Hearing and Balance

Conductive

This kind of hearing loss involves impairment in the part of the ear that conducts sound pressure waves from outside to the tympanic membrane (wax, popcorn kernel, otitis media, otosclerosis)

Sensorineuronal

This kind of hearing loss involves impairment to the sensory receptors (organ of Corti) or CN VIII

Mixed

This kind of hearing loss involves hearing loss attributed to both conductive and sensorienuronal

Hidden/silent

This kind of hearing loss involves normal audiogram/hearing tests but problems hearing in noisy rooms, encoding speech

Auditory neuropathy spectrum disorder

This kind of hearing loss involved sensorineuronal hearing loss where speech is most severely affected

Weber test

This test for hearing loss involves testing of bone conduction with 512 Hz tuning fork on forehead or top of head. Normally localizes to midline. Sensorineuronal loss localizes to good ear, conductive hearing loss localizes to bad ear

Rinne test

This test for hearing loss involves comparison of air and bone conduction: 512 Hz tuning fork on mastoid process until patient cannot hear it anymore, then place in front of external auditory meatus; air conduction is normally better than bone conduction. With sensorineuronal loss – air > bone (but hearing is diminished), with conductive hearing loss – bone > air

Otosclerosis

abnormal bony growth involving the ossicles that prevents normal conduction of sound to the oval window; signs/symptoms - low frequency hearing loss, Weber test localizes to affected ear, in affected ear, Rinne test = bone > air

Presybcusis

age-related hearing loss and most commonly involves elevated thresholds to higher frequencies (4-8 kHz)

Vestibular nerve/nuclei

Key vestibular s/s of injury to the ______ are blurred vision (from nystagmus), vertigo, impaired balance, nausea and temporary changes in blood pressure.

Meniere’s syndrome

episodic vertigo, tinnitus and hearing loss; caused by excess endolymph in the scala media and subsequent degeneration of hair cells

Benign paroxysmal positional vertigo

Outbursts of vertigo and nystagmus with particular positions of the head (especially lying down or rolling over); caused by free otoliths in the semicircular canals; most common in the posterior canal. Can be treated with Epley maneuver to reposition loose otoliths

Dix-Hallpike positional testing

Reproduce symptoms of benign paroxysmal positional vertigo with ______ – position pt to maximally stimulate the posterior canal = vertigo and nystagmus; sitting up should reverse the direction of the nystagmus

Vestibular neuritis

inflammation of the vestibular nerve from viral infection

Caloric testing

cold caloric testing = nystagmus to opposite side, warm caloric testing = nystagmus to same side [COWS]