Hearing Loss and Tinnitus Flashcards
t/f the inner 2/3 (bony) of the ear does not have ceruminous and sebaceous glands = no cerumen
true, skin is thin and tight, prone to injury
most common cause of hearing loss in ph
cerumen impaction
causes of cerumen impaction
cotton buds use
clinical presentation and treatment of cerumen impaction
- hearing loss or ear fullness
- pain is uncommon
treatment: manual extraction
represent abnormal accumulation of keratin in the external ear canal
keratosis obturans
cholesteatoma of external ear
cause of keratosis obtruans
overproduction of sq epithelium and/or faulty migration of epithelium with subsequent accumulation and impaction
presentation and treatment of keratosis obturans
- hearing loss
- enlarging keratin plug = diffuse widening of ear canal
- pain
treatment: removal of debris, antibiotics
clinical presentation of external canal cholesteatoma
- hearing loss with pain
- epithelial plug
- skin ulceration or bone necrosis
- granulation tissue and otitis externa
treatment for external canal cholesteatoma
remove debris and necrotic tissue, antibiotic therapy
3 types of otitis externa
acute circumscribed otitis externa
acute diffuse oe
otomycosis
cause of acute circumscribe oe
infection from trauma (s aureus)
presentation of acute circumscribed oe
- circumscribed swelling of outer 1/3
- hearing loss, pain, tragal tenderness
- purulent ear discharge
cause for diffuse otitis externa
- dip in water
- vigorous ear manipulation
- pseudomonas
presentation of diffuse otitis externa
- hearing loss and pain
- more severe than acoe
cause of otomycosis
aspergillus and candida
presentation of otomycosis
- ear pruritus!!
- hearing loss from cotton like fungal debris and purulent discharge
- pain
foreign body is more common in __ and can cause ___
younger age group
causes obstruction and hearing loss
t/f tumors in the external ear are usually malignant
false, malignant uncommon, usually benign (nevi, chondroma, osteoma, papilloma)
- no symptoms except hearing loss
causes of direct trauma on middle ear
overzealous cleaning or compressive barotrauma –> hearing loss, bloody otorrhea, tinnitus
otoscopy findings in direct trauma
- tympanic perforation with jagged edges
- ear drum congested with preset hematoma
what is the persistent infection of the middle ear where drainage accompanied by perforation of the tympanic membrane is seen
chronic otitis media
otoscopy findings in chronic otitis media
- tympanic membrane perforation with SMOOTH edge
- no bleeding or hematoma
- with mucoid discharge
in acute otitis media, the tympanic membrane can be perforated during the __ stage
suppurative stage
thickening of the fibrous middle layer of tympanic membrane (white patches from middle ear infections)
tympanosclerosis
otoscopy: whitish plaque
what is bullous myringitis
- primary inflammation of tympanic membrane
- bleb/blister/bulla
- caused by m pneumoniae, s pneumoniae, and moraxella
presentation of bullous myringitis
- acute progressive otalgia and hearing loss
- self limiting
- otoscopy: bleb/ blister/ bulla in lateral wall
cause of eustachian tube problems
stiffness of tympanic membrane increases due to negative pressure in middle ear and tympanic membrane is pulled inwards
causes of compromise in patency of e tube
- nasopharyngeal or nasal inflammation
- mechanical compression
== persistent middle ear negative pressure
most severe form of tympanic membrane retraction where pars tensa becomes adherent to bony medial wall of middle ear
adhesive otitis media
presentation of adhesive otitis media
- persistent conductive hearing loss
- otoscopy: retraction of tympanic membrane and outlining of ossicles (han solo)
when negative pressure induces transudation of fluid from middle ear mucosa into ear space
otitis media with effusion
presentation of otitis media with effusion
- only mild or no ear pain
- fullness in ear
- otoscopy: middle ear fluid is clear, air fluid level
occurs due to poor e tube function and drops in barometric pressure during diving/flying
otitic barotrauma
presentation of otitic barotrauma
- high pressures can retract ear drum and small vessels = hemorrhage
- hemotypmanum
- pain, ear fullness, loss of hearing
- otoscopy: hemorrhagic eardrum or hemotympanum
t/f increased stiffness or discontinuity of ossicular chain can cause decreased hearing
true
t/f chronic external ear infection can cause the gap between bony parts of ossicular chain to occur
false, middle ear infections
ossicular stiffness in children can be caused by ___
congenital underdevelopment of ear structures
what happens in cholesteatoma in middle ear
chronic infection -> squamous epithelium accumulates in mastoid and middle ear -> erode surrounding bone -> conductive hearing loss
hereditary condition that causes progressive hearing loss starting adulthood
otosclerosis
pathology in otosclerosis
- otospongosis forms at lip of stapes causing fixation of stapes on otic capsules
- normal otoscopy
most common congenital hearing loss
scheibe aplasia (aplasia of cochlear duct)
michel aplasia (lack of development of inner ear) mondini aplasia (underdeveloped cochlea has 1.5 instead of 2.5 turns) genetic syndromes
mechanisms of infectious hearing loss
- oval or round windows
- pre-formed pathways
- blood (hematogenous)
viruses that can cause hearing loss
mumps!!!
chickenpox, measles, influenza, adenovirus
t/f ototoxic drugs can use sensorineural hearing loss as well
true
enlarging masses in the __ can cause dysfunction in cn 8 can cause __ and __
internal acoustic canal
cause slowly progressive hearing loss, tinnitus, and vertigo
tumors in the iac
cn 7 schwannomas, meningiomas, hemangiomas, vascular malformations
age related hearing loss
presbycusis (loss of hair cells and cochlear neurons)
the __ is affected the most in environmental hearing loss
basal hair cells
causes hearing loss and reduced speech discrimination
abnormal noise perceived in one or both ears in the head
tinnitus
t/f tinnitus is a diagnosis
false, it’s a symptom and very common
most common form of tinnitus
subjective tinnitus
rare: objective tinnitus
hyperacusis and misophonia / phonophonia
hyperacusis: perception of over amplification of environmental sounds
misophonia / phonophonia: dislike or fear of environmental sounds
causes of tinnitus
- loud noise
- presbycusis
- middle ear problems
- vestibular disorders
- cn 8 damage or central auditory system change
- head and neck trauma
- medications
- vascular
- others
abnormal amounts of endolymph collecting in the middle ear
tear or rupture of oval windows –> leak of perilymphatic fluid from membranous to middle ear
secondary endolymphatic hydrops
perilymphatic fistula
damages to the cn 8
- acoustic neuroma (vestibular schwannoma)
- vestibular neuritis (viral)
- microvascular compression syndrome
hyperactivity in central auditory system is caused by damage to __
cochlea and vestibulocochlear nerve (8)
t/f tinnitus in head and neck trauma is perceived as louder and more severe
true (somatic tinnitus)
t/f masking devices can eliminate tinnitus
false, can obscure but not eliminate
therapy to help person retrain the brain to avoid thinking about tinnitus
tinnitus retraining therapy
goal: retrain conditioned negative response
t/f psychological treatment can help manage tinnitus
true
t/f there is a drug to cure tinnitus
false, but drugs can treat psychological effects
indications for surgery in tinnitus
acoustic neuroma, perilymph fistula, otosclerosis
most important interventions for reducing risk of tinnitus
- avoid exposure to loud sounds
- get prompt treatment for ear infections
