Hearing

Question 1

Describe the etiology/risk factors for eustachian tube disorder & middle ear effusion

Answer 1

• Dilatory type: most common, ear won’t pop
• patulus type: chronic patency
• poorly functioning eustachian tube causing pressure, serous fluid trapping, middle ear effusion, can occur from inflammation

Question 2

Describe the clinical presentation of ETD & MEE

Answer 2

• plugging/fullness
• popping/crackling
• hearing loss
• tinnitus
• disequilibrium
• pain
• retracted TM in ETD
• fluid/bubbles in MEE

Question 3

Describe the diagnostic testing for ETD & MEE

Answer 3

• insufflation: limited movement
• tympanometry: diagnostic
• Weber/Rinne & Audiometry: conductive loss in MEE
• Nasal endoscopy: +/- carcinoma
  Diagnostic criteria: sxs of ETD + otoscopic evidence of retraction or fluid OR tympanogram showing B or C pattern

Question 4

Describe the treatment for ETD & MEE

Answer 4

• treat underlying issue, topical nasal steroids, saline rinse, decongestants
• myringotomy, PE tube placement
• eustachian tube dilation
• may have lingering sx for months
• may lead to perforation, cholesteatoma, hearing loss

Question 5

Describe the etiology/risk factors for cholesteatoma

Answer 5

unsafe ear
benign growth of keratinized skin from middle ear d/t chronic negative pressures causing retratction pockets in tympanic membrane
- commonly acquired
- RF: chronic ETD, poor medical care, LMICs

Question 6

Describe the clinical presentation of cholesteatoma

Answer 6

- CHL
- fullness/plugging
- drainage
- tinnitus
- pain
- imbalance
- CN7 weakness
- chronic perforation + drainage

Question 7

Describe the diagnostic testing/PE for cholesteatoma

Answer 7

• otoscopy, CT temporal bone w/o contrast

Question 8

Describe the treatment of a cholesteatoma

Answer 8

• MC surgery: tympanoplasty, tympanomastoidectomy, ossicular chain reconstruction
• middle ear pressure management with tubes
• address infection
• preserve hearing

Question 9

Describe the etiology/risk factors for barotrauma

Answer 9

• trauma to middle ear from pressure change, +/- damage to tympanic membrane & ossicles
• RF: scuba, airplanes, ETD, infection, blast exposure, hyperbaric O2 treatment

Question 10

Describe the clinical presentation of barotrauma

Answer 10

- plugging/fullness
- pain
- hearing loss
- tinnitus
- bleeding
- drainage
- injected or perforated tympanic membrane

Question 11

Describe the diagnostic testing for barotrauma

Answer 11

• insufflation: floppy TM
• tympanometry: hypermobile vs flat w/ large volume
• Webber/Rinne & audiometry: CHL of TM perforated or ossicles disrupted
• criteria: clinical hx, PE showing injury

Question 12

Describe the treatment of barotrauma

Answer 12

• valsalva maneuver
• candies/gum on planes
• decongestants
• myringotomy/tubes for flying
• paper patch or tympanoplasty for persistent perforations
• spontaneously heal within 2 mos

Question 13

Describe the etiology of presbycusis

Answer 13

age related hearing loss d/t atrophy of the outer hair cells of cochlea and cells in spiral ganglion & vestibulocochlear nerve
- RF: fam hx, white, smoking, vascular/metabolic disease, ototoxic meds, noise exposure, diet

Question 14

Describe the clinical presentation of presbycusis

Answer 14

- progressive bilateral high frequency sensorineural hearing loss
- tinnitus
- disequilibrium

Question 15

Describe the diagnostic testing for presbycusis

Answer 15

audiogram gold standard
- word recognition score determines benefit from hearing aids (50% or greater)
- criteria: audogram showing general symmetric SNHL sloping downward at high frequencies

Question 16

Describe the etiology/risk factors of acoustic neuroma

Answer 16

aka vestibular schwannoma
- benign, usually unilateral, slow growing tumor on CN8
- RF neurofibromatosis-2, childhood radiation exposure

Question 17

Describe the clinical presentation of acoustic neuroma

Answer 17

- unilateral SNHL, tinnitus, unsteadiness, CN5 numbness/pain, CN7 weakness

Question 18

Describe the diagnostic testing for acoustic neuroma

Answer 18

• audiogram: asymmetric SNHL
• vestibular testing +/- normal
  - MRI w/wo IV contrast = gold standard

Question 19

Describe the treatment for acoustic neuroma

Answer 19

• refer to neuro for surgical removal d/t risk of hearing loss, facial/vestibular weakness
• radiation
• observe if minor

Question 20

Describe the etiology/risk factors for Meniere’s Disease

Answer 20

endolymphatic hydrops
- excess fluid buildup in endolymphatic space of inner ear
- RF: 20-40, F>M, fam hx, migraines
- cochlear hydrops similar without vertigo

Question 21

Describe the clinical presentation of meniere’s

Answer 21

- hearing loss, severe tinnitus, vertigo
- spinning, n/v, ear fullness, drop attacks, fluctuating SNHL for low frequencies, tinnitus
- discomfort, nystagmus

Question 22

Describe the diagnostic testing for Meniere’s

Answer 22

• audiogram: unilateral SNHL for low-mid frequencies
• vestibular testing: peripheral hypofunction
• MRI w/wo contrast WNL
• Criteria: 2+ spontaneous episodes of vertigo 20min-12hr, audiometry showing low-mid SNHL, fluctuating aural sx of tinnitus, fullness, distorted hearing

Question 23

Describe the treatment for Meniere’s

Answer 23

• prevention: lifestyle changes (salt, caffeine, nicotine, stress)
• acute: oral/TTI steroids, vestibular rehab, zofran
• last resort: steroids, gentamicin injection, vestibular nerve section, labyrinthectomy

Question 24

Describe the complications of Meniere’s

Answer 24

30% progress bilaterally and most have residual/permanent unilateral effects

Question 25

Describe the etiology/risk factors for tinnitus

Answer 25

Perception of a sound not actually there (symptom or diagnosis) - RF: noise exposure, age, tobacco, anx, insomnia, pain, meds, neuro disorders - can be secondary to hearing loss **Vascular = pulsatile, MSK = clicking/tapping**

Question 26

Describe the clinical presentation of tinnitus

Answer 26

- sound: ringing, hissing, buzzing, tones, water running, white noise, humming - unilateral/bilateral, constant/intermittent

Question 27

Describe the diagnostic testing for tinnitus

Answer 27

**audiogram: usually see hearing loss (also on otoscopy)** - MRA for pulsatile tinnitus with vascular bruit on auscultation - vestibular abnormalities are rare

Question 28

Describe the treatment for tinnitus

Answer 28

- reassurance and education - address underlying cause - refer to ENT for audiogram - masking & redirection: tinnitus retraining therapy