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208 The Ear > Hearing Loss > Flashcards

Hearing Loss Flashcards

1
Q

What is conductive deafness?

A

Pathologies of the outer and middle ear

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2
Q

What is sensorineural deafness?

A

Pathologies of the inner ear

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3
Q

How would a Pinna deformity affect hearing?

A

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

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4
Q

What is canal atresia?

A

Congenital disorder → absent or closed external acoustic meatus

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5
Q

What is a cerumen plug?

A

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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6
Q

What is otitis externa? and what are the causes?

A

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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7
Q

What is the presenation of otitis externa?

A

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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8
Q

What is the treatment for otitis externa?

A

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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9
Q

What is osteotoma?

A

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

Stimulated by cold water

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10
Q

What is acute otitis media?

A

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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11
Q

What causes acute otitis media?

A

Usually capsulated gram +ves -

Strep P,

Haem Inf,

Moraxella Cartharralis

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12
Q

What are the symptoms of acute otitis media?

A

Discomfort → Deep pain (also over mastoid process)

Impaired hearing

Fever, malaise

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13
Q

What are the signs of acute otitis media?

A

Inflamed tympanic membrane pre-perforation

Perforation and profuse mucoid discharge post perforation

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14
Q

What is the treatment for acute otitis media?

A

Oral ABx - Amoxicillin or Co-Amoxiclav; also Trimethoprim

Analgesia

Warm olive oil drops

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15
Q

What are some complications of acute otitis media?

A

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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16
Q

What is chronic mucosal otitis media?

A

Persistent/recurrent infection and perforation - sequalae of AOM

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17
Q

What can cause Chronic Squamous otitis media?

A

Cholesteatoma

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18
Q

What are the two types of glue ear?

A

Can be:

Supparative - pus secretion

Secretory - mucoid secretions

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19
Q

What is the pathophysiology of glue ear?

A

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

Partial resorption of mucous → decrease pressure → drum retraction

Often bilateral

20
Q

In what children is glue ear common?

A

Down’s Syndrome children, due to horizontal tubes

Also associated with adenoid infection - blocks exit

21
Q

What is a possible cause of Glue ear in adults?

A

Nasopharyngeal Carcinoma

22
Q

What are the symptoms and signs of glue ear?

A

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

Recurrent infection +/- perforation

Retracted tympanic membrane

23
Q

What is the treatment for glue ear?

A

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

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

Adenoidectomy

Hearing aid

24
Q

What investigations should be done for glue ear?

A

Tympanometry - measures membrane compliance

Noise sent down EAM, reflection from ear drum recorded

Pathology → ↓Compliance

25
Q

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

A

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

26
Q

What is an “unsafe” perforation?

A

Marginal perforation/Attic perforation

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

27
Q

How would you treat an “unsafe” perforation?

A

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

28
Q

What is a cholesteatoma?

A

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

29
Q

What are complications of cholesteatoma?

A

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

30
Q

How would cholesteatoma present?

A

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

31
Q

What is the treatment of cholesteatoma?

A

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.

32
Q

What is otosclerosis?

A

Growth of small focus of bone - obstructing stapes vibration → oval window

Inherited, autosomal dominant

33
Q

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

A

Otosclerosis

34
Q

How would someone with otosclerosis present?

A

Onset 30+

Progressive conductive hearing loss

Also sensorinerual loss if cochlea affected

35
Q

What investigations would you do for otosclerosis?

A

Audiograms conductive hearing loss in typical OS pattern

Tympanograms - decreased compliance

CT

36
Q

What is the treatment for otosclerosis?

A

Stapedectomy - replace stapes with piston attached to incus

37
Q

What is ossicular discontinuity?

A

Infection - long process of incus eroded

Head trauma - dislocation

38
Q

What is presbyacusis? what is the pathophysiology?

A

Progressive age-related sensorineural hearing loss.

Hair cell degeneration, especially at base of cochlea (higher frequencies)

39
Q

How does presbyacusis present?

A

Progressive, bilateral sensorineural hearing loss

Loss of consonants

Problem drowning out background noise

40
Q

What investigation should be done for suspected presbyacusis?

A

Audiogram - symmetrical SN hearing loss, worse at high frequencies

41
Q

What is the treatment for presbyacusis?

A

Hearing aids (inc. cochlear implant)

42
Q

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

A

Acute >120dB

Chronic >80dB

43
Q

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

A

Notched audiogram - hearing loss worst at one frequency

44
Q

What are possible causes for ototoxicity?

A

Drugs - Aminoglycosides (gentamycin), Furosemide, Platinum therapeutics

Reversible drugs - quinine, aspirin

45
Q

How does ototoxicity present?

A

SN hearing loss

Tinnitus

Vertigo +/- nystagmus

46
Q

What is acoustic neuroma?

A

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

47
Q

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

A

Progressive unilateral sensory hearing loss

Mild vertigo/imbalance but balacne centre compensates

MRI

Surgery or radiotherapy

208 The Ear (4 decks)

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