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Ear - Clinical Medicine IV > Hearing Loss > Flashcards

Hearing Loss Flashcards

1
Q

How many newborns have profound hearing loss?

A

1/800 to 1/1000

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2
Q

What is the pathway for conductive phase of hearing?

A

external ear to middle ear
vibration of TM -> ossicular chain malleus –> incus –> stapes –> oval window mvmt –> fluid waves go into vestiblue and cochlea

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3
Q

What is the pathway for sensoineural phase?

A

fluid wave inside chochlea causes displace of hair cells on BM –> electric signal –> cochlear nerve to brainsem

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4
Q

What does the labyrinth do?

A

vertigo and loss of balance, semicircular canals

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5
Q

What is the input regarding center of gravity and linear motion?

A

otoconia

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6
Q

What are the conductive hearing?

A

external and middle ear

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7
Q

What happens with damage past oval window?

A

sensioneural issues

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8
Q

What are the most common causes of hearing impairment?

A

impaction, eustachian tube dysfunction and increased age (presbycusis)

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9
Q

When should hearing screenings start?

A

at birth

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10
Q

Who gets screened?

A

sudden loss, kids at school age, at birth, pt over 50 yo, occupational, adults complaining of hearing loss

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11
Q

How can you tell if newborn has hearing loss?

A

doesn’t respond to voice in 1st wk

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12
Q

What could delayed motor development signal?

A

vestibular deficits that are often sensorineural hearing loss

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13
Q

What are things you should exam on external ear with hearing loss?

A

obstruction, infection, congential malformations, perforation of TM, otitis media, cholesteatoma

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14
Q

What neurological exams do you do?

A

CN function, balance, facial weakness, taste functions

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15
Q

What are landmarks on otoscope?

A

umbo, cone of light, malleus

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16
Q

What is the test where you place a 512 hz or 1024 hz on midline of head? Pt says which ear is louder

A

Weber

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17
Q

How does the weber test present for unilateral conductive hearing loss?

A

tone is louder in ear with hearing loss

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18
Q

What does weber test present for unilateral sensorineural hearing loss?

A

louder in normal ear, stims both inner ears equally but pt perceives stimulus with unaffected ear

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19
Q

What is the test for hearing by bone and air conduction, stem of a vibrating fork is held against mastoid then moved to pinna?

A

Rinne test

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20
Q

What is normal Rinne test?

A

AC>BC

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21
Q

What is conductive hearing loss in Rinne test?

A

BC>AC - rinne

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22
Q

What is sensorineural hearing loss?

A

AC and BC reduce but AC>BC. + rinne

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23
Q

What is an audiogram?

A

controlled test of hearing, sound proof booth and give tones and clicker, chart it

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24
Q

What is normal hearing in audiogram?

A

> 20-25 decibals - loudness

through all frequencies

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25
Q

What are the types of hearing loss?

A

conductive, sensori-neural, mixed, non-organic

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26
Q

What is a tympanogram?

A

tells if conductive hearing loss due to eustachian tube, where is the issue

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27
Q

What is the procedure for tympanogram?

A

put prob in ear, creates sucking, puts pressure and moves eardrum and records

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28
Q

Where do you want the peak in a tympanogram?

A

around 0 peak

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29
Q

What if a tympanogram is flat?

A

type B - Effusion no movement or perforation

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30
Q

How do you differentiate tympanogram flat?

A

large ear canal volume + flat = hole

Normal ear volume + flat = effusion

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31
Q

What is negative type C tympanogram?

A

retraction with eustachian tube closure

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32
Q

What is positive type C tympanogram?

A

pt is constantly popping ears and gets hypermobile, not common

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33
Q

What occurs from a dysfunction in transmitting sound of the outer or middle ear?

A

conductive hearing loss

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34
Q

What is conductive hearing loss deficit?

A

loudness only

35
Q

How do these pt present?

A

soft voice, excellent speech discrimination when loud enough, low frequency or flat hearing loss

36
Q

What happens in conductive hearing loss?

A

bone conduction = ability to hear

Air conduction = actual hearing

37
Q

What are the causes of conductive hearing loss?

A

occlusion/foreign body, congential atresia, otitis externa

38
Q

What is the most common cause of treatable hearing loss?

A

cerumen impaction

39
Q

When can you have permanent conductive hearing loss?

A

destruction of ossicles with otitis media

40
Q

What are characteristics of SNHL?

A

inappropriately loud voice, tinnitus, high frequency less common, speech sounds distorted, background noise makes it difficult to listen

41
Q

What is the tx for SNHL?

A

hearing aids

42
Q

How do you describe a SNHL audiogram?

A

rate it normal to moderate ect

43
Q

What area is of concern with SNHL?

A

2000 Hz

44
Q

What are causes of SNHL?

A

ototoxic drugs, ID, congenital, Head trauma, Presbycusis, Meniere’s disease, Acoustic neuroma, AI, Labyrinthitis, Noise exposure

45
Q

What is the noise notch?

A

audiogram 4000 Hz dip

46
Q

What is the onset of NIHL?

A

sudden in trauma, but more is gradual

47
Q

What is the fainest sound?

A

0

48
Q

What is whisper or quiet library?

A

30

49
Q

What is normal conversation?

A

60

50
Q

What is a lawnmover, shop tools, truck traffic?

A

90

51
Q

How long can you max exposure to 90 hz?

A

8 hrs

52
Q

What is chainsaw, pneumatic, snowmobile and whats the max time?

A

100 hz, 2 h/day

53
Q

What is sandblasting, loud rock concerts and time limit?

A

115 hz, 15 min

54
Q

What are the characteristics of NIHL?

A

affects 3000-6000 Hz first
Bilateral and symmetric
Tinnitus
Reduce speech comprehension

55
Q

Why do you get high frequency loss before low?

A

little hairs at front of hearing cochlea

56
Q

What are vowels?

A

low tone, 90% speech

57
Q

What are consonants?

A

high tones, give meaning

58
Q

What are the 4 Ps of NIHL?

A

painless, progressive, permanent, preventable

59
Q

What is the management of SNHL?

A

permanent and untreatable, hearing aids

60
Q

What is the most common cause of SNHL?

A

idiopathic

61
Q

What is the characteristics of sudden SNHL?

A
62
Q

What is the requirement for sudden SNHL?

A

hearing loss in 2 contingous frequencies of at least 20-30 dB

63
Q

What is sudden SNHL?

A

OTOLOGIC EMERGENCY

64
Q

When do most sudden SNHL occur?

A

first 2 weeks but recovery decreases with longer the loss

65
Q

How do you evalulate sudden SNHL?

A 
otoscopy, head and neck exam, CN exam
audiogram and tympanogram
Vestibular tests is present
MRI IAC/Brain with contrast
ABR if only mild/moderate severity of loss
Routine labs not typical
66
Q

What is dysfunction of inner ear or auditory nerve that is usually permanent and untreatable?

A

SNHL - loudness deficit and distorted hearing

67
Q

What are the ID causes of SNHL?

A

mumps, measles, meningitis, CMV

68
Q

What are the ototoxic drugs that cause SNHL?

A

aminoglycosides, erythromycin, vanco, chem, quinine, ASA, loop diuretics

69
Q

What head trauma causes SNHL?

A

temporal bone fracture

70
Q

What is the treatment for sudden SNHL?

A

refer - steroids mainstay
Prednisone PO 60 mg 7 d followed by 9 day taper
Intratympanic injection of steroids

71
Q

When do you give intra tympanic injections?

A

when 1 wk of PO not working
Dexamethasone 24 mg/mL
3 injections, 1 wk apart

72
Q

When does sudden SNHL pt return to baseline?

A

3-4 months post event

73
Q

What could cause unilateral SNHL?

A

sudden SNHL

74
Q

What is hearing loss with no medical or physical reason and may be voluntary or involuntary?

A

non organic hearing loss

75
Q

What is consciously faking or exaggerating a hearing impairment for monetary or personal gain to escape responsibility or anti-establishment?

A

malingering

76
Q

What are symptoms that can alert you to malingering?

A

substantial equal hearing loss at all frequencies or no response to pure tones
inconsistent results - unilateral
exaggerated attention to test

77
Q

What is central hearing loss involve?

A

CNS (cortex, brainstem or scending auditory pathway)

78
Q

What is central hearing loss associated with?

A

neurological disorders - MS, tumors

79
Q

What occurs as usually low frequency or flat, affects outer and or middle ear, usually temporary or medically/surgical treatable?

A

conductive hearing loss

80
Q

What is high freuqency loss, affects inner ear, usually permanent?

A

SNHL

81
Q

What usually affects both high and low frequencies, both conductive and SN but only conductive treatable?

A

Mixed hearing loss

82
Q

What is typically flat loss or total deafness in one ear, exaggerate a true loss, may be involuntary, prior results best clue?

A

non-organic hearing loss

83
Q

What is hearing for pure tones often normal, problem btw cochlea and cortex?

A

central hearing loss

Ear - Clinical Medicine IV (15 decks)

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