Auditory Apparatus

[DeeJay2728]

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Has anyone seen a lot of HY ear stuff while doing banks or NBMEs?

 

[ArmyTiger]

Has anyone seen a lot of HY ear stuff while doing banks or NBMEs?

OI/Alport's Syndrome/Paget's Disease lead to decreased hearing, aminoglycosides/loop diuretics/thiazides/cisplatin have ototoxicity. You can get schwannomas of CNVIII that lead to hearing loss. The bugs (not viruses) that cause URIs can cause otitis media.

 

[Missorleans]

You should also have a good understanding of the Weber and Rinne tests and what findings are associated with what pathologies. Probably missed a question on a test yesterday about that 🙁

 

[DeeJay2728]

Good ones, thanks guys!!!

 

[alicealicealice]

Def know Weber/Rinne.
Rinne: Hit fork. Place bottom of fork on mastoid. Count till person says they can't hear. That bone conduction time (BC). Then quickly put the tines of the fork next to their ear and count till person says they can't hear. Thats air conduction time (AC). If BC>AC, or if they can't hear the fork at all after your remove it from the mastoid, its conductive loss. Rinne is not really useful for sensorineural loss as both would be diminished equally (so the times would be shorter compared to a normal person, but AC is still > than BC).

Weber: Hit fork, place on midline on top of head. Sound lateralizes to bad ear in conductive hearing loss (stick your finger in your ear and hum to prove it to yourself) and to good ear in sensorineural hearing loss.

Don't get caught up in details, they're crappy tests in real life, in questions it will be clear if you know the above basics.

A random list, not all necessarily high yield:

Malignant otitis externa: diabetics, pseudomonas, tx PO ciprofloxacin (topicals dont work)
BPPV (Benign Position Paroxysmal Vertigo): Dx with Dix Hall Pike, TX with Epley maneuver. NO hearing loss, NO tinnitus, NO ataxia, NO CN palsy.
Menineres Disease: Tinnitus, Hearing loss, profound vertigo lasting 30 mins with nasuea/vomiting. Some doctor dude records himself on youtube while hes having an attack and describes it as it occurs, watch that and youll never forget the presentation. HY Pathogenesis: Due to Increased Endolymphatic Fluid (endolymph hydrops). LOW frequency hearing is lost first. Unlike neuritis and labyrinthitis, it is relapsing and remitting. The first line treatment is diuretics and salt restriction.

Vestibular Neuritis: Viral prodrome followed by vertigo. Affects vestibular nerve only therefore NO hearing loss or tinnitus . Tx symptoms with meclizine (antihistamine).
Labyrinthitis: Viral prodrome. Affects the whole labyrinth, therefore BOTH hearing loss/tinnitus and vertigo (distinguished from vestibular neuritis).
Presbyacusis: Age related bilateral senorineural hearing loss that comes from atrophy of the apparatus at the base of the cochlear membrane therefore you lose HIGH frequency first. This results in difficulty hearing in crowded areas with background noise.

Noise Induce hearing Loss: Either due to one time acoustic trauma (explosion) or continued exposure (rock band), sensorineural (affects the cochlea, specifially the cilia). Note that not all acoustic trauma = a ruptured eardrum.
Otosclerosis: Usually unilateral conductive hearing loss in a young (20-30 year old) patient. Differentiated from menieres by being bilateral and/or having conductive instead of sensorineural hearing loss. Also no tinnitus. Supported by (+) Family History of hearing loss.
Cholesteatoma: keratin accumulation in middle ear that presents with ear discharge, conductive hearing loss, facial twitching and weakness. Ear Discharge + Hearing Loss = Cholesteatoma until proven otherwise. (look up some pics)
Petrosal Bone Fracture: Sensorineural hearing loss after major head trauma with hemotympanum, due to laceration of CN8
Acoustic Neuroma = Vestibular Schwannoma: insidious ipsilateral sensorineural hearing loss + tinnitus + ataxia in a 50-70 yo or a pt with NF
Pagets Disease of Bone: Sensorineural hearing loss in old man with increasing hat size and headaches. Isolated elevated alk phos. Nerve impingement due to ostetitis deformans
Bacterial Meningitis (especially basilar)
Hypothyroid: Can cause Sensorineural hearing loss
Drugs: Quinine (cinchonism), Aminoglycosides, Furosemide + cepahlosporin combo, cisplatinum, Aspirin overdose in questions presents with tinnitus, hyperthermia (oxidative phosphorylation decoupling), and mixed metabolic acidosis and respiratory alkalosis (hyperventilation due to direct action on respiratory center)

Also, hearing loss or tinnitus + nystagmus = peripheral nystagmus (CN8).
Vertical or bidirectional nystagmus = central nystagmus (cerebellar). PCP intoxication classically presents with vertical nystagmus and violent behavior.

 

[DeeJay2728]

Thank you, this is EXACTLY what I was looking for!!!!!

 

[dyspareunia]

Def know Weber/Rinne.
Rinne: Hit fork. Place bottom of fork on mastoid. Count till person says they can't hear. That bone conduction time (BC). Then quickly put the tines of the fork next to their ear and count till person says they can't hear. Thats air conduction time (AC). If BC>AC, or if they can't hear the fork at all after your remove it from the mastoid, its conductive loss. Rinne is not really useful for sensorineural loss as both would be diminished equally (so the times would be shorter compared to a normal person, but AC is still > than BC).

Weber: Hit fork, place on midline on top of head. Sound lateralizes to bad ear in conductive hearing loss (stick your finger in your ear and hum to prove it to yourself) and to good ear in sensorineural hearing loss.

Don't get caught up in details, they're crappy tests in real life, in questions it will be clear if you know the above basics.

A random list, not all necessarily high yield:

Malignant otitis externa: diabetics, pseudomonas, tx PO ciprofloxacin (topicals dont work)
BPPV (Benign Position Paroxysmal Vertigo): Dx with Dix Hall Pike, TX with Epley maneuver. NO hearing loss, NO tinnitus, NO ataxia, NO CN palsy.
Menineres Disease: Tinnitus, Hearing loss, profound vertigo lasting 30 mins with nasuea/vomiting. Some doctor dude records himself on youtube while hes having an attack and describes it as it occurs, watch that and youll never forget the presentation. HY Pathogenesis: Due to Increased Endolymphatic Fluid (endolymph hydrops). LOW frequency hearing is lost first. Unlike neuritis and labyrinthitis, it is relapsing and remitting. The first line treatment is diuretics and salt restriction.

Vestibular Neuritis: Viral prodrome followed by vertigo. Affects vestibular nerve only therefore NO hearing loss or tinnitus . Tx symptoms with meclizine (antihistamine).
Labyrinthitis: Viral prodrome. Affects the whole labyrinth, therefore BOTH hearing loss/tinnitus and vertigo (distinguished from vestibular neuritis).
Presbyacusis: Age related bilateral senorineural hearing loss that comes from atrophy of the apparatus at the base of the cochlear membrane therefore you lose HIGH frequency first. This results in difficulty hearing in crowded areas with background noise.

Noise Induce hearing Loss: Either due to one time acoustic trauma (explosion) or continued exposure (rock band), sensorineural (affects the cochlea, specifially the cilia). Note that not all acoustic trauma = a ruptured eardrum.
Otosclerosis: Usually unilateral conductive hearing loss in a young (20-30 year old) patient. Differentiated from menieres by being bilateral and/or having conductive instead of sensorineural hearing loss. Also no tinnitus. Supported by (+) Family History of hearing loss.
Cholesteatoma: keratin accumulation in middle ear that presents with ear discharge, conductive hearing loss, facial twitching and weakness. Ear Discharge + Hearing Loss = Cholesteatoma until proven otherwise. (look up some pics)
Petrosal Bone Fracture: Sensorineural hearing loss after major head trauma with hemotympanum, due to laceration of CN8
Acoustic Neuroma = Vestibular Schwannoma: insidious ipsilateral sensorineural hearing loss + tinnitus + ataxia in a 50-70 yo or a pt with NF
Pagets Disease of Bone: Sensorineural hearing loss in old man with increasing hat size and headaches. Isolated elevated alk phos. Nerve impingement due to ostetitis deformans
Bacterial Meningitis (especially basilar)
Hypothyroid: Can cause Sensorineural hearing loss
Drugs: Quinine (cinchonism), Aminoglycosides, Furosemide + cepahlosporin combo, cisplatinum, Aspirin overdose in questions presents with tinnitus, hyperthermia (oxidative phosphorylation decoupling), and mixed metabolic acidosis and respiratory alkalosis (hyperventilation due to direct action on respiratory center)

Also, hearing loss or tinnitus + nystagmus = peripheral nystagmus (CN8).
Vertical or bidirectional nystagmus = central nystagmus (cerebellar). PCP intoxication classically presents with vertical nystagmus and violent behavior.

This is interesting. We weren't taught to count for Webber/Rinne. The only thing we were taught to do is ensure that AC>BC by holding the fork on the mastoid (as you said) until pt can't hear it anymore then moving it near the auricle. If they can hear it, then AC>BC and you're done (no counting time or anything). If they can't hear it, then BC>AC and you have a problem.

 

[alicealicealice]

This is interesting. We weren't taught to count for Webber/Rinne. The only thing we were taught to do is ensure that AC>BC by holding the fork on the mastoid (as you said) until pt can't hear it anymore then moving it near the auricle. If they can hear it, then AC>BC and you're done (no counting time or anything). If they can't hear it, then BC>AC and you have a problem.

I threw that in there because i had a step 2 UW q that put it that way. The simple hear it or not test is specific and not as sensitive. Technically, AC:BC should be a 2:1 ratio. http://www2.webster.edu/~davittdc/ear/rinne/rinne.htm. In real life no one counts, but in the UW q they did and AC<BC. But even if you didnt know about the counting, if they gave you numbers and AC<BC you should still be able to figure out its conductive hearing loss.