Sensory: Hearing/Balance/Vision Flashcards
Conductive hearing loss
occurs in outer ear
sound unable to travel normally to inner ear
reflects audibility problem
ear canal
sensorineural hearing loss
occurs in inner ear
caused by aging, illness, noise
nerves
mixed hearing loss
inner & outer ear
both sensorineural and conductive loss
inner ear hearing disorder
cochlear hair cell or auditory nerve dysfunction
a very common disorder
inner ear hearing disorder systemic
referral crucial: to audiologist or otolaryngologist
promt management of sudden hearing loss can reverse impact
inner ear hearing disorder cause
genetic infectious vascular neoplastic traumatic toxic iatrogenic degenerative immunologic/inflammatory
weber’s test
512 Ht tuning fork on forehead see if sound is heard louder on one side or the other
dx: ipsilateral conductive hearing loss or contralateral sensorineural hearing loss
rinne’s test
base of tuning fok on mastoid process until sound is no longer heard then vibrating top placed an inch from external ear canal
(air conduction)
sensorineural hearing loss progression
damage to outer/middle/inner ear, aging process, loud sound damage
> wear/tear on hairs/nerve cells in the cochlea that send neural signals
> electrical signals can’t be transmitted efficiently
> symptoms of hearing loss
genetic hearing loss
very common birth defect
s/s: nonsyndromic hearing loss (hearing loss only) vs syndromic hearing loss (also other clinical abnormalities)
genetic hearing loss TX
regular audiologic monitoring
sensorieneural hearing loss (hearing aid/cochlear implant)
conductive hearing loss (hearing aid or osseointegrated hearing implant)
noise-induced hearing loss
from chronic prolonged exposure to high-intensity noise or single acute exposure to intense impulse sound
s/s: acoustic trauma (sudden hearing loss maybe w/ tinnitus) usually sensorineural
noise-induced hearing loss tx
amplification/assistive listening devices
education on noise-related changes in hearing
counseling/assistance coping
NIOSH allowable hearing exposure limits
8 hours a day for 85-dB sound reduction in exposure at >85 dB 60 dB = conversation 90 = motorcycle/lawnmower 110-120 = concert/chainsaw
conventional aids
amplify within canal
place in ear canal
osseointegrated bone-conducting hearing prostheses
applied to retroauricular skull
provide hearing via bone conduction
dental appliance-based bone-conduction systems similar
placed on mastoid bone sticks out through skin
implantable middle ear hearing devices
interface at level of ossicles & bypass eardrum
typically used for mild-moderate sensorineural hearing losss
cochlear implants
directly stimulate remaining neural elements w/in cochlea
used for severe or profound hearing loss
outer ear disorders
most highly treatable
typically don’t involve hearing loss except congenital outer ear malformations
Otitis Media
inflammation of middle ear space
associated w/ eustachian tube dysfunction
usually dx’d in children (7 or younger) tube shorter/horizontal
URIs, allergies, auditory tube irritation
acute or chronic
Otitis Media s/s
cold-like symptoms
upper respiratory problems
Acute otitis media
inflammation of middle ear w/ acute onset
moderate - severe bulging of tympanic membrane
middle ear effusion
complications: rupture of tympanic membrane or temp conductive hearing loss
tx: ABX
recurrent acute otitis media (AOM)
3 or more episodes of AOM in 6 months
or 4 + episodes in 12 months
RF: male, passive exposure to smoking, winter season
chronic otitis media
infection > 6 weeks w/ persistent effusion in middle ear space
mild- moderate conductive hearing loss
TX: topical ABX or steroids, frequent cleansing of ear canal
severe: surgery/systemic ABX, ventilation/pressure equalization tubes
bacterial otitis media vectors
acute: strep, pneumonia, haemophilius influenzae & M. catarrhalis
chronic: pseudomonas aeruginosea, staph aureus, fungus
otitis media drugs of choice/ supportive therapy
amoxicillin (clindamycin if allergic to PCN)
meds for pain/edema/inflammation/itching
NSAIDs or acetaminophen
corticosteroids to tx severe pain
otitis media in infants/todderls
pulling at ear
decreased appetite
postauricular & cervical lymph node enlargement
sucking aggravates pain
fever @ 104
decreased pain after tympanic membrane ruptures
mastoiditis
inflammation of mastoid sinus > mucosal lining of middle ear
children: acute complication of acute otitis media/recurrent bacterial otitis media
adults: URI or exacerbationo f seasonal allergy rhinitis preces
purulent material accumulates in mastoid cavitites
usually: strep, pneumoniae, staph, MRSA
mastoiditis DX
children: postauricular erythema, tenderness, swelling, mass, protrusion of auricle, otalgia, fever
adults: typically unilateral, otalgia, decreased/muffled hearing, sudden relief of pain/purulent otorrhea if TM ruptures
mastoiditis TX
children: empiric (vancomycin or linezolid)
adults: empiric (amoxicillin clavulanate or cefdinir)
pathogen-specific
mastoiditis complications
^ pressure = thin bones may be destroyed can result in hearing loss if untreated facial nerve paralysis osteomyelitis meningitis abscess
otitis externa
inflammation/infection of external auditory canal
cause: prolonged moisture = thriving bacteria
increased incidence among cotton swab users
can be acute/chronic bacterial/fungal (usually if immunocompromised)
most common after swimming in lakes/rivers
chronic: allergies, hearing aid irritation, autoimmune disorders
prevention: avoid cotton swabs/aggressive use of swabs; dry ears after swimming or apply acidic drops after swimming (1:1 vinegar solution)
TX: topical ABX
otitis externa pharmacotherapy
topical ABX or ABX/corticosteroid combo
chloramphenicol or ciprofloxacin or cipro+dexamethasone
apply ear wick (otowick) > warm bottle dropper by rolling between hands 1-2 minutes (cold could cause dizziness), instill ABX drops onto wicks, leave wick in for 24-48 hours, replace until course complete
ear disorder pharmacotherapy assess
baseline hearing/auditory status or other symptoms
ask about hypersensitivy (hydrocortisone, neomycin sulfate, polymyxin B)
many otic meds contra in perforated eardrum (if TM is perforated don’t irrigate or put anything in)
chloramphenicol contra in hypersensitivity/perforation (burning, redness, rash, swelling)
Otosclerosis
abnormal bone growth in middle ear space
associated w/ bilateral, slowly progressive, conductive (or mixed) hearing loss
alternating bone resorption/formation, genetic component, viral factors, autoimmune
otosclerosis s/s
conductive hearing loss
possible reduced speech recognition ability
tinnitus
dizzinezz/imbalance
aural fullness
paracusis willisii (hear better in noise environment)
DX: HX, otoscopy, audiologic results, radiologic studies
otosclerosis TX
annual hearing tests surgical procedures hearing aids fluoride calcium vitamin D
Presbycusis
hearing loss due to aging, idiopathic, most common form of hearing loss
sensorineural types: sensory (loss of hair cells/high-frequency hearing deficit) metabolic-strial (loss of stria vascularis & low-frequency hearing deficit) neural (loss of ganglion cells/variable pattern of hearing deficit)
s/s: progressive decrease in hearing thresholds, decreased ability to understand speech
dX: HX, complete audiologic assessment
presbycusis TX
hearing aids
assistive listening devices
cochlear implants
rehabilitation
meniere disease
inner ear disorder w/ both auditory & vestibular symptoms
excess endolymph w/in membranous labyringth of inner ear (abnormal fluid/ions in inner ear)
s/s: intense vertigo w/ accompnaying n/v, tinnitus, pressure or fullness in ear, fluctuating hearing loss
meniere disease DX/TX
2 or + spontaneous episodes for 20 min to 12 hours, testing for low-mid frequency hearing loss
definitive only postmortem
TX: anti-nausea, antiemetics, vestibular suppressants, low-salt diet, avoid allergens, diuretics, surgical decompression of endolymphatic sac
ototoxicity
SE of some medications (damages sensory cells of inner ears) most widely used meds (aminoglycoside ABX, platinum-based antineoplastic meds) chochleotoxic meds (aminoglycosides-neomycin): damage cochlea sensory cells = sensorineural heaing loss usually bilateral vestibulotoxic meds (aminoglycosides-strepteomycin/gentamicin): damages sensory cells of balance system usually bilateral
factors affect ototoxic effects
age
coexisting med conditions
genetic
drug/dosage/schedule
ototoxic meds in high doses
loop diuretics/salicylates
tinnitus/hearing loss
ototoxic monitoring/cautions
establish baseline hearing/balance
patient education to avoid meds
hearing aids/assistive devices
vestibular rehabilitation
cerumen impaction
mechanical obstruction
earwax accumulates in ear canal > narrows canal > interferes w/ hearing
earwax removal kits high seller, but excessive earwax requiring intervention is usually very rare
cerumen impaction TX
removing excess earwax (instillation of earwax softner/gentle lavage w/ tepid water) carbamide peroxide
teaching: don’t go overboard w/ removal, fats/oild stick to foreign particles to keep them out, antibacterial properties of ear wax
cerumen impaction s/s
pain in ear fullness in ear constant ringing noise in ear less hearing ability in affected ear cough dizziness
vestibular schwannoma
acoustic neuroma sensoineural hearing loss neurofibromatosis type 2 RF: childhood exposure to low-dose radiation (head & neck), brain tumors, noise-exposure DX: MRI
vestibular schwannoma s/s and TX
cerebellar compression
tumor progression (CNS)
hearing loss/tinnitus (cochlear nerve)
unsteady ambulation (vestibular)
facial numbness, pain (trigeminal)
facial paresis, taste disturbance (facial)
TX: surgery, radiation therapy (sterotactic, proton-beam)
visual pathway
light into eye by cornea > anterior chamber > pupil > lens (image inverted) > light onto retina > optic nerve via optic disc
normal vision: 20/20 (can see clearly an object at 20 feet)
dry eyes
red eyes: usually caused by allergies eye fatigue, over-wearing contact lenses, common eye infections (conjunctivitis)
dry eye TX
topical OTC that lubricate eye (artificial tears) or vasoconstrict capillaries of eye (stops transportation of inflammatory chemicals to site of irritation)
naphazoline
tetrahydrozoline
phenylephrine
hordeolum
stye
tender/red/pus-filled bump along edge of eyelid
bacterial infection in oil glands at base of eyelash
resolves usually in a week w/out TX (warm compress)
chalazion
painless lump in eyelid blockage of gland which makes tears sterile chronic inflammation hard, nontender resolves in days - week (warm compress)
ptergium
benign growth on conjunctiva, may extend to cornea
RF: high exposure to UV light, wind, airebone irritants
causes for removal: unsightly, interferes w/ vision, causes discomfort
conjunctivitis
viral or bacterial (highly contagious)
s/s: redness, discharge, itching, burning in eye
increased tearing, blurred vision, light sensitivity
viral conjunctivitis
adenoviruses
herpes simplex (< 5% = vision loss, blindness, keratitis)
in neonates: chorioretinitis
resolves 7 - 21 days
bacterial conjunctivitis
resolves w/in 1 week
symptoms persist up to 3 weeks
TX: topical ABX
allergic conjunctivitis
not contagious
treated w/ saline and/or oral & topical meds
corneal abrasion
scratch or cut cornea
causes: foreign body or chemical irritant, rubbing eye too hard or poking eye
DX: fluorescein stain w/ wood’s lamp, only after visual acuity, yellow/orange dye/stain
external eye disorders s/s and TX
eye redness tearing eye pain blurred vision light sensitivity TX: flushing w/ water or sterile saline solution topical ABX and anti-inflammatories
color blindness
red/green color blindness (most common)
blue/yellow color blindness
achromatopsia [total absence of color] (most severe)
congenital or acquired
strabismus
one or both eyes turn in/out/up/down
if untreated = amblyopia (lazy eye)
TX: occlusion therapy, vision therapy, prisms in glasses, surgery
esotropia
inward turning of eye
strabismus
extropia
outward turning of eye
strabismus
myopia
nearsightedness
refractive errors
eye has long axial length, focus short of retina
TX: concave glasses, contact lenses, laser surgery
hyperopia
farsightedness
refractive errors
eye has short axial length, focus “behind” retina
TX: convex glasses, contacts, lasersurgery
astigmatism
refractive errors
eye has elliptical shape, focus on two points in eye
TX: toric glasses, contacts, laser surgery
presbyopia
refractive errors
decline in focusing ability of eye (ciliary muscle)
TX: convex glasses
amblyopia
refractive errors
one or both eyes can’t see clearly despite corrective lenses
vision loss an be irreversible if not treated before age 8
TX: correction of refractive error & occlusion therapy
accommodation
lens if flatter for distant object light and more convex for closer rays. both brought to focus on the retina
hyperopia and myopia corrected by
biconvex lens or bi concave lens
heterochromia
irises are different colors
complete (two different colors)
partial (part or both different colors)
central (inner ring different than outer)
congenital heterochromia
may be benign associated w/: horner's syndrome sturge-weber syndrome waardenbur piebaldism hirschsprung bloch-sulzberger parry romber recklinghausen bourneville
acquired heterochromia
eye injury bleeding in eye swelling iritis or uveitis fuch's heterochromic cyclitis acquired horner's glaucoma litisse (med for glaucoma or eyelash growth) pigment disbursement syndrome ocular melanosis diabetes chediak-higashi iris ectropian syndrome
cataracts
cloudy or opaque discoloration of lens
causes: age-related, trauma, congenital anomalies, systemic disease, pharmacologic triggers
DX: opthalmologic exam
TX: limit exposure to UV light, surgery, artificial lens, ultrasonic vibrations, capsulotomy
s/s: blurred vision
glaucoma
increased intraocular pressure
normal: 12- 22 mmHg
slow, painless progressive loss of vision/optic nerve damage/visual-field loss
leading cause of preventable blindness
open-angle or close-angle
both b/c of buildup of aqueous humor (excessive production of blockage of outflow)
glaucoma risk factors
long-term use of some medications (glucocorticoids, antihypertensives, antihistamines, antidepresssants) hypertension migraine headaches severe near/far sightedness normal aging (>80)
ocular hyptension
> 22 mmHg pressure but not s/s of glaucoma
glaucoma vision
curtain like
black edges, can clearly see central only
extreme is worse than advanced
open angle glaucoma
peripheral vision affected first then central 90% of cases usually bilateral develops slowly over years asymptomatic at first (bloind spots, ptaches of vision losss) if untx = blindness iris does not cover opening dx: routine eye exam
open angle glaucoma TX
eye drops lower production of aqueous humor/increase outflow
close angle glaucoma
acute/narrow-angle glaucoma
5% of cases
usually unilateral
iris pushed over drainage area = angle narrows/closes
causes: stress/impact injury/meds, sudden increase in IOP
close angle glaucoma s/s
abrupt onset steamy looking cornea redness dull-to-severe eye pain HA bloodshot eyes foggy vision w/ halos bluging iris fixed pupil dilation DX: measure IOP w/ tonometer/pupils
close angle glaucoma TX
medical emergency = surgery can loos vision in 2-3 hours from onset miotic eye drops carbonic anhydrase inhibitors acetazolamide irridectomy
glaucoma pharmacology
goal: prevent damage to optic nerve by lowering IOP
if IOP 21 - 30 mmHg = begin tx
many antiglaucoma drugs affect autonomic nervous system
glaucoma meds
prostaglandins (dilate trabecular meshwork = ^ AH outflow)
beta-adrenergic blockers (decrease AH production/SE: bronchoconstriction/dysrhthmias/hypotension)
alpha-adrenergic agonists (decrease AH production)
carbonic anhydrase inhibitors (decrease AH production)
cholinergic agonists (miotics) (constrict pupil = more outflow)
osmotic diuretics - mannitol (reduce formation of aqueous humor)
latanoprost
antiglaucoma drug (prostaglandin)
reduces IOP by increasing outflow of AH
1 drop in affected eye in evening (peak affect in 12H)
SE: conjuctival edema, tearing, dryness, burning, pain, irritation, itching, feeling of foreign body in eye, photophobia, visual disturbances, eyelashes thicker/darker, change in iris color
contra: pregnancy, lactation, intraocular infection, conjunctivitis, closed-angle glaucoma
interx: thimerosal (causes precipitation)
C
timolol
antiglaucoma drug (beta-adrenergic blocker)
reduces formation of AH
requires 2-4 weeks for effect
SE: local burning/stinging upon application, temp blurred vision, if misapplied = hypotension, disrhythmia
contra: ashtma, severe COPD, sinus bradycardia, second/third degree AV block, heart failure, cardiogenic shock
interx: other beta-blockers, anticholinergics, nitrates, methyldopa, verapmil ]= hypotension/brady; w/ epinephrine = HTN followed by severe bradycardia
C
uveitis
inflammation in one or more tissues composing uvea (iris, choroid, cilliary body beneath cornea/sclera)
anterior/posterior or both
uveitis TX
meds most common
surgery (vitrectomy) to remove small amount of vitreous humor
corticosteroids (prednisolon Q4-5 hrs x2Days then taper)
sometimes ABX
immunosuppressive/cytotoxic drugs (severe bilateral cases)
uveitis s/s
eye redness
pain
blurred vision
retinopathy
any disorder/damage to retina
diabetic retinopathy (types, DX)
non-porliverative vs proliferative (PDR)
DX: through opthalmologic exam
TX: fluorescein angiography & laster
retinal detachment
retina separates from underlying structures
often described as “hanging curtain”
RF: significant myopia, cataract surgery, trauma
diabetic retinopathy
disorder of retina’s blood vessels caused by glucose destruction
(post 20 yrs of DM 99% of T1, 60% T2)
asymptomatic in early stages
s/s: blurred vision, floaters, distored vision, dark areas, poor night vision, novascularization in retina (new vessels)
TX: tight control of diabetes, laser surgery, vitrectomy
non-proliferative DR
structural&functional abnormalities of retinal vessels; basement membrane of retinal blood vessels thickened
poliferative DR
appearance of new vessels sprouting on surface of either optic nerve or retina (neovascularization)
retinal detachment s/s
painless but w/ warning signs
sudden appearance of many floaters
curtain-like shadow over visual field
floaters diminish gradually over weeks/months but don’t go away completely
retinal detachment patho/etiology
etiology: inflammation, fluid build up, vascular injuries, trauma
liquefied vitreous humor seeps through tear
detached retina sends wrong messages to brain thru optic nerve = blurred then failed vision
retinal detachment TX
scleral buckles (tiny synthetic band attached to outside of eyeball to gently push wall of eye against detached retina) maybe vitrectomy if necessary
retinal detachment vision
spots of black
some corners hidden
age-related macular degeneration etiology/patho
low perfusion & inflammation
distortion/loss of central vision
dry - non-exudative (most common) = blurry/wavy central vision, normal peripheral vision
wet - exudative (more severe) = new blood vessels grow around macula causing bleeding, scarring, photoreceptor atrophy
age-related macular degeneration RF
age genetics smoking Caucasian obesity diet
age related macular degeneration TX
no cure
delay progression/improve vision
depends on if dry or wet (can lead to serious vision loss)
wet = stopping abnormal BV growth w/ photodynamic light therapy
monthly ranibizumab injections
macular degeneration vision
object obstruction
blurry
blurry blocks
nystagmus
rapid, involuntary eye movement
latent (rare, RF amblyopia/strabisumus)
congenital (most commonly horizontal/fixed in direction)
acquired nystagmus
peripheral (disruption of normal function of sensory cells in peripheral balance system; horizontal in direction ; abducens cranial nerve palsy)
central acquired nystagmus (can be vertical rotary, horizontal, oblique, may be faster when eyes are open vs closed)
ocular trauma
globe rupture (pupil forms “tear drop” shape/points to rupture area)
fractures to orbital bones/floor (can result in impingement, eye cannot move, increased IOP)
lateral canthotomy
lateral canthotomhy
surgical intervention to allow the eye to bulge out/help relieve IOP
