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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
noise exposure, inner ear cause of hearing loss
compounded overtime - damages inner ear hair cells
26
inner ear barotrauma
cause of hearing loss | pressure difference btw inner + middle ear --> oval window rupture
27
trauma, inner ear cause of hearing loss
penetrating - gunshot, fracture of temporal bone, blunt trauma may shear cochlea
28
tumors, inner ear cause of hearing loss
most common is vestibular schqannoma
29
endocrine/metabolic, inner ear cause of hearing loss
DM, hyperthyroid, anemia
30
autoimmune, inner ear cause of hearing loss
RA, SLE, polyarteritis nodosa
31
iatrogenic, inner ear cause of hearing loss
after surgery, radiation or medication
32
ototoxic substances (inner ear)
``` abx + chemo primarily gentamycin, tobramycin, tetracycline cysplatin, 5-FU high dose aspirin phosphodiesterase 5 inhibitors quinine, chloroquine cocaine lead, mercury, cadmium, arsenic ```
33
how does DM predispose to hearing loss
necrotizing cochlea
34
neurologic causes of hearing loss
CVA TIA Arnold-Chiari malformations MS
35
what does the vestibulocochlear nerve connect (CN VIII)
inner ear w brain
36
2 parts of CNVIII
1) transmitting sound | 2) helps balancing info from inner ear to brain
37
what is a vestibular schwannoma
acoustic neuroma schwann cell-derived tumors that arise from vestibular portion of CNVIII slow growing unilateral in 90% except in NF2
38
median diagnosis age of vestibular schwannoma
50 | rare in kids w/o neurofibromatosis type 2
39
vestibular schwannoma NF2 manifestation
neurofibromatosis type 2 (genetic disorder) bilateral, symmetric, non-malignant neuromas dysequillibrium headaches facial numbness + weakness hearing loss tinnitus
40
What gene is affected in vestibular schwannoma NF2
merlin gene - tumor suppressor
41
PE of pt w vestibular schwannoma NF2
abnormal corneal reflex - trigeminal (CN V) nystagmus facial hypesthesia
42
risk factors for vestibular schwannoma
NF2 childhood low-dose radiation hx of parathyroid adenoma exposure to loud noises - acoustic trauma
43
nerves affected by vestibular schwannoma + associated sx
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
physical exam of vestibular schwannoma
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
best initial screening test for vestibular schwannoma
audiometry
46
does degree of hearing loss in vestibular schwannoma correlate w size of tumor
no
47
diagnosis of vestibular schwannoma
asymmetric sensorineural hearing loss audiometry MRI w gadolinium 1-2mm CT w.o contrast first - then w contrast
48
treatment for vestibular schwannoma
surgery radiation observation conservation management
49
surgery for vestibular schwannoma
good long term control | 3 approaches: retromastoid suboccipital, translabyrinthine, middle fossa
50
retromastoid suboccipital surgical approach for vestibular schwannoma
for any size tumor w or w.o attempted hearing preservation
51
translabyrinthine surgical approach for vestibular schwannoma
for tumors larger than 3cm + for smaller tumors when hearing preservation is not an issue
52
middle fossa surgical approach for vestibular schwannoma
suitable for small <1.5cm tumors when hearing preservation is the goal
53
vestibular schwannoma surgical outcomes
few recurrences if whole tumor is removed | less favorable w subtotal removal - in effort to preserve facial or acoustic nerves
54
complications of surgical correction of vestibular schwannoma
``` hearing loss facial weakness vestibular disturbances persistent headaches CSF leakage hemorrhage infections ```
55
radiation therapy for vestibular schwannoma
sterotactic radiosurgery fractionated sterotactic radiosurgery proton beam therapy
56
proton beam therapy for vestibular schwannoma
delivery of high dose radiation to target volume while decreasing scatter to surrounding tissues
57
fractionated sterotactic radiosurgery for vestibular schwannoma
focused doses given over series of tx sessions
58
stereotactic radiosurgery for vestibular schwannoma
utilizes multiple convergent beams to deliver single beam high dose radiation (Gamma knife)
59
observation as a tx for vestibular schwannoma
slow growing (1-2mm a year) follow up MRI 6-12mo CI in pts w large tumors or brain stem compression
60
indications for conservation management of vestibular schwannoma
``` >60 yrs significant comorbidities lack of sx risk further hearing loss pt preference ```
61
what is cholesteatoma
destructive + expanding growth consisting of keratinizing squamous epithelium in middle ear or mastoid process can destroy ossicles
62
what causes cholesteatoma
3 causes: congenital primary acquired secondary acquired
63
congenital cholesteatoma
squamous epithelium trapped w.i temporal bone during embryogenesis identified in early childhood (6mo-5yrs) obstructed ET --> chronic middle ear infection
64
primary acquired cholesteatoma
result of progressive TM retraction over the ossicles, leading to their destruction
65
secondary acquired cholesteatoma
injury to TM, either perforation from otitis media or trauma | can be caused by placement of tympanostomy tubes
66
clinical presentation of cholesteatoma
painless otorerhea infections that are hard to eradicate hearing loss dizziness
67
PE of cholesteatoma
drainage granulation tissue in canal + middle ear TM perforation (90%- not in congenital)
68
diagnosis of cholesteatoma
no lab test or bx otoscopy head CT is modality of choice
69
management of cholesteatoma
surgical removal canal wall up canal wall down
70
canal wall up for cholesteatoma
preserves canal less invasive/complications higher rate of recurrence
71
canal wall down for cholesteatoma
removes posterior part of ear canal less likely to recur widens meatus
72
what fills the middle ear
gas- should not have fluid
73
why does pressure inside middle ear need to match the outside
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
what causes barotrauma
eustachia tube dysfunction blast injuries diving flying
75
primary blast injury
overpressure + subsequent shock waves
76
secondary blast injury
fragmentation
77
tertiary blast injury
blast wind propels body into fixed object
78
quaternary blast injury
flash burn, crush injury
79
what is a blast wave
single pulse of inc. air pressure (lethal = 100 PSI @ 1500mph) followed immediately by negative pressure blast
80
what body parts are most affected by blast waves
gas filled | ear, lungs, GI tract, sinuses
81
clinical manifestation of barotrauma
``` ear pressure pain w TM stretching hearing loss tinnitis vertigo ```
82
diagnosis of barotrauma
clinical good history otoscopy for ruptured TM
83
prevention of barotrauma
``` plan for pressure change avoid flying, cancel dives decongestants + antihistamines ear plugs ventilation tubes ```
84
tx of barotrauma
most heal w time supportive surgical tympanoplasty

clin med I exam II (10 decks)

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