Hearing Loss & Ototoxicity

Question 1

What needs to be done prior to hearing aid fitting?

Answer 1

Medical clearance needs to be done prior to fitting any patient for hearing aids

Question 2

Common ototoxic medications (4)

Answer 2

1. Aminoglycosides (ex. gentamycin)
2. Platinum based chemo therapy drugs (ex. Cisplatin)
3. Loop diuretics (ex. furosemide)
4. Salicylates (ex. aspirin)

Question 3

What needs to be ruled out in a patient with prolonged unilateral otitis media with effusion?

Answer 3

mass obstructing the eustachian tube opening (nasopharyngoscopy)

Question 4

What are the top 4 causes of CHL?

Answer 4

1. Cerumen impaction
2. Otitis media with effusion (MC in children)
3. TM perforation
4. Otosclerosis

Question 5

What are the top 3 causes of SNHL?

Answer 5

1. Presbycusis
2. Noise exposure
3. Hereditary

Question 6

What is the treatment for sudden SNHL?

Answer 6

-Confirm with audiogram
-High-dose oral steroid burst and taper (60mg QD for 10 days)
or
intratympanic steroid injection (if brittle diabetic, or can’t tolerate oral steroid for another reason)

-MRI of the internal auditory canal to assess for acoustic neuroma

Question 7

What is the MC radiographic finding in a pediatric patient with SNHL?

Answer 7

Enlarged vestibular aqueduct

Question 8

What is the maximal amount of CHL?

Answer 8

60 decibels

Question 9

CHL over 50 decibels is most likely caused by what?

Answer 9

ossicular chain pathology

Question 10

Differential for SNHL (10)

Answer 10

1. Presbycusis
2. Noise exposure (machinery, guns, loud music)
3. Hereditary
4. Acoustic trauma
5. Ototoxicity
6. Sudden idiopathic hearing loss
7. Autoimmune hearing loss
8. Meniere’s
9. Tumors
10. Infections (ex. menigitis, viral labyrinthitis)

Question 11

What is the most commonly used test for newborn screening? Other common test?

Answer 11

Otoacoustic emissions (OAE)

Auditory brainstem response (ABR)

Question 12

True or False ototoxicity with high doses of NSAIDs and aspirin is reversible

Answer 12

true, almost always completely reversible with stopping the drug

Question 13

Causes of sudden SNHL

Answer 13

-Idiopathic (MC*)

Rarely:

• Acoustic neuroma
• Syphillis
• Lyme disease
• Vascular disease
• Autoimmune disease

Question 14

Describe immune-mediated SNHL

Answer 14

• Bilateral
• Rapidly progressive
• Roaring tinnitus

Question 15

Treatment for immune-mediated SNHL

Answer 15

oral steroids 60mg for 4 weeks

Question 16

Define otosclerosis

Answer 16

Fixation of the stapes footplate in the oval window caused by abnormal remodeling in this area

• unilateral or bilateral
• Carhart notch pattern (artificial 10-15 decibel decrease in bone conduction at 2,000Hz)

Question 17

Carhart Notch

Answer 17

• associated with otosclerosis

- artificial 10-15 decibel decrease in bone conduction at 2,000Hz

Question 18

“Maximal” CHL

Answer 18

60 db

Question 19

Patient presents with 3 months of unilateral decreased hearing, recurrent epistaxis, headache, vision changes and a painless neck mass. What exam do you perform?

Answer 19

nasopharyngoscopy

Question 20

What is the test of choice to evaluate for a cholesteatoma or middle ear mass (ex. glomus tumor)?

Answer 20

CT temporal bone without contrast

Question 21

Your patient is a child with conductive hearing loss that will need to be surgically corrected. What needs to be done prior to surgery?

Answer 21

CT temporal bone to assess for enlarged vestibular aqueduct

Question 22

What is semicircular canal dehiscence?

Answer 22

(aka labrynthine fistula) dehiscence of bone in the superior semicircular canal

Question 23

What are the symptoms of superior semicircular canal dehiscence?

Answer 23

1. CHL
2. Tullio’s phenomenon (vertigo with loud sounds)
3. Autophony (eye move/blink, heart beat or joint movements)
4. Fullness/pressure in the ear

Question 24

What is Hennebert sign?

Answer 24

Dizziness or nystagmus after Valsalva maneuver or pneumatic otoscopy