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ENT: Hearing loss
Hearing loss ENT
51
Anatomy
Graduate
10/03/2011

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Term
Pple don’t really complain about hearing loss. About 1 in 10 pple with hearing loss do complain.
Definition
Term
Most common chronic handicap in the US:
Definition
hearing loss

22 million Americans have some degree of hearing impairment
Only 10% of people 65 years of age or older report having normal hearing
Term
3 types of hearing loss:
Definition
- conductive
- sensorineural
- mixed
Term
Conductive hearing loss originates in the __ or __ ear.
Definition
- external or middle ear

Passage of sound to cochlea is obstructed or reduced secondary to cerumen impaction, fluid, congenital deformities, tumors, trauma, or otosclerosis within the sound-conducting apparatus
Term
Symptoms of cerumen impaction:
Definition
- hearing loss that gradually worsens
- tinnitus
- dx: look in ear
Term
Impaired eustachian tube function- impaired opening or closing, defective mucocilliary clearance may cause pathological changes to middle ear
Definition
Term
Eustachian tube dysfunction may lead to __ __ and/or a ___.
Definition
adhesive otitis and/or a cholesteatoma
Term
normal physiological function of the eustachian tubes:
Definition
- ventilation and pressure regulation of the middle ear
- protection of the middle ear from nasopharyngeal secretions and sound pressure
- clearance/drainage of middle ear into nasopharynx
Term
A functional and patent eustachian tube is necessary for ideal middle ear sound mechanics
Definition
Term
List the 3 eustachian tube function tests:
Definition
1. Pneumatic otoscopy
2. Tympanometry
3. Valsalva test
Term
Pneumatic otoscopy- examination of the tympanic membrane assesses the patency and perhaps the function of the tube
Definition
Term
Tympanometry measures __ __ __ with an __ __ __ to assess __ __ __.
Definition
- middle ear pressure
- electroacoustic impedance meter
- eustachian tube function
Term
Valsalva test- the eustachian tube and middle ear are inflated by a forced expiration with the mouth closed and the nose pinched by the thumb and forefinger
Definition
Term
Presbycusis is the loss of hearing that __ occurs in most individuals as the __ __.
Definition
- gradually
- grow older
Term
Hearing loss is a common disorder associated with aging. About 30-35 percent of adults between the ages of 65 and 75 years have a hearing loss.

It is estimated that 40-50 percent of people 75 and older have a hearing loss
Definition
Term
symptoms of presbycusis:
Definition
- speech of others seems slurred/mumbled
- high pitched sounds like "s" and "th" are difficult to hear/distinguish
- conversations are difficult to understand, especially when there is back ground noise
- mans voice easier to hear than high pitched womans voice
- certain sounds seem annoying and very loud
- tinnitus

tmt: hearing aids
Term
Hearing problems in elderly can result in ___.
Definition
dementia
Term
Sensorineural hearing loss occurs when the __ or __ __ of cranial nerve __ is affected, preventing transmission of auditory signal to the brain.
Definition
- cochlea
- cochlear portion of cranial nerve VIII
Term
Causes of sensorneural hearing loss:
Definition
- ototoxicity
- presbycusis
- Meniere's disease
- trauma
- noise induced hearing loss
- multiple sclerosis
- autoimmune disease
- tumors
- hereditary/genetic
Term
An acoustic neuroma is a __ __ __ tumor of __ __ __ of the __ ___.
Definition
- benign primary intracranial tumor
- myelin forming cells
- vestibulocochlear nerve (CN VIII)
Term
Incidence of acoustic neuromas peaks in the __ and __ decades and are equal between men and women.
Definition
fifth and sixth
Term
Earliest symptoms of acoustic neuromas include ___ __ __ __.
Definition
ipsilateral sensorineural hearing loss
Term
symptoms of acoustic neuroma:
Definition
- ipsilateral sensorineural hearing loss
- tinnitus
- headache
- vomiting
- altered consciousness
Term
Ototoxicity is damage to the the hearing/balance functions of the ear by __ or __.
Definition
drugs or chemicals
Term
Ototoxicity is caused primarily by __. list them.
Definition
antibiotics

amikacin (Amikin) kanamycin (Kantrex)
streptomycin tobramycin (Nebcin)
neomycin netilmycin (Netromycin)
gentamicin (Garamycin) vancomycin (Vancocin)
erythromycin (E-Mycin, Eryc)
Term
2 classes of drugs besides antibiotics that cause ototoxicity:
Definition
- Diuretics (loops): furosemide (Lasix), bumetanide (Bumex)
- Anti-cancer drugs: cisplatin (Platinol), Vincristin(Oncovin)
Term
Prognosis of ototoxicity depends on the causative drug and its dosage. There is no cure. Hearing aids may help.
Definition
Term
Acoustic trauma is injury to the hearing mechanisms in the inner ear due to very loud noise.
caused by:An explosion near the ear
Gunshots
Long-term exposure to loud noises (such as loud music or machinery)
Symptoms- Hearing loss
Usually partial and involving high-pitched sounds
May slowly get worse
Noises, tinnitus in the ear
The hearing loss may not be treatable. The goal of treatment is to protect the ear from further damage
Definition
Term
mixed hearing loss:
Definition
Includes components of both conductive and sensorineural hearing loss
Primary component should be identified
Causes include trauma, otosclerosis, chronic otitis media
Term
presentation of hearing loss depends on __ of disease
Definition
site
Term
If the hearing loss if fluctant, what are you thinking?
Definition
cerumen impaction
Term
Sudden hearing loss is a medical emergency:
Definition
Trauma, such as a head injury.
Abnormal tissue growth.
Toxic causes, such as snake bites
Neurologic causes such as multiple sclerosis.
Early medical intervention increases the chances for recovery.
Term
Questions to ask:
Definition
Was the onset of hearing loss sudden, progressive, or fluctuant?
How long has the patient been aware of a change?
Is the hearing loss unilateral or bilateral?
What is the patient’s family history?
What is the patient’s exposure to noise?
What is the patient’s medication history?
Were there any precipitating events, such as an upper respiratory tract infection or trauma?
Term
Any abnormal findings on cranial nerve examination are suggestive of serious central nervous system (CNS) pathology
Definition
Term
In an adult without a recent history of upper respiratory tract infection, the presence of fluid in the middle ear necessitates referral to an otolaryngologist for a complete head and neck examination to rule out carcinoma.
Definition
adult, no URI, effusion in ear> refer to rule out cancer
Term
Weber looks at conductive and sensorineural hearing loss. Rinnes just looks a conductive hearing loss.
Definition
- conductive mechanism: outer and middle ear
- sensorineural mechanism: inner ear and auditory nerve
Term
With the Weber test, if the patient has conductive hearing loss, the noise will lateralize to the ___ ear. If someone has sensorineural hearing loss, it will lateralize to the __ ear.
Definition
- affected (CA)
- good
Term
what fork do you use for Weber and Rinne's tests?
Definition
512 Hz
Term
symmetric weber test:
Definition
- normal or bilateral symmetric hearing loss
Term
Rinne test is used to detect __ hearing loss and assess the severity.
Definition
conductive
Term
A positive Rinne test means __ conduction is longer than __ conduction. This suggests __ __ or ___ hearing loss in the __ ear.
Definition
- air
- bone
- normal hearing
- sensorineural hearing loss in the tested ear
Term
A negative Rinne test means the __ conduction is greater than the __ conduction, suggesting a __ hearing loss of at least __ __ in the __ ear.
Definition
- bone
- air
- conductive
- 20 dB
- tested ear
Term
what do you if Weber or Rinne is abnormal?
Definition
refer to ENT for additional evaluation
Term
acute causes of conductive hearing loss:
Definition
- foreign body
- trauma
- burn
- laceration
- fracture
- barotrauma
- TM perforation
Term
acute causes of sensorineural hearing loss:
Definition
- acoustic neuroma
- vascular occlusion
- Meniere's disease
- Labyrithitis (viral/bacterial)
Term
progressive causes (>24 hours) of conductive hearing loss:
Definition
- otitis externa
- acute otitis media
- tumor
- otosclerosis
- cerumen impaction
Term
Progress causes (>24 hours) of sensorineural hearing loss:
Definition
- presbycusis
- noise- induced
- acoustic neuroma
- ototoxicity
- inner ear autoimmune disease
Term
__ __ is usually necessary for definitive diagnosis of hearing loss cause.
Definition
Audiometric testing
Term
normal conversation is how many decibils:
Definition
60 dB
Term
Noise-induced hearing damage is due to __ and __ of exposure. The safe exposure limit is __ ___ for __ hours a day.
Definition
- duration and volume
- 85 dB
- 8 hours
Term
Hearing aid types:
Definition
Behind the ear
In the ear
In the canal
Completely in the canal
CROS (Contralateral Routing of sound)
Implantable
Fully
Partially
Bone-conduction aids
Traditional
Baha (3 parts titanium implant, ext. abutment, sound processor)
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