Hearing Loss Flashcards by Adrian Yan

What is conductive deafness?

Pathologies of the outer and middle ear

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What is sensorineural deafness?

Pathologies of the inner ear

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How would a Pinna deformity affect hearing?

May reduce volume of sound entering external acoustic meatus by 5-10dB

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What is canal atresia?

Congenital disorder → absent or closed external acoustic meatus

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What is a cerumen plug?

Wax - may obstruct meatus, or sit against drum, dampening vibrations

Wax is only produced in the outer 1/3 of EAM - usually pushed in by cotton buds etc.

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What is otitis externa? and what are the causes?

Infection of the soft tissues surrounding the EAM

Usually caused by gram -ve bacteria - occasionally fungal

Pseudomonas may → malignant otitis externa → invasion (CN palsies, intracranial)

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What is the presenation of otitis externa?

Pain - pinna my be tender on movement

Erythema - may be diffuse or localised if OE boil (furuncle)

Furuncles always in outer EAM as no follicles deeper

May spread to form pre-auricular rash (erysipelas) or cellulitis

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What is the treatment for otitis externa?

Acute bacterial - Topical ABx - Gentamycin, Neomycin - drops/Pope Wick

Acute viral - Topical antifungals - Clotrimazole, Nystatin

Swelling reduction - Magnesium sulphate
Chronic OE → swabs, clean, antimicrobials + steroid

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What is osteotoma?

Surfer’s ear - benign growth of bone surrounding EAM → stenosis/obstruction

Stimulated by cold water

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What is acute otitis media?

Inflammation of the middle ear - can be supparative (pus discharge) or secretory (mucoid secretions)

The whole middle ear including the mastoid antrum and eustatian tube.

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What causes acute otitis media?

Usually capsulated gram +ves -

Strep P,

Haem Inf,

Moraxella Cartharralis

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What are the symptoms of acute otitis media?

Discomfort → Deep pain (also over mastoid process)

Impaired hearing

Fever, malaise

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What are the signs of acute otitis media?

Inflamed tympanic membrane pre-perforation

Perforation and profuse mucoid discharge post perforation

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What is the treatment for acute otitis media?

Oral ABx - Amoxicillin or Co-Amoxiclav; also Trimethoprim

Analgesia

Warm olive oil drops

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What are some complications of acute otitis media?

Mastoiditis - infection → mastoid air cells → erosion of bony trabeculae. CT to check +/- surgical exploration

Facial palsy, Venous sinus thrombosis, Meningitis, Brain abscess

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What is chronic mucosal otitis media?

Persistent/recurrent infection and perforation - sequalae of AOM

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What can cause Chronic Squamous otitis media?

Cholesteatoma

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What are the two types of glue ear?

Can be:

Supparative - pus secretion

Secretory - mucoid secretions

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What is the pathophysiology of glue ear?

Inefficient drainage of the middle ear via eustatian tube → mucoid build up

Partial resorption of mucous → decrease pressure → drum retraction

Often bilateral

In what children is glue ear common?

Down’s Syndrome children, due to horizontal tubes

Also associated with adenoid infection - blocks exit

What is a possible cause of Glue ear in adults?

Nasopharyngeal Carcinoma

What are the symptoms and signs of glue ear?

Conductive hearing loss - may lead to behaviour problems/developmental delay

Recurrent infection +/- perforation

Retracted tympanic membrane

What is the treatment for glue ear?

Conservative - treat if two +ve tympanograms >3 months apart

Grommets - tube inserted through drum → equalise pressure, allow drainage

Adenoidectomy

Hearing aid

What investigations should be done for glue ear?

Tympanometry - measures membrane compliance

Noise sent down EAM, reflection from ear drum recorded

Pathology → ↓Compliance

What is a "safe" perforation? and how would you treat it?

Central perforation - rim of pars tensa all the way round perforation Treat cause Conservative - membrane should grow back Surgery - Myringo/Tympanoplasty - necessary if _umbo_ damaged, as source of epithelial growth

What is an "unsafe" perforation?

Marginal perforation/Attic perforation Any perforation involving margin of membrane or pars flaccida may → cholesteatoma growth +/- necrosis of underlying bone

How would you treat an "unsafe" perforation?

Combined approach tympanoplasty - graft close perforation but may enclose cholesteatoma Mastoidectomy - middle ear and drum destroyed - mastoid cavity and middle ear joined, and skin encouraged to grow along walls

What is a cholesteatoma?

Sac of epithelium grows into middle ear Due to sucking of pars flaccida into middle ear or Downwards migration of epithelium from attic/marginal perforation

What are complications of cholesteatoma?

Erode ossicles, inner ear, facial nerve or meninges (→ meningitis, abscess)

How would cholesteatoma present?

Discharge and _foul odour_ - infection of dead tissue at core Conductive hearing loss - ossicle erosion, or progress into inner ear Facial nerve palsy, mastoiditis, meningitis, brain abscess Examination might show visible cholesteatoma

What is the treatment of cholesteatoma?

Mastoidectomy - removal of middle ear and drum, mastoid cavity and middle ear joined and skin encouraged to grow along walls In early presentation, CA Tympanoplasty is possible.

What is otosclerosis?

Growth of small focus of bone - obstructing stapes vibration → oval window Inherited, autosomal dominant

What is the most common hearing loss cause in young/middle-ages adults?

Otosclerosis

How would someone with otosclerosis present?

Onset 30+ Progressive conductive hearing loss Also sensorinerual loss if cochlea affected

What investigations would you do for otosclerosis?

Audiograms conductive hearing loss in typical OS pattern Tympanograms - decreased compliance CT

What is the treatment for otosclerosis?

Stapedectomy - replace stapes with piston attached to incus

What is ossicular discontinuity?

Infection - long process of incus eroded Head trauma - dislocation

What is presbyacusis? what is the pathophysiology?

Progressive age-related sensorineural hearing loss. Hair cell degeneration, especially at base of cochlea (higher frequencies)

How does presbyacusis present?

Progressive, bilateral sensorineural hearing loss Loss of consonants Problem drowning out background noise

What investigation should be done for suspected presbyacusis?

Audiogram - symmetrical SN hearing loss, worse at high frequencies

What is the treatment for presbyacusis?

Hearing aids (inc. cochlear implant)

What noise level is significant for acute and chronic noise induced hearing loss?

Acute \>120dB Chronic \>80dB

What would the audiogram show for someone with noise induced hearing loss?

Notched audiogram - hearing loss worst at one frequency

What are possible causes for ototoxicity?

Drugs - Aminoglycosides (gentamycin), Furosemide, Platinum therapeutics Reversible drugs - quinine, aspirin

How does ototoxicity present?

SN hearing loss Tinnitus Vertigo +/- nystagmus

What is acoustic neuroma?

Vestibular Schwannoma - benign tumour of myelin sheath schwann cells of vestibular nerve in internal acoustic meatus Hearing is affected first - narrow acoustic nerve Motor neurons thicker, so balance compensates

How might acoustic neruoma present? What investigations should be conducted and what treatments?

Progressive unilateral sensory hearing loss Mild vertigo/imbalance but balacne centre compensates MRI Surgery or radiotherapy