questions 5

Acquired Auditory Disorders

Topic updated on 01/28/17 8:08am

  • Loss of hearing after having previous auditory functioning
  • Etiolgoies
    • presbycusis
      • age-related hearing loss
      • onset in the 5th-6th decade
      • predominantly a high frequency hearing loss 
    • drug-induced ototoxicity
      • loop diuretics 
      • aspirin
      • aminoglycosides
      • cisplatin
    • lymphadenopathy
      • may result in serous otitis media
    • bacterial meningitis
      • most common cause of hearing loss in children
      • meningitis patients should have their hearing tested following bacterial meningitis
    • otosclerosis
      • one of the most common cuases of hearing loss in adults
      • caused by fusion of otic bones resulting in conductive hearing loss
    • tympanic membrane rupture
      • blunt/penetrating trauma
      • barotrauma
      • temporal bone fracture
    • malignancy
      • ex.) acoustic neuroma
    • multiple sclerosis
    • pseudotumor cerebri
    • sarcoidosis
  • Symptoms
    • gradual to subacute to acute hearing loss
    • may or may not be associated with vestibular symptoms
  • Physical exam
    • Rhine and Weber tests to determine conductive vs sensorineural hearing loss 
    • Rinne test
      • tunning fork placed on the mastoid process
      • normal: air (AC) > bone conduction (BC)
    • Weber test
      • tunning fork placed in the middle of the forehead
    • Normal
      • sound should be of equal intensity in both ears
    • Conduction deafness
      • Rinne: BC > AC (in damaged ear)
      • Weber: lateralization to damaged ear
    • Sensorineural deafness
      • Rinne: AC > BC (in damaged ear)
      • Weber lateralizes to healthy ear
  • Audiometry
  • Brain imaging
  • Supportive to surgical depending on cause


Qbank (4 Questions)

(M2.ET.4) A 52-year-old male presents to his primary care physician for complaints of "hearing loss." He denies any associated symptoms of dizziness or headache. His current medication includes a statin for hyperlipidemia. On physical exam, the Weber test is non-localizing, while a Rinne test displays greater air conduction than bone conduction bilaterally. An audiogram is shown in Figure A. Which is the most likely cause of this patient's hearing loss? Topic Review Topic
FIGURES: A          

1. Otosclerosis
2. Drug-induced ototoxicity
3. Acoustic neuroma
4. Meniere's disease
5. Presbycusis

(M2.ET.5) A 79-year-old woman with hypertension, atrial fibrillation, hypercholesterolemia, gout, Crohn diseases, chronic renal disease, and a previous stroke presents with the onset of tinnitus and decreased hearing bilaterally. If she states that she takes only her prescribed dose, pharmacologic agents for which of the following conditions would most likely have resulted in this presentation? Topic Review Topic

1. Hypertension
2. Atrial fibrillation
3. Hypercholesterolemia
4. Gout
5. Crohn disease

(M2.ET.6) A 53-year-old male presents with new-onset unilateral hearing loss. On otoscopic exam, the tympanic membrane is dull and pneumatic otoscopy reveals hypomobility. This condition is commonly seen as a sequelae of which of the following conditions? Topic Review Topic

1. Hypertension
2. Hypercholesterolemia
3. Rheumatoid arthritis
4. Systemic Lupus Erythematosus
5. Human Immunodeficiency Virus

(M2.ET.16) A 42-year-old male presents to his primary care physician at the urging of his wife who thinks he is becoming increasingly "hard of hearing." He denies any sudden change in hearing, and says that he feels like it has been a gradual process and seems to be worse in his right ear. He denies headaches, vertigo, or imbalance. His past medical history is significant for hypertension, which is well controlled on a thiazide. As part of the physical exam, Weber and Rinne tests are performed. If the patient had otosclerosis of the right ear, which of the following would be the expected result of these two tests? Topic Review Topic

1. Non-lateralizing Weber with air conduction > bone conduction bilaterally
2. Weber lateralizing to the left with air conduction > bone conduction on the right
3. Weber lateralizing to the right with air conduction > bone conduction on the right
4. Weber lateralizing to the left with bone conduction > air conduction on the right
5. Weber lateralizing to the right with bone conduction > air conduction on the right

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