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ENT > Hearing loss disorder > Flashcards

Hearing loss disorder Flashcards

1
Q

Otosclerosis : definition

A
  • Age related conductive hearing loss
  • Hardening of auditory ossicles in the middle ear - which transmit sound from tympanic membrane to cochlea in inner ear,
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2
Q

Otosclerosis : Pathophsyiology

A
  • Anatomy :
    1. Auditory ossicles : Malleus, incus, stapes } Middle ear
    1. Function : Transmit sound via vibrations from Tympanic membrane (outer ear) —> Oval window -> Cochlea in inner ear
  • Pathophysiology :
    1. Abnormal remodelling } changed shape of auditory ossicle
    1. Base of Stapes } attaches to oval window
    1. Stiffening } prevents sound transmission
    1. Conductive hearing loss
  • Cause
  • Autosomal dominant disease
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3
Q

Otosclerosis : Incidence

A

Young adults < 40 years old with +ve family history

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4
Q

Otosclerosis : Clinical presentation

A

Patient under 40 years presenting with unilateral or bilateral (both sided affected:
* Progressive development of sx
* Hearing loss } affects low pitched sounds more
* Tinnitus

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5
Q

Otosclerosis : Clinical signs

A
  • Otoscopy : ‘Pink flamingo tinge’ on tympanic membrane (10%)
  • Rinne’s test : Conductive hearing loss
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6
Q

Otosclerosis : Management

A
  • Conservative, with the use of hearing aids
  • Surgical (stapedectomy or stapedotomy)
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7
Q

Presbycusis : Definition

A
  • Age related - sensorineural hearing loss
  • Gradual, bilateral hearing loss - affects high-pitched sounds more
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8
Q

Presbycusis : Pathophysiology

A
  1. Age related changed in the inner ear such as;
    * Loss of hair cells in cochlea
    * Loss of neurone of cochlea
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9
Q

Presbycusis : Risk factor

A
  1. Older, males
  2. FH
  3. Hx of loud noice exposure
  4. Chronic disease : Diabetes, HTN,
  5. Smoking
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10
Q

Presbycusis : Clinical features

A
  • Hearing loss (slow and gradual) } affects > high pitch noise
    (high freq hair cells more prone to damage)
  • Bilateral
  • Assoc : Tinnitus
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11
Q

Presbycusis : Ix for diagnosis

A
  • Audiometry ;
    Sensorineural hearing loss - worse at higher frequencies
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12
Q

Presbycusis : Management

A
  1. Non reversible
    * Optimise environment (quiet for conversation)
    * Hearing aids / Cochlear implant
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13
Q

Cholesteatoma : Definition

A
  • Abnormal collection of squamous epithelial cells in the middle ear.
  • It is non-cancerous but can invade local tissues and nerves and erode the bones of the middle ear.
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14
Q

Cholesteatoma : Pathophysiology

A
  1. Squamous epithelial cells originate from the outer surface of the tympanic membrane
  2. Eustachian tube dysfunction- increases middle ear pressure and causes tympanic membrane to get pulled in
  3. The squamous cells lining the tympanic membrane - proliferate into the middle ear
  4. Damage ossicles and components of middle ear
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15
Q

Cholesteatoma : Presentation

A

The typical presenting symptoms are:
* Foul discharge from the ear
* Unilateral conductive hearing loss

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16
Q

Cholesteatoma : Clinical signs

A
  • Otoscopy : abnormal build up of white debris/crush in the upper tympanic membrane
17
Q

Cholesteatoma : Complications

A

As it expands into nearby tissues can cause;
* Vertigo
* Facial nerve palsy
* Increases risk of infection

18
Q

Cholesteatoma : Diagnosis

A
  1. CT head : visualise tumor
  2. MRI : visualise soft tissue damage
19
Q

Cholesteatoma : Management

A

Surgical removal

20
Q

Tinnitus : Definition

A
  • Persistent ringing in ears
  • Cause : Background sensory signal produced by the cochlea that is not effectively filtered out by the central auditory system
21
Q

Tinnitus : Causes

A
  1. Primary tinnitus : no identifiable cause and often occurs with sensorineural hearing loss.
  2. Secondary tinnitus : refers to tinnitus with an identifiable cause
  • Impacted ear wax
  • Ear infection
  • Ménière’s disease
  • Noise exposure
  • Medications (e.g., loop diuretics, gentamicin and chemotherapy drugs such as cisplatin)
  • Acoustic neuroma
  • Multiple sclerosis
22
Q

Tinnitus : Drug causes

A
  • Aspirin/NSAIDs
  • Aminoglycosides - Gentamicin
  • Loop diuretics
  • Quinine
23
Q

Tinnitus : Investigations

A
  1. Audiology
  2. Imaging (e.g., CT or MRI) : may be rarely required to investigate for underlying causes such as vascular malformations or acoustic neuromas.
24
Q

Tinnitus : Management

A
  1. Tinnitus tends to improve or resolve over time without any interventions.
  2. Treat underlying cause
  3. Symptomatic relief
    * Hearing aids
    * Sound therapy (adding background noise to mask the tinnitus)
    * Cognitive behavioural therapy
25
Q

Sudden hearing loss : Conductive causes

A
  1. Ear wax (or something else blocking the canal)
  2. Infection (e.g., otitis media or otitis externa)
  3. Fluid in the middle ear (effusion)
  4. Eustachian tube dysfunction
  5. Perforated tympanic membrane
26
Q

Sudden hearing loss : Sudden senorineural hearing loss

A
  • Sudden sensorineural hearing loss (SSNHL) is defined as hearing loss over less than 72 hours, unexplained by other causes
27
Q

Sudden hearing loss : SSNHL causes

A
  1. 90% of cases are idiopathic
  2. Infection (e.g., meningitis, HIV and mumps)
  3. Ménière’s disease
  4. Ototoxic medications
  5. Multiple sclerosis
  6. Migraine
  7. Stroke
  8. Acoustic neuroma
28
Q

Sudden hearing loss : Investigations

A
  1. Audiometry : 30 decibels in 3x consecutive frequencies on an audiogram
  2. MRI / CT head - r/o Stroke or Acoustic Neuroma
29
Q

Sudden hearing loss : SSNHL Management

A
  1. Immediate referral to ENT for assessment within 24 hours : tx with oral or intratympanic steroids

ENT (9 decks)

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