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CM 1B: ID/EENT > Lecture 6: Hearing Loss > Flashcards

Lecture 6: Hearing Loss Flashcards

1
Q

What are the 4 goals of evaluating potential hearing loss?

A
  1. Nature of impairment
  2. Severity of impairment
  3. Anatomy of impairment
  4. Etiology
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2
Q

What are the two main types of hearing loss?

A
  • Conductive
  • Sensorineural
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3
Q

When is hearing loss typically screened for?

A
  • Birth
  • Kindergarten
  • Pre-employment/military physicals
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4
Q

When is an otoacoustic emission (OAE) test performed?

A

At birth to check for inner ear function.

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5
Q

Describe an otoacoustic emission test.

A
  • Provider places a small earphone in the ear.
  • Earphone plays a sound that should echo within the ear canal.
  • Ear should send back in an echo

Can be performed while baby is sleeping, very quick.

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6
Q

What is an auditory brainstem response test? (ABR)

A
  • Electrodes placed on forehead, and earphone in ears.
  • Sound send through earphones, while the patch monitors brain function/response.
  • Can check for abnormal sensorineural development.
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7
Q

If an infant fails a hearing screening, what is the protocol?

A

Need an EENT referral if the infant cannot pass a hearing test by the age of 3 months.

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8
Q

What signs might suggest that a baby has hearing loss?

A
  • Not being startled by loud sounds
  • Not turning towards a sound after 6mo
  • Not saying single words like mama or dada by 1 year old.
  • Turns head if sees you, but not if you only call out name.
  • Seems to hear some sounds but not others.
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9
Q

How do we treat a child that has abnormal hearing screenings?

A

Visual reinforcement audiometry (VRA)

Must be 6m to 2y.

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10
Q

What is a VRA test?

A
  • Patient sits in a booth while distracted.
  • Patient trained to look towards the sound source.
  • Rewarded if they look properly.
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11
Q

What is a conditioned play audiometry test? (CPA)

A
  • Child performs an activity when a sound is heard.

2-5y old

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12
Q

What is a pure tone audiogram?

A

Test to see what a person’s hearing range is.
Tests decibels a patient can hear at certain frequencies.

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13
Q

How do we read an audiogram?

A

Y axis: intensity of sound in decibels.
X axis: pitch/frequency of sound.

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14
Q

What kind of sounds are at the top of an audiogram? Bottom?

A

Top: Whispers
Bottom: Jackhammer

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15
Q

What are the two types of conduction an audiogram can measure?

A
  • Air conduction hearing using headphones.
  • Bone conduction hearing using mastoid stimulators.
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16
Q

How do you read an audiogram?

A

Each frequency is plotted based on what decibel the patient could hear it at. Both ears are tested, generating a graph, which is then compared to a standard.

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17
Q

What is normal hearing range?

A

250-6000 Hz
-10 to 25 decibels.

0 decibels is the softest sound an average person can hear. Hearing something like -5 decibels on an audiogram just means you have very good hearing.

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18
Q

How many decibels different is profound hearing loss from regular?

A

Nearly 100 decibels less than the average.
AKA you need a sound at 100 decibels to hear it.

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19
Q

What is a tympanogram?

A

Measures mobility/compliance of the tympanic membrane and the small bones in the middle ear.

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20
Q

What are the 3 types of tympanograms and what do they represent?

A
  • Type A: normal
  • Type B: Abnormal finding, no compliance
  • Type C: Abnormal finding, eustachian tube dysfunction.
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21
Q

What curves do each tympanogram type generate?

A
22
Q

What does a Type A tympanogram indicate?

A
  • Normal middle ear system without fluid and normal conduction.
  • Maximal peak compliance (at 0 Pa)
23
Q

What does a type B tympanogram indicate?

A
  • No peak, non-mobile.
  • Suggests severely restricted middle ear system.
  • Often consistent with OM.
  • Consistent with a middle ear pathology, such as effusion or perforation.
24
Q

What does a type C tympanogram indicate?

A
  • Indicator of eustachian tube dysfunction.
  • Negative pressure in middle ear space, consistent with middle ear infection or cold-eustachian tube dysfunction.
  • Consistent with a sinus, allergy, or end stages of a cold.
  • Presents with an early peak.
25
Q

What is Conductive hearing loss? What tests do we run?

A

When sound does not conduct efficiently through the outer ear canal to the tympanic membrane and ossicles, or middle ear.

Rinne Test: BC > AC
Weber test: Lateralized to defective ear.

Correct medically or surgically.

26
Q

What is sensorineural hearing loss? What tests do we run?

A

Damage to inner ear/cochlea or nerve pathways. Loss of hearing higher pitched sounds.
Weber test: Lateralization to good ear
Rinne Test: AC > BC (but they stop hearing it really early. You can probably hear it as the tester still.)

Most common type of PERMANENT loss. Difficult to correct.

27
Q

What are some examples of autosomal syndromes that cause hearing loss?

A
  • Treacher Collins syndrome
  • Crouzon syndrome
28
Q

What is an example of an autosomal recessive syndrome that causes hearing loss?

A

Usher Syndrome

29
Q

What is an example of a X-linked syndrome that causes hearing loss?

A

Alport syndrome.

airport = LAX (LINKED X)

30
Q

What are the other hereditary causes of hearing loss?

A
  • TORCH infections
  • RH factor incompatibility
  • Prematurity
  • Anoxia
  • Hyperbilirubinemia
31
Q

What are the TORCH infections?

A
  • Toxoplasma Gondii
  • Other (Syphilis, Parvo B19, VZV, Listeria)
  • Rubella
  • CMV
  • HSV2
32
Q

What are the main/common ototoxic drugs?

A
  • ASA
  • Anti-malarials/tonic water
  • LASIX
  • Gentamicin/tobramycin
  • Erythromycin
  • Cisplantin/Carboplantin
  • Mercury and Lead
33
Q

What is the mnemonic for hearing loss drugs?

A

Medications Neglected Can Cause Loss Auditory-Vestibular System
* Malaria drugs: Quinine or Macrolide: erythromycin
* NSAID
* Cisplatin/Carboplatin
* Loop diuretics: Furosemide and ethacrynic acid
* Aminoglycosides: gentamicin/tobramycin
* Vancomycin/vincristine
* Salicyclic acid: ASA

34
Q

What is otosclerosis?

A
  • Disease of the ossicular chain in which the stapes affixes to the oval window.
  • Presents as conductive hearing loss.
  • It is an inherited, autosomal dominant disease!!
35
Q

How does otosclerosis typically present?

A
  • Progressive unilateral/bilateral conductive hearing loss.
  • Improved hearing with BKG noise.
  • Tinnitus
  • Weber test should lateralize to defective ear
36
Q

How is otosclerosis treated?

A

Stapedectomy or hearing aid if sensorineural loss has occurred.

37
Q

What is a schwartz sign?

A

Red blush of the tympanic membrane over the promontory, often suggestive of otosclerosis.

38
Q

What is presbycusis?

A

Age-related hearing loss.

39
Q

How does presbycusis present?

A
  • Progressive BILATERAL symmetrical sensorineural hearing loss.
  • Most notable at high frequencies
  • MOST SEVERE in males and often confused with noise-induced hearing loss.
40
Q

What parts of the ear are generally affected in presbycusis?

A

Cochlea and ossicles.

41
Q

What is the treatment for presbycusis?

A
  • Hearing aids (common)
  • Cochlear implants (severe)
  • OTC CoQ10 (maybe)
42
Q

What is an acoustic neuroma/vestibular schwannoma?

A

BENIGN tumor of the schwann cells (myelin forming) that occurs on CN8

43
Q

How does an acoustic neuroma present?

A
  • Unilateral, sensorineural hearing loss.
  • Usually only affects CN8.
  • Dizziness/balance problems.
44
Q

How is an acoustic neuroma diagnosed? Treated?

A

MRI to locate it.
Treatment is either monitoring or radiation/surgery.

45
Q

What is the pathophysiology behind noise-induced hearing loss? (NHL)

A

Permanent hearing impairment due to hair cell damage/death.

46
Q

How loud do sounds need to be to cause NHL?

A

85+ decibels (lawnmower minimum)

47
Q

What sound range does NHL ruin?

A

Bilateral hearing of 2000-4000 Hz?

48
Q

How should we approach treatment of hearing loss in general?

A
  • If due to cerumen impact or OM, treat there.
  • If not easily remediable, refer to EENT since it may require time-sensitive treatment like corticosteroids.
49
Q

When is routine auditory screening recommended?

A
  • 65+
  • Adults with previous exposure to injurious noise levels.
50
Q

Where are the 4 types of hearing aids placed?

A
  • Completely in the canal
  • In the canal
  • In the ear
  • Behind the ear
51
Q

What is the gold standard for auditory rehabilitation of advanced sensorineural hearing loss? (SNHL)

A

Cochlear implant

52
Q

What is a cochlear implant?

A
  • External microphone and speech processor under ear.
  • Receiver underneath temporalis muscle.
  • Internal receiver in the cochlea.

CM 1B: ID/EENT (27 decks)

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