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Questions and Answers
What dB level is considered the boundary for severe hearing loss?
Conductive hearing loss originates from problems in the inner ear.
False
What term describes hearing loss that occurs before the development of speech and language?
Prelingual
Sounds above ______ dB can lead to immediate permanent hearing damage.
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Match the following levels of hearing loss with their dB range:
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Which of the following is important to prevent hearing damage?
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Sensorineural hearing loss is often considered temporary.
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List one common cause of conductive hearing loss.
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Which of the following is NOT a congenital conductive cause of hearing loss?
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Otosclerosis is characterized by abnormal bone growth that improves sound transmission.
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What is the leading cause of sensorineural hearing loss attributed to prenatal infections?
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_____ growth near the stapes in the middle ear is a cause of conductive hearing loss.
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Which of the following conditions can lead to temporary hearing loss of about 25dB?
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Dysfunction of the ossicular chain can cause improper amplification of _____?
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Match the following conductive hearing loss causes with their descriptions:
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Foreign body blockage can impede sound from reaching the eardrum.
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What percentage of genetic causes of hearing loss is attributed to autosomal recessive traits?
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Environmental prenatal factors include exposure to ototoxic drugs and excessive incubator noise.
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What is the condition characterized by the complete absence of the inner ear?
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Both autosomal dominant and autosomal recessive traits can lead to hearing loss that is either ________ or ________.
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Match the following types of hearing loss with their definitions:
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Which of the following is NOT a risk factor for neonates regarding hearing loss?
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High levels of ________ can be toxic to auditory pathways if untreated.
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Name one acquired sensorineural cause of hearing loss.
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Study Notes
Introduction to Hearing and Hearing Loss
- Hearing is the process of receiving sound, analyzing it, and transmitting it to the brain.
- Hearing impairment refers to any loss or abnormality in the ear's structures or auditory pathways' functions.
Range and Levels of Hearing Loss
- Normal Hearing: 10-25 dB
- Mild Loss: 26-40 dB
- Moderate Loss: 41-55 dB
- Moderate Severe Loss: 56-70 dB
- Severe Loss: 71-90 dB
- Profound Loss: Greater than 90 dB
Sound Levels
-
Safe Range (30-75 dB):
- 30 dB: Whisper
- 40 dB: Refrigerator noise
- 60 dB: Normal conversation
- 75 dB: Dishwasher noise
-
Risk Range (85-165 dB):
- 85-95 dB: Heavy city traffic/school cafeteria
- 100-120 dB: Motorcycles/snowmobiles/rock concerts
- 140-165 dB: Fireworks/firearms
Age of Hearing Impairment
- Prelingual: Hearing loss before speech and language development.
- Postlingual: Hearing loss after speech and language development.
Types of Hearing Loss
-
Conductive Hearing Loss:
- Occurs due to problems in the outer or middle ear, blocking or reducing sound transmission.
- Common causes include:
- Obstructions (earwax)
- Infections (otitis externa or otitis media)
- Structural malformations
-
Sensorineural Hearing Loss (SNHL):
- Caused by damage to the inner ear or auditory nerve.
- Often permanent as it usually involves damage to the hair cells in the cochlea or auditory nerve.
-
Mixed Hearing Loss:
- A combination of conductive and sensorineural hearing issues, affecting multiple parts of the ear and auditory pathways.
Causes of Hearing Impairment
- Hearing impairment can be classified based on origin:
-
Hereditary vs. Non-hereditary:
- Genetic factors vs. environmental factors
-
Congenital vs. Acquired:
- Present at birth vs. developed later in life
-
Physiological and Psychological:
- Physical causes vs. mental health factors
-
Prenatal, Perinatal, and Postnatal:
- Before birth vs. during birth vs. after birth
-
Hereditary vs. Non-hereditary:
Risk Factors
- Aging: Natural hearing decline with age.
- Loud Noise Exposure: Damages hair cells in the inner ear.
- Infections and Illnesses: Otitis media, meningitis, and other ear infections.
- Genetics: Inherited conditions can cause hearing loss.
- Injury: Head trauma or ear injuries.
Causes of Hearing Loss: Detailed Classification
Conductive Hearing Loss
Congenital Conductive Causes
- Microtia: Deformities in the external ear (pinna) varying in severity.
-
External Ear Canal Atresia/Stenosis: Complete absence or narrowing of the external ear canal, affecting sound transmission, usually unilateral with other Craniofacial Abnormalities:
- Syndromes like Treacher-Collins, Robin sequence, and Crouzon syndrome.
- Tympanic Membrane Issues: Congenital cholesteatoma (2-3%) can grow a white mass behind the eardrum, causing obstructions.
-
Ossicular Malformations: The ossicular chain (malleus, incus, stapes) may be malformed, hindering sound transmission. (They won't vibrate properly causing improper amplification of sound)
- Stapes atresia is the most common.
- Osteogenesis imperfecta: brittle bone disease, 50% of individuals with OI have hearing loss.
Acquired Conductive Causes
- Otitis Externa: Inflammation/infection of the external auditory canal/pinna or both, often due to bacterial or fungal infections.
- Otitis Media with Effusion: Thick fluid buildup in the middle ear, affecting eardrum mobility and sound conduction. Temporary hearing loss of 25dB until fluid disappears.
- Cholesteatoma: A benign growth that compresses middle ear structures, causing hearing loss due to increased growth size (made of keratin and cells).
- Otosclerosis: Abnormal bone growth near the stapes in the middle ear, restricting movement and sound transmission.
- Foreign Body or Earwax Blockage: These obstructions impede sound reaching the eardrum.
- Trauma: Due to pressure changes, loud noises, temporal bone fractures, etc.
Sensorineural Hearing Loss
Congenital Sensorineural Causes
Prenatal Infections
- Cytomegalovirus (CMV): Common virus leading to sensorineural hearing loss with delayed or progressive onset.
- Toxoplasmosis: Mimics herpes, cytomegalovirus, and rubella.
- Syphilis: Bacterial infection passed by pregnant mothers, becoming infected through the placenta. It can be prevented. Hearing loss by age 2.
Genetic Factors
-
Autosomal Recessive (80% of genetic causes) and Autosomal Dominant (20% of genetic causes): Inherited traits may lead to hearing loss with or without associated syndromes.
- Autosomal dominant: one parent affected, the other is not.
- Autosomal recessive: both parents are carriers of the disease.
-
Syndromic vs. Nonsyndromic:
- Syndromic: hearing loss with abnormalities in other parts of the body.
- Nonsyndromic: hearing loss without symptoms.
Anatomic Abnormalities
- Michel Aplasia (Complete Labyrinth Aplasia): Complete absence of the inner ear.
- Mondini Dysplasia: Partial malformation of the cochlea and other inner ear structures.
- Scheibe (Saccule) and Alexander (Membranous Labyrinth) Anomalies: Degeneration and malformations in inner ear components.
Environmental Prenatal Factors
- Exposure to ototoxic drugs, prematurity, hypoxia, or excessive incubator noise can lead to congenital sensorineural impairment.
Acquired Sensorineural Causes:
- Infections: Bacterial meningitis
- Trauma to temporal bone:
- Noise exposure, tumors, radiation, neurodegenerative disorders:
- Renal tubular acidosis with deafness: Kidney problems and hearing loss.
- Hyperbilirubinemia: bilirubin is toxic to central auditory pathways and cochlear nuclei.
History and Risk Assessment for Hearing Loss
Neonate Risk Factors (0-28 days)
- Family history of hearing loss.
- Low birth weight.
- Low APGAR score.
- Prolonged mechanical ventilation.
- Hyperbilirubinemia (high bilirubin levels) can be toxic to auditory pathways if untreated.
Post-28 Days Risk Factors
- Parental concern.
- Persistent otitis media for over three months.
- Head trauma.
- Bacterial meningitis.
- Specific syndromes linked to hearing loss.
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Description
This quiz covers the fundamentals of hearing and various levels of hearing loss. It includes information on the range of sound levels, the impact of age on hearing impairment, and classifications of hearing loss. Test your knowledge on these essential auditory concepts.
