Hearing Problems

Question 1

What are some causes of presbycusis? Which population experiences it?

Answer 1

– causes:

• degeneration of tissue
  
  • damage to nerves in cochlea
  • decreased elasticity of basal membrane
  • decreased blood supply
• B12 deficiency
• acid deficiency

– population = high incidence in adults 70 - 80 years old

Question 2

What is the difference between conductive and sensorineural hearing loss?

Answer 2

– conductive hearing loss: obstruction in sound wave transmission

• obstruction present
• abnormal tympanic membrane
  
  • perforation
  • infection
• pts speak softly
• pts hear best in noisy environments
• Rinne test
  
  • air conduction > bone conduction
• Weber test
  
  • lateralization to affected ear

– sensorineural hearing loss: persbycusis or hearing loss due to excessive noise exposure, otoxicity, or infection

• normal external/tympanic membrane
• tinnitis/occasional dizziness
• pts speak loudly
• pts hear poorly in noisy environments
• Rinne test
  
  • air conduction < bone conduction
• Weber test:
  
  • lateralization to unaffected ear

Question 3

Discuss the difference between the etiologies of conduction and sensorineural hearing loss.

Answer 3

– conductive hearing loss:

• inflammation
• obstruction of external or middle ear
• changes in eardrum
• otosclerosis – overgrowth of soft bony tissue on ossicles

– sensorineural hearing loss:

• damage to inner ear or auditory nerve (CN VIII)
  
  • prolonged exposure to loud noises
  • ototoxic drugs
    
    • NSAIDs
    • amnioglycosides
    • diuretics
  • presbycusis

Question 4

What is otitis media? What is the difference between acute and chronic otitis media? What are some signs and symptoms? What are some interventions?

Answer 4

– otitis media: middle ear infection

• acute: sudden onset; 3 week duration
• chronic: repeat episodes; each episode causes even more damage to middle ear
  
  • could result in eardrum perforation and necrosis of ossicles and hearing loss if untreated

– s/s:

• ear pain
• reduced hearing
• tinnitus
• h/a
• malaise
• nausea
• dizziness

– interventions:

• drugs:
  
  • analgesics
  • antihistamines
  • decongestants
• surgery:
  
  • myringotomy
    
    • surgical opening of eardrum
    • relieves pain in ear
    • allows fluid to drain

Question 5

What is external otitis? What are some causes? What are some signs and symptoms? What are some interventions?

Answer 5

– external otitis: inflammation to outer ear

– causes:

• infection – most common
• water sports
  
  • common in summer time
  • common in pts who spend a lot of time outside
• trauma from insertion of objects into ear
• headphones

– s/s:

• painful, red, swollen external ear
• temporary hearing loss

– interventions:

• remove materials from ear cannal
• apply heat to ear 3x per day
• drugs:
  
  • topical antibiotics
  • eardrops
  • PO or IV antibiotics for severe cases

Question 6

What is mastoiditis? What are some signs and symptoms? What are some interventions?

Answer 6

– mastoiditis: infection of mastoid air cells (protect the structures of the ear and regulate pressure within the ear)

• caused by progressive otitis media

– s/s:

• swelling behind ear
• pain when moving ear or head
• red, dull, thick, immobile eardrum

– interventions:

• antibiotics
• surgical removal of infected tissue if no response to antibiotics

Question 7

What parts of the ear can experience trauma? How long do eardrum perforations take to heal? What are some complications of trauma?

Answer 7

– can occur to eardrum, ossicles, or middle ear structures

– most perforations heal within 1 - 2 weeks without treatment

• repeat perforations heal slowly and can scar

– if ossicles are damaged, auditory and sensory perception may not return

Question 8

What is tinnitus? How is it diagnosed? What are some interventions?

Answer 8

– tinnitus: ringing in the ear(s)

– diagnosis:

• testing cannot confirm but can assess hearing which can rule out other disorders

– interventions:

• mask tinnitus

Question 9

What is meniere disease? Which population experiences it more frequently? What are some signs and symptoms? What are some interventions?

Answer 9

– meniere disease: disorder of the inner ear which can result in dizziness (vertigo) and hearing loss

• due to progressive fluid accumulation in the ear
• usually affects one ear, but can progress to the other ear

– population = 20 - 60 years old

– s/s:

• episodic vertigo
• tinnitis
• hearing loss
  
  • may be reversible at first
  • repeat damage can lead to permanent loss

– interventions:

• move slowly
• physical therapy – vestibular rehabilitation
• drug therapy