Hearing Loss
common
prevalence increases with age
classification:
- conductive v. sensorineural
- acute v. gradual
Conductive Hearing Loss
dysfunction of middle or external ear
often temporary
Conductive Hearing Loss: mechanisms
obstruction
mass effect
stiffness
discontinuity
Conductive Hearing Loss: etiology
Most common in adults:
- cerumen impaction
- eustachian tube dysfunction
Sensorineural Hearing Loss: mechanisms
sensory loss
- most common
- dysfunction of cochlea (loss of hair cells)
neural loss
-dysfunction of CN VIII or central auditory pathway
Sensorineural Hearing Loss: etiology
most common: presbycusis
loud noise exposure
trauma
disease
Hearing Loss: diagnostics
formal audiologic assessment:
- pure tone testing
- speech audiometry
- impedance audiometry
evoked responses:
- auditory brainstem response
- VEMP
imaging:
- MRI
- CT
other tests:
- glucose
- CBC
- TSH
- syphilis
- sjorgen’s syndrome
Sensorineural Hearing Loss: treatment
conductive
-surgical correction
sensorineural
- hearing aids
- cochlear implants
refer
education
Tinnitus
perception of sound in hear or head
mild, high pitched sounds (ringing, buzzing, hissing)
continuous or intermittent
associated with sensory hearing loss
prevalence increases with age
men>women
Tinnitus: other forms
pulsatile
- hearing ones own heartbeat
- indicates vascular abnormality
staccato
- rapid series of pops or clicks with sensation of ear fluttering
- middle ear muscle spasm
Tinnitus: unilateral without obvious etiology
consider MRI
Tinnitus: pulsatile
consider MRA, MRV, temporal bone CT
Tinnitus: treatment
patient education treat underlying conditions stop ototoxic medications avoid exposure to excessive noise behavioral therapy masking experimental therapy
Dizziness: ddx
vertigo
disequilibrium
presyncope
nonspecific dizziness
Vertigo
sense of motion when there is no motion (spinning, tumbling, falling)
primary symptom of vestibular disease
classification
central v. peripheral v. mixed
Vertigo: peripheral causes
vestibular neuritis/labrynthitis meniere disease benign positional vertigo ethanol intoxication inner ear barotrauma semicircular canal dehiscence
Vertigo: central causes
seizure multiple sclerosis wernicke encephalopathy chiari malformation cerebellar ataxia syndromes
Vertigo: central
gradual (insidious) onset
progressive increase in severity
gait and posture significantly impaired
NO auditory symptoms
nystagmus
- any direction (vertical)
- nonfatigable
- not latency
- no suppression with visual fixation
Vertigo: peripheral
sudden onset acutely severe symptoms N/V tinnitus hearing loss
nystagmus
- horizontal with rotary component
- mild latency
- fatigable
- will break with fixation
Vertigo: Dik Hallpike maneuver
supine position
head 30 degrees lower than the body
turn L or R
positive: delayed onset fatigable nystagmus (peripheral)
negative: non-fatigable nystagmus (central)
Benign Paroxysmal Positional Vertigo (BPPV)
caused by sediment in semicircular canals (most common: posterior canal)
provoked by changes in head position
- latency period
- acute vertigo, imbalanced for hours
brief episodes, recurrent
appear in clusters
BPPV: treatment
eply maneuver
PT or OT
pharmaceutical agents
bed rest
education: risk for falls
BPPV: Epley Maneuver
sitting position
head rotated 45 degrees
supine position
30 degree neck extension
1-2 minutes
rotate head 90 degrees
1-2 minutes
rotate head 90 degrees (45 degrees downward)
1-2 minutes
sitting position
30 seconds
Labyrinthitis: etiology
inflammatory disorder of vestibular portion of CN VIII
post viral infection
