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Explain common problems pertaining to the auditory system

Contents Key to resources 1 Introduction 2 Congenital hearing loss 2 Outer ear pathologies 3 Middle ear pathologies 4 Inner ear pathologies 4 Tinnitus 5 The ear and body systems 6 Summary 7 Further reading 7 Feedback to activities 9

Key to resources Resources The following resources are provided in Your Resources. 1 Audiometry – Pathologies 3064-2/HLSP 2 Understanding the basic anatomy and physiology of the human body

Explain common problems pertaining to the auditory system 1 © NSW DET 2007

Introduction In following this guide you will learn about common auditory pathologies.

Specifically, you will learn about pathologies in the:  outer ear  middle ear  inner ear.

You will find there are activities to complete throughout this Task guide. Completing these activities will help you gain a better understanding of some of the more common pathologies found in the human ear.

Congenital hearing loss

Now go to Resource 1

Go to Resource 1: Audiometry – Pathologies 3064-2/HLSP and read from pages 11 to 13. Once you have read and understood the information, reflect on what it means to have a congenital hearing loss. For some children it will mean a lifetime of hearing disability. For their parents it will mean many trips to specialists and audiology clinics. It will also mean decisions about aided hearing and educational options. Congenital and acquired hearing loss in children is an enormous area and may be one you are interested in pursuing.

2 Explain common problems pertaining to the auditory system © NSW DET 2007

Outer ear pathologies

Continue on with Resource 1

On pages 15 and 16 of Resource 1: Audiometry – Pathologies 3064-2/HLSP you will read about the outer ear and associated pathologies with this section of the auditory system. Once you have completed this part of the Resource you can attempt the first activity. Some basic information for the Activity is found in the resource, but you may wish to perform a search on the internet or read Chapter 8 in the required text for this area of study, Introduction to Audiology (9th edn), by Martin and Clark.

Activity 1: Otitis externa

Investigate the pathology otitis externa and answer the following questions:  What part of the ear is affected by this pathology?  What are the common symptoms of otitis externa?  Will otitis externa affect the client’s hearing levels? Why? Why not?  If a client presented at your clinic with suspected otitis externa, what would your course of action be?

Middle ear pathologies

On pages 17 to 19 of Resource 1: Audiometry – Pathologies 3064-2/HLSP, you can begin reading about middle ear pathologies. Once you have finished this section you can complete the next activity. Some basic information for the Activity is found in the resource, but you may wish to perform a search on the internet or read chapter 9 in the required text for this area of study, Introduction to Audiology (9th edn), by Martin and Clark.

Activity 2: Otosclerosis

Investigate the pathology otosclerosis and answer the following questions:  What part of the ear is affected by this pathology?  What are the common symptoms of otosclerosis?  Will otosclerosis affect the client’s hearing levels? Why? Why not?  If a client presented at your clinic with suspected otosclerosis, what would your course of action be?

Inner ear pathologies

Inner ear pathologies begin on page 21 of Resource 1: Audiometry – Pathologies 3064-2/HLSP. A number of common pathologies are discussed from page 21 to 25. Some basic information for the Activity is found in the resource, but you may wish to perform a search on the internet or read chapter 10 in the required text for this area of study: ‘Introduction to Audiology’ 9th edition, by Martin & Clark.

Tinnitus Tinnitus is a symptom that is often experienced with hearing loss; in fact it occurs in about 50% of hearing loss cases. People can also experience tinnitus without having a hearing loss. Generally, tinnitus is associated with pathologies of the inner ear, but can also occur with outer and middle ear pathologies.

Tinnitus is a term which comes from the Latin word ‘to ring’ It refers to any perception of sound in the absence of an external stimulus. People describe their tinnitus as being many different sounds, eg cicadas, buzzing or beeping. It can be constant or intermittent, in one ear or both and it can range from mild to severe.

When we use the word tinnitus, we are usually referring to subjective tinnitus. Subjective tinnitus is only heard by the person experiencing it and can only be described by them. The other kind of tinnitus is objective tinnitus. If a person is experiencing objective tinnitus, it can be heard by someone else. This type of tinnitus is often an indication of a serious medical condition and the person must see their medical practitioner immediately.

Tinnitus can occur with many conditions of the ear. For example, it can occur temporarily with occluding wax or a middle ear condition. It is sometimes an indication that damage has occurred, eg after going out to a noisy concert you might experience tinnitus with hearing loss for a day or two afterwards.

Tinnitus can cause some people a great deal of distress. These people can be helped by a number of treatment or management options. However, they must first see an Ear, Nose & Throat (ENT) specialist to exclude any reasons for the tinnitus that may require medical treatment.

People that have unilateral tinnitus or tinnitus that starts very suddenly particularly with other symptoms like hearing loss and vertigo (dizziness) should be asked to see their family doctor and obtain a referral for an ENT specialist.

There is a lot to learn about tinnitus and it is a fascinating area. If you are interested in learning more there are many books and websites that you can refer to. For example, www.tinnitus.org or www.tinnitus.asn.au can be excellent sources of information.

The information produced by self-help groups provides a great starting point.

Activity 3: Presbycusis

Investigate the pathology presbycusis and answer the following questions:  What part of the ear is affected by this pathology?  What are the common symptoms of presbycusis?  Will presbycusis affect the client’s hearing levels? Why? Why not?  If a client presented at your clinic with suspected presbycusis, what would your course of action be?

The ear and body systems

Go to Resource 2

Some auditory pathologies have an impact on other body systems.

It is time to review the material from Task guide 1. Using what you have learnt from this task guide and the knowledge you have gained in this task guide, you will now consider some pathologies that affect both the auditory system and other body systems.

Activity 4: Body systems

For this activity, review the body systems table in Resource 2. .To find this table click on Resource 2 then click on The organisation of the body and scroll down to the heading ‘Systems’.

In the table below are some pathologies which can affect the auditory system. Associated websites with information regarding the diseases are provided for you to investigate, Once you have read more about these diseases, consider what systems in the body they will affect and how.

Paget’s disease www.anzbms.org.au/resources/patient/PagetsDisease.pdf

Multiple sclerosis www.msaustralia.org.au/msinformation/faqs.htm#1

Alzheimer’s disease www.alzheimers.org.au/content.cfm?infopageid=379#wh

Diabetes www.diabetes.com.au/diabetes.php

Pathology/Disease Part of auditory system affected Other body system/s affected? How?

Paget’s disease Inner ear if skull affected by disease

Multiple sclerosis Hearing loss is generally minimal, but if it occurs it is in the inner ear. The balance organs can be greatly affected by MS, therefore the semi-circular canals are often affected by this disease Alzheimer’s disease Inner ear although hearing loss may be a result of presbycusis not this disease

Diabetes Cochlea

Meniere’s syndrome Inner ear, semi-circular canals and cochlea

Now that you have finished this task guide and the activities, compare your answers to the ‘Feedback to activity’.

Summary In this topic you have learnt about the common pathologies of the auditory system. This information will help you to understand the symptoms a client might present with at your clinic and guide you in your decisions of your plan of action for each client.

Further reading If you wish to carry out further research, here are some urls for you to investigate.

www.dizziness-and-balance.com/disorders/hearing/sensorineural.htm

www.merck.com/mmpe/sec08/ch084/ch084b.html#CIHEIFFH

http://earsurgery.org

www.healthinsite.gov.au/topics/Ear_Diseases

www.hpisum.com/downloads/Chapter9.pdf

www.tinnitus.asn.au

www.vicdeaf.com.au/tinnitus-management

www.tinnitus.org

Feedback to activities

Activity 1: Otitis externa

Investigate the pathology otitis externa and answer the following questions:  What part of the ear is affected by this pathology? The outer ear, generally in the external auditory meatus (ear canal).  What are the common symptoms of otitis externa? Pain, redness and itching of EAM, discharge and fever.  Will otitis externa affect the client’s hearing levels? Why? Why not? It can affect the hearing to a certain degree. If the otitis externa has not affected the outer ear structures with too much swelling or discharge a hearing loss is unlikely. Any associated hearing loss will generally be mild.  If a client presented at your clinic with suspected otitis externa, what would your course of action be? Refer to their doctor for diagnosis and treatment. If the ears were too painful, it would be best not to attempt a hearing test but to rebook the client for a later date when the otitis externa has resolved.

Activity 2: Otosclerosis

Investigate the pathology otosclerosis and answer the following questions:  What part of the ear is affected by this pathology? The middle ear, (although with advanced cases of otosclerosis, the cochlea can also be affected). The third bone in the ossicular chain (the stapes), becomes fixated as the bones over-calcify due to this condition. This is generally a hereditary pathology occurring slightly more in women than men (approximately 60% of cases are females). Women are more susceptible to develop this condition as they produce more calcium when they are pregnant or menopausal and this can speed up the calcification process. A stapedectomy can be performed on the client with otosclerosis and this operation has a fairly high success rate, returning hearing to near normal levels.  What are the common symptoms of otosclerosis? Hearing loss is the only symptom.  Will otosclerosis affect the client’s hearing levels? Why? Why not? Yes, there will usually be a conductive hearing loss, increasing in severity over time.  If a client presented at your clinic with suspected otosclerosis, what would your course of action be? Refer the client to their doctor with

recommendations to be assessed by an Ear, Nose & Throat specialist. If the client opted against surgery or surgery was not possible, a hearing aid fitting could be worth considering.

Activity 3: Presbycusis

Investigate the pathology presbycusis and answer the following questions:  What part of the ear is affected by this pathology? This pathology is a hearing loss associated with aging. This hearing loss affects the cochlea where the hair cells wear out with the aging process. It may also include a deterioration of the neural pathways.  What are the common symptoms of presbycusis? Hearing loss is the only symptom. Poor discrimination of words is a feature of presbycusis.  Will presbycusis affect the client’s hearing levels? Why? Why not? Yes, the hearing loss usually begins in the high frequencies, increasing in severity over time, and generally occurs in both ears.  If a client presented at your clinic with suspected presbycusis, what would your course of action be? Discuss with the client if they would be interested in trialling hearing aids. Refer them to an appropriate agency for hearing aid fitting if they were interested in pursuing this path of treatment.

Activity 4: Body systems

Pathology/ Part of auditory Other body system/s affected? How? Disease system affected

Paget’s disease Inner ear if skull Musculo-skeletal system affected by disease The normal process of bone remodelling is affected by Paget’s disease. A person’s bones with this disease will not break down and rebuild in the normal fashion. The re-growth of bone is softer and more porous. Excess bone can also be formed as the re-building process is much quicker with Paget’s disease. Bones can therefore be larger, cause more pain and break easily. There are more blood vessels than normal, increasing the blood supply to the area, making it feel warmer than normal. The disease commonly affects the spine, pelvis, skull, femur and tibia. Multiple Hearing loss is Nervous system sclerosis generally minimal, Multiple sclerosis (MS) affects neurons, brain but if it occurs it is in cells and the spinal cord by disrupting the the inner ear. The ability to carry information, create thought and balance organs can be perception, and body control. The electrical greatly affected by signals carried by the neurons are MS, therefore the compromised by the breakdown of the myelin semi-circular canals sheath which surrounds the neurons. When the are often affected by myelin is destroyed, the neurons can no longer this disease. effectively conduct their electrical signals. MS is a chronic, inflammatory, disease. Symptoms include changes in sensation, visual problems, muscle weakness, depression, difficulties with coordination and speech, severe fatigue, cognitive impairment, problems with balance, overheating and pain. Alzheimer’s Inner ear although Nervous disease hearing loss may be a This common disease affects the brain and result of presbycusis gets worse over time. Brain cells are affected, not this disease causing them to stop functioning or die off. Alzheimer’s disease impacts on the sufferer’s ability to organise and express thoughts and recall events or objects misplaced. It also can change their personality and behaviour. Diabetes Cochlea Nervous and circulatory Diabetes is a metabolic disorder characterised by high blood sugar (hyperglycemia). The characteristic symptoms are increased thirst, excessive urine production and blurred vision. Not all diabetics have these symptoms.

Diabetes is caused by the pancreas not being able to produce enough insulin. This condition is incurable but can be treated by insulin supplements and dietary control. Meniere’s Inner ear, semi- Nervous and lymphatic syndrome circular canals and Meniere’s syndrome (or disease) causes cochlea episodes of rotational vertigo, nausea, tinnitus, fluctuating hearing loss and the sensation of fullness in the ear. All symptoms and ‘attacks’ can vary in intensity and duration. It is thought this condition is caused by an excess of endolymphatic fluid in the semi-circular canals.