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Nervous System > Lecture 6.2: Hearing Disorders > Flashcards

Lecture 6.2: Hearing Disorders Flashcards

1
Q

What is Sound?

A
  • A compressive wave that travels at 343m/sec in air
  • > 1500m/sec in water
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2
Q

What are the 2 properties of sounds waves?

A

1) Frequency = Distance = Hertz (Hz)
2) Volume = Pressure = Decibels (dB)

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3
Q

What is the hearing range (frequency) of humans?

A

20-20,000 Hz

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4
Q

What is normal volume of conversation in humans?

A

60dB

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5
Q

At what volume doe sound get painful for humans?

A

120dB

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6
Q

What is Hearing?

A

Conscious appreciation of vibration perceived as sound

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7
Q

What is Deafness?

A

Hearing loss so severe that there is very little or no functional hearing

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8
Q

What does it mean to be Deaf (capital D)?

A
  • Deaf (capital D) people that have been deaf for all of
    their lives, or since before they started to learn to talk * Prelingually deaf
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9
Q

What does it mean to be deaf (lower case d)?

A
  • Anyone that has a severe hearing problem
  • Usually postlingual
  • May use hearing aids/cochlear implants
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10
Q

What does it mean to be hard of hearing?

A

Mild to moderate hearing loss

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11
Q

External Ear Anatomy (3)

A
  • Pinna (Auricle)
  • External Auditory Meatus
  • Tympanic Membrane
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12
Q

Middle Ear Anatomy (4)

A
  • Tympanic Membrane
  • Ossicles
  • Mastoid
  • Eustachian Tube
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13
Q

Inner Ear Anatomy: Bony Labyrinth (4)

A
  • Cochlea
  • Vestibular Apparatus
  • 3 Semicircular Canals
  • Filled with perilymph
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14
Q

Inner Ear Anatomy: Membranous Labyrinth (4)

A
  • Inside Bony Labyrinth
  • Cochlear Duct
  • Utricle and Saccule
  • Semicircular Ducts
  • Filled with Endolymph
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15
Q

Mechanism of Hearing

A
  • The pinna collects and amplifies sound waves
  • The EAM funnels them to the tympanic membrane
    (TM)
  • The TM vibrates, transferring the vibrations
    sequentially to the ossicles, the oval window and the
    fluid of the inner ear
  • The middle ear amplifies the sound by ~30dB
  • Thus the middle ear converts sound waves in air of
    EAM to vibrations in fluid of inner ear
  • The inner ear converts mechanical signals (vibrations
    in fluid) to electrical signals → auditory pathway→
    brain
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16
Q

Function of the Inner Ear

A

1) Convert mechanical signals (vibrations in
fluid) to electrical signals → auditory pathway→
brain
2) Maintain balance

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17
Q

Inner Ear openings to Middle Ear (2)

A
  • Oval window (connects vestibule to ME at stapes
    footplate)
  • Round window (connects scala tympani with middle
    ear)
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18
Q

Mechanism of Hearing in the Cochlea

A
  • Vibration of stapes at oval window→ vibrations of
    perilymph in scala vestibuli
  • Vibrations transmitted to endolymph in cochlear duct
    and spiral organ of Corti on basilar membrane
  • Hair cells stimulated→impulses travel along CNVIII to
    brain
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19
Q

Auditory Transduction: Hair Cells

A
  • 4 rows of hair cells
  • 1 inner hair cells row (provide most of the signal to CN
    VIII)
  • 3 outer hair cell rows (role in modulating the response
    of the inner hair cells)
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20
Q

What is the Primary (Lemniscal) Pathway?

A

Main pathway through which auditory information reaches the primary auditory cortex

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21
Q

What is the Non-Lemniscal Pathway?

A

Mediating unconscious perception eg. attention, emotional response, and auditory reflexes

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22
Q

Can supranuclear lesions cause hearing loss?

A

No

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23
Q

Where in the ear do lesions occur in conductive hearing loss?

A

Lesions in the outer or middle ear

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24
Q

Where in the ear do lesions occur in sensorineural hearing loss?

A

Lesions in the inner ear or vestibuloccochlear nerve (VIII)

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25
Q

What is Mixed hearing loss?

A

Lesions in the outer or middle ear AND Lesions in the inner ear or vestibuloccochlear nerve (VIII)

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26
Q

Where in the ear do lesions occur in Central hearing loss?

A

Lesion in the auditory pathway in the brain (rare)

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27
Q

Hearing loss usually involves sensitivity and acuity, what does this mean?

A

Sounds are harder to hear (sensitivity) and they are usually distorted (acuity)

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28
Q

What happens to the Tympanic Membrane in Conductive Hearing Loss?

A
  • EAM/TM may look abnormal
  • (except otosclerosis)
  • May be temporary or treatable
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29
Q

What happens to the Tympanic Membrane in Sensorineural Hearing Loss?

A
  • TM usually looks normal
  • Often permanent
30
Q

What is the Weber Test?

A
  • Tuning fork in middle of head
  • Sound should be equal in both ears if normal
31
Q

Weber Test in Conductive Hearing Loss

A

Sound lateralises to affected side

32
Q

Weber Test in Sensorineural Hearing Loss

A

Sound lateralises to unaffected side

33
Q

What is the Rinnes Test?

A
  • Tuning fork behind ear and in front of ear
  • Compares perception of sounds transmitted by air
    conduction to those transmitted by bone conduction
  • Patient should be able to hear the sound of the tuning
    fork adjacent to their ear for approximately twice as
    long as the sound they heard over their mastoid.
    process
34
Q

Rinnes Test in Conductive Hearing Loss

A

Bone conduction is better than air conduction

35
Q

Rinnes Test in Sensorineural Hearing Loss

A

Air conduction is better than Bone conduction

36
Q

What is the Speech Banana?

A

Represents the level/intensity and tone/frequency of sounds of speech in language

37
Q

Ability to hear depends on….? (2)

A
  • Pitch (frequency) (Hertz (Hz))
  • Loudness (decibel (dB))
38
Q

What is a Pure Tone Audiogram?

A

A graphical representation of a person’s hearing acuity at a range of frequencies and loudness levels

39
Q

Pure Tone Audiogram: Normal Hearing

40
Q

Pure Tone Audiogram: Conductive Hearing Loss

41
Q

Pure Tone Audiogram: Sensorineural Hearing Loss

42
Q

Pure Tone Audiogram: Mixed Hearing Loss

A
  • BC > AC
  • BC >20dB hearing loss
43
Q

Mild High-Frequency Loss

44
Q

Moderate-to-Severe Bilateral Loss

45
Q

What conditions can cause Conductive Hearing Loss? (5)

A
  • Acute Otitis Media (AOM)
  • Glue Ear (OME)
  • TM Perforation/Retraction
  • Cholesteatoma
  • Otosclerosis
46
Q

What conditions can cause Sensorineural Hearing Loss Bilaterally? (5)

A
  • Congenital Defect
  • Infections: measles, meningitis
  • Presbyacusis
  • Noise induced hearing loss
  • Ototoxic Drugs (eg. gentamicin)
47
Q

What conditions can cause Sensorineural Hearing Loss Unilaterally? (3)

A
  • Congenital Defect
  • Acoustic Neuroma (vestibular schwannoma)
  • Menieres
48
Q

What can cause Congenital Hearing Loss? (3)

A
  • Genetic
  • Intrauterine Infections (rubella, CMV)
  • Prematurity
49
Q

When are children tested for congenital hearing loss in the UK?

A
  • Newborn screening hearing test
  • Again at 8 months of age
50
Q

How do people with hearing loss go about daily life? (2)

A
  • Hearing Aids
  • Sign Language
51
Q

What is seen on an Audiogram in Noise Induced Hearing Loss?

52
Q

What is seen on an Audiogram in Congenital Hearing Loss?

A

Cookie Bite like shape

53
Q

What is seen on an Audiogram in Presbyacusis?

A

High frequency SNHL

54
Q

What is seen on an Audiogram in Menieres?

A

Low frequency SNHL

55
Q

What is seen on an Audiogram in Noise Induced Hearing Loss?

56
Q

What is Presbyacusis?

A

Bilateral age-related hearing loss.

57
Q

What is Acute Otitis Media?

A
  • An infection of the middle ear
  • Most commonly seen between the ages of 6 to 24
    months
58
Q

What is Glue Ear (OME)?

A

Glue ear is where the middle part of the ear canal fills up with fluid, the Eustachian tube seems to lose the ability to drain away the mucus

59
Q

What is Cholesteatoma?

A

A type of skin cyst that is located in the middle ear and mastoid bone in the skull

60
Q

What is Otosclerosis?

A
  • Fixation of the stapes footplate to the oval window of
    the cochlea
  • This greatly impairs movement of the stapes
  • Therefore transmission of sound into the inner ear
    (“ossicular coupling”) is lost
61
Q

What is Menieres?

A

A distension of membranous labyrinth by the endolymph, equally called endolymphatic hydrops

62
Q

What are the 4 symptoms of Menieres Disease?

A
  • Vertigo Attacks
  • Fluctuating Hearing Loss
  • Tinnitus
  • Auricular Plenitude Sensation
63
Q

What is an Acoustic Neuroma (Vestibular Schwannoma)?

A
  • Tumour of the vestibulocochlear nerve arising from
    the Schwann cells of the nerve sheath
  • Benign and usually slow-growing
  • Bilateral acoustic neuroma occurs in
    neurofibromatosis-type 2 (NF2)
  • Investigate unilateral SNHL and/or tinnitus with MRI
64
Q

Management of Acoustic Neuroma (3)

A
  • Microsurgery
  • Stereotactic Radiosurgery
  • Observation
65
Q

What treatments can be given for Sensorineural Hearing Loss?

A
  • Hearing Aids
  • Cochlear Implant
66
Q

What key investigation should be done in Sensorineural Hearing Loss?

A

MRI Internal auditory meati if unilateral, to exclude
acoustic neuroma

67
Q

How do Hearing Aids aid hearing?

A
  • Improve sensitivity to sound by amplifying it
  • But do not improve acuity.
  • Make it louder but not clearer
68
Q

How do Cochlear Implants work?

69
Q

How do Cochlear Implants aid hearing?

A

Bypass damaged portions of the ear and directly stimulate the auditory nerve

70
Q

Bone Anchored Hearing Aid (BAHA)

A
  • Transferring sound through bone conduction, and
    stimulating the cochlea of the normal hearing ear
  • Effectively transmitting sounds from the bad side into
    the normal ear resulting in a sensation of hearing
    from a deaf ear
71
Q

How to prepare for communicating with people who are d/Deaf or hard of hearing? (11)

A
  • Book an interpreter
  • Talk directly to your patient, not the person
    interpreting for them
  • Make sure you have your patient’s attention before
    talking
  • Maintain eye contact whilst communicating
  • Use normal lip movement
  • Make sure the room is well lit so that the patient can
    see your face clearly
  • Speak in plain English at a normal speed
  • Use written notes or diagrams
  • Use gestures and facial expressions to help explain
    yourself
  • Point to parts of your body if necessary
  • Keep checking to make sure your patient understands
    you

Nervous System (18 decks)

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