Otolaryngology Flashcards
What are the two types of hearing loss?
Conductive and sensorineural
What are the most common causes of hearing loss?
- Cerumen impaction
- Eustachian tube dysfunction (2/2 to URI)
- Increasing age (presbycusis)
Weber lateralizes to the affected ear. Rinne test might show greater bone conduction than air conduction on affected side. What type of hearing loss?
Conductive pattern via weber and rinne
Weber lateralizes to the better hearing/unaffected side. Ring test will show that air conduction is greater than bone conduction. What type of hearing loss?
Sensorineural pattern via weber and rinne
What is the definition of conductive hearing loss?
Impaired sound transmission to inner ear
What is definition of sensorineural hearing loss and how does it present?
Damage/impairment of the inner ear (cochlea) or neural pathways
Possible causes of conductive hearing loss
- blockage/obstructoin due to cerumen impaction or exudate from otitis externa
- otitis media with effusion
- otosclerosis (abnormal bony growth of the middle ear)
- ear trauma/injury
Possible causes of sensorineural hearing loss?
- Presbycusis is most common (age)
- Meniere disease
- Acoustic trauma (second most common)
How does presbycusis present?
Genetic predisposition is strong; risk increased with noise exposure and exposure to various medications
What is the cause and what are the symptoms of Meniere disease?
Cause: unknown etiology
- Recurrent vertigo
- Lower range hearing loss
- Tinnitus
- One-sided aural pressure
Caloric testing shows nystagmus is lost on impaired test (normally with cold water, eyes turn toward the ipsilateral ear, with horizontal nystagmus to the contralateral ear
What is the first-line tx for Meniere disease?
Low-sodium diet and diuretics (.e., acetazolamide); if unresponsive may try more invasive procedures like intratympanic corticosteroid therapy, surgery
Acoustic trauma occurs at what dB?
> 85 dB can cause cochlear damage. Increased risk with chronic exposure
What nerve do acoustic neuromas (vestibular schawnnomas) affect?
Intracranial benign tumor affecting the 8th CN
Typical presentation of acoustic neuroma?
Uni vs. bilateral
Acute vs. progressive
Other sxs
Patient presents with unilateral, progressive (but may be more acute) one-sided hearing loss with impaired speech discrimination. Other sxs include vertigo, which is usually continuous
How to dx and treat acoustic neuroma?
Dx: MRI
Tx: Maybe surgery or focused radiation depending on age, health status, and tumor size
What drugs may induce hearing loss?
Permanent damage can occur despite correct dosing
- Aminoglycosides
- Loop diuretics
- Vancomycin
- Anticancer drugs (cisplatin)
What are causes of hearing loss in infants and children?
- Congenital (asphyxia, erythroblastosis, maternal rubella)
2. Acquired: measles, mumps, pertussis, meningitis, influenza, labrynthitis
Explain the process of AOM
- Begins usually as viral URI that leads to eustachian tube dysfunction or blockage
- A bacterial infection occurs with the subsequent buildup of fluid and mucus
What are most common agents of AOM?
- Strep pneumo
- H. flu
- Moraxella catarrhalis
- Strep pyogenes
A child presents with fever, otalgia, and hearing impairment. On exam, the TM may appear erythematous. It has limited mobility with pneumotoscopy. what’s the dx?
AOM
If someone with ear pain has otorrhea and an abrupt decrease in pain, what might be the cause?
AOM -> Bulging and eventual rupture of TM
When can tx for AOM be “watchful waiting”?
- If >2 years old w/o otorrhea
2. If
What is the treatment of AOM?
- Amoxicillin
- Cephalosporin, TMP/SMX, and Azithromycin also might be acceptable.
- Amox/Clav or Cofactor in resistant cases
What is a complication of inadequately treated otitis media?
Mastoiditis
A child presents with spiking fever, post auricular pain, erythema, and a fluctuant painful mass behind the ear. What is the cause?
Mastoiditis from inadequately treated AOM. Treat initially with IV antibiotics and myringotomy followed by full course of oral antibiotic. If ineffective, surgery (mastoidectomy) is indicated.
What are causes of chronic otitis media?
Repeated episodes of acute otitis media, trauma, or cholesteatoma