Hearing loss

Question 1

commonest causes?

Answer 1

ear wax

otitis media and externa

Question 2

what is presbycusis

Answer 2

age related SNHL

Question 3

audiometry of presbycusis?

Answer 3

bilateral high frequency HL

Question 4

what is otosclerosis?

Answer 4

replacement of normal bone by vascular spongy bone

Question 5

features of otosclerosis

1) Conductive/ SNHL
2) other symptom
3) 10% of pts have what on otoscopy

Answer 5

1) conductive
2) tinnitus
3) ‘flamingo tinge’ TM (hyperaemia)

Question 6

commonest cause of conductive HL and elective surgery in childhood?

Answer 6

glue ear: otitis media with effusion

peak at 2 y/o

Question 7

pts with glue ear may present with secondary problems such as what?

Answer 7

speeh developmental abonrmality

Question 8

Meniere’s disease

1) more common at what age
2) features?
3) O/E?
4) duration of symptoms?

Answer 8

1) middle aged
2) VERTIGO, tinnitus, SNHL, aural fullness
3) nystagmus, positive Rombergs test
4) minutes- hours

Question 9

ototoxic drugs?

Answer 9

Aminoglycosides (gentamicin)
Loop diuretics
NSAIDs

Question 10

noise damage hearing loss is typically UNI/ BI -lateral and worse at frequencies of _____Hz

Answer 10

bilateral

3000-6000

Question 11

Vestibular schwannoma (aka acoustic neuroma)

Symptoms?

Answer 11

CNV: loss of corneal reflex
VNVII:
CNVIII: HL, tinnitus, vertigo

Question 12

B/L acoustic neuromas are seen in what hereditary condition?

Answer 12

NFT2

Question 13

what is otosclerosis?

Answer 13

replacement of normal bone by vascular spongy bone

Question 14

Otosclerosis

1) pattern of inheritance
2) age
3) otoscopy findings
4) Rx

Answer 14

1) AD
2) 20-40
3) nil (flamingo tinge TM in 10%)
4) hearing aid, stapedectomy

Question 15

type of SNHL that affects the elderly

Answer 15

Presbycusis

Question 16

Presbycusis typically progresses slowly, as sensory hair cells and neurons in the ____ atrophy over time

Answer 16

cochlea

Question 17

T/F: Presbycusis is distinct from noise-related hearing loss

Answer 17

true (although accumulated noise exposure is a risk factor for Presbycusis)

Question 18

patients with Presbycusis can, uncommonly, present with hyperacusis- what is this?

Answer 18

heightened sensitivity to certain frequencies of sound

Question 19

Ix in Presbycusis

1) otoscopy
2) tympanometry
3) audiometry
4) blood inc inflammatory markers

Answer 19

1) normal
2) normal middle ear function with hearing loss
3) bilateral high-freq HL
4) normal

Question 20

Sudden onset SN hearing loss? (SSNHL)

1) Rx
2) Ix?
3) main cause?

Answer 20

1) urgent referral to ENT + high dose oral corticosteroids
2) MRI (exclude vestibular schwannoma)
3) idiopathic

Question 21

how is suitability for cochlear implant determined in adults?

Answer 21

trialled with appropriate hearing aids for at least 3 months with little to no benefit

Question 22

Contraindications for consideration for cochlear implant?

Answer 22

Lesion of CNVIII or in the brainstem causing deafness
Chronic infective otitis media, mastoid cavity or TM perforation
Cochlear aplasia

Question 23

impacted ear wax is v common and may cause of variety of symptoms including….

Answer 23

pain
HL
vertigo
tinnitus

Question 24

main treatment in primary care for impacted ear wax?

Answer 24

ear drops (olive oil, sodium bicarbonate 5%, almond oil)
irrigation (syringing)

Question 25

treatment for impacted ear wax should not be given to which patients

Answer 25

perforation

grommets

Question 26

HL with a positive family history?

Answer 26

otosclerosis

Question 27

HL with a positive family history?

Answer 27

otosclerosis