Unit 3 Flashcards
1
Q
What are diagnostic tests used for?
A
Diagnostic tests are administered to determine the underlying condition causing hearing loss
2
Q
How does the knowledge of pathologies and disorders help audiologists?
A
It narrows the list of possible conditions, they choose tests that will help identify the condition, and they are able to determine the prognosis and auditory rehabilitation
3
Q
Disorder
A
An abnormal physical or mental condition that affects the bodies function
4
Q
Lesion
A
Specific area of damaged tissue
5
Q
Gross/Macroscopic lesions
A
Can be see by the unaided eye
6
Q
Histological/microscopic lesions
A
Can only be seen under the microscope
7
Q
Molecular lesions
A
Damage to structure of biological molecules (like DNA or RNA), caused primarily many generic disorders but can also be caused by some serious infections
8
Q
Focal lesion
A
Restricted to a specific area
9
Q
Diffuse lesions
A
Extends beyond primary site and will usually involve multiple organ systems
10
Q
Systematic lesions
A
Affects organs that share a common function
11
Q
Structural lesions
A
Abnormal change in structure to an organ or tissue
12
Q
Depressive leisons
A
Decreases the functional activity of a structure
13
Q
Destructive lesions
A
Cases erosion or damage to the tissue or structure
14
Q
Degenerative lesions
A
Destruction occurring over time (expected to get worse)
15
Q
Irritative lesions
A
Produces hypersensitivity or abnormal sensation
16
Q
Traumatic lesions
A
Caused by an injury
17
Q
Vascular lesions
A
Caused by changes in bloodflow
18
Q
Trophic or metabolic disorders
A
Caused by changes in the metabolic activity or cell structure
19
Q
Idiopathic lesions
A
Of unknown cause or origin (a disease of unknown cause)
20
Q
Can a disorder have more than one label?
A
Yes
21
Q
Acquired Hearing loss
A
HL occurs later on in life (not born with it)
22
Q
Hereditary Hearing loss
A
Passed along through families (may be manifested at birth)
23
Q
Outer ear malformation
A
Anotia & Microtia & Preauricular pits & atresia & excessive cerumen & foreign objects & collapsing ear canal & tympanic membrane perferation
24
Q
Anotia
A
An absent pinna
25
Microtia
Abnormally shaped pinna
26
What types of HL would Anotia and Microtia have?
Conductive HL
27
Preauricular pits, sinuses, apendages
Abnormally formed portions of the pinna
28
Atresia
Absent extremal auditory canal or severe stenosis leading to a small tympanic membrane
29
Stenoisis
Abnormally narrow EC
30
What are the 2 types of treatments for outer ear malformations?
Surgical & Amplification
31
How to treat Anotia & Microtia?
Surgical reconstruction of the pinna or orthotic pinna (your ME and IE need to work for this surgery to work)
32
How to treat Atresia?
Surgical options depend on the specific condition of the ME and Cochelea
33
Amplification
If the cochlea is function put a osseointegrated hearing air on to directly vibrate the bones of the skull which vibrates straight to the cochlea
34
Excessive Cerumen
Can have considerable wax buildup where the cerumen is pushed down the ear canal beyond the point where it can migrate out naturally
35
What is the most common disorder of the outer ear?
Excessive cerumen
36
Foreign objects
Things in the EC that aren't supposed to be there (common in children)
37
What are some example of items that have been removed from the human ear canal?
Toys, bobby pins, rocks, insects, beans, safety pins, money
38
Do foreign objects cause HL?
No, but they will cause a lot of discomfort
39
Collapsing ear canal
Partial or complete closure of the ear canal when pressure is applied to the pinna
40
Who is a collapsing EC more prevalent in?
10-33% of adults over 65 have a collapsing ear canal
41
What is a treatment for a collapsing EC?
Use a hearing test device that maintains the opening of the ear canal during the testing (insets , earphones)
42
Tympanic membrane perforation
Tear or hole in the TM due to trauma or pressure build up in the ME
43
Treatment for Tm performation
If small enough they can heal on their own or if not we use a patch called a myringoplasty
44
Otitis Media
Inflammation or infection of the middle ear (caused by a problem in the Eustachian tube)
45
What may cause inflammation in the Eustachian tube
Allergies, infection, manual blockage
46
What is otitis media with effusion?
it means that the inflammation is secreting fluid
47
Serous otitis media
Thin and watery fluid
48
Suppurative otitis media
Thick and white fluid (more painful bc more swelling and pressure)
49
Acute otitis media
OM that has come on quickly (within 5 days)- most painful form of OM
50
Chronic otitis media
OM persisting over 3 weeks- Less painful because only some fluid remains
51
What is the prevalence of otitis media in kids?
76-95% of kids will have at least one ear infection by 6 years old
52
What is the incidence of otitis media in kids?
Highest incidence is between 6 mo and 2 years of age
53
Why are children more susceptible to ear infections?
Because their eustachian tubes are shorter and more horizontal so bacteria will not be pulled down but instead it will stay there
54
Why are older children susceptible to ear infections?
Exposure in school and daycare
55
How do we treat otitis media?
Wait, antibiotic, surgery
56
Antibiotics
Only effective during the infectious stage and only in cases of bacterial infection (won't work on a virus)
57
Surgical
Only in chronic cases over 3 months, a myringotomy is performed and pressure equalization tubes are placed in the TM
58
When do the myringotomy tubes fall out?
6-12 mo
59
Otosclerosis
Abnormal bone growth of the ME
60
Ossicular chain discontinuity
Abnormal separation of one or multiple of the bones of the ME
61
What HL does ossicular chain disorders cause?
conductive HL
62
Otospongiosis
Formation of spongy material around the bone (bone forming cel builds up of foam)
63
Otosclerosis
Hardening of the spongy material
64
Where is otosclerosis it most common to occur?
Anywhere within the otic capsule but most commonly involves the stapes footplate
65
What HL does osteosclerosis result in?
A progressive, conductive HL (starts in one ear but can become bilateral)
66
What does otosclerosis prevent?
It prevents the stapes from moving in and out so it cannot send vibration into the cochlea
67
What is the etiology/cause of otosclerosis?
There is no defined cause but we know that there is probably a genetic factor involved
68
What do we know about otosclerosis?
It is unique to humans, positive family history of disease, more prevalent in women than men, more prevalent in caucasians, potential link to measles
69
What is the treatment to otosclerosis?
Non-surgical (wait and watch or hearing aids) or surgical (stapedectomy- replaces stapes with a prosthetic which does not solve the issue because the bone could still grow after)
70
What are the 2 types of tumors in the ME?
Cholesteatoma & glomus
71
Cholesteatoma
The most dangerous tumor in the EM that is a growing collection of dead skin cells (there is no blood supply and it forms a mass that can spread and erode the ME bones and make its way into the EC). The only way to remove this is through surgery
72
Glomus Tumor
A hypervascular tumor arising from the jugular bulb (a collection of blood cells/vessels). It appears as red and people usually describe the sensation of this as hearing blood pumping in the ears because it settles right behind the TM)
73
Presbycusis
Hearing loss caused by the degenerative effects of aging
74
percentage of effects of age
National health survey reports 51.5% of males and 48.5% of females who are 65 years and older have a significant hearing loss
75
Do we expect hearing to get worse as age increases?
Yes
76
What hearing loss do we expect with presbycusis?
A high frequency sensorineural HL
77
Sensory Prebycusis
Loss of hair cells distributed evenly along the basilar membrane and primarily involves the OHC
78
Neural Presbycusis
Loss of auditory nerve fibers
79
Strial Presbycusis
Damage of the striia vascularis (membrane in the cochlea that regulates bloodflow)
80
Cochlear Conductive Presbycusis
Structural alterations in the basilar membrane or spiral ligament (still and not vibrating efficiently)
81
How loud is too loud?
Sounds can cause hearing loss at level of 85 db (the louder the sound is the faster it can damage your hearing)
82
What are the risk factors for presbycusis?
Noise exposure (strong association between noise exposure and increased hearing loss), heart disease, smoking, genetic, diet, ototoxic medications
83
Noise induced HL
Temporary or permanent hearing loss due to long term exposure to high level noise
84
Temporary threshold shift (TTS)
Hearing loss lasting a few hours to several days (concerts)
85
Permanent threshold shift (PTS)
Can occur suddenly (after extreme exposure) or after many exposures that result in TTS
86
NIHL pathophysiology
Auditory nerve fiber synapses (high noise levels swell the nodes comprising the synapses causing TTS (problem w connection between the hair cells and nerves) , too much TTS can cause permanent damage to synapses causing auditory nerve fiber to die
87
Sudden Sensorineural HL
idiopathic (without cause), an onset is rapid and may occur in minutes and develop over a few hours, this is usually seen in 3 contiguous frequencies next to each other
88
Meniere's disease
A chronic inner ear disorder that causes vertigo, tinnitus, hearing loss, and a feeling of fullness (we need all 4 symptoms) and it is also referred to as endolymphatic
89
What causes meniere's disease?
The endolymphatic sac is swelling in the IE
90
What type of HL is meniere's disease?
A low frequency (unilateral) sensorineural HL
91
What is the vertigo symptom with meniere's?
Lasts 20 - 24 hours but is most common for 2-4 and the episodes are variable and can sometimes cause drop attacs
92
Treatment for meniere's disease
Less sodium diet, hearing aids, counslining, could cut the nerve but will cause permanent HL
93
Superior Semicircular Canal Dehiscence
When the bone gets eroded or dissolved away and creates a 3rd window into the ME
94
SSCD symptoms
Vertigo in response to loud sounds and pressure (VEMPS is not normal)
95
What kind of HL does SSCD cause?
Low frequency conductive HL
96
Treatment for SSCD
Surgery to patch up the opening
97
Retrocochlear disorders
Behind the cochlea (auditory nerve to brain_
98
Auditory Nerve Spectrum Disorder
Usually found in childhood and is a condition where the OHC integrity is normal but the auditory pathway is abnormal (the ear is detecting sound but it is not going up to the brain)
99
Where are the presumed sights of lesions for ANSD?
Inner hair cells, synaptic dysfunction, axonal loss due to demyelination of the auditory nerve
100
Etiologies for ANSD
Genetic or acquired from an infection or physical trauma
101
Treatment for ANSD
Devices such as hearing aids or cochlear implant or an FM system, or communication training such as listening strategies, speech reading training, or ASL
102
Acoustic neuroma
An 8th nerve tumor that arises from the neural sheath (it is benign, slow growing, and unilateral)
103
Treatment for acoustic neuroma
Surgery/removal
104
Vestibular Neuritis
Inflammation of the vestibular nerve or ganglion (infection of the vestibular nerve) and this causes dizziness
105
What are the leading symptoms to vestibular neuritis?
Sudden onset of intense vertigo that lasts for hours to days (nausea and vomiting) - if the vertigo fatigues they will still feel off balance. Many people report having upper respiratory virus prior.
106
What do we expect with VNG testing?
There will be nystagum which will show eyes bouncing back which infers dizziness.
107
What do we expect with the audiogram?
This should not cause a HL
108
What do we expect with VEMPS?
Absent or reduced amplitudes
109
Vestibular labyrinthitis
combination of symptoms of vestibular neuritis with the addition of a hearing loss
110
Treatment for vestibular neuritis
Medicine to dull dizzy sensation, wait for virus to subside but the nerve will be damaged for good
111
What do we expect to see for ANSD on the case examples?
Absent ABR results and normal OAE
112
What do we expect to see for acoustic neuroma?
High frequency sensorineural Hl, and no ABR results, word recognition is really bad, unilateral
113
What is an audiologist?
health care professional who diagnose, treat, and manage hearing, balance, and ear problems
114
Diagnos
Audiologists examine patients, interpret the hearing results, and diagnose the probelm
115
Treatment
Audiologists develop treatment plans, select and fit hearing aids/cochlear implants, and provide care for routine procedures
116
Prevention
Audiologists educate patients on how to prevent hearing loss and manage hearing loss prevention programs (military, airlines, manufacturing, etc)
117
Counseling
Audiologists counsel patients and their families on ways to listen and communicate
118
Adults 20-69 with 5 years of more of work with exposure to loud noise what percent have HL?
18% speech frequency HL
119
In the workforce what is the percentage of workers exposed to hazardous noise?
25% and 53% of these people are not wearing hearing protection
120
What percentage of noise-exposed workers have a hearing impairment?
20%
121
How does noise damage hearing?
It damages the hair cells and nerves (usually damage at the synapse level) so either TTS or PTS
122
What factors do you think put someone at risk of HL due to noise damage?
environments, professions, hobbies
123
Occupational Safety and Health Administration (OSHA)
has set a legal limit for noise exposure in the workplace. They work with noise dosage and permissible exposure limit (how much noise can you be exposed to everyday)
124
What are the 2 factors in permissible exposure limit?
Level of noise (how loud) and duration of exposure (how long)
125
8 hours
90 db
126
4 hours
95 db
127
2 hours
100 db
128
Potential role for audiologist?
monitor noise level, implementing and assessing efficiency of noise reduction (engineering, administation, protective equipment), monitoring for hearing changes
129
Non-custom protective equipment
Plugs, headphones
130
Custom protective equiptement
Formed to the ear and always fit
131
Noise-reduced rating
Label on the protective equiptment that when used as directed that is the decrease in the noise by as much as it is labeled
132
How to monitor the environment?
measuring average noise levels in a period of time and sound level meters
133
How to monitor the individual?
establishing baselines, regular hearing screenings
134
What is the treatment role of an audiologist?
Develop treatment plans, select and fit hearing aids/implants, and provide care for routine procedures
135
What is the counseling role of an audiologist?
Audiologists counsel patients and their families on ways to listen and communicate
136
What is the goal of auditory/vestibular rehab?
Provide therapies, implement amplification devices, help people use hearing aids/implants, explore hearing assistive technology, and improve communication (this is a wholistic approach because it is not always about fixing the hearing loss)
137
Balance Rehab
Improving balance and reducing risk of falls
138
Dizziness Rehab
Decreasing the sensation of dizziness
139
Stability Rehab
Improving stability while moving
140
Neuromuscular Coordination Rebab
Improving neuromuscular coordination
141
Anxiety Rehab
Reducing anxiety and somatization
142
Is there a positive correlation between anxiety and dizziness?
Yes, anxiety can cause dizziness and dizziness can cause anxiety
143
Traditional Hearing aids purpose
Make sounds louder, noise cleaning, and interface with other devices
144
What HL are hearing aids good for?
Mild - Severe sensorineural hearing loss (could be used for conductive/mixed as well but there are better options)
145
How do hearing aids work?
There is a microphone on them and it funnels sound into the HA. There is a chip that registers the sound and the HA will play the sound in the ear canal via air conduction
146
Bone anchored hearing aids purpose
To convert air conduction sound to bone conduction and amplify (makes sounds louder, noise cleaning, and interface with other devices)
147
Bone anchored hearing aids surgical
Screw into bones of skull that clips onto a hearing aid that will vibrate the bones of the skill OR thin out bones of skull and place a device in and outside that is magnetic
148
Bone anchored hearing aids non-surgical
Sticker behind the ear that clips onto a device (common for kids)
149
What HL are bone anchored hearing aids good for?
Conductive or Mixed HL (middle ear problems)
150
Cochlear implants purpose
Replaces the function of the cochlea
151
Does a cochlear implant require surgery?
Yes
152
What HL are cochlear implants good for?
Severe - Profound sensorineural HL
153
How do cochlear implants work?
There is an external component that process sound, a transmitter inside the skin is receiving it, it is then sending this through a wire to an electrode in the cochlea that is going to stimulate different areas of the auditory nerve
154
Assistive technology
Anything that helps make hearing easier (that connects to a hearing air or cochlear implant) - microphone system, streaming connection to device, visual alerts, bed shake alarm
155
How to support communication as an audiologist or family member?
1. Slow down but do not exaggerate speech
2. Face-Face speech
3. Avoid a dim light or strongly lit light source
4. Reduce background noise
5. Lower the pitch of voice
6. Gesture and facial expressions
7. Inclusion
8. Avoid gum or covering mouth
9. Repeat yourself
10. One person speak at a time
11. Be patient, positive, and relaxed
156
Can most vestibular disorders be fixed?
No (we need to work with a system that has challenges and cannot be fixed)
157
Vestibular Rehab
VRT is a form of physical therapy that is used to treat and improve symptoms caused by vestibular disorders. It involves movement to reduce vertigo/dizziness, visual issue, and imbalances
158
Medications
Can dull symptoms but should not be dependent on them
159
Safety considerations
lighting of rooms, hazards out of the way, supports in the shower, etc
160
Habituation Exercises
Long-term reduction in a reactivity to a stimulus that is facilitated by repeated exposure to that stimulus (do what makes you dizzy to let your brain get used to the response/exposure)
161
Adaptation Exercises
Refers to the response of the CNS to asymmetrical peripheral vestibular afferent activity and resulting sensory conflicts (reprogram brain and eye movements)
162
Substitution
Substitution by other eye movements (vision, somatosensory cues, and postural strategies)
