SLHS 340 Exam #3

Microtia

Malformed or smaller pinna

Anotia

Absent pinna

Atresia

Absence or closure of ear canal

Can you do otoscopy with a patient who has complete atresia?

No! Nowhere to look into.

Would you get tympanometry results with a patient who has microtia with complete atresia?

No, nowhere to put the probe.

Is it possible to get bone conduction thresholds in patient with complete atresia?

Yes! Can still stimulate their cochlea via BC

Is it possible to get air conduction threshold in a patient who has complete atresia?

Yes, you just have to use supra-aurals

How would you fix anotia?

Surgically, they can reconstruct a pinna for you. The surgery is just cosmetic though

How would you manage atresia?

You could get surgery, depending on how malformed the pinna is.

Also you can use bone anchored hearing aids

What is BAHA?

Bone anchored hearing aids, it snaps onto the temporal bone

External otitis

Inflammation of the external auditory canal caused by virus, fungus, but most commonly bacteria.

Also known as swimmer's ear

Otorrhea

Discharge and smelliness

Some symptoms of external otitis

Red external auditory canal, itching and pain in the pinna or canal. May see otorrhea

Would you have a hearing loss associated with external otitis?

No, unless the canal swells shut, then you would have a conductive hearing loss

How do you manage external otitis?

Topical antibiotics, clean and flush ear canal regularly

What population is excessive cerumen most prevalent in?

Older adults

What type of hearing loss is associated with impacted cerumen?

Relatively flat, conductive hearing loss.

How can you determine if the wax is occluded?

Only the tympanogram will show you that there is an occlusion

What would occluded wax look like on a tympanogram?

Flat tympanogram, reduced ear canal volume, absent acoustic reflexes

What would just a lot of wax look like on a tympanogram?

It would still be peaked, but the ear canal volume would be reduced

How do you manage excessive cerumen?

Remove it by using ear drops, irrigation, or having an ENT use special tools

Will foreign objects in the ear cause a hearing loss?

No, unless it is completely blocking the canal (rare)

What would reveal a foreign object in the ear?

Otoscopy

Stenosis

Narrowing of the ear canals

What population is stenosis common in?

Individuals with Down's Syndrome

Is there a hearing loss associated with stenosis?

No, unless they have another pathology paired with it

What population is collapsing ear canals present in?

Occurs at any age, but most prevalent in older adults

What would a collapsing ear canal look like on an audiogram if you don't catch it?

Will show up as an ABG or conductive hearing loss

Exostosis

Bony growths in the external auditory canal

What population is exostosis found in?

Cold water swimmers

Is there a hearing loss associated with exostosis?

No, unless there is an occlusion

Tympanic membrane perforation

caused by trauma (Q-tips, flying with a bad cold, acoustic trauma related to the military) or middle ear infections (build up of pressure)

What are some ways you would be able to see a perforation?

Otoscopy may reveal a perf, but in a tympanogram you would be able to see it clearly

What would a perforation look like on a tympanogram?

Flat, with abnormally high ear canal volume, absent acoustic reflexes

Is there a hearing loss associated with TM perforations?

May or may not have a hearing loss, if so it would be a mild conductive hearing loss

How would you treat a perforation?

Usually it heals by itself, but recurrent perforations can weaken TM's ability to heal. Surgery may also be necessary

What are the names of the 2 types of surgery available for perforations?

Myringoplasty and tympanoplasty

Myringoplasty

A graft is used to close the perforation (for less severe cases)

Tympanoplasty

Surgical reconstruction of the middle ear system (for more severe cases)

Tympanosclerosis

White plaques on the TM which stiffens the TM

Is there a hearing loss associated with tympanosclerosis?

Not usually, but if so it would be a mild conductive hearing loss

How would you treat tympanosclerosis?

Go in with a numbing agent and scoop out plaque

Otitis media

Inflammation or infection of the middle ear

What is otitis media caused by?

Eustachian tube dysfunction most of the time

What would otitis media look like on a tympanogram?

Type C

Serous otitis media

Thin liquid free of bacteria

Secretory otitis media

Thick liquid free of bacteria

Purulent or suppurative otitis media

Fluid that contains cellular debris and bacteria

When is otitis media most prevalent?

First 2 years of age, 75-95% of children will have at least one episode by age 6 years old

Who is more at risk for otitis media?

Boys, bottle fed children, day care children, and infants in a smoking environment

How does otitis media develop?

The TM retracts, the eustachian tube is closed off by swelling, then bacteria drawn up the ET into the middle ear space, the TM is bulging, and fluid and pus gets in the ME space

What will you see in an otoscopy in an individual who has otitis media?

Vascularization of the TM, fluid behind the TM, bulging TM, and discharge

Will you have a hearing loss with otitis media?

Not usually, but can get conductive loss with the degree of loss dependent on the volume of liquid in the ME space

What would a tympanogram look like in someone who had otitis media?

Flat tympanogram, normal ear canal volume, absent reflexes

Treatment of otitis media

Antibiotics, PE tubes if it is a chronic condition, maybe tonsillectomy and adenoidectomy

Effect of otitis media on language devlopment

Attenuation of sounds create an auditory deprivation, miss critical milestones, huge economic costs

Otosclerosis

Growth of spongy bone around the ossicular chain and stapes footplate, it immobilizes the footplate at the oval window and can result in ankylosis (fixed footplate)

What is the cause of otosclerosis?

Unknown

Who is otosclerosis more prevalent in?

Women

Is there a hearing loss associated with otosclerosis?

Yes, progressive conductive hearing loss, with a rising or flat configuration, because without the stapes footplate moving, there is no transfer of info in the ME

What is a carhart notch and where does it occur?

Occurs in individuals with otosclerosis, it is a worsening of bone conduction thresholds by 10-15 dB at 2000 Hz

What would otosclerosis look like on a tympanogram?

Shallow or flat tympanogram, with absent reflexes

How do you fix otosclerosis?

Surgical treatment, have to loosen the stapes with chisel like instrument, or perform a stapedectomy

What is a stapedectomy?

Replacement of all or part of the stapes with a prosthesis

Will conditions get better post surgery for those with otosclerosis?

No, there is no change or hearing gets worse post surgery, regrowth of sclerotic tissue occurs, and it may create a leak in the cochlea

Ossicular discontinuity

Usually caused by head trauma or disease, dislocations occurs at the incudostapedial joint

What would ossicular discontinuity look like on an audiogram?

flat conductive hearing loss

What would ossicular chain discontinuity look like on a tympanogram?

high peak admittance tympanograms with absent reflexes on affected side

Cholesteatoma

A cyst filled with keratin that grows within the middle ear, occurs as a result of chronic otitis media, the growth may be infectious, and it may restrict movement of the ossicles and possibly lead to erosion of the ossicular chain, accompanied by otorrhea

Is there a hearing loss associated with cholesteatoma?

Progressive conductive hearing loss

What would a tympanogram look like for cholesteatoma?

Shallow or flat tympanograms depending on development of it, absent reflexes on affected side

How do you remedy cholesteatoma?

Surgical treatment- removal of it, but it can grow back

If untreated, it will erode the bone leading into the inner ear possibly causing hearing loss and balance problems

Meniere's Disease

Pressure equalization problems within cochlea and semicircular canals

What is Meniere's disease also called?

Endolymphatic hydrops

Who does Meniere's Disease primarily affect?

Mainly adults

What is the cause of Meniere's Disease?

Unknown

What happens during an episode of Meniere's Diesease?

Fluctuating sensorineural hearing loss, with a low frequency loss at the beginning that becomes more flat over time. It is unilateral, and you may have poorer word recognition score than expected

How do you treat Meniere's with drugs?

Use dramamine or meclizine for vertigo. Diuretics to reduce fluid, vasodiliators to attempt to shorten the episode. Redult of salt, chocolate, or maybe caffeine intake.

How do you treat Meniere's surgically?

Shunt of endolymphatic sac for decompression, you could destroy the vestibular system, labrynthectomy (destroying hair cells on the semicircular canals)

Sudden Sensorineural Hearing Loss

Hearing loss with sudden onset and no apparent cause, mild to profound hearing loss with poor word recognition

What does Suddent SNHL often start with?

Tinnitus

Treatment of Sudden SNHL

25% recover spontaneously, the sooner the treatment begins the better. You can use steroids, vasodilators, or antibiotics

Noise Induced Hearing Loss

Notch around 3000, 4000 or 6000 Hz. Progressive high frequency hearing loss. Probably normal immittance measures

With Noise Induced Hearing Loss will you have acoustic reflexes?

Depending on how deep the notch is, they might be elevated or absent

Presbycusis

Age-related decrease in hearing, more hearing loss in men than women.

List some ototoxic medication

Loop diuretics (flurosimide), aminoglycosides, some cancer medications (cisplatin)

How would you monitor a patient while they were taking ototoxic medication?

You would use any sort of otoacoustic emission to see if their outer hair cells were functioning

Head trauma

Type and degree of hearing loss may vary according to nature of injury

Vestibular schwannoma

Benign tumors arising from the Schwann cells of the vestibular branch of the VIIIth cranial nerve

95% unilateral

In who does vestibular schwannoma occur in?

adults 30 years and older

Is there pain associated with vestibular schwannoma?

Rarely

Is there a hearing loss associated with vestibular schwannoma?

Yes, progressive, unilateral high frequency hearing loss, also you will have tinnitus

Would you have acoustic reflexes with vestibular schwannoma?

They would either be elevated or absent.

Also you would have acoustic reflex decay, which is the big red flag you have this diagnosis

How do you treat vestibular schwannoma?

you can surgically remove it, but it may cause total hearing loss in that ear. You may still have low frequencies present, depending on severity and placement.

Facial nerve disorders

Generally not related to hearing loss but because the stapedius is innervated by the 7th nerve, an audiologist may be asked to evaluate.

Would you have acoustic reflexes with a facial nerve disorder?

No!

Bell's Palsy

Pain behind the ears, numbness and tingling on the affected side of the face. Altered taste and hearing

Would you have acoustic reflexes with Bell's Palsy?

No

Auditory neuropathy

Normal hearing using pure tones but may show hearing loss, poor word recognition based on pure tones, normal robust OAE's, absent or delayed ABR

What is ABR

Auditory brainstem responses