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AUDE 5340 AUD DIAG II > Final Exam > Flashcards

Final Exam Flashcards

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1
Q

If setting up Stenger test, PT R thres is at 5 and L thres is at 45 at 2,000 Hz. How would you set the tone for L ear? How would you set tone for the right ear?

A

L: 35 (10-45)
R: 15 (5+10)

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2
Q

if the patient says they DID NOT hear the tone for the above example, were they likely faking?

A

yes

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3
Q

In the example above, if the patient reports that they DID NOT hear the tone, in which ear did they likely hear it in?

A

left ear

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4
Q

If you determined that the person was presenting with a nonorganic hearing loss and wanted to estimate a pure tone threshold at 2000 Hz, how would you set that up?

A

R ear: 15
L ear: 0

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5
Q

When using Stenger principals to estimate threshold, would you expect the patient to report that they DO or DO NOT hear the tone at your initial presentation?

A

they would say they do hear it at the first presentation

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6
Q

If the hearing loss at the the left ear were nonorganic and the hearing was actually symmetrical based on the right ear thresholds, would the patient be able to hear a 40 dB tone presented to the left ear?

A

yes

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7
Q

How would you set up a Stenger at 1000 Hz for PT with L thres at 0 and R thres at 45?

A

L ear: 10
R ear: 35

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8
Q

Assume the patient in the above case is giving you valid responses. Would this result in a negative Stenger or a positive Stenger?

A

negative stenger

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9
Q

If the patient in the previous case is giving you valid responses, in which ear would they have heard the tone during a Stenger test?

A

left ear

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10
Q

contra’s missing, ispi present, no HL

A

brainstem pathology

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11
Q

probe side absent, normal tymps, normal hearing, descending pathway

A

facial nerve pathology

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12
Q

conductive loss on audiogram (ABGs, Low frequ HL), normal tymps & reflexes

A

SSCD

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13
Q

bilateral, no reflexes on both sides
normal OAE, hearing below 60dB, BILATERAL, rare are stim effect, thresh varies, is retro, has to occur w/ SNHL

A

ANSD

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14
Q

thresholds normal & reflexes bw 70-90 SL

A

normal hearing

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15
Q

HL in one ear, same side probes - abs
stim - 70-90 ABOVE air thresholds (elevated)

A

conductive

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16
Q

SNHL, STIM ear reflexes affected, <70 dB SL, stim effect, generally expect reflex up to 60dB cochlear hearing, if AC thres >60 dB absent reflexes are not diagnostic

A

cochlear HL

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17
Q

SNHL/NH, STIM ear, >90dB SL/ABS

A

retrocochlear/vestibular schwanoma

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18
Q

what is sensitivity

A

correctly identifying those with the disease
TP/TP+FN
Number of true positives / total number who have it

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19
Q

what is specificity

A

correctly identifying those without the disease
TN/FP+TN
Number of true negatives / total number who do not have it

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20
Q

Is standard low frequency tympanometry good at differentiating between otosclerosis and a normal middle ear?

A

no because you can have a normal tymp with otosclerosis

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21
Q

What is a primary factor that influences sensitivity and specificity for a specific test?

A

how you set the screening criteria

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22
Q

Is high frequency audiometry more sensitive for detecting damage to the as?

A

could be, need more research

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23
Q

common use for high frequency audiometry

A

monitoring ototoxicity

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24
Q

What transducer type must be used for high frequency audiometry?

A

circumaural headphones

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25
what is acoustic reflex decay
based on reflex adaptation presented 10dB above reflex threshold unimpaired system can hold this for longer than 10 seconds retrocochlear pathology adapts and decays
26
+ decay
retrocochlear pathology sign did not hold for the full 10 seconds
27
- decay
not indicative of retrocochlear pathology holds for the full 10 seconds
28
difference between baseline admittance and admittance at the reflex
50%
29
How is a test for acoustic reflex decay administered?
Present 10 dB above reflex threshold (without exceeding 105 dB) for ten seconds Note whether reflex is maintained for the ten seconds or if it decays If reflex decays by 50% or more, this is considered “positive” for reflex decay and is an abnormal finding Suggestive of retrocochlear Decay less than 50% = negative for reflex decay
30
what is considered a + decay
If reflex decays by 50% or more retrocochlear
31
what is considered a - decay
Decay less than 50%
32
what is the ideal condition for acoustic reflex decay
CONTRALATERAL if cannot, ipsi is ok only present at 500 or 1000 Hz
33
Why are you not likely to actually measure positive reflex decay even in cases of retrocochlear pathology?
Typically we have no response with retrocochlear (reflex threshold) so we won’t do it on them because it is too loud Cochlear - can do it on them and could rule out retrocochlear this way
34
What are some indications that a hearing loss might be nonorganic?
Exaggerates difficulty hearing Case history Financial compensation (work injury, for example) Referred by an attorney Difficulty in school (pediatric) Age (most common age for pediatric functional hearing loss is10-12 years old) Based on observable discrepancies Between behavior and test results Among audiology test results
35
what is nonorganic
faking a HL apparent hearing deficit in absence of an anatomic or physiologic explanation
36
What dB of difference between ears is needed to do a Stenger?
20 dB
37
How do you set up a Stenger test? What do the different results suggest?
+10 to better ear and -10 to poorer ear Hear it = better ear Didn’t hear it = hear in poor ear and are lying to you
38
How do you estimate thresholds using Stenger principles?
+10 to better ear and 0dB at worse ear Present simultaneous and louder at better ear so they say they hear it Increase in 5 steps to poorer ear and will stop responding to hearing it (threshold)
39
What are some other tests or test modifications that suggest or confirm nonorganic hearing loss?
Have them count the number of beeps, change step size, descending and ascending thresholds and compare them, test bone first
40
Modification of pure tone test procedure
Have them count the number of beeps, change step size, descending and ascending and compare them, test bone first, switch from side to side (different thresholds can tell they are faking because IA is close to zero)
41
modification of behavioral tests
Repeat words in noise, see if voice gets louder - lombard Part of the story in each ear and ask them about it - switching speech test
42
modification of physiologic tests
ABR/OAE/Reflexes
43
How do you work with a patient you suspect is exaggerating (or feigning) a hearing loss? What kinds of things do you say to them to let them know you are suspecting functional?
First thing you do is give them an out (pretend equipment isn’t working, make sure they understand the instructions) give an opportunity to be honest with you (maybe you didn’t understand my instructions and you are waiting until it gets loud, click it even if it is soft)
44
What are some reasons someone might pretend to have better hearing than they actually do?
Often motivated by financial gain Wants cochlear implants instead of hearing aids
45
asymmetries that raise suspicion of retrocochlear
Word recognition scores (already covered) Pure tone Unilateral tinnitus
46
criterial for pure tone asymmetry
3 adjacent pure tones that differ by 15dB+” Or 20 dB at one frequency
47
criteria for WRS asymmetr
48
criteria for unilateral tinnitus
49
what is loudness adaptation?
Reduction of neural response to continuous stimulation
50
How is the Olson and Noffsinger tone decay test implemented? What instructions do you give?
Begin 20 dB above their threshold (20 dB SL) Present tone for 60 seconds if PT hears the tone full minute = negative for tone decay If PT cannot, increase 5dB and if PT holds minute = negative if PT cannot increase 5 (10 total) if pt hears it for the minute - negative if they still cannot for the minute = positive **Only increase 10dB above their threshold total
51
What results suggest normal, conductive, cochlear, retrocochlear?
>30 dB after increasing and if they cannot hear tone for the minute after increasing by 10 total, it is positive for tone decay and retrocochlear sign cochlear/normal/conductive = negative for tone decay, they heard it the whole time
52
Define recruitment of loudness. What type of hearing loss is indicated if recruitment is seen? Why does this happen?
Rfers to reduction of dynamic range Smaller distance from threshold to UCL - this suggests cochlear HL Test involving loudness perception, cochlear Happens because of cochlear amplifier
53
what are the 3 asymmetries that are suggestive of retrocochlear
word rec scores unilateral tinnitus pure tones (3 adjacent ones that differ by 15dB or more at 1 frequency
54
people with cochlear hl have
reduced dynamic range
55
Which type of hearing loss exhibits recruitment of loudness?
cochlear
56
Define tone decay Which type of hearing loss exhibits tone decay? Which type of hearing loss exhibits reflex decay?
inability to perceive a continuous tone for a full minute retrocochlear HL
57
when the PT has control
method of adjustments
58
bekesey audiometry testing conducted what two ways
sweep frequency tracing fixed frequency tracing
59
type Iv bekesey is with what HL
retrocochlear
60
type III bekesey is with what HL
retrocochlear
61
type II bekesey is with what HL
cochlear
62
type I bekesey is with what HL
normal or condutive HL overlapping of I and C tracings, with a tracing width of about 10 dB
63
role of the Eustachian tube in the healthy middle ear
To ventilate the middle ear, allows fluid to drain
64
Define Eustachian tube dysfunction Describe how this is assessed without a perforation and with a perforation
Inflation, deflation Run tymp, have them swallow (max negative pressure) swallow again (max positive pressure) Serial tympanograms (one after another)
65
what do tymps show for ETD
left = neg pressure right = pos pressure if it doesn't shift, ETD does not open when it should
66
Define patulous Eustachian tube and describe how this is assessed
Monitoring admittance and have the PT breathe (air will go in and out of ME, will see a definite definite increase and decrease that will show their breathing patterns) normal = flatline sinosoidal wave = abnormal and always open
67
advantages of multifrequency tympanometry and wideband acoustic immittance.
More sensitive because you are testing more frequency (to middle ear disorders) You have different normative data you can compare it to (better at identifying the specific disorder)
68
Excessively low absorbance at low frequencies
Indicates increased stiffness such as OME or otosclerosis
69
Excessively high absorbance at low frequencies
indicates decreased stiffness such as a TM perforation or ossicular discontinuity
70
Know what the WAI 3D graph is plotting
Still plots tymp (changing pressure) plotting admittance, absorbance, how much sound is getting through the system
71
The resonant frequency (RF) of the middle ear ranges from what?
1100-1800
72
primary diagnostic utility of MFT is
ability to determine whether the ME is characterized by a RF that is typical or Higher than normal as observed with otosclerosis Or lower than normal as observed with ossicular discontinuity
73
Low resonant frequency
Ossicular discontinuity
74
High resonant frequency
Otosclerosis ME effusion
75
What is an advantage of running WAI at ambient pressure?
don’t have to change the frequencies
76
What is coding used for besides billing?
Internal data collection Medicare and insurance billing Code for every patient encounter Code what you did Diagnostic appointment (testing performed, diagnosis/reason for test) Treatment appointment
77
What are the 3 coding systems that we use?
CPT ICD-10 HCPCS
78
What is CPT and who maintains it
AMA current procedure terminology tests that we do
79
what is ICD-10 and who maintains it
government reason for the test diagnosis code developed by WHO
80
what is HCPCS and who maintains them
government just for devices
81
What procedures are required to be completed to use the code 92557, comprehensive audiometry evaluation?
both ears air bone and speech
82
What are the two modifiers discussed in class and what are they used for?
52 - reduced 22 - expanded
83
Identify the 3 conditions where a masking dilemma may occur
Bilateral conductive with significant abg Large abg in NTE (same as first for air) Large asymmetry and you need to mask the better ear
84
Calculate maximum masking level
Bone of te + IA - 5
85
Explain what to do is a potential masking dilemma is encountered.
Mask anyway because IA is different by frequency, transducer and individual person As long as you have correct SL and you get a plateu you get a valid threshold
86
underlying premise for the NU-6 Ordered by Difficulty
If we put most diff words first we can identify who actually needs all 50 words and who we can only give 10 words to Give as few words as possible without sacrificing reliability
87
Rule out\
exclude the possibility of a particular condition/disorder as part of a diagnosis
88
rule in
include the possibility of a particular condition/disorder as part of a diagnosis
89
When a disorder is rare it is easier to find the people who DON’T have the condition so the approach is to rule ____ rather than to rule _____
out, in
90
What is a potential benefit of using this word list?
It is a validated shortcut
91
What are the restrictions for administering WRS using NU-6 Ordered by Difficulty?
Has to be the exact recording in the same voice in that same order You can’t read the list or take the words recorded by someone else has to be exact same recording
92

AUDE 5340 AUD DIAG II (9 decks)

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