HL Flashcards by E *

Two types of hearing loss?

Conductive and Sensoineural

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Conductive HL is a dysfx of?

Middle/external ear

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Sensoineural HL is a dysfx of?

Deterioration of cochlea

Lesions on CN VIII

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What tests help differ Conductive and Sensoineural HL?

Weber and Rinne tuning fork tests

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What does Weber test evaluate?

Lateralization

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Weber test w/ sound lateralizing as louder on affected side has?

CHL

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Weber test w/ sound lateralizing as louder in better/NL ear has?

SNHL

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CHL - weber test result

sound will lateralize and be perceived as louder on the affected side

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SNHL - weber test result

sound will be perceived as louder in the better or NL hearing ear

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CHL in the right ear will have a Weber test of?

Heard better in Right ear

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SNHL in the right ear will have a weber test of?

Heard better in Left ear

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What does Rinne test evaluate?

Air vs Bone conduction

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NL Rinne test is?

AC > BC

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CHL Rinne test result?

Sound is heard through bone longer than air

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SNHL Rinne test result?

Sound hear longer through air than bone

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What are the 4 main causes of CHL? (all impairment of passage)

(MCC of CHL) -Obstruction (i.e. cerumen impaction)

Mass loading (i.e. middle ear effusion)
Stiffness effect (i.e. otosclerosis)
Discontinuity (i.e. ossicular disruption)

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CHL TXT?

Medical: treat infections, impaction
Surgical: tympanoplasty or prosthesis

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Transient CHL is usually due to?

Cerumen impaction or ETD due to URI

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Persistent CHL is usually due to?

Chronic ear infection
Trauma
Otosclerosis

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Differences between sensory/neural HL?

Sensory HL - cochlea deterioration

Neural HL - involves lesions of CN 8

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SNHL causes

Noise/physical trauma
Presbycusis
Ototoxicity
Autoimmune HL

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Unilateral or asymmetric SNHL suggests?

Lesion Proximal to cochlea (acoustic neuroma)

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Are cochlea diseases reversible?

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MC cause of SNHL?

Presbycusis - age related

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Presbycusis Affects what range of hearing?

High freq and symmetric - Bird chirping - Telephone ringing

Is Presbycusis unilateral?

No - bilateral

MC complaint of Presbycusis

Loss of speech discrimination

2nd MC cause of SNHL

Noise trauma

Noise trauma def

>85dB injury to cochlea

Noise trauma HL begins w/ what freq?

``` High freq (esp. 4000 Hz) - progresses to speech ```

Otoxicity affects what inner ear system?

Auditory and vestibular

MC Otoxic Rx?

aminoglycosides loop diuretics antineoplastic agents

Otoxic therapeutic doses may cause what

Irreversible HL

Reduce otoxicity risks by?

Serial audiometry Monitor Rx levels Substitute non-otoxic Rx

(top) ototoxic Rx?

Ear drops - neomycin - gentamicin

What must be avoided w/ topical ototoxic Rx?

Avoid placing in ear w/ TM perf

Sudden sensory HL is?

Unilateral HL in >20yo

TXT of Sudden sensory HL?

Prompt (po) CCS/audiogram Intratympanic admin Not effective >6w

Autoimmune HL is ass/w what D/O?

SLE granulomatosis Polyangiitis Cogan syndrome

Cogan syndrome triad?

HL keratitis Aortitis

What labs may be elevated w/ Autoimmune HL?

Ana Rheum factor ESR

TXT of Autoimmune HL

1st-L - (po) CCS prednisone | 2nd-L - (po) cytotoxics methotrexate

SNHL Txt -

``` Not correctable Hearing aids (cochlear implant) ```

Tinnitus essentials of Dx

ABNL ear or head noises

Persistent Tinnitus often indicates?

SNHL

Intermittent Tinnitus often is?

Normal

Dx Tinnitus - non-pulsatile - unilateral - pusaltile

- non-pulsatile - audiogram R/O HL - unilateral w/ HL no cause (noise trauma) MRI - pusaltile - Magnetic resonance angiography and venography

Pusatile Tinnitus is described as?

ABNL - Listening to own heartbeat

Pusatile Tinnitus May be due to

``` CHL or Serious - glomus tumor - venous sinus stenosis - carotid occlusion - AV malform - aneurysm ```

Staccato tinnitus is?

Rapid series Clicking/popping lasting seconds to mins w/ fluttering feeling in ear

Staccato tinnitus is due to?

Middle ear spasm | Palatal myoclonus - (rhythmic involuntary movement of soft palate.)

Tinnitus TXT

``` Avoidance - noise, Rx Habituation techniques -masking/retraining therapy Antidepressants -nortriptyline ```

Hyperacusis is

Excessive sensitivity to sound w/ normal hearing.

Hyperacusis Causes?

Ear disease Noise trauma Migraine susceptible Psych

TXT of Hyperacusis?

Earplugs in noisy environments

Eval HL points

``` Type HL Degree/severity of HL Config (audiogram) Anatomy Etiology ```

Unilateral serous effusions in adult req?

Prompt fiberoptic exam of nasopharynx for neoplasms

CN V and VII dysfx May indicate?

Tumors involving cerebropontine angle

Every patient w/ HL (except due to impaction/OM) should be referred where?

Audiologic exam

Augiograms are measured between?

250-8000 Hx (pure tones) by dB

Pure tone testing - Notes

Soundproof booth the higher the threshold > poorer the hearing Tests each ear and both types (CHL)AC/BC(SNHL)

What are ABNL thresholds for audiogram?

>20dB

Typmanometry is used for?

Eval TM and middle ear

Tympanogram is measured via

Pressure -x axis Compliance -y axis > Graph

According to the shape of the graph where are the different types?

Type A - NL Type AS - shallow (Ossicular fixation) Type AD - deep (Ossicular Disarticulation) Type B - Poorly mobile TM (Fluid/Perf) Type C - Retracted TM or ETD (ETD)

If there is HL but a normal Tympanogram then?

HL is SNHL

A Type A - NL tympanogram peak pressure falls where?

Near 0 decapascals

A Type AS - shallow tympanogram peak pressure is located where?

Near 0 decapascals BUT w/ very shallow peak indicating decreased compliance.

Type AS - shallow tympanogram is ass/w?

Ossicular fixation Otosclerosis TM scarring ETD is NL

Type AD - Deep tympanogram peak complaince curve is and a pressure curve?

>2.0mL - compliance | NEAR 0 decapascals - pressure

Type AD - deep tympanogram essentially indicates?

Ossicular disarticulation OR Ossicular chain discontinuity ETD is NL

Type B - (flat) poorly mobile tympanogram peaks are?

Absent/poorly defined peaks w/ a markedly negative middle ear pressure greater than -200daPa - little or no TM mobility

Type B - (flat) poorly mobile tympanogram indicates?

Fluid in middle ear or a TM perf

Type B - (flat) poorly mobile tympanogram max compliance is?

Below NL range

Type C - retracted TM or ETD tympanogram peak is?

clearly defined peak but falls Negative 150daPA or less on pressure scale indicating NEG middle ear pressure.

Type C - retracted TM or ETD tympanogram compliance peak will be?

Normal

Type C - retracted TM or ETD tympanogram Dx?

ETD w/ very mild CHL or WNL

HL Flashcards

(77 cards)