HEENT

Question 1

Be able to distinguish conductive from sensorineural hearing loss

Answer 1

– Conductive phase: External ear through the middle ear

Conductive hearing loss occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones (ossicles) of the middle ear. Conductive hearing loss usually involves a reduction in sound level or the ability to hear faint sounds. This type of hearing loss can often be corrected medically or surgically.

– Sensorineural phase: Cochlea and cochlear nerve (after it gets through the middle part of the ear).

Sensorineural hearing loss (SNHL) occurs when there is damage to the inner ear (cochlea), or to the nerve pathways from the inner ear to the brain. Most of the time, SNHL cannot be medically or surgically corrected. This is the most common type of permanent hearing loss.

SNHL reduces the ability to hear faint sounds. Even when speech is loud enough to hear, it may still be unclear or sound muffled.

Question 2

1) In Weber test if the sound is heard _____ in both ears with normal hearing = (nodeficits).
2) If it lateralizes _____ the impaired ear in conductive loss (i.e.otitis media, perforated eardrum, obstructed canal with cerumen).
3) It lateralizes _____ from the impaired ear in sensorineural hearing loss.

Answer 2

1) In Weber test if the sound is heard equally well in both ears with normal hearing = (nodeficits).
2) If it lateralizes toward the impaired ear in conductive loss (i.e.otitis media, perforated eardrum, obstructed canal with cerumen).
3) It lateralizes away from the impaired ear in sensorineural hearing loss.

Question 3

1) In the Rinne test, normally air conduction __ bone conduction.
2) In conductive loss, often AC ___ BC
3) In sensorineural loss, AC ____ BC

Answer 3

1) In the Rinne test, normally air conduction > bone conduction.

2) In conductive loss, often AC = or < BC
- since bones are affected

3) In sensorineural loss, AC still > BC
- since nerves are not affected

Question 4

• Weber lateralizes to Right ear, Rinne shows BC>AC at the right ear.
– Is this conductive or sensorineural problem? – Which ear is affected?

Answer 4

right ear conductive affected

Question 5

• Weber lateralizes to the left ear, Rinne shows AC>BC both ears.
– Is this conductive or sensorineural problem? – Which ear is affected?

Answer 5

Sensoneural so right ear affected

Question 6

Give mnemonic for differential diagnosis

Answer 6

VINDICATE

Vascular
Inflammatory/Infection
Neoplasm
Degenerative/Deficiency/Drugs
Idiopathic/Intoxication/Iatrogenic (caused by medical examination or treatment)
Congenital
Autoimmune/Allergic/Anatomic
Traumatic
Endocrine/Environmental

Question 7

In the notes, there are many diseases for conductive hearing loss, but only 1 for sensorineural–what is it?

Answer 7

cochlear damage

I only should memorize this one & just know that anything else is conductive

Conductive diseases: otitis media, perforated eardrum, obstructed canal with cerumen

Question 8

Read lecture quickly.

Answer 8

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