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Audiological Procedures > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

What comprises immittance audiometry?

A

Acoustic reflexes and tympanometry

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2
Q

What is immittance?

A

A measure of how well sound transmits through the outer and middle ear

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3
Q

What is impedance?

A

Opposition to the flow of energy (Z)

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4
Q

What is admittance?

A

How much of the energy flows through the system (Y)

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5
Q

What is the probe ear?

A

The ear the results are measured from

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6
Q

What is the stim ear?

A

The ear the stimulus is sent into

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7
Q

What are the components of a probe?

A

Speaker (226 Hz at 85 dB SPL), microphone (monitors the dB SPL) and an air pressure pump

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8
Q

What are the immittance instruments?

A

Tympanometer, middle ear analyzer, and impedance bridge/meter

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9
Q

What is a tympanogram?

A

A graphical representation of how admittance (y-axis) changes as a function of applied air pressure (x-axis)

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10
Q

What is tympanometry?

A

Shows, on a tympanogram, how it’s affected by different conditions of the middle ear

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11
Q

When does max compliance/peak occur?

A

When the pressure being applied in the ear canal is equal to the pressure inside the middle ear behind the tympanic membrane

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12
Q

What is compliance/status acoustic admittance, and what are the normal values?

A

The measure of admittance that is representative of the middle ear; where the eardrum is most compliant, and where the maximum admittance of sound energy occurs

Normal values: 0.3 to 1.7 (0.2 to 1.0 for kids)

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13
Q

What is tympanometric peak pressure and what are the normal values?

A

The pressure level where the peak admittance occurs, which ranges from -400 to +200 daPa. The normal range is +50 to -150

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14
Q

What is ear canal volume?

A

A measure of the volume between the probe tip and the tympanic membrane, giving the volume of the ear canal.

Normal values: 0.6 to 1.5 (0.4 to 1.3 for up to 7 years old)

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15
Q

What is tympanometric width?

A

The width of the tympanogram at half its height; describes the shape of a tympanogram

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16
Q

What would you expect to see in a type A tympanogram?

A

Normal peak admittance, normal TPP, and normal TW

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17
Q

What would you expect to see in a type Ad tympanogram?

A

High peak admittance, normal TPP, and normal TW

Suggests ossicular disarticulation or flaccid tympanic membrane

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18
Q

What would you expect to see in a type As tympanogram?

A

Low peak admittance, normal TPP, and normal TW

Suggests otosclerosis or tympanic membrane scarring

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19
Q

What would you expect to see in a type B tympanogram?

A

No peak: flat, no TPP, unmeasurable TW

Suggests middle ear fluid, TM perforation, or impacted cerumen

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20
Q

What would you expect to see in a type C tympanogram?

A

Normal or reduced peak admittance, more negative than normal TPP, normal or too wide TW

Suggests eustachian tube dysfunction

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21
Q

What is an acoustic reflex?

A

A bilateral involuntary contraction of the stapedius muscle when stimulated by loud sounds

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22
Q

How do you record an acoustic reflex?

A
  • Present reflex-eliciting tones (500, 1000, and 2000 Hz)
  • Monitor changes in admittance that occur in response to stapedius muscle contraction
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23
Q

What is an acoustic reflex threshold (ART)?

A

The lowest dB HL (intensity level) of a reflex-eliciting tone that produces a repeatable admittance change of at least 0.02 ml

Normal range: 70-95 dB HL

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24
Q

What are the three rules of eliciting an acoustic reflex?

A
  1. The probe ear cannot have any outer or middle ear pathology
  2. The stim ear must receive a tone that is loud enough (NOTE: a conductive hearing loss greater than 30 dB won’t elicit an AR)
  3. The integrity of the neural pathway must be adequate to activate the contraction of the stapedius

8th nerve disorders
- Stim ear has disorder: ipsi and contra are absent
- Probe ear has disorder: present

7th nerve involvement (Bell’s Palsy)
Probe ear has 7th nerve disorder
- The problem is proximal: absent
- The problem is distal: present

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25
What is the purpose of the acoustic reflex decay?
It can provide evidence of 8th nerve pathology
26
How do you record the acoustic reflex decay?
- Find the contralateral ART (1000 Hz) - Go 10 dB above this ART - Present for 10 seconds
27
What are normal vs abnormal results for acoustic reflex decay?
- Normal ear: negative; no reflex decay - Abnormal ear: deflection drifts up by more than 50% within 5 seconds Called “positive” acoustic reflex decay (positive for 8th nerve involvement)
28
How does a tumor on the 8th nerve affect ARs?
ARs are usually absent with a tumor on the 8th nerve, but in some cases, a patient has normal hearing and ARs, but positive AR decay (which may then be the only sign of a possible 8th nerve tumor), which is why it’s often included in a hearing test
29
What is a physiologic test?
An automatic test that doesn't require understanding or behavioral responses
30
What are the functions of physiological tests?
- Useful for testing young infants or difficult-to-test patients - Useful in differentiating a cochlear loss from a neural loss - Not “true” hearing tests, but they measure the function of the auditory mechanisms
31
What does the accuracy of physiologic tests depend on?
On the skill/experience of the audiologist
32
What is latency?
Time in milliseconds
33
What is rate?
The number of stimuli per second presented to the ear
34
What is an otoacoustic emission (OAE)?
A soft sound measured in the EAM, generated by the cochlea as a result of OHC movement
35
What is the pattern of the reverse traveling wave of the OAE?
Emissions travel back - Basilar membrane - Ossicular chain - Eardrum - Outer ear canal
36
What does the computer use to minimize other noise during OAEs?
Signal averaging
37
What do present OAEs suggest?
Normal cochlear function
38
What do OAEs tell us about the degree of hearing loss?
They don’t tell us the degree/amount of hearing loss - If OAEs are absent: hearing loss could be mild or greater - If OAEs are present: hearing is normal or no worse than mild hearing loss
39
What are the two types of OAEs?
Transient-evoked OAEs and distortion product OAEs
40
Tell me about TEOAEs.
- Evoked by clicks - Measures from 1000-4000 Hz - You need to be at least 6 dB above the noise threshold at each frequency for it to be considered present - Present in 99% of ears with thresholds at 20 dB or better Absent - If hearing loss is greater than 30-35 dB - When all pure tones are 40 dB or worse - May or may not be present when thresholds are between 25-35 dB - An effective tool to separate those with essentially normal hearing function
41
Tell me about DPOAEs.
Made up of f1 and f2 - Always a ratio of 1.22 between them (f2/f1 = 1.22) - f1 is always lower in frequency - f1 is usually 65 dB, f2 55 dB - They are presented simultaneously and produce a “distortion product”; Cubic difference tone = 2f1 - f2 (so if f1 = 2000 Hz, f2 = 2440 Hz, then the DP = 1560 Hz) - Measures from 1000-6000 Hz - Needs to be at least 6 dB above the noise floor to be considered present f2 is plotted on the DP-gram - Present in normal ears (better than 25 dB) - Absent with a cochlear hearing loss that’s greater than 40 dB - Can be present with hearing loss up to 50-60 dB (with reduced amplitudes and louder primary tones) - Reduced or absent with CHL
42
What are auditory evoked potentials?
A series of neuroelectric responses/waveforms recorded using electrodes and computer-averaging techniques
43
What kinds of stimuli are used for auditory evoked potentials?
- Clicks (transient): broadband spectrum - Tone bursts: spectrum built around a center frequency (500, 1000, 2000, 4000) The computer measures the neuroelectric response to the stimulus up to 20 ms after the onset of the stimulus; the response is time-locked to the onset of each stimulus - Typically there are 2000 repetitions; 2000 time-locked stimuli at a rate of about 11 to 41 clicks per second - The response is averaged over many stimuli, which allows the computer to perform signal averaging (the enhancement of the evoked response and minimization of the background noise/electrical activity) - Each recording is repeated (and usually plotted on top of the first recording)
44
What is an auditory brainstem response?
A series of wave peaks that occur 2-10 ms after the presentation of a click/tone burst stimulus
45
What anatomical structures crease the ABR waves?
Wave I: 8th CN - distal Wave II: 8th CN - proximal Wave III: cochlear nucleus Wave IV: superior olivary complex Wave V: lateral lemniscus and inferior colliculus
46
How is an ABR waveform evaluated?
By latency and the presence of waves
47
What are the types of latencies found in an ABR?
- Absolute latency: the time from the onset of a stimulus to the peak of the wave - Interpeak latency: the time difference between any two waves - Inter-aural latencies: the latencies between the same wave in both ears (usually looking at wave V)
48
What is morphology regarding ABR?
The overall shape of the waveform
49
For ABR, as intensity decreases...
Latencies increase
50
For ABR, as rate increases...
The latency of wave V increases more so than for earlier waves; the lower the rate, the better the morphology of the waveforms
51
For ABR, as frequency decreases...
The latency of wave V increases
52
Where do the higher-frequency tone bursts (4000 Hz) stimulate?
Higher-frequency tone bursts (4000 Hz) stimulate more basal regions of the cochlea and have sharper peaks because of greater neural synchrony (the speed of the traveling wave is faster at the base)
53
Where do the lower-frequency tone bursts (500 Hz) stimulate?
Lower-frequency tone bursts (500 Hz) stimulate more apical regions and have broader peaks because of less neural synchrony (the speed of the traveling wave is slower as it moves toward the apex)
54
What is ABR used for?
- To test young children or difficult-to-test clients - When there are suspected 8th nerve disorders - For screening newborns - As a diagnostic test for newborns who fail the hearing screening
55
What is the advantage of an ABR?
The person being tested can be sedated, asleep, etc.; they don’t have to pay attention
56
What are the two types of ABR?
Threshold and neurodiagnostic ABRs
57
Tell me about threshold ABR.
- Used to find a hearing threshold - You decrease the stimulus intensity until wave V disappears - Used as an estimate of the amount of hearing loss between 2000-4000 Hz (only for click stimuli) - Use a correction factor of 10-15 dB - Not a true test of hearing, but does reflect the neural activity in the auditory pathway that can be used to predict hearing sensitivity
58
What does neurodiagnostic ABR do?
Identifies 8th nerve pathologies
59
How do you interpret a neurodiagnostic ABR?
Check the latency difference between waves I-III, III-V, and I-V compared to norms - If I-III is abnormal, this suggests an abnormality in the 8th cranial nerve - If III-V is abnormal, this suggests a problem in the brainstem If an individual has acoustic neuroma on the proximal portion of the 8th CN, wave I may be present, but all other waves would be absent
60
8th nerve pathology can have:
- Abnormal interpeak latency intervals that are delayed more than 2 SD (0.4) from norms - Interaural latency differences (wave V) that are more than 2 SD from norms - Absent waveforms when hearing is good enough to expect normal latencies

Audiological Procedures (3 decks)

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