Hearing Loss Overview

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Questions and Answers

What percentage of adults over 50 years old is affected by sudden sensory hearing loss?

25% (correct)

75%

10%

50%

Which of the following is NOT a potential cause of sudden sensory hearing loss?

Temporal bone fracture

Bacterial infection

Cochlear implant failure (correct)

Aminoglycoside toxicity

Which of the following theoretical pathways is NOT associated with idiopathic sudden sensory hearing loss?

Immune-mediated inner ear disease

Labyrinthine viral infection

Auditory nerve compression (correct)

Labyrinthine vascular compromise

What should be the initial step in the work-up for sudden hearing loss?

Receive a thorough patient evaluation Signup and view all the answers

Which age group has the highest occurrence of sudden sensory hearing loss?

Adults over 80 years Signup and view all the answers

Which condition is associated with labyrinthine vascular compromise?

Waldenstrom macroglobulinemia Signup and view all the answers

What type of trauma can potentially lead to sudden sensory hearing loss?

Acoustic trauma Signup and view all the answers

What is the most prevalent sensory deficit found in older adults?

Sudden sensory hearing loss Signup and view all the answers

What is the immediate goal when assessing sudden hearing loss?

To discover a treatable or defined cause Signup and view all the answers

What factor can improve the prognosis for recovery from hearing loss?

Early presentation and treatment initiation Signup and view all the answers

What type of hearing loss does the Rinne test help to specifically identify?

Conductive hearing loss Signup and view all the answers

In a Weber test, with unilateral conductive loss, where does the sound lateralize?

To the affected ear Signup and view all the answers

What is a common reversible cause of sensorineural hearing loss?

Aspirin ingestion Signup and view all the answers

What does a normal Rinne test indicate regarding air conduction (AC) and bone conduction (BC)?

AC > BC Signup and view all the answers

What should be carefully examined during the physical exam for hearing loss?

Head and neck, focusing on otologic and neurologic aspects Signup and view all the answers

Which of the following statements about tuning fork tests is true?

They can help identify sensorineural vs conductive hearing loss. Signup and view all the answers

What defines sudden hearing loss?

Hearing loss characterized by abrupt or rapidly progressive changes Signup and view all the answers

Which of the following is a type of sensorineural hearing loss?

Presbycusis Signup and view all the answers

What is the primary treatment for sensorineural hearing loss?

Amplification devices Signup and view all the answers

What type of hearing loss occurs due to issues in the outer and middle ear?

Conductive hearing loss Signup and view all the answers

Which of the following is NOT included in the classification of sudden hearing loss?

Progressive loss of hearing over years Signup and view all the answers

What can cause conductive hearing loss?

Structural abnormalities in the ear Signup and view all the answers

Which of the following is a common factor associated with hearing loss?

Age-related changes Signup and view all the answers

What does the organ of Corti relate to in terms of hearing loss?

It is involved in the pathophysiology of sensorineural hearing loss Signup and view all the answers

What condition is NOT listed as a differential diagnosis for sudden hearing loss?

Cardiac arrest Signup and view all the answers

Which treatment is used to improve blood supply to the cochlea in cases of sudden hearing loss?

Vasodilators Signup and view all the answers

What is presumed to be the mechanism of action for corticosteroids in treating sudden hearing loss?

Reduction of cochlear and auditory nerve inflammation Signup and view all the answers

How does hearing loss impact the elderly population according to the content?

It can contribute to faster brain atrophy. Signup and view all the answers

What is the relationship between hearing loss and dementia in older adults?

Hearing loss increases the risk of developing dementia. Signup and view all the answers

Which treatment option is mentioned as having limited use in treating hearing loss?

Antiviral agents Signup and view all the answers

What potential consequence of hearing loss can affect the quality of life in older adults?

Social isolation and depression Signup and view all the answers

What is one of the anti-inflammatory agents primarily used to treat sudden hearing loss?

Pentoxifylline Signup and view all the answers

Study Notes

Hearing Loss

Hearing loss is the decreased ability or complete inability to hear.
Hearing loss may involve the external, middle, or inner ear and can be unilateral or bilateral.
Definitions of sudden hearing loss are based on severity, time course, audiometric criteria, and frequency spectrum of the loss.

Sensorineural Hearing Loss

Sensorineural hearing loss involves a lesion in the organ of Corti or the central pathways, including the eighth nerve and auditory cortex.
Examples of causes include presbycusis, noise-induced hearing loss, and ototoxic drug-related hearing loss.
Sensorineural hearing loss is typically irreversible, and amplification is often required.

Conductive Hearing Loss

Conductive hearing loss involves a lesion in the outer or middle ear, up to the level of the oval window.
Examples of causes include structural abnormalities, cerumen impaction, perforation of the tympanic membrane, middle ear fluid, damage to the ossicles from trauma or infection, middle ear tumors, trauma, and temporal bone fractures.

Occurrence of hearing loss

Hearing loss occurs in about 25% of adults over 50 years old and over 80% of those over 80 years old.
It is the most common sensory deficit in older adults and increases with age.

Pathophysiology of sudden hearing loss

Theories for the pathophysiology of idiopathic sudden sensory hearing loss include labyrinthine viral infection, labyrinthine vascular compromise, intracochlear membrane ruptures, and immune-mediated inner ear disease.

Causes of Hearing Loss

Infections: Bacterial or viral
Inflammation: Sarcoidosis, Wegener granulomatosis, Cogan syndrome
Vascular: Hypercoagulable states (including Waldenstrom macroglobulinemia), emboli (including post CABG surgery), and post-radiation therapy
Tumors: temporal bone metastases, carcinomatous meningitis
Trauma: Temporal bone fracture, acoustic trauma, penetrating temporal bone injuries
Toxins: Aminoglycoside antimicrobials, cisplatin

Work-up for Sudden Hearing Loss

Sudden hearing loss is considered an otologic emergency.
Patient evaluation should be prompt and expedited.
Early presentation to a clinician and early institution of treatment improves the prognosis for hearing recovery.

Physical Examination

A careful head and neck examination should be performed, focusing on the otologic and neurologic examinations.
Otoscopic examination of the external auditory canal and middle ear to assess for erythema, foreign objects, discharge, lesions, fluid, or cerumen should be performed.
Tuning fork tests and a fistula test using a pneumatic speculum can be performed.

Tuning fork Tests:

Weber Test: Tuning fork placed on the bridge of the forehead, nose, or teeth. Normally, sound is not lateralized. With unilateral conductive loss, sound lateralizes toward the affected ear. With unilateral sensorineural loss, sound lateralizes to the normal or better-hearing side.
Rinne Test: Tuning fork placed on the mastoid bone behind the ear. Patient indicates when sound is no longer heard. The fork is then moved beside the ear, and the patient is asked if they can hear it again. In a normal test, air conduction exceeds bone conduction. With conductive loss, bone conduction exceeds air conduction.

Differential Diagnosis for Sudden Hearing Loss

Meniere’s disease
Acoustic neuroma
Embolic or thrombotic phenomenon
Trauma
Otitis media with effusion
Acute otitis media
Central auditory processing disorder

Treatment of Sudden Hearing Loss

There is no preferred treatment regimen for sudden hearing loss.
Vasodilators: Improve blood flow to the cochlea to help against hypoxia
Rheologic Agents: Alter blood viscosity using low molecular weight dextrans, pentoxifylline, or anticoagulants (including heparin or warfarin) to improve oxygen delivery
Corticosteroids: Primary anti-inflammatory agents used to treat ISSHL. The mechanism of action is unknown, but it is presumed to reduce cochlear and auditory nerve inflammation.
Diuretics: The mechanism of action is not understood, but it is likely related to cochlear endolymphatic hydrops.
Antiviral Agents: Acyclovir and amantadine have had limited use in treating hearing loss, presuming a viral etiology.
Triodobenzoic acid derivatives: These agents are thought to affect the stria vascularis and assist in maintaining the endocochlear potential.

Considerations for the Geriatric Population

Studies have shown that older adults with hearing loss face an elevated risk of developing dementia compared to those with normal hearing.
Hearing loss can hinder communication and significantly affect an older person's quality of life.
Hearing loss can contribute to faster brain atrophy.
Hearing loss can diminish personal safety, cause social isolation, depression, and agitation.

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Description

This quiz explores the different types of hearing loss, including sensorineural and conductive hearing loss. You will learn about their causes, characteristics, and implications for treatment. Test your knowledge on this crucial aspect of auditory health.