Hearing Loss Flashcards
What is a perforated tympanic membrane associated with
Acute otitis media
What can cause a perforated tympanic membrane
Trauma
Clinic presentation of perforation
Sudden severe pain followed by bleeding from the ear, hearing loss and tinnitus
2 main investigations for perforation
Audiology and Otoscopy
Audiometry in perforation
Conductive hearing loss
Management of perforation
Usually heals spontaneously
Surgical repair if symptomatic with recurrent discharge
What is otosclerosis
Hereditary condition in which bony deposit is within the stapes footplate and cochlear lead to gradual conductive hearing loss
When is otosclerosis usually seen
2nd - 3rd decade
Who is otosclerosis more common in
Females - linked to high oestrogen
Pathophysiology of otosclerosis
Fixation of the stapes footplate
Clinical presentation of otosclerosis
Gradual onset hearing loss
Classic finding when investigating otosclerosis
Carharts notch at 2KHz
Investigation of otosclerosis
Audiometry
Management of otosclerosis
Hearing aids
Stapedectomy
What is presbycusis
Degenerative disorder of the cochlear resulting in hearing loss
When does presbycusis usually present
Old age
What causes presbycusis (3)
Loss of outer hair cells
Loss of ganglion cells
Strial atrophy
Clinical presentation of presbycusis
Gradual onset hearing loss
Investigation for presbycusis
Audiometry
Audiometry in presbycusis
Higher frequencies affected most
Usually sensorineural hearing loss
Management of presbycusis
High frequency specific hearing aid
What is vestibular schwannoma
Rare benign tumour of the CN8 nerve sheath
Where does vestibular schwannoma arise
Internal auditory meatus
What has vestibular schwannoma been associated with
Extensive exposure to excessively loud noise
What do you need to consider in a young patient with bilateral vestibular schwannoma
Neurofibromatosis type 2
Where do vestibular schwannoma occur
Within the temporal bone
Gross appearance of vestibular schwannoma
Circumscribed white/tan/yellow mass
What are the 2 growth patterns associated with vestibular schwannoma
Antoni A and B
Clinical presentation of vestibular schwannoma
Progressive sensorineural unilateral hearing loss and tinnitus
Imbalance in larger tumours
Compression of Trigeminal nerve can cause facial numbness
Investigation for vestibular schwannoma
MRI
Definitive management of vestibular schwannoma
Surgical excision
What is another name for otitis media with effusion
Glue ear
What is glue ear
Inflammation of the middle ear with an accumulation of fluid
WITHOUT symptoms and signs of acute inflammation
Who usually gets glue ear
Children
When is the most common time to get glue ear
2-8
What is associated with glue ear
Eustachian tube dysfunction or obstruction
Common organisms associated with glue ear
Strep pneumo
H, influenza
Moraxella
Risk factors for glue ear
Day care, older siblings, smoking household, recurrent URTI, prematurity, immunodeficiency
Causes of glue ear in adults
Rhinosinusitis
Nasopharyngeal carcinoma or lymphoma
Symptoms of glue ear
Often asymptomatic !!!
May present with hearing loss: poor performance or bad behaviour at school
No otalgia
Clinical signs of glue ear
Middle ear effusion
TM retraction and discolouration
Impaired TM mobility
Investigations for glue ear
Otoscopy
Tuning fork tests: conductive hearing loss
Management of glue ear
Watchful waiting
When do you refer a patient with glue ear
Persistent bilateral OME
Conductive hearing loss
Speech/language problems
Behavioural problems
General management of glue ear
Grommets
Secondary intervention of glue ear
Adenoidectomy
Complications of grommets
Infection/discharge
Early extrusion
Retention
Persistent perforation
Swimming/bathing issues
What is the most common tumour of the ear
Squamous cell carcinoma
What is squamous cell carcinoma of the ear associated with
Chronic inflammation or radiation
Clinical presentation of squamous cell carcinoma on the ear
Firm red nodules and sores on the skin of the ear
Discomfort
Hearing problems, tinnitus, vertigo
Name some other tumours of the ear
Meningioma
Middle ear adenoma
How does noise-induced hearing loss look on Audiometry
Sensorineural hearing loss
Dip at 4 KHz
Name some drugs that can induce hearing loss
Gentamicin
Cisplatin
Vincristine
Aspirin and NSAIDs
How do we classify hearing loss
Based on which part of the auditory system is affected
Sensorineural, conductive or mixed
What is sensorineural hearing loss
No significant air-bone gap on audiogram
What are other names for sensorineural hearing loss
Sensory, cochlear or inner ear hearing loss
How does sensorineural hearing loss occur
Damage to the hair cells within the cochlear or the hearing nerve
Name some other causes of sensorineural hearing loss
Trauma, Ménière’s, vestibular schwannoma, loud sounds, genetics, complications at birth
What is conductive hearing loss
Significant air-bone gap on an audiogram
What causes conductive hearing loss
Usually as a result of sounds not being able to pass freely to the inner ear
Presentation of conductive hearing loss
Fluctuating hearing loss
Name some causes of conductive hearing loss
Otitis media and externa, perforation, cholesteatoma
What is mixed hearing loss
Combination of conductive and sensorineural hearing loss, meaning there’s damage in the outer or middle ear and the inner ear
