Hearing loss Flashcards by Christine Hsu

Causes of sensorineural hearing loss

presbycusis

Meinere’s dx

Barotrauma

acoustic neuroma

cerebrovascular ischemia

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Sensorineural hearing loss is from

disorder involving inner ear, cochlea, and auditory nerve

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conductive hearing loss is from

any cause that limits sound from gaining access to inner ear

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causes of conductive hearing loss is from

otitis externa or media

cholesteatoma

trauma

cerumen

tympanic membrane perforation

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Purpose of Weber test

place tuning fork on forehead. normal is symmetric lateralization. This test only tells you there’s a difference. You need to do the Rinne test to figure out if conductive or sensorineural hearing loss.

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Rinne test shows

if there’s bone or air conduction is better. if weber lateralizes to left and Rinne test shows bone is better than air (bone >air) then it means it’s conductive hearing loss If weber lateralizes to left and Rinne test shows that air is better than bone conduction (air>bone) then there’s the opposite ear has sensorineural hearing loss.

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sudden sensorineural hearing loss needs evaluation with

audiometry and MRI to exclude vestibular schwannoma.

even if evaluation is nondiagnostic, some experts recommend empiric therapy with high dose systemic glucocorticoids and antiviral drugs valacyclovir

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otosclerosis and conductive hearing loss treatment

stapedectomy involves removal of stapes and replacement with a prosthesis.

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viral cocleitis

acute unilateral sensorineural hearing loss that recovers in 3-4 months.

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Patterns for hearing conductive hearing loss and sensorineural hearing loss with weber test.

Tuning fork on forehead. If there’s conductive hearing loss, the defect ear hears weber turning fork louder and normal ear is quieter. if there’s sensorineural hearing loss, the normal ear hears the tuning fork sound better and the affected ear hears it quieter.

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how to perform a Rinne test

vibrating tuning fork is placed on mastoid process behind each ear until sound is no longer heard.

Then without re-striking the fork, fork is placed quickly behind the ear with the patient to ask when the sound caused by vibration is no longer heard

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Normal Rinne test (positive test)

sound is still heard when the tuning fork is moved to air near the ear.

This means air conduction is longer than bone conduction.

AC>BC

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Negative Rinne test (abnormal Rinne test)

in conductive hearing loss bone conduction is better than air or

BC>AC so this means the patient does not hear the fork once it is removed from the mastoid process.

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why can’t we use the Rinne test by itself

not ideal for distinguishing sensorineural hearing loss.

Both sensorineural hearing loss and normal hearing report a positive Rinne test (normal Rinne test) since they can still hear a little of vibration once fork is moved to the air.

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what causes pulsatile tinnitis?

dural AV fistula

carotid cavernous sinus fistula

paraganglioma

inner ear muscle spasms

eustachian tube dysfunction

idiopathic intracranial HTN

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what causes non pulsatile tinnitis?

temporomandibular joint dx

ototoxic medications

presbycusis

otosclerosis

vestivular schwannoma

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what is tinnitus?

sound perception within head or ears that can be buzzing, ringing, hissing.

What is needed for someone who has pulsatile tinnitus?

needs a thorough investigation with NET consult and brain imaging.

what can cause non puslatile tinnitus?

generally less sinister causes - dysfunction in the auditory system - cochlear end organ, cochlear nerve, brain stem or auditory complex

what is tinnitus often a symptom of?

sign of sensorineural hearing loss even though pts may not complain of hearing los.

whispered voice test is:

test performed at standing one arm’s length behind pt

masked hearing in one ear and whispering a short sentence with letters and numbers

Ask pt to repeat sentence test is repeated by switching ears and occluding other ear.

presbycusis is

age related hearing loss

form of sensorineural hearing loss caused by inner ear disorders, processing centers in the brain or the vestibulocochlear nerve.

presentation of presbycusis

progressive symmetrical high frequency hearing loss (consonant sounds) over many years can

see bilateral tinnitus, vertigo and disqequilibrium leading to frequent falls.

pt has difficulty hearing with competing background sounds like at a party or with TV but appears to hear well on a one to one basis

presbycusis presentation.

why is important to identify presbycusis early?

to **prevent isolation and depression** in pt as they can't hear

how to evaluate for presbycusis

PE to exclude other causes of hearing loss like cerumen impaction and tumor. Do a whispered voice test and a Weber and Rine Test Get an audiogram to confirm diagnosis and guide treatment.

how to treat presbycusis

**hearing aides are effective** in most pts some refractory hearing loss may benefit from **cochlear hearing implants**

what are risk factors for presbycusis?

\>50% adults by **age of 75 yrs.** Factors affecting onset and severity include **socioeconomic status,** **exposure to noise and ototoxins,** **chronic dx (HTN, DM2, vascular dx)** **smoking.**

otosclerosis is

inherited disorder that caused by abnormal bony growth in the middle ear, footplate of the stapes and see unilateral conductive hearing loss.

Sensorineural hearing loss causes

Meniere's dx acoustic neuroma presbycusis ototoxic drugs (aminoglycosides)

treatment acoustic neuroma

surgical

acute labynrinthitis

severe peripheral vertigo, n/v gait instability that peaks in 1-2 days and improves

treatment of sudden sensorineural hearing loss is

dose 1mg/kg of prednisone per day or equivalent doses if other glucocortcoids are used with a max of 60 mg/day for 10-14 days.

test of choice to ruling out an acoustic schwannoma is

**MRI and audiometry test form** of unilateral sensorineural hearing loss.

Meniere's dx is seen with

recurrent episodes of vertigo tinnitus sensorineural hearing loss (unilateral) have ear fullness or pain in affected ear.

progressive high frequency hearing loss over many years this is sensorineural hearing loss

**Presbycusis** difficulty hearing with competing background sounds (social gatherings, TV sounds) but does well on a one-on-one basis

what are ototoxic drugs?

NSAIDs, aminoglycosides platinum based chemotherapy - cisplatin IV loop diuretics gentamicin.

unilateral conductive hearing loss that runs in families

consider **otosclerosis** inherited disorder caused by **abnormal bony growth of the middle ear** (footplate of the stapes) causes unilateral conductive hearing loss.

what should all patients who have sudden sensorineural hearing loss get?

audiometric evaluation and MRI rule out acoustic neuroma.

sudden sensorineural hearing loss presents with

hearing loss and lateralization to the opposite with Weber test and Rinne test showing air longer than bone condunction. also presents with fullness (like Meienere's dx)

labyrinthitis

**peripheral vertigo that is continuous and long lasting** with **sensorineural hearing loss.** Affects both branches of vestibulocochlear nerve 8 followed a URI.

Meniere's disease's vertigo is?

**recurrent spontaneous** and **brief episodes of vertigo** (which can last hours not seconds like BPPV), **tinnitis,** and **hearing loss.** nystagmus may be present. the hearing loss is sensorineural this is different from labyrinitis where the vertigo can last days. both can present after a URI.