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Otolaryngology/ENT > Hearing Loss > Flashcards

Hearing Loss Flashcards

1
Q

Causes of conductive hearing loss

A
  • Pinna
    • Microtia/atresia
  • EAC
    • Wax, FB, OE, osteoma, exostosis, stenosis
  • TM
    • Large perforations/large tympanosclerotic plaques
  • Middle ear
    • OME, haemotympanum, cholesteatoma, ossicular disruption, otosclerosis
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2
Q

Causes of sensorinuerual hearing loss

A
  • Inner ear
    • Cochlear aplasia/hypoplasia
    • Perilymph fistula
    • Otoxic medication
    • Meningitis
    • Meniere’s
    • Cochlear otosclerosis
    • Labyrinthitis
    • Noise induced HL
    • Presbyacusis (age-related sensorineural hearing loss)
  • Retrocochlear
    • Cochlear nerve damage
    • IAM/CPA lesions
    • Intracranial lesions/disease
  • Other
    • Vascular
    • Traumatic (otic capsule/central)
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3
Q

Pure tone audiometry

A
  • Two components frequency (pitch) and intensity (loudness)
  • Air conduction thresholds and bone conduction thresholds are measured
  • A difference in the two is called an air bone gap (ABG)
  • The CHL is quantified by the size of the ABG
  • SNHL is quantified as mild, moderate, severe or profound
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4
Q

Legend for audiograms

A
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5
Q

Normal audiogram

A
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6
Q

Conductive hearing loss - mechanical problem audiogram

A
  • Air bone gap seen in conductive hearing loss
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7
Q

Sensorineural hearing loss audiogram

A
  • No air bone gap - lines on top of each other
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8
Q

Age-related sensorineural hearing loss audiogram

A
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9
Q

Mixed hearing loss audiogram

A
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10
Q

Tympanometry

A
  • Abjective test of hearing (patient participation not required)
  • Middle ear function - middle and outer ear pressure needs to be equal for efficient sound energy to be transferred to the oval window
  • Sound is produced
  • Energy transfer to the ossicles then oval window then fluid in inner ear
  • Pressure changes occur due to sound vibrations which are measured
  • Test of compliance - ‘how springy is your ear’
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11
Q

Types of tympanograms

A
  • Compliance on y axis
  • Pressure on x axis
  • Type A - Normal
  • Type B - Perforation or glue ear
  • Type C - Eustachian tube dysfunction
  • Type As - Ossicular chain immobility
  • Type Ad - Ossicular chain disruption/hypermobility
  • Total canal volume is also provided and is large in case of perforation
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12
Q

Types of hearing aids

A
  • Air conductions hearing aids
    • Useful for high tone hearing loss
    • Moulds required for severe losses
    • Can predispose to moisture and infection
  • Bone conduction hearing aids
    • Indications
      • CHL with no benefit from AC hearing aids
      • Discharging/infected ear
      • Canal atresia
      • Mucrotia preventing wearing of normal AC hearing aid
      • May be useful in SNHL to improve directional hearing
  • Implantable devices
    • Bone bidges and vibrant sound bridges require surgical implantation so not always appropriate
  • Cochlear implants
    • While hearing aids can only amplify sound a cochlear implant transforms sound into electrical energy that is used to stimulate auditory nerves in the inner ear
    • Indications
      • Hearing ≤90dB at 2 and 4kHz and in adults if aided hearing BKB score <50%
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13
Q

Presbycusis (age-related hearing loss)

A
  • Peripheral degeneration and reduction in number of inner and outer hair cells
    • Leads to secondary neural (centrel degeneration)
    • Central component (atheriosclerosis)
  • Hearing impaired in background noise
  • Management - hearing aids
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14
Q

Tinnitus (symptom not a disease)

A
  • Sound perceived in he absence of any external acoustic of electrical stimulation
  • Any type of noise except speech
  • Increases with age
  • Commoner in depression/anxiety
  • Commoner with hearing loss
  • Higher prevalence in higher socio-economic classes
  • Can be bilateral or unilateral
  • Subjective - only heard by patient
  • Objective - somatosounds, other’s can hear (i.e. AVM, glomus, palatal or tympanic myoclonus)
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15
Q

Causes of tinnitus

A
  • Idiopathic
    • Drugs (i.e. salicylate, quinine, ototoxic)
  • Noise induced
    • Recreationary (i.e. concerts, temporary)
    • Hearing loss
  • Meniere’s
  • Vestibular schwannoma
  • Somatosounds
    • Vascular tumours
    • Vascular malformations
    • Increased ICP (venous hum)
    • Transmitted cardiac murmurs
    • Hyperdynamic states (i.e. pregnancy, hyperthyroidism, anaemia)
    • Neurological
    • Palatal myoclonus
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16
Q

Investigation and management of tinnitus

A
  • Hx - pulsatile, unilateral, associated vestibular symptoms of signs
  • Management
    • Habituation
      • Explanation and information
      • Reassurance
      • Marking (i.e. white noise, hearing aids)
      • Formal tinnitus counselling
    • Medication (rarely required)
      • TCA
      • Benzodiazepines
      • High dose lignocaine
    • Surgical (rarely required)
      • Anatomical causes (glomus tumour)
17
Q

Unilateral sensorineural hearing loss

A
  • Acousting neuroma a.k.a. vestibular schwannoma
  • Benign tumour
  • MRI to diagnose
  • Majority do not require active treatment
    • Watchful waiting
    • Stereotactic radiotherapy (small but growing rapidly)
    • Surgery
18
Q

Otosclerosis

A
  • Abnormal bone growth around stapes learing to stapes fixation
  • Gradual hearing loss
  • Age of onset young adult/adult
  • AD inheritence
  • Treatment
    • Hearing aid
    • Stapedectomy if does not tolerate hearing aid and sensorineural component negligible
      • Risk of dead ear
19
Q

Pharyngeal arch structures

A
20
Q

Newborn hearing screening

A
  • Should be done in the first 4 to 5 weeks, but it can be done at up to 3 months of age.
  • The test is called the AOAE (automated otoacoustic emission)
  • Test takes a few minutes. A small soft tipped earpiece is placed in the baby’s ear and soft clicking sounds are played. When an ear receives sound, the inner part (called the cochlea) responds and this can be picked up by the screening equipment.
  • It is not always possible to get clear responses from the first test. This does not necessarily mean your baby has a hearing loss. It can mean:
    • Baby was unsettled when the test was done
    • There was background noise
    • Baby has fluid or a temporary blockage in their ear – this is very common and passes with time
    • Baby has a hearing loss
  • In these cases offered another test. This may be the same as the first test, or another type called the AABR (automated auditory brainstem response) test. This involves 3 small sensors being placed on your baby’s head and neck. Soft headphones are placed over your baby’s ears and soft clicking sounds are played. This test takes between 5 and 15 minutes.
21
Q

Acquired causes of hearing loss

A
  • Prenatal (i.e. toxoplasma, rubella, CMV)
  • Perinatal (i.e. SCBU babies from hypoxia, jaundice, aminoglycoside antibiotics)
  • Postnatal (i.e. meningitis, head injury, ototoxic drugs such as cisplatin, aminoglycosides)
22
Q

Congenital causes of hearing loss

A
  • 1/3 syndromic (i.e. Usher’s Pendred’s Branchio-oto-renal, Jervell & Lange-Nielsen, Stickler’s)
  • 2/3 non-syndromic (i.e. deafness is an isolated feature, most AR conditions due to mutations in connein 26 gap junction gene)

Otolaryngology/ENT (20 decks)

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