Hearing Loss Slides (PDF)

12/12/2022 ENT TOPICS- HEARING LOSS PREPARED AND PRESENTED BY K. SOPER, DNP, MS, RN, ANP-BC, AOCNP OBJECTIVES Upon completion of this lecture, student will be able to: List the risk factors associated with hearing loss Understand the pathophysiology as...

12/12/2022 ENT TOPICS- HEARING LOSS PREPARED AND PRESENTED BY K. SOPER, DNP, MS, RN, ANP-BC, AOCNP OBJECTIVES Upon completion of this lecture, student will be able to: List the risk factors associated with hearing loss Understand the pathophysiology associated with hearing loss Describe the clinical presentation and work up of a person with hearing loss Develop a medical plan for a person with hearing loss 1  12/12/2022 INTRODUCTION Hearing loss is the decreased ability or complete inability to hear. The loss may involve the external, middle or inner ear and can be unilateral or bilateral. Definitions of sudden hearing loss have been based on severity, time course, audiometric criteria, and frequency spectrum of the loss. Abrupt as well as rapidly progressive losses have been included under a single definition of sudden hearing loss. Awakening with a hearing loss, hearing loss noted over a few days, selective low- or high-frequency loss, and distortions in speech perception have all been classified as sudden hearing losses. ETIOLOGY SENSORINEURAL CONDUCTIVE Sensorineural hearing loss: a lesion in the Conductive hearing loss: a lesion organ of Corti or in the central pathways, involving the outer and middle ear to including the eighth nerve and auditory the level of the oval window. cortex causes sensorineural hearing loss. Examples include: Presbycusis, noise- Examples: Various structural induced hearing loss and ototoxic drug- abnormalities, cerumen impaction, related hearing loss. Because there is no perforation of the tympanic cure for this, amplification is usually membrane, middle ear fluid, damage required. to the ossicles from trauma or infection, middle ear tumors, trauma, temporal bone fractures 2  12/12/2022 OCCURRENCE Occurs in about 25% of adults more than 50 years old and in over 80% of those more than 80 years old. The most common sensory deficit in older adults Increases with age PATHOPHYSIOLOGY The postulated pathophysiology for A disease process involving any of idiopathic sudden sensory hearing loss has these theoretical possibilities 4 theoretical pathways, as follows: could have sudden hearing loss as Labyrinthine viral infection a symptom. Each theory may explain a fraction of the episodes Labyrinthine vascular compromise of sudden sensory hearing loss, Intracochlear membrane ruptures but none of the existing theories Immune-mediated inner ear disease. individually could account for all episodes. 3  12/12/2022 POTENTIAL CAUSES Infection - Bacterial or Viral Tumor -temporal bone metastases, Inflammation – Sarcoidosis, Wegener carcinomatous meningitis granulomatosis, Cogan syndrome Trauma –Temporal bone fracture, Vascular - Hypercoagulable states (eg, acoustic trauma, penetrating Waldenstrom macroglobulinemia), emboli temporal bone injuries (eg, postcoronary artery bypass graft Toxins - Aminoglycoside [CABG] surgery), post-radiation therapy antimicrobials, cisplatin WORK-UP FOR SUDDEN HEARING LOSS Sudden hearing loss has been called an otologic Information about the onset, time course, emergency. associated symptoms, and recent activities may Patient evaluation should proceed promptly and be helpful. expeditiously. Past medical history may reveal risk factors for Early presentation to a clinician and early hearing loss. institution of treatment improves the prognosis All medications, including over-the-counter for hearing recovery. products, must be described. The immediate goal is discovering a treatable or Aspirin can cause a reversible sensorineural defined cause of the sudden hearing loss. hearing loss, and the list of aspirin-containing products is extensive. 4  12/12/2022 PHYSICAL EXAM Perform a careful head and neck examination, with special Weber test: Place the base of a struck tuning fork attention to the otologic and neurologic examination. on the bridge of the forehead, nose, or teeth. In a Otoscopic examination of the external auditory canal and normal test, there is no lateralization of sound. middle ear to assess for erythema, foreign objects, discharge, With unilateral conductive loss, sound lateralizes lesions, fluid or cerumen. toward affected ear. With unilateral sensorineural Tuning fork tests and a fistula test using pneumatic speculum loss, sound lateralizes to the normal or better- can be performed. hearing side. Rinne’s test & Weber’s test can be performed. Rinne test: Place the base of a struck tuning fork on the mastoid bone behind the ear. Have the patient indicate when sound is no longer heard. While these are not good screening tests for hearing Move fork (held at base) beside ear and ask if now loss, they can help to identify if the loss if audible. In a normal test, AC > BC; patient can hear sensorineural or conductive. fork at ear. With conductive loss, BC > AC; patient will not hear fork at ear. 5  12/12/2022 DIFFERENTIAL DIAGNOSIS Meniere’s disease Acoustic neuroma Embolic or thrombotic phenomenon Trauma Otitis media with effusion Acute otitis media Central auditory processing disorder TREATMENT- NO PREFERRED TREATMENT REGIMEN EXISTS FOR SUDDEN HEARING LOSS Vasodilators: improve blood supply to the cochlea, Anti-Inflammatory Agents: Corticosteroids are the reversing hypoxia. primary anti-inflammatory agents used to treat Rheologic Agents: By altering blood viscosity with the ISSHL. The mechanism of action for corticosteroids use of low molecular weight dextrans, pentoxifylline, in sudden hearing loss is unknown, although or anticoagulants (eg, heparin, warfarin), better oxygen reduction of cochlear and auditory nerve delivery might be achieved inflammation is the presumed pathway. Diuretics: The mechanism of action is not understood Antiviral Agents: Acyclovir and amantadine have had but likely related to cochlear endolymphatic hydrops. 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. 6  12/12/2022 CONSIDERATIONS FOR THE GERIATRIC POPULATION Studies have shown that older adults with hearing loss have a greater risk of developing dementia than those with normal hearing. Hearing loss can impair the exchange of information and significantly impact a geriatric person’s quality of life. Hearing loss may contribute to a faster rate of atrophy in the brain. Hearing loss dramatically effects the elderly person’s ability to interact with others and experience life. Can diminish personal safety, cause social isolation, depression and agitation. REFERENCES Buttaro, T. M., Trybulski, J., Bailey, P. P., & Sandburg-Cook, J. (2017). Primary care a collaborative practice. (5 ed.). St. Louis, Missouri: Mosby Elsevier. Mathur, M. & Meyers, A. (2021, December 28). Sudden Hearing Loss. Retrieved June 17, 2022, from https://emedicine.medscape.com/article/856313-overview 7