MDT EAR Barotrauma/ Noise Induced Hearing Loss/Tinitus

Question 1

The diagnosis of barotrauma is based upon what?

Answer 1

an accurate history and a confirmatory
physical examination.

Question 2

Any problem occurring when there is a change in surrounding pressure raises the likelihood that what has occurred?

Answer 2

barotrauma

Question 3

How would you secure your diagnosis for barotrauma?

Answer 3

If the physical examination confirms the injury

Question 4

What is the most frequent etiology for barotrauma?

Answer 4

flying

Question 5

Your patient has these issues what would you suspect?
Symptoms
(1) Middle ear pain
(2) Hearing loss due to deformation of tympanic membrane that can hinder membrane mobility
(3) Specific MOI to include sx associated with changes in inner ear pressure (relevant hx)
(4) SEVERE cases: Sensorineural hearing loss and vertigo due to inner ear damage (perilymphatic fistula)

Physical Findings:
(a) Positive Conductive hearing loss.
(b) Possible TM Perforation from acute pressure changes.
(c) TM Bulging appearance.
(d) May have fluid in the ear canal.
(e) Severe findings:
1) Vertigo
2) Sensorineural hearing loss

Answer 5

Barotrauma

Question 6

What are some DDx for Barotrauma?

Answer 6

(1) Tympanic membrane perforation
(2) Acute otitis media

Question 7

Do you need to run and labs/studies for suspected barotrauma?

Answer 7

No

Question 8

True/false
When traying barotrauma it is best treat the predisposing conditions (e.g. upper respiratory congestion prior to air travel)

Answer 8

True

Question 9

True/False
Antibiotics are indicated for barotrauma

Answer 9

False
they are not indicated

Question 10

What meds would you use to treat barotrauma?

Answer 10

-1. Pseudoephedrine:
-Immediate release: 60 mg every 4 to 6 hours
-Extended release: 120 mg every 12 hours or 240 mg every 24 hours
-MAX 240mg per day

2. Oxymetazoline (Afrin).
3. Antihistamines as needed for symptomatic relief.-

Question 11

True/False
Mild barotrauma case may take weeks to resolve.

Answer 11

False
May resolve spontaneously

Question 12

Cases of barotrauma that include TM rupture may take how long to heal?

Answer 12

weeks to months

Question 13

What type of referral would you consider if inner ear is exposed, perilymphatic fistula and/or sensorineural hearing loss?

Answer 13

otolaryngology

Question 14

What are some complications for Barotrauma?

Answer 14

(1) Permanent Hearing Loss
(2) Ruptured TM
(3) Chronic Tinnitus/Vertigo

Question 15

Sudden hearing loss (3 days or less) and is divided into what?

Answer 15

-Conductive hearing loss
-Sensory hearing loss

Question 16

What type of Sudden hearing loss is more likely due to a reversible cause, such as otitis media, serous otitis, or a cerumen impaction.

Answer 16

Conductive hearing loss

Question 17

What type of Sudden hearing loss is more likely due to diseases of the cochlea, a condition that is usually irreversible.

Answer 17

Sensory hearing loss

Question 18

True/False
The most common form of Sensory hearing loss is a gradually progressive, predominantly highfrequency loss with advancing age

Answer 18

True

Question 19

Loss typically begins in what frequencies?

Answer 19

the high frequencies especially 4000 Hz

Question 20

Common sources of injurious noise are what?

Answer 20

industrial machinery,
weapons
excessively loud music

Question 21

what study confirms significant hearing loss

Answer 21

Audiogram testing

Question 22

What physical exam special testing is useful for noise induced hearing loss

Answer 22

Weber and Rinne

Question 23

Treatment for Noise induced hearing loss

Answer 23

(1) Remove the member from further exposure.
(2) Educate member on wearing earplugs.
(3) Refer to ENT specialist for further evaluation as necessary.

Question 24

DDx for noise induced hearing loss

Answer 24

(1) Presbyacusis
(2) Cerumen Impaction
(3) Ototoxicity

Question 25

Complications for noise induced hearing loss

Answer 25

(1) Irreversible hearing loss.
(2) Deafness

Question 26

Patient has thee issues what would you suspect?
(1) “Ringing Noise”
(2) Conductive hearing loss/changes
(3) Headache
(4) Noise intolerance
(5) Vertigo
(6) TMJ dysfunction

Answer 26

Tinnitus

Question 27

Tinnitus is divided into what two types

Answer 27

Objective and subjective

Question 28

DDx for Tinnitus

Answer 28

(1) Hyperthyroidism
(2) Otitis Media
(3) Temporomandibular joint dysfunction (TMJ)

Question 29

What labs would you run for Tinnitus?

Answer 29

(1) CBC
(2) TSH
(3) HIV
(4) RPR/autoimmune panel

Question 30

What type of imaging would you get for tinnitus if any

Answer 30

(5) MRI with or without contrast
(6) CT scan for pulsatile tinnitus

Question 31

When would you order a CT scan for Tinnitus?

Answer 31

pulsatile tinnitus

Question 32

True/False
No pharmacologic agent has been shown to cure or consistently alleviate tinnitus

Answer 32

True

Question 33

What is the patient education for tinnitus?

Answer 33

Help patients understand the relatively benign nature of tinnitus and importance of PPE for noised induced areas.

Question 34

What consult would you do for tinnitus?

Answer 34

Referral to Audiologist for comprehensive hearing evaluation and management

Question 35

Complications for Tinnitus

Answer 35

(1) Perforated TM
(2) Hearing Loss
(3) Cellulitis