HL Flashcards
Two types of hearing loss?
Conductive and Sensoineural
Conductive HL is a dysfx of?
Middle/external ear
Sensoineural HL is a dysfx of?
Deterioration of cochlea
Lesions on CN VIII
What tests help differ Conductive and Sensoineural HL?
Weber and Rinne tuning fork tests
What does Weber test evaluate?
Lateralization
Weber test w/ sound lateralizing as louder on affected side has?
CHL
Weber test w/ sound lateralizing as louder in better/NL ear has?
SNHL
CHL - weber test result
sound will lateralize and be perceived as louder on the affected side
SNHL - weber test result
sound will be perceived as louder in the better or NL hearing ear
CHL in the right ear will have a Weber test of?
Heard better in Right ear
SNHL in the right ear will have a weber test of?
Heard better in Left ear
What does Rinne test evaluate?
Air vs Bone conduction
NL Rinne test is?
AC > BC
CHL Rinne test result?
Sound is heard through bone longer than air
SNHL Rinne test result?
Sound hear longer through air than bone
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)
CHL TXT?
Medical: treat infections, impaction
Surgical: tympanoplasty or prosthesis
Transient CHL is usually due to?
Cerumen impaction or ETD due to URI
Persistent CHL is usually due to?
Chronic ear infection
Trauma
Otosclerosis
Differences between sensory/neural HL?
Sensory HL - cochlea deterioration
Neural HL - involves lesions of CN 8
SNHL causes
Noise/physical trauma
Presbycusis
Ototoxicity
Autoimmune HL
Unilateral or asymmetric SNHL suggests?
Lesion Proximal to cochlea (acoustic neuroma)
Are cochlea diseases reversible?
No
MC cause of SNHL?
Presbycusis - age related
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