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180 Cards in this Set
- Front
- Back
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Peripheral
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happening to sensory organs
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Central
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brain/brainstem, starts at 8th nerve
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Functional/Non-organic
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They truely believe they have hearing loss- all psychological
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organic
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physiological, elevated thresholds, not normal. most like peripheral
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Atresia
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Absense or closure of ear canal. Usually unilateral but can be bilateral
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Atresia location
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outer ear
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atresia caused by
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congential absence of external ear canal due to failur to form during embryologic development... alterations during development stage, manifests in different ways. genetics often involved (or syndromic)
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Atresia complaints
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none as an infant; may have classroom difficulties as a child
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Atresia physical signs
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atretic ear canal on affected side. may have microtia (deformed pinna?)
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Atresia Audio problems
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moderate severe conductive loss in affected ear. may also be bilateral
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Atresia treatments
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Elective surgery; CROS or BAHA hearing aid. preferential seating in classroom.
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CROS
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type of hearing aid- microphone on bad ear and sends signal to other ear. or if can hear in that ear it will amplify and send signal?
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BAHA
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newer BA- bone anchored. Put steel bolt in head and attach equivalent to bone ossilator, connected to microphone stimulates cochlea without needing conductive system.
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Atresia audiogram
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looks like a conductive hearing loss around 60-70 dB
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Exotosis
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• Bone-like growths arising from the lining of the ear canal
• Often found after repeated exposure to cold water • Rarely cause hearing loss • Are generally not removed may lead to secondary problems like impacted cerumen |
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Impacted Cerumen
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A build up of wax deep in the ear canal. If it's severe enough it can occlude the ear canal and hairs are coated with wax-- debri will collect foreign objects.
an acquired disorder of the external aud canal that occurs when there is an overaccumulation of cerumen that becomes impacted somewhere along the canal. |
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new wax is
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soft not dark
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older wax
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dark and still soft
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old wax
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hard and dark
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Impacted cerumen location
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outer ear canal
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impacted cerumen causes
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cleaning ears with cotton swabs
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impacted cerumen complaints
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difficulty hearing on affected side
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impacted cerumen physical signs
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cerumen plug; unable to visualize tympanic membrane
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impacted cerumen audio
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mild conductive loss on affected side.
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treatments for impacted cerumen
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removal of cerumen by health service provider; over-the-counter softening agents; instruct patient not to clean canals with cotton swabs
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impacted cerumen audiogram
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looks like a mild conductive loss around 30 dB
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Otitis Externa (Swimmers Ear)
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infection of the tissues lining the external ear canal. these infections are usually caused by bacteria or fungus or viral (like herpes zoster)
painful and may be accompanied by swelling and/or fluid discharge Usually a dermatological issue but becomes an audiological issue when swells ear canal shut and change in pH balance in ear and throws everything off (sensitive to change) |
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otitis externa treatment
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topical or oral antibiotics depending on the severity. earplugs while swimming may also help prevent otitis media
Treated with dry agents and time |
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Otitis Media
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Inflammation of the middle ear, usually accompaned by fluid (effusion); acquired from poor eustachian tube function; common in children.
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Serous otitis media
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fluid in the middle ear is clear and noninfected with bacteria
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acute otitis media
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fluid in the middle ear is infected with bacteria
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mucoid otitis (purulent)
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fluid becomes thickened or pusslike (glue ear)
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chronic otitis media
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if fluid remains in the middle ear for an extended period of time (over 8 weeks)
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Otitis media causes
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poor eustachian tube function and fluid build up in middle ear; may become infected by way of the eustachain tube though coughing or sneezing. common in young children
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otitis media complaints
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difficulty hearing; lack of attention in school. Fever, tugging on ears, irritability
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otitis media physical signs
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tympanic membrane may be retracted, reddened, thickened, ruptured; may have visible discharge
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otitis media audio
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mild to moderate conductive loss in both ears if bilateral. may also be unilateral
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otitis media treatments
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medical observation; may need antibiotics for infection or PE tubes for chronic/reocurring cases
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Perforation
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puncture or rupture of the tympanic membrane. can vary in size. PE tube may act like a small perforation
Can be chronic or short term |
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location of perforation
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tympanic membrane
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perforation causes
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sharp object, slap to the ear, otitis media, or PE tube
trauma to eardrum.. racquetball, water skiing, bomb and explosion-- enequal pressure-- |
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perforation complaints
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usually not noticed. may have secondary problem if water gets in ear.
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perforation physical signs
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small hole in tympanic membrane; may have discharge if related to otitis media
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perforation audio
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normal hearing to slight conductive loss on affected side.
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perforation treatments
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none. will usually heal itself (when smaller). swim plugs recommended when in water
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tympanoplasty
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type 1- patch hold in ear drum
type 5 - replace entire middle ear pretty much |
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Otosclerosis
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Spongy growth of emporal bone around oval window. can encapsulate stapes or invate cochlea. begins in second to fourth decade. some hereditary link.
slow growing process, but if reduces movement of stapes it causes conductive hearing loss |
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Otosclerosis location
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middle ear (stapes footplate)
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otosclerosis causes:
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bony growth of temporal bone around stapes footplate. appears in second to third decade. may have a genetic link; exacerbated during pregnacy (hormones)
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otosclerosis complaints
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difficulty hearing. may hear better in noisy situations
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otosclerosis physical signs
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may see pinkish glow otoscopically (blueish black) called Schwartz's sign
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otoscerlosis audio
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progressive mild to moderate conductive loss as fixation increases. may begin unilateral and progress to bilateral. characteristic bone conduction notch at 2000 Hz (Carharts notch)
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otitis media augiogram
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look like mild conductive hearing oss at 20-30 dB
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perforation audiogram
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looks like mild conductive loss
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otosclerosis treatment
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elective surgery to replace stapes with prosthesis (stapedecotmy). Hearing aids/BAHA alos options
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peak age of onset for otosclerosis
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20
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sclerosis means
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hardening
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Cholesteatoma
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Skin flap (squamous epithelium) growing in the middle ear, usually from retraction pocket. sloughed-off skin builds up and becomes infected. continues to grow in middle ear and may rupture tympanic membrane, producing smelly discharge. can spread into mastoid or temporal bone and considered a medical emergency
usually secondary to a perforation or otitis media |
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otorrhea
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foul smelling discharge
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otalgia
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ear pain
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cholesteatoma location
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middle ear
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cholesteatoma causes
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skin flap grows into middle ear, eg. from retraction pocket in pars flaccida. sloughed-off skin becomes trapped casuing pseudotumor to grow; becomes keratinized and infected
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cholesteatoma complaints
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hearing loss on affected side. may have otalgia and smelly drainage from ear
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cholesteatoma phsyical signs
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whitish mass behind tympanic membrane. may have discharge in ear canal
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cholesteatoma audio
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normal to moderately severe conductive loss in affeted ear depenidng on how it affects ossicles
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cholesteatoma treatments
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surgery is required to remove growth. ossicular reconstruction may be option if needed. hearing aids also option if conductive hearing loss dur to removal of ossicles after surgery
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#1 reason for sensorineural loss
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presbycousis
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#1 conductive disorder
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otitis media
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what percent of kids will have otits media before age 6
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90%
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if you have an ear infection before age one, what is the possibility of having chronic ear infections
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50%
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Eustachian tube dysfunction.. the cuase of otitis media has to do with
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nursing and breathing at same time. need as a newborn and can grow out of it as get older. then their ET slants downwards as they grow
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acute OM
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0-21 days
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subacute OM
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22 days- 8 weeks
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chronic OM
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greater than 8 weeks
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how many doctor visits per year for OM
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30+ million
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fluid effusion: serous
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thin, watery, sterile
(drain out of middle ear lining, looks like bubbles with otoscopy) |
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fluid effusion: perulent
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pus-like infected fluid
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fluid effusion: mucoid
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thick, mucus like
(advanced, sever, colorful. wait long enough it will perferate eardrum. called glue ear. can smell it across room) |
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acute otitis media is common with
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male, caucasians, people who live in cold climates, and upper respiratory infections
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cholesteatoma audiogram
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looks like conductive hearing loss from normal to moderately severe depending on how it affects ossicles
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For otitis media to occur
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1. Eustachian tube has to become dysfunctional
2. must get it so that it is swelled shut and then the ET is easy to clog up when tissue is irriated. 3. seals off middle ear space and can't equalize pressure 4. creates air pocket (body hates) 5. will try to get rid of air pocked by absorbing air (by M.E. lining) 6. will create negative pressure (vacuum) 7. get retracted ear drum from neg. pressure (first seals off, can get pos. pressure, but then has vacuum process start, eardrum is pulled in) 8. since vacuum is created, no air pockets so now moisure lining is being sucked out.. pulls lining away from where it's suposed to be 9. create swimming pool for germs, dark warm, moist, dead skin cells to eat 10. whiteish business in fluid means bacteria is growing |
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OM otalgia comes a lot from
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irritated and inflamed binding of skin around eardrum - that's where a lot of pain come from.
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tell if babies have otalgia by
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grabbing at ears, cry, irritability more than normal, not eating right
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OM tympanic membrane can appear
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red
yellow retracted or bulging depending on stage may see white stuff |
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what can you use to tell if PE tubes are working
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tympanogram
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how many OM cases will resolve by themselves
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75-85%
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otosclerosis audiogram
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conductive loss from mild to moderate. may begin unilateral and progress to bilateral. characteristic bone conduction notch at 2000 Hz
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Aerotitis Media (Barotrauma)
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inability to get to equalize pressure (airplanes, scuba divers, won't open - not due to infection but due to external extreme pressure changes)
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50% of people with PE tubes will get
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tympanic sclerosis
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tympanic sclerosis
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scarring, build up on tympanic membrane may develop mild conductive loss.
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recurrent otitis media
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more than 3 episodes in 6 months
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ossicular erosion
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worst thing to do is let it sit too long and bones start to dissolve bc they are little, soft, flexible
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Ossicular Disarticulation
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separation of ossicular chain or break in one of the ossicles, typicall dislocation of the long process of the incus from the stapes
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only disorder that the tympoanogram shows if your ear is too floppy
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ossicular disarticulation
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disarticulation location
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middle ear (ossicular chain)
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disarticulation cause
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head injury, slap to ear, cholesteatoma
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disarticulation complaints
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hearing loss on affected side
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disarticulation phsyical signs
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none. may notice hyperflaccid tympanic membrane, otoscopically
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disart. audio
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moderately severe conductive loss in affected ear
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disart. treatments
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ossicular reconstruction may be option if needed. CROS hearing aid or BAHA options if surgery not done or if hearing loss continues after surgery
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Cochlear otosclerosis
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otospongiosis of temporal bone around oval window invades the inner ear and eithe produces toxins or alteration of the blood supply that destroy the hair cells. It's slow, progressive sensorineural HL.
no reversing, slowly grow, impede movement of basilar membrane conductive loss inside ear and sensorineural loss in inner ear NO CARHARTS NOTCH PROGRESSIVE, SLOW GROWING INVADES COCHLEA- TOXIC |
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cochlear otosclerosis location
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middle ear around oval window and cochlea
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cochlear otosclerosis caues
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bony growth of temporla bone around oval window invades cochlea. toxins destroy hair cells in cochlea
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cochlear otosclerosis complaints
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progressive mild to moderate bilateral sensorineural loss, usually worse in mid frequencies. no carharts notch. if combined with stapes fixation, there may be a mixed hearing loss and carharts notch.
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cochlear otosclerosis treatments
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sodium flouride. hearing aids when hearing loss affect communication
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Noise induced hearing loss (NIHL)
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hearing loss that occurs from exposure to extremely loud impulsive type sounds, like an explosion or gunshot, or more commonly from longer term exposures to high level industrial military and or recreational noises, such as jackhammers, airplanes, machinery, or music. ONE OF THE MOST COMMON ACQUIRED SENSORINEURAL HEARING LOSSES
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HL associated with NIHL results from
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damage to stereocilia, tectorial membrane, metabolic changes to the hair cell, rupture of Reissner's membrane, or complete destruction of the organ of Corti
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NIHL location
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inner ear
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NIHL causes
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disruption of stereocilia, first on OHCs, then on IHCs, can produce biochemical changes in HCs or other structural damage to cochlea
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NIHL compaints
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difficulty hearing, especially in background noise. high pitched tinnitus
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NIHL physical signs
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none
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NIHL audio
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sensorineural typically bilateral. begins as a notched loss 3-6 kHz region; progressive, and eventuall affects a wider frequency range
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NIHL treatments
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none for exisitng damage. ear protection devices when exposed to noise/loud music to prevent further damage. should have hearing conservation program if in noisy work environment
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NIHL is characterized by at notch at what Hz on auiodgram
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4000 Hz
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85 dBA for 8 hours
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have to offer hearing protection
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90 dBA 8 hours
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don't have a choice to wear hearing protection. wear it or i'll fire you
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95 dBA
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only allowed 4 hours
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100 dBA
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2 hours
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105 dBA
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1 hour
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110 dBA
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half hour
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rule for dBA
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every increase in 5 dB, only be in it half as long
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TTS- temporary threshold shifts
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may occur when exposed to loud noise levels for a few hours as might occur from a music concert or loud stereo and you may notice that sounds seem muffled and you have tinnitus
may last 2 mins to 24 hrs. |
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PTS- permanent threshold shift
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may vary depending on type of noise as well as one's susceptibility, other health factors, or exposure to chemiclas or drugs that may damage the ear.
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Acoustic trauma
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permanent cochlear damage resulting immediately from single exposure to very high sound press. levels like gunshot/explosion
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gradualling developing NIHL
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slowly develops over time of repeated exposures to sound press. levels lower than those producing acoustic traumas.. common in factory or industrial work.
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Presbycusis
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hearing loss due to aging
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percent of presbycusis over 65
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25-40%
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percent of presbycusis at 90
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90%
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Result of hearing impariment in elderly
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psychological issues: depression, confusion, inattentivesness, tension, and negativism
Psyiological issues of poor health, reducd mobiliyt and reduced interpersonal communications have been associated |
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what percent of hearing impaired elderly actually received rehabilitation
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20%
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gender differences with presbycusis
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womean lose LF and retain HF better. HF are worse in men
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max output a heading aid can give
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140 dB
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Presbycusis locaiton
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inner ear
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Presbycusis causes
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hearing loss due to agin, beginning around age 50 years. affects cochlear hair cells, stria vascularions, and or neural auditory pathways
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Presbycusis complaints
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difficulty hearing, esp. in background noise. high-pitched tinnitus
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Presbycusis phsyical signs
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none
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Presbycusis audio
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high frequency sensorineural loss. degree of loss and range of affected frequences increase slowly with age.
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Presbycusis treatments
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none for existing damage. hearing aids are primary treatment when loss is affecting communication
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presbycusis diagnosed by
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exclusion
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4 types of presbycusis
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1. sensory (cochlear)-degeneration of hair cells
2. neural- loss of chochlear neurons resutling in problems of transmission inforamtion coding 3. strial or metabolic - degeneration (atrophy) of stria vascularis in cochlea (stroke may cause this) 4. mechanical or cochlear conductive- results from alterations to cochlear mechanics..due to stiffening as aging, mechanical things wear out. |
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Meniere's Disease has to have these 4 things
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a disorder that is characterized usually by four conditions:
a. episodes of vertigo often sever with vomiting. true rotary vertigo.. room spinning and won't stop - dizziness b. LF sensorineural HL which can fluctuate in early stages c. fluctuating aural fullness (pressure in ears) d. fluctuating low pitched tinnitus (ocean roar) |
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Meniere's Disease
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too high fluid pressure in middle ear
trying to pump a lot of fluid in small confined space.. causes imbalance hearing issues ENDOLYMPATHIC HYDROPS |
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Meniere's Disease location
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inner ear
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Meniere's Disease causes
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excessive buildup of endolymp in the scala media and vestibular labyrinths. may occur spontaneously, or from viral attack, or from late onset genetic link
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Meniere's Disease complaints
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vertigo, ocean roar tinnitus, aural fullness, and hearing loss in affected ear. vertigo may be debiliating
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Meniere's Disease physical signs
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none
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Meniere's Disease audio
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fluctuation, low frequency, sensorineural heairng loss, initially. may end up with a perment flat moderate sensorineural loss. often see best thresholds at 2000 Hz
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Meniere's Disease Treatments
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eliminate salt and caffeine from diet. may benefit from a prescribied diuretic. sever cases may require endolymphatic shunt operation or vestibular/cochlear nerve section
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Hearing thresholds change dramatically and have whole life
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Meniere's Disease
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Ototoxicity
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Hearing damage due to chemicals
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Ototoxicity location
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inner ear
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Ototoxicity (from aminoglycosides) causes
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systemic biochemical damage to cochlear and or vestibular hair cells from aminoglycoside antibiotic treatment
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Ototoxicity complaints
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slight hearing loss may be noticed. high frequency tinnitus often very sick from another medical disorder, which is why aminoglycosides were administered
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Ototoxicity (from aminoglycosides) phsyical signs
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none
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Ototoxicity (from aminoglycosides) audio
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permanent bilateral high frequency sensorineural loss. begins in ultra high frequency range. degree of loss and range of affected frequencies increase with dosage and time.
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Ototoxicity (from aminoglycosides) treatments
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none for exisitng damage. may alter drug therapy if appropraite. hearing aids are the primary treatment when loss affects communication
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other considerations for ototoxicity
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age, kidney function (drugs build up in body), and exisitn ghearing loss (going to be bilateral)
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drugs that can cause a sensorineural HL
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antibiotics (aminoglycosides)
Diuretctics aspirin causes TTS and tinnitus; reversible NSAIDS antimalarials chemotherapy drugs |
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tinnitus current research
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brain making up for lack of input
treated with diet in some caess Maskers are available |
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tinnitus maskers
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little white noise generators in ear all day long
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Ototoxicity (from loop diuretics or asprin) causes
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loop diuretics affect function of stria vascularis; asprin biochemistry of cochlear hair cells
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Ototoxicity (from loop diuretics or asprin) complaints
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noticeable hearing loss bc of the involvment of speech frequences. high frequency tinnitus is offten prominent sign of beginning ototoxicity from asprin
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Ototoxicity (from loop diuretics or asprin) phsyical signs
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none
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Ototoxicity (from loop diuretics or asprin) audio
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temporary mild to moderate relatively flat sensorineural HL
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Ototoxicity (from loop diuretics or asprin) treatment
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hearing should improve spontaneously when loop diuretic treatment is finished.
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Sudden Sensorineural Hearing loss
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rapid onset of hearing loss, considered a medical emergency. urge client to see doctor immediately (may be able to reverse in short window of time) often treatead with steroids, but must be soon after onset.
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sudden sen. HL location
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inner ear
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sudden sensorineural HL causes
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autoimmune disorder, viral attacks, or idipathic disorders that produce damage to cochlear hair cells. perilymp fistula can alter fluids and cause hearing loss and vertigo
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sudden sensorineural HL physical signs
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none
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sudden sensorineural HL auido
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sudden unilateral relataivcely flat mild to moderate sensorineural loss. may progress and or may spontaneous recover. may occur in other eat at a later date.
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sudden sensorineural HL treatments
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seek medical attention immediately to stabilize hearing and maximize potential for recovery. typicall treated with corticosteroids. hearing aid should be considered after hearing los has stabalized.
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Acoustic Neuroma
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a slow-growing benign tumor on the 8th nerve causes hearing loss and vestibular symptoms
son't wpread to other types of body, but can cause nerve damage that will affect hearing |
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Acoustic Neuroma location
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8th cranial nerve usually arises from Schwann cells of veestibular branch of nerve
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Acoustic Neuroma causes
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benign tumor of unknonw origin. compresses on cochlear nerve; first affects outermost layer of high frequency fibers. damages cochlear blodd supply with continued growth causing cochlear loss
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Acoustic Neuroma complaints
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difficulty understanding speech, especially on the phone. unilateral high freq. tinnitus. may have sligh balance problem
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Acoustic Neuroma phsyical signs
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none
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Acoustic Neuroma auido
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unilateral or asymmetircal high frequency sensorineural loss. degree of loss and range of affect frequencies increase slowly as tumor grows.
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Acoustic Neuroma treatments
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surgical removal of tumor. with early detection and treatment. may be preserved
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Acoustic Neuroma most likely found in two places
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internal auditory meaturs (ear canal for 8th nerve) or CPA (cerebellopontine angle.. where the cerebellum and pons meet)
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Acoustic Neuroma thresholds
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may not chagne but word ID may be poor. disortions make intelligibility hard
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