Final Flashcards
(180 cards)
1
Q
Case History Purpose
A
Investigate why problems exist - understand problems & system
2
Q
Case History Information to Gather
A
- ID Info
- Occupation
- School Level
- Chief Complaint
- Timeline
- Severity
- Symptoms
- Medical History
- Family History
3
Q
What age is the auditory system fully developed?
A
6 months
4
Q
CNT
A
Could not test - attempted testing, but could not complete
5
Q
DNT
A
Did not test - did not attempt to test
6
Q
Otalgia
A
ear ache or ear pain
AS: otitis externa, otitis media, TMJ, teeth grinding
INT: Medical referral
7
Q
Conductive hearing loss
A
issue within outer or middle ear
can be medically remediated
air & bone scores more than 10dB apart
bone within normal limits
8
Q
Paracusis Willisii
A
symptom of conductive loss
hearing better in noise than quiet
9
Q
Sensorineural Hearing Loss
A
issue with inner ear & beyond
air & bone scores within 10dB of each other
10
Q
Mixed Hearing Loss
A
air & bone more than 10dB apart, bone outside normal limits
11
Q
Retrocochlear
A
issue past the cochlea (ie. central pathway, brainstem, etc.)
symptoms can include diminished understanding
12
Q
Outer Ear Disorders
A
- impacted cerumen
- foreign bodies
- otitis externa (swimmer’s ear)
- otorrhea
13
Q
Impacted Cerumen
A
impedes sound from getting to the TM (occlusion)
AS: aural fullness, tinnitus, sudden HL
INT: removal
14
Q
Foreign Body
A
anything in the ear canal that doesn’t belong
AS: blood, discharge, HL, tinnitus (occlusion), aural fullness
INT: removal
15
Q
Otitis Externa
A
infection of outer auditory meatus
AS: discharge, itching, edema, pain, HL
INT: medicated drops (medical referral)
16
Q
Otorrhea
A
discharge from ear
AS: otitis media (perforation), odor, infectious material, otalgia, itching
INT: medical referral immediately - follow infectious control protocol
17
Q
TM Disorders
A
- retraction
2. perforation
18
Q
TM Retraction
A
negative pressure on the TM
AS: depends on severity, stuffy, blocked, HL
INT: depends on severity - decongestants, tubes, tympanoplasty
19
Q
TM Perforation
A
hole in TM
AS: fullness, tinnitus, HL, vertigo, blood, otalgia, discharge
INT: drops, heal on its own, surgery
20
Q
Middle Ear Disorders
A
- otitis media with effusion
- cholesteatoma
- disarticulated ossicles
21
Q
Otitis Media with Effusion (serous)
A
fluid within the middle ear cavity, more serious audiologically - harder to identify can thicken
AS: sterile fluid, see through TM, dull TM, hearing loss, fullness
INT: nasal spray/decongestants, tympanostomy tubes
22
Q
Otitis Media with Effusion (suppurative)
A
infectious fluid within the middle ear space
AS: infectious material, TM red, TM bulging, thick, hearing loss, fullness, sickness, pain
INT: Antibiotics
23
Q
Cholesteatoma
A
tumor-like sack in the middle ear with infectious material, usually under lining of middle ear; can be from perforation, chronic OMWE; highly erosive
AS: HL, pain, TM perforation
INT: surgery, reconstruction of ossicles or TM
24
Q
Disarticulated Ossicles
A
gap in ossicles; can be caused by trauma or infection
AS: sudden HL, tinnitus
INT: can heal on its own, surgery, prosthetics
25
Inner Ear Disorders
1. Noise Induced HL
2. Presbycusis/Sociocusis
3. Sudden Loss
4. Meniere's Disease
26
Noise Induced HL
permanent damage to inner ear; can be from blast exposure or impact noise
AS: high blood pressure, stress, bilateral notch 3-6kHz
INT: prevention, avoidance, amplification, auditory training/sp reading
27
Presbycusis/Sociocusis
loss due to aging or the exposure of daily life
AS: HL
INT: amplification, communication strategies, speech reading
28
Sudden Loss
can be caused by viral, vascular, idiopathic, autoimmune issues, etc.
AS: tinnitus, fullness, HL, vertigo
INT: refer immediately - first 48hrs. - better recovery, steroids
29
Meniere's Disease
buildup of fluid in inner ear - endolymph overproducation in the vestibular system (connected to scala media) - puts pressure on membrane; progressive
AS: fluctuating low frequency HL, fullness, low roaring tinnitus, pressure, true spinning vertigo
INT: amplification, vertigo medicine, therapy
30
Central Auditory Disorders
1. Lesions
2. APD
3. Tinnitus
31
Central Auditory Lesions
growths on central pathway; acoustic neuroma
AS: asymmetric high frequency HL, progessing HL (with tumor growth), reduced understanding, balance issues, facial numbness, headaches
INT: benign - let grow until hearing gone, malignent - quick removal
32
Central Auditory Processing Disorders
CAPD, effectiveness of using auditory information; worse in noise situations; larger issue in children - mislabled
33
Tinnitus
sound without stimulus; spectrum of severity; commonly "can't hear because of tinnitus," strong relationship bt tinnitus & HL, rule out retrocochlear pathology
external factors: caffeine, nicotine, alcohol, medications
34
Dizziness
imprecise term describes various symptoms such as faintness, vertigo, disequilibrium, unsteadiness, etc.
35
Disequilibrium
disturbance or absence of equilibrium
36
Equilibrium
condition of being evenly balanced
37
Faint
extremely weak; threatened with syncope
38
Syncope
loss of consciousness & postural tone; caused by diminished cerebral blood flow
39
Vertigo
sensation of spinning; objects around them are spinning or whirling
40
Vestibular info to gather
1. meaning of vague terms
2. onset
3. frequency
4. length of duration
5. nausea
6. changes in hearing
7. tinnitus
8. swallowing, speaking, or vision issues
9. warning signs
10. loss of consciousness
11. fullness or pressure at back of head
12. medications
13. blood pressure or heart issues
14. medications
41
Otoscopy
visual inspection of pinna, outer ear canal, & TM
42
Otoscopy Procedure
1. wash hands
2. gloves
3. inspect ear
4. clinician positioning (eye level)
5. manipulate ear (adult - up & back, infant - down & out)
6. remove gloves
7. wash hands
43
.Tuning fork test limitations
1. no set frequency or intensity
2. varied patient response
3. done in poor acoustic environments
44
Weber
OBJ: determine whether unilateral loss is SN or conductive
TECH: tuning fork struck on baseline
OUT:
1. hear tone in both ears or in middle of head - normal or SN bilateral loss
2. hear tone in better ear: SNHL (in the bad ear) or mixed if BC thresholds are better in that ear than other
3. hear tone in worse ear: conductive (stenger - occlusion)
45
Rinne
OBJ: determine if air or bone is most efficient
TECH: fork struck on mastoid then moved to front of canal; pt asked which is louder
OUT:
1. positive: louder at canal - normal or SNHL
2. negative: louder for bone - conductive
46
Bing
OBJ: determine if SN or conductive
TECH: fork struck on mastoid: open & close tragus
OUT:
1. positive: occluded is louder: SN or normal
2. negative: no difference: conductive
47
Schwabach
OBJ: determine hearing loss conductive or SN
TECH: base on mastoid until no longer heard then placed on physician's mastoid
OUT
1. physician hears longer than patient: SNHL
2. patient hears longer than physician: conductive
3. same: normal
48
Exhaustive Calibration Times
1. at least once a year
2. before use
3. any reason output may have changed
49
Basic Calibration Instruments
1. couplers
2. sound level meter
3. voltmeter
4. electronic counter/timer
5. oscilloscope
50
Transducers & Calibration
transducers calibrated for specific equipment; transducers set to otologically normal individual age 18-30
51
Audiometric Zero
0dB HL - cannot be measured
52
RETSPL
Reference Equivalent Threshold Sound Pressure Levels - air conduction with transducers
53
RETFLs
Reference Equivalent Threshold Force Levels - bone conduction (artificial mastoid)
54
ANSI Standards
From the year of production of the equipment; specifies how the audiometer is to perform when manufactured
55
NASED
National Association of Special Equipment Distribution; several major audiology services united and established "gold standard" but voluntary
56
Recommended calibration output values
dB deviation from the standard
57
Absolute SPL reading limitation
do not easily allow determination of total output error nor the ANSI compliance values
58
Process of Determining Max Testing Output Error
1. Obtain SPL reading at 1500Hz
2. Locate ANSI level at 1500Hz
3. Calculate difference
4. Locate worse positive attenuation error
5. Add worse positive to calculate difference
6. Locate worse negative attenuation error
7. Subtract from difference
8. MTOE range from sum of step 5 & difference of step 7
59
What is Max Total Output Error Calculated for?
1. Each transducer
2. Each frequency
3. Both channels
60
How is Frequency Accuracy Measured during Calibration?
Precision frequency counter
61
ANSI specified audiometers
1. two full channel audiometer
2. one & a half main/masking channel
3. air/bone portable
4. air portable
62
ANSI Frequency Tolerances
For type 1 & 2 audiometers: +/- 1% of indicated dial setting
| For type 3 & 4 audiometers: +/- 2% of indicated dial setting
63
Pure Tone and Speech Calibration
1. Left & right primary earphones (both channels)
| 2. secondary transducers
64
Max Permissible Ambient Noise Level
Must test down to audiometric zero
65
Determination of Ambient Noise Levels
1. SLM at location of patient's head
2. levels recorded & compared to ANSI standards
3. CANNOT OVERCOME EXTERNAL NOISE WITH ACOUSTICAL MODIFICATION (ie. noise reducation headphones)
66
Noise Reduction Headphones Limitation
1. no calibration standards
2. greater test/retest variability
3. greater variability in amount of noise attenuated
67
White noise Calibration for Masking
recorded in absolute dB SPL
| each manufacturer determines WN calibration level
68
Noise masking Tolerance
+5/-3dB
69
How to measure Harmonic Distortion
use a precision analyzer
70
leading cause of transducer distortion
mistreatment (ie. dropping)
71
Bone Output is recorded in
dB deviations due to artificial mastoid & meter sensitivities
72
Bone output Tolerance
+/-3dB for 250-4kHz pure tone & speech inputs
| +/-5dB for 6k-8kHz pure tone
73
SF tolerance (azimuth)
+/-3dB for 125-5kHz or speech inputs
| +/-5dB for 6k & up
74
SF calibration is recorded in
dB deviations
75
Attenuation Linearity Measures
recorded as dB deviations for each 5dB step; start at 70dB, decreasing by 5; error tolerance is +/-1dB for each step
76
Rise/Fall time (calibration)
time it takes to get to peak target sound (milliseconds); rise tolerance: 20ms, fall tolerance: 50ms
77
overshoot value
intensity rises higher than needed before reaching target level; tolerance less than 1dB
78
Inspection check
1. power cord
2. power light
3. transducer cords
4. cushions
5. headbands
6. controls & switches
79
Listening Check
must be done on normal hearing individual
1. audiometer noise
2. frequency (all heard at appropriate levels, 70dB)
3. attenuator linearity (any distortions/changes)
4. transducer cords (manipulate)
5. interruptor switch
6. cross talk (place one headphone on all freq at 70dB)
7. acoustic radiation (bone osc tactile response)
8. known threshold search within 5dB
80
Sources of transmission
1. patient
2. clinician
3. instruments/surfaces
81
Major Pathways of Disease Transmission
1. Patient to clinician
2. clinician to patient
3. patient to patient
82
Routes of Transmission
1. direct contact
2. indirect contact (instruments/surfaces)
3. airborne contamination
83
Routine Prevention Measures (infection control)
1. hand washing
2. protective barriers (ie. masks, gloves, eye protection)
3. immunizations
4. waste management
84
Clean, Disinfect, Sterilize
clean: remove all debris
disinfect: kill some germs
sterilize: kill all germs (heat or chemical)
85
threshold characteristics
not an absolute, a range, influenced by outside factors, behavioral response, ranges 10-15dB due to factors
86
Method of Limits
experimenter in control of stimulus intensity; present well above or below until a change is presented, reverse, find mean - threshold
87
Method of Adjustment
Listener is in control of intensity, use response want to control loudness
88
Method of Constant Stimulus
determine set number of trials at a range of intensities
89
Loudness vs. Intensity
loudness: perceived/subjective impression
intensity: physical property
influenced by duration (longer-louder), frequency (grows faster for low & high vs. slower in mid), bandwidth (wider - louder [more neurons stimulated])
90
Phon
means of equating loudness across frequencies
set to intensity level of 1kHz
each phon line is of equal loudness
most sensitive at 2k-5kHz
91
Sone
```
means of determining growth of loudness
1kHz at 40dB SL
1 sone = 40 phon
does not grow linearly with intensity
lower levels grow faster than higher levels
```
92
Pitch vs. Frequency
pitch: related to frequency, subjective impression
frequency: physical property
93
Mel
measure of pitch [ref. 1kHz at 40dB SL = 1k Mel]
O-jive curve: low and high frequencies grow slower than mids
perception not linear to frequency
94
Binaural Fusion
a cognitive process that involves the combination of different auditory information presented binaurally
95
Binaural Sumnation
advantage of using both ears: boost
adds 3-6dB depending on intensity of stim
helps with localization
96
Localization
deals with timing & intensity differences between ears (processing differences)
97
False positive & False negative
False positive: response with no stimulus
| False negative: no response when heard
98
ASHA Recommended Pure Tone Procedure
1. Familiarization (1kHz continuously increased until response)
2. Present 1kHz at 30dB (if response TH search; if no increase 50dB, then 10dB until response)
3. start well below threshold & increase 5dB until response then down 10, up 5
4. TH=lowest level responses occur 50% of the time [2/3 ASHA]
99
Monitoring Technique frequencies vs. Diagnostic
Monitoring: 500, 1k, 2k, 3k, 4k, 6k, 8k
Diagnostic: [125], 250, 500, 1k, 2k, 3k, 4k, 6k, 8k
If difference greater than 20dB present between 2 adjacent frequencies: test interoctave: 750 or 1500
100
Order of Pure Tone testing
better ear first
begin with 1kHz
2-8kHz then retest 1k, 500, 250, 125
101
Masking
gives non test ear an artificial hearing loss through noise [raises thresholds]
102
AC Masking
SA: AC[TE] - 40dB > BC[NTE]
Inserts: AC[TE] - 60dB > BC[NTE]
103
Interaural Attenuation
decrease in intensity from one ear to the other via the skull [from test to non test ear]
104
crossover
when sound crosses to the other side [height of floodwall] from nontest ear to test ear
105
Bone conduction vibration patterns [forehead placement]
200: vibrates as a unit - back & front
800: vibrates out of phase
1600: vibrates in 4 pieces
106
osseotympanic stimulation
bone & cartilage of outer ear canal vibrate, creating sound waves in the canal [forehead & mastoid placement]
107
inertial stimulation [ossicular lag]
mastoid placement: vibrates skull side to side - inducing more movement of the ossicular chain [10-15dB increase]
forehead placement: vibrates front & back, blocking ossicular chain movement
108
distortional stimulation
skull vibration distorts cochlea; scala vestibuli larger than scala tympani; vibration creates an up & down movement of basilar membrane - stimulating it
109
Compressional Stimulation
oval window not displaced as much; cochlear fluid & basilar membrane move downward, stimulating the hair cells
110
mastoid v forehead placement
mastoid: +10-15dB
forehead: more reliable
111
never cover test ear in bone conduction - why
occlusion effect - louder
112
bone conduction responding cochlea & IA
IA: 0dB
| better cochlea responds
113
Bone Conduction Influences
1. size & thickness of skin over mastoid
2. tactile responses [low frequencies]
3. interaural attenuation [0-10dB]
4. environmental influences [open ears]
5. occlusion effect [increases lower frequencies, only seen in SN or normal, not conductive or mixed because already occluded]
114
BC Masking
AC[TE] - unmasked BC[TE] > 10dB
115
minimum info for audiogram
1. date & location
2. names of patient, audiologist, referral source
3. professional credentials
4. description of equipment
5. calibration information
6. threshold values
7. explanation of symbols
8. observations
9. modifications
10. reliability
11. reason for evaluation
116
Right ear air conduction unmasked symbol
O
117
Left ear air conduction unmasked
X
118
Right ear bone conduction unmasked
>
119
Left ear bone conduction unmasked
>
120
Right ear air conduction masked
triangle
121
Left ear air conduction masked
square
122
right ear bone conduction masked
[
123
Left ear bone conduction masked
]
124
Right ear sound field
Circle w line through
125
Left ear sound field
x with lines on the ends
126
Masked Forehead right
upside down L straight line on right
127
Masked forehead left
upside down L, straight line on left
128
no response symbols
arrow pointing down - for left to right, for right to left
129
unspecified BC mastoid unmasked
^
130
unspecified BC forehead unmasked
v
131
masking levels on audiogram
reported for NONTEST ear
132
adult degrees of hearing
```
-10 to 15 normal
16-25 slight
26-40 mild
41-55 moderate
56-70 moderately-severe
71-90 severe
90+ profound
```
133
configurations
```
flat
sloping
precipitous
high frequency
low frequency
notch
scoop/cookie bite
inverted scoop
fragmented
```
134
sound field limitations
```
characteristics of the room
background noise level
properties of speakers
movement of listener
type of stimuli
```
135
sound field equipment
audiometer
speakers
calibration equipment
136
sound field speaker characteristics
```
broad bandwidth
constant output at each frequency
low distortion
accurately transducing transient & steady state signals
uniform radiation pattern in sound field
high electroacoustic efficiency
```
137
near field
large SPL changes occur with small changes in distance from speaker
138
far field
inverse square law applies
| for every doubling of distance, 6dB decrease in SPL
139
sound field challenges not encountered with headphones
more complex signal
affects of loudspeaker on test signal
recognize interaction between characteristics of loudspeakers & test environment
140
ear canal resonance
2700Hz
141
reverberation influence
increases SNR
raises thresholds
worsens intelligibility
142
types of sound field stimuli
frequency modulated (warbled)
narrowband noise
amplitude modulated
143
frequency modulated stimuli
most common
| central frequency with a set deviation & modulation rate
144
narrow band noise
filtered white noise
slightly exceeds cochlear filters
higher distortion than freq mod
145
variables that influence speech processing
```
direct relationship between what is heard & what is understood
type of hearing loss
degree of hearing loss
patient's age (language experience)
linguistic sophistication
```
146
SDT/SAT
minimum level one can discern presence of speech material 50% of the time
Speech Detection Threshold (SDT more accurate that SAT)
Speech Awareness Threshold
147
SRT
Speech Recognition Threshold
minimum level one can correctly recognize speech material 50% of the time
use spondee words (2 syllables, equal stress)
148
monitored live voice limitations
no consistency
149
recorded limits
time, however recommended
150
SRT familiarization reasoning
more likely to get closer to threshold
151
when to test SDT
unable to get SRT; ie. poor discrim, poor understanding, cognitive issue, difficult to test individual
152
SRT masking
SRT[TE] - SRT[NTE] > 40dB (60-70 for inserts)
153
SRT instructions
orient to task, specify response mode, only response w words from list, respond if soft, guess
154
Chaiklin & Ventry SRT method
```
Prelim phase
1. familiarize
2. 25dB SL re: 500 & 1k avg pure tone
3. present one word at each level
4. decrease 5dB steps until missed
Threshold Phase
1. start 10dB SL re: missed level
2. present up to 6 words
3. once 3 words correct - drop 5dB until all 6 are missed
SRT = lowest level 3 correct
```
155
ASHA Descending SRT Method
Preliminary
1. start 30-40dB SL re: estimated SRT
2. present 1 word [if correct, drop 10 until missed, if incorrect increase 20dB until response]
3. present second word at missed level, continue presenting 2 words decreasing 10dB steps until both missed
Threshold Phase
1. start 10dB SL re: missed level
2. present 5 for 5step & 2 for 2step words at each level
3. decrease in 5dB or 2dB steps until all are missed or 5/6 for 2step
Calculation
starting level - correct responses + correction (2dB for 5step & 1dB for 2 step)
156
Chaiklin, Font, & Dixon SRT Method
```
Preliminary
1. start below expected SRT
2. present 1 word at each level
3. up 10dB steps until 1 correct
Threshold
1. present up to 4 words at each level
2. 4 words missed before raising intensity 5dB
3. lowest level where 3 words correct = SRT
```
157
ASHA Ascending SRT
Preliminary
1. present below SRT
2. 1 word at each level in 10dB steps until 1 correct
Threshold
1. present 15dB below correct level
2. present 4 words at each level
3. increase in 5dB steps until at least 3 correct
4. decrease 10dB complete second ascending trial
5. SRT=lowest level 3 words correct in 2 trials
158
Reasons for Suprathreshold testing
1. estimate communicative capability at normal conversational level
2. determine need for diagnostic assessment
3. HA considerations (quiet & noise)
4. analysis of error pattern
159
WRS for normal hearing
25-40dB SL re: SRT
160
WRS Configurations
normal: asymptotes close to 100
sensorineural: max > 100, increases but does not reach 100
conductive: similar to normal hearing
rollover: performance peaks, then decreases
161
Suprathreshold masking
PL[TE] > 40dB of best BC score in NTE
162
Ways to determine WRS PL
1. UCL-5
2. 2k TH + SL [25>50dB]
3. SRT + SL [35>35dB]
163
problems with SRT + SL
20-35 limited audibility
| 40+ too loud
164
50 word lists
50 words at 2% each
originally created this way & ordered properly
time consuming
165
25 word lists
less accurate, variability increases
| 25 words for 4% each
166
why test in noise
quiet testing does not predict functioning in noise
167
scoring SRT methods
phonemic
| whole word
168
whole word scoring interpretation
```
92-100 - excellent
82-90 good
70-80 moderate difficulty
52-68 severe difficulty
22-50 very poor
0-20 extremely poor
```
169
PIPB [performance intensity function] procedure
inform patient hear words & repeat
present 10dB SL re:SRT
increase 10dB steps until plateau
170
rollover index formula
PBmax-PBmin/PBmax if greater than .2, refer for retrocochlear
171
Stenger Test
```
validates unilateral loss
use speech or pure tones
10dB SL in better ear
10dB below worse ear
positive: no response - invalid indicates pseudo-psychosis
negative: response - valid
```
172
ascending-descending gap test
complete ascending threshold search & descending threshold search
if gap is 20-30dB better ascending compared to descending, pseudo-psychosis
173
Lombard Reflex
patient reads passage while hearing noise & slowly increasing it
if vocal intensities rise w noise levels lower than thresholds, pseudo-psychosis
174
Doerfler-Stewart test
introduce noise during SRT testing
disrupts loudness judgement
allows determination of true SRT
175
Bekesy Audiometry
uses method of adjustment
evaluates one frequency at a time (250 or 500, 1k, 2k, 4k)
30 sec to 1 min for pulsed frequency
1-2 mins for continuous frequency
sweep method changes continuously at an octave per minute
176
BA Type I
P & C intertwined
10dB wide
indicates normal or conductive loss
177
BA Type II
P & C intertwined up to 1k
1. C falls below P then runs parallel to C (tone decay) or
2. continuous tracing narrows due to intensity difference limens around TH
indicated: sensorineural, idiopathic, presbycusis
178
BA Type III
c falls quick from p
often to limit of audiometer
indicated retrocochlear
179
BA Type IV
c quickly falls below p then runs parallel
| indicates cochlear dysfunction, retrocochlear
180
BA Type V
P falls below C
could be due to effects on loudness memory, so pulsed seems more intense
indicates functional or non organic HL
