GMSL 7001 Module 5 Audiological Diagnoses, Etiologies & Treatment PDF

Module #5 Audiological Diagnoses, Etiologies & Treatment Considerations Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com. Diagnosing Pathology Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com...

Module #5 Audiological Diagnoses, Etiologies & Treatment Considerations Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com. Diagnosing Pathology Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com “consistent with…” “Results reveal a hearing loss which is cause by…”  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Treatment Considerations Diagnoses, Etiologies and The Outer Ear  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Otalgia of the Outer Ear  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Visible Signs of Outer Ear Pathology  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com The Outer Ear  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Conductive Hearing Loss  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Conductive Hearing Loss  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Then-Otoscopy Visual Inspection is Key First-Visual Inspection  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Otitis Externa  Otitis Externa Otitis Externa: An infection and inflammation of the external ear canal. Characterized by:  Severe otalgia Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com  Active drainage (moist and dripping)  Inactive (crusty and dry).  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Tympanogram and Audiogram Otitis Externa  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Microtia / Atresia / Anotia  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Microtia / Atresia Typing Microtia / Atresia Altmann first reported classification of the degree of microtia / atresia in 1955 Microtia/Atresia is a MEDICAL DIAGNOSIS (Pediatric Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Otology) Degree of hearing loss and recommended type of amplification within scope of practice for audiology (not SLP) Microtia / Atresia Epidemiology 1 in 10,000 to 15,000 births Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com 10% are associated with a syndrome Can be unilateral or bilateral 30% are bilateral Atresia without Microtia 7:1 Microtia / Atresia Tympanogram and Audiogram Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Maximum conductive hearing loss Microtia / Atresia Treatment Considerations Bone Anchored Hearing Aid (BAHA) Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Treatment Considerations: Surgical Intervention Microtia / Atresia  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Occluding Cerumen (Ear Wax) Occluding Cerumen Probably the most common of all pathologies of the outer ear Causes: very narrow ear canal Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com failure to maintain daily hygiene abundance of overactive cerumen glands use of Q-tips in the ear canal Poor positioning (ex., Severe CP)  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Why We Don’t Use Q-tips Why We Don’t Use Q-tips #1. While you may think that you are getting all the ear wax out of your ears with the Q-tip, you have no idea how much wax you are actually pushing further down inside your ear canal. Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Disruption of the body’s natural process of moving dust and dirt out of the ear canal using cerumen and cilia. The body now has to do double the work, continue cleaning the ear canal with the ongoing production of ear wax AND moving the excess ear wax that you have shoved deeper into the ear canal out toward to opening of the canal at the pinna. Why We Don’t Use Q-tips #2. As you use the Q-tip, it may feel good and you move it back and forth as to scratch an itch. This movement actually stimulates the cerumen glands, causing them to produce even more cerumen. Any time you stimulate a Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com gland, it produces more of its intended fluid. Why We Don’t Use Q-tips #3 You do not know how long your ear canal actually is Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Grandma Was Right! “Never stick anything smaller than your elbow in your ear!” Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Audiometry/Tympanometry Impacted Cerumen Volume=0.03ml  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Ear Lavage Treatment Considerations Impacted Cerumen  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Foreign Body in Ear Canal  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Foreign Body in Ear Canal Audiometry and Tympanometry Foreign Body (Can be occluding or non-occluding) Volume=0.03ml Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Foreign Body Treatment Consideration Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Primary Care physician or Otologist/Otorhynolaryngologist ONLY  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Collapsed Ear Canal  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Collapsed Ear Canal Testing Considerations  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Audiometry and Tympanometry Collapsed Ear Canal  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Treatment Considerations: Diagnoses, Etiologies and The Middle Ear Diagnosing Pathology Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com “consistent with…” “Results reveal a hearing loss which is cause by…”  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Etiologies of the Middle Ear Myringosclerosis Myringosclerosis of the tympanic membrane develops in response to infection or inflammation. Irregular white patches consisting of calcium are visible on the membrane. Isolated myringosclerosis of the tympanic Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com membrane rarely causes significant conductive hearing loss. However, extensive myringosclerosis, referred to as tympanosclerosis, involves the tympanic membrane, ossicular chain, and middle ear mucosa, and causes significant conductive hearing loss by stiffening the entire system.  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Myringosclerosis  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Myringosclerosis  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Inactive Drainage Active Drainage Perforated Tympanic Membrane Tympanic Membrane Perforation (Can also be caused intentionally by a Pressure Equalization Tube) Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Tympanic Membrane Perforation Tympanogram and Audiogram  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Clogged PE Tube  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Tympanic Membrane Perforation Tympanoplasty Treatment Considerations  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Otitis Media  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Otitis Media The “Silent” Ear Infection Perhaps one of the most frustrating type of otitis media is the silent infection. There are no outward symptoms There is no fever There is no sign of pain There is no drainage from the ear Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com They are overlooked by the pediatrician The only symptom that the child exhibits is hearing loss  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Otitis Media  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Tympanogram and Audiogram Otitis Media  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Treatment Considerations Otitis Media  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Otitis Media and the AAP (2003/2013)  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Otitis Media and the AAP (2018)  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Eustachian Tube Dysfunction  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Eustachian Tube Dysfunction Eustachian Tube Dysfunction (Why is the prevalence in children so high?) Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Eustachian Tube Dysfunction Tympanogram and Audiogram  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Eustachian Tube Dysfunction Barotrauma  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Eustachian Tube Dysfunction Treatment Considerations  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Cholesteotoma Cholesteotoma A cholesteatoma is an abnormal, non-cancerous skin growth that can develop in the middle section of your ear, behind the eardrum. It may be a birth defect, but it's most commonly caused by repeated middle ear Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com infections. A cholesteatoma often develops as a cyst, or sac, that sheds layers of old skin. It is characterized by a pungent odor emulating from the ear. The “odor” is caused by the decaying skin cells that make up the cystic sac. Cholesteotoma Tympanogram and Audiogram Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Typically, cholesteotomas are unilateral  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Treatment Considerations Cholesteotoma  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Pathologies Causing Mixed Hearing Loss  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Otosclerosis (Conductive or Mixed) Otosclerosis Otosclerosis is an abnormal growth of the bones in the middle ear at the footplate of the stapes, which causes hearing loss. In many cases, surgical intervention in the form of debridement or the placement of a Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com prosthesis may restore some or all hearing.  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com WDS= 96% at 30SL Tympanogram and Audiogram Otosclerosis  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Otosclerosis Epidemiology  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Treatment Considerations: Stapedial Prosthesis Otosclerosis  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Treatment Considerations Otosclerosis  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Ossicular Discontinuity Ossicular Fixation  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Ossicular Discontinuity/Fixation Tympanometry and Audiometry Ossicular Discontinuity/Fixation Treatment Considerations: (Middle Ear Prosthesis) Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Ossicular Discontinuity/Fixation Treatment Considerations Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com  Audiological Diagnoses, Etiologies and Treatment Considerations The Inner Ear Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Etiologies of the Inner Ear  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Sensorineural Hearing Loss  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Presbycusis Presbycusis Presbycusis is the most common type of Sensorineural Hearing Loss caused by the natural aging of the auditory system. It occurs gradually and Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com initially affects the ability to hear higher pitched (higher frequency) sounds. Presbycusis Epidemiology No race, sex differences Increases with wage 25%-30% of people aged 65-75 Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com are estimated to have impaired hearing 40%-50% of people aged 75 and older are estimated to have impaired hearing Westernized countries have very different patterns of hearing loss  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Tympanogram and Audiogram Presbycusis  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Treatment Considerations Presbycusis  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Amplification… Treatment Considerations Presbycusis Presbycusis Treatment Considerations Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Doing nothing about it… Using other OTC devices…  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Ototoxicity  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Tympanogram and Audiogram Ototoxicity  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com 18 months Treatment Considerations Ototoxicity  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Noise Induced Hearing Loss  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Noise Induced Hearing Loss  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Noise Induced Hearing Loss  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Noise Induced Hearing Loss  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Noise Induced Hearing Loss Tympanogram and Audiogram  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Noise Induced Hearing Loss Treatment Considerations  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Cranial Trauma Longitudinal/Transverse Temporal Bone Line Fracture Tympanogram and Audiogram Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com OR Longitudinal/Transverse Temporal Bone Line Fracture Treatment Considerations Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Meniere’s Disease Meniere’s Disease Meniere's disease is a disorder of the inner ear that causes episodes in which you feel as if you're spinning (vertigo), and you have fluctuating hearing loss with a progressive, ultimately permanent loss of hearing, Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear.  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Meniere’s Disease  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Meniere’s Disease  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Tympanogram and Audiogram Meniere’s Disease  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Meniere’s Disease Treatment Considerations Autoimmune Inner Ear Disease (AIED) A syndrome of progressive hearing loss and/or dizziness that is caused by antibodies Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com or immune cells attacking the inner ear. In most cases, there is reduction of hearing accompanied by tinnitus (ringing, hissing, roaring) which occurs over a few months.  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Autoimmune Inner Ear Disease (AIED)  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Tympanogram and Audiogram AIED  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Treatment Considerations Steroidal Therapy AIED  Audiological Diagnoses, Etiologies and Treatment Considerations 8th Cranial Nerve Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Etiologies of the 8th Cranial Nerve Still sensori “neural” in nature, since the terminology does not specifically separate out a sensory hearing loss from a neural one. Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Acoustic Neuroma  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Unilateral Impact Acoustic Neuroma Acoustic Tumors Epidemiology  Accounts for 10% of all brain tumors  80% of all Cerebello-pontine angle tumors  Mean age of 40-60 years old Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com  Male:Female 3:2  Unilateral incidence 90%  Bilateral incidence 10%  (Bilateral tumors seen in neurofibromatosis)  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Tympanogram and Audiogram Acoustic Neuroma Acoustic Neuroma Treatment Considerations Acoustic neuromas are typically benign & inoperable. Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Audiological Diagnoses, Etiologies, and Treatment Considerations Site-of-Lesion Unspecified Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Viral Causes of Hearing Loss Cochleitis is a viral infection of the cochlea. This can be caused by a wide variety of viral diseases including mumps, measles, Cytomegalovirus, human immunodeficiency virus, rubella, chicken pox, Herpes Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Zoster and infectious mononucleosis (EBV).  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Viral Causes of Hearing Loss Epidemiology  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Viral Causes of Hearing Loss Tympanogram and Audiogram Viral Causes of Hearing Loss Treatment Considerations A strong interdisciplinary approach to patient care is vital. Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Without the collaboration of a team of physicians and allied health professionals, the patient is denied better care and overall outcomes.  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Genetically Linked Syndromic and Non-Syndromic Hearing Loss  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Genetically Linked, Non-Syndromic Hearing Loss  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Syndromic Hearing Loss Genetically Linked (an example of Tympanogram and Audiogram) Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Cookie Bite Hearing Loss Genetically Linked Hearing Loss (another example of Tympanogram and Audiogram) Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com “Corner Audiogram”  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Genetically Linked Syndromic Hearing Loss Tympanogram and Audiogram  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Genetically Linked Syndromic Hearing loss Treatment Considerations Genetically Linked Syndromic & Non- Syndromic Hearing Loss Treatment Considerations Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Auditory Neuropathy Spectrum Disorder (ANSD) What is Auditory Neuropathy Spectrum Disorder (ANSD)? ANSD occurs when sounds are received normally by the cochlea, but become disrupted as they travel to the brain. (Normal OAE’s but absent/abnormal ABR) Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Children with ANSD are likely to have greater difficulty understanding speech and distinguishing one sound from another than a child with a similar level of hearing, especially when there is background noise. They may have a similar experience to someone using a mobile phone when the reception is poor and the sounds they hear What is Auditory Neuropathy Spectrum Disorder (ANSD)? Symptoms may not be obvious, or they may only appear over time. Symptoms can vary from mild to severe and are not predictable – they can vary from person to person and change over time. Common Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com symptoms of ANSD include: Hearing loss Changes in hearing – even on a day to day basis Difficulty understanding speech in loud settings or speech that changes quickly Difficulty distinguishing sounds Can’t tell the difference between sounds Sounds may seem distorted or different than expected  What is Auditory Neuropathy Spectrum Disorder (ANSD)? Epidemiology  1:183 diagnosed with SNHL (Journal of ENT/Head & Neck Surg 2016)  In one study genetically linked in 5 out of 22 ANSD SNHL to families (Audio Neurotology, 2010)  In terms of age Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com  14.8% were aged between zero and 20 years,  44.1% were 41 to 60 years old,  7.4% were above the age of 60.  Degrees of Sensorineural Hearing Loss  Mild 29.6%; Moderate 55.5% ; Severe 7.4%; Profound 7.5%  Sex  37% males; 63% females (Brazilian Journal Of Medicine 2013)  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Auditory Neuropathy Spectrum Disorder (ANSD)  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Treatment Considerations ANSD Other Hearing Losses Sudden Sensorineural Hearing Loss Progressive Hearing Loss Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com Psudohypoacoustis  Copyright © 2023 by Jones & Bartlett Learning, LLC. www.jblearning.com …by no means have we covered everything…