Hodgepodge Topics Flashcards
Case History Pseudohypoacusis Tinnitus Hyperacusis Hearing Loss Prevention
What is this document?
Client-Oriented Scale of Improvement is a tool that is helpful to bond with patients
How are previous evaluations helpful in case history? (3)
- Previous evaluations often contain critical information
- They will save time and stress
- But remember that things change
What are the characteristics of Tinnitus?
- May be related to hearing loss
- Ototoxicity
- Vestibular schwannomas (likely unilateral)
- Ménière’s disease
How could Tinnitus be related to hearing loss?
TTS/PTS
What is the relationship between Tinnitus and Meniere’s disease?
- Tinnitus may be described as ‘roaring’ or have a sound like wind or rushing water
- Often accompanied by aural fullness and low-frequency hearing loss
- Balance problems
- Progressive
Why ask clients about ear surgery during client history?
- May influence thresholds
- May be residual differences (e.g., stapedotomy)
- May affect what procedures you perform
ear impressions
immittance measures
Why ask about ME history? (3)
Because of diseases like:
chronic otitis media
trauma and disarticulation
barotrauma
perilymphatic fistula
otosclerosis
cholesteatoma
What is ET dysfunction by infection?
- ET is normally closed
- Blocked by edema, so cannot open (fluid build-up under skin)
- Oxygen is trapped in ME and creates a vacuum and results in negative pressure within the ME space, lining becomes reddened
Which population is more at risk of ET dysfunction?
- Children at a greater risk because ET is shorter, more horizontal, and more compliant
95% of children will have 1 episode of OM before 6 years of age
50% of children will have OM prior to 1 year & will have 6 or more bouts in the following 2 years
What are the types of Otitis Media?
Acute Otitis Media (< 3 weeks)
Chronic Otitis Media (≥ 3 months)
Chronic Suppurative (discharge) Otitis Media
What are the characteristics of AOM? (2)
(< 3 weeks)
with or without effusion (fluid in middle ear space)
with effusion called “Serous “ or “Secretory”
purrulent (i.e., with pus) or non-purrulent
What are the characteristics of COM? (2)
(≥ 3 months)
with or without effusion (fluid in middle ear space)
over time, may become thick: ‘glue ear’
What are the characteristics of Chronic Suppurative (discharge) Otitis Media? (2)
perforation in TM
otorrhea (discharge of pus)
What is Cholesteatoma? (2)
- After a perforation, tympanic membrane skin grows through hole, and continues to grow into a benign tumour in the middle ear (generally when there is infection)
- May eat away at middle ear structures
What is Otosclerosis? (3)
- Disorder of bony growth where stapes become spongy and often fixed
- Genetic component
- Usually bilateral
How does Otosclerosis appear on the audiogram?
- Carhart’s notch – reduction of bone conduction values at 2 kHz (but not SNHL!)
What are treatments for Otosclerosis?
- Surgical or hearing aids (if surgery rejected)
placement of prosthesis
How is dizziness related to the ear? (3)
- Meniere’s disease
- Recent (or fluctuating) vestibular problem
- B ut there are many reasons that people are dizzy
low blood sugar
other medications
e.g. Bance Dizziness Diary
Why might knowing about previous head injuries matter?
SNHL
Petrous Damage
Perception issues at the level of the cortex
What are illnesses/conditions HL are associated with? (3)
- Diabetes
- Alport’s syndrome
- Cancer
- Charcot-Marie-Tooth
- Multiple sclerosis
- COVID 19
Why is important to ask about medication/drugs used to clients?
Because of potential Otoxicity
- Loop diuretics (for kidney problems or hypertension – congestive heart failure)
furosemide - Salicylates (e.g., aspirin)
- Cancer medications
carboplatin
cisplatin - Quinine
- Aminoglycosides (for bacterial infection)
gentamycin
kanamycin
Why is it important to ask about exposure to noise
Because of:
musicians
industrial workers
hunters
consider TTS and PTS in the evaluation
Why is it important to ask if the client wears/wore HA?
read the file
call the company
What is pseudohypoacusis?
- Also called malingering, functional hearing loss, non-organic hearing loss
- may be psychogenic
(psychological cause) - prevalence estimates
2% …. 50% ??
What are some clues to help you identify the reasons for pseudohyposyacusis?
- financial incentive
- childhood/adolescence
difficulty at school - Mismatch between thresholds and performance
- Speech results different than expected
- excessive straining to hear
- excessive detail about impact of loss
- attributing success to lipreading
How does Hypoacusis appear on the audiogram?
- Inconsistent thresholds during test
- A large number of false negatives
How does Hypoacusis appear on the audiogram in terms of consistency?
- Inconsistent thresholds during test
- A large number of false negatives
How does Hypoacusis appear on the audiogram in terms of curves?
No Shadow Curve
How does Hypoacusis appear on the audiogram in terms of speech test?
- SRT measurements
- strange SRT errors
- WRS scores odd
What are strategies to counter Pseudohypoacusis? (3)
- ascending measurement
- random level presentation
- inform the patient of the discrepancy
What are strategies to counter Pseudohypoacusis? (3)
the gift of fear
open communication
false task
What are physiological approaches?
- Electrodermal audiometry
- AR
- OAEs
- Electrophysiology
ABR/MLR/LLR - the Lombard effect
- …. the STENGER!
What is the Stenger?
- Requires at least 40 dB asymmetry
- A tone is presented 10 dB above (louder than) threshold in the better ear, and 10 dB below (softer than) threshold in the “worse” ear,
Give an example of the Stenger:
- better” ear 0 dB HL threshold (present at 10 dB HL), “worse” ear 60 dB HL threshold (present at 50 dB HL)
- patient will think this is only in the “worse” ear if they’re faking the hearing loss (and they will NOT respond) positive Stenger (pseudohypoacusis)
- patient will hear this in the better ear if the hearing loss is real, and the patient WILL respond negative Stenger (true hearing loss)
- the patient always hears it, so if they say they don’t, they’re lying
What is the Lombard effect?
The involuntary tendency of speakers to increase their vocal effort when speaking in loud noise
What is the prevalence of Tinnitus?
5-15%
12% after 60
5% from 20-30
Interferes with Quality Of Life for 1-3%
What could be the causes of Tinnitus?
- produced in cochlea?
auditory nerve activity is decreased in noise-induced hearing loss and for toxic substances like quinine and aminoglycosides, but these all cause tinnitus - could be related to increased gain in the brainstem, up-regulation of excitatory receptors and a decrease in inhibitory receptors after hearing loss
- could also be cortical diminished cochlear output causes reduced cortical inhibition, hyperexcitability, increased synchrony, and cortical remapping
What helps against Tinnitus?
- background noise
fans
noisy appliances - music
- hearing aids
- noise generators
- tinnitus apps
What is Acoustic Enrichment (Eggermont)?
- After hearing loss is induced, an acoustically enriching environment mitigates cortical reorganization
- wear hearing aids early
What is Tinnitus Retraining Therapy (Jastreboff)?
- tinnitus masker (but incomplete masking)
- Intensive counseling
- Used for severe cases
what can cause Hyperacusis?
- Often goes along with Tinnitus
- Ménière’s disease
- neuropathies
- head trauma
- emotional and psychological problems
What is Misophonia?
- Hatred of sound, usually particular sounds
What is Phonophobia?
- fear of sound
loud sounds
voices
What is Jastreboff’s Model?
- Emotion is involved in perception
- Misophonia (term coined by Jastreboff) develops because of association with limbic system
What are Naive strategies to deal with sounds if you have Misophonia?
quiet lifestyle
earplugs : wearing earplugs makes sounds sound louder (Formby et al., 2003, 2007; Schaette et al., 2014)
this occurs after about 5 days of plugging
recovery can take a day to a wee
What are Better strategies to deal with sounds if you have Misophonia?
- hearing aids
- noise generators
- sensitization
What is dBA?
Decibels can be adjusted to human hearing.
dBA: Average level of human shape sensitivity
Noise level is thus described in decibels A (dBA). The effects of noise vary with the noise to which a person is exposed
What is the 3 dB rule?
Increase the sound level by 3 dB and divide the safe exposure limit by 2
Below 85 dBA is safe and considered acoustically quiet
