CC May 2015 Sudden hearing loss

echoecho's version from 2015-05-06 21:10


Question Answer
Define sudden hearing loss?a loss of hearing of at least 30 dB in 3 or more contiguous frequencies over a period of 72 hours
Afftected patients may suffer three ways, name them?1. a sudden loss of hearing that does not return 2. a progressive hearing loss over time 3. sudden hearing loss that improves slightly over time
Hearing loss can be unilateral or bilateral. Which one is more common?unilateral
What 2 conditions should be determined first?1. the severity of hearing loss 2. the type of hearing loss
List the 2 types of hearing loss?1. conductive (outer or middle ear) 2. sensorineural (inner ear or central nervous system)
Why is it important to determine the severity of the hearing loss and the type of hearing loss?because some patients may have multiple underlying factors for sudden hearing loss
***What type of testing should first be done in the evaluation of sudden hearing loss?pure-tone audiometry (best test for evaluating BOTH severity and type of hearing loss)
***Describe pure-tone audiometry?it measures air and bone conduction
*** Although bedside testing with a tuning fork and whisper test can help in the initial assessment of sudden hearing loss, whould this be used alone to determine further work-up?no
Wht shoudl be done if conductive hearing loss is detected?1. inspection of the outer ear and canal for obstruction (cerumen, foreign body, occlusive otitis externa) 2. viscual inspection of the tympanic membrane 3. tympanometry
List the 4 most common etiologies for conductive hearing loss?1. cerumen 2. foreign body 3. trauma tot he ear canal 4. otitis externa
List the 5 most common etiologies for conductive hearing loss?1. barotrauma 2. tympanic perforation 3. cholesteatoma 4. ossicular chain pathology 5. otitis media
List the 10 common etiologies for sensorineural hearing loss?1. idopathic 2. diabetes 3. viral infection 4. syphillis 5. noise induced 6. sarcoidosis 7. acoustic neuroma 8. multiple sclerosis 9. vascular injury 10. autoimmune disorders
If there is more than ____dB hearing loss between ears, magnetic resonance imaging (MRI) with gadolinium should be obtained to evaluate for the possibility of what, however, this should not be ordered untl after pure-tone audiometry?15; acoustic neuroma
Additional testing for underlying disorders (list 4) should be based on hx and PE?1. CVA 2. DM 3. autoimmune disease 4. sarcoidosis
List additional labs that are reasonable second-tier tests?1. D dimer 2. ES
Which is better, CT of the posterior fossa or MRI?MRI
***If no underlying cause can be determined for sudden sensorineual hearing loss, what dx should be suspected?Idiopathic sudden sensorineural hearing loss
*** What is the treatment for Idiopathic sudden sensorineural hearing loss?Oral corticosteroids (prednisolone 1 mg / kg up to a max dose of 60 mg daily) x 7-14 days close follow-up to determine response to therapy