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CMSD5260 Hearing Disorders > Traumatic Injuries of the Ear, SSNHL and Tinnitus > Flashcards

Traumatic Injuries of the Ear, SSNHL and Tinnitus Flashcards

1
Q

In auricular injuries, hematomas ______________________________________ where ___________________________________________

A

separate the perichondrium from the cartilage where the blood supply disrupted causing cartilage deformities

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2
Q

In this injury case:

What would be the symptoms related to her hearing?

A

Traumatic TM perf with cochlear damage
Bleeding
Decreased hearing
Dizziness

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3
Q

What is Barotrauma?

A

Any type of pressure induced trauma
Baro = pressure

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4
Q

What can cause barotraumas? (2)

A

Diving, valsalva, sneezing, elevation changes,…
Injury can be implosive or explosive

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5
Q

What is Caisson Disease?

A

Aka “the bends” or decompression sickness
Can occur with deep sea diving
Arises from dissolved gasses coming out of solution into bubbles inside the body on depressurization

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6
Q

What occurs with the gasses in Caisson disease?

A

Compressed nitrogen (N) -> soluble
Decompressed N -> gas emboli/bubble -> back, joint, muscles -> sickness
Treatment-hyperbaric oxygen

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7
Q

Fistula =

A

abnormal connection

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8
Q

Perilymphatic fistula =

A

= between inner and middle ear

Different locations
Round window
Oval window
Others

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9
Q

What is this condition?

A

Round Window Fistula

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10
Q

What can cause Perilymphatic Fistula?

A

Usually an inciting event
Blow to the head
Sneezing
Lifting a heavy object
Sudden changes in pressure (flying, diving)

Sometimes spontaneous

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11
Q

What is the high-risk population from perilymphatic fistula?

A

Post-stapedotomy
Inner ear anomalies (Mondini malformation and large vestibular aqueduct)

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12
Q

How can we diagnose perilymphatic fistula?

A

Difficult to diagnose
History
Exam - Hennebert’s sign and Tullio’s phenomenon
Audiogram - sudden or rapid progressive HL
Definitive - look in the operating room

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13
Q

Explain Hennebert’s sign related to perilymphatic fistula.

A

Hennebert’s sign (fistula test)
Nystagmus/dizziness produced by pressure applied to the EAC
Positive in PLF, syphilis

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14
Q

Explain Tulliio’s phenomenon related to perilymphatic fistula.

A

Tullio’s phenomenon
Dizziness induced by sound
Positive in PLF, SSCDS, Meniere’s disease

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15
Q

How can we treat perilymphatic fistula?

A

Refer to ENT
Strict bed rest
HOB elevated 30 degrees
Avoid lifting, straining or hard nose blowing
Stool softeners
Surgery if no improvement (middle ear exploration and patching of fistula)

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16
Q

What can cause Temporal Bone Fractures (TBF)?

A

MVA
Physical assaults
Falls
Motorcycle accidents
Pedestrian injuries
Bicycle accidents

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17
Q

How can TBF cause hearing loss?

A

Hemotympanum
Ossicular chain disruption
Inner ear fracture
Others (concussion, nerve injury, TM rupture,…)

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18
Q

What are the types of TBF and how are they defined and diagnosed?

A

Types
Longitudinal vs transverse
Otic capsule sparing vs otic capsule violating
Defined with respect to the long axis of the temporal bone
Diagnosed with CT scans

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19
Q

Which type of TBF is this?

A

Longitudinal orOtic Capsule Sparing

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20
Q

Which type of TBF is this?

A

Transverse orOtic Capsule Violating

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21
Q

What are the characteristics of longitudinal TBF?

A

Lateral blows
Blood in EAC
TM perforation
CHL
20% facial nerve weakness

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22
Q

What are the characteristics of Transverse TBF?

A

Front/back blows
Hemotympanum
Intact TM
SNHL (mixed)
50% facial nerve weakness
Vertigo

23
Q

What can we see here?

A

Other signs of skull base fractures

24
Q

What are the acute complications of TBF?

A

Hearing loss (CHL, SNHL, mixed)
Vertigo
Tinnitus
Facial paralysis
CSF leak/perilymphatic fistula
Vascular injury

25
What are ossicular injuries of TBF?
Separation of the incudostapedial joint Dislocation of the incus Fracture of stapedial arches Fracture of malleus handle Footplate fracture-dislocation
26
What are the delayed complications of TBF?
BPPV (most common) Meniere’s disease Tinnitus Central vestibular disorders Meningitis Cholesteatoma Pneumocranium Psychogenic malingering
27
What constitutes a sudden onset of SNHL?
30 dB or greater SNHL 3 contiguous frequencies Within 3 days or less
28
How can SNHL affect patients and providers?
Devastating to patients Frustrating for healthcare providers Definitive etiology and treatment still unknown
29
What are associated symptoms of SSNHL? (3)
Vertigo/dizziness Aural (ear) fullness Tinnitus
30
What can cause SSNHL?
Neurological symptoms and signs Ototoxic medication use Recent viral infections (colds) Head trauma, straining, sneezing, nose blowing, intense noise exposure Recent flying or scuba diving (sudden pressure changes)
31
What are past medical history diseases that can cause SSNHL?
Autoimmune diseases Vascular diseases Malignancies Neurologic conditions Hypercoagulable states Sickle cell disease
32
What are past surgical history cases that can cause SSNHL?
Stapedectomy Mastoidectomy
33
What are exams to help us diagnoses SSNHL?
1. Ears (otoscopy) Effusion, cholesteatoma, cerumen impaction 2. Tuning fork 3. Neurologic exam
34
What investigative tests for SSNHL identification?
1. Audiometry 2. Laboratory tests CBC (complete blood count)-infections ESR (erythrocyte sedimentation rate)-inflammation VDRL FTA-Abs (syphilis test) Coagulation studies 3. Imaging tests MRI (magnetic resonance imaging) Assess for brainstem (CPA) tumors Multiple sclerosis Ischemic (stroke) changes 10% of patients with vestibular schwannomas (acoustic neuromas) present with SSNHL*
35
Give etiological cases of SSNHL?
Idiopathic Infectious (viral) Autoimmune Traumatic Vascular Neoplastic
36
Give SSNHL Autoimmune Etiology:
Cogan’s syndrome Wegener’s granulomatosis Polyarteritis nodosa Temporal arteritis Systemic lupus erythromatosis
37
Explain the pathophysiology of SSNHL from autoimmune complications.
Vasculitis of blood vessels of the inner ear Autoantibodies attack the inner ear (cross-reacting antibodies)
38
Explain the etiology and causes of SSNHL from autoimmune complications.
Any causes that disrupts blood supply to the cochlea can lead to SSNHL Cochlea is intolerant to ischemia (no collateral blood supply) Causes Strokes (vasospasms, embolism) Blood clotting tendencies (Sickle-cell disease)
39
What are treatments for SSNHL?
Treatment depends on the cause General treatment for idiopathic SSNHL Steroids* Antivirals (controversial) Vasodilators (controversial) Anticoagulants (controversial)
40
In SSNHL, there might be a worst prognosis if associated with:
Vertigo Total deafness Advanced age Downsloping audiogram Associated vascular risk factors
41
In SSNHL, there might better prognosis if associated with:
Minimal hearing loss Low-frequency loss
42
Tinnere means:
Means “ringing” in Latin
43
What us Tinnitus?
Perception of sound in the absence of external stimuli Usually described as originating in the ears or around the head Can be extremely annoying and cause reduced quality of life May be the first or only symptom of a serious disease (eg vestibular schwannoma)
44
Tinnitus symptoms can manifest from
- ringing, buzzing, hissing, roaring, clicking, pulsatile - high or low pitched - Unilateral or bilateral
45
What is subjective tinnitus?
Sound is only perceived by the patient More commonly related to hearing loss Pitch of tinnitus may correlate with frequency of hearing loss (3-5 KHz) Little known about physiologic mechanism Hyperactive hair cells or nerves Reduced suppressive influence of CNS
46
What is objective tinnitus?
Sound can be detected by another person Usually caused by an internal body sound or vibration May be exacerbated by CHL More commonly related to pathology
47
What is the difference between non-pulsatile and pulsatile tinnitus?
Pulsatile Usually objective tinnitus Possible vascular etiology (increased or turbulent blood flow) Non-pulsatile Usually subjective tinnitus Ringing, buzzing,…
48
What are the possible causes of subjective tinnitus?
Presbycusis -Medications Noise exposure -Middle ear effusion Head trauma -TMJ problems Otosclerosis -Syphilis Meniere’s disease -Depression Acoustic neuroma -Metabolic -Meningitis - -Cardiovascular
49
What drugs could help against subjective tinnitus?
Aspirin Non-steroidal anti-inflammatory drugs (NSAIDs) Aminoglycoside antibiotics Antidepressants Ototoxic drugs (+more)
50
What is the relationship between subjective tinnitus and depression?
Depression: More prevalent in patients with chronic tinnitus than those without tinnitus Increased severity of tinnitus reported for patients with depression Tinnitus -> Depression or Depression -> Tinnitus
51
What is objective Tinnitus?
* Audible to other people/observers * Evaluation Pulsatile or non-pulsatile Relation to heart rate, light exercise Diligent otoscopy Auscultate external auditory canal, mastoid, skull, neck Audiometry, imaging
52
What are the possible causes of objective tinnitus?
Vascular tumors Glomus jugulare Glomus tympanicum Abnormal vascular anatomy Patulous Eustachian tube Palatal myoclonus Idiopathic stapedial muscle spasm Benign intracranial hypertension
53
What can we say about objective tinnitus and vascular tumors?
Glomus jugulare and tympanicum Otoscopy reveals redish mass behind TM Tinnitus is not altered by compression of neck blood vessels
54
What can we say about Arteriovenous malformations (AVM) and objective tinnitus?
Arteriovenous malformations (AVM) Pulsatile tinnitus synchronous with heartbeat May be secondary to trauma Managed with removal or blockage of AVM (embolization

CMSD5260 Hearing Disorders (12 decks)

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