Hearing Loss Mnemonic
Having trouble remembering all the important questions to ask during your patient encounter? Then try this Hearing loss Mnemonic for USMLE Step 2 CS.
PHYSICAL EXAMINATION Hearing loss Mnemonic
NOTE: Make sure to wash your hands or wear gloves before you start physical examination. Make sure to ask for permission before you start each physical exam. Make sure to use proper draping (don’t forget to tie back patient’s gown). Make sure to explain each physical examination in layman’s term to your patient. Do NOT repeat painful maneuvers.
- HEENT: Test hearing by speaking with back turned, Rinne & Weber, Whisper test, Otoscopy, Funduscopic exam,
- CV exam: Auscultation.
- Pulmonary exam: Auscultation.
- Neuro: CN 2-12, Sensation, Motor, DTRs, Cerebellar: Finger to nose, Heel to shin.
DIFFERENTIAL DIAGNOSIS Hearing loss Mnemonic
- Presbycusis: This is a process of the inner ear in which bone loss is greater than air loss, leading to a gradual loss of hearing. It is typically bilateral. Presbycusis is a common diagnosis as people age and can be detected by performing the Rinne test.
- Cochlear nerve damage: The cochlear nerve can become damaged as a result of loud noise. This patient is a military veteran and admits to a history of exposure to loud noises.
- Otosclerosis: Is a disease of the elderly that presents as gradual hearing loss resulting from abnormal temporal bone growth. It is a conductive hearing loss, so air loss exceeds bone loss. Otosclerosis is usually bilateral, but in a minority of patients the disease can be unilateral or can affect one side more than the other.
- Ménière disease: This condition usually presents with hearing loss, tinnitus, and episodic vertigo. It is caused by endolymphatic disruption in the inner ear. Causes include head trauma and syphilis. It can be unilateral or bilateral.
- Acoustic neuroma: It is unlikely that the patient has an intracranial lesion such as a brain tumor in the absence of any other signs. However, this diagnosis should be considered if evidence of focal neurologic deficits is found.
- Ototoxicity: Hearing loss caused by antibiotics (such as gentamicin) will become more pronounced and may continue to worsen for a time after the drug is discontinued. Other medications that may cause ototoxicity includes loop diuretics and aspirin. If patient is taking aspirin, it should be withheld while the workup is pending.
DIAGNOSTIC WORKUP Hearing loss Mnemonic
- Audiometry: To assess hearing function and deafness to specific frequencies.
- Tympanography: A graphic display that represents the conduction of sound in the middle ear. It may help distinguish middle ear from inner ear dysfunction.
- Brain stem auditory evoked potentials: Used to diagnose auditory neuropathy.
- CT of the Head: Used to rule out any intracranial process, tumor, bleed, or CVA. An MRI of the brain would be better for an acoustic neuroma or a schwannoma.
- VDRL/RPR: To r/o syphilis associated with Ménière’s disease.
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