questions 5

Acquired Auditory Disorders

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Topic updated on 04/30/17 5:24pm

Introduction
  • Loss of hearing after having previous auditory functioning
  • Etiologies
    • 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
        • etiologies include
          • airplanes
          • gunshots
          • diving
      • temporal bone fracture
    • malignancy
      • ex.) acoustic neuroma
    • multiple sclerosis
    • pseudotumor cerebri
    • sarcoidosis
Presentation
  • 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
Evaluation
  • Audiometry
  • Brain imaging
Treatment
  • Supportive to surgical depending on cause


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Qbank (5 Questions)

TAG
(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

PREFERRED RESPONSE ▶
TAG
(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

PREFERRED RESPONSE ▶
TAG
(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

PREFERRED RESPONSE ▶
TAG
(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

PREFERRED RESPONSE ▶
TAG
(M2.ET.4751) A 74-year-old female with a history of lung adenocarcinoma status post lobectomy, chronic obstructive pulmonary disease, congestive heart failure, and diabetic nephropathy presents to clinic complaining of hearing loss. Over the last week, she has noticed that she has had difficulty hearing the telephone or the television. When sitting in a quiet room, she also has noticed a high-pitched ringing in her ears. She denies any vertigo or disequilibrium. Further review reveals ongoing dyspnea on exertion and worsening cough productive of whitish sputum for the last month. The patient was recently discharged from the hospital for a congestive heart failure exacerbation. She lives alone and keeps track of all her medications, but admits that sometimes she gets confused. She has a 20 pack-year tobacco history. Her home medications include aspirin, lisinopril, furosemide, short-acting insulin, and a long-acting ß-agonist inhaler. She does not use supplemental oxygen. Two weeks ago she completed a course of salvage chemotherapy with docetaxel and cisplastin. In the office, her temperature is 37.4°C (99.3°F), blood pressure is 150/90 mmHg, pulse is 84/min, respirations are 18/min, and oxygen saturation is 94% on room air. Her tympanic membranes are clear and intact with no signs of trauma or impaction. Auditory testing reveals bilateral hearing impairment to a whispered voice. The Weber test is non-lateralizing. Rinne test is unrevealing.

Hemoglobin: 11.8 g/dL
Leukocyte count: 9,400/mm^3
Platelet count: 450,000/mm^3

Serum (Present visit):
Na+: 134 mEq/L
K+: 3.8 mEq/L
Cl-: 95 mEq/L
HCO3-: 30 mEq/L
BUN: 45 mg/dL
Creatinine: 2.1 mg/dL

Serum (1 month ago):
Na+: 135 mEq/L
K+: 4.6 mEq/L
Cl-: 102 mEq/L
HCO3-: 24 mEq/L
BUN: 22 mg/dL
Creatinine: 1.2 mg/dL

On follow up visit two weeks later, the patient's hearing has significantly improved. Which of the following is the most likely cause of her initial hearing loss? Topic Review Topic

1. Lisinopril
2. Cisplatin
3. Aspirin
4. Docetaxel
5. Furosemide

PREFERRED RESPONSE ▶


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