🤔 MEDIUM

Hearing loss can be very isolating and so it’s important to have an understanding of the different causes and tests available to diagnose the types of hearing loss

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Hearing Loss

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Question 1

Stem 1, question 1 of 5

Tyler, a 44 year old man, presents with gradual unilateral hearing loss in his left ear to his GP. He states his ear feels full and sometimes there is discharge, but he is systemically well. He regularly cleans his ears with cotton buds.
What is the most likely diagnosis?
A
Infection
B
Otosclerosis
C
Goldenhar syndrome
D
Foreign body
E
Cerumen
Question 1 Explanation: 
A build up of cerumen aka ear wax causes hearing loss by the impaction of wax and is more common in those who clean their eats with instruments like cotton swabs. Accumulaton of cerumen causes symptoms such as hearing loss, fullness, otorrhoea, tinnunitus, and dizziness.
Question 2

Stem 1, question 2 of 5

The GP informs the patient that the cerumen has resulted in a conducted hearing loss. What is conductive hearing loss?
A
Damage to the inner ear or auditory nerve resulting in hearing loss
B
Damage or a problem with the external and middle ear by interfering with the ability of sound to be transmitted to the inner ear
C
Damage to the ossicles resulting in the inability to transmit sound
D
Damage to brain that results in the inability to perceive the neural message
E
The presence of a foreign body that prevents sound waves from reaching the ossicles
Question 2 Explanation: 
Conductive hearing loss occurs in the external and middle ear by interfering with the ability of sound to be transmitted to the inner ear, with many causes reversible.
Question 3

Stem 1, question 3 of 5

The patient asks what he can do to treat the cerumen build up. Which of the following is a cerumenolytic agent?
A
Docusate
B
Cimetidine
C
Acetazolamide
D
Disopyramide
E
Quinidine
Question 3 Explanation: 
Docusate is a cerumenolytic agent, as is olive oil! This is a simple management that patients can do themselves with aural irrigation at home.
Question 4

Stem 1, question 4 of 5

Tyler's sister, Elena a 28 year old , presents to the GP also with progressive hearing loss in both ears. Elena has noticed that she speaks more quietly but hears better in noisy environments.
What is the most likely diagnosis?
A
Ramsay Hunt Syndrome
B
Foreign body
C
Otits media
D
Otosclerosis
E
Congenital atresia of the external acoustic meatus
Question 4 Explanation: 
Otosclerosis is the commonest cause of progressive deafness in young adults. The base of the stapes becomes thickened and fuses with the cochlea and as such results in a conductive hearing loss Individuals often talk more quietly but hear better in noisy environments and hear sounds from their bodies.
Question 5

Stem 1, question 5 of 5

Elena is sent for a CT scan of the temporal bone. What finding is seen in otosclerosis?
A
Uniformly enhanced, dense mass extending into the internal acoustic meatus
B
A fracture of the temporal bone
C
New bone formation around the oval window
D
Mass in middle ear and erosion of the jugular bulb
E
Unremarkable
Question 5 Explanation: 
Answer one describing an accoustic neuroma, answer two describes a temporal bone fracture, the third is a glomus tumour. Otosclerosis results from abnormal bone growth and so visible on CT scan
Question 6

Stem 2, question 1 of 4

Olivia, 77 year old female, presents to her GP with a 12 month history of gradual bilateral hearing loss.
What is the most likely diagnosis?
A
Ototoxcity
B
Ramsay Hunt syndrome
C
Toxoplasmosis
D
GATA2 deficiency
E
Presbycusis
Question 6 Explanation: 
Presbyacusis aka age related hearing loss is a insidious and gradual hearing loss that is usually bilateral. It is a form of sensorineural hearing loss. It is a very common condition and usually results in high frequency hearing loss. It is a multifactorial condition combining intrinsic and environmental factors.
Question 7

Stem 2, question 2 of 4

In the winter, Olivia develops a Community Acquired Pneumonia and is treated with gentamicin. Her hearing suddenly deteriorates, what is the most likely cause of this?
A
Macrolide ototoxicity
B
Viral infection
C
Aminoglycoside ototoxicity
D
Hypopastic auditory nerve
E
Expected worsening of presbycusis
Question 7 Explanation: 
There are a number of drugs that can result in ototoxicity, the ears and hearing system are exquisitely sensitive to drug levels act a little like the canaries in the mine, working as the early warning system. Both macrolides and aminoglycosides can result in ototoxicity, but as gentamicin is an aminoglycoside that is the correct answer. If this occurs, remove the offending drug, monitor drug levels and promote excretion by giving fluids.
Question 8

Stem 2, question 3 of 4

Olivia's grandchild is born with hearing loss, which of the following is not a congenital cause of sensorineural hearing loss?
A
Congenital rubella syndrome
B
Cytomegalovirus
C
Hypoplastic auditory nerve
D
GATA2 deficiency
E
Treacher-Collins syndrome
Question 8 Explanation: 
The question tests whether you understand the difference between causes of congenital conductive hearing loss and congenital sensorineural hearing loss. Treacher-Collin Syndrome results in abnornalities of the external ear and ossicles thus results in a conductive hearing loss. The other answers are all causes of congenital sensorineural hearing loss.
Question 9

Stem 2, question 4 of 4

Audiometry tests are used to assess hearing loss, what does pure tone audiometric air conduction measure?
A
The individual's ability to hear and understand speech
B
The movement and air pressure of the middle ear system
C
The cochlea and neural function
D
The lowest intensity in decibels at which a tone is perceived 50% of the time
E
The middle ear reflexes
Question 9 Explanation: 
Pure tone audiometric air conduction measures the lowest intensity in dB at which this tone is perceived 50% of time, the indication for this is to test air conduction. The other options are for the following tests respectively: Speech testing, impedance audiometry, auditory brainstem response
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