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Audiology > Physiological Testing > Flashcards

Physiological Testing Flashcards

1
Q

Physiological Testing …

A
  • Does not require a voluntary response from the patient
  • Can help pinpoint the sit of dysfunction (“site of lesion”)
  • Used as cross checkers
  • particularly useful for infants and those with disabilities
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2
Q

Otoscopy

A
  • This is not a physiological test

- visual inspection to verify that the ear canal is not occluded, no tubes, drainage, trauma, infection, etc.

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3
Q

What are the three main types of Physiological Tests?

A
  • Immittance
  • Otoacoustic Emission
  • Auditory Evoked Potentials
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4
Q

Name the two parts of Immittance Testing:

A
  • Tympanogram

- Acoustic Reflexes

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5
Q

What does Immittance Testing measure and in what units is it measured in?

A
  • It measures acoustic immittance vs impedance
  • immittance units in cm3 or mmho
  • daPa/decapascals units of ear canal pressure
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6
Q

what are the 4 primary components of immittance testing?

A
  • transducer
  • air pump
  • manometer
  • microphone
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7
Q

Tympanometry … main points

A
  • the first part of immittance testing
  • measures the flexibility of the eardrum and how sound bounces back toward microphone as pressure changes (daPa)
  • used to diagnose middle ear pathologies
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8
Q

A tympanogram creates _____________ with a ______ and mechanically changes the air pressure in the ear canal (_______________). It also creates a tone of ______ Hz

A
  • an airtight seal with a probe tip
  • (+200 to -400 daPa compared to atmosphere)
  • 226 Hz
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9
Q

In infants younger than 12 months of age, we use _______ Hz tone due to the __________________.

A
  • 1000 Hz

- smaller diameter of the ear drum

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10
Q

Peak immittance is at the point of _____________________.

A

Maximum Displacement

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11
Q

Zero on a tympanogram =

A

normal

inner and outer pressure are equal

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12
Q

other info on Tympanograms:

A
  • it is rare to see a positive
  • scar tissue can lead to abnormal readings due to lack of flexibility
  • A = normal
  • lower than A is deep
  • Above A is stiff
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13
Q

If pressure behind the eardrum is very _______ then there is an issue with the Eustachian tube. If it is ______ then there is no movement.

A
  • negative

- flat

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14
Q

Tympanogram reading of A=

A

peak compliance between +100 and -100 daPa

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15
Q

Tympanogram reading of As=

A

peak compliance normal but very shallow (less than 0.3 mmho)

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16
Q

Tympanogram reading of Ad=

A

peak compliance normal but very deep (grater than 1.4 mmho)

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17
Q

Tympanogram reading of C=

A

peak compliance is negative pressure (beyond -100 daPa to -400 daPa)

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18
Q

Tympanogram reading of B=

A

Flat tracing with no peak (malfunction, fluid, perforation or tube)

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19
Q

Ear canal volume

Normative values for ear canal sizes …

A
  • less than 0.3 the tip may be against the canal wall
  • greater than 0.2 may be measuring beyond the ear canal
  • 0.4-1.0 normal for kids less than 7 yrs
  • 0.6-1.5 average size for adults
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20
Q

Acoustic Reflex testing …

A

-Needs a normal tympanogram
(tubes or fluid=CNT)
-measure of the acoustic arc including afferent and efferent systems
-used to diagnose retrocochlear pathologies, can suggest pathologies of the VIII nerve or brainstem
-can be measured ipsilateral (afferent) or contralateral (efferent)
-occurs at the peak pressure of the eardrum
-test at 500, 1k, 2k 3k and 4k
-helps predict levels of hearing loss
-modern tech can self determine responses

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21
Q

Acoustic reflex decay testing

A
  • tone continues for ten seconds
  • if reflex decays by %50 or more it is abnormal
  • often used when suspecting a vestibular schwannoma
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22
Q

Otoacoustic Emissions (OAE) …

A
  • a test of cochlear function
  • can be spontaneous or evoked
  • low level sounds create a cochlear response that can be recorded in the ear canal
  • separates cochlear from retrocochlear pathologies
  • separates sensory from neural
  • requires a normal conductive system (outer/middle ear)
23
Q

Otoacoustic Emissions were discovered by _________ in _______ and was clinically available by the __________.

A
  • David Kemp
  • 1978
  • early 90’s
24
Q

What are the three kinds of evoked emissions that are used for testing?

A
  • Transient Evoked (TEOAE)
  • Distortion Product (DPOAE)
  • Stimulus Frequency (SFOAE)
25
Q

Transient Evoked (TEOAE) …

A

-uses a broadband click stimulus
-pass or fail
-typically used as a screener
-used in Universal Newborn Hearing Screening (Not present if hearing loss is greater than 30 dBHL)
-Does not give frequency specific info
-uses computer averaged data collection
-has artifact rejection software
(Poor seal, crying, talking, moving, equipment noise, nursery, NICU, use of oxygen equipment)

26
Q

What can interfere with TEOAE/

A

-Poor seal, crying, talking, moving, equipment noise, nursery, NICU, use of oxygen equipment

27
Q

Distortion Product (DPOAE) …

A
  • uses 2 frequencies 2(f1-f2) at 2 different intensities (L1 and L2)
  • measures the distortion product of 2 simultaneous frequencies
  • L1 and L2 separated by 15 dB SPL (65/50)
  • frequency specific info
  • can elicit response in moderate hearing loss or less
  • Test frequencies 1000-8000Hz
  • (high frequency equip. used in ototoxicity monitoring)
  • distortion product is 60 dB SPL less than the two stimulus tones
28
Q

Compromised patients of DPOAE?

A

-cognitive, autism, severe disabilities

29
Q

Stimulus Frequency (SFOAE) …

A

-clinically, not very useful, not used outside research

30
Q

Auditory Evoked Potential Testing …

A
  • Computerized technology gathers and averages thousands of responses
  • averages out random info to tease the response (potential) out of the genera muscle/neural activity
  • uses typical time frames for each potential (referred to as latencies)
31
Q

Early potentials in evoked potential testing …

A
  • IHC (inner hair cell function) and VIII nerve
  • exogenous: impacted by movement, talking, etc.
  • not impacted by sedation
32
Q

Late potentials in evoked potential testing…

A
  • Central system
  • endogenous: resistant to movement and noise
  • impacted by sedation
33
Q

Other uses of evoked potential testing:

A
  • estimate hearing loss levels
  • interoperative monitoring
  • ANSD diagnostics
  • site of lesion/retrocochlear diagnosis
  • CAPD testing
34
Q

Stimulus frequencies of evoked potential testing:

A

-click
-500 Hz
-1k Hz
-4k Hz
(all tone bursts)

35
Q

Stimulus levels for evoked potential testing and the two main types:

A
  • 90 dB nHL for neural integrity
  • descending levels of hearing loss evaluation typically beginning at 80dB nHL for threshold detection
  • Far Field Recordings
  • Near Field Recordings
36
Q

Far Field Recordings:

A
  • electrodes placed on the forehead, top of head and each ear (earlobe or mastoid)
  • ABR, AMIP, ASSP, LEP
37
Q

Near Field Recordings:

A
  • Needle electrode placed through the eardrum/middle ear and placed on the cochlea
  • called ECochG
  • Most often used in interoperative monitoring and research
38
Q

ABR: Auditory Brainstem Response Screening

A
  • Automated equipment used in Newborn screening test, noted as AABR
  • tested at 35 dB nHL with click stimulus
  • pass/fail only
  • only waves 1 and 5 are visible to Newborns
39
Q

ABR diagnostic

A
  • Can test down to 20 dBHL in sound booth
  • Can perform frequency specific testing
  • Can use masking
40
Q

ABR stimulus rates

A
  • Typically 11-33 / sec

- Slower rate may improve waveform morphology

41
Q

ABR data collection

A
  • Sweeps of 2000-4000

- Higher numbers of sweeps may improve morphology

42
Q

ABR normative data

A
  • Correction factors to dBHL
  • Different for males and females
  • Newborn data collected separately
43
Q

If morphology is poor _____________

A

suspect retrocochlear

44
Q

ABR interpretation of Conductive hearing loss:

A

-Delayed wave 1, inter peak latencies normal

45
Q

ABR interpretation of Sensorineural hearing loss:

A
  • Delayed wave 1, hard to detect this wave

- Interpeak 1-5 latency shortened

46
Q

ABR interpretation of Retrocochlear pathology:

A
  • Wave 1 normal latency
  • Waves 2-5 delayed
  • Interpeak latencies abnormal
47
Q

ABR is a test of ___________

A

Neural integrity

48
Q

What is the full test battery for new borns?

A
  • tympanometry
  • acoustic reflex testing
  • OAE
  • ABR
49
Q

Electrocochleography (ECochG) …

A
  • measures three waves from VIII nerve to the brainstem
  • AP action potential ABR wave 1
  • SP summating potential hair cell activity
  • uses near field recording
  • stimulus short tone bursts
  • may help diagnose m’s disease
50
Q

Auditory Middle Latency Responses AMLR…

A
  • Far field recordings
  • Longer time frame (8-50ms)
  • slow stimulus rate
  • lower frequency
  • record at same time as ABR
  • amplitude increases from infancy to adolescence
  • Pa is bilateral response with unilateral stimuli
51
Q

Auditory Steady rate response ASSR…

A

-aka steady state evoked potential
-1,2024 ms time frame
-1 time frame = epoch
16 epochs/16 seconds=1 sweep
-p300 most studied
-used in CAPD diagnosis
-cannot be sedated and not yet in clinical use

52
Q

Late evoked potentials…

A
  • Pb (P1) 50-80ms
  • N1 100-150 ms
  • P2 150-200 ms
  • N2 180-250 ms

-Used in 5 ms bursts

53
Q

Latencies ___________________.

A

mature over time

Audiology (8 decks)

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