Hearing Loss & Ototoxicity Flashcards
What needs to be done prior to hearing aid fitting?
Medical clearance needs to be done prior to fitting any patient for hearing aids
Common ototoxic medications (4)
- Aminoglycosides (ex. gentamycin)
- Platinum based chemo therapy drugs (ex. Cisplatin)
- Loop diuretics (ex. furosemide)
- Salicylates (ex. aspirin)
What needs to be ruled out in a patient with prolonged unilateral otitis media with effusion?
mass obstructing the eustachian tube opening (nasopharyngoscopy)
What are the top 4 causes of CHL?
- Cerumen impaction
- Otitis media with effusion (MC in children)
- TM perforation
- Otosclerosis
What are the top 3 causes of SNHL?
- Presbycusis
- Noise exposure
- Hereditary
What is the treatment for sudden SNHL?
-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
What is the MC radiographic finding in a pediatric patient with SNHL?
Enlarged vestibular aqueduct
What is the maximal amount of CHL?
60 decibels
CHL over 50 decibels is most likely caused by what?
ossicular chain pathology
Differential for SNHL (10)
- Presbycusis
- Noise exposure (machinery, guns, loud music)
- Hereditary
- Acoustic trauma
- Ototoxicity
- Sudden idiopathic hearing loss
- Autoimmune hearing loss
- Meniere’s
- Tumors
- Infections (ex. menigitis, viral labyrinthitis)
What is the most commonly used test for newborn screening? Other common test?
Otoacoustic emissions (OAE)
Auditory brainstem response (ABR)
True or False ototoxicity with high doses of NSAIDs and aspirin is reversible
true, almost always completely reversible with stopping the drug
Causes of sudden SNHL
-Idiopathic (MC*)
Rarely:
- Acoustic neuroma
- Syphillis
- Lyme disease
- Vascular disease
- Autoimmune disease
Describe immune-mediated SNHL
- Bilateral
- Rapidly progressive
- Roaring tinnitus
Treatment for immune-mediated SNHL
oral steroids 60mg for 4 weeks
Define otosclerosis
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)
Carhart Notch
- associated with otosclerosis
- artificial 10-15 decibel decrease in bone conduction at 2,000Hz
“Maximal” CHL
60 db
Patient presents with 3 months of unilateral decreased hearing, recurrent epistaxis, headache, vision changes and a painless neck mass. What exam do you perform?
nasopharyngoscopy
What is the test of choice to evaluate for a cholesteatoma or middle ear mass (ex. glomus tumor)?
CT temporal bone without contrast
Your patient is a child with conductive hearing loss that will need to be surgically corrected. What needs to be done prior to surgery?
CT temporal bone to assess for enlarged vestibular aqueduct
What is semicircular canal dehiscence?
(aka labrynthine fistula) dehiscence of bone in the superior semicircular canal
What are the symptoms of superior semicircular canal dehiscence?
- CHL
- Tullio’s phenomenon (vertigo with loud sounds)
- Autophony (eye move/blink, heart beat or joint movements)
- Fullness/pressure in the ear
What is Hennebert sign?
Dizziness or nystagmus after Valsalva maneuver or pneumatic otoscopy
