Disorders of Hearing, Balance, and Vision

patho final exam

Structures in Ear

Hear and interpret sounds

Provide info about position and movement of head in space

Receptors within eye

Shapes and colors conveyed in light energy

Impairments to ear and eye

Alter information available to cortex to process

Disease, aging, medications, environmental factors, genetics

Disorders of hearing, balance and vision

Have a negative effect on quality of life

Children will have developmental, communication, and mobility delays

Adults will have mobility, nutrition, stress, coping, and mood problems

• increased susceptibility to environmental issues

Hearing process

Sound waves transformed into neural impulses

Pitch, loudness, timing preserved at each step, allowing brain to perceive sound accurately

Auditory system pathologies

Disrupt normal sound transmission process

Types of hearing loss

• Sensorineural

▪Conductive

▪Mixed

INNER EAR AND PERIPHERAL BALANCE DO slides 11-13

Conductive Hearing Loss Disorders

Sound unable to travel normally to inner ear

Reflect audibility problem

Types of Conductive hearing loss

Outer ear disorders

Otitis media

Otosclerosis

Outer ear disorders

Highly treatable

Typically do not involve hearing loss

• exception is congenital outer ear malformations

Some common disorders

• Cerumen impaction

• Collapsed ear canal

• External otitis

• Stenosis of ear canal

Otitis Media (OM)

Inflammation of middle ear space

• Associated with Eustachian tube dysfunction

• Commonly diagnosed in children

OM Clinical man

Cold like symptoms and/or upper respiratory problems

Acute Otitis Media

Inflammation of middle ear with acute onset

Moderate to severe bulging of TM and middle ear effusion

Complications

• Rupture of Tm

• Conductive hearing loss (temporary)

Treatment

• Antibiotics

Recurrent Acute Otitis Media

3+ episodes of AOM in 6 months

4+ episodes in 12 months

Factors that increase risk

• male

• Passive exposure to smoking

• Winter

Chronic Otitis Media

Infection longer than 6 weeks with persistent effusion in middle ear space

Mild to moderate conductive hearing loss

Treatment:

• Topical antibiotics and/or steroids

• Frequent cleaning of ear

Severe cases:

• Surgery

• PE tubes (pressure equalization)

Otosclerosis

Abnormal bone growth in middle ear space

Associated hearing loss

• bilateral

• Slowly progressive 

• Conductive

Otosclerosis cause and patho

Alternating bone resorption and formation

Genetic component as autosomal dominant

Viral factors

Autoimmune system disorders

Otosclerosis diagnosis

History

Otoscopy

Audiologic results

Radiologic studies

Otosclerosis treatment

Annual hearing tests

Surgery

Hearing aids

Presbycusis

Hearing loss due to aging

Most common form of hearing loss

Various contributing factors

4 types of Presbycusis

Sensory

Neural

Metabolic/strial

Mechanical/cochlear conductive

Presbycusis clinical man

Progressive decrease in hearing thresholds

Decreased ability to understand speech

Presbycusis diagnosis

History and complete audiologic assessment

Presbycusis treatment

Hearing aids

Assistive listening devices

Cochlear implants

Ménière Disease (inner ear disorder)

Inner ear disorder with both auditory and vestibular symptoms

• Excess endolymph within membranous labyrinth of

inner ear

Ménière Disease

Intense vertigo with accompanying nausea and vomiting

Tinnitus

Pressure or fullness in the ear

Fluctuating hearing loss

Ototoxicity

Side effect of some meds

• damage to sensory cells of inner ear

Cochleotopic meds

Damage to sensory cells of cochlea

Cause sensorineural hearing loss

Typically bilateral

Vestibulotoxic medications

Damage sensory cells of peripheral balance system

Effects typically bilateral

Factors that affect Ototoxicity

Age

Coexisting medical conditions

Genetic predisposition

Drug

Genetic hearing loss

One of the most common birth defects

Caused by genetic mutation

Genetic hearing loss clinical man

Nonsyndromic hearing loss: Hearing loss only

Syndromic hearing loss: Accompanied by pattern of

other clinical abnormalities

Genetic hearing loss diagnosis

Physical attributes related to syndrome

Genetic testing for definitive diagnosis

Genetic hearing loss treatment

Regular audiologic monitoring

Sensorineural hearing loss

• hearing aid or cochlear implant

Conductive hearing loss

• hearing aid or osseointegrated hearing implant

Myopia

Nearsightness, image focused in front of the lens

Hyperopia

Farsightness, eyeball is too small, image focused behind the retina

Presbyopia

Farsightness associated with aging, loss elasticity reduce accommodation

Ciliary muscles weakening and th eye’s lens becoming less flexible with age

Astigmatism

Irregular curvature in the cornea or lens

Strabismus

Result from deviation of one eye, double vision (diplopia)

May cause by weak or hypertonic muscle, short muscle or neurological defect

In children - must be treated immediately to prevent development of amblyopia

Nystagmus

Rapid, involuntary eye movement

Develops in some individuals with amblyopia and strabismus.

May result from neurological causes, inner ear or cerebral

disturbance, drug toxicity

Inhered Diplopia

Result from neurological causes (stroke), paralysis of extraocular muscle

Loss depth perception

Color blindness

Types

▪ Red/green color blindness (most common)

▪ Blue/yellow color blindness

▪ Achromatopsia (most severe)

Congenital or acquire

Hordeolum (stye)

Tender, red, often pus-filled bump along edge of eyelid

Bacterial infection in oil glands at base of eyelash

Resolve in week without treatment

Conjunctivitis (pinkeye)

Symptoms

▪Redness, discharge, itching, burning of eyes

▪Increased tearing; blurred vision, Light sensitivity

Viral Conjunctivitis

Most common

Adenoviruses; herpes simplex virus

Resolves 7-21 days

Bacterial Conjunctivitis (chlamydia)

Resolves in 1 week

Symptoms persist up to 3 weeks

Topical antibiotics

Allergic Conjunctivitis

Not contagious

Treated with saline and/or oral and topical meds

Pterygium

Benign growth on Conjunctiva; may extend to cornea

Risk factors:

• High levels of UV exposure, wind

Causes for removal

• Unsightly

• Interferes with vision

• Causes discomfort

Keratitis

Severe pain and photophobia: Develops when cornea is infected or irritated

• Transfer from herpes lesion around month.

• Increase the risk of ulceration eroding the cornea.

• Scar formation damages the cornea

Cause: Damage from chemicals, splashes and fume

Corneal Abrasion

Scratch or cut on cornea

Causes:

▪ Foreign body or chemical irritant

▪ Rubbing eye too forcefully or being poked in eye

Symptoms: eye redness, tearing, eye pain, blurred vision, light sensitivity

Treatment

▪ Flushing with water or a sterile saline solution

▪ Topical antibiotics and anti-inflammatories

Cataracts

Cloudy or opaque discoloration of lens

Causes

▪ Age-related changes, trauma, congenital anomalies,

systemic disease, pharmacologic triggers

Diagnosis

▪ Ophthalmologic exam

Treatment

▪ Limit exposure to ultraviolet light

▪ Surgery; ultrasonic vibrations; artificial lens

▪ Capsulotomy

Glaucoma

Increase in intraocular pressure (IOP)

–Leads to slow, painless, progressive loss of vision

–Numerous risk factors

–Cause of blindness

–Signs and symptoms

– Halos around the eye at night

- Loss of peripheral vision.

- Pain may occur if IOP is greatly increased.

Acute Glaucoma (narrow angle)

Angle between cornea and iris is decreased

Cause:

• aging developmental abnormalities, trauma or infection

Treatment

• Surgery

Chronic Glaucoma (open-angle)

Higher in older than 50

Thickness of trabecular network which allows for resorption of fluid

Pressure increases over time: May cause damage to the retina or optical nerve.

Irreversible and may cause blindness

Retinopathy

Any disorder of, or damage to, retina

exs:

Diabetic retinopathy: Leading cause of blindness in US.

Non proliferative diabetic retinopathy (no- angiogenesis)

Proliferative diabetic retinopathy (PDR) angiogenesis

(angiogenesis)

Retinal Detachment

Retina separates from underlying structures

Risk factors:

• significant myopia

• Cataract surgery; PDR; trauma

Macular degeneration (age related macular degeneration)

• Macula degenerates; distortion or loss of central vision

Dry macular degeneration (most common)

▪Blurry or “wavy” central vision with normal peripheral vision

Wet macular degeneration (more severe)

• New blood vessels grow around macula

• Causes bleeding, scarring, and photoreceptor atrophy