Hearing Loss Flashcards
tumor that blocks ES
Nasopharyngeal tumor
Tx bell’s palsy *extra
steroid
DISEASES: external - pinna, canal
OE, Exostosis/Osteoma, Cerumen Impaction
DISEASES: middle - TM, Ossicles, ES
OM, Cholesteatoma, Otosclerosis, ETD
DISEASES: inner - cochlea, semicircular canals, auditory nerve
Meniere’s, BPPV, Aucoustic Neuroma, Sensorineural HL
labyrinth - location, function
Inner Ear
Hearing, Balance
Transmit to CN 8
what provide brain w/ info about Head Movement and Motion?
saccule
utricle
Conductive hearing loss:
Weber lateralizes to…
affected side
Sensorineural Hearing Loss:
Weber lateralizes to…
unaffected side
Rinne: AC>BC
normal
Sensorineural hearing loss
Rinne: BC>AC
Conductive Hearing loss
tinnitus risk factors
noise exposure old male smoker cardio disease
Intermittent tinnitus workup/Tx
NONE
pulsatile tinnitus
rhythmic with pulse
Tinnitus causes
idiopathic acoustic trauma (acute/chronic) Neuro damage vascular TM perf purulent/serous OM ETD
Tinnitus Dx
Refer ENT
subjective (most) vs. objective
Pulsatile? MRA/carotid doppler
imaging/neuro-otologic tests
Acute Tinnitus Tx
oral steroid taper
Chronic Tinnitus Tx
Lipoflavinoids
Niacin / B complex
White noise
Hearing aid
Tinnitus prevention
minimize noise exposure (<85dB)
which are first sounds to go in elderly hearing loss?
low decibel, extreme high + low frequencies
what frequency is cochlea near oval window?
high
Presbycusis : characteristics
sensorineural hearing loss
old age
symmetrical + high frequency
Presbycusis : risk factors
half adults over 75
genetic
noise exposure
DM/ atherosclerosis
Presbycusis : presentation
bilateral worsening over time difficulty w/ social situations can't localize tinnitus isolation
Presbycusis : Dx
Dx of exclusion
audiogram - symmetrical, high frequency loss
Presbycusis : Tx
Hearing Aid
Prevention (noise)
Acoustic trauma : damage frequency + decibel
high frequency, >85 dB
Acoustic Trauma : Presentation
hearing loss
tinnitus
Hx of noise exposure
Acoustic Trauma: Dx
PE normal
Audiometry = 4K noise notch
bilat/unilat
Acoustic Trauma: Tx
hearing aid
possible steroid
Prevention *noise
Where does Acoustic Neuroma/Vestibular Schwannoma grow?
CN 8 - Schwann cells
Acoustic Neuroma/Vestibular Schwannoma
: S/S
UNILATERAL hearing loss + tinnitus Headaches/dizziness Facial weakness/numbness Possibly silent until large continuous vertigo
Acoustic Neuroma/Vestibular Schwannoma
: risk factors
Neurofibromatosis Type II (cafe au lait/bilat)
Ionized radiation
What should you order if UNILATERAL Sensorineural hearing loss?
MRI
Acoustic Neuroma/Vestibular Schwannoma
: Dx
Audiogram: unilateral loss
**MRI - Cerebellopontine Angle w/ gadolinium contrast
Auditory Brainstem Response
Acoustic Neuroma/Vestibular Schwannoma
: Tx
Refer ENT/neurosurgery/radiation
Image/audio monitor every 6 mos.
Causes of conductive hearing loss
Cerumen impaction OM/OE TM perf Otosclerosis Mastoiditis Cholesteatoma Foreign Body Exostoses/Osteomas
Cerumen impaction : Presentation
Hearing Loss
Ear discomfort
Dizziness/tinnitis if impacted against TM
Cerumen impaction: Tx
Dissolve (H2O2, OTC)
Irrigation, removal
Refer ENT if fail or no audio return
Exostoses: cause
Cold water swimming as child
Exostoses (multiple) : Tx
Monitor
If obstruct, refer ENT
Osteomas (single - tympanic bone) - Tx
Monitor
Refer ENT if obstruction
Otosclerosis: risk factors
Genetic
White female
Young adult to middle age
Otosclerosis: what is
Spongy bone growth at stapes-oval window junction
Worsens over time
Possible tinnitus
Otosclerosis: Dx
TM moves normal
Conductive hearing loss (Carthart notch 2K)
DX: Temporal bone CT/exploratory surgery
Otosclerosis : Tx
Refer ENT : exploration, stapedectomy, ossicular chain reconstruction
*hearing amp/monitor
Cholesteatoma is
Middle ear cyst w/ keratin
Destroys middle ear, labyrinth, mastoid air cells, facial nerve, *middle cranial fossa of brain
Cholesteatoma: associated w/
ETD, TM perf, Congenital
Cholesteatoma : presentation
CHRONIC DRAINING EAR (brown/yellow/odor) PAINLESS Conductive H.L. Dizziness TM pearl DX: CT temporal bone, otoscope granular tissue
Cholesteatoma: Tx
Surgical excision
ETD : cause
- Hairs can’t remove
- Bad ES contraction
- Narrow ES
- Adenoid blocks ES
- Swollen nose blocked
- Adult - NP tumor (unilat OM)
ETD: associated w/
OM
Barotrauma
Maybe cholesteatoma
ETD : presentation
Follow URI/allergic rhinitis
Ear pain/pressure
Stuffy - valsalva useless
Hearing loss/ tinnitus
ETD : physical exam
Retracted TM
Tympanogram flat
ETD : Tx
Nasal Decongest - *Sudafed, *Afrin
Nasal steroid - *Flonase, *Nasonex
SEVERE - oral steroid, myringotomy/tube
