Upgrade to remove ads
ENT (Hearing Loss)
Terms in this set (63)
What is the most prevalent occupational health hazard in the military?
When is hearing protection really required?
When noise levels exceed continuous noise levels > 84 dB (i.e. lawnmower) and/or impact noise levels > 140 dB (Gun shots)
If hazardous noise is > 84 continuous/140 impact dB, what type of hearing protection is required?
Single Dose Protection
If hazardous noise is > 104 dB (continuous noise) what is required?
Hearing loss is extremely common, how is it described?
Type of HL (Conductive of Sensory)
Degree of HL (Moderate, Severe)
Configuration of HL (Symmetrical, Unilater)
T or F. Intermittent periods of mild, high-pitched tinnitus lasting seconds to minutes are common in normal-hearing folks
Persistent tinnitus often indicates the presence
Sensioneuronal Hearing loss
What are the treatment options for tinnitius?
Avoid exposure to excessive noise, ototoxic agents, and other factors that cause cochlear damage.
Habituation techniques, such as retraining therapy and masking techniques (using a fan)
Masking with music or amplification with hearing aid
Antidepressant Nortriptyline; initially 50mg PO qHS
If a patient reports Pulsatile tinnitus like being able to hear their "heartbeat"
DO NOT SHRUG OFF!
Think of more serious cause: glomus tumor, venous sinus stenosis, carotid vaso-occlusive disease, AVM, or aneurysm or the following:
2) Hypermetabolic state
What causes a Staccato tinnitus "clicking"?
Middle ear muscle spasm
Describe a Staccato tinnitus "clicking"
Rapid series of popping noises, lasting seconds to minutes and accompanied by a fluttering feeling in the ear
**What is Hyperacusis?
Excessive sensitivity to sound
May occur in normal-hearing folks either for psychological reasons, in association with ear disease, or following noise trauma
(Thomke wears earplugs when he goes to the club LMAO)
For any patient that comes into the clinic for hearing loss, what must I get on them?
What will the Weber test tell me?
If it is midline and make sure it doesn't lateralize to one side
What will the Rhinne test tell me?
Whether there is Air Conduction is Greater than Bone conduction (This is normal)
If it is sensory, we need need an audiogram
What are the most common causes of Conductive hearing loss?
Swelling of the EAC, FOBs, or tumors (secondary to otitis externa can be treated with appropriate topical medication)
Impacted cerumen (can be cleaned with specialized instruments)
Perforated TM or fluid in middle ear (perforations will heal or can be surgically repaired; fluid can be treated with medication or myringotomy tubes)
Ossicular chain abnormalities
What does conductive hearing loss present on audiogram and not readily apparent on the physical exam suggest?
problems with the ossicular chain
If I do a conductive hearing test (Rhinne) and there is a conduction hearing loss, what should I consider?
Otosclerosis (I can tell there is a conductive hearing loss, but I cant see the bones in the ear sclerosed together)
How is Otosclerosis fixed?
Surgical correction (stapedectomy)
What is by far the most frequent cause of Sensorineural hearing loss (SNHL)?
Presbycusis (hearing loss due to old age)
What is the 2nd most common cause of Sensorineural hearing loss (SNHL)?
Persistent noise exposure
What are the other most common causes of Sensorineural hearing loss (SNHL)?
Infectious or postinflammatory processes
Fracture of the temporal bone
Tumor growth along the course of CN VIII
***What are the drugs that have been associated with hearing loss or vertigo?
- *Aminoglycosides (gentimicin, neomycin drops)
What is the most common cause of hearing loss?
Sensorineural hearing loss (SNHL)
Many causes of SNHL, however, ___________is by far the most frequent cause.
As we age, we should experience Sensorineural hearing loss (SNHL) as a result of the outer hair cells within the cochlea gradually deteriorating cause a
Symmetrical Sensorineural hearing loss (SNHL) that begins at higher frequencies
This will Typically have a "NOISE NOTCH" pattern on audiometry at approximately 4000 Hz
Acoustic trauma (noise exposure)
Patients with asymmetric SNHL require more thorough evaluation to rule out a benign tumor of CN VIII (acoustic neuroma). What is the GOLD STANDARD diagnostic study?
How can I measure the severity of hearing loss?
***Use an audiogram= Pure Tone Audiometry ("the hearing test")
Know the next slides!
0-20 db =
- Normal Hearing
- Soft whisper
20-40 db =
- Soft voice
40-60 db =
- Moderate HL
- Normal voice
60-80 db =
- Loud voice
The 0 dB is "normalized" to young, healthy adults and doesn't mean there is absence of detectable sound. Some hear 0 decibels. Can some hear (- numbers)?
yes that means they have excellent hearing
Describe Pure tone testing (audiogram)
In soundproof booth
dB detected 50% of time by patient
Sound levels increase in stepwise fashion until heard
The higher the threshold is, the poorer the patient's hearing
Thresholds > 20 dB are considered abnormal
If if the AC and BC thresholds are equal but higher than 20 dB, this =
What are some examples of the configuration of speech?
High-freq vs. Low-freq HL vs. Flat
Bilateral vs. Unilateral HL
Symmetric vs. Asymmetric HL
Progressive vs. Sudden HL
Fluctuating vs. Stable HL
What is the entire human range of frequencies?
What range of frequency is needed to understand speech?
What are the evaluation goals of determining hearing loss?
The nature of the impairment (type, degree, and configuration)
The anatomy of the impairment (external, middle, inner, central auditory pathway)
A sudden onset of unilateral HL, with or without tinnitus, may represent ______
Inner ear viral infection or a vascular accident
What do Patients with unilateral HL often complain of?
Poor sound localization and difficulty hearing clearly with background noise
This type of hearing loss is common with otosclerosis, noise-induced, vestibular schwannoma, or Meniere disease
This presents with asymmetric HL, tinnitus, and imbalance, then cranial neuropathy when large (esp CN V or VII)
This may be associated with episodic vertigo, tinnitus, and aural fullness
These are The sounds we use to produce speech in conversation have frequencies and decibels.
The most typical frequency and decibel for each speech sound has been graphed on an audiogram to provide information about what sounds can be heard at specific degrees of hearing loss.
The speech banana
This is An average shift of greater than or equal to 10 dB (positive or negative) at 2000, 3000 and 4000 Hz in either ear.
Significant Threshold Shift (STS)
No STS on annual/periodic test?
Counsel patient on results and re-test within
If Negative STS (improved hearing) on annual/ periodic test?
Repeat test immediately. If shift confirmed, revise reference with no additional actions
If negative STS resolved, return to annual testing status.
If Positive STS (worsened hearing) on annual/periodic, explain results, then?
Needs otoscopic exam and tympanometry to rule out canal occlusion or middle ear problem,
medical referral if needed.
If no conductive problem is evident, schedule follow-up #1 on another day,
Counsel and re-fit HPDs.
If STS persists on f/u #1, perform follow-up # 2, but when?
If STS resolved on f/u #2, what next?
Counsel patient, again check HPD's, return to annual testing
Persisting STS =
Permanent threshold shift (PTS)
What is used to evaluate the TM AND MIDDLE EAR STATUS
How does Tympanometry work?
Introduces a pure tone into EAC through 3-function probe tip
(pump) varies air pressure against TM (controls mobility)
introduces 220Hz probe tone
measures loudness in ear canal
This is described as the following:
- The peak of the pressure curve falls between +50 and -150 millimeters of pressure
- Peak compliance falls between .2 and 1.8 mm
- Results indicate the ABSENCE of middle ear pathology
Intact & mobile TM with normal eustachian tube function
If there is a hearing loss, it is likely to be SNHL!
Type A: Normal Tympanogram
This is described as the following:
- T he peak of the pressure curve falls between +50 and -150 millimeters of pressure (WNL), but the compliance very low (below .2 mm)
- Often associated with OSSICULAR FIXATION or
TM scarring (NOT middle ear effusion)
May result in a fairly flat, non-fluctuating hearing loss
Eustachian tube function is normal
Type As (shallow): Abnormal Tympanogram
This is described as the following:
- The peak of the pressure curve falls between +50 and -150 millimeters of pressure (WNL)
- The peak aural immittance is ABOVE 2.0 ML
Indicates ossicular disarticulation
- Peak compliance very high or off chart
- Associated with OSSICULAR DISARTICULATION
- May result in a fairly flat, non-fluctuating hearing loss
- Eustachian tube function is normal
Type Ad (disarticulation): Abnormal Tympanogram
- Peak is absent/poorly defined and at markedly negative middle ear pressure (>-200 mm)
- Max compliance = below normal range
- Indicates FLUID in middle ear or a TM PERFORATION
Type B (flat): Retracted, poorly mobile
If there is a clearly defined peak, but it falls on the negative side of the chart, indicating a negative middle ear pressure, what type is this?
What is Type C associated with?
Eustachian tube dysfunction
THIS SET IS OFTEN IN FOLDERS WITH...
ENT (Disease of the External Ear)
ENT (Diseases of the MIddle Ear)
ENT (Diseases of the Nose & Paranasal Sinuses)
YOU MIGHT ALSO LIKE...
CSD 402 (Dr. Tripp)-Final Exam
SHS 450 Final Exam Practice Questions
OTHER SETS BY THIS CREATOR
Operational Contract Support (OCS)
Planning, Programming, Budgeting, and Execution (P…