Hearing loss and vertigo Flashcards
what is in middle ear
- ossicles
- malleus, incus, stapes - middle easr cleft
- tympanic membrane
what is sense in the cochlea
- organ of corti
- tonotopically organized - base high freq, apex low
2 parts of labrynth and funct.
3 semicircular canals - rotational movements
2 otoliths - linear movement
- utricle
- saccule
what does weber test show
normal - hear on both sides
if hear on one side - C loss on same ear, or SN on opposite ear
what are 2 possible findings on rinne and what they mean
AC>BC - normals
BC>AC - conductive loss
what is normal audiogram
should have range in 20s
O - R
X - L
3 things seen in conductive hearing loss
- AC are outside normal limits
- BC are normal
- > 15dB gap between BC and AC
3 things seen in SN loss
- AC outside normal
- BC outside normal
- gap less than 15dB between 2
3 Tx of cerumen impaction
- cerumenolytics
- syringing
- debridment
4 contraindications to syringing
- non-occulsive
- previous ear surgery
- only hearing ear
- tympanic membrane perf
clinical features of ot. externa
- PAIN - severe and with touching tragus
- otorrhea
- CLoss
etiology and risk for ot. externa
etio - bacteria risks - swimmer - trauma - Q-tip - hearing aids
5 Tx for ot externa
- debridment
- analgesia
- local AB drops
- anti-pseudomonal
- corticosteroids - pope wick
- systemic ABs if complications
1 ear drop prescription
ciprodex
- cipro and dexamethasone
what is malignant OE
osteomylitis of temporal bone
- elderly, immunocompromised
- 99% pseudomonas
- nocturnal pain
- granulation tissue in audtoyr canal
5 Tx for malignant OE
- admit
- IV AB
- debridement
- CT
- gallium scan
3 middle ear diseases
- cholesteatoma
- otosclerosis
- perf
what is cholesteatoma
- squamous epithelium of middle ear/mastoid
- due to retracted pockets of pars flaccida
- presents with draining and hearing loss
- surg. Tx
2 general types of complications of chole
- local
- cond. HL
- SNHL
- vertigo
- mastoiditis - intracranial - into dura
- meningitis
- sigmoid sinus thromboisi
what is otosclerosis
bony fixation of the stapes to oval window
- 1% of pop
- F>M - esp in preg
clinical signs of otosclerosis and what is seen on audiogram***
- progressive cond. HL
- CARHART notch at 2000Hz
3 Tx for otosclerosis
- serial audiograms
- hearing aids
- stapedectomy
2 main etiologies of perfs
- infections - O media
- traums
- baro
- direct
- syringing
3 types of perfs
- central - no annulus
- marginal - involves annulus
- subtotal - large, with intact annulus
mgmt of perf
- remove debris
- keep ear dry until healed
- no drops unless infection
- monitor
- tympanoplasty if not resolved
2 main cats of SN hearing loss
- congential
2. aquired
2 main cats of congential
- herditary
- syndromic
- non-syndromic - non- heriditary
- TORCH
- meningitis
6 types of aquired (cochelar)
- presbycotisis
- noise induced
- ototoxicity
- meniers
- sudden SN loss
- temporal bone trauma
what is presbycucsis and what is seen on audiogram**
age related
- progressive bilateral loss of high freq
what is noise induced and what is seen on audiogram***
prolonged exposure to >85dB
- “boilermaker” notch at 4khz
- can have perm or temp. threshold shift
3 main causes of ototoxicity
- aminoglycocides
- salicylates
- chemo - cicplatin
what is mech of ototox
- outer hair cells most susceptable
- high freq. loss
what is sudden SN loss
- sudden unilateral loss
- idiopathic
- must rule out retrocochlear path
Tx of SNHL
steroids in 72 hrs
functions of vestibular system
- maintain balance and gaze stability
- perceive linear and angular accel
def. vertigo
- hallucination of movement
- spinning sensation
3 main types of vertigo based on time
- benign positional - sec-minutes
- menieres - minutes-hours
- vestibular neuronitis - days-weeks
what is benign positional
- caused by Ca debris in post. semi-circualr canal
- provoked by certain head movements
how to diagnose BPPL
Hx
- dix halpike in 50-80%
Tx of BPPV
- REASSURE
- epley
- semont
3 things for “definite meniers”
- 2 spontaneous episodes of vertigo lasting at least 20 minutes
- audiometric confirmation of SNHL
- tinnitus and/or perception of aural fullness
meniers triggers
- salt
- caffeine
- alc.
- nicotine
- stress
- MSG
mgmt of acute meniers
- vestibular supressants
- anti-emetics
- diet
- diuretics
- betahistine
3 types of surgical mgmt
vestibular ablation
- gentamicin injection
- vest. neurectomy
- labrynthectomy
what is vestibular neurontis
spontaneous nystagmus that is unilateral, horizonatal or torsional
- neuro Sx are absent
2 phases of vest. neurontis
- acute (1-5 days)
- vert/N/V/imbalance
- nystagmus - convalescent
- imbalance, motion sickness (days-weeks)
- adaptation - weeks-months
Tx of vest. neurontis
spntaneous complete recovery in most
- Tx aimed at stopping inflammation
