hearing loss Flashcards
rinnes and Webbers are carried out using what kind of tuning fork
512
ask the pat if they hear the vibration better infront of the ear or when tuning fork is on the mastoid process
rinnes
positive rinnes
air conduction is better than bone - hear better infront than behind
negative rinnes indicates
conductive hearing loss
place tuning fork in middle of patients forehead and ask if they hear the vibration equal in both ears
Webbers
normal Webbers
sound is equal in both ears
in conductive hearing loss where does Webbers localise to
the side effected
in SNHL where does Webbers localise
to the opposite side to the effected side
test used to identify the nature and degree of hearing loss
audiometry
0 in audiogram
air conduction on RHS
X on audiogram
air conduction on LHS
triangle on audiogram
bone conduction on RHS/LHS
[ on audiogram
masked bone conduction on RHS
] on audiogram
masked bone conduction on LHS
air bone gap on audiogram
CHL
no air bone gap on audiogram
SNHL
normal plot of audiogram
10-20
mild loss on audiogram
30
moderate loss on audiogram
40
severe loss on audiogram
70
profound loss on audiogram
90
assesses how well the tympanic membrane is moving
tympanography
type A tympanography
normal
type B tympanogrpahy
membrane not moving
cause of Type B tympanography
OME, ossification
type C tympanography
membrane is moving but it is being retracted
cause of type C in tympanography
middle ear congestion
type As in tympanography
very little movement
type As in cause in tympanography
otosclerosis
type Ad in tympanography
too much movement
cause of type Ad in tympanography
perforation
deafness due to failure to adequately transmit sound from out to inner ear
conductive hearing loss
causes of conductive hearing loss
cholesteatoma, otosclerosis, was impaction, perforated ear drum, otitis media with effusion, infection with otitis externa and media
most common cause of conductive hearing loss
wax impaction
rinnes- negative, webers - localising to effected side, air-bone gap on audiometry - diagnose
conductive hearing loss
when skin grows into the middle ear causing local destruction and inflammation
cholesteatoma
a patient presents with conductive hearing loss, oltagia, headache, foul smelling, cheesy white discharge, a pearly white tympanic membrane and is between the age 5-15 - what is the diagnosis
cholesteatoma
management of cholesteatoma
surgical removal
hereditary autosomal dominant metabolic condition of the otic capsule that results in fixation of the footlate of the stapes to the oval window
otosclerosis
conductive hearing loss better with background noise, resents in early adult life, made worse by pregnancy, +/- tinnitus and vertigo
otosclerosis
carhaarts notch on audiometry
otosclerosis
management of otosclerosis
hearing aid, surgery- replace tapes, CO2 laser, cochlear implant
otitis media with effusion
inflammation of middle ear in absence of infection
majority of otitis media with effusion cases come from
follow an acute otitis media
development of acute otitis media is though to be due to what
dysfunction of the Eustachian tube
risk factors of otitis media with effusion
URTI, prematurity, craniofacial abnormalities and smoking households
child presents with deafness, speech delay, behavioural issues, poor school performance and a retracted tympanic membrane with a visible fluid level +/- fluid bubbles behind the membrane
otitis media with effusion
unilateral OME in an adult - suspect what
nasopharyngeal cancer
investigation of OME
CHL and flat type B tympanogram
management of OME
usually resolve in 3 months - refer if longer, bilateral or having significant implication
management of OME in <3 years old
grommets
management of OME in > 3 year old
1st time grommets then grommets with adenoidectomy
why are grommets used in OME
to improve hearing p not to treat effusion
deafness due to failure of the hair cells to detect sound in the inner ear
SNHL
SNHL is typically worse or better with background noise
WORSE
SNHL is usually associated with what symptoms
tinnitus / change in quality of sound
causes of SNHL
prebysusis, noise induces, menieres, vestibular schwannoma, drug side effects
red flag drugs for SNHL
gentamicin, loop diuretics, chemotherapy, hydrochloroquine
rinnes positive, weber localised to opposite ear, no ear bone gap but a bilateral symmetrical high frequency loss on audiometry indicates
SNHL
mainstay management of SNHL
hearing aids q
age related hearing loss
presbycusis
presbycusis presentation
gradual reduction in hearing loss as individual ages - particular difficulty hearing when there is background noise
benign sheath tumour of CN 8 that grows at the cerebellar - pontine age
vestibular schwannoma
most commonly vestibular schwannomas are
unilateral
bilateral vestibular schwannomas are indicative of
NF2
a patient presents with SNHL w/ distortion of sound and tinnitus, they Compton of unsteadiness, vertigo and deep earache, facial pain, palsy and paraethesiae, unilateral headache
vestibular schwannoma
investigation of vestibular schwannoma
MRI - ix of choice bt CT
management of vestibular schwaonnoma
watch and wait or surgical excision
acoustic neuromas are more correctly called
vestibular schwannomas
acoustic neuroma affecting cranial nerve VIII presentation
hearing loss, vertigo, tinnitus
acoustic neuroma affecting cranial nerve V presentation
absent corneal reflex
vestibular neuroma impacting CNVII presentation
facial palsy
head injury can cause what type of hearing loss
mixed
