Pars fllaccida`
True or false: The absence of this fibrous middle layer makes the pars flaccida more vulnerable to pathologic disorders than the pars tensa
TRUE
The cochlea and semicircular canals are housed in the
Bony labyrinth
The cochlea and semicircular canals are housed in the
Bony labyrinth
surrounds and protects the membranous labyrinth
Bony labyrinth
The fluid that baths the membranous labyrinth
Perilymph
Membranous Labyrinth : utricle, saccule,
cochlear duct, semicircular canals, organ of
Corti (all of which are surrounded by a fluid
called _____)
endolymph
posterior, superior, and lateral, which lie at 90-degree angles to one another—contain sensory receptor organs, arranged to detect rotational movement
3 semicircular canals
The _____ and ______ are involved with linear movements.
utricle and saccule
housed in the cochlea, a snail-shaped, bony tube about 3.5 cm long with two and a half spiral turns.
Organ of corti
separate the cochlear duct (scala media) from the scala vestibuli and the scala tympani from the basilar membrane
Organ of Corti membranes
also called the end organ for hearing
Organ of Corti
Hearing is conducted over two pathways:
air and bone
Manipulation of the auricle, does not cause pain, if with pain, _______ is suspected
external otitis
The tympanic membrane is inspected with an ____
otoscope
indirect palpation is done with a _______
pneumatic otoscope
general estimate of hearing can be made by assessing the patient’s ability to hear a whispered phrase or a ticking watch, testing one ear at a time.
Evaluation of Gross Auditory Acuity -
Test: the examiner whispers softly from a distance of 1 or 2 feet from the unoccluded ear and out of the patient’s sight. The patient with normal acuity can correctly repeat what was whispered.
Whisper test
Test: - bone conduction to test lateralization of sound; detecting unilateral hearing loss. A tuning fork (ideally, 512 Hz), set in motion by grasping it firmly by its stem and tapping it on the examiner’s knee or hand, is placed on the patient’s head or forehead A person with normal hearing hears the sound equally in both ears or describes the sound as centered in
the middle of the head.
Weber Test
such as from otosclerosis or otitis media, hears the sound better in the affected ear in weber test
Conductive hearing loss
resulting from damage to the cochlear or vestibulocochlear nerve hears the sound in the better-hearing ear in weber test
Sensorineural hearing loss
the examiner shifts the stem of a vibrating tuning fork between two positions: 2 inches from the opening of the ear canal (for air conduction) and against the mastoid bone (for bone conduction) As the position changes, the patient is asked to indicate which tone is
louder or when the tone is no longer audible. It useful for distinguishing between conductive and sensorineural hearing loss.
Rinne test
hears bone-conducted sound as long
as or longer than air-conducted sound in Rinne test
Conductive hearing loss
hears air-conducted sound longer
than bone-conducted sound in Rinne test
Sensorineural hearing loss
The patient wears earphones and signals to the audiologist when a tone is heard. When the tone is applied directly over the external auditory canal, air conduction is measured.
Audiometry
Audiometry: sound stimulus consists of a pure or musical tone (the louder the tone before the patient perceives it, the greater the hearing loss)
Pure-tone audiometry
Audiometry: spoken word is used to determine the ability to hear and discriminate sounds and words
Speech audiometry
a logarithmic function of intensity that is not easily converted into a percentage. Hearing loss is measured in _____
Decibels
The critical level of loudness is approximately _____dB.
30
refers to the number of sound waves emanating from a source per second, measured as cycles per second, or Hertz (Hz)
Frequency
Normal Hz
Normal: 20 to 20,000 Hz
speech range or speech frequencies: 500 to 2000 Hz.
is the term used to describe frequency
Pitch
a tone with ____ Hz is considered of low pitch; a tone of____ Hz is considered of high pitch.
100; 10,000
measured in decibel (dB), the pressure exerted by sound.
Intensity (loudness)
measures middle ear muscle reflex to sound stimulation and compliance of the tympanic membrane by changing the air pressure in a sealed ear canal.
Tympanogram or impedance audiometry
is a detectable electrical potential from cranial nerve VIII and the ascending auditory pathways of the brain stem in response to sound stimulation. Electrodes are placed on the patient’s forehead. Acoustic stimuli (eg, clicks) are made in the ear. The resulting electrophysiologic measurements can determine at which decibel level a patient hears and whether there are any impairments along the nerve pathways (eg, tumor on cranial nerve VIII).
Auditory brain stem response
is the measurement and graphic recording of the changes in electrical potentials created by
eye movements during spontaneous, positional, or calorically evoked nystagmus. It helps diagnose conditions such as Ménière’s disease and tumors of the internal auditory canal or posterior fossa. Any vestibular suppressants, such as sedatives, tranquilizers, antihistamines, and alcohol, are withheld for 24 hours before testing.
Electronystagmography
is used to investigate postural control capabilities such as vertigo. It can be used to evaluate if a person’s vertigo is becoming worse or to evaluate the person’s response to treatment. The integration of visual, vestibular, and proprioceptive cues (ie, sensory integration) with motor response output and coordination of the lower limbs is tested. The patient stands on a platform, surrounded by a screen, and different conditions such as a moving platform with a moving screen or a stationary platform with a moving screen are presented. The responses from the patient on six different conditions are measured and indicate which of the anatomic systems may be impaired. Preparation for the testing is the same as for electronystagmography
Platform posturography
is used to assess the vestibulo-ocular system by analyzing compensatory eye movements in response to the clockwise and counterclockwise rotation of the chair. Although such testing cannot identify the side of the lesion in unilateral disease, it helps identify disease (eg,
Ménière’s disease and tumors of the auditory canal) and evaluate the course of recovery. The same patient preparation is required as for electronystagmography.
Sinusoidal harmonic acceleration, or a rotary chair
performed safely and effectively as an office procedure to evaluate suspected perilymphatic fistula and newonset conductive hearing loss, the anatomy of the round window before transtympanic treatment of Ménière’s disease, and the tympanic cavity before ear surgery to treat chronic middle ear and mastoid
infections.
Middle ear endoscopy
usually results from an external ear disorder, such as impacted cerumen, or a middle ear
disorder, such as otitis media or otosclerosis, the efficient transmission of sound by air to the
inner ear is interrupted.
Conductive Hearing Loss
involves damage to the cochlea or vestibulocochlear nerve
Sensorineural loss
have conductive loss and sensorineural loss, resulting from dysfunction of air and bone conduction.
Mixed hearing loss
nonorganic and unrelated to detectable structural changes in the hearing mechanisms; it is usually a manifestation of an emotional disturbance.
Functional (Psychogenic) Hearing Loss
unwanted and unavoidable sound
noise
refers to hearing loss that follows a long period of exposure to loud noise (eg, heavy machinery, engines, artillery, rock-band music)
Noise-Induced Hearing Loss
refers to hearing loss caused by a single exposure to an extremely intense noise, such as an explosion.
Acoustic Trauma
progressive hearing loss in geriatric patients.
Presbycusis
If a hearing loss is permanent or untreatable or if the patient elects not to be treated, _____ may be beneficial.
aural rehabilitation
Accumulation of cerumen as a cause of hearing loss
Cerumen Impaction
a sensation of fullness or pain in the ear, with or without a hearing loss
Otalgia
inflammation of the external auditory canal
External Otitis (Otitis Externa)
3 standard methods in removing foreign bodies:
Irrigation, Suction, and Instrumentation
a progressive, debilitating, and occasionally fatal
infection of the external auditory canal, the surrounding tissue, and the base of the skull.
Malignant External Otitis
are small, hard, bony protrusions found in the
the lower posterior bony portion of the ear canal; they usually occur bilaterally, and the usual treatment, if any, is surgical excision
Exostoses
results from wearing heavy pierced earrings for a long time or after an infection, or as a reaction from the earring or impurities in the earring.
Gapping Earring Puncture
A condition of the middle ear usually caused by infection or trauma.
Tympanic membrane perforation
is an acute infection of the middle ear, usually lasting less than 6 weeks.
Acute Otis media
An incision in the tympanic membrane
Myringotomy
involves fluid, without evidence of active infection, in the middle ear.
Serious Otitis Media (Middle ear effusion)
is the result of recurrent AOM causing irreversible tissue pathology and persistent perforation of the tympanic membrane.
Chronic Otitis Media
is an ingrowth of the skin of the external layer of the eardrum into the middle ear. It is generally caused by a chronic retraction pocket of the tympanic membrane, creating a persistently high negative pressure of the middle ear.
Cholesteatoma
Surgical reconstruction of the middle ear bones to restore hearing
Ossiculoplasty
remove the cholesteatoma, gain access to diseased structures, and create a dry (noninfected) and healthy ear.
Mastoidectomy
involves the stapes and is thought to result from the formation of new, abnormal spongy bone, especially around the oval window, with resulting fixation of the stapes.
Otosclerosis
involves removing the stapes superstructure and part of the footplate and inserting a tissue graft and a suitable prosthesis
stapedectomy
any altered sensation of orientation in space.
DIzziness
is defined as the misperception or illusion of motion of the person or the surroundings.
Vertigo
an involuntary rhythmic movement of the eyes.
Nystagmus
disturbance of equilibrium caused by constant motion.
Motion sickness
an abnormal inner ear fluid balance caused by a malabsorption in the endolymphatic sac or a blockage in the endolymphatic duct.
Ménière’s Disease
a dilation in the endolymphatic space, develops, and either increased pressure in the system or
rupture of the inner ear membrane occurs, producing symptoms of Ménière’s disease.
Endolymphatic hydrops
a brief period of incapacitating vertigo that occurs when the position of the patient’s head is changed with respect to gravity, typically by placing the head back with the affected ear turned down.
Benign Paroxysmal Positional Vertigo (BPPV)
symptom of an underlying disorder of the ear that is associated with hearing loss; roaring,
buzzing, or hissing sound in one or both ears
Tinnitus
inflammation of the inner ear can be bacterial or viral in origin.
Labyrinthitis
a slow-growing, benign tumors of cranial nerve VIII, usually arising from the Schwann cells of the vestibular portion of the nerve.
Acoustic Neuroma
maximize the communication skills of the person with hearing impairment.
Aural Rehabilitation
a device through which speech and environmental sounds are received by a microphone, converted to electrical signals, amplified and reconverted to acoustic
signals.
Hearing Aids
Three types of implanted hearing devices
the cochlear implant
the bone conduction device
and the semi-implantable hearing device
Specially trained dogs (service dogs) are available to assist the person with a hearing loss.
Hearing Guide Dogs
