Sensory - Hearing Impairments

Question 1

auditory function

Answer 1

• ear provides essential data about hearing and balance
• ear works with the brain to interpret sounds
• loss of hearing and balance poses safety risks and socialization problems
• may impact communication
• cranial nerve VIII - vestibulocochlear nerve (2 portions/2 roles): responsible for transmitting sound (cochlear nerve) and equilibrium information (vestibular nerve) to the brain
• factors for higher risk of developing hearing loss: aging; heredity; occupational noises; recreational noises; exposure to certain medications; illnesses including autoimmune disorders; congenital abnormalities

Question 2

hearing loss

Answer 2

• conductive hearing loss: physical obstruction of sound wave transmission
• sensorineural hearing loss: a deficit present in cochlea, cranial nerve VIII, or brain; sensory hearing loss is sometimes reversible; neural hearing loss is permanent
• mixed conductive-sensorineural hearing loss: profound hearing loss encompasses both conductive and sensorineural injuries

Question 3

clinical manifestations of hearing loss

Answer 3

• turning up the volume on electronics
• frequently asking others to repeat conversations
• withdrawal from conversations
• avoiding social situations
• disturbance in patient’s own quality of speech

Question 4

auditory system assessment

Answer 4

• history: detailed patient history; current health; medications; past illnesses; smoking history; allergies; family history
• personal hygiene: assess how patient cares for and cleans their ears; movement of serumen by a foreign object may cause cerumen impaction
• genetics: more than 400 syndromes are linked to hearing loss
• physical inspection of ear using otoscope: evaluation of tympanic membrane > includes color, translucency, and drum position
• diagnostic testing: audiometry, tympanometry, electronystagmography (ENG); CT and MRI > detailed visualization of the internal ear

Question 5

ototoxic medications

Answer 5

most common categories of meds that pose ototoxic risks

• antibiotics (gentamicin, erythromycin, vancomycin)
• diuretics (furosemide)
• NSAIDs (aspirin, ibuprofen)
• chemotherapeutic agents (cisplatin)
• miscellaneous (quinine)
• usually the first sign of ototoxicity is ringing in the ears

Question 6

hearing protection

Answer 6

• protection of the ears from excessive noise: ear plugs, earmuffs, or other protective equipment
• patient education: relationship between volume levels and hearing loss
• risk of using cotton swabs or other foreign objects to “clean” the ear canal

Question 7

age-related changes

Answer 7

• outer ear: cilia lining the ear canal become coarse and stiff; cerumen may accumulate and oxidize; atrophy of the apocrine glands
• middle ear: stiffening of the tympanic membrane and calcification of the ossicles
• inner ear: presbycusis

Question 8

otitis media

Answer 8

• inflammation of the middle ear canal commonly by a bacterial source
• fluid buildup behind the eardrum leads to bacterial growth and infection
• affects adults but commonly seen in children
• rapid growth of bacteria becomes overwhelming
• often secondary to viral upper respiratory infection
• complications: chronic suppurative otitis media; facial nerve paralysis; labyrinthitis; labyrinthine fistula; mastoiditis meningitis
• management: antibiotics; recurrent acute otitis media (OAE) > myringotomy with/without tympanostomy

Question 9

tinnitus

Answer 9

• 2 types: subjective and objective; males have slightly higher incidence than females
• pathophysiology: tinnitus is a clinical manifestation, not a disease process

Question 10

tinnitus

Answer 10

clinical manifestations: ringing, buzzing, roaring, clicking, whistling, and hissing sounds in the ear
*management and diagnosis: provider try to discover the underlying cause of the clinical presentation; medications aimed at reducing the symptoms but not as a curative treatment

Question 11

vertigo

Answer 11

• abnormally in semicircular canals or CNS structures that process signals from semicircular canals
• spinning sensation at rest or with minimal movement, imbalance, and lightheadedness
• nausea/vomiting and hearing loss
• treatment goals focus on treating the cause
• medications
• complications include injuries from falls
• depression and anxiety

Question 12

ménière’s disease

Answer 12

• inner ear disorder that affects balance and hearing
• clinical triad of vertigo, tinnitus, and hearing loss
• excess of endolymphatic fluid
• clinical manifestations: varies from daily to rare symptomatology; onset with or without warning
• management: no known cure; treatment is aimed at providing symptomatic relief; clinical manifestations may be relieved with medications and dietary changes