Hearing Disorders Inner ear test 3
Neuritis (inflammation of the nerve)
affects the vestibular branch of the auditory nerve, resulting in vertigo/dizziness or but no change in hearing. The term neuronitis (damage to the sensory neurons of the vestibular ganglion) is also used.
SOSNHL (Neoplastic)
Acoustic neuroma Leukemia Myeloma Metastasis to internal auditory canal Meningeal carcinomatosis Contralateral deafness after acoustic neuroma surgery
Treatment
Acute phase: antivert/meclizine, anti-emetic Chronic phase: vestibular rehabilitation therapy (cease and desist on antivert/meclizine and anti-emetics)
SOSNHL Antivirals
Acyclovir Valacyclovir
Chronic Phase
After a period of gradual recovery that typically lasts several days to a week, some people are completely free of symptoms. Others have chronic dizziness if the virus has damaged the vestibular nerve. May experience fleeting disorientations Without necessarily understanding the reason, they may observe that everyday activities are fatiguing or uncomfortable. Difference between acute vertigo and lightheadedness/imbalance
Hearing loss
Hearing loss in Meniere's disease will fluctuate, particularly early in the course of the disease. Eventually, most people experience some degree of permanent hearing loss. A fluctuating SNHL is the hallmark of Meniere's
categories etiology of SHL
(1) viral and infectious, (2) autoimmune, (3) labyrinthine membrane rupture/traumatic, (4) vascular, (5) neurologic, and (6) Neoplastic. There are multiple conditions within each of these categories that have been associated with sudden hearing loss. The following is a partial list of reported causes of SHL
Aural fullness.
-Aural fullness in the affected ear often accompanies Meniere's disease. A typical episode might start with a feeling of fullness in your ear, increasing tinnitus and decreasing hearing followed by severe vertigo, often accompanied by nausea and vomiting. Episodes often occur in clusters, with long periods of mild or no symptoms (remission) between.
Vertigo can also increase your risk of:
-Falls -Accidents while driving a car or operating heavy machinery -Depression or anxiety in dealing with the disease Permanent hearing loss
SOSNHL Diuretics
-Hydochlorothiazide/triamterene -Furosemide
A number of potential causes or triggers have been proposed, including:
-Improper fluid drainage, perhaps because of a blockage or anatomic abnormality -Abnormal immune response -Allergies -Viral infection -Genetic predisposition -Head trauma
SOSNHL (Neurologic)
-Multiple sclerosis -Focal pontine ischemia -Migraine
Noise Induced Hearing Loss (NIHL)
-NIHL can be caused by a one-time exposure to an intense "impulse" sound, such as an explosion, or by continuous exposure to loud sounds over an extended period of time, such as noise generated in a factory. Sources of noise that can cause NIHL include motorcycles, firecrackers, and small firearms, all emitting sounds from 120 to 150 decibels. Long or repeated exposure to sounds at or above 85 decibels can cause hearing loss. The louder the sound, the shorter the time period before NIHL can occur. According to OSHA, sounds of less than 75 decibels, even after long exposure, are unlikely to cause hearing loss. Exposure to harmful sounds causes damage to the hair cells as well as the auditory nerve. Impulse sound can result in immediate hearing loss that may be permanent. This kind of hearing loss may be accompanied by tinnitus which may subside over time. Hearing loss and tinnitus may be experienced in one or both ears, and tinnitus may continue constantly or occasionally throughout a lifetime. Most typically, we expect noise exposure to be binaural with symmetric effects
Presbycusis
-Presbycusis is hearing loss that gradually occurs in most individuals as we age. Hearing loss is a common disorder associated with aging. 30-35 percent of adults aged 65 - 75 have a hearing loss. 40-50 percent of people 75+ have a hearing loss. -The loss associated with presbycusis is usually greater for high-pitched sounds.
What happens over time for noised induced hearing loss
-When a person is exposed to loud noise over a long period of time, symptoms of NIHL will increase gradually. -Over time, the sounds a person hears may become distorted or muffled, and it may be difficult for the person to understand speech. -Someone with NIHL may not even be aware of the loss, but it can be detected with a hearing test -There is a genetic component to NIHL as well We inherit our susceptibility to NIHL genetically
Signs and symptoms of Meniere's :
1.Recurring episodes of vertigo. 2.Hearing loss. 3.Tinnitus. 4.Aural fullness.
SOSNHL Vasodilators
5% carbon dioxide with 95% oxygen (Carbogen) Papaverine Buphenine (nylidrin) Naftidrofuryl (nafronyl) Thymoxamine Prostacyclin Nicotinic acid Pentoxifylline
Defibronigenators
Batroxobin
Medical History and Physical Examination of SOSNHL
Evaluation and management of SHL should be considered medically urgent, if not an emergency. The primary goal is to rule out any treatable causes. Diagnostic evaluation of the patient with sudden hearing loss begins with a thorough history and physical exam. Details of the circumstances surrounding the hearing loss and the time course of its onset should be elicited. Associated symptoms, such as tinnitus, vertigo or dizziness, and aural fullness should also be asked about. Clinical experience has shown that about one-third of patients note their hearing loss upon first waking in the morning, and that about one- half the cases will have associated vertigo. Patients should also be questioned about previous otologic surgery, ototoxic drug use, and previous or concurrent viral or upper respiratory tract infections. Any history of trauma, straining, diving, flying, and intense noise exposure should be noted.
Example of Presbycusis hearing high pitched sounds
For example, it may be difficult for someone to hear the nearby chirping of a bird or the ringing of a telephone. However, the same person may be able to hear clearly the low-pitched sound of a truck rumbling down the street.
Enlarged Vestibular Aqueduct Syndrome (EVAS)
Genetic testing often but not always reveals that EVA is associated with mutation of the SLC26A4 gene (also called the PDS gene) which also causes Pendred syndrome, a condition associated with syndromic hearing loss and thyroid disease. Pendred syndrome occurs in an estimated one-third of all cases of EVA and is an autosomal-recessive genetic disorder, meaning each parent must be a genetic carrier. Some people are born with the hearing loss. However, in most cases of EVAS, a child will hear normally in the first years of life and then notice hearing loss later in childhood, or less commonly in adolescence or early adulthood. Generally, this occurs after a minor or major head impact, upper respiratory infection, or air pressure trauma, such as occurs during the rapid depressurization of an airplane. Even active play, especially jumping, can jar the head enough to result in hearing loss if an EVA is present. The loss can be progressive, fluctuating, stable, or sudden, and can involve tinnitus, a ringing in the ears. However, generally the hearing loss occurs in a series of steps. With each minor event, hearing drops one or more levels, a downward progression often culminating in profound hearing loss.
Time since onset -
His study confirmed that the sooner the patient was seen and therapy initiated, the better the recovery. 56% of patients presenting within the first seven days of their hearing loss recovered compared to 27% who presented thirty days or later.
Hemodiluters
Hydroxyethyl starch Low-molecular-weight dextran
Treatment for SOSNHL
It is unlikely that any single one of these pathophysiologic processes explains all cases of ISSNHL. Treatment regimens aimed at addressing the underlying problem in each of these states have been suggested including decreasing cochlear inflammation, improving inner ear blood flow and oxygenation.
etiology of SHL
It is unlikely that any single one of these pathophysiologic processes explains all cases of ISSNHL. Treatment regimens aimed at addressing the underlying problem in each of these states have been suggested including decreasing cochlear inflammation, improving inner ear blood flow and oxygenation.
Meniere's Disease
Meniere's disease is a disorder of the inner ear that causes spontaneous episodes of vertigo — a sensation of a spinning motion — along with fluctuating sensorineural hearing loss, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear. In most cases, Meniere's disease affects only one ear. People in their 40s and 50s are more likely than people in other age groups to develop Meniere's disease, but it can occur in anyone, even children. Although Meniere's disease is considered a chronic condition, there are various treatment strategies that can help relieve symptoms and minimize the disease's long-term impact on your life
Calcium Antagonists
Nifedipine
Acute Phase
Onset of symptoms is usually very sudden, with severe dizziness developing abruptly. Often, the symptoms are present upon waking in the morning. The sudden onset of such symptoms can be very frightening; many people go to the emergency room or visit their physician on the same day (which is a good thing)
Other agents
Other agents Amidotrizoate Acupunture Iron Vitamins Procaine Remember, these results were found in a patients with audiograms in the so called "steroid effective zone". Patients with profound hearing loss did not benefit significantly from steroid use. They concluded that steroids appear to be of benefit only if the injury is partial and reversible. Some physicians also advocate treatment with diuretics and low salt diet. Athough there is no data to support this treatment, the rationale is based on histopathologic studies of temporal bones in patients with autoimmune SHL which have shown endolymphatic hydrops.
Prognosis for SOSNHL
Spontaneous recovery rates for patients with SHL range from 47% to 63%. These reviews combined patients with partial and complete recovery and patients with all audiogram types. Four variables have been shown to affect recovery from ISSNHL: (1) time since onset, (2) audiogram type, (3) vertigo, and (4) age.
Sudden Onset SNHL
Sudden onset SNHL, (SOSNHL) is also known as idiopathic SNHL Sudden hearing loss (SHL) is a medical emergency for which definitive diagnosis and treatment is still largely unknown. SHL generally a refers to hearing loss of sensorineural origin. It has been defined for research purposes and has been accepted by most authorities as 30 dB or more sensorineural hearing loss over at least three contiguous audiometric frequencies occurring within 3 days. Estimates report approximately 15,000 reported cases of SOSNHL per year worldwide with 4000 of those occurring in the United States. One in every 10,000 to 15,000 people will suffer from this condition, with the highest incidence occurs between 50 and 60 years of age. The lowest incidence is between 20 and 30 years of age. Of the patient suffering from SHL, 2% are bilateral. The incidence was nearly equal in men and women.
Complaints of presbycusis
The speech of others seems mumbled or slurred. High-pitched sounds such as "s" and "th" are difficult to hear and tell apart. Conversations are difficult to understand, especially when there is background noise. A man's voice is easier to hear than the higher pitches of a woman's or child's voice. Certain sounds seem annoying or overly loud. Tinnitus (a ringing, roaring, or hissing, buzzing, chirping, or clicking sound in one or both ears) may also occur.
symptoms of AIED
The symptoms of AIED are sudden hearing loss in one ear progressing rapidly to the second ear. The hearing loss can progress over weeks or months. Patients may feel fullness in the ear and experience vertigo. Can be confused with Meniere's Tinnitus may be experienced. Diagnosis of AIED is difficult because it can mimic Meniere's and other pathologies Most patients with AIED respond to the initial treatment of steroids and methotrexate, a chemotherapy agent. When drug therapy is partially effective, hearing aids may be an option. If the drug therapy is ineffective, CI may be warranted.
Vertigo in Meniere's Disease
The unpredictable episodes of vertigo are usually the most debilitating problem of Meniere's disease. The episodes often force a person to lie down for several hours and lose time from work or leisure activities, and they can cause emotional stress.
Causes of Presbycusis
There are many causes of presbycusis. Most commonly it arises from changes in the inner ear but can also result from changes in the middle ear or from changes along the neural pathways. Presbycusis most often occurs in both ears, affecting them equally. Because the process of loss is gradual, people who have presbycusis often don't realize that their hearing is diminishing.
SOSNHL (Infectious)
Vascular disease/alteration of microcirculation Vascular disease associated with mitochondriopathy Vertebrobasilar insufficiency Red blood cell deformability Sickle cell disease Cardiopulmonary bypass
Recurring episodes of vertigo.
Vertigo is similar to the sensation you experience if you spin around quickly several times and suddenly stop. You feel as if the room is still spinning, and you lose your balance. Episodes of vertigo occur without warning and usually last 20 minutes to two hours or more, up to 24 hours. Severe vertigo can cause nausea and vomiting.
Signs and Symptoms of Neuritis include:
Vertigo/Dizziness and/or imbalance Visual disturbances Nausea Emesis Infections of the inner ear are usually viral; less commonly, the cause is bacterial.
Labryinthitis/Neuronitis
Vestibular neuritis and labyrinthitis are disorders resulting from an infection that inflames the inner ear or the auditory nerve. This inflammation disrupts the transmission of sensory information from the ear to the brain.
Tinnitus
With Meniere's disease, tinnitus is often low-pitched.
Medications for vertigo
Your doctor may prescribe medications to be taken during an episode of vertigo to lessen the severity of an attack: Motion sickness medications, such as meclizine (Antivert) or diazepam (Valium), may reduce the spinning sensation of vertigo and help control nausea and vomiting. Anti-nausea medications, such as promethazine, may control nausea and vomiting during an episode of vertigo.
Autoimmune inner ear disease (AIED)
is an inflammatory condition of the inner ear. It occurs when the body's immune system attacks cells in the inner ear that are mistaken for a virus or bacteria. AIED is a rare disease occurring in less than one percent of the 28 million Americans with a hearing loss.
Labyrinthitis (inflammation of the labyrinth)
occurs when an infection occurs within the cochlea, resulting in hearing changes as well as vertigo/dizziness.
