MDT EAR Barotrauma/ Noise Induced Hearing Loss/Tinitus Flashcards
The diagnosis of barotrauma is based upon what?
an accurate history and a confirmatory
physical examination.
Any problem occurring when there is a change in surrounding pressure raises the likelihood that what has occurred?
barotrauma
How would you secure your diagnosis for barotrauma?
If the physical examination confirms the injury
What is the most frequent etiology for barotrauma?
flying
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
Barotrauma
What are some DDx for Barotrauma?
(1) Tympanic membrane perforation
(2) Acute otitis media
Do you need to run and labs/studies for suspected barotrauma?
No
True/false
When traying barotrauma it is best treat the predisposing conditions (e.g. upper respiratory congestion prior to air travel)
True
True/False
Antibiotics are indicated for barotrauma
False
they are not indicated
What meds would you use to treat barotrauma?
-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
- Oxymetazoline (Afrin).
- Antihistamines as needed for symptomatic relief.-
True/False
Mild barotrauma case may take weeks to resolve.
False
May resolve spontaneously
Cases of barotrauma that include TM rupture may take how long to heal?
weeks to months
What type of referral would you consider if inner ear is exposed, perilymphatic fistula and/or sensorineural hearing loss?
otolaryngology
What are some complications for Barotrauma?
(1) Permanent Hearing Loss
(2) Ruptured TM
(3) Chronic Tinnitus/Vertigo
Sudden hearing loss (3 days or less) and is divided into what?
-Conductive hearing loss
-Sensory hearing loss
What type of Sudden hearing loss is more likely due to a reversible cause, such as otitis media, serous otitis, or a cerumen impaction.
Conductive hearing loss
What type of Sudden hearing loss is more likely due to diseases of the cochlea, a condition that is usually irreversible.
Sensory hearing loss
True/False
The most common form of Sensory hearing loss is a gradually progressive, predominantly highfrequency loss with advancing age
True
Loss typically begins in what frequencies?
the high frequencies especially 4000 Hz
Common sources of injurious noise are what?
industrial machinery,
weapons
excessively loud music
what study confirms significant hearing loss
Audiogram testing
What physical exam special testing is useful for noise induced hearing loss
Weber and Rinne
Treatment for Noise induced hearing loss
(1) Remove the member from further exposure.
(2) Educate member on wearing earplugs.
(3) Refer to ENT specialist for further evaluation as necessary.
DDx for noise induced hearing loss
(1) Presbyacusis
(2) Cerumen Impaction
(3) Ototoxicity
Complications for noise induced hearing loss
(1) Irreversible hearing loss.
(2) Deafness
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
Tinnitus
Tinnitus is divided into what two types
Objective and subjective
DDx for Tinnitus
(1) Hyperthyroidism
(2) Otitis Media
(3) Temporomandibular joint dysfunction (TMJ)
What labs would you run for Tinnitus?
(1) CBC
(2) TSH
(3) HIV
(4) RPR/autoimmune panel
What type of imaging would you get for tinnitus if any
(5) MRI with or without contrast
(6) CT scan for pulsatile tinnitus
When would you order a CT scan for Tinnitus?
pulsatile tinnitus
True/False
No pharmacologic agent has been shown to cure or consistently alleviate tinnitus
True
What is the patient education for tinnitus?
Help patients understand the relatively benign nature of tinnitus and importance of PPE for noised induced areas.
What consult would you do for tinnitus?
Referral to Audiologist for comprehensive hearing evaluation and management
Complications for Tinnitus
(1) Perforated TM
(2) Hearing Loss
(3) Cellulitis
