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61 Cards in this Set

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  • Back
What is Conductive hearing loss?
Inability of sound to reach the inner ear as a result of obstruction. Onset may be sudden or progressive.
What is the etiology of sudden conductive hearing loss?
Usually results from infection or trauma to the ear.
What is the etiology of progressive conductive hearing loss?
Results from;
Otosclerosis (new formation of spongy bone)
Cerumen impaction
What are the S/Sx of conductive hearing loss?
▲s in hearing may be sudden or progressive, Pt frequently asks for statements to be repeated or may give inappropriate responses to questions.
What are the pathophysiologic processes & manifestions of conductive hearing loss?
S/Sx may be related to the cause of the hearing loss, such as fever & leukocytosis in the presence of infection.
If cerumen is excessive, it will be visible on otoscopic exam.
What are the pathophysiologic processes & manifestions of conductive hearing loss if OM is the cause?
Sx may include; itching, discharge, fluid, throbbing & pressure in the ear, fever, & red, bulging or retracted TM.
What are the pathophysiologic processes & manifestions of conductive hearing loss it otosclerosis is the cause?
Tinnitus may be present & reduced air conduction on the Rhinne test is noted.
What is the tx for conductive hearing loss?
Hearing aids, Tympanoplasty for chronic OM & trauma, stapedectomy for otosclerosis, appropriate ABX, pain meds.
What is sensorineural hearing loss?
(perceptive hearing loss) Hearing loss resulting from damage to the hair cells of the organ of Corti or neural damage, onset may be sudden or progressive.
What is the etiology of sudden sensorineural hearing loss?
Can result from damage/trauma to CN-VIII, the chochlea, brain dysfunction or ototoxicity.
What is the etiology of progressive sensorineural hearing loss?
Results from aging, noise, acoustic tumors & meniere's dz, genetic cause, intrauterine infections, developmental malformation of the inner ear, systemic dz (SLE, MS, DM)
What are the pathophysiologic processes & manifestions of sensorineural hearing loss?
Unilateral or bilateral, most common form is presbycusis (affects the cochlear cells & nerve fibers), begins w/the loss of high-frequency sounds & may progress to middle & low frequencies.
Sensorineural peripheral & central hearing disorder in children may lead to?
Language, speech & learning problems.
S/Sx of Sensorineural hearing loss?
May include tinnitus, dizziness & pain.
What are the types of presbycursis?
Sensory presbycusis (begins in middle age, characterized by loss of cochlear cells), Neural prebycusis (late in life, progresses gradually), Metabolic presbycusis (familiar, begins in middle age), Cochlear (conduction presbycusis)
How is sensorineural hearing loss diagnosed?
Careful hx of associated otologic factors & PE, testing, tuning forks (weber & rinne diferinate between sensory & conductive), audioscopes (tests pts ability to hear speech), Auditory Brain Stem Evoked Response (auditory nerve pathway)
What is the management of sensorineural hearing loss?
Aimed @ preventing further hearing loss, because loss is usually permanent. Hearing aids, Cochlear implants, Speech learning.
How is congenital hearing loss transmitted?
Genetically as an autosomal dominant, autosomal recessive, or X-linked recessive trait. In neonates, it may result from trauma, toxicity, or infection during pregnancy or delivery (rubella).
What are the predisposing factors to congenital hearing loss?
Family hx (of hearing loss or hereditary disorders), Exposure (to ototoxic drugs during pregnancy), Maternal exposure (to rubella or syphillis during pregnancy), Prolonged fetal anoxia (during delivery), Congenital abnormalities (of ears, nose or throat)
Which infants are likely to have structural or functional hearing impairments?
Premature or Low-birth-weight,
W/a serum billirubin level >20mg/dl (from billirubin toxicity to the brain), Trauma during delivery (intracranial hemorrhage, damage to the cochlea or acoustic nerve.
Describe Otitis Externa;
Inflammation & infection of the outer auditory canal.
What is the etiology of Otitis Externa?
Bacterial or fungi invasion, Associated w/swimming or swimming in contaminated H2O, Dissolution of cerumen.
What are the pathophysiologic processes & manifestations of Otitis Externa?
Fluid builds up in the ear→pain & a sense of fullness, hearing loss may result, commonly occurs in summer.
What are the S/Sx of otitis externa?
Itching, redness, tenderness, narrowing of ear canal, watery or purulent drainage d/c & intermittent hearing loss.
What is the tx for otitis externa?
Symptomatic, analgesics, ABX drops, antifungal agents, protect ear from moisture & avoid trauma from scratching, instillation of a dilute alchol, acetic acid or Burrow's otic solution immediately p swim.
Describe Otitis Media;
Inflammation & infection of the middle ear, most commonly seen in infants & young children.
What is the etiology of Otitis Media?
Blockage of the eustachian tubes, bottle-fed-infants (anatomy), winter months, more common in peds w/frenquet URI, 2nd hand smoke ↑ URI so ↑ OM.
What are the common causitive agents of Otitis Media?
Strep pneumoniae
Strep pyogenes
As eustachian obstruction progresses microbes multiply.
Why are bottle fed infants (in the supine position) at greater risk for OM?
Because Peds eustachian tubes are positioned differently than adults.
What is aerotitis media?
Rupture of the TM
What can be expected upon PE of OM?
Inflammation of the inner ear structures, w/exudate behind the TM, TM is swollen, red or yellow, as exudate ↑ TM may rupture.
OM commonly follows what?
A cold or respiratory infection.
What are the S/Sx of OM?
Fever, Lymph glands may be swollen, peds may complain of pain of pull on ears.
What are the two important types of eustachian tube dysfunctions?
1. Abnormal patency (abnormally patent tube)
2. Obstruction (functional or mechanical)
Abnormalities in eustachian tube function are important factors in the pathogenesis of?
Middle ear infections
What is the tx for OM?
Antimicrobial therapy for AOM, tympanotomy tubes for persistent bilateral effusion or significant hearing loss.
What are the complications of OM?
mastoiditis, brain abscess (develops very slowly, seen on X-ray), meningitis, chronic OM w/hearing loss.
What is proprioception?
Sense or perception (usually at a subconscious level) of body movements & position, (especially the limbs) independent of vision.
What does proprioception result from?
Sensor terminals found in muscles, tendons & joint capsules.
What are the two general types of sensory receptors for proprioception?
Exteroceptors (end organs, eye, ears, skin, recieves stimuli from outside the body)
Proprioceptors (stimulis inside the body)
What is a exteroceptor?
A sense organ (e.g., in the eye, ear, or skin) adapted for the reception of stimuli from outside the body.
What is a proprioceptive receptor?
A muscle or tendon spindle. These are the receptors of muscle or kinesthetic stimuli.
What are receptors in the labyrinth sometimes called (considered)?
What is the peripheral vestibular system?
Set of paired inner ear sensory organs.
What is the cause of dysfunction of the peripheral vestibular system?
When signals are destroyed as in BPPV & when signals are unbalanced by unilateral movement of one of the vestibular organs as in Meniere's dz.
What is the most common cause of vertigo?
Benign paroxysmal positional vertigo (BPPV)
At what age does benign paroxysmal positional vertigo (BPPV) usually develop?
After the 4th decade
What is benign paroxysmal positional vertigo (BPPV) characterized by?
Brief periods of vertigo, usually lasting <1min, & precipitated by ▲s in head position.
What is the cause of benign paroxysmal positional vertigo (BPPV)?
Damage to the delicate sensory organs of the inner ear, semicircular ducts & otoliths.
BBPV Pathophysiology;
Otoliths from the utricle become dislodged → free-floating debris in the endolymph of the posterior semicular duct (PSD), movement of the debris → more sensitivity of the PSD, movement of the head → vertigo & nystagmus, there is usually a several second delay between head movement & onset of vertigo, sx usually subside w/continued movement.
How is BPPV diagnosed?
Use of ▲ of head position.
The Dix-Hallpike test.
What is the tx for BPPV?
Drug therapy
Non-drug therapy
What is Meniere's dz?
A labyrinthine dysfunction, AKA endolymphatic hydrops, causes sefere vertigo, sensorineural hearing loss & tinnitus, usually affects adults between 30-60yrs, ♂>♀, rarely peds, usually unilateral.
What are the causes of Meniere's dz?
Family hx, immune disorder, migraine HA, middle ear inf., head trauma, ANS dysfunction, premenstrual edema.
What is the pathophysiology of Meniere's dz?
Overproduction or ↓ absorbtion of endolymp, it accumulates & dialtes the semicircular canals, utricle, saculae & causes degeneration of the vestibular & cochlear hair cells, overstimulation of the vestibular branch of CN VIII impairs postural reflexes & stimulates the vomiting reflex, perception of sound is impaired due to excessive cranial nerve stimulation, & injury to sensory receptors for hearing may affect auditory aculity.
What are the clinical manifestations of Meniere's dz?
Sudden vertigo due to ↑ endolymph, tinnitus, hearing impairment, feeling of fullness or blockage in the ear preceding attack, severe n/v, sweating & pallor during attack, nystagmus, loss of balance & falling to the affected side.
What are the complications of Meniere's dz?
Hearing loss
How is Meniere's dz diagnosed?
Pt's hx, electronystagmography (normal or ↓ vestibular response), cold caloric testing (impairment of oculovestibular reflex), electrocochleography (↑ ratio of summating potential to action potential), brain stem evoked response audiometry test, CT, MRI
What is the tx for Meniere's dz during the attack?
Supine to minimize head movement, promethazine or prochlorperazine, atropine, dimenhydrinate, antohistamines, CNS depressants.
What is the long term tx for Meniere's dz?
Diuretics, betahistine, vasodilators, sodium restriction, antohistamines, systemic streptomycin.
What is the tx for persistent Meniere's dz?
Endolymphatic drainage & shunt procedures, Vestibular nerve resection in pts w/intact hearing, labyrinthectomy, cochlear implantation.