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ENT > Hearing Loss in adults and children > Flashcards

Hearing Loss in adults and children Flashcards

1
Q

What about sensorineural hearing loss makes it difficult to treat?

A

It often involves the loss of hair cells in the organ of corti and because hair cells cannot be regenerated they often lead to permanent hearing loss

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2
Q

At what age do children lose the brain elasticity to learn languages?

A

5 years

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3
Q

What are the 2 causes of congenital conductive hearing loss?

A

ear atresia and ossicular abnormalities

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4
Q

What are the causes of acquired conductive hearing loss?

A

external ear: wax, foreign body, otitis externa

middle ear: middle ear effusion, eardrum perforation, choleostatoma, otosclerosis

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5
Q

What is the most common cause of acquired conductive hearing loss?

A

Otitis media with effusion

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6
Q

Which childhood groups are at risk of developing hearing loss?

A
  • premature babies
  • neonatal jaundice
  • low birth weight babies
  • aminoglycoside administration
  • parents and siblings with hearing loss
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7
Q

What other medical conditions can we expect in a child with otitis media effusions?

A

Upper respiratory tract infections

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8
Q

How long does it take to make a diagnosis of chronic otitis media?

A

It takes 12 weeks of fluid build-up behind the ear-drum

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9
Q

Name 3 clinical features of a child with OME?

A

-usually present with hearing loss
-recurrent otalgia
-immobile eardrum on tymapnometry
-

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10
Q

What is the treatment for OME?

A
  • antibiotics

- surgery(grommet insertion which can stay in the ear for up to 12 months)

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11
Q

What are the complications of insertion of grommets?

A

They can cause otorrhea even after insertion with a mucoid like discharge. Instil ear droplets to try to treat it and oral antibiotics if a infection is prevalent

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12
Q

What are the causes of hearing loss in adults?

A
  • wax

- presbyacusis

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13
Q

How can we treat wax accumuation?

A
  • syringing

- using sodium bicarbonate and hydrogen peroxide 3 times a day

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14
Q

What is keratosis obturans?

A

The desquamated skin and wax in the deepest part of the meatus that erodes the ear canal

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15
Q

What are the 3 causes of perforations of the eardrum?

A
  • acute and chronic otitis media

- trauma

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16
Q

How are perforations from chronic otitis media treated?

A

They are treated with a tympanoplasty with a graft from the temporalis fascia

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17
Q

What other things should we look for if an adult has recurring middle ear effusions?

A

-nasophyrangeal tumours
-sinusitis
Blocking the eustachian tube

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18
Q

What is otosclerosis?

A

New bone growth in the capsule of the inner ear

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19
Q

What is the clinical picture of someone with otosclerosis?

A
  • Young adults
  • usually family history
  • conductive hearing loss
  • usually aggravated by pregnancy
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20
Q

What are the different causes of sensorineural hearing loss in adults?

A
  • presbyacusis
  • idiopathic hearing loss
  • noise exposure
  • perilymph fistula
  • inflammatory diseases
  • ototoxicity
  • acoustic tumours
  • dysacusis
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21
Q

What is presbyacusis?

A

It is the loss of hair cells along the cochlea due to old age

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22
Q

Why do old people say you must speak louder and then lower your voice in a short space of time?

A

This is because they have recruitment which means they have decreased dynamic range of hearing. The threshold of hearing and the uncomfortability of hearing are abnormally close

23
Q

What is the management of presbyacusis?

A

Bilateral hearing aids

24
Q

How does noise exposure cause acoustic trauma?

A

By a sudden blast of music or by prolonged exposure of noise

25
Q

What decibels of noise should the patient wear ear defenders?

A

at 90 dB

26
Q

What is woolly hearing?

A

When the patient has a temporary threshold shift of noise and it is accompanied by tinnitus

27
Q

What diseases can cause cochlear damage?

A

meningitis, measles, mumps, syphillis

28
Q

What are the labyrinthe windows?

A

Round and oval

29
Q

What is a perilymph fistula and how does it present?

A

It is rupture of the windows which causes perilymph to be released. This then leads to imbalance and vertigo and sensorineural hearing loss

30
Q

What causes perilymph fistula?

A

It is caused by increased intracranial pressure like straining when lifting or stapedectomy surgery where the perilymph secretion is fixed but still persists

31
Q

What is the renal and ear connection of drugs?

A

Drugs that affect the renal system similarly affect the ears

These are aminoglycosides and cytotoxic agents

32
Q

What is the presentation of acoustic tumours?

A

They are progressive, unilateral and usually present with tinnitus
An MRI is the investigation of choice

33
Q

What are the otological causes of otalgia?

A
  • Acute otitis externa
  • furunculosis
  • maligant otitis externa
  • myringitis bullosa
  • perichondritis
  • acute otitis media
  • acute otitic barotrauma
  • herpes zoster oticus
  • neoplasia of the ear
34
Q

What are the non-otological causes of otalgia?

A
  • referred otalgia in children

- referred otalgia in adults

35
Q

What are the usual infective agents of acute otitis externa?

A
  • streptococcus
  • staphylococcus
  • pseudomonas
  • fungi
36
Q

What are the symptoms of acute otitis externa?

A

Itching, irritation and possible excruciating pain

37
Q

What is the treatment of acute otitis externa?

A

It depends on whether the meatus is patent or not.

  1. If patent: remove the debris in the canal and give antibiotic drops/steroid drops
  2. If meatus is oedematous, then start by using otowick dressing and then the antibiotics/steroid drops but make sure to remove the dressing after 48 hours
38
Q

Define furunculosis?

A

Furunculosis is the infection of a hair follicle in the outer ear

39
Q

What does a person with furunculosis present with?

A
  • severely throbbing painful ear

- pyrexia

40
Q

What is maligant otitis externa?

A

An aggressive form of otitis externa which involves osteomyelitis of the temporal bone caused by pseudomonas pyocyaneus

41
Q

In which patients does maligant otitis externa present in?

A

Immunocompromised patients such as older diabetics

42
Q

How do you treat malignant otitis externa?

A

-local aural toilet and insertion of wicks with antipseudomonals and antibiotics
-surgery is necessary in patients where the disease progresses despite conservative treatment
-

43
Q

What is myringitis bullosa?

A

It is a localised form of otitis externa where blisters form on the eardrum and the deep meatus and presents with excruciating pain

44
Q

What is perichondritis?

A

It is infected cartilage that produces a tender and swollen pinna. Oedema can spread to the face and the pretragal LN are swollen

45
Q

What is the treatment of perichondritis?

A

magnesium sulphate

Systemic antibiotics

46
Q

What are the lower cranial nerves?

A

-glossopharyngeal, hypoglossal, vagus

47
Q

What is the pathophysiology of acute otitis media?

A
  • Usually affects children
  • The infection ascends up the eustachian tube, the eardrum becomes retracted because the tube is blocked, pressure in the middle ear causes the eardrum to bulge and then ruptures causing a bloodstained discharge
48
Q

What is the treatment of acute otitis media?

A
  1. If after 24-48 hours have passed and there is no spontaneous resolution theng give:
  2. A broad spectrum antibiotic that cover haemophilus and streptococci
  3. Dry, mop and swab the discharging ear
  4. Use grommets(myringotomy) and possibly do a adenoidectomy
  5. Alternative to above is to give 125mg of penicillin for 6 weeks
49
Q

What is acute otitic barotrauma?

A

Occurs during descent of an aircraft

50
Q

How does herpes zoster oticus occur?

A

When the facial nerve ganglion is affected by shingles and creates severe vesicles in the ear canal and concha and accompanied by facial palsy

51
Q

What is the RX of herpes zoster otticus?

A

Acyclovir and famcyclovir

52
Q

Where does referred otalgia usually occur in children?

A

From tonsillitis or 5-7 days post a tonsillectomy

As well as dental cavities

53
Q

Where does referred otalgia come from in adults?

A
  • The teeth
  • The TMJ joint
  • cervical spondylosis particularly of C2, C3
  • The parotid gland
  • The tongue, nose and sinuses
54
Q

What is another name for acute fungal otitis externa?

A

otomycosis- from pseudomonas and candida

Rx with aural toilet, quadrigerm and acetic acid

ENT (8 decks)

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