Hearing Loss in adults and children Flashcards
What about sensorineural hearing loss makes it difficult to treat?
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
At what age do children lose the brain elasticity to learn languages?
5 years
What are the 2 causes of congenital conductive hearing loss?
ear atresia and ossicular abnormalities
What are the causes of acquired conductive hearing loss?
external ear: wax, foreign body, otitis externa
middle ear: middle ear effusion, eardrum perforation, choleostatoma, otosclerosis
What is the most common cause of acquired conductive hearing loss?
Otitis media with effusion
Which childhood groups are at risk of developing hearing loss?
- premature babies
- neonatal jaundice
- low birth weight babies
- aminoglycoside administration
- parents and siblings with hearing loss
What other medical conditions can we expect in a child with otitis media effusions?
Upper respiratory tract infections
How long does it take to make a diagnosis of chronic otitis media?
It takes 12 weeks of fluid build-up behind the ear-drum
Name 3 clinical features of a child with OME?
-usually present with hearing loss
-recurrent otalgia
-immobile eardrum on tymapnometry
-
What is the treatment for OME?
- antibiotics
- surgery(grommet insertion which can stay in the ear for up to 12 months)
What are the complications of insertion of grommets?
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
What are the causes of hearing loss in adults?
- wax
- presbyacusis
How can we treat wax accumuation?
- syringing
- using sodium bicarbonate and hydrogen peroxide 3 times a day
What is keratosis obturans?
The desquamated skin and wax in the deepest part of the meatus that erodes the ear canal
What are the 3 causes of perforations of the eardrum?
- acute and chronic otitis media
- trauma
How are perforations from chronic otitis media treated?
They are treated with a tympanoplasty with a graft from the temporalis fascia
What other things should we look for if an adult has recurring middle ear effusions?
-nasophyrangeal tumours
-sinusitis
Blocking the eustachian tube
What is otosclerosis?
New bone growth in the capsule of the inner ear
What is the clinical picture of someone with otosclerosis?
- Young adults
- usually family history
- conductive hearing loss
- usually aggravated by pregnancy
What are the different causes of sensorineural hearing loss in adults?
- presbyacusis
- idiopathic hearing loss
- noise exposure
- perilymph fistula
- inflammatory diseases
- ototoxicity
- acoustic tumours
- dysacusis
What is presbyacusis?
It is the loss of hair cells along the cochlea due to old age
Why do old people say you must speak louder and then lower your voice in a short space of time?
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
What is the management of presbyacusis?
Bilateral hearing aids
How does noise exposure cause acoustic trauma?
By a sudden blast of music or by prolonged exposure of noise
What decibels of noise should the patient wear ear defenders?
at 90 dB
What is woolly hearing?
When the patient has a temporary threshold shift of noise and it is accompanied by tinnitus
What diseases can cause cochlear damage?
meningitis, measles, mumps, syphillis
What are the labyrinthe windows?
Round and oval
What is a perilymph fistula and how does it present?
It is rupture of the windows which causes perilymph to be released. This then leads to imbalance and vertigo and sensorineural hearing loss
What causes perilymph fistula?
It is caused by increased intracranial pressure like straining when lifting or stapedectomy surgery where the perilymph secretion is fixed but still persists
What is the renal and ear connection of drugs?
Drugs that affect the renal system similarly affect the ears
These are aminoglycosides and cytotoxic agents
What is the presentation of acoustic tumours?
They are progressive, unilateral and usually present with tinnitus
An MRI is the investigation of choice
What are the otological causes of otalgia?
- Acute otitis externa
- furunculosis
- maligant otitis externa
- myringitis bullosa
- perichondritis
- acute otitis media
- acute otitic barotrauma
- herpes zoster oticus
- neoplasia of the ear
What are the non-otological causes of otalgia?
- referred otalgia in children
- referred otalgia in adults
What are the usual infective agents of acute otitis externa?
- streptococcus
- staphylococcus
- pseudomonas
- fungi
What are the symptoms of acute otitis externa?
Itching, irritation and possible excruciating pain
What is the treatment of acute otitis externa?
It depends on whether the meatus is patent or not.
- If patent: remove the debris in the canal and give antibiotic drops/steroid drops
- 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
Define furunculosis?
Furunculosis is the infection of a hair follicle in the outer ear
What does a person with furunculosis present with?
- severely throbbing painful ear
- pyrexia
What is maligant otitis externa?
An aggressive form of otitis externa which involves osteomyelitis of the temporal bone caused by pseudomonas pyocyaneus
In which patients does maligant otitis externa present in?
Immunocompromised patients such as older diabetics
How do you treat malignant otitis externa?
-local aural toilet and insertion of wicks with antipseudomonals and antibiotics
-surgery is necessary in patients where the disease progresses despite conservative treatment
-
What is myringitis bullosa?
It is a localised form of otitis externa where blisters form on the eardrum and the deep meatus and presents with excruciating pain
What is perichondritis?
It is infected cartilage that produces a tender and swollen pinna. Oedema can spread to the face and the pretragal LN are swollen
What is the treatment of perichondritis?
magnesium sulphate
Systemic antibiotics
What are the lower cranial nerves?
-glossopharyngeal, hypoglossal, vagus
What is the pathophysiology of acute otitis media?
- 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
What is the treatment of acute otitis media?
- If after 24-48 hours have passed and there is no spontaneous resolution theng give:
- A broad spectrum antibiotic that cover haemophilus and streptococci
- Dry, mop and swab the discharging ear
- Use grommets(myringotomy) and possibly do a adenoidectomy
- Alternative to above is to give 125mg of penicillin for 6 weeks
What is acute otitic barotrauma?
Occurs during descent of an aircraft
How does herpes zoster oticus occur?
When the facial nerve ganglion is affected by shingles and creates severe vesicles in the ear canal and concha and accompanied by facial palsy
What is the RX of herpes zoster otticus?
Acyclovir and famcyclovir
Where does referred otalgia usually occur in children?
From tonsillitis or 5-7 days post a tonsillectomy
As well as dental cavities
Where does referred otalgia come from in adults?
- The teeth
- The TMJ joint
- cervical spondylosis particularly of C2, C3
- The parotid gland
- The tongue, nose and sinuses
What is another name for acute fungal otitis externa?
otomycosis- from pseudomonas and candida
Rx with aural toilet, quadrigerm and acetic acid
