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249 Cards in this Set

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  • Back
three types of hearing loss
1. conductive
2. sensori- neural
3. mixed
what is conductive hearing loss...what part of the ear does it effect
sound cannot conduct its way through the ear. there is some kind of barrier in the way within the outer or middle ear
in conductive hearing loss, sound is attenuated or decreased because of
blockage
what are some examples of causes of a conductive hearing loss
ear wax, fluid
in conductive hearing loss, the inner ear is
perfectly normal
is conductive hearing loss generally permanent or not
not permanent
what is sensori- neural hearing loss
outer and middle ear are perfectly normal. attenuation takes place in inner ear only.
most hearing loss is which of hte three types
sensori- neural
is sensori-neural hearing loss permanent or not
is permanent
what is mixed hearing loss
attenuation of sound in inner ear and middle or outer hearing loss.
when testing hearing loss, it is conductive hearing loss when the person cannot hear well when it is a
air conduction
when testing sensori- neural hearing loss...
attenuation will be the same for the air and bone conduction will give the same results
when testing mixed hearing loss
the results won't make sense at first. air conduction will be worse than bone conduction.
outer ear disorders: auricle(pinna)

what is microsia? when might it occur? does it have to do with both?
small sized pinna. may happen during fetal ddevelopment. doesn't have to be both pinnas
what is atresia
acquired or congenital absense or malformation of an opening (auricle) (closure of ear canal)
what is the etiology of atresia if acquired? what is the etiology if congential?
acquired: surgical procedure, burns, other injuries

congenital: Treacher Collins (Hereditary Syndrome), Drugs- Thalidomide
what is the diagnosis of atresia
otologic: observing, history taking- syndrome, accident, surgery
what is the type of hearing loss invovled with atresia
conductive
why might you not be able to do air conduction testing on a person with atresia
no place to put the ear bud
bone conduction testing with a person with atresia will be
normal only for better ear
remediation or atresia
surgery with considerations
when will surgery most likely be done to cure atresia
if bilateral
will there be a chance of restoring hearing
may be able to restore hearing to normal or near normal level. dependent of other structures
at what age will surgery will be done? what does the age that it is done depend on?
on unilateral: age 15-17 (full grown)

on bilateral: age 5-7

wait to obtain valid bone conduction testing-get sound into the kids
outer ear disorder: Basal Cell Carcinoma
skin cancer of the pinna
in what age group does Basal Cell Carcinoma generally occur?
elderly
in what groups of people is there a higher incidence of Basal Cell Carcinoma?
in males, and in fair skinned people
what percentage of all skin cancer is Basal Cell Carcinoma?
5-8%
1/2 of cases of Basal Cell Carcinoma begin where?
on top portion of ear
what does Basal Cell Carcinoma look like? does it hurt? when do people realize it is there? what steps must be taken once detected?
generally small, crusty Growth

doesn't hurt

ppl often don't know it's there

must be biopsied by a physician
what is the only treatment of basal cell carcinoma
removal
are there any audiological problems associated with basal cell carcinoma
no
Pathologies of Ear Canal: Stenosis
narrowing
does Stenosis produce hearing loss
no
what does Stenosis make a person more prone to?
wax build up and other bacterial problems
Exostosis and Osteoma
boney growths that occur in boney part of ear canal
is exostosis seen often?
yes
does exostosis occur by itself or in multiples
in multiples
what does exostosis look like?
fat at the bottom (tree trunk) (sessile).

Looks like you're looking through a forest.
is exostosis usually found in one ear or both? is there pain? does the person no that they're there?
usually in both ears.

no pain

person doesn't know they're there
is osteoma bilateral or unilateral
unilateral
what does it look like in comparasin to the exostosis
more rounded
does osteoma occcur in multiples or by itself? does this disorder occur often? will the person know right away that they have it?
usually single

pretty rare

won't know you have it
what group of people is osteoma found in more often
in ppl who work in cold water (divers)
what is the diagnosis?
-how do you know its there?
- color?
-texture?
- what does osteoma do to the ear canal?
- is there a hearing losss associated with osteoma?
visual, whitish in color, hard-boney, narrowing of ear canal.

not ususally a hearing losss, unless there is a lot, then may be conductive loss
treatment of exostosis and osteoma
surgical removal only if there is a llot and it causes a problem
ear canal pathologies: foreign bodies
- how does it occur
-does it effect hearign loss
- does it hurt
- how is it found sometimes?
people stick things in their ears. can effect hearing if blocks off canal. may hurt or may not. may not find unless starts to smell
treatment of foreign bodies in ear canal
tweezers. flush out with water
pathologies of ear canal: collapsing canal
-hard or soft canal?
- what is it seen as?
-desribe the cartilage
soft canal, seen as a narrow slit, cartilage is soft, floppy,
what group of people are more likely to suffer from collapsing canals
people with tiny ear canals
what happens during hearing testing with people with collapsing canals
not good with hearing testing, because ear phones must be very tight
generally the canals only collapse with
pressure
cerumen
ear wax
polyps
any mass of tissue
where doe polyps usually originate
in middle ear- grown out by the time you see them
what might polyps be the first sign of?
carcinoma or glomus tumor(very dangerous tumor)
is there a hearing loss associated with polyps? how are they found?
possible conductive hearing loss, found by otoscope
treatment of polyps
surgery, tissue studied to look for cancer
otitis external
outer ear infection aka swimmers ear aka diffuse O.E.

most common ear infection- occurs across all ages
what is otitis external caused by? in what climate does it usually occur? what are the symptoms?
bacterial, occurs often in hot, humid weather
itchiness, redness
Otomycosis
what is it caused by?
where is it found?
symptoms?
what is responsible for it?
fungal, not bacterial. not found around here, found in tropics. pain, redness, itching. 50+ types of fungus may be responsisble for it
Chronic Diffuse Otitis External
what is it caused by?
symptoms?
unknown cause. running ears (puss) (skin), scaling
treatment of chronic diffuse otitis external (3)
avoid water in ear. rinse ears with a solution
prescription treatment
Pathologies of Tympanic Membrane: Tympanosclerosis
-what is it?
-does it effect hearing?
thickening of eardrum. no necessarily an effect on hearing.
how does tympanosclerosis occur
happens when then tympanic membrane breaks and heals thicker each time.
myringitis-what is it?
when does it occur?
inflammation
acute: usually occurs when you have a middle ear infection
characteristics of myringitis (5)
TM will be swollen
TM will be thicker
may be blistering or buldging
flaking look on ear drum
normal hearing

can't always see them
treatment
often will subside with no treatment. if it doesn't then you have chronic myringitis
chronic myringitis
will occur with infection. same characteristics as acute

not treatment
tympanic membrane perforations
-easy or hard to see?
-caused by?
very hard to see. caused by infections. through trama
3 types of trama that cause tympanic membrane perforations
1. loud blasts, barotrauma- in military
2. flying, diving
3. QTip
central perforation
per. of pars tensa with the rim remaining in tact at all borders
the bigger the perforation>>>
the bigger the problem with hearing
Marginal Perforation
some part of the perforation extends into the boney rim of the TM.
is central per. or Marginal Per. more serious in terms of correcting
Marginal Per.
treatment of TM per.
patch test- paper used to temporarily cover the per. to see if Perm. patch would work.
--->myringoplasty- surgical repari- patch
how do most TM per. heal
spontaneously
disorders of middle ear: Cholesteotoma: what is it? is it serious?
an ingrowth in the epithelial tissue. needs to be removed. eats away. erode what it comes in contact with.
what happens with a cholesteotoma? ( a piece of skin...
that got somewhere it didn't belong. body builds up around it.
where is a cholesteotoma usually found?
in middle ear or back of TM
what is a cholesteotoma usually shaped like? if cut, what does it look like?
round. like rings of onion.
is a cholesteotoma unusual to find?
no
does a cholesteotoma cause hearing loss
yes, conductive heraing losss
first type of cholesteotoma: Congenital
-what is it a result of?
-do ppl know it is there at birth?
primary. started priar to birth. not a result of disease. fetal tissue becomes imbedded in other tissue. don't know it's there at birth
location of cholesteotoma
bony labrinth
when cholesteotoma is in boney labrinth...at what age is it found and how is it found
at age 35-55. found due to symptoms of facial wekaness, erosion of body portions of middle ear and inner ear.
-visual
how is cholesteotoma removed if in boney labrinth
surgically removed but hard to get all of it
another location of congenital cholesteotoma? how found? at what age?
middle ear and mastoid: found in childhood with hearing loss. visualization of whitemass behind TM.
what can congenital cholesteotoma of the middle ear and mastoid cause
middle ear ossicular damage- is an agressive power
if cholesteotoma is not fully removed...
can reoccur
Secondary acquired cholesteotoma
secondary to soemthing else like ear infection that causes tissue to be moved. same features of congenital cholesteotoma.
if cholesteotoma is left alone....
can cause real problems. will continue to grow. will go into mastoid. can then go to brain.
surgical treatment if in mastoid is called
mastoidectomy
once resolved if bones have been eaten away...
they can be rebuilt
disorders of middle ear: Paget's Disease
structural bone changes in skull and enlarge bones in the body
are males or females effected more
males effected 4:1
at what age is the onset of Paget's disease
middle age
what is the etiology of Paget's Disease
unknown, maybe inherited
people with Paget's disease have an ______ skull and a ______ stature
enlarged, short
does someone with paget's disease have a hearing loss
yes
what is the treatment of Paget's disease
no cure/treatment
Otitis Media (OM)- several different types and causes: Supperative
most common middle ear disorder
what are the characteristics of Supperative Otitis Media
redness of eard drum and membrane around. often pain and fever. perforation of ear drum (mainly in children)
what is supperative otitis media caused by
bacteria - Eustacian tube makes easy for kids to acquire
what percentage of children have an ear infection before age 2
70%
what percentage of children in US have more than one ear infection
50%
ear infection with colds, alergies. some children apt. with
down syndrome or deformity.
is hearing loss associated with supperative otitis media
often with conduct hearing loss. ear infection- ear filled with fluid
what is the treatment for supperative otitis media
antibiotics or may clear without treatment
myringotomy
insision in ear drum to open (ENT, M.D)
if middle ear stays infected, doctor will
scrape out
otosclerosis
calcification of middle ear bones. abnormal bone growth around middle bones
is otosclerosis bacterial or hereditary
hereditary- can track symptoms of young adults (teens, 20s)
what can the bone growth invade
the cochlea
what is the onset of otosclerosis
10 years
what is the incidence in poeople? in women?
1:200

2:1
what type of hearing loss (bilateral, unilateral, progressive, stagnant)
bilateral, progressive
increase of gettting otosclerosis with
pregnancy
if otosclerosis invades cochlea then what type of hearing loss
sensori-neural loss
as gets older what type of hearing loss will it be
mixed hearing loss
ringing in the ears...
tinitis is also exhibited in otosclerosis
what is the treatment of otosclerosis (3)
hearing aid, scrape desposits, remove stapes and put in fake
fenestration
since bones does not equal function. will give new oval window function without no middle ear bones
Eustachian Tube Dysfunction
does not open or close, like it is supposed to
why would allergies effect eustachian tube dysfucntion
mucus
adnoids( glands by ET) will
get swollen, block ET
what type of hearing disorder makes up the largest group of hearing imparied
people with inner ear hearing loss
Inner ear Disorders: Meniere's Disease- etiology
unknown. could be allergies, psychological
symptoms of meniere's disease (5)
-unilateral hearing loss
-tinnitus (roaring, low pitch)
-fluctuating hearing loss
-audiogram- flat or low frequency SNHL
-suddent attacks of vertigo
when not having an episode...hearing
may be normal
treatment of Meniere's disease: (3)
-antivert
-nicotinic acid
-surgical- shunt (drains endolympathic sac, labyrinthectomy, vestibular nerve section)
subcategory of Meniere's Disease- Vestibular Menieres
no hearing loss with other symptoms.
Inner Ear Disease: Presbycusis
hearing loss associated with age. largest group of hearing impaired people
etiology of Presbycusis (4)
- all have some conductive loss with by the 80s.
- reduced mechanical function of the inner ear
- changes in blood vessels
loss of neurons in the CNS

fluid that goes over the hair cells has gone over them so much that they being not to send info as well.
symptoms of presbycusus (6)
- progressive/ gradual decrease in hearing
- poorer speech understanding
- difficulty hearing in noise
- tinnitus
- recruitment- abnormal increase in loudness
- vertigo at times
at what age does presbycusis occur
at any age
is presbycusis bilateral or unilateral
usually unilateral
treatment of Presbycusis
refer to physician immediately. hearing aids
sudden hearing loss: etiology
vascular
viral
autoimmune disorder
symptoms of sudden hearing loss (4)
tinnitus
vertigo
unilateral hearing loss
mild to severe loss
type of recovery in sudden hearing loss
spontanteous
treatment for sudden hearing loss
dependent upon etiology. refer to physician immediately
ototoxicity
toxic to your ear
etiology of Ototoxicity (6)
- antibiotics- some ototoxic to vestibulotoxic
- diuretics
- anticancer meds- chemotherapies
- salycylates
- quinine
- aspirin- heavy doses
symptoms of ototoxicity (2)
-high frequency hearing loss
-vestibular problems
treatment of ototoxicity (4)
-pre-treatment patient councelling
- baseline measuremens- hearing test before any treatment is started
- periodic evaluation during treatment at set intervals and post treatment evaluation
- change in medication (if an option) if any change in hearing is identified.
Noise induced hearing loss
insult to the cochlea. can be short term very intense exposure- acoustic trauma
- can be long term steady exposure without hearing protection
symptoms of noise induced hearing loss: high frequency
high frequency: hearing loss. temporary threshold shift- hearing imporves after impairemnt
permanenet threshold shift
irreversible impairment
what age does noise induced hearing loss occur
any age
high incidence in males or females
males
an increase in noise induced hearing loss is being observed in kids because
of toys, ipods, etc
treatment of noise induced hearing loss
hearing protection- ear plugs, limiting exposure.
childhood disorders of inner ear: Labyrinthitis
bacterial infection
onset of labyrinthitis
first two years of life
etiology of Labyrinthitis
- bacteria- strep, staph, etc
- meningitis- infection and inflammation of the meninges (covering the brain and spinal cord)
symptoms of Labyrinthitis
-symtpoms related to disease
-hearing loss
-high fever
treatment of labyrinthitis
related to type of disease causing problem
viral infection
a virus is submicroscopic. a virus moves through the blood stream and damages ear structures
maternal rubella
(1963-1965) most recent epidemic
viral epidemic caused
developmental defects and hearing loss (worse with virus in the 1st trimester)
is there a hearing loss involved
heraing loss ranged from mild/ moderate to profound
other viruses include
influenza, mumps
if hearing loss is related to mumps then it is
unilateral
is there hearing loss related to measles
yes
syphalus
- how spread
- what can happen if left untreated
virus. baby can get from mother. if left untreated can cause brain damage.
cytomegalovirus
can transmit from mother, pre, peri or post natal.
is there hearing loss associated with (CMV)
high incidence of hearing loss (31%)
another way CMV can be transmitted
saliva, or any bodily fluid
can HIV/AIDS effect cochlea
yes
why can any of these viruses effect hearing
a virus is in the bloodstream and if it flows to the cochlea then it will effect hearing.
RH Factor Incompatibility
imcompatability of parental blood proteins. fetus develops with a protein molecule called the Rh Factor
mother without the blood protein will...
produce antibodies for protection against the harmful effects of the Rh Factor
generally by a third pregnancy with the Rh Factor issue there are
so many antibodies in the mother's system that the red blood cells of the fetus are damaged and cannot carry oxygen efficeintly to areas including the cochlea
there can be many abnormalities beyond hearing impairment related to RH incompatibility but these issues are
manageable due to early prediction, immunizations, and blood transfusions

pretty well managed overall
prematurity: symptoms
1. susceptibility to infection ( which can go to the cochlea and effect hearing)
2. intracranial bleeds
3. cyanosis (failure to breath)- anoxia
NICU (neonatal intensive care unit) why would cause hearing loss
exposure to high levels of noise- crying babies

if extended period of time could have noise induced hearing loss
dna
deoxyribonucleic acid- a basic molecule that contains all of our hereditary information
genes
sequence of DNA molecules (contains DNA molecules)
hereditary traits
inherited info
phenotype
the actual manifestation or expression of a physical trait. observable
genotype
genetic information that results in a physical trait. blue print- everything you are
chromosomes
the structure that holds the genetic information ( have approx. 30,000)
how many pairs of chromosomes
23 total
how many pair are autosomes ( non sex related)
22
how many pair are sex chromosomes
1
we get one randomly selected chromosome ...
for each pair from each parent
allele
a certain type or form of a gene
if we get the same allele (gene type) from both parents that gene is called
homozygous (pure)
if we get a different allele/ gene from each parent for a particular trait this is considered
hterozygous (mixed)
dominant gene
only one gene is needed in a pair inorder for that trait to show/express the allele/ characteristic
recessive gene
one identical gene/allele is needed from each parent in order for the trait to express itself
variable expressivity
there are times when for some reason a dominant gene/allele does not express itself
a trait may....a generation
skip
types of genetic hearing loss can be caused by
defective gene mutation. attacks the inner ear
where is the defective gene found in Autosomal Dominant Hearing Loss
in one of the 22 pair of chromosomes. not the sex chromosome
what are two characteristics of Autosomal dominant hearing loss
1. will see a family pattern of hearing loss with this type of loss.
2. one parent will have hearing loss and the defective dominant gene
if you have one parent with hearing loss and the other normal hearing...what are the chances of the children haveing hearing loss
each child will have a 50% chance of inheriting the hearing loss. dominance is key
can normal hearing children from this type of family pass along the hearing loss
no they don't have the defective DOMINANT gene
what accounts fro about 80% of genetic hearing loss
autosomal recessive hearing loss
how many parents must have autosomal recessive hearing loss in order to pass it along to their children
2
where is the defective gene found in autosomal recessive hearing loss
one of the 22 pair of chromosomes
about 50% of this type of loss is related to...
a syndrome that has hearing loss as one of its characteristics
people/ children with this type of loss have two normal hearing parents but...
but carry the abnormal recessive gene for hearing loss ( not necessarily)
each child in this family has what percent chance of getting the hearing loss
25%
are children of these parentswho do not show hearing loss carries of hte gene
may be
sex-linked of (X-linked) Genes
the 23rd pair of chromosomes- the pair of chromosomes that determine the sex of a child
what is the female chromosome and what is the male chromosom
X female (XX)
Y Male (XY)
which of the two carries the most genetic information
X
which can contain a recessive allele for hearing loss
X
which is much smaller and only carries information about sex determination
Y
abnromal x-linked genes can be domianat or
recessive
x-linked hearing loss (many types) appears to be a ______ gene
recessive
x-linked hearing loss accounts for what amount of hearing loss
small percentage of hearing loss
female with a recessive gene for hearing loss on only one of her "X" chromosomes will have
normal hearing but carries the trait
50% of her chilren will get
the recessive gene
female child- one normla gene from dad, one abnormal from mom...child will
be carrier
male children- only have one "Y" chromosome which comes from father-
50% of the boys will have hearing loss
what is a syndrome
group of symptoms of characteristics (skull deformities, cleft palat, eye problems, skin pigmentation issues, hearing losss, mental retardation) that occur together that diagnose a particular occurrence
Trisomy
hereditary/ chromosomal. this is when there is an extra chromosome present on a pair of chromosomes
Trisomy 13
extra chromosome on the 13th pair of chromosomes- has specific characteristics including hearing loss
Auditory Nerve and Central Hearing Loss:

Disorders of the 8th Nerve: 3 reasons lesions/ disorders of the 8th nerve may occur

-can occur within the_____________ or at the _____________
1. disease
2. Pressure on the nerve
3. irritation of the nerve



can occur within the internal auditory cnaal or at the cerebellopontine angle CPA
Tumor of the 8th Nerve
acoustic tumor- biggest one you'll hear about
etiology of acoustic tumor
- cancerous or benign?
- size?
-occurance?
- aka
most are benign and vary in size.
- occur about 1 per 100,000 people per year
- usually called acoustic neuroma, neurinoma, vestibular schwannoma (old term)
where does the tumor arise from
the cells that surround/protect the 8th nerve, put pressure on the 8th nerve
onset of the tumor is
generally over the age of 30- most common in the 40s
symptoms of the tumor
-depends on?
-uilateral or bilateral?
-3 characteristics
-with pressure of facial nerve-3 things that occur
depend upon size and exact location of the tumor
- unilateral hearing loss
- tinnitus
-vertigo(sometimes)
- headaches
- With pressure of the facial nerve
-changes in the sense of taste, visual changes, gait problems (difficulty walking)
Diagnosis of tumor
- first evaluation-why
hearing evaluatio is first eval. due to decreased hearing and/or tinnitus
types of testing
-ABR- Brainstem Stem Testing
-CT Scan/ MRI- magnetic resonance Imaging
-High Protein in Cerebrospinal Fluid
- PET Scan- Positron Emission Tomography
-Inject radioactive material- look for biochemical changes
Treatment of Tumor
- what betters chances?
- ...may not be first symptom....
-surgeons try to remove....
Surgical Removal
- earlier found better chance of successsful removal
- hearing loss may not be an early symptom if tumors are often larget when first found.
- surgeons try to remove the tumor with as little damage as possible to the accoustic nerve and the facial nerve if involved- often there is permanent hearing loss even following surgery
Neurofibromatosis
Von Recklinghausen Disease- causes multiple neuroma's throughout the body including acoustic neuroma
multiple Sclerosis (MS)
- what happens
- can affect what nerve ( that we care about)
- hearing loss is usuallly ...
- overall loss of....
- progressive or stagnant
- cure? treatment?
Demyelinating disease- myelin covering of the nerves slowly deteriorate
- can affect acoustic nerve
- hearing lsss is usually unilateral -not always
- overalll lloss of muscular function
- progressive disease
- no cure- many treatments
Auditory Neuropathy (malfunction of a nerve)/ Dys- Synchrony
brain doesn't get info correctly
symtpoms (hearing related)
hearing loss- likely progressive.
-no benefit from hearing aids
- may benefit from cochlear implant( tube of electrodes placed in cochlea- send info to the brain)
symptoms cont
- types of testing..what do the results mean
significant speech understanding problems
- absent ABR testing with only a moderat hearing loss
- present Oto Acoustic Emission (OAE) testing- tells us that the outer hair cells are workign-

this means:
- the cochlea is working.
- auditory nerve is not working
- no brainstem waves
location of abnormality
-unclear
-maybe inner hair cells- cannot test
- maybe nerve fibers within the cochlea or beyong
- maybe combo of both
Disorders of Central Auditory Pathways: Etiologies
(2)
Infetion- such as Encephalitis, Meningitis, Syphilis, RH incompatibility, Brain Trauma, Anoxia(lack of blood supply), Stroke/ CVA


Kernicterus- poor liver function- bile deposits occur throughout body- damage nerve fibers everywhere including brain
symptoms of Central Auditory Pathways Disorders (4)
-decreased speech understanding
-work finding/confusion
- possible hearing loss
- poor school performance- often where problem is found
diagnosis
-based upon disease or accident
-hard to diagnose location of issue due to the intricacies of the brain and its pathways
Minimal Auditory Deficiency SYndrome MADS
related to slight or mild hearing loss- associated with chronic O.M. (otitis Media)
Chronic O.M.
may effect language learing due to deprivation of sensory input
see more children with langauge disorders that have a
history of transient hearing loss
Functional/ Non- Organic Hearing Loss
a hearing loss that has no apparent organic disorder or pathological evidence to explain the extent of the loss
may also be called
Pseudohypacusis- means false hearing loss
Malingere
deliberately reporting symptoms for some kind of gain (not a possitive term)
adults or children-why do this?
looking or attention

-kids not doing well in school
-people in accidents
Etiology
maybe some kind of trigger evet- legal claim due to an auto accident, monetary gain such as $ from government due to a service related loss
symptoms
behavioral- such as exaggerated behaviors in an attempt to simulate a hearing impaired person. unreliable and exaggerated responses
test management
use strategy- testing techniques and be non-accusatory