Hearing Loss - Exam 3 Flashcards
Briefly describe how hearing works
auricle catches sound waves, waves vibrate the TM which causes the ossicles to move in a piston-like effect of the stapes pushes the vibrating sound waves into the cochlea, sound vibrations makes the fluid in the cochlea move which stimulates the hair cells, hair cells generate a nerve impulse to that travels to the brain to create a meaningful sound
Name 3 life events during which people are screened for hearing loss
birth
kindergarden
pre-employment or military physicals
All newborns should be screened before they reach ____ of age. Either _____ or _____. **If you fail, need to have Audiologic assessment by ____ of age. Intervention needs to be completed by ___ of age. Why is it important?
one month
otoacoustic emissions (OAE)
automated auditory brainstem response (AABR)
**3 months
6 months
early invention is important for SPEECH
Describe the Otoacoustic Emissions (OAE) test. What is normal? abnormal?
Sound generated in inner ear; checks inner ear’s response. The hair cells respond by sending back vibrations; echoes in mid ear. Small earphone in the baby’s ear that plays a sound that should echo into the baby’s ear canal
Normal: hair cells in normal functioning ear send back vibrations
Abnormal: no echo aka hearing loss
Describe the Auditory Brainstem Response (ABR). What is normal? abnormal?
electrodes patches placed on baby’s head and soft earphones in ears. A computer checks the baby’s brain waves to see how the brain is reacting to the sound. Test can show if the brain isn’t getting sound information in a clear manner
usually performed after surgery
What does a full workup for a baby who failed their first hearing evaluation include?
-repeat ABR testing
- test that measures how a baby reacts to sound
-how early respond to sound
**Name 5 signs that indicate that a baby is having trouble hearing
-Not being startled by loud sounds
-Not turning toward a sound after he’s 6 months old
-Not saying single words like “mama” or “dada” by the time he’s 1 year old
-Turns his head if he sees you, but not if you only call out his name
-Seems to hear some sounds but not others
Children who are at risk for acquired, progressive or delayed onset hearing loss should repeat hearing test by _____
2 1/2 years
_____ is the testing method of choice used 6 months to 2 years. Describe the test.
Visual Reinforcement Audiometry (VRA)
Child is trained to look toward a sound source. When child gives a correct response, they are rewarded with visual reinforcement (such as a toy)
What age range is Conditioned Play Audiometry (CPA) used? Describe the test.
ages 2-5 years old
Child is trained to perform activity when a sound is heard. Activity may include putting a block in a box or peg in a hole
_____ determines the faintest tones in decibels (dB) a person can hear at selected frequencies (pitches), from low to high
Earphones are worn and patient is in sound proof booth to prevent outside extraneous stimulation. What are 2 limitations?
Pure Tone Audiogram
- subjective to patient behavior
- limited to children and adults old enough to cooperate with testing
the audiogram graph, what does the y axis represent? x axis? where are soft sounds heard? loud sounds? what is the normal range?
X: pitch or frequency
Y: intensity of sound
soft sounds are graphed at the top and loud sounds are at the bottom
normal: is -10 to 20
Audiogram: Testing with headphones is called ______ testing because the sound must travel through the air of the ear canal to reach the inner ear. ______ testing, in which a device is placed behind the ear in order to transmit sound through the vibration of the mastoid bone
air conduction
Bone conduction
air conduction results right ear are ___. left ___
Bone conduction: are _____
air right: O
air left: X
bone: [ or <
**What is mixed hearing loss defined as ?
decrease in both air and bone conduction with at least 15 decibal difference between the two
_____ measures the mobility (or compliance) of the tympanic membrane and the small bones in the middle ear. The eardrum moves in and out when varying pressures are applied to the ear canal
When the eardrum is activated by a sound wave, part of the sound is absorbed and sent through the middle ear, while the other part of the sound wave is reflected.
What are the 3 types?
Tymphanogram
Type A
Type B
Type C
Name 5 reasons you would order an tympanogram.
Otitis media
Fluid in middle ear space
Eustachian tube dysfunction
Indirectly can diagnose hearing loss
Tympanic membrane perforation
Information obtained with _____ includes compliance (flexibility or stiffness) of the middle ear system, ear canal volume, and an estimate of middle ear pressure. Where is the probe placed?
tympanometry
placed snugly in the external ear canal
Describe this finding. What test?
type A: normal, middle ear system without fluid and normal conduction to cochlea. Shows maximal peak compliance
tympanogram
Describe this finding. What test?
Type B: abnormal, no compliance. Indicates a severely restricted mobility of the middle ear system, and often is consistent with otitis media.
**aka middle ear pathology, effusion or perforation
tympanogram
Describe this finding. What test?
Type C: abnormal, eustachian tube dysfunction due to inadequate ventilation of the middle ear space.
indicates negative pressure in the **middle ear space consistent with middle ear infection or cold
tympanogram
Describe what test results you would expect from a person with sensorineural and conductive hearing loss when you conduct the Rinne and Weber test
What are the 3 categories of hearing loss. Name some causes of each
conductive: aka anything that blocks the sound from coming through the canal
sensorineural
mixed (both)
Conductive hearing loss occurs when sound is not conducted efficiently through the ______ to the ____ ear which is composed of ____ and _____
outer ear canal to the middle ear
tympanic membrane and ossicles
**For conductive hearing loss, using the Rinne test which one is greater? BC or AC
BC > AC
**For conductive hearing loss, what is the result of the Weber test?
Lateralized to defective ear
_______ occurs when there is damage to the inner ear (Cochlea) or to the nerve pathways from the inner ear to the brain. What pitch do they lose?
sensorineural
loss of hearing higher pitched sounds
**Sensorineural hearing loss, what is the result of the Weber test? What is the result of the Rinne test?
Lateralization to Good ear
AC > BC
Rinne test
______ MC permanent loss, not easily medically or surgically corrected
Sensorineural hearing loss
____ one parent carried dominant gene for hearing loss and typically has a hearing loss passes it on to child. 50% probability that child will have hearing loss. Also more likely to occur if grandparents have hearing loss.
Autosomal Dominant Hearing Loss
Treacher Collins and Crouzon Syndrome are examples of ______
Autosomal Dominant Hearing Loss
_____ both parents who typically have normal hearing but carry recessive gene. Probability of child having hearing loss is 25 %. Usually unexpected for the child to have hearing loss
Autosomal Recessive Hearing Loss
Usher Syndrome is an example of ______
Autosomal Recessive Hearing Loss
_____ mother carries recessive trait for hearing loss on the X chromosome. She can pass trait onto male and female, although most commonly males affected.
X-linked Hearing Loss
Alport Syndrome is an example of ______
X-linked Hearing Loss
Name 5 causes of hereditary hearing loss
(1) Intrauterine infections (TORCH)
(2) RH factor incompatibility
(3) Prematurity
(4) Anoxia (brain injury at birth)
(5) Hyperbilirubinemia
What are the 8 intrauterine infections that can lead to hearing loss?
Toxoplasma gondii
syphillis
parvovirus B19
varicella zoster virus
listeria
rubella
cytomegalovirus
HSV-2
ototoxic drugs usually cause ___ hearing loss. What nerve does it damage
bilateral
CNVIII
**What are 7 drug classes with 10 drugs that can cause ototoxicity?
**Salicylates : Aspirin
Quinine : Anti-malarial drugs, tonic water
**Loop Diuretics: Lasix or demadex
**Aminoglycoside antibiotics: Gentamicin or Tobramycin
Macrolide antibiotics: Erythromycin
Anti-neoplastic drugs: Platinum containing
Cisplantin and Carboplantin
Heavy metal: Mercury and Lead
_____ is a disease of the ossicular chain. Stapes footplate affixes to the oval window causing a conductive hearing loss
Otosclerosis
______ Abnormal growth of bone in the middle ear. Prevents structures within the ear from working properly
Otosclerosis
Otosclerosis is ????. What is essential in these patients?
Inherited, Autosomal Dominant, meaning 50% obtaining otosclerosis if one parent has it
**Essential to get good FAMILY HX
Otosclerosis hearing loss begins at what age range? What gender?
Hearing loss begins on average between age 10 to 30. Women 2 X more likely than men
Slowly progressive unilateral or bilateral conductive hearing loss
May report improved hearing with background noise, a paradoxical phenomenon
Tinnitus
normal, intact mobile TM
a “flamingo flush” or Schwartz sign
What am I?
What are the dx tests with results?
What is the tx?
Otosclerosis
-Otoscopic exam
-Audiogram to document conductive hearing loss
-Weber test should lateralize to the ear with the greater conductive deficit
-CT scan of temporal bones some benefit
tx: Stapedectomy, and if sensorineural damage occurs may also require amplification (hearing aid)
Describe the “flamingo flush” or Schwartz sign. What dz is it associated with?
a red blush of the TM over the promontory
Otosclerosis
What is this?
“flamingo flush” or Schwartz sign in otosclerosis
What is this?
Tympanosclerosis
Describe the pattern of presbycusis hearing loss. **What gender? What is it commonly confused with?
Progressive Bilateral symmetrical sensorineural hearing loss especially at HIGH pitch frequencies
**More severe in males and commonly confused with Noise Induced Hearing Loss
**What are the anatomy changes that happen to the ossicles and cochlea in presbycusis?
Ossicles: joints between bones calcify and become thinner
Cochlea: outer and inner hair cells degenerate
What is the tx for presbycusis? What is the OTC supplement that may be benefitial?
tx: hearing aids
OTC supplement: CoQ 10
_____ is a benign tumor of the schwann cells that occurs on the nerve that communicates the ear to the brain (CN VIII). What is the pattern of hearing loss?
Acoustic Neuroma (Vestibular Schwannoma)
Unilateral, sensorineural hearing loss
compresses CN VIII
What are schwann cells?
myelin forming cells
Unilateral hearing loss (sometimes sudden)
Tinnitus
Dizziness and Balance problems
What am I?
How do you dx?
What is the tx?
Acoustic Neuroma
MRI of the brain
sx or radiation
____ permanent hearing impairment usually results from prolonged exposure to high levels of noise. What is it due to? What percent of americans?
noise induced hearing loss
due to hair cell damage/death
1 in 10 Americans
Noise induced hearing loss is caused by long or repeated exposure to ____ decibels
85+
Routine audiologic screening is recommended for adults with prior exposure to potentially injurious noise levels or in adults at age ____ and every few years thereafter
age 65
What are some effects of untreated hearing loss: 6 reasons
depression, anxiety
accelerated rate of cognitive decline
higher incidence of dementia
higher falls risk
higher healthcare costs
more hospital stays
_____ is an electronic device that restores partial hearing for patients with advanced hearing loss who gain limited benefit from a conventional hearing aid
cochlear implant
**_____ is considered the GOLD standard for auditory rehabilitation of advanced sensorineural hearing loss (SNHL) and poor speech perception for both adults and children.
cochlear implant
Cochlear implant: external microphone and speech processor worn on the ear and a receiver implanted underneath the _____ muscle. The internal receiver is attached to an electrode that is placed surgically in the _____
temporalis muscle
cochlea
