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ear lecture

Ear lecture

Meniere's disease dfn Referred to Endolymphatic hydrops Chronic disorder of the labyrinth in the inner ear Labyrinth: system of cavities and canals in the inner ear that affects hearing, balance, and eye movement
Meniere's disease stats Characterized by unknown cause of attacks of: Vertigo Loss of hearing: one or both ears Ringing in the ear Diagnosed about 1 in every 2,000 people: 2.4 millions affected Equally affects men and women between the ages of 35 and 60
Meniere's disease patho Controlled balance and position sense by Semicircular canals of the inner ear & Cranial nerve VIII. Semicircular canal is filled with fluid. Swelling of the part of the semicircular canal: endolymphatic sac.
Meniere's disease patho Endolymphatic sac controls the filtration & excretion of the fluid of the semicircular canal. Unclear the exact cause of the condition Ab high amount of endolymphatic fluid = Abnormal pressure within the inner ear: leads to disturbed balance & hearing.
Meniere's disease risk factors Middle ear infection (Otitis media) Syphilis, Head injury, Viral illness, Respiratory infection Stress, Fatigue, Smoking, Alcohol use
Meniere's disease clinical manifestations Repeated episodes of sudden, severe dizziness Worse with sudden mvmt Lost low frequency noises first and may have changes in the extent of hearing loss  Tinnitus, Nausea/Vomiting Sweating: may be profuse Loss of balance Feeling of fullness in the e
Meniere's disease clinical manifestations timing CMs appear periodically and can last from a few hours to most of a day or longer. May have no symptoms at all for long periods from several hrs to yrs
Meniere's disease triggers and timing Most ppl experience few attacks & learn to cope with the inconvenience & discomfort associated with the s/s Commonly identified symptom triggers High salt Too much caffeine or alcohol High level of stress.
Meniere's disease comorbidities Some people who suffer from debilitating nausea, vertigo, and complete deafness
Meniere's disease diagnostic tests Neurological exam: abnormality of cranial nerve VIII. Ct scan or MRI: to rule out other problems related to head. Electroencephalogram – brain waves. Weber test: usually shows sensorineural hearing loss (both ears have poor hearing)
Meniere's disease diagnostic tests Auditory brain stem response: measures electrical activity in the hearing nerve and brain stem Electrocochleography: records the electrical activity of the inner ear in response to sound
Meniere's disease diagnostic tests Electronystagmography: measure involuntary, rapid eye movement in response to stimulation of vestibular system (most common with hot water in ear canal to watch rapid eye mvmt)
Meniere's disease medical management No known cure Treatment is focused on relieving symptoms by decreasing the pressure within the endolymphatic sac.
Meniere's disease lifestyle changes Limit daily sodium intake to 1500 mg to reduce fluid retention Reduction of stress: biofeedback, meditation, yoga, daily exercise Avoid vasoactive stimulants (caffeine and alcohol) No smoking Avoid sudden movements that may aggravate symptoms
Meniere's disease lifestyle changes Help may be needed with walking b/c loss of balance. Rest during severe episodes & gradually incr activity Avoid hazardous activities until 1 wk after symptoms disappear. Avoid bright lights, TV, or reading which may make symptoms worse during episodes
Meniere's disease medications Decrease inner ear pressure Diuretics: Dyazide, Furosemide, Methazolamide (carbonic anhydrase inhibitor commonly used for glaucoma to decrease eye pressure) by increasing fluid excretion thru kidneys
Meniere's disease medications: Controlling vertigo, nausea, and vomiting Valium, Antivert: sedate the vestibular sys Phenergan: help n-v & vertigo anti-histamine effect Maj of pts: success tx with conservative Txs 20-40% of patients continue to have disabling attacks of vertigo may less conservative treatment such as surger
Conductive hearing loss affect the outer/external or middle ear Interrupted nml trans of sound waves from the tympanic membrane to the sensory part of the middle ear neg Rinne test: BC>AC: beter bone than air conduction Not always perm treated medically or surgically.
Risk factors for conductive hearing loss Earwax build-up, Severe ear infections Acoustic trauma (i.e. explosion, loud noise): Harden and less mobile middle ear bones (Otosclerosis) Middle ear infections (otitis media).
Sensorineural heaing loss Permanent hearing loss from damage to the pathway that sound impulses take from the hair cells of the inner ear to the auditory nerve and the brain.
Risk factors for hearing loss Presbycusis, Drugs, Acoustic traumaAcoustic trauma by loud noise: damage hair cells. Acoustic neuromas: benign tumor affecting the auditory nerve Mumps, Meningitis: loss of hair cells or damage to auditory nerve Meniere's Disease neuro conditions
Presbycusis Age-related hearing loss partly due to the loss of hair cells in the cochlea progressive: starts with high-freq sound such as speech
Drugs r/t sensorineural hearing loss powerful antibiotics, high doses of aspirin (temporary tinnitus), anti-malarial drug (Quinine)
CM of presbycusis diff to hear high-pitched voices of wmn & child Distortion of sound in speech: may confuse consonants: S, F, SH, CH, C Diff understanding speech in noisy enviro
Med management of presbycusis no known cure; tx focused on fcnl improvement reading lips and visual cues may help Prognosis: hearing loss is pregressive may lead to deafness annual hearing test
Noise-induced hearing loss aka: occupational hearing loss dmg to inner ear from noise or vibration from job or entertainment max job noise exposure reg by law: prot measures taken partial, complete, or progressive hearing loss may not be corrected
Otosclerosis Abnml growth of bone of inner ear affects stapes: becomes fixed into the oval window and interferes with sound waves most common cause of conductive in yg adults: age 30 unknown cause 10% of pop runs in fam both ears asymmetrical rates of hearing l
CM of otosclerosis slow, progressive hearing loss hearing better in noisy than quiet areas ringing in ears (tinnitus) reddish or pinkish-orange tympanic membrane b/c increased vasc of middle ear Rhinne: BC= or > AC diff conversing in person, better on phone
Diagnostic tests for otosclerosis audiometry, CT scan of head skull x-ray: rule out other cause of hearing loss
Med management of otosclerosis conservative tx to communicate (hearing aid) sodium flouride stependectomy: microscopic laser surgery to remove disease stapes
Sodium Flouride tx otosclerosis slow bone absorption & enhance calcification of new bone, essentially to prevent further disease progression: can stabilize hearing loss in 80% reduce tinnitus & s/s of imbalance SE: rash, arthritis, and GI
Audiogram/audiometry measured air conduction placing earphones over both ears and tests ability to hear various sound freq hearing threshold: quietest sound heard by the person nml: 20dB or better
Created by: Marissagostanian