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ENT > Hearing Loss > Flashcards

Hearing Loss Flashcards

1
Q

Which anatomical structures may be damaged in sensorineural hearing loss (SNHL)?

A

Hair cells of the organ of Corti in the cochlea
CNVIII
Auditory cortex

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2
Q

Give some examples of genetic causes of SNHL?

A

Huge number of syndromes:

  • Connexin 26 GJB2 deafness
  • Waardenburg’s
  • Stickler
  • Usher’s
  • Pendred’s
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3
Q

Which antenatal factors might causes SNHL in a newborn?

A

Maternal infection –> rubella, chicken pox, HIV, CMV, streptococcus
Drug/alcohol misuse during pregnancy

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4
Q

What are some acquired causes of SNHL?

A 
Presbyacusis
Noise-induced hearing loss
Inflammatory
Trauma
Autoimmune
Tumours
Meniere's disease
Drugs
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5
Q

What is presbyacusis?

A

Age related high frequency SNHL

- loss of hair cells and neurones

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6
Q

What are the features of noise induced hearing loss?

A

Tinnitus common

Typically worst at 4kHz on audiogram

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7
Q

What are some causes of inflammatory SNHL?

A

Meningitis - important to identify in children who have had meningitis

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8
Q

What are the features of autoimmune SNHL?

A

Rapidly progressing, fluctuating, unilateral SNHL
Associated with vertigo and tinnitus
–> RA, GPA, sarcoidosis

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9
Q

Which tumours might cause SNHL?

A

Vestibular schwannoma

Meningioma

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10
Q

What are the features of a vestibular schwannoma?

A

Unilateral SNHL

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11
Q

What investigation should be done in a patient with unilateral SNHL?

A

MRI –> T1 weighted, gadolinium enhancement of CP angle + internal acoustic meatus

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12
Q

How is a vestibular schwannoma managed?

A

Yearly MRI to monitor for growth
If growing persistently:
- stereotactic radiosurgery
- surgical removal

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13
Q

What type of hearing loss is seen in Meniere’s?

A

Low frequency SNHL

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14
Q

Which drugs can cause SNHL?

A

Aminoglycosides e.g. gentamicin

Some chemotherapy agents

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15
Q

Which investigations should be done in someone presenting with hearing loss?

A

Pure tone audiogram (PTA) + Rinne/Weber
–> used in conjunction to see if SNHL or CHL
MRI if unilateral SNHL

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16
Q

How is Weber’s carried out and how are the results interpreted?

A

512Hz tuning fork in middle of forehead
If louder in one ear
–> conductive loss in that ear or
–> sensorineural loss in other ear

17
Q

How is Rinne’s carried out and how are the results interpreted?

A

Tuning fork held against mastoid process (bone) and in from of external auditory canal (air) - which is louder?

  • air louder than bone –> normal (+ve test)
  • bone louder than air –> conductive loss in that ear (-ve test)
18
Q

If Weber’s is central and Rinne’s in +ve bilaterally (AC>BC), what is the interpretation?

A 
Normal or 
Bilateral SNHL (presbyacusis)
19
Q

If Weber’s is louder in right ear and Rinne’s is +ve left and -ve right, what is the interpretation?

A

Conductive hearing loss right ear

20
Q

If Weber’s is louder in the right ear and Rinne’s is +ve right and -ve left, what is the interpretation?

A

SNHL left ear

21
Q

What are the management options for SNHL?

A

Open fitting hearing air –> mild hearing loss
Mould hearing aid
Cochlear implant –> profound SNHL where conventional hearing aids don’t help

22
Q

How might hearing loss present in young children?

A

Developmental delay

Behavioural problems

23
Q

How is hearing loss identified in newborns?

A

Newborn screening exam - automated otoacoustic emission
If fails twice –> automated auditory brainstem response audiogram
If fails –> audiology for further testing

24
Q

How is SNHL in a newborn managed?

A

Early aids/cochlear implants to improve communication outcomes

  • cochlear implantation age > 2 –> poorer outcomes
  • if deaf from birth, implantation > 5 is not worthwhile as too late for brain auditory centres
25
Q

What are the causes of conductive hearing loss and which parts of the ear do they affect?

A 
Ear canal:
- congenital: atresia
- acquired: stenosis, otitis externa, wax
Ear drum:
- perforation, cholesteatoma
Middle ear space:
- otitis media with effusion (glue ear)
- acute otitis media
Ossicles:
- congenital, trauma, otosclerosis
26
Q

What causes otosclerosis?

A

Fixation of the stapes footplate

27
Q

What are the features of otosclerosis?

A

Gradual onset conductive hearing loss with normal otoscopic appearance
More common in women –> progresses more rapidly during pregnancy

28
Q

What is the treatment for otosclerosis?

A

Surgery –> stapedectomy

or hearing aids

29
Q

How is otosclerosis investigated?

A

PTA –> 2kHz raised bone conduction threshold (Carhart notch)
CT

30
Q

What are the management options for excessive wax occluding the ear canal?

A

Topical ear drops –> warm olive oil, sodium bicarbonate
Microsuction
Jobson Horne wax probe
Syringing

ENT (14 decks)

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