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ENT > Hearing Loss > Flashcards

Hearing Loss Flashcards

1
Q

what are the different types of hearing loss?

A

conductive
sensorineural
mixed

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2
Q

what is the pathophysiology of conductive hearing loss?

A

impaired sound transmission via the external canal and the middle ear ossicles to the foot of the stapes
Inner ear can still analyse signal

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3
Q

what are the different causes of conductive hearing loss?

A

o External canal obstruction
o Drum perforation
o Problems in the ossicular chain
o Inadequate eustachian tube ventilation of the middle ear

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4
Q

what are the causes of external canal obstructive causes in conductive hearing loss?

A

wax, pus, debris, foreign body, development anomalies, otitis externa, exostosis (suffers ear, abnormal bone growth in ear canal, gradual hearing loss), tumour, stenosis

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5
Q

what are the causes of drum perforation causes of conductive hearing loss?

A

trauma, barotrauma, infection

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6
Q

what are the causes of ossicular chain problems in conductive hearing loss?

A

otosclerosis, infection, trauma, otitis media, cholesteatoma, middle ear tumour, congenital malformation

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7
Q

what will an audiogram in conductive hearing loss show?

A

impairment in all frequencies

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8
Q

what is the management of conductive hearing loss?

A

treat underlying cause - will respond to treatment

surgical, pharmaceutical, supportive

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9
Q

what is the pathophysiology of sensorineural hearing loss?

A

results from defects central to the oval window in the cochlea (sensory), cochlear nerve (neural), or rarely, more central pathways
signal cannot be transmitted to brain

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10
Q

what are the causes of sensorineural hearing loss?

A 
o	genetic, congenital, presbycusis (age related), acquired (nose induced) 
o	Ototoxic Drugs
o	Post Infective 
o	Cochlear vascular disease
o	Meniere’s disease
o	Trauma 
o	Rare
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11
Q

what are the ototoxic drugs associated with sensorineural hearing loss?

A

streptomycin, vancomycin, gentamicin, chloroquine and hydroxychloroquine, vinca alkaloids)

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12
Q

what are the post infective causes of sensorineural?

A

meningitis, measles, mumps, flu, herpes, syphilis (damage cochlear)

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13
Q

what are the rare causes of sensorineural hearing loss?

A

acoustic neuroma, B12 deficiency, MS, brain mets

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14
Q

what is important to exclude in sensorineural hearing loss?

A

If unilateral exclude acoustic neuroma, cholesatoma , effusion from nasopharyngeal cancer

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15
Q

what is the shape of the audiogram in sensorineural hearing loss?

A

sloped

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16
Q

what is the pharmaceutical management of sensorineural hearing loss?

A

vitamins, vasodilators, anti-inflammatories

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17
Q

what is the definition of sudden hearing loss?

A

loss of >30dB in 3 contiguous pure tone frequencies over 3 days
Hearing loss may be sudden and abrupt, or rapidly progressive

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18
Q

what is the management of sudden hearing loss

A

depends on cause, high dose steroids (prednisolone), hyperbaric O2 therapy

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19
Q

what are the different kinds of hearing aids?

A

conventional
bone anchored hearing aids
cochlear implant s

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20
Q

what are the different types of conventional hearing aids?

A

Behind the ear (BTE)
In the Ear (ITE)
In the canal (IC)

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21
Q

what are the features of BTE hearing aids?

A

 consists of a case hanging behind the pinna
 case is attached to an earmold by a tube or wire
 tube or wire courses from superior-ventral protion of pinna to choncha, where the earmold inserts into external auditory canal

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22
Q

what is the structure of BTE hearing aids?

A

case contains the electronics, controls, battery + microphone

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23
Q

when at BTE hearing aids used?

A

good in severe hearing loss, versatile, good balance between ease and appearance

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24
Q

what are the features of ITE hearing aids?

A

 Fit in the outer ear bowl (concha)

 Custom made (mould taken)

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25
Q

what is the structure of ITE hearing aids?

A

made from silicone, being larger can hold extra features

26
Q

when at ITE hearing aids used?

A

used in mild hearing loss, superior cosmesis, feedback is a problem

27
Q

what are the advantages of Completely IC hearing aids?

A
  • Fits deeper in ear canal
  • Prevents wind noise + makes easier to use phone
  • Larger models stop plugging feeling
28
Q

what are the disadvantages of completely in canal hearing aids?

A
  • Doesn’t have directional microphone + battery life short

* Trickier to use, not suitable for severe hearing loss

29
Q

what are the advantages of invisible IC hearing aids?

A
  • Fits deep in canal
  • Custom made
  • Use of venting + deep positioning = more natural
  • Shape doesn’t block ear – sound collected more naturally to travel down canal
  • More suitable middle age device due to fiddleness
30
Q

what are the disadvantages of invisible in canal hearing aids?

A

• Not suitable for severe hearing loss

31
Q

what is the description of bone anchored hearing aids?

A

comprise of a titanium screw abutment and an external hearing aid processor. Titanium screws can be implanted into bone and become firmly anchored. This enables them to have a hearing air attached and allow sound to be transmitted to the cochlea via bone conduction (via skull bones)

32
Q

when are bone anchored hearing aids used?

A

patients with atresia of the ear canal, or in those who can’t have conventional aids e.g. continuous ear discharge

33
Q

how do cochlear implants work?

A

o cochlear implants bypass the peripheral auditory system
o pick up sound and digitises it, converts said signals into electrical signals and transmits those to cochlear electrodes
o electrodes stimulate cochlear nerve to send signals to brain

34
Q

what is structure the cochlear implants?

A

electrode array wrapped around cochlea, sound processor behind ear, coil that connects sound processor + electrodes

35
Q

what is the pathophysiology of osteosclerosis

A

new bone is formed around the stapes footplate, which leads to it fixation and subsequent conductive hearing loss

36
Q

what are cochlear implants used for?

A

non hearing children <3/4, adult who previously hear but can’t

37
Q

what is the cause of otosclerosis?

A

autosomal dominant with incomplete penetrance

38
Q

what are the clinical features of otosclerosis?

A

o conductive hearing loss (hearing better with background noise)
o young adults
o tinnitus and transient vertigo
o Pregnancy worsens symptoms

39
Q

what do eardrums look like in otosclerosis?

A

looks normal (maybe light pink tinge (Scwartzes sign)

40
Q

what does the audiometry look like in otosclerosis?

A

conductive pattern with dip at 2kHz (Caharts notch)

41
Q

what is the management of otosclerosis?

A

o Hearing aid
o Surgery – stapedectomy, stapedotomy (microdrill of CO2 laser)
o Cochlear implant (if severe)

42
Q

what is the pathophysiology of presbycusis?

A

Loss of hair cells on cochlear as age increases

43
Q

what is the cause of prebycusis?

A

age related

44
Q

what are the clinical features of presbycusis?

A

o SNHL
o Gradual, do not notice until hearing of speech is affected (loss of 3-4kHz)
o Most affected with background nose

45
Q

what is the audiogram of presbycusis?

A

high frequencies lost first, low frequencies stay in normal range, no increased air-bone gap

46
Q

what is the management of presbycusis?

A

hearing aids, no treatment to prevent worsening

47
Q

what are the additional causes of SNHL?

A

Idiopathic

Noise Exposure

48
Q

what are the features of idiopathic SNHL?

A

sudden deterioration, ear may feel blocked, tinnitus and vertigo

49
Q

what is the cause of idiopathic SNHL?

A

viral infection or vascular event

50
Q

what is the management of idiopathic SNHL?

A

bed rest and vasodilators

51
Q

what are the clinical features of noise exposure SNHL?

A

tinnitus and “wooly ears”, bilateral

52
Q

what is the audiometry of noise exposure SNHL?

A

loss of very high frequencies first, notch in audiometry

53
Q

what is the management of noise exposure SNHL?

A

aural hearing aids

54
Q

what is the pathophysiology of tinnitus?

A

o Spontaneous otoacoustic emissions, altered or increased spontaneous activity in the auditory nerve or central structures plastic reorganisation of central pathways, inappropriate feedback via descending pathways and auditory -limbic interactions

55
Q

what is the clinical feature of tinnitus?

A

“ringing” – perception of sound in absence of auditory stimulation

56
Q

what are the two types of tinnitus?

A

objective

subjective

57
Q

what is objective tinnitus?

A

tinnitus that audible to examiner

58
Q

what is subjective tinnitutis?

A

tinnitus that audible only to patient

59
Q

how is tinnitus diagnosed?

A

audiometry, tympanogram

60
Q

how is tinnitus managed?

A

o Treat underlying cause

o Symptom management – hearing aids, psychological support, CBT

61
Q

what are the causes of objective tinnitus?

A

Vascular Disorders: pulsatile vibratory sounds from e.g. AV malformations, carotid pathology, glomus tumours
High outlet cardiac states – Paget’s, hyperthyroidism, anaemia
Myoclonus or palatal or stapedius/tensor tympani muscles
Patulous Eustachian Tube

62
Q

what are the causes of subjective tinnuitits?

A

SNHL causing conditions – presbycusis, noise induced hearing loss, Menieres
 Conductive hearing loss – impacted ear wax, otosclerosis
 Ototoxic Drugs
 Others: hypo/hyperthyroidism, diabetes, MS, acoustic neuroma, trauma, anxiety, depression

ENT (13 decks)

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