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249 Cards in this Set
- Front
- Back
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three types of hearing loss
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1. conductive
2. sensori- neural 3. mixed |
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what is conductive hearing loss...what part of the ear does it effect
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sound cannot conduct its way through the ear. there is some kind of barrier in the way within the outer or middle ear
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in conductive hearing loss, sound is attenuated or decreased because of
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blockage
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what are some examples of causes of a conductive hearing loss
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ear wax, fluid
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in conductive hearing loss, the inner ear is
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perfectly normal
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is conductive hearing loss generally permanent or not
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not permanent
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what is sensori- neural hearing loss
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outer and middle ear are perfectly normal. attenuation takes place in inner ear only.
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most hearing loss is which of hte three types
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sensori- neural
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is sensori-neural hearing loss permanent or not
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is permanent
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what is mixed hearing loss
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attenuation of sound in inner ear and middle or outer hearing loss.
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when testing hearing loss, it is conductive hearing loss when the person cannot hear well when it is a
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air conduction
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when testing sensori- neural hearing loss...
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attenuation will be the same for the air and bone conduction will give the same results
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when testing mixed hearing loss
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the results won't make sense at first. air conduction will be worse than bone conduction.
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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
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what is atresia
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acquired or congenital absense or malformation of an opening (auricle) (closure of ear canal)
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what is the etiology of atresia if acquired? what is the etiology if congential?
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acquired: surgical procedure, burns, other injuries
congenital: Treacher Collins (Hereditary Syndrome), Drugs- Thalidomide |
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what is the diagnosis of atresia
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otologic: observing, history taking- syndrome, accident, surgery
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what is the type of hearing loss invovled with atresia
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conductive
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why might you not be able to do air conduction testing on a person with atresia
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no place to put the ear bud
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bone conduction testing with a person with atresia will be
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normal only for better ear
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remediation or atresia
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surgery with considerations
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when will surgery most likely be done to cure atresia
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if bilateral
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will there be a chance of restoring hearing
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may be able to restore hearing to normal or near normal level. dependent of other structures
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at what age will surgery will be done? what does the age that it is done depend on?
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on unilateral: age 15-17 (full grown)
on bilateral: age 5-7 wait to obtain valid bone conduction testing-get sound into the kids |
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outer ear disorder: Basal Cell Carcinoma
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skin cancer of the pinna
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in what age group does Basal Cell Carcinoma generally occur?
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elderly
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in what groups of people is there a higher incidence of Basal Cell Carcinoma?
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in males, and in fair skinned people
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what percentage of all skin cancer is Basal Cell Carcinoma?
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5-8%
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1/2 of cases of Basal Cell Carcinoma begin where?
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on top portion of ear
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what does Basal Cell Carcinoma look like? does it hurt? when do people realize it is there? what steps must be taken once detected?
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generally small, crusty Growth
doesn't hurt ppl often don't know it's there must be biopsied by a physician |
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what is the only treatment of basal cell carcinoma
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removal
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are there any audiological problems associated with basal cell carcinoma
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no
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Pathologies of Ear Canal: Stenosis
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narrowing
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does Stenosis produce hearing loss
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no
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what does Stenosis make a person more prone to?
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wax build up and other bacterial problems
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Exostosis and Osteoma
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boney growths that occur in boney part of ear canal
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is exostosis seen often?
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yes
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does exostosis occur by itself or in multiples
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in multiples
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what does exostosis look like?
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fat at the bottom (tree trunk) (sessile).
Looks like you're looking through a forest. |
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is exostosis usually found in one ear or both? is there pain? does the person no that they're there?
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usually in both ears.
no pain person doesn't know they're there |
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is osteoma bilateral or unilateral
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unilateral
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what does it look like in comparasin to the exostosis
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more rounded
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does osteoma occcur in multiples or by itself? does this disorder occur often? will the person know right away that they have it?
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usually single
pretty rare won't know you have it |
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what group of people is osteoma found in more often
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in ppl who work in cold water (divers)
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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 |
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treatment of exostosis and osteoma
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surgical removal only if there is a llot and it causes a problem
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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
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treatment of foreign bodies in ear canal
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tweezers. flush out with water
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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,
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what group of people are more likely to suffer from collapsing canals
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people with tiny ear canals
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what happens during hearing testing with people with collapsing canals
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not good with hearing testing, because ear phones must be very tight
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generally the canals only collapse with
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pressure
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cerumen
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ear wax
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polyps
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any mass of tissue
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where doe polyps usually originate
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in middle ear- grown out by the time you see them
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what might polyps be the first sign of?
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carcinoma or glomus tumor(very dangerous tumor)
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is there a hearing loss associated with polyps? how are they found?
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possible conductive hearing loss, found by otoscope
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treatment of polyps
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surgery, tissue studied to look for cancer
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otitis external
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outer ear infection aka swimmers ear aka diffuse O.E.
most common ear infection- occurs across all ages |
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what is otitis external caused by? in what climate does it usually occur? what are the symptoms?
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bacterial, occurs often in hot, humid weather
itchiness, redness |
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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
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Chronic Diffuse Otitis External
what is it caused by? symptoms? |
unknown cause. running ears (puss) (skin), scaling
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treatment of chronic diffuse otitis external (3)
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avoid water in ear. rinse ears with a solution
prescription treatment |
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Pathologies of Tympanic Membrane: Tympanosclerosis
-what is it? -does it effect hearing? |
thickening of eardrum. no necessarily an effect on hearing.
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how does tympanosclerosis occur
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happens when then tympanic membrane breaks and heals thicker each time.
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myringitis-what is it?
when does it occur? |
inflammation
acute: usually occurs when you have a middle ear infection |
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characteristics of myringitis (5)
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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 |
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treatment
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often will subside with no treatment. if it doesn't then you have chronic myringitis
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chronic myringitis
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will occur with infection. same characteristics as acute
not treatment |
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tympanic membrane perforations
-easy or hard to see? -caused by? |
very hard to see. caused by infections. through trama
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3 types of trama that cause tympanic membrane perforations
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1. loud blasts, barotrauma- in military
2. flying, diving 3. QTip |
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central perforation
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per. of pars tensa with the rim remaining in tact at all borders
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the bigger the perforation>>>
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the bigger the problem with hearing
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Marginal Perforation
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some part of the perforation extends into the boney rim of the TM.
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is central per. or Marginal Per. more serious in terms of correcting
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Marginal Per.
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treatment of TM per.
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patch test- paper used to temporarily cover the per. to see if Perm. patch would work.
--->myringoplasty- surgical repari- patch |
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how do most TM per. heal
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spontaneously
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disorders of middle ear: Cholesteotoma: what is it? is it serious?
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an ingrowth in the epithelial tissue. needs to be removed. eats away. erode what it comes in contact with.
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what happens with a cholesteotoma? ( a piece of skin...
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that got somewhere it didn't belong. body builds up around it.
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where is a cholesteotoma usually found?
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in middle ear or back of TM
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what is a cholesteotoma usually shaped like? if cut, what does it look like?
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round. like rings of onion.
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is a cholesteotoma unusual to find?
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no
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does a cholesteotoma cause hearing loss
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yes, conductive heraing losss
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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
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location of cholesteotoma
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bony labrinth
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when cholesteotoma is in boney labrinth...at what age is it found and how is it found
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at age 35-55. found due to symptoms of facial wekaness, erosion of body portions of middle ear and inner ear.
-visual |
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how is cholesteotoma removed if in boney labrinth
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surgically removed but hard to get all of it
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another location of congenital cholesteotoma? how found? at what age?
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middle ear and mastoid: found in childhood with hearing loss. visualization of whitemass behind TM.
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what can congenital cholesteotoma of the middle ear and mastoid cause
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middle ear ossicular damage- is an agressive power
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if cholesteotoma is not fully removed...
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can reoccur
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Secondary acquired cholesteotoma
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secondary to soemthing else like ear infection that causes tissue to be moved. same features of congenital cholesteotoma.
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if cholesteotoma is left alone....
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can cause real problems. will continue to grow. will go into mastoid. can then go to brain.
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surgical treatment if in mastoid is called
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mastoidectomy
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once resolved if bones have been eaten away...
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they can be rebuilt
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disorders of middle ear: Paget's Disease
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structural bone changes in skull and enlarge bones in the body
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are males or females effected more
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males effected 4:1
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at what age is the onset of Paget's disease
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middle age
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what is the etiology of Paget's Disease
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unknown, maybe inherited
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people with Paget's disease have an ______ skull and a ______ stature
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enlarged, short
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does someone with paget's disease have a hearing loss
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yes
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what is the treatment of Paget's disease
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no cure/treatment
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Otitis Media (OM)- several different types and causes: Supperative
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most common middle ear disorder
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what are the characteristics of Supperative Otitis Media
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redness of eard drum and membrane around. often pain and fever. perforation of ear drum (mainly in children)
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what is supperative otitis media caused by
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bacteria - Eustacian tube makes easy for kids to acquire
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what percentage of children have an ear infection before age 2
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70%
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what percentage of children in US have more than one ear infection
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50%
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ear infection with colds, alergies. some children apt. with
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down syndrome or deformity.
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is hearing loss associated with supperative otitis media
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often with conduct hearing loss. ear infection- ear filled with fluid
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what is the treatment for supperative otitis media
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antibiotics or may clear without treatment
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myringotomy
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insision in ear drum to open (ENT, M.D)
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if middle ear stays infected, doctor will
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scrape out
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otosclerosis
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calcification of middle ear bones. abnormal bone growth around middle bones
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is otosclerosis bacterial or hereditary
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hereditary- can track symptoms of young adults (teens, 20s)
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what can the bone growth invade
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the cochlea
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what is the onset of otosclerosis
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10 years
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what is the incidence in poeople? in women?
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1:200
2:1 |
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what type of hearing loss (bilateral, unilateral, progressive, stagnant)
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bilateral, progressive
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increase of gettting otosclerosis with
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pregnancy
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if otosclerosis invades cochlea then what type of hearing loss
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sensori-neural loss
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as gets older what type of hearing loss will it be
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mixed hearing loss
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ringing in the ears...
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tinitis is also exhibited in otosclerosis
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what is the treatment of otosclerosis (3)
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hearing aid, scrape desposits, remove stapes and put in fake
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fenestration
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since bones does not equal function. will give new oval window function without no middle ear bones
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Eustachian Tube Dysfunction
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does not open or close, like it is supposed to
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why would allergies effect eustachian tube dysfucntion
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mucus
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adnoids( glands by ET) will
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get swollen, block ET
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what type of hearing disorder makes up the largest group of hearing imparied
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people with inner ear hearing loss
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Inner ear Disorders: Meniere's Disease- etiology
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unknown. could be allergies, psychological
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symptoms of meniere's disease (5)
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-unilateral hearing loss
-tinnitus (roaring, low pitch) -fluctuating hearing loss -audiogram- flat or low frequency SNHL -suddent attacks of vertigo |
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when not having an episode...hearing
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may be normal
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treatment of Meniere's disease: (3)
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-antivert
-nicotinic acid -surgical- shunt (drains endolympathic sac, labyrinthectomy, vestibular nerve section) |
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subcategory of Meniere's Disease- Vestibular Menieres
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no hearing loss with other symptoms.
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Inner Ear Disease: Presbycusis
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hearing loss associated with age. largest group of hearing impaired people
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etiology of Presbycusis (4)
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- 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. |
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symptoms of presbycusus (6)
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- progressive/ gradual decrease in hearing
- poorer speech understanding - difficulty hearing in noise - tinnitus - recruitment- abnormal increase in loudness - vertigo at times |
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at what age does presbycusis occur
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at any age
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is presbycusis bilateral or unilateral
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usually unilateral
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treatment of Presbycusis
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refer to physician immediately. hearing aids
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sudden hearing loss: etiology
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vascular
viral autoimmune disorder |
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symptoms of sudden hearing loss (4)
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tinnitus
vertigo unilateral hearing loss mild to severe loss |
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type of recovery in sudden hearing loss
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spontanteous
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treatment for sudden hearing loss
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dependent upon etiology. refer to physician immediately
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ototoxicity
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toxic to your ear
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etiology of Ototoxicity (6)
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- antibiotics- some ototoxic to vestibulotoxic
- diuretics - anticancer meds- chemotherapies - salycylates - quinine - aspirin- heavy doses |
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symptoms of ototoxicity (2)
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-high frequency hearing loss
-vestibular problems |
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treatment of ototoxicity (4)
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-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. |
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Noise induced hearing loss
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insult to the cochlea. can be short term very intense exposure- acoustic trauma
- can be long term steady exposure without hearing protection |
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symptoms of noise induced hearing loss: high frequency
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high frequency: hearing loss. temporary threshold shift- hearing imporves after impairemnt
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permanenet threshold shift
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irreversible impairment
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what age does noise induced hearing loss occur
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any age
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high incidence in males or females
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males
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an increase in noise induced hearing loss is being observed in kids because
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of toys, ipods, etc
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treatment of noise induced hearing loss
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hearing protection- ear plugs, limiting exposure.
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childhood disorders of inner ear: Labyrinthitis
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bacterial infection
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onset of labyrinthitis
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first two years of life
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etiology of Labyrinthitis
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- bacteria- strep, staph, etc
- meningitis- infection and inflammation of the meninges (covering the brain and spinal cord) |
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symptoms of Labyrinthitis
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-symtpoms related to disease
-hearing loss -high fever |
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treatment of labyrinthitis
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related to type of disease causing problem
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viral infection
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a virus is submicroscopic. a virus moves through the blood stream and damages ear structures
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maternal rubella
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(1963-1965) most recent epidemic
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viral epidemic caused
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developmental defects and hearing loss (worse with virus in the 1st trimester)
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is there a hearing loss involved
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heraing loss ranged from mild/ moderate to profound
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other viruses include
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influenza, mumps
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if hearing loss is related to mumps then it is
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unilateral
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is there hearing loss related to measles
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yes
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syphalus
- how spread - what can happen if left untreated |
virus. baby can get from mother. if left untreated can cause brain damage.
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cytomegalovirus
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can transmit from mother, pre, peri or post natal.
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is there hearing loss associated with (CMV)
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high incidence of hearing loss (31%)
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another way CMV can be transmitted
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saliva, or any bodily fluid
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can HIV/AIDS effect cochlea
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yes
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why can any of these viruses effect hearing
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a virus is in the bloodstream and if it flows to the cochlea then it will effect hearing.
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RH Factor Incompatibility
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imcompatability of parental blood proteins. fetus develops with a protein molecule called the Rh Factor
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mother without the blood protein will...
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produce antibodies for protection against the harmful effects of the Rh Factor
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generally by a third pregnancy with the Rh Factor issue there are
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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
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there can be many abnormalities beyond hearing impairment related to RH incompatibility but these issues are
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manageable due to early prediction, immunizations, and blood transfusions
pretty well managed overall |
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prematurity: symptoms
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1. susceptibility to infection ( which can go to the cochlea and effect hearing)
2. intracranial bleeds 3. cyanosis (failure to breath)- anoxia |
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NICU (neonatal intensive care unit) why would cause hearing loss
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exposure to high levels of noise- crying babies
if extended period of time could have noise induced hearing loss |
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dna
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deoxyribonucleic acid- a basic molecule that contains all of our hereditary information
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genes
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sequence of DNA molecules (contains DNA molecules)
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hereditary traits
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inherited info
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phenotype
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the actual manifestation or expression of a physical trait. observable
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genotype
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genetic information that results in a physical trait. blue print- everything you are
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chromosomes
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the structure that holds the genetic information ( have approx. 30,000)
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how many pairs of chromosomes
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23 total
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how many pair are autosomes ( non sex related)
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22
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how many pair are sex chromosomes
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1
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we get one randomly selected chromosome ...
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for each pair from each parent
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allele
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a certain type or form of a gene
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if we get the same allele (gene type) from both parents that gene is called
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homozygous (pure)
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if we get a different allele/ gene from each parent for a particular trait this is considered
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hterozygous (mixed)
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dominant gene
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only one gene is needed in a pair inorder for that trait to show/express the allele/ characteristic
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recessive gene
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one identical gene/allele is needed from each parent in order for the trait to express itself
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variable expressivity
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there are times when for some reason a dominant gene/allele does not express itself
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a trait may....a generation
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skip
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types of genetic hearing loss can be caused by
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defective gene mutation. attacks the inner ear
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where is the defective gene found in Autosomal Dominant Hearing Loss
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in one of the 22 pair of chromosomes. not the sex chromosome
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what are two characteristics of Autosomal dominant hearing loss
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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 |
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if you have one parent with hearing loss and the other normal hearing...what are the chances of the children haveing hearing loss
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each child will have a 50% chance of inheriting the hearing loss. dominance is key
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can normal hearing children from this type of family pass along the hearing loss
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no they don't have the defective DOMINANT gene
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what accounts fro about 80% of genetic hearing loss
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autosomal recessive hearing loss
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how many parents must have autosomal recessive hearing loss in order to pass it along to their children
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2
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where is the defective gene found in autosomal recessive hearing loss
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one of the 22 pair of chromosomes
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about 50% of this type of loss is related to...
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a syndrome that has hearing loss as one of its characteristics
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people/ children with this type of loss have two normal hearing parents but...
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but carry the abnormal recessive gene for hearing loss ( not necessarily)
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each child in this family has what percent chance of getting the hearing loss
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25%
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are children of these parentswho do not show hearing loss carries of hte gene
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may be
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sex-linked of (X-linked) Genes
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the 23rd pair of chromosomes- the pair of chromosomes that determine the sex of a child
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what is the female chromosome and what is the male chromosom
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X female (XX)
Y Male (XY) |
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which of the two carries the most genetic information
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X
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which can contain a recessive allele for hearing loss
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X
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which is much smaller and only carries information about sex determination
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Y
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abnromal x-linked genes can be domianat or
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recessive
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x-linked hearing loss (many types) appears to be a ______ gene
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recessive
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x-linked hearing loss accounts for what amount of hearing loss
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small percentage of hearing loss
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female with a recessive gene for hearing loss on only one of her "X" chromosomes will have
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normal hearing but carries the trait
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50% of her chilren will get
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the recessive gene
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female child- one normla gene from dad, one abnormal from mom...child will
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be carrier
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male children- only have one "Y" chromosome which comes from father-
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50% of the boys will have hearing loss
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what is a syndrome
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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
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Trisomy
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hereditary/ chromosomal. this is when there is an extra chromosome present on a pair of chromosomes
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Trisomy 13
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extra chromosome on the 13th pair of chromosomes- has specific characteristics including hearing loss
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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 |
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Tumor of the 8th Nerve
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acoustic tumor- biggest one you'll hear about
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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) |
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where does the tumor arise from
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the cells that surround/protect the 8th nerve, put pressure on the 8th nerve
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onset of the tumor is
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generally over the age of 30- most common in the 40s
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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) |
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Diagnosis of tumor
- first evaluation-why |
hearing evaluatio is first eval. due to decreased hearing and/or tinnitus
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types of testing
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-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 |
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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 |
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Neurofibromatosis
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Von Recklinghausen Disease- causes multiple neuroma's throughout the body including acoustic neuroma
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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 |
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Auditory Neuropathy (malfunction of a nerve)/ Dys- Synchrony
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brain doesn't get info correctly
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symtpoms (hearing related)
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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) |
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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 |
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location of abnormality
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-unclear
-maybe inner hair cells- cannot test - maybe nerve fibers within the cochlea or beyong - maybe combo of both |
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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 |
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symptoms of Central Auditory Pathways Disorders (4)
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-decreased speech understanding
-work finding/confusion - possible hearing loss - poor school performance- often where problem is found |
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diagnosis
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-based upon disease or accident
-hard to diagnose location of issue due to the intricacies of the brain and its pathways |
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Minimal Auditory Deficiency SYndrome MADS
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related to slight or mild hearing loss- associated with chronic O.M. (otitis Media)
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Chronic O.M.
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may effect language learing due to deprivation of sensory input
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see more children with langauge disorders that have a
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history of transient hearing loss
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Functional/ Non- Organic Hearing Loss
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a hearing loss that has no apparent organic disorder or pathological evidence to explain the extent of the loss
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may also be called
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Pseudohypacusis- means false hearing loss
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Malingere
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deliberately reporting symptoms for some kind of gain (not a possitive term)
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adults or children-why do this?
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looking or attention
-kids not doing well in school -people in accidents |
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Etiology
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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
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symptoms
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behavioral- such as exaggerated behaviors in an attempt to simulate a hearing impaired person. unreliable and exaggerated responses
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test management
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use strategy- testing techniques and be non-accusatory
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