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Hearing Disorders Flashcards
Terms in this set (163)
Define: Hearing impaired
Generic umbrella term for all degrees, types, and severities of hearing loss
Define: Hard of hearing
Hearing impairment ranges from slight (15dB loss) to severe (90 dB loss)
Greater than 90 dB hearing loss, cannot hear conversational speech under normal circumstances
Define: Minimal hearing loss
15-25 dB loss
Define: Mild hearing loss
25-40 dB loss
Define: Moderate hearing loss
40-55 dB loss
Define: moderate-severe hearing loss
55-70 dB loss
Define: severe hearing loss
70-90 dB loss
Define: profound hearing loss
90-110 dB loss
Define: Exogenous hearing loss
Non-organic cause of hearing loss
Define: Endogenous hearing loss
Genetic/hereditary cause of hearing loss
-X linked genes
Define: Congenital hearing loss
Present at birth
Can be endogenous (genetic) or exogenous (anoxia during pregnancy, rubella)
Define: Acquired hearing loss
Not present at birth
Endogenous conditions may not be noticeable until some time after birth
Define: Sudden hearing loss
Rapid onset hearing loss
-May have been progressive but is suddenly more noticeable
-May be caused by trauma
Define: Progressive hearing loss
Slow onset of hearing loss
Ex: presbycusis (age-related hearing loss)
Define: Pre-lingual hearing loss
Hearing loss occurs before onset of language
Congenital or acquired causes hearing loss before age 3-5
Define: Post-lingual hearing loss
Hearing loss occurs after development of language
Loss occurs after age 5-10
Child has enough hearing prior to loss to develop good speech and language
What is the difference between "deaf/Deaf" and "deafened"?
Deafened is when hearing loss occurs after completion of education
What is the anatomical location of disorder in cases of conductive hearing loss?
Outer ear and/or middle ear
What is the anatomical location of disorder in cases of sensorineural hearing loss?
Inner ear, Cranial nerve VIII
What is the anatomical location of disorder in cases of central auditory processing disorder?
Central auditory system
What is the anatomical location of disorder in cases of mixed hearing loss?
Outer ear/middle ear, and/or inner ear/CNXIII, and/or central auditory system
What is the anatomical location of peripheral hearing loss?
Outer ear, middle ear
What is the anatomical location of cochlear and retrocochlear hearing loss?
Cochlear: In the cochlea.
Retrocochlear: CNXII or central auditory system
Conductive hearing loss: What is the cause, where is the location of disorder, is it temporary/permanent, what are potential treatments?
Caused by anything that affects the conduction of sound from the environment to the inner ear.
Location: outer ear or middle ear
Most cases are temporary, some can be permanent
Often treatable with surgery or medication
Sensorineural hearing loss: What is the cause, where is the location of disorder, is it temporary/permanent, what are potential treatments?
Caused by anything that prevents the cochlea, CNXII, or central auditory system from sensing/sending auditory information.
Location: Cochlea, CNXII, or central auditory system
Symptoms: Sound is not loud enough or clear enough, high frequencies affected more than low frequencies, conversational understanding is affected.
Most cases are permanent and not treatable
Mixed hearing loss: What is the cause, where is the location of disorder, is it temporary/permanent, what are potential treatments?
Caused by anything that affects the auditory pathway from the outer ear to the central auditory system.
Can be temporary or permanent
Central hearing loss (Auditory processing disorder)
What are the causes, what are the symptoms, what are the functional problems affecting hearing?
Caused by a problem at the brainstem or in cortical areas.
Cochlea receives information, but processing the information takes too long so context/clarity/understanding is poor.
Peripheral hearing sensitivity is normal
Psuedohypacusis/functional/nonorganic hearing loss
No hearing loss, erroneous report of hearing loss, exaggerated hearing loss
Patient may be trying to get attention, having an unconscious reaction, or have an unidentifiable etiology
dB level range of normal speech sounds
frequency range of normal speech sounds
Specifically, how is incoming sound affected by a conductive hearing loss?
Conductive hearing loss causes a decrease in loudness
Specifically, how is incoming sound affected by a sensorineural hearing loss?
Sensorineural hearing loss causes a distortion or decrease in clarity of sound, and may also cause a decrease in loudness
What are three acquired causes of Outer Ear Disorders?
2. Otitis Externa
3. Obstruction of OE
What are the common causes of trauma to the outer ear?
People sticking foreign objects in their ear, poorly performed medical procedures (cerumenectomy). Less common is barotrauma or acoustic trauma.
True/False: Trauma to outer ear can cause more serious problems if other areas of the ear become affected
True/False: Blood, clots, scabs, and wax can prevent identification of exact location of injury to outer ear
What is the most common acquired disorder affecting the outer ear?
Define: Otitis media, describe 4 classifications
inflammation of skin of outer ear caused by variety of factors
Chronic: long term
diffuse: over a large area
localized: specific/small area
Whitish, watery secretions and discharge
Describe 4 symptoms of otitis externa
Otorrhea: whitish/watery secretions/discharge
Acute localized otitis externa - describe 2 causes and 4 symptoms
Can be caused by staph infection or allergic reaction to something in ear
Furunculosis: small boil-like eruptions
Bullous myringitis: blebs on tympanum filled with fluid
Chronic otitis externa: 1 cause, 3 symptoms, treatment
Can be caused by seborrheic dermatitis, esp. in elderly
Dry, scaly skin
Treat with scrubs and medicated wash
How does otitis externa affect hearing?
Causes conductive hearing loss, usually temporary, due to tissue edema, which closes the external auditory meatus and prevents sound transmission.
True/False: Earwax is a mixture of secretions and skin cells from the cartilagenous ear canal.
False: Earwax is a mixture of secretions and skin cells from the entire ear canal.
True/False: The cartilagenous portion of the external ear canal contains two types of glands which end in or next to hair follicles.
True: It contains ceruminous glands and pilo sebaceous glands
True/False: The dead skin lining of the ear canal tends to collect within the osseous ear canal
False: Skin lining of ear canal migrates outwards, flaking off in large pieces like a snakeskin.
True/False: The dead skin of the ear canal tends to flake off and leave the ear canal quickly.
False: Unlike the skin of the rest of the body, it takes a long time for dead skin to migrate out of the ear canal, beginning as a sheet and breaking up at the osseous/cartilagenous border.
Describe 3 functions of cerumen
Describe 5 symptoms of outer ear canal obstruction
Sensation of obstruction
Mild conductive hearing loss
True/False: Obstruction of the outer ear canal caused by a foreign object can always be managed without a referral to a medical professional.
Name two congenital disorders of the auricle
Name two congenital disorders of the outer ear canal
Abnormally small pinna
Narrowing of the external ear canal
Complete closure of the external auditory meatus and/or absence of the external ear canal
Total failure to develop (of some body part)
Partial failure to develop (of some body part)
Describe 5 types of anomalous auricle shapes
Constricted: hooding or folding of helical rim
Lop: top of ear folded down and forward
Cupped: malformed protruding ear with the top folded down and a large concha (cup).
Stahls: Spock ears
Macrotia: Larger than normal pinnae
Microtia: Smaller than normal pinnae
Define preauricular pits and fistulae and explain causes
Depressions or holes near the auricle caused by abnormal development of auricular hillock
Define preauricular tag/rudiment
Small growths at or near the area of the auricle
caused by abnormal development of accessory auricular hillock
True/False: Mild external abnormalities of the auricle tend to be isolated and do not usually indicate the presence of other structural abnormalities
False: Mild external abnormalities of auricle may indicate presence of other abnormalities not easily viewable.
Name one cause of stenosis and one developmental disorder it commonly occurs in
Stenosis can be caused by chronic outer ear disorder (Otitis Externa, multiple exostoses), and is common in people with Downs syndrome
True/False: Microtia is more common in men, and it is usually bilateral
False: Microtia is more common in men, and it is usually right unilateral
True/False: Atresia is usually comorbid with severe microtia, but it can occur when pinnae are normal
True/False: Atresia is usually comorbid with other middle ear abnormalities
Aural atresia is more common in men, and is usually right sided unilateral
What kind of hearing loss does atresia cause?
Conductive hearing loss
What does deep atresia look like?
Ear canal ends in a shallow pit deep to the pinna
True/false: Genetic disorders which affect the branchial arches of the developing fetus primarily cause conductive hearing loss
False: Genetic disorders affecting the development of the branchial arches can cause all types of hearing loss, as well as other abnormalities
Give an example of a disorder that affects the development of the branchial arches
Treacher collins syndrome
Treacher collins syndrome: what does it affect, what abnormalities does it cause, what kind of hearing loss is associated with it?
Genetic, autosomal dominant condition that affects development of facial bone structure.
Common: bilateral microtia (85%), bilateral atresia (30-40%), conductive hearing loss
Less common: sensorineural hearing loss
Name 3 kinds of medical/surgical interventions for congenital disorders of the pinnae or external ear canal
Define cosmesis for disorders of the pinnae
Prostheses fastned with bone anchor mounts, e.g. a prosthetic auricle
Cosmetic process to reshape pinnae using already present soft tissue/cartilage or using a synthetic implant.
e.g. skin is pulled over a synthetic implant
What are 3 surgical hearing restoration procedures for disorders of the external meatus and middle ear?
Meatoplasty: repair/reconstruction of ear canal
Tympanoplasty: repair/reconstruction of eardrum
Ossiculoplasty: repair/reconstruction of ossicular chains
True/False: An audiologist may perform a surgical intervention if asked to do so by the client
Name two kinds of nonsurgical audiological intervention procedures for disorders of the outer ear
Describe hearing amplification intervention for disorders of the outer ear
Make sounds louder to overcome the air-bone gap (conductive hearing loss).
Can use traditional air conduction and bone conduction hearing aids or bone anchored hearing aids
Describe aural rehabilitation interventions for disorders of the outer ear
Select and fit aids
Train client to recognize amplified sounds (auditory training) and use speech reading
Train client to use amplification aid
Teach social compensation strategies
What are the 3 common disorders affecting the middle ear?
Eustachian tube dysfunction (ETD)
Otitis media with effusion (OM w/E)
Possible complications of OM w/E
True/False: The eustachian tube is normally open.
False. The eustachian tube should normally be closed .
Fill in the blanks: The eustachian tube connects the ____ and the ____
The eustachian tube connects the nasopharynx and the middle ear (typanic cavity)
Name three functions of the eustachian tube
Optimal functioning of the middle ear
How is the eustachian tube different in children?
more horizontal (10 deg vs. 45 deg in adults)
LVP and TVP muscles weaker
walls of tube are thinner (compliant) and more prone to collapse
Name 4 possible symptoms of eustachian tube dysfunction
Feeling of blockage
Otalgia due to tension on tympanum
(anything that interferes with the tube's function)
Name three structural deformities causing eustachian tube dysfunction
Craniofacial anomalies (cleft, down syndrome)
Adenoid hypertrophy (swollen adenoids)
What are functional causes of eustachian tube dysfunction?
Patulous eustachian tube (tube stays open)
Blockage due to foreign material
What is a traumatic cause of eustachian tube dysfunction?
Barotrauma (sudden changes in air pressure while flying or diving
Name the most common cause of eustachian tube dysfunction
inflammation/swelling of mucous membranes due to:
Upper respiratory tract infection
abnormal growth of tissue
Type of cancer that develops from epithelial cells
True/False: Neoplasms do not cause eustachian tube dysfunction
False. Neoplasms, or nasalpharyngeal carcinomas, can cause eustachian tube dysfunction.
What are two treatment procedures used to force open a blocked eustachian tube?
Valsalva: hold nose, close mouth, blow
Toynbee: Close mouth, hold nose, swallow
Define otitis media with effusion (OM w/E)
Inflammatory process of middle ear cavity
True/False: Chronic or accute otitis media rarely affects the mastoid
False. Chronic or acute otitis media often affects the mastoid air cells
True/False: Nearly 50% of kids have otitis media once before age 3
False: Nearly 80% of kids get otitis media once before age 3. (most common childhood inflammatory disease after common cold)
True/False: otitis media is more common in certain populations
True. More common in native americans and pacific islanders
What is the most common cause of otitis media?
Eustachian tube dysfunction
True/False: Complications of otitis media are common
False: complications are uncommon, but can be life-threatening
Name two environmental factors that can increase an infants' risk of otitis media
Smoking in the house
Angle of bottle feeding
Describe the 3 general stages of the progression of otitis media
Obstruction of e. tube causes negative pressure in middle ear which draws fluid/bacteria in to middle ear
True/False: positive pressure in the middle ear cavity causes fluid to be drawn in to the middle ear space
False. Negative pressure causes fluid to be drawn in to the middle ear space
Describe how a blocked eustachian tube can create negative pressure within the middle ear
Cells of the middle ear's epithelial lining consume oxygen and use up stagnant air, creating negative pressure
How does a sporadic partial opening of the eustachian tube contribute to otitis media?
It can draw bacteria in to the e. tube from the nasopharynx.
How does an upper respiratory tract contribute to otitis media?
Fluid/swelling/mucus caused by infection can block the e. tube on the pharyngeal surface
Define serous fluid
natural, benign (sterile) transparent fluid that fills many body cavities
Where does the serous fluid involved in otitis media come from?
Serous fluid is drawn into the middle ear space from the mucosal lining by negative pressure
True/False: Sporadic partial openings of a blocked eustachian tube causes bacteria to be drawn in to eustachian tube from middle ear
False: It causes bacteria to be drawn in from nasopharynx.
True/ False: Someone with acute otitis media first experiences negative pressure on their tympanic membrane, then positive pressure.
Define "glue ear"
Antibiotics have successfully killed off an infection in the middle ear, but a thin, mucoid type fluid remains post-treatment.
Name 5 symptoms of otitis media with effusion
Restless sleep, temperament disorders
Balance & hearing disorders
What are the 3 categories of otitis media defined by duration and onset?
Acute (1-21 days)
Subacute (22 days - 3 months)
Chronic (3+ months)
What are the 3 types of effusion in cases of otitis media?
Serous: sterile fluid
Suppurative/purulent: bacteria in fluid
Mucoid: thick, glue-like, some bacteria in fluid
Acute suppurative otitis media: Symptoms
Accumulation of fluid in middle ear
TM red and bulging outward
Effusion/rupture of TM is possible
Subacute otitis media: Symptoms
TM shows increased vasodilation (redness)
Acute serous otitis media: Symptoms
TM retracted by negative pressure
Eardrum not as red (no bacteria present)
Unifected fluid in middle ear
Fluid line or bubbles may be seen behind TM
Chronic suppurative otitis media
TM remains unperforated/ruptured
Tubotympanic or atticoantral involvement
Chronic serous otitis media
Glue like mucus-like serous fluid present in middle ear
Fluid is rich in proteins which can eventually erode the ossicles, bony labyrinth, etc
Name some treatments for otitis media
Analgesics (pain relievers)
Autoinflation of eustachian tube
Polerization (forced air into e. tube)
Tympanostomy (pressure equalizing/ventilating tube placed into TM to drain fluid)
What are 4 procedures used to diagnose otitis media?
Immitance audiometry (tympanometry)
Pure tone & speech audiometry
What are the 5 common complications of otitis media?
TM retraction pockets
Common complication of acute or chronic otitis media. Infection/inflammation of the mastoid portion of the temporal bone.
Membraneous lining of mastoid bone may also become infected.
What are some symptoms of mastoiditis?
tenderness behind auricle
What type of hearing loss is associated with mastoiditis? Why?
Conductive hearing loss, caused by inadequate drainage of mastoid mucosa, fluid in middle ear, decreased mobility of tympanum. Can cause sensorineural hearing loss if left untreated
True/False: Chronic mastoiditis can impact the brain
True. Life threatening medical complications include meningitis, brain abscess, and cerebellar abscess.
What is a mastoidectomy? What is a wall-down mastoidectomy?
A mastoidectomy is a surgical procedure to expose and drain the mastoid air cells. (Canal) wall-down mastoidectomy is when the posterior wall of the outer ear canal is removed during the operation.
Define perforation of the TM
Spontaneous rupture/perforation of tympanic membrane that can result from middle ear effusion associated with otitis media.
Also caused by barotrauma, acoustic trauma, or self-inflicted trauma
True/False: The TM can spontaneously heal post-perforation.
True/False: A perforation of the pars flaccida will result in a greater degree of conductive hearing loss than a perforation of the pars tensa.
False: Perforations of the pars tensa will result in greater hearing loss than perforations of the pars flaccida
True/False: A perforation in the superior/marginal portion of the tympanum will result in greater hearing loss than a perforation in the central portion of the tympanum
False: Perforations of the central portion of the tympanum will result in greater hearing loss than a perforation of the superior/marginal portion.
True/False: Perforations of the tympanic membrane must be monitored closely to prevent skin cells from migrating into the ear canal and causing a cholesteatoma
False: Perforations must be monitored closely to prevent skin cells from migrating into the tympanum and causing a cholesteatoma.
Procedure in which a tissue graft, usually of fascia or vein, is used to close a perforation of the TM
Hole opened in tympanum to allow fluid in middle ear to drain out ear canal
Reconstructive surgery of the middle ear, usually classified in types according to the magnitude of the reconstructive process:
Type I: Repair to TM perforation alone
Type II-V: Increasingly complex procedures performed when other ME structures are affected.
Define monomeric TM
A monomeric (latin, "one part") tympanum can occur post-perforation because the fibrous middle layer of the tympanum does not regrow.
True/False: A portion of the tympanum will be more opaque in the monomeric portion post-tympanic rupture.
False. The thin monomeric layer will be more translucent without the fibrous middle layer.
What is a tympanic membrane retraction pocket?
Weakened portions of the tympanic membrane are invaginated (sucked in to) tympanic space.
Commonly caused by negative pressure on tympanum secondary to otitis media.
Typically occur in the pars flaccida
What is the most common cause of a tympanic membrane retraction pocket?
Negative pressure in the middle ear, caused by eustachian tube dysfunction
complete or total collapse
What is a common complication of a tympanic membrane retraction pocket?
Membrane of tympanum thickens via formation of whitish calcification plaques on TM and nodular deposits (dense connective tissue) in the mucosa of the ME.
What causes tympanosclerosis?
Tympanosclerosis is caused by chronic inflammation or trauma, secondary to chronic otitis media
Also caused by medical intervention, such as putting tubes in tympanum
How and what kind of hearing loss is caused by tympanosclerosis?
Tympanosclerosis causes conductive hearing loss (especially in lower frequencies) via the stiffening/fixation of TM and ossicles.
What is a cholesteatoma?
A psuedotumor, keratoma, skin cyst, or "pearl tumor"
How does a cholesteatoma form?
These "tumors" form when cellular (squamos epithelial) debris accumulates in a TM retraction pocket. If they accumulate and grow large, they can fall into the middle ear.
True/False: A perforation in the central tympanic membrane poses the greatest risk of developing a cholesteatoma
False. A perforation in the central TM poses the least risk, a perforation in the pars flaccida/attic the greatest risk of developing a cholesteatoma
True/False: Attic cholesteatomas are typically visible from the outer ear canal
False: Cholesteatomas in the attic of the tympanic cavity are hard to see
Progression of cholesteatoma: describe possible risks posed to ossicles, mastoid air cells, sensory cells, nerves
Cholesteatoma can fall in to tympanic cavity, causing TM perforation and foul otorrhea
Typical slow, constant growth can envelop the ossicles, cause fistulas in the mastoid air cells, the labyrinth, and the facial nerve canal.
True/False: cholesteatomas normally cause conductive hearing loss
False: Cholesteatomas may or may not affect hearing, depending on their location.
True/False: Cholesteatomas can lead to facial palsy
True/False: Cholesteatomas are not a cause of preauricular or retroauricular fistulae
True/False: Partial removal of an entrenched cholesteatoma is usually enough to prevent it from growing further.
False: If not removed completely, the keratoma can regrow.
True/False: Audiologists diagnose to determine the possible site of problem, and hypothesize about the structures causing the observed deficit in hearing
True/False: Audiologists can refer a patient to a medical professional but are not a part of the post-surgical monitoring
False. Audiologists monitor patients post-medical referral or surgery
Define and describe the two ways that audiologists can provide treatment for a patient who was left with hearing loss
Amplification (hearing aids, implants)
Aural rehabilitation (speech reading or auditory training, compensatory strategy training)
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