Chapter 19 Hearing Loss

True False: we use the term “hearing impaired” to describe ppl

False! Use Deaf/HOH

Outer (external) ear

The concave, somewhat funnel-like structure that collects, resonates, and directs sound waves to the tympanic membrane, assists in localizing the direction from which sound is coming, and helps protect the middle ear; composed of the auricle (pinna), ear canal, and outer layer of the tympanic membrane.

Tympanic membrane (eardrum)

A thin, semitransparent membrane that separates the ear canal from the middle ear and transmits sound vibrations into the middle ear.

3 main parts of outer ear

auricle/pinna, ear canal, and tympanic membrane

what does the outer ear do

_____ and______ sound

assist in locating _____ sound comes from

helps protect ____ ear from ____

collects and resonates sound

assist in locating direction sound comes from

helps protect middle ear from damage

Cerumen (keeps insects out)

A yellowish or brownish waxy secretion produced by ceruminous glands in the ear canal that protects the ear canal from intrusion by insects.

middle ear

An air-filled chamber located within the temporal bone of the skull; beginning at the inner side of the tympanic membrane and attaching the ossicular chain to the oval window of the cochlea.

ossicular chain

The three small bones (ossicles) of the middle ear named after their basic shapes: malleus, for the mallet or hammer; incus, for the anvil; and stapes, for the stirrup

what does the middle ear contain

ossicular chain- 3 joined bones

what is the ossicular chain- what is the significance of them?

malleus (hammer), incus (anvil), stapes (stirrup) SMALLEST BONES IN BODY

where are the ossicles and connect what

suspended in middle ear and connect the tympanic membrane to oval window of cochlea

what do ossicles do

amplify sound before it reaches cochlea

the external ear canal is a narrow _____ leading from an opening in the _____ to the ______ membrane (eardrum)

tube/ skull/ tympanic

what does the tympanic membrane separate

the ear canal from the middle ear

what does the tympanic membrane do

transmit sound waves or vibrations into the middle ear

hearing threshold

In audiometry, the level at which a stimulus sound, such as a pure tone, is barely perceptible; usual clinical criteria demand that the level be just high enough for the subject to be aware of the sound at least 50% of the time it is presented.

Eustachian tubes lead from the ______ ear to the ______ at a _____ angle

middle/ nasopharynx/ downward

the openings of ET are normally _____ at the nasopharyngeal ____ but remain _____ until in babies ____ months old

closed/ end/ open/ 6 months

what fraction of ET are bone? Cartilage?

superior ½ bone

lower 2/3 cartilage

ET's open when we c____, s_____, y____, and s_____ to allow air ___ into the _____ ear cavity

chew, swallow, yawn, and sneeze

air flow

middle ear cavity

Barotrauma? Symptoms?

A feeling of fullness or pressure in the middle ear as a result of ascending or descending with changes in altitude. Symptoms may include general ear discomfort, fullness or stuffiness in the ear, difficulty hearing, and dizzines

what does prolonged barotrauma cause?

may result in ear pain, nosebleed, moderate to severe hearing loss, and, in severe cases, rupture of the tympanic membrane.

when is ear barotrauma particularly dangerous?

when the Eustachian tubes are closed, such as from an upper respiratory infection or allergies

how do we intentionally open ET’s

Valsalva maneuver: The procedure of closing  the mouth and pinching the nostrils closed with the fingers and forcefully exhaling air, usually causing the Eustachian tubes to open and air to flow into the middle ear to equalize middle ear cavity air pressure with atmospheric air pressure, for example, when going up or down in an elevator or ascending or descending in an airplane, causing the ears to “pop”; any exhaling of air against tightly closed vocal folds, as when lifting heavy objects.

what does the inner ear consist of

cochlea and vestibular system

cochlea

The part of the inner ear containing the sensory mechanism of hearing; a spiral tunnel with 2¾ turns about 30 mm (about 1.25 inches) long, resembling a tiny snail shell.

vestibular system

The inner ear structures associated with balance and position sense, including the vestibule and semicircular canals of the vestibular mechanism, with interactions of the visual and proprioceptive systems and connection to the cerebellum.

in the inner ear, the _____ is protected by being housed in the ____ bone of the skull

cochlea/ temporal

what is a fun fact about the cochlea that allows cochlear implants in infants and young kids

it’s actually full size at time of birth

cochlear implant

A device that enables individuals with profound hearing loss to perceive sound through an array of electrodes that are surgically implanted in the cochlea and deliver electrical signals to the vestibulocochlear (VIII cranial) nerve, and an external amplifier that activates the electrode array.

the cochlea has ______+ tiny ____ cells that are stimulated by movement of _____ fluid in response to sound

15k

hair

cochlear

higher frequencies trigger hairs ____ the oval window, lower frequencies trigger ____ from oval window

nearer , farther

Hair cells process:

• stapes vibrates against the oval window of the cochlea

• moves fluid inside the cochlea—> stimulates hair cells

• hair cells send impulses to auditory nerve (cranial nerve VIII)

vestibular mechanism acts as a

motion detector

what is vestibular motion affected by

gravity and inertia

what is the vestibular mechanism is made up of

3 semicircular canals that contain fluid

As we move our _____ or ____, fluid stimulates different portion of the _______ canals

• this sends ______ to the __________ nerve

• head or body, semicircular

  • sensation/ vestibulocochlear nerve

Vestibular system can become confused:

• when we are ____ around (roller coaster, heavy waves)

• _____ sickness: ______ or rhythmic motions (ex: boat stimulate canals

• results in ____, nausea, vertigo

• turned

• motion/ erratic

• headache

what is vertigo

sensation of instability; loss of equilibrium

what is the most common of all physical impairments

hearing loss

auditory nervous system is primarily a ____ system that sends nueral impulses from the _____ to the ____ cortex in the _____ lobes of the brain

sensory

cochlea

auditory

temporal

Primary auditory cortex (Heschl’s gyrus)

The portion of the posterior superior region of both temporal lobes (Heschl’s gyrus) that receives auditory signals from the ears and processes the signals as environmental sounds, human speech sounds, and human nonspeech sounds (coughs, burbs, etc.).

Differential threshold

The smallest difference that can be detected between two auditory signals.

adolescents have had a _____% increase in hearing _____ compared to their same age group ____ years ago

5%/ loss/ 15

Nearly ____ of those over _____ years old are

½

75

HOH

conductive hearing loss is a problem with the

• any in_____, infe____, or both of the _____ membrane lining the ____ of the ____ ear

middle ear

• any inflammation, infection, or both of the mucous membrane lining the interior of the middle ear

attenuation

decrease in strength of sound

some disorders or malformations may result in hearing loss like:

• otis atresia= _____ audtiory canal damage

• external otitis= infection in ____ of ____ auditory canal (swimmers ear)

• ear ____ —> blockages

• ____ bodies—> blockages

• p_____ (rupture) of _____ membrane

• external

• skin of external

• ear wax

• foreign

• perforation/tympanic

what is one of the most common middle ear disorders

Otis Media with Effusion (middle ear infection)

OME occurs particularly common in ____ and often associated with a common ___, allergies, ___ infections, and sore ____

cold, allergies, sinus infections, sore throat

organisms produce ____ that results in _____

pus—>effusion

what is effusion

fluid in middle ear

middle ear infections occur in almost _____ % of children born in _____ before they are ___ years old

70%

US

2 years

True or False: in middle ear infections multiple episodes are rare

false! It’s common to have multiple episodes

causes of middle ear infections

• exposure to _____

• upper _____ tract infections

• a_____

exposure to cig smoke, upper respiratory tract infections, allergies

in OME… ____ tube is _____ and ____up

• so it can’t ventilate the _____ ear

eustachian tube is infected and swells up

• middle ear

in OME air inside the ___ ear is trapped and begins to be _____ by the walls of the ____ ear cavity

middle/ absorbed/ middle

in OME the _____ of the ear becomes _____, and ____ from the inflammation seeps into the middle ear _____

lining/inflamed/fluid/cavity

what kind of hearing loss does OME cause? why?

• ____ movement of _____ and ______ membrane

conductive hearing loss bc impeded movement of ossicles and tympanic membrane

Behaviors of children with middle ear infections include ir_____, difficulty hearing _____ conversational____ and turning up the television ____

• As the infection worsens, children usually have elevated_____ and are visibly ___

Behaviors of children with middle ear infections include irritability, difficulty hearing normal conversational levels, and turning up the television volume

• As the infection worsens, children usually have elevated temperatures and are visibly ill

the child may have large _____ which block the opening to the ___ and prevent ____ of the ____ ear and normal _____

• look for _____ _______

• large adenoids block the opening of the ET and prevent aeration of the middle ear and normal breathing

  • look for mouth breathing!

adenoids

Lymphoid tissue (tissue that produces lymphocytes, which help fight infection) found on the pharyngeal wall in the nasal– pharyngeal region.

do you surgery for adenoids

sometimes surgically removed to allow nasal breathing and help prevent middle ear infections.

With OME what causes infection? what does that lead to

harmful bacteria in middle ear fluid cause infection—> temp and get sick

what is the treatment for OME? how does it owrk

• take child to pediatrician IMMEDIATLY

• antibiotics sterilize fluid but don’t remove it

True or false: after antibiotics if the child fever go away so does conductive hearing loss

false! even if fever gone still have it

mastoiditis

An infection of one of the mastoid bones (just behind the ear) that is usually an extension of a middle ear infection; characterized by earache, fever, headache, and malaise; medical treatment may require intravenous antibiotics for several days, and residual hearing loss may follow the infection.

otologist

A physician who is first trained in otolaryngology (ENT) and then specializes in diagnosis and treatment of diseases and other disorders of the ear.

purpose of surgery for patients with middle ear infection

• is it inpatient or outpatient? long recovery or go home right away?

eliminate disease; in some cases, reconstruction of a damaged hearing mechanism is also needed

• outpatient surgical setting and the patient is allowed to go home that same day

Myringotomy: small surgical _____ is made into the ______ membrane to relieve _____ and release ____ from the ear

• they insert a tiny pressure ______ tube to act as a _____ and _____ the middle ear

small surgical incision made into tympanic membrane to relieve pressure and release pus from the ear

• pressure equalizing tube to act as a drain and ventilate the middle ear

Following the myringotomy and cleaning of the middle ear, the otolaryngologist may insert a pressure-equalizing (PE) tube through the incision in the tympanic membrane

A small silicone tube inserted into the tympanic membrane following a myringotomy to equalize air pressure between the middle ear cavity and the atmosphere as a substitute for a nonfunctional Eustachian tube.

otosclerosis

Typically, a hereditary condition that occurs when there is growth of bony tissue around the footplate of the stapes that presses against the oval window, resulting in a conductive hearing loss, and causing attenuation in the cochlea.

Auditory nervous system impairments may occur:

• c____, ______ nerve (cranial nerve VIII) or inside the _____

cochlea, auditory nerve, or inside the brain

what is an acoustic neuroma

benign brain tumor on the auditory nerve

what can a acoustic neuroma cause

permanent hearing loss, ringing in the ear, and balance problems

when does ear development take place

between 4-8 weeks gestation

what factors cause HL during pregnancy

teratogens like drug/alc exposure or illness in mom

• even over counter meds can cause HL in uterus

Ototoxic

Drugs that have harmful effects on the central auditory nervous system, including aspirin, aminoglycoside antibiotics, furosemide, and quinine.

other causes of hearing loss include:

• childhood diseases like _____ and _____

• ____ trauma

• when ppl take _____ medications

• measles and mumps

• head trauma

• when ppl take ototoxic medications

Newborn hearing screening is _____ and ____ in most states

routine and compulsory

what is ABR? is it invasive?

auditory brainstem response

• noninvasive: electrodes are attached to a baby’s scalp

is noise-induced hearing loss temporary or permanent

can be either temporary or permanent

what is most common cause of hearing loss

noise induced/long-time exposure to excessive noise

noise-induced hearing loss

A permanent sensorineural hearing loss caused by exposure to excessive loud noise, often over long periods of time.

acoustic trauma

Damage to hearing from a transient, high-intensity sound.

do younger or older ppl have more permanent HL

younger ppl bc of personal listening devices

Gradual hearing loss from repeated exposure to excessive sound can damage or destroy the delicate____cells in the cochlea

hair

what is presbycusis? what is difficult with it?

progressive hearing loss that occurs due to aging- difficulty hearing in noisy environments

what age does presbycusis set in

usually around age 60

what does menire’s disease involve:

• accumulation of _____ impinging on the eardrum or ____ the _____ auditory canal

cochlea and vestibular system accumulation of cerumen impinging on the eardrum or occluding the external auditory canal

symptoms of Menire’’s disease:

• v____, t____, ear feels _____

vertigo, tinnitus, ear feels full

True False: Meniere’s is bilateral, static sensorineural hearing loss

False: it’s unilateral, fluctuating hearing loss

tinnitus

ringing, roaring, swishing sound in ear

what can Tinnitus be a sign of

otosclerosis- form of abnormal bone growth within middle ear that causes progressive hearing loss

True false: tinnitus is only a sign of acoustic neuroma and not menire’s

false it can be either

what variables do you look at for communication disorders of indiv. who are D/HOH

• ____ of onset, s____, and _________ of the hearing loss

• ____ of loss: conductive or sensorineural

• beginning of _____ care

• presence of other _______

age of onset, severity, and configuration

• type of loss

• start of professional care

• presence of other handicaps

what frequency loss is most common

high frequency loss

what sounds are hardest for ppl to hear

s, f, th, sh, sometimes children drop sounds from end of words

• many kids fluent in ________

• those who recieve _____ implants early in life often have _____-_______ speech and language skills

  • there may be _____ and _____ delays if ch don’t get support like learning _____, getting ____ implants, or both

ASL

• cochelar, average-superior

  • speech/language, ASL, cochlear

in certain circumstances, may be challenges with:

• hearing final _____

• distinguishing _____ from _____ sounds

• pitch and ____

• ______ errors in writing

• ______ skills (not being able to respond on topic, problems taking turns appropriately

• final consonants

• voice from voiceless

• pitch and prosody

• grammatical

• pragmatic skills