Hearing Loss - Scholting Flashcards
Conductive Hearing Loss
Sound conduction is impeded through the external ear, middle ear, or both
Identify the condition and describe the management:
pt complains of ringing in his ears, full feeling ears and occasionally has some hearing loss in just the left ear. the pt also complains of periods of vertigo with nausea that lasts a couple of hours.
Meniere’s Disease
labrynthine disorder, uncertain etiology, thought to be caused by increased fluid pressure within the ear
usually self limited
**diagnostic work-up: **audiometry, vestibular testing, MRI to rule out acoustic neuroma
**tx: symptomatic treatment - **antiemetic (compazine, tigan), vestibular suppressant (meclizine), diuretics, decrease sodium intake
Identify the condition and describe the management:
pt complains of vertigo that lasts for a few seconds after he rolls over in bed or gets up quickly from a chair
Benign Paroxysmal Positional Vertigo (BPPV)
caused by otoconia particles from the utricle or sacccule lodging in the posterior semicircular canal
exam: ENT, orthostatic hypotension, ocular exam, balance tests, assess gait, CN assessment
Dix-Hallpike Manuever
symptomatic tx: meclizine
Common Ototoxins
salicylates
aminoglycosides
chemotherapeutics
Identify the condition and describe the management:
pt presents with white patches on the TM (see below) and has reduced movement on pneumatic otoscopy
pt has a prior hx of recurrent otitis media and tympanostomy tube
Tympanosclerosis
clacium patches on the TM in response to infection
involves the TM, ossicles, middle ear mucosa - stiffens system
tx: ENT referral
Rinne Test
Tuning Fork (512) at mastoid, when pt no longers hears sound, place tuning fork adjacent to ear canal to check air conduction
Air conduction better than bone conduction (AC > BC)
Abnormal in Conductive Hearing Loss
Whisper Test
Patient occludes opposite ear
Examiner whispers questions or commands
Patient answers or follows commands
Avoid testing with finger snapping or ticking watch
Not accurate for Hearing Testing
Identify the condition and describe the management:
pt is a 45 yo female
she complains of ringing in her ears, and that she has slowly lost hearing in her right ear
Weber: + Left ear
Rinne: negative
Accoustic Neuroma
- benign tumor that arises from the Schwann cells of CN 8
- most common in middle age
- symptoms: tinnitus and hearing loss
- hearing loss is usually gradual, progressive, unilateral
diagnostics: MRI
tx: srugery or radiothrapy
Identify the condition and describe the management:
pt reports reduced ability to hear in his R ear
Weber: lateralizes to R side RInne: R BC>AC
exam shows: pt has a bony overgrowth in the EAC
Exostoses / Osteoma
tx: surgery, rarely necessary
can cause impared cerumen migration
Tinnitis
“ringing” in the ears, preceived internal noise heard by patient with associated hearing loss
can be secondary to vascular problem, intracranial mass, metabolic disorders, medications
if “blood rushing” or “heartbeat” - vascular problem
if bilateral, NOT pulsatile, not instrusive and mild hearing loss - secondary to hearing loss
tx: find the underlying cause and manage that
What is the most common PREVENTABLE cause of sensorineural hearing loss?
Noise Trauma
high-frequency affected first
tx: aggressive use of noise protection
Identify the condition and describe the management:
pt presents with otorrhea from the right ear and complains of hearing loss in the right ear
Weber lateralizes to the right, Rinne: BC>AC
otoscopic exam:
TM Perforation
reduces surface area available for sound transmission
usually secondary to chronic OM or trauma
tx: surgery for large perforations
keep ear dry
Meniere’s Disease Triad of Symptoms
episodic vertigo (Hours)
tinnitis
fluctuating hearing loss - LOW frequency, unilateral
Identify the condition and describe the management:
pt complains of unilateral hearing loss
otoscopic exam shows effusion in the middle ear and decreased TM mobility
Otitis Media
most common cause of conductive hearing loss in children
TX: treat the OM, possible myringotomy tubes
Common Causes of Conductive Hearing Loss
- Cerumen Impaction
- Foreign Body
- Otitis Externa
- Exostoses and Osteomas
- Otosclerosis
- Tympanic Membrane Perforation
- Otitis Media
- Tympanosclerosis
- Tumors/cysts of the auditory canal
What type of hearing loss is this, and which ear is affected?
weber: lateralizes to the right ear
rinne: R: BC>AC; L: AC>BC
conductive hearing loss of the right ear
Weber: lateralizes to the ipsilateral ear in conductive loss
Rinne: bone conduction is greater than air conduction
Weber Test
Tuning Fork (256) at midline forehead
Sound radiates TO Conductive Hearing Loss ear
Sound radiates AWAY from Sensorineural Hearing Loss ear
Identify the condition and describe the management:
pt had a cold last week and now complains of sudden vertigo that lasts for days, she also notes some hearing loss
Acute Labrynthitis
inflammation of the inner ear - often after viral URI
tx: symptomatic tx: antiemetic (compazine) and vestibular suppresent (meclizine)
Common Causes of Senorineural Hearing Loss
- Presbycusis
- Noise Trauma
- Ototoxin Exposure
- Meniere’s Disease
- Acoustic Neuroma
- Acute Labrynthitis
- Tinnitis
Sensorineural Hearing Loss
Occurs with dysfunction of the inner ear
problem with cochlea or neural pathway to auditory cortex
mainly affects adults; children can be affected usually secondary to congenital hearing loss
sudden sensorineural hearing loss requires urgent ENT referral if cause cannot be found on exam
Identify the condition and describe the management:
pt is a 49 year old female
presents with bilateral hearing loss (less than 50 DB) that has gotten worse
family hx: father had something similar
Otosclerosis
abnormal bone deposition at the base of the stapes
leads to fixation of the stapes, preventing vibration
tx: hearing aids or surgery (stapedectomy)
Tumors/Cysts of the Auditory Canal
Uncommon
refer to ENT or surgical removal
What type of hearing loss is this and which ear is affected?
Weber: sound lateralizes to the right ear
Rinne: R: AC>BC; L: AC>BC
left ear sensorinueral hearing loss
Weber: sound will latealize the the contralateral ear in sensironeural hearing loss
Rinne: normal hearing or sensorineural loss result in AC>BC (2:1)
Identify the condition and describe the management:
pt complains of vertigo that lasts for 3-4 days, but has no hearing loss
Vestibular Neuritis:
occurs spontaneously or after a URI
symptomatic tx: antiemetic, vestibular suppressant, antihistamines, benzodiazepines, anticholinergics
Identify the condition and describe the management:
pt is a 75 yo male brought in by his wife, he reports increased difficulty hearing the tv and difficulty understanding speech with both ears
audiometry testing shows high pitched hearing loss
Presbycusis
- symmetric, progressive deterioration of hearing - usually in adults and elderly
- loss of cochlear hair cell function
- combination of genetic disposition and envrionmental factors
- secondary to neurovascular injury: HTN, DM
- high frequency hearing and speech discrimination are affected
TX: audiology consult, hearing aids
