SHS 561 Final Study Guide

Cholesteatoma

  • Unilateral

  • Site of Issue: Middle ear

  • Hearing Loss Characteristics: Conductive HL that ranges in severity

  • Symptoms: Aural fullness and hearing loss

  • Management:

    • Medical: cleaning of tissue, surgical removal

    • AuD: HAs, or BAHAs

  • Audiogram Example: [Not provided, but expect conductive hearing loss]

Labyrinthitis

  • Unilateral

  • Site of Issue: Inner Ear (auditory and vestibular portions)

  • Hearing Loss Characteristics: Abrupt/sudden onset SNHL that may be profound

  • Symptoms: Intense vertigo, tinnitus, and (sometimes) aural fullness

  • Management:

    • Medical: Steroid treatment for inflammation, bed rest, hydration

    • AuD: CROS, HA, or CI depending on loss

Vestibular Schwannoma

  • Unilateral

  • Site of Issue: Auditory Nerve

  • Hearing Loss Characteristics: Slow-progressing unilateral HF SNHL of varying degrees

  • Symptoms: Unilateral ringing tinnitus and general dizziness WITHOUT VERTIGO/IMBALANCE

  • Management:

    • Medical: monitoring and/or surgery

    • AuD: HAs until hearing/speech understanding degrades and then CROS/BiCROS or remote mics

Vestibular Neuritis

  • Unilateral

  • Site of Issue: Vestibular Nerve

  • Hearing Loss Characteristics: Normal hearing thresholds

  • Symptoms: Sudden onset acute dizziness and vertigo that lasts for hours to days and nystagmus towards unaffected ear

  • Management:

    • Medical: Vestibular suppressants and steroid use

    • AuD: monitoring symptoms and encouragement to exercise/be active to aid in recovery

Ramsay Hunt

  • Unilateral

  • Site of Issue: Facial and cochlear nerves

  • Hearing Loss Characteristics: Mild to moderate SNHL

  • Symptoms: Facial palsy on the side of the issue, red rash on the side of the face or in ears, hearing loss, and vertigo

  • Management:

    • Medical: Steroids

    • AuD: Monitoring and HAs

Meniere's Disease

  • Unilateral

  • Site of Issue: Cochlear

  • Hearing Loss Characteristics: HL begins as LF intermittent loss and then progresses to a flat configuration; HL fluctuates

  • Symptoms: Roaring tinnitus, episodic vertigo, aural fullness

  • Management:

    • Medical: Corticosteroids and conservative measures like reducing salt intake

    • AuD: Monitor audiograms, if episodes stabilize then HAs

Sudden Sensorineural Idiopathic Hearing Loss (SSNHL)

  • Unilateral

  • Site of Issue: Inner Ear

  • Hearing Loss Characteristics: SNHL that varies in severity but can be profound

  • Symptoms: Sudden hearing loss, high-pitched ringing tinnitus

  • Management:

    • Medical: oral or intratympanic steroids

    • AuD: HAs or CIs

Otitis Media

  • Can start unilateral, usually ends up bilateral

  • Site of Issue: Middle ear

  • Hearing Loss Characteristics: Conductive HL that ranges in severity

  • Symptoms: Redness, pain, fluid, ear pressure/fullness and hearing loss

  • Management:

    • Medical: antibiotics, PE tubes

    • AuD: Tympanometry and monitoring

Otosclerosis

  • Bilateral

  • Site of Issue: Middle ear, at the stapes

  • Hearing Loss Characteristics: Initially LF conductive loss progressing to a more severe conductive loss with CARHART'S NOTCH at 2000 Hz (can be a mixed loss if cochlear otosclerosis)

  • Symptoms: Speech understanding is better in noise than quiet

  • Management:

    • Medical: Stapedectomy, monitoring

    • AuD: Amplification (and CIs if cochlear otosclerosis) and monitoring

    • Note: Carhart's notch is a specific dip in the bone conduction thresholds at 2000Hz2000 Hz. It's often seen in otosclerosis due to changes in the resonance of the ossicular chain.

Ototoxicity

  • Bilateral

  • Site of Issue: Inner Ear

  • Hearing Loss Characteristics: Begins as HF SNHL but can progress to LF either rapidly or gradually

  • Symptoms: Constant, high-pitched tinnitus; Complaint that they can hear, but not understand

  • Management:

    • Medical: Switching medications if possible

    • AuD: Monitoring with audiograms, amplification depending on degree

Autoimmune Inner Ear Disease (AIED)

  • Bilateral

  • Site of Issue: Inner Ear

  • Hearing Loss Characteristics: Fluctuating HL initially, turning to rapidly progressive SNHL (usually flat configuration) that will improve with steroids

  • Symptoms: Fluctuating tinnitus, aural fullness, and general imbalance. May also have dizziness or vertigo.

  • Management:

    • Medical: Steroids

    • AuD: Hearing aids

Measles

  • Bilateral

  • Site of Issue: Inner Ear

  • Hearing Loss Characteristics: Profound SNHL with no recovery

  • Symptoms: Cough, fever, runny nose, rash, etc.

  • Management:

    • Medical: Antibiotics for secondary infection

    • AuD: CIs

Cytomegalovirus (CMV)

  • Either (Unilateral or Bilateral)

  • Site of Issue: Inner Ear

  • Hearing Loss Characteristics: SNHL that ranges from mild to profound, may be delayed onset

  • Symptoms: Microcephaly, reduced birth weight, jaundice, retinitis, seizure

  • Management:

    • Medical: Antivirals or monitoring

    • AuD: HAs or CIs

Cerumen

  • Either (Unilateral or Bilateral)

  • Site of Issue: Outer ear

  • Hearing Loss Characteristics: HL may or may not be present, but if it is, it is conductive

  • Symptoms: Aural fullness, autophonia, and itching may be present

  • Management:

    • Medical/AuD: Removal

Superior Semicircular Canal Dehiscence (SSCD)

  • Either (Unilateral or Bilateral)

  • Site of Issue: Inner Ear

  • Hearing Loss Characteristics: Appears as a lower frequency pseudo-conductive hearing loss that ranges in severity and configuration. ALL ME TESTS WOULD BE NORMAL WHICH INDICATES SSCD

  • Symptoms: Autophonia, dizziness with loud sounds (Tulio Phenomenon) and pressure (Hennebert's Sign)

  • Management:

    • Medical: Canal plugging

    • AuD: Monitoring