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clin med I exam II > hearing loss > Flashcards

hearing loss Flashcards

1
Q

sensorineural hearing loss

A

involves inner ear, cochlea or auditory nerve

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2
Q

conductive hearing loss

A

outer or middle ear- doesn’t let sound get to inner ear

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3
Q

mixed hearing loss

A

combo of sensorineural + conductive

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4
Q

congenital, outer ear cause of hearing loss

A

atresia or stenosis of EAC

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5
Q

external auditory canal (EAC)

A

develops btw 8th+28th week of gestation

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6
Q

infection, outer ear cause of hearing loss

A

otitis externa- accumulation of debris, edema or inflammation

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7
Q

trauma, outer ear cause of hearing loss

A

penetration - knife, bullet or fracture causes scarring

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8
Q

tumor, outer ear cause of hearing loss

A

most common - squamous cell carcinoma- causes occlusion

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9
Q

benign growth, outer ear cause of hearing loss

A

exostosis- multiple benign bony growths

osteoma solitary

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10
Q

dermatologic, outer ear cause of hearing loss

A

psoriasis causes scaling and edema of eAC

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11
Q

cerumen, outer ear cause of hearing loss

A

NO Q TIPS! - perforation

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12
Q

congenital, middle ear cause of hearing loss

A

atresia or malformation of ossicular chain

most common abnormality is missing or malalignment of crura of the stapes

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13
Q

eustachian tube dysfunction, middle ear cause of hearing loss

A

allergies + URI

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14
Q

infection, middle ear cause of hearing loss

A

otitis media- fluid filling middle ear prevents TM from vibrating

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15
Q

cholesteatoma

A

causes hearing loss
middle ear
growth of squamous epithelium in middle ear, erodes ossicular chain

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16
Q

otosclerosis, middle ear cause of hearing loss

A

bony overgrowth of footplate of the stapes

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17
Q

TM perforation, middle ear cause of hearing loss

A

depends on size + location of perf

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18
Q

middle ear barotrauma

A

causes hearing loss in middle ear

sudden, large change in ambient pressure during flying or diving

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19
Q

jugulotympanic paragangliomas

A

cause hearing loss in middle ear highly vascular + benign growths , arise from TM + grow inward; can erode ossicles

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20
Q

congenital, inner ear cause of hearing loss

A

insult to developing cochlea

CMV, hepatitis, rubella, toxoplasmosis, HIV + syphilis

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21
Q

hereditary, inner ear cause of hearing loss

A

autosomal recessive, parents hear normally

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22
Q

presbycusis

A

age related hearing loss in inner ear

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23
Q

infection, inner ear cause of hearing loss

A

viral cochleitis due to meningitis destroys inner ear hair cells

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24
Q

meniere’s disease

A

cause of hearing loss in inner ear

occasionally affected by cochlear hydrops, episodic hearing loss that recovers

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25
Q

noise exposure, inner ear cause of hearing loss

A

compounded overtime - damages inner ear hair cells

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26
Q

inner ear barotrauma

A

cause of hearing loss

pressure difference btw inner + middle ear –> oval window rupture

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27
Q

trauma, inner ear cause of hearing loss

A

penetrating - gunshot, fracture of temporal bone, blunt trauma
may shear cochlea

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28
Q

tumors, inner ear cause of hearing loss

A

most common is vestibular schqannoma

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29
Q

endocrine/metabolic, inner ear cause of hearing loss

A

DM, hyperthyroid, anemia

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30
Q

autoimmune, inner ear cause of hearing loss

A

RA, SLE, polyarteritis nodosa

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31
Q

iatrogenic, inner ear cause of hearing loss

A

after surgery, radiation or medication

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32
Q

ototoxic substances (inner ear)

A 
abx + chemo primarily
gentamycin, tobramycin, tetracycline
cysplatin, 5-FU
high dose aspirin
phosphodiesterase 5 inhibitors
quinine, chloroquine
cocaine
lead, mercury, cadmium, arsenic
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33
Q

how does DM predispose to hearing loss

A

necrotizing cochlea

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34
Q

neurologic causes of hearing loss

A

CVA
TIA
Arnold-Chiari malformations
MS

35
Q

what does the vestibulocochlear nerve connect (CN VIII)

A

inner ear w brain

36
Q

2 parts of CNVIII

A

1) transmitting sound

2) helps balancing info from inner ear to brain

37
Q

what is a vestibular schwannoma

A

acoustic neuroma
schwann cell-derived tumors that arise from vestibular portion of CNVIII
slow growing
unilateral in 90% except in NF2

38
Q

median diagnosis age of vestibular schwannoma

A

50

rare in kids w/o neurofibromatosis type 2

39
Q

vestibular schwannoma NF2 manifestation

A

neurofibromatosis type 2 (genetic disorder)
bilateral, symmetric, non-malignant neuromas
dysequillibrium
headaches
facial numbness + weakness
hearing loss
tinnitus

40
Q

What gene is affected in vestibular schwannoma NF2

A

merlin gene - tumor suppressor

41
Q

PE of pt w vestibular schwannoma NF2

A

abnormal corneal reflex - trigeminal (CN V)
nystagmus
facial hypesthesia

42
Q

risk factors for vestibular schwannoma

A

NF2
childhood low-dose radiation
hx of parathyroid adenoma
exposure to loud noises - acoustic trauma

43
Q

nerves affected by vestibular schwannoma + associated sx

A

cochlear (95%) - hearing loss + tinnitus
vestibular (61%) - unsteadiness, tilting or veering
trigeminal (17%) - facial paresthesia, hypesthesia + pain
facial nerve (6%) - taste disturbances, facial paresis

44
Q

physical exam of vestibular schwannoma

A

asymmetric sensorineural hearing loss - rinne AC > BC, weber louder in good ear
decreased or absent ipsilateral corneal reflex
facial twitching
hypesthesia
audiometry- asymmetrical sensorineural hearing loss at high frequencies

45
Q

best initial screening test for vestibular schwannoma

A

audiometry

46
Q

does degree of hearing loss in vestibular schwannoma correlate w size of tumor

A

no

47
Q

diagnosis of vestibular schwannoma

A

asymmetric sensorineural hearing loss
audiometry
MRI w gadolinium 1-2mm
CT w.o contrast first - then w contrast

48
Q

treatment for vestibular schwannoma

A

surgery
radiation
observation
conservation management

49
Q

surgery for vestibular schwannoma

A

good long term control

3 approaches: retromastoid suboccipital, translabyrinthine, middle fossa

50
Q

retromastoid suboccipital surgical approach for vestibular schwannoma

A

for any size tumor w or w.o attempted hearing preservation

51
Q

translabyrinthine surgical approach for vestibular schwannoma

A

for tumors larger than 3cm + for smaller tumors when hearing preservation is not an issue

52
Q

middle fossa surgical approach for vestibular schwannoma

A

suitable for small <1.5cm tumors when hearing preservation is the goal

53
Q

vestibular schwannoma surgical outcomes

A

few recurrences if whole tumor is removed

less favorable w subtotal removal - in effort to preserve facial or acoustic nerves

54
Q

complications of surgical correction of vestibular schwannoma

A 
hearing loss
facial weakness
vestibular disturbances
persistent headaches
CSF leakage
hemorrhage
infections
55
Q

radiation therapy for vestibular schwannoma

A

sterotactic radiosurgery
fractionated sterotactic radiosurgery
proton beam therapy

56
Q

proton beam therapy for vestibular schwannoma

A

delivery of high dose radiation to target volume while decreasing scatter to surrounding tissues

57
Q

fractionated sterotactic radiosurgery for vestibular schwannoma

A

focused doses given over series of tx sessions

58
Q

stereotactic radiosurgery for vestibular schwannoma

A

utilizes multiple convergent beams to deliver single beam high dose radiation (Gamma knife)

59
Q

observation as a tx for vestibular schwannoma

A

slow growing (1-2mm a year)
follow up MRI 6-12mo
CI in pts w large tumors or brain stem compression

60
Q

indications for conservation management of vestibular schwannoma

A 
>60 yrs
significant comorbidities
lack of sx
risk further hearing loss
pt preference
61
Q

what is cholesteatoma

A

destructive + expanding growth consisting of keratinizing squamous epithelium in middle ear or mastoid process
can destroy ossicles

62
Q

what causes cholesteatoma

A

3 causes:
congenital
primary acquired
secondary acquired

63
Q

congenital cholesteatoma

A

squamous epithelium trapped w.i temporal bone during embryogenesis
identified in early childhood (6mo-5yrs)
obstructed ET –> chronic middle ear infection

64
Q

primary acquired cholesteatoma

A

result of progressive TM retraction over the ossicles, leading to their destruction

65
Q

secondary acquired cholesteatoma

A

injury to TM, either perforation from otitis media or trauma

can be caused by placement of tympanostomy tubes

66
Q

clinical presentation of cholesteatoma

A

painless otorerhea infections that are hard to eradicate
hearing loss
dizziness

67
Q

PE of cholesteatoma

A

drainage
granulation tissue in canal + middle ear
TM perforation (90%- not in congenital)

68
Q

diagnosis of cholesteatoma

A

no lab test or bx
otoscopy
head CT is modality of choice

69
Q

management of cholesteatoma

A

surgical removal
canal wall up
canal wall down

70
Q

canal wall up for cholesteatoma

A

preserves canal
less invasive/complications
higher rate of recurrence

71
Q

canal wall down for cholesteatoma

A

removes posterior part of ear canal
less likely to recur
widens meatus

72
Q

what fills the middle ear

A

gas- should not have fluid

73
Q

why does pressure inside middle ear need to match the outside

A

for TM to vibrate normally + hearing to sound clear

if it’s not it can cause negative pressure in the middle ear with anything about 1Pa change–> inward rupture of TM

74
Q

what causes barotrauma

A

eustachia tube dysfunction
blast injuries
diving
flying

75
Q

primary blast injury

A

overpressure + subsequent shock waves

76
Q

secondary blast injury

A

fragmentation

77
Q

tertiary blast injury

A

blast wind propels body into fixed object

78
Q

quaternary blast injury

A

flash burn, crush injury

79
Q

what is a blast wave

A

single pulse of inc. air pressure (lethal = 100 PSI @ 1500mph)
followed immediately by negative pressure blast

80
Q

what body parts are most affected by blast waves

A

gas filled

ear, lungs, GI tract, sinuses

81
Q

clinical manifestation of barotrauma

A 
ear pressure
pain w TM stretching
hearing loss
tinnitis
vertigo
82
Q

diagnosis of barotrauma

A

clinical
good history
otoscopy for ruptured TM

83
Q

prevention of barotrauma

A 
plan for pressure change
avoid flying, cancel dives
decongestants + antihistamines
ear plugs
ventilation tubes
84
Q

tx of barotrauma

A

most heal w time
supportive
surgical tympanoplasty

clin med I exam II (10 decks)

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