Hearing loss Flashcards

1
Q

Conductive hearing loss & its mechanisms

A

Mechanical disruption of the external
auditory canal or middle ear
Mechanisms:
1. Obstruction
2. Mass loading
3. Non-compliant structures
4. Discontinuity of structures

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2
Q

Sensorineural hearing loss & its mechanisms

A

Deficit in the inner ear (sense) or central nervous system auditory pathway (neural)
Mechanisms:
1. Deterioration of cochlea – usually loss
of hair cells in Organ of Corti

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3
Q

> ____% of childhood hearing impairment is thought to be hereditary

A

50

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4
Q

Nonsyndromic vs. Syndromic hearing loss

A
  • Nonsyndromic hearing loss: hearing loss is the only clinical abnormality
  • Syndromic hearing loss: in which hearing loss is associated with anomalies in other organ systems
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5
Q

_____: retinitis pigmentosa & hearing
loss

A

Usher syndrome

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6
Q

______: pigmentary
abnormality (hair, skin, & nails) & hearing loss

A

Waardenburg syndrome

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7
Q

____ → thyroid organification
defect & hearing loss

A

Pendred syndrome

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8
Q

____ → renal disease & hearing loss

A

Alport syndrome

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9
Q

_____ → prolonged
QT interval & hearing loss

A

Jervell & Lange Nielson syndrome

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10
Q

Ototoxic Medications

A
  • Aminoglycoside antibiotics: Gentamicin, Amikacin, Neomycin, Streptomycin
  • Other antibiotics: Vancomycin, Erythromycin
  • Antimalarials: Chloroquine, Quinine
  • Platinum-based chemotherapy agents: Cisplatin, Carboplatin
  • Loop diuretics: Furosemide, Torsemide
  • Nonsteroidal anti-inflammatory drugs: Aspirin, Ketorolac, Ibuprofen
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11
Q

Hearing Loss presentation

A
  • Sudden, unexplained hearing loss
  • Gradual painless hearing loss
  • Bilateral or unilateral
  • Deficits affecting high, low, or all
    frequencies
  • Distorted sound (like “blown”
    loudspeaker)
  • Ear fullness or pressure
  • Ear feels numb or blocked
  • May be associated with ear pain
  • May also have Tinnitus or Vertigo
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12
Q

T/F Remove impacted cerumen prior to
making a Dx of hearing loss

A

T

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13
Q

Conductive hearing loss structures

A
  • Involves auditory canal, tympanic membrane, & the ossicles
  • Lesions in the auricle, external auditory canal, or middle ear
    can cause conductive hearing loss
  • Often reversible
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14
Q

Sensorineural hearing loss structures

A
  • Involves cochlea and CN VIII
  • Often permanent
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15
Q

Weber test

A
  • A 256 or 512 Hz tuning fork is placed on the mid forehead
  • Sound should be perceived equally bilaterally
  • Lateralization of sound = + test
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16
Q

Rinne test

A
  • Place the tuning fork against the mastoid process & count
  • When the patient no longer hears the sound, note the number of seconds & rapidly
    reposition the tuning fork 1-2 cm from the auditory canal, & count
  • The patient should indicate when sound is no longer heard
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17
Q

Review weber/rinne results

A

:)

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18
Q

Audiometry

A
  • Most widely accepted diagnostic test for
    hearing loss or concerns
  • Usually obtained in a sound-proof
    environment
  • Demonstrates how loud sounds need to be at
    different frequencies for you to hear them
  • “Audible threshold”
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19
Q

Most widely accepted diagnostic test for hearing loss or concerns

A

Audiometry

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20
Q

Tympanometry

A

Graph
* Relationship between air pressure in the canal and movement of
the tympanic membrane (TM)
* Provides volume measurement and pressure measurement

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21
Q

Otosclerosis

A

Overgrowth of bone in the
inner ear
* Often stapes

22
Q

Otosclerosis etiology - 3 main theories

A
  • Abnormal osteoclast & osteoblast activity of mature endochondral bone of the otic capsule
  • Genetic: Inherited in an autosomal dominant pattern
    with incomplete penetrance
  • Viral infection (likely measles)
  • Endocrine factors (hormonal): Abnormalities in PTH & estrogen contribute to
    abnormal bone turnover
23
Q

Otosclerosis clinical presentation

A
  • Gradual conductive hearing loss beginning in young adulthood
  • Typically speak quietly & report better hearing in noisy
    environments, when voices tend to be raised
  • Tinnitus ~50% of patients
  • Vertigo ~10% of patients
  • Exam is normal
24
Q

Weber test in Otosclerosis

A

lateralizes

25
Otosclerosis Audiogram
Audiogram confirms either unilateral or bilateral conductive hearing loss * Conductive hearing loss (about 40-60 decibels in lower frequencies & less in higher frequencies) on audiometry, without tympanic membrane abnormality * Carhart notch at 2000 Hz
26
Tx for mild hearing loss
observation and/or hearing aids with routine hearing tests to determine if condition is progressing * Florical * Bisphosphonates
27
Aggressive Tx for hearing loss
stapedectomy with prosthesis (stapedoplasty) * Most Successful
28
Otosclerosis Complications
* Progressive hearing loss * Conductive at early stages of disease & progresses to mixed or sensorineural hearing loss in later stages of disease * Severe conductive hearing loss can develop in patients with obliterative otosclerosis
29
Most common cause of hearing loss in adults
Presbycusis
30
4 theories of etiology in Presbycusis
* Sensory presbycusis: Epithelial atrophy with loss of sensory hair cells & supporting cells in the organ of Corti * Neural presbycusis: Atrophy of nerve cells in the cochlea & central neural pathways; ~2100 neurons are lost every decade (of 35,000 total) * Metabolic presbycusis: Atrophy of the stria vascularis * Mechanical presbycusis: Results from thickening & secondary stiffening of the basilar membrane of the cochlea
31
Clinical presentation of presbycusis
* Sensorineural hearing loss usually occurs first with high- frequency sounds & progresses to lower tones * Difficulty understanding rapidly spoken language, vocabulary that is less familiar or more complex, & speech within a noisy, distracting environment * Localizing sound becomes difficult
32
_____ is a diagnosis of exclusion
Presbycusis
33
Management of Presbycusis
* No cure * ENT, audiology referral * Amplification devices: hearing aids * Lip reading: * Assistive listening devices: * Cochlear implants:
34
Acoustic Neuroma
Intracranial, extra-axial tumors arising from the Schwann cell sheath investing either the vestibular or cochlear nerve
35
High dose ionizing radiation is the only known risk factor for _____
Acoustic Neuroma
36
Clinical Presentation of Acoustic Neuroma
* Unilateral hearing loss is the most common symptom * 50-60% of patients experience headache at the time of diagnosis * 25% of patients report facial numbness * Unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise
37
Unilateral sensorineural hearing loss is ____
acoustic neuroma until proven otherwise
38
Diagnosis of Acoustic Neuroma
* Audiogram * Gadolinium-enhanced MRI brain with attention to IACs
39
Acoustic Neuroma Management
* Refer to neurotology for surgical excision of the tumor: Treatment of choice for tumor eradication * Stereotactic radiation therapy: Stops tumor growth * Serial observation
40
____ Americans risk noise-induced hearing loss (NIHL)
5-10 million
41
Noise-Induced Hearing Loss Etiology
* Several minutes after exposure to noise: * Edema of the stria vascularis appears, & may persist for several days * The cochlea also becomes inflamed in response to acoustic trauma Outer hair cells are more susceptible to noise exposure than inner hair cells → ↓ stiffness of the stereocilia of outer hair cells * Severe exposure → injury from a loss of adjacent supporting cells to complete disruption of the organ of Corti, which may be permanent
42
Clinical Presentation of NIHL
* History of long-term exposure (10+ years) * With hearing loss in the high frequencies, the patient is unlikely to report difficulty in quiet conversational situations * Trouble understanding speech when significant background noise is present * May progress to difficulty understanding high-pitched voices (women, children)-even in quiet conversational situations
43
Noise-Induced Hearing Loss diagnosis
* Audiometry * Sensorineural hearing loss * Almost always bilateral * Loss is greater with frequencies 3000-6000 Hz, less with 500-2000 Hz
44
Noise-Induced Hearing Loss management
* No cure * Reduce or eliminate exposure to noise * Control other factors (Smoking, DM, CVD)
45
Safe noise exposure limit
85 decibels for 8 hours a day
46
Earphones usage adjustments
* 70% of max vol. should be limited to <4.6 hrs/day * 80% of max. volume, limit to less <1.2 hrs/day
47
Sudden Sensorineural Hearing Loss
* Sensorineural hearing loss of 30dB or greater over at least three contiguous audiometric frequencies occurring within a 72-hr period
48
Reported causes of Sudden Sensorineural Hearing Loss
* Infectious diseases (viral URI) * Otologic disease * Trauma * Vascular or hematologic conditions * Neoplasms (vestibular schwannoma)
49
Sudden Sensorineural Hearing Loss presentation
* Usually in 1 ear (< 5% of cases BL) * Mild to severe-profound * Can affect high, low, or all frequencies * Sound may be distorted (like "blown loudspeaker”) * Ear fullness or pressure
50
Sudden Sensorineural Hearing Loss Diagnosis
* Weber & Rinne * Audiogram * Evaluate for alternative diagnoses suggested by symptoms such as: bilateral sudden hearing loss, recurrent episodes of sudden hearing loss, or focal neurologic findings * Consider MRI to identify: Stroke, acoustic neuroma, multiple sclerosis * Labs to evaluate autoimmune disorders, syphilis, HIV, West Nile, cat scratch
51
Sudden Sensorineural Hearing Loss Management
* Treat specific causes * Idiopathic sudden sensorineural hearing loss * Oral corticosteroids tapered over 10-14 days if within 2 weeks of onset * Intratympanic dexamethasone injections * Antiviral
52
Otologic emergency, until proven otherwise
Sudden Sensorineural Hearing Loss