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CMSD5260 Hearing Disorders > Ototoxicity, Presbycusis and Noise Induced Hearing Loss > Flashcards

Ototoxicity, Presbycusis and Noise Induced Hearing Loss Flashcards

1
Q

Ototoxicity HL induced by

A

medications (& others)

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2
Q

Presbycusis HL associated with

A

aging

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3
Q

Noise-induced hearing loss (NIHL) HL induced by

A

noise exposure

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4
Q

Who is affected by ototoxicity, presbycusis, and NIHL?

A

Ototoxicity
Adults and children (high-risk register)

Presbycusis
Adults

Noise-induced hearing loss (NIHL)
Adults and children

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5
Q

How can ototoxicity affect cochleovestibular function?

A

Partial or total reduction of cochleovestibular function from exposure to toxic chemical substance

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6
Q

What are teratogens?

A

substances that cause birth defects

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7
Q

What is latrogenic?

A

complications caused by medical or surgical intervention (caused by HCP)

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8
Q

Ototoxicity =

A

Ototoxicity = iatrogenic

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9
Q

Do all patients who take ototoxic medications usually get HL?

A

Not all patients who take ototoxic medications will get hearing loss
Degree of ototoxicity varies

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10
Q

What are the susceptibility risk factors of ototoxicity HL?

A

Pre-existing hearing loss
Age
Renal function
Drug dosage
Method of administration

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11
Q

Susceptibility risk factors related to:

A

Mitochondrial gene mutation (12S ribosomal RNA gene in Chinese)

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12
Q

Ototoxic HL presents with: (5)

A

SNHL
Tinnitus
Dizziness/imbalance
Nausea
Reduced speech discrimination

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13
Q

Give 5 medications that cause ototoxic HL:

A

Aminoglycosides (antibiotics)
Diuretics
Salicylates
Antimalarial agents
Chemotherapeutic agents

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14
Q

When do we use aminoglycosides?

A

Commonly used to treat gram-negative bacteria associated sepsis
- UTI or pneumonia

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15
Q

Aminoglycosides are usually given:

A

IV lines
Poorly absorbed through GI tract
Rarely given as ototopical drops

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16
Q

How do Aminoglycosides affect IE structures?

A

Directly damage inner ear structures

  • Cochlea
    Basal turn > apical turn
    Outer hair cells > inner hair cells > stria vascularis
  • Vestibular organ
    Utricle and saccule
    Vertigo/dizziness may be present
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17
Q

How does ototoxic HL due to aminoglycosides appear on the audiogram?

A

High frequency affected first (> 8 KHz)
May not initially be detected by audiogram
Bilateral SNHL
Irreversible
Acute or chronic loss

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18
Q

Aminoglycosides: Neomycin and Kanamycin
are more likely to cause________________

A

cochlear toxicity first

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19
Q

Aminoglycosides: Gentamycin and Streptomycin are more likely to cause________________

A

to cause vestibular toxicity first
Intratympanic therapy used in severe Meniere’s disease (close monitoring required)

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20
Q

When used in early pregnancy, some aminoglycosides may cause ______________________________________________________

A

When used in early pregnancy, some aminoglycosides may cause ototoxicity and other congenital anomalies in the newborn

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21
Q

How do diuretics affect your system and hearing?

A

Affects the fluid flow in your body
Damages the stria vascularis
Tinnitus and vertigo
May be temporary/reversible SNHL
High doses can cause permanent SNHL

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22
Q

Salicylates are commonly found in ________________________ and ____________________________

A

Salicylates are commonly found in antipyretics and analgesics

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23
Q

Antipyretics are:

A

Antipyretics-fever relieving drugs

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24
Q

Analgesics are:

A

Analgesics-pain relieving drugs

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25
How do salicylate drugs affect hearing?
Mechanism of HL Reduced blood flow to cochlea (No hair cell loss)
26
What are features of salicylates hearing loss?
Common cause of high frequency tinnitus Reversible, mild to moderate SNHL (rarely permanent)
27
What are antimalarial agents? (3)
Not commonly used in North America Originally thought malaria caused hearing loss but it was the drug to treat malaria Hearing loss depends on the dose
28
How do Quinine drugs affect hearing?
A similar mechanism as aspirin Reduced blood flow to the cochlea Reversible, bilateral SNHL Rarely dizziness High-pitched tinnitus
29
What are Chemotherapeutic Agents?
Systemic cancer treatment drugs Most agents kill cells that divide rapidly (main properties of cancer cells) Other normal cells that divide rapidly include bone marrow, digestive tract and hair follicles They are also targeted
30
Chemotherapeutic Agents affect Bone marrow causing: Digestive tract: Hair follicles:
Bone marrow causing: immunosuppression Digestive tract: mucositis (inflammation of lining of GI tract) Hair follicles: hair loss
31
In Chemotherapeutic Agents, what are the two platinum-containing agents?
Cisplatin Carboplatin Binds to DNA and interferes with normal repair mechanism Mostly used in breast, head/neck, and ovarian cancers, lymphomas
32
How does cisplatin affect hearing? (3)
HL is dose dependent Damages the cochlear hair cells starting at the basilar end Stria vascularis also damaged
33
Risk of Ototoxicity from: Aminoglycosides = Diuretics = Aspirin = Cisplatin=
Aminoglycosides = 5-10% in ICU patients Diuretics = 1-5% Aspirin = <1% Cisplatin= >50% (dose-dependent)
34
What are other causes of ototoxicity? (6)
Anticoagulants (blood thinners) Anticonvulsants (seizure medications) Beta blockers (heart medications) Topical antimicrobials Alcohol (fetal alcohol syndrome) Radiation therapy
35
What are topical antimicrobials? (3)
Commonly prescribed for otorrhea Garamycin, gentamycin, neomycin Agents may enter the middle ear through TM perforations and eventually enter the inner ear, causing SNHL
36
What is fetal alcohol syndrome?
A recognizable pattern of congenital anomalies seen in children of women who use (abuse) alcohol during pregnancy
37
What are the clinical features of fetal alcohol syndrome? (5)
Dysmorphic characteristics (craniofacial anomalies) Growth deficiency (low birth weight, failure to thrive) Organ system defects (heart problems, GI issues) CNS dysfunction (intellectual disability, hypertonia) Hearing disorders (SNHL, CAPD, ± CHL)
38
What is radiation therapy?
Used in treating cancers Ionizing radiation damages DNA
39
What are other sources of radiation? (3)
Nuclear power plant Multiple x-rays, CT scans Submarines, military
40
Which cancers tend to receive radiation treatment?
Head and neck cancers tend to receive radiation treatment
41
What is synergistic effects?
can occur when patients receive radiation and chemotherapy
42
How does radiation therapy affect hearing? (2)
SNHL Atrophy of organ of Corti, spiral ligament, and stria vascularis CHL Otitis externa, EAC/middle ear damage, OME
43
What is Presbycusis? (2)
Progressive deterioration of hearing associated with aging Most common cause of adult hearing loss > 50% of elderly have presbycusis
44
What is apoptosis?
Process of programmed cell death Part of normal aging in organisms Orderly process ensuring renewal of cells But over time, it results in aging
45
What occurs in apoptosis?
Billions of cells die daily in adult humans Malignancies are thought to be related to a disruption of this process
46
What occurs in necrosis?
Cell death due to injury Not a normal process (ototoxicity and NIHL)
47
How does presbycusis affect hearing?
Cumulative effect of aging Apoptosis of auditory cells Bilateral, symmetrical, progressive, and irreversible The degree of loss is variable between individuals
48
What is the epidemiology of presbycusis? (4)
Prevalence is equal between males and females Extent of HL worse in men Rate of decline worse in men Earlier onset HL in men
49
How does presbycusis affect structures in the IE and how does it look on the audiogram?
Loss of hair cells (basal end of the cochlea) Flattening of the organ of Corti High-frequency hearing loss Reduced speech discrimination
50
What is Neural presbycusis? (4)
Damage and loss of cochlear neurons Starts earlier in life and is progressive but pure tone thresholds are unaffected until later Lower and higher frequencies involved Marked reduction in speech understanding (central etiology)
51
How does presbycusis affect the Strial vascularis?
Strial presbycusis 1. Damage to stria vascularis 2. Occurs at both high and low frequencies 3. Hearing loss begins at 30s-40s and progressive 4. Good speech discrimination 5. Responds well to amplification
52
Explain undefined presbycusis:
About 25% have no distinguishable characteristics No specifically defined problem
53
Specific types of presbycusis deal only with ______________________________________________________
age-related changes to the cochlea and 8th nerve
54
What are other aspects of age-related hearing changes?
Central auditory processing delays Recruitment Reduced sound localization abilities Reduced speech perception in noise
55
What could be age-related ear changes at the level of the EE, ME and IE?
External ear Elongation of lobule Calcification of ear cartilage Middle ear Reduced blood supply to TM (stiff) Increased density of ossicles Inner ear Hair cell changes
56
What are other aging changes?
Loss of muscle tone Skin changes Neurologic changes Presbylarynges
57
Against NIHL: OSHA regulations Exposure equivalent above ____dBA time-weighted average for ___hours requires hearing protection programs 95 dBA for_______________ 100 dBA for ___________ 130 dBA for ___________
OSHA regulations Exposure equivalent above 85 dBA time-weighted average for 8 hours requires hearing protection programs 95 dBA for 4 hours 100 dBA for 2 hours 130 dBA for < 2 mins
58
What is TTS?
Temporary SNHL that resolves within 24 hours Intense, short duration of exposure
59
What is PTS?
Permanent SNHL Chronic exposure
60
What could be work-related risks NIHL in adults?
Factory workers Military Heavy machinery
61
What could be work-related risks NIHL in adults?
Factory workers Military Heavy machinery Guns
62
Estimates suggest up to ______% of children will experience NIHL
Estimates suggest up to 15% of children will experience NIHL (ex: from toys)
63
Explain the culture of noise from NIHL like fitness clubs, movies and concerts:
Fitness clubs Noise measured at 90 clubs across USA Levels reached 120 dB 80% reached 100 dB for 1 hour classes Movies Armageddon: 117 dB shuttle take off scene Godzilla: 115 dB shriek Concerts Standard rock concert level is 125 dB Consider hearing protection at rock concerts
64
How does NIHL mechanically damage our hearing organs?
Outer hair cell damage from chronic loud noise due to oxygen radical formation Single intense exposure (eg explosion, gunfire) may mechanically damage the organ of Corti or rupture cochlear membranes
65
What are the features and diagnosis of NIHL?
SNHL (mostly bilateral) High-pitched tinnitus History of noise exposure Audiogram
66
How can we manage NIHL?
Hearing conservation programs having for objective to reduce the risk of developing a permanent NIHL
67
What are the elements of the hearing conservation program?
Noise measurement and reducing exposure Audiometric testing Employee training and education Record keeping Program evaluation
68
How can we reduce exposure to loud sounds for NIHL?
Repair or change machinery Isolate worker from machinery Limit time exposure to noise Ear protection
69
What is the purpose of audiometric testing?
Identify significant threshold shift Monitor the effectiveness of the hearing conservation program Establish readiness and fitness for work Ensure proper referral and diagnosis
70
What is pseudohypocusis?
Pseudo-false or fake Aka-functional hearing loss Subjective loss of hearing by a person with absence of organic pathology
71
What are clinical features we see in pseudohypoacusis?
Suspect when the patient hesitates, shifts pure tone thresholds or expresses confusion PTA at 500, 1000, and 2000 Hz should be within 10 dB of SRT Acoustic reflexes should be absent if tests suggests significant hearing loss Normal ABR/OAE
72
Why would people fake a hearing loss?
Mostly deliberate for psychological reasons or for compensation Rarely it is unrealized by the client
73
How do you test for pseudohypacusis?
OAE ABR Startle or gentle confrontation Stenger’s test Lee’s speech delay test Lombard test
74
How does the stenger test work?
2 tones of same frequency presented to each ear cannot be heard simultaneously if one is louder Client given 2 simultaneous tones with matched frequency but the alleged poorer ear receives louder tone For real HL, the tone should be heard in the better ear Fakers will report hearing nothing
75
How does Lee's speech delay test works?
Client is played back his or her own speech at a delay that would cause the subject to stutter
76
How does the Lombard test work?
Background noise is gradually introduced below the client’s recorded response threshold as the client is asked to read aloud Volume of the reader’s voice increases as the masking noise is presented in pseudohypacusis

CMSD5260 Hearing Disorders (12 decks)

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