PMS III Week 8: Hearing Loss
Terms in this set (78)
Original
How do we hear?
Complex pathway that changes sound waves traveling through the air into electrical signals to the
auditory nerve which carries these signals to the brain.
Hearing Pathway
1. Sound waves enter the outer ear and travel through EAC leading to the TM
2. TM vibrates from sound waves and sends vibrations to ossicles (malleus, incus, stapes) within the
middle ear space
3. Vibrations from ossicles pass through the oval window into the inner ear. The inner ear, the
cochlea, houses fluid which ripples secondary to the vibrations causing a traveling sound wave along
the basilar membrane consisting of hair cells that generate the signal for the auditory nerve
4. The sound wave ends at the round window where the energy is released
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Brainpower
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History and physical questions
One ear? Both ears? One ear worse than the other?
Duration? Sudden vs Gradual
What makes it better/worse? Provocative vs Palliative factors
Injury/Trauma/Recent travel?
Recent infection/illness?
History of surgery, trauma, recurrent ear infections, pregnancy
Family history of hearing loss? What age?
New medications?
Noise exposure? Occupational, military, hobbies
Associated symptoms:
Pain, pressure, popping, drainage, ringing, headache, vertigo
Physical Exam
External ear: lesions, injury/trauma, proptosis, redness, drainage
EAC: cerumen, FB (bugs, Qips, cotton, ear buds, ear plugs, beads, earrings), drainage, blood,
lesions, mass
TM: intact? Perforation- how big? Thick? Scarring (tympanosclerosis), retraction, cholesteatoma
, STUVIA
Middle ear: effusion- serous vs mucoid?, masses (glomus tumor)
Rinne Test
Normal hearing will show an air conduction that is longer and louder than bone conduction
If you have conductive hearing loss, the bone conduction is heard louder than the air conduction
sound.
If you have sensorineural hearing loss, air conduction is heard louder than bone conduction, similar to
normal hearing
Webber Test
Normal hearing: equal sound in both ears.
Conductive loss: sound to be heard best in the abnormal ear.
Sensorineural loss: sound to be heard best in the normal ear.
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Pneumatic Otoscopy
Helpful to detect middle ear effusion and key in diagnosis otitis media with effusion (OME)
Shown to have high sensitivity and specificity for diagnosis
Allows determination of the mobility of the TM in response to pressure changes
Normal TM: moves in response to pressure
Immobility: due to fluid in the middle ear, perforation, tympanosclerosis
Toynebee Maneuver
Used in office to equalize pressure within the middle ear
Combination of the valsalva maneuver and swallowing
Instruct patient to plug both nostrils and position their tongue on the roof of their mouth and swallow.
The action of swallowing causes the tongue to move gently upward, which facilitates the muscle
movement of the palate required to equalize the pressure.
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