I can't ear you
Mike Tyson's afternoon snack
Come ear often?
Can you ear me now?
I'm ear for you
100

What are the 3 types of hearing loss?

-Conductive:Any mechanism that limits the amount of external sound from gaining access to the inner ear by impairing the passage of sound waves.

-Sensory:Occurs due to damage to or deterioration of the cochlea (most often due to loss of hair cells from the organ of Corti)

-Neural:

  • Degeneration of the nerves: lesions of the CN 8, auditory nuclei, ascending tract or auditory cortex
  • The least common type of hearing loss
  • Etiology includes acoustic neuroma, multiple sclerosis, and auditory neuropathy

Sensory and neural are difficult to differentiate between due to available testing methods so are referred to as sensorineural

Another slide she has says 3 broad clinical categories for hearing loss are conductive, sensorineural and mixed so....

100

40 to 60 dB is considered what level of hearing loss?

moderate loss

  • Normal: VE = soft whisper, dB = 0 to 20 dB
  • Mild loss: VE = soft spoken voice, dB = 20 to 40 dB
  • Moderate loss: VE = normal spoken voice, dB = 40 to 60 dB
  • Severe loss: VE = loud spoken voice, 60-80 dB
  • Profound loss: VE = shout, dB = > 80dB
100

What is the most common form of sensorineural hearing loss?

Presbycusis (aging)


    • Types of hearing loss-
      • Presbycusis- age related
      • Noise trauma- burn out hair cells in cochlea
      • Physical trauma
      • Ototoxicity- like chemo
      • Sudden hearing loss
      • Hereditary hearing loss
      • Autoimmune disorders
      • Other systemic diseases
100

In conductive hearing loss, sound lateralizes to which ear

The ear with hearing loss. 

That is the opposite of sensorineural hearing loss. 

100

What are risk factors for hearing loss?

Age: ≥65 (most important risk factor)

History of exposure to loud noises, occupational exposures

Exposure to ototoxic substances

Family history, genetic factors

Previous reoccurring ear infections, systemic diseases (DM)

200

Cerumen Impaction, Foreign Bodies and Otitis Externa are all disorders of which part of the ear?

External ear

200

True or False

Irrigation should be performed only when the TM is known to be intact.

True

200

Psoriasis and atopic dermatitis predispose the patient for what ear disorder?

otitis externa
200

A patient was swimming 2 day ago and the next day developed itching and discomfort in the left ear and today had ear pain, discharge and some hearing loss. One exam you notice erythema to the auricle and tragus and pain with movement. Canal is edematous and erythematous. What is the likely diagnosis?

Otitis Externa

200

What is the most common neoplasm of the auricle?

Basal cell carcinoma

  • Related to chronic long-term sun exposure (UVB)
  • Presents as a skin lesion that is nodular, ulcerated, and/or bleeding
300

A patient presents with painless otorrhea and conductive hearing loss and on otoscopic exam you see a marginal TM perforation with granulation tissue. What is the likely diagnosis?

Cholesteatoma

300

A patient presents with:

  • Fever, irritability, headache, disturbed or restless sleep, poor feeding, vomiting, and diarrhea
  • Aural pressure
  • Decreased hearing

They report they had increasing pain which all of a sudden stopped and now they have discharge from the ear.

Acute otitis media with subsequent TM perforation.

the hallmark of chronic otitis media is purulent aural discharge.

300

True or False

A Tympanocentesis is a tiny incision created in the TM to relieve pressure.

False. 

A myringotomy is a tiny incision created in the TM to relieve pressure. Myringotomy tubes can be placed for ventilation.

A tympanocentesis is for bacterial and fungal culture and is a puncture of the TM with a small gauge needle. 

300

What are treatments of chronic otitis media?

  • Goals and General Management

    • Stop otorrhea
    • Heal the tympanic membrane
    • Eradicate current infection
    • Prevent complications/recurrence
    • Remove debri regularly, wear earplugs to prevent moisture in the ear
  •      Medication

    • Antibiotics 


        • Topical: ofoxacin 0.3% otic drops or ciprofloxacin with dexamethasone 0.3%/0.1%
        • Systemic: Cipro 500 mg P.O. 2/day x 1-6 weeks
    • Surgery


        • Remove of infected tissue in the middle ear and if necessary mastoidectomy
        • Reconstruction of the tympanic membrane
300

The Eustachian tube is part of which part of the ear?

middle ear

400

Eustachian tube dysfunction is defined as 

a. failure of the "functional valve" of the ET to open and/or close properly

b.air trapped in the middle ear gets absorbed resulting in negative pressure in the middle ear

c. dysfunction creates a sensation of aural fullness and mild to moderate hearing impairment. 

d. all of the above.

d. all of the above

  • History presents as:
    • Ear pain
    • A sensation of aural (ear) fullness or pressure
    • Mild to moderate fluctuating hearing loss
    • Tinnitus
    • Patients commonly describe their ear(s) as feeling “plugged”
    • “Popping” or discomfort with barometric pressure changes
    • Vertigo and disequilibrium may be reported in severe cases
    • Recent history of URI or allergy
400
Why do kids get more ear infections than adults?
Their Eustachian tube is more horizontal and shorter than adults.
400
Sensory hearing loss is disease of the ________.

a) vestibule

b)cochlear

c) semicircular canal

d) TM

b) cochlear

400

Tinnitus can be caused by

a) vascular

b) neuro

c)ETD

d)ototoxic medications

e) all of the above

e) all of the above

as well as sensorineural hearing loss

400

True/False

Vertigo is a diagnosis.

False

Vertigo is a symptom and is the cardinal symptom of vestibular disease.

500

Match the type of vertigo with the direction of the nystagmus

peripheral                       vertical

central                           horizontal

peripheral-horizontal with a rotary component

central-vertical

500

A patient presents with acute onset of severe vertigo lasting several days to a week with unilateral hearing loss, tinnitus, N/V. On exam you note fast phase nystagmus beats away from the affected side- ability to walk but sway or fall to the opposite side of the fast beat of nystagmus, hearing loss and symptoms of a viral infection. What is the likely diagnosis?

Labyrinthitis

500

This test is preformed by quickly lowering the patient to the supine position with the head extending over the edge of the table. Head should be placed 30 degrees lower than the body and turned either to the left or right. 

Dix-Hallpike Test

500

Vestibular Schwannoma involves which cranial nerve?

CN VIII

Benign lesions that may grow and compress the pons leading to hydrocephalus. Most lesions are unilateral.

500

A patient presents with nystagmus and vertigo reproduced with positional change following a 10-15 second latency period (delay). The nystagmus beats upward and torsionally. There is no new hearing loss on audiogram and Tympanogram should be normal. What is the likely diagnosis?

Benign Paroxysmal Positioning Vertigo

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