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SPA 4326 Exam 2

Terms in this set (102)

Etiology
Generally used in medicine and audiology when referring to the cause of a disease or disorder
Prevalence
estimate of how common the hearing loss occurs in a population during a certain time period
Outer ear disorders
- Often visualized with the naked eye or with an otoscope
- usually can be medically or surgically treated
- may be embryological or acquired
- disorders of the outer ear may or may not cause hearing loss
- if it is a congenital condition be suspicious for abnormalities in other parts of the auditory system
Pinna
Outermost portion of a patients ear
Collapsing ear canals
Most common in infants and in elderly adults
Malignant diseases particularly cancerous growths...
can develop on the pinna and in the external ear canal
Congenital malformation
is present at birth
Pre-auricular pit
small depression in the skin in front of the tragus of the outer ear
Pre-auricular tags
consist of one or more small stalks of skin and tissue located directly in front of the earlobe
Microtia
Term used for more pronounced malformations of the ear
Aural atresia
Absence of an outer ear with perhaps only small remnants of skin and tissue is generally referred to as aural atresia
Cauliflower ear
usually due to trauma
Cancers
infections- herpes zoster, staph infection
Cerumen means
earwax
Otitis externa
- means inflammation of the outer ear
-encompasses a number of diseases of the external ear canal, including bacterial, viral, and fungal infections
Stenosis
The technical term for a constriction or narrowing of the external ear canal
Osteomas
growths projecting into the ear canal on a stalk
Exostoses
hard growths with a broad base that project outward from the ear canal wall, deep in the ear canal close to the tympanic membrane
Exostoses usually do NOT
cause hearing loss
Disorders of the middle ear are more likely to cause
hearing loss than outer ear disorders
First course of treatment for disorders of the middle ear is
medical/surgical but sometimes may be helped with hearing aids
Conductive hearing loss is a common finding in patients with
middle ear disorders
Eustachian tube
provides communication between the space in the back of the mouth and the middle ear space
Type C tympanogram means
-negative pressure in middle ear space
-possible conductive hearing loss
Otitis media
- technical term for middle ear inflammation
- otitis media is a general term for a variety of disorders that involve fluid in the middle ear space
- otitis media encompasses a spectrum of disease conditions, not a single disease
Middle ear effusion (MEE), Serous otitis media (SOM), and Otitis media with effusion (OME) are
synonymous
MEE does not always mean that there is an
infection
You can have sterile fluid with
MEE
If there is an infection it is called
acute otitis media (AOM)
Symptoms of eustachian tube dysfunction
- tugging at the ear
- speech development stalling
- unresponsiveness
- fussiness
- sometimes fever if infected
Otitis media
- common cause of conductive hearing loss
- there is almost always some hearing loss with OM
- treated with watchful waiting, antibiotics, myringotomy, pressure equalization (PE) tubes with or without adenoidectomy and/or tonsillectomy
BMTT:
bilateral myringotomy (hole cut in the TM) and tympanovstomy tubes
PE tubes
tympanovstomy tubes=ventilation tubes
If there is no infection sometimes watchful waiting is done with
MEE
Untreated otitis media
- conductive hearing loss
- language delay, behavior problems, auditory processing disorders
- ex: TM perforation, glue ear, mastoiditis, meningitis, encephalitis
Watchful waiting is usually not the best course for
-untreated otitis media
- especially if there isa language delay
Hearing loss in children with otitis media with effusion (OME) is typically in the range of
25 to 30 dB
OM usually results in
hearing loss
Small perforations produce surprisingly little
hearing loss
TM perforations
- cause varying amounts of conductive hearing loss (small holes may have normal hearing)
- result from an acute infection or from trauma
- Type B tympanogram with a large ear canal volume measure
TM perforations
Sometimes ENT decides to use "watchful waiting" rather than active treatment
Chronic otitis media
longstanding disease process which begins with acute otitis media and then involves a long, drawn out course of otitis media with effusion
Cholesteatoma
-Benign but very invasive and serious, usually a secondary problem from a chronic infection or a hole in the TM
- Signs: foul small, conductive hearing loss
- The enzymes secreted can destroy the ossicles and even the bony shelf between the middle ear and brain
- can reoccur even after surgery
Chronic otitis media and cholesteatomas symptoms and treatment
-dizziness, facial nerve weakness, life threatening infections of the skull
- surgical treatment is often required for chronic otitis media
- surgical removal of a cholesteatoma is almost always necessary
Otosclerosis
-progressive bone disease that typically results in fixation and stiffening of the ossicular chain
- affects twice as many females as males
Cochlear otosclerosis
- mixed hearing loss
- after surgery, will have some SNHL and may need hearing aids
Glomus tumor
-highly vascular tumor of the middle ear
- benign
- bright red aura behind the TM, ear fullness, pulsing sound, conductive hearing loss
Conductive hearing loss (CHL)
- the maximum CHL is approximately 60 dBHL
- acoustic reflexes will be absent
- OAEs will be absent
Hearing aids
if medical/surgical management does not correct the hearing loss sometimes use hearing aids until surgical treatment is complete
Engineering controls
dampen or reduce noise levels
Administrative controls
limit the amount of time in hazardous areas
Personal protective equipment (PPE)
earplugs, earmuffs, double protection, special helmets, electronic noise cancelling headsets of helmets
Noise exposure limits are set by
federal law
OSHA stands for
-occupational safety and health administration
- 5dB time-intensity measure (doubling rule)
- backed by federal legislation (LAW)
OSHA 5 dB time intensity measure is the one used in industry...
- 85 dB for 8 hours
- 90 dB for 4 hours
Sound level meters
use the DBA weighting scale which mimics human hearing sensitivity in sound field/free field
Sound dosimeters
person wears a device that measures sound exposure over time
Noise reduction rating (NRR)
labels vs. real world
Signs of nonorganic/functional hearing loss
SRT and PTA are not in alignment, inconsistent performance./intensity functions with tests, inconsistent physiological tests and pure tone results, lack of cross over
Stenger phenomenon
if sound stimuli that are the same except for intensity (loudness) are presented to both ears, the person will perceive the sound as coming from the ear receiving the louder stimulus
The stinger test
-A test for unilateral or asymmetric nonorganic hearing loss
- positive: stenger suggets nonorganic hearing loss
- negative: stenger suggests that the hearing loss is "real" (organic)
Not everybody with tinnitus has
hearing loss
Subjective means
common
objective
rare
Tinnitus is often accompanied by
hyperacusis (abnormal intolerance to louder everyday sounds)
Noise exposure is the most common cause of
tinnitus
Most tinnitus is
subjective
There is no test to confirm
tinnitus
Noise exposure is the most common cause of
tinnitus
Tinnitus can occur with or without
measurable hearing loss
Hyperacusis
...
Misophonia
...
Phonophobia
...
Hypervigilance
- relationship to PTSD
Balance mechanism
- vestibular system
- vision
- somatosensory
1. lower leg muscles
2. neck muscles
Nystagmus
effectively elicited with irrigation of the external ear canal with caloric stimulation, consisting of warm and cool water or air
ENG/VNG
includes positional testing, teaching movement with the eyes and caloric testing
Balance is maintained by the coordination of
- the somatosensory sense
- the visual sense
- the vestibular sense
***Benign paroxsymal positional vertigo (BPPV)
One of the most common causes of vertigo
***BPPV
- calcium carbonate crystals normally reside in the vestibule
- sometimes the otoconia become dislodged from the utricle and migrate into a semicircular canal
- the movement of the otoconia with head movement causes sloshing of the vestibular endolymph which causes firing of the afferent nerves and causes vertigo
***BPPV is in the
inner ear and it is a peripheral not central disorder
Meniere's disease
affects both the vestibular and the hearing organs
Endolymph is
continuous from the cochlea through the vestibular system
Endolymphatic hydros and treatment
-is synonymous with meniere's disease
- may be treated with low salt diet, injections and/or surgery
- the hearing component may be treated with hearing aids
Vestibular rehabilitation is
the usual treatment for vestibular disorders
The majority of all hearing loss is
sensorineural hearing loss (SNHL)
Word recognition may be good or it may be
poor
Remember that acoustic reflexes may be present if the loss is less than
severe
Sensory hearing loss may range in degree from mild to profound whereas conductive hearing loss rarely exceeds
60 dB HL
Sensory hearing loss is more likely to be
permanent
Conductive hearing loss caused by middle ear dysfunction is often
temporary
Two most common causes of sensory hearing loss are
- exposure to excessive levels of noise (noise induced hearing loss)
- cochlear dysfunction due to advancing age (prespycusis)
More than 90% of deaf children have
hearing parents
Usher's syndrome
- SNHL and retinitis pigmentosa
- progressive hearing loss and blindness
Mondini's dysplasia
- malformed inner ear
- includes enlarged vestibular aqueduct
- susceptible to traumatic worsening of hearing with impact
- avoid contact sports
***Endolymphatic hydrops
one of the key features of meniere's disease, describes a buildup of fluid pressure in the cochlea
four symptoms associated with the diagnosis of meniere's disease
- fluctuating hearing loss
- episodic vertigo
- tinnitus (low frequency roaring sound)
- a sensation of ear fullness or pressure
Audiological emergency (sudden SNHL)
-must see ENT physician ASAP as treatment is rarely effective after 72 hours
-more common in adults than in children
- often accompanied by aural fullness, popping sensation, and/or tinnitus
- watchful waiting is never appropriate with SSNHL
Noise induced hearing loss is characterized by
A notch type decrease in hearing thresholds within the region of 3,000 to 4,00 Hz
Presbycusis
technical term for age related hearing loss
The only treatment for prespycusis is
amplification (hearing aids)
***Is BPPV hard to treat?
No it usually goes away on its own in a few weeks if treatment is needed it usually consists of employ maneuver which is basically head movements
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