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Hearing Exam > week 3 > Flashcards

week 3 Flashcards

conductive hearing loss

1
Q

causes of conductive hearing loss

A 
•	infection of the EAM (swimmers ear)
•	wax/cerumen
•	structural, congenital issues
o	atresia
o	microtia
•	foreign bodies
•	benign tumours
•	otosclerosis
•	otitis media
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2
Q

Otosclerosis characteristics

A

o disrupts movement of the middle ear bones
o progressive
o no spontaneous resolution – doesn’t get better with intervention
o significant HL – if no movement between ossicles
o more common in women
o familial link

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3
Q

Otosclerosis treatment

A

o stapedectomy
o hearing aids (only amplify mechanical sounds – not to be used when no movement between ossicles – therefore move to cochlear implant)
o cochlear implant

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4
Q

what is otitis media

A

• otitis media is an inflammation of the middle-ear cavity, commonly involving the presence of fluid in the middle ear (but not always)
• Acute otitis media is requencty responsible for ear pain of sudden onsetmay be asymptomatic
In Australia, three to five children die each year because of otitis media complications, and 15 children will suffer permanent hearing loss each year as a result of otitis media

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5
Q

otitis media visual examination

A
  • redness on external auditory canal
  • ear pain
  • pulling on ears (younger children)
  • irritability, fever, lack or loss of appetite for food, vomiting, lethargy
  • similar to other bacterial infections
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6
Q

otitis media otoscopy

A
  • Bulging, red TM
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7
Q

otitis media tympanometry (A, B, C)

A

decreased TM mobility

  • type B tympanogram – otitis media
  • type A: normal, equal pressure in middle and outer ear
  • type C: retraction of TM, Eustachian tube dysfunction
    i. e., observation and pressure testing
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8
Q

challenges to researching OM

A

o differences in definition
o methods of identifying cases
o intervals between observations
o population characteristics

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9
Q

OM prevalence

A

• “a prevalence rate of Chronic suppurative otitis media greater than 4% in a defined population of children is indicative of a massive public health problem requiring urgent attention.” - WHO

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10
Q

Acute OM

and treatment

A 
heal within a couple of days or week
 Treatment of Acute OM
-	GP assessment – may result in no treatment
-	antibiotics
o	not very useful for most children
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11
Q

otitis media with effusion

A

OME: fluid present (Glue ear)

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12
Q

TM rupture

A

bursts, fluid escapes the ear

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13
Q

Tympanosclerosis

A

repeated TM rupture, plaque builds up known as tympanosclerosis

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14
Q

Chronic OM

A

the infection has persisted for months

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15
Q

risk factors: endogeneous

A 
o	age
o	anatomical features
o	ethnic group
o	gender
o	prematurity
o	allergy
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16
Q

risk factors: exogeneous

A

o crowded conditions
o smoke exposure
o seasons

17
Q

protective factors

A

o the inverse of risk factors

  • breast feeding
  • swimming pool
18
Q

complications of OM

extracranial complications intracranial complications

A 
In Australia, approximately 60% of extracranial and intracranial complications of otitis media occur in children
o	extracranial complications
	mastoiditis
	cholesteatoma
o	intracranial complications
	meningitis
	brain abscess
	lateral sinus thrombosis
19
Q

Otitis media with effusion (OME) (i.e. glue ear) diagnostic signs

A 
retracted TM
•	visible fluid level or bubbles
•	decreased TM mobility
•	White/red/yellow TM
•	Type B or C tympanogram
•	mild-moderate HL
20
Q

Otitis media with effusion (OME) (i.e. glue ear) symptoms

A

usually no pain or fever

21
Q

Behavioural signs of hearing loss due to OME

A
  • not following instructions
  • asking you to repeat what you said
  • Seems to be ignoring you
  • Does not seem to pay attention to sounds or speech most children would be interested in
  • Sometimes their speech can be more unclear than is typical for their age
22
Q

mastoiditis

A
  • potentially life-threatening condition
  • initial treatment for a severe infection may include hospitalization
  • 2.4% of acute hospital admissions related to OM in US
23
Q

Chronic suppurative otitis media (CSOM)

A

a perforated tympanic membrane with persistent drainage from the middle ear (i.e. lasting >6-12 week)

24
Q

cholesteatoma

A

facial palsy arising from cholesteatoma: facial nerve travel through the middle ear

25
Q

Treatment of OME

A
  • Surgical management is the effective treatment if resolution fails after active monitoring
  • Treatment of OME is subject to political interference and attempts to further limit access to treatment are likely
  • Commonly used medical treatments and “complementary or alternative” treatments have not been proven to be effective
  • Improvement in quality of life, social and educational performance are recognized but so far not well measured in trials, and not customary in routine clinical service.
26
Q

Otitis Media and Literacy

A
  • OM and subsequent HL in early school years has a detrimental effet on development on phonological awareness skills
  • Hearing loss is likely to impact on social and educational well-being
  • OM and subsequent HL are possible risk factors for language development
  • OM can lead to mild-moderate HL which can lead to breakdown in language processing which can result in language processing difficulties including literacy development delay and phonological awareness delay
27
Q

what might we see clinically with OM?

A
  1. Vocabulary 2. Speech intelligibility 3. Phonological awareness
28
Q

what are the effects of an Underpowered linguistic system:

A

Underpowered linguistic system: The system may be functional for communication, but it may be slow, inaccurate and underspecified for the task of literacy. Each child may present differently depending on risk factors.
 Effects on phonological repertoire: Vowels may be restricted or distorted; voiceless sounds are difficult to perceive/discriminate and articulate. (softer, less articulated sounds, more likely to be affected in phonological repertoire)
 Effects on phonotactics: Reduction of blends, weak syllable deletion, final sound deletion, underspecified syllables in multisyllabic words. (softer, aren’t as loud, thus result of mild-moderate intermittent HL)

29
Q

retrieval in OM

A

o Poor speech processing impacts on vocabulary size and organisation, leading to slow retrieval.
 Increasing syntactic complexity is associated with difficulties with input (comprehension) and output (intelligibility).
o

30
Q

PA in OM

A

Phonological awareness needs to be taught and practised. Some children may have weak or emerging skills and just need to practice!
 practice practice practice
 If PA is not assessed prior to the introduction of phonics in a classroom, the alphabetic code will seem illogical to children with:
• Poor discrimination
• Unspecified motor plans
• Missing sounds
• Difficulties segmenting to onset level

31
Q

Effects of speech

A
  • At 0-6 months those with OM showed lower rates of canonical syllable production and smaller expressive vocabularies at 18 months (Rvachew et al., 1999).
  • Hearing levels at 12-18months were significantly associated with subclinical or clinical speech disorder at 3 (Shriberg et al., 2000)
  • At 9 years children with persistent, bilateral OME had significantly lower scores for articulation and sound discrimination (Klausen et al., 2000)
32
Q

OM, CHL AND INDIGENOUS AUSTRALIANS

A
  • endemic
  • has an early onset
  • high rates of CSOM
  • less likely to resolve
  • extends to adulthood
  • associated with high rates of permanent damage
33
Q

INDIGENOUS AUSTRALIANS incidence

A

o Indigenous Australians have the second highest prevalence rate of OM in the world (WHO, 1996)
o 42% of Indigenous school aged children in Perth had OM between 1998 and 2004(Williams, et al., 2009)
o 30% of Indigenous school aged children in Perth had OM in 2009 (Timms, et al., 2010)

34
Q

INDIGENOUS AUSTRALIANS HL

A

o Between the age of 2 and 20 years, the average Indigenous Australian will experience 32 weeks of HL because of OM compared to the 2 weeks experienced by the average non-Indigenous Australian (Coates, 2002)
o Repeated damage to the tympanic membrane caused by infection can result in scarring and cause permanent HL (Zubrick, et al., 2004)

35
Q

INDIGENOUS AUSTRALIANS OM and Literacy

A

o Overall literacy rates: the good news and the bad news
o Aboriginal children with OM perform more poorly (PA, reading, spelling) than those without. (Walker & Wigglesworth, 2001)
o No impact of OM / CHL on literacy outcomes of urban Aboriginal children (Timms, 2015)

36
Q

KEYS TO REDUCING THE BURDEN OF OTITIS MEDIA IN AUSTRALIA

A

1 Prevention: known risk factors for OM must be addressed
2 Intervention: defined and evaluable interventions to prevent and treat OM
3 Treatment: children at high risk should be identified early and treatment options should be enhanced
4 Investigation: ongoing laboratory research
5 Participation: involvement of Indigenous people in prioritisation, implementation and transfer of research is critical to sustainable improvements
6 Communication: research findings should be conveyed to the broader community particularly health care providers and policy leaders

37
Q

Determinants of Health

A

• Determinants of health include a range of factors such as functional housing and overcrowding, health behaviours such as smoking and alcohol use, socioeconomic factors such as educational participation and attainment and employment, income, and housing tenure and community/income factors such as safety and crime , child protection , transport and access to traditional lands.

38
Q

Indigenous Australians are

A

o 5 times more likely to live in overcrowded houses
o 40% of ATSI adults in bottom 20% of incomes.
o 15 times more likely to be imprisoned.
o Aboriginal women = fastest growing prison population
o 20 times more likely to be imprisoned than non-Aboriginal women.
o 71 % of Indigenous people had no school qualification compared to 49% non indigenous
o Unemployment rate double the rate of non-indigenous
o Child protection notifications around 5 times higher

39
Q

Population-based approach

A
  • Speech pathologists need to engage in preventative programs that are not necessarily tied to specific children on the case load.
  • Bell (2011): Service delivery rated by 75% of therapists working in Indigenous communities rated individual therapy as least suitable. They strongly recommended community wide capacity building with clinical work reserved for the minority of referred cases

Hearing Exam (3 decks)

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