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Flashcards in Lecture 1 Deck (22):
1

What are the purposes of hearing measurement?

  • Aid in medical diagnosis
  • Guide management of hearing disorder
  • identification of people at risk
  • Monitoring purposes

2

How does the audiologist aid in the medical diagnosis? In other words, what can an audiogram tell us that can help in a medical diagnosis?

  • Symmetry of hearing loss
  • Type of loss
  • Configuration
  • Degree

3

How does an audiologist guide the management of the hearing disorder?

  • Is this something that can be treated medically? 
  • Amplification and hearing technology
  • Aural rehabilitation
  • cognitive training
  • special education or vocational guidance
  • medical or legal consultation

4

How does hearing measurement identify people at risk for hearing loss?

  • Hearing screenings
    • Schools, military, senior centers, noisy industries, new born hearing screenings 

5

How does hearing measurement help with monitoring purposes?

  • Can show how much hearing changes over time
    • due to things such as ototoxic drugs, noise exposure, surgery (how much improved)

6

What is the goal of audiometric assessment and what are the requirements to achieve this goal (5)?

  • Goal of audiometric assessment
    • to obtain an accurate measure of auditory ability on that day
  • Requirements to achieve this goal:
    • Controlled environment - booths
    • Accurate instrument - calibration
    • Informed tester 
    • Use of appropriate measures - valid and reliable tests
    • Patient cooperation - do they understand?

 

7

What are some pathologies associated with the outer and middle ears?

  •  outer ear: congenital microtia, acute external otitis, collapsing ear canals, foreign substance causing occlusion
  • middle ear: otitis media, otosclerosis, ossicular discontinuity, cholesteatoma, perforation of tm 

8

What are some pathologies associated with the inner ear, N. VIII, and CANS?

  • inner ear: noise induced hearing loss, ototoxicity, Meniere’s Disease (endolymph accumulation), hereditary hearing loss (inner ear dysplasia), labyrinthitis, perilymphatic fistula (hole in round or oval window) 
  • N. VIII: vestibular schwannoma, presbycusis 
  • CANS: multiple sclerosis, tumors, trauma (incl. TBI) (for details, see ppt slide show on Canvas)

9

What is the difference between peripheral and central lesions?

  •  Peripheral
    • Conductive 
    • Sensorineural
      •  Neural = extra-axial (before) brainstem disorder 
  • Central auditory nervous system 
    • inta-axial (after) brainstem disorder  
    • Cortical lesion
  • [Retrocochlear lesion = beyond the cochlea]

10

Describe a case history in an otolaryngologic evaluation. Who conducts it? strategies for obtaining information? What information is gained about the hearing loss? What physical symptoms are asked about? Perceptual symptoms? Medical history? Communication history?

  •  Case History
    • PA, NP, audiologist, physician conduct
    • Can use a questionnaire
      • Why are you here today - person's assessment
    • information about hearing loss
      •  Onset (sudden/gradual) and progression 
      • Unilateral/bilateral - start in better ear
      • Constant vs. fluctuating (meniere's, conductive, syphilis)
    • physical symptoms:  pain, discharge, facial numbness
    •  perceptual symptoms: tinnitus, vertigo, hyperacusis 
    • medical history: general health, past illnesses, meds, noise exposure 
    • communication history

 

11

Describe a physical examination (ENT) of an otolaryngologic evaluation. What is examined before the ear? What is checked in an aural exam? What is screened for? What can be used to visualize problem?

 

  • Prior to examining the ear:
    • mouth, head and neck exam 
  • Aural exam (normal vs. pathologic signs) 
    • Tympanic membrane – structure 
    • Tympanic membrane – mobility
    •  Patency of Eustachian tube  
  • Screen for neurologic function
  • Screen for nystagmus 
  • Imaging/radiologic tests

12

What kind of otoscopes are there?

  • Standard otoscopes
    • Hand held
  • Pneumatic otoscopes (can test pressure)
    • Digital pneumatic otoscope
    • Pneumatic bulb
  • Video otoscopes

13

Review root words: myringo, tympano, stape, mastoid 

Review suffixes: plasty, -otomy, -ectomy

What are some non-surgical medical treatments?

  •  Surgical techniques
    • Myringotomy Myringoplasty Tympanoplasty Stapedotomy Mastoidectomy 
      Also: Tumor removal, Patch operation, Shunt operation

  • Review root words  
    • myringo - tympanic membrane
    • tympano - middle ear
    • stape - stapes 
    • mastoid - mastoid bone, hair cell system
  • Review suffixes
    • plasty - reconstruction
    • otomy - cut
    • ectomy - removal
  • Non-surgical medical treatments
    • Antibiotics, antihistamines, injections of gentamycin (reduces vestibualr function) 

14

Describe the Rinne tuning fork test. What kind of test is it and for what kind of hearing loss? What does it indicate? What does it compare? How do normal-hearing people perform? What do the results mean (-/+)? What are some limitations?

  •  Qualitative test for bilateral hearing loss 
    • Indicates type of loss (conductive vs. sensorineural)
    • Compares hearing by ac to hearing by bc
      • Which way does patient hear longer – ac or bc?
    • Normal hearing people hear longer by ac because of ear canal resonances that make sound louder by up to 30 dB
    • Classification of results:
      • - Rinne - Conductive loss. Hears louder by bc because sound is attenuated by ac because of conductive HL
      • + Rinne - Sensorineural loss. Hears longer by ac
    • Limitations - self report of hearing loss.

 

15

Describe the Weber tuning fork test. What kind of test is it and for what type of hearing loss? What does it indicate about the loss? What is it based on? How do you condict a Weber test? How are the results classified?

  • Qualitative test for unilateral hearing loss  
    • Indicates if unilateral loss is conductive or sensorineural
  • Based on:
    • Stenger effect - if same tone in frequency and phase is sent to both ears simultaneously, only heard in one ear where it is more intense
    • occlusion effect - if occlude one ear, a bone conductive stimulation gets louded (conductive HL acts as built in occlusion effect)
  • Conduct of Weber Test:
    • Tuning fork placed on forehead
    • Ask patient where they hear the tone
  • Classification of results:
    • Tone lateralizes to good ear - SN HL in bad ear because good cochlea will pick it up
    • Tone lateralizes to poor ear - Conductive HL in bad ear because of built in occlusion effect
    • Tone heard in center of head - normal hearing or equally sensitive cochleas

 

16

Who can infection be transmitted to and from? What infections are we most concerned about? What audiologic procedures can spread infection? 

  • Mechanism of transmission:
    • Patient-to-patient or patient-to-audiologist
    • Most concerned about HIV/AIDS and hepatitis B
    • Also - bacterial infections and fungal growths
  •  Audiologic procedures that could spread infection:
    • Insert earphones, supra-aural earphones
    • Electrodes on scalp (ABR, ECoG)
    • Probe microphone measures and probe tips
    • CIC hearing aids 

17

How is disease transmitted? Is cerumen infectious? How can you tell if cerumen contains blood? How should cerumen be handled? What other exposure should be considered?

  • Exposure to disease:
    • Through bodily fluids, esp. blood and mucous
    • Cerumen, by itself, is not infectious
    • BUT – cerumen can contain dried blood (hepatitis B can live in dried blood for 7 days)
    • Impossible to tell if cerumen contains blood
    • Handle cerumen using infection control protocols
    • Also exposure through contact with skin, open sores

18

What are some ways infection can be transmitted? Through audiologic procedures? Through patient contact? What bacteria is often found on hearing instruments? In the waiting room?

  • Transmission possibilities
  • audiologic procedures
    • Audiometry, immittance, OAEs, ABR, hearing aid fitting
  • patient contact
    • Equipment that patient touches with open sores or rash
      • Includes: earphones, response buttons, bone oscillator, headbands, immittance probe tips
    • Handling of hearing aids and earmolds
      • *Staphylococcus - most common bacteria found on hearing instruments removed from patients.
    • Direct patient contact (skin)
  • waiting room
    • Sick patients handle toys
    • Saliva can spread CMV, meningitis, hepatitis A and B, common cold

 

19

What is cleaning? What is disinfecting? What is the hardest germ to kill? What is sterilization? How is it done?

 

  • Clean: remove all visible debris without killing germs
  • Disinfect: kill certain germs, but not all
    • Tuberculosis is the most difficult germ to kill
    • Tuberculocidal hospital grade disinfectant will kill most germs
  • Sterilize
    • Kills 100% germs and their resistant endospores
    • Performed with heat and pressure in an autoclave or with a chemical with 2% glutaraldehyde

20

What are the goals of infection control protocol? What is the protocol for non-critical equipment? What is the protocol for critical equipment?

  • Goals of protocol
    • Clean and disinfect noncritical audiology equipment (stethoscopes, toys, headphones, response buttons, etc.)
    • Clean and sterilize critical audiology equipment that touches body fluids or cerumen (probe tips, ear specula, earmolds)
  • protocol for non-critical equipment
    • Clean surfaces with soap and water
    • Disinfect surfaces with hospital-grade disinfectant
  • protocol for critical equipment
    • Clean surfaces with soap and water
    • Run objects in ultrasonic cleaner to loosen debris
    • Soak overnight in 2% glutaraldehyde solution in a covered container
    • Rinse objects in water and dry

 

21

What are some personal percautions an audiologist should take when it comes to infection control?

  • Always wear gloves in the presence of:
    • Blood, mucous, other body fluids
    • Lesions, scratches, sores, open cuts
    • Intraoperative monitoring, needle electrodes
    • Invasive procedures
    • Draining ear and healing ear
  • Audiologists should consider using gloves:
    • Handling hearing aids
    • Cleaning and disinfecting audiology equipment
    • Taking CIC impressions
    • Exposed to cerumen

22

Hand washing procedure

  1. wash hands when they are visibly dirty or contaminated with bodily material or fluids;
  2. wash hands with an antimicrobial soap and water, 15-20 s
  3. If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations
  4. Decontaminate hands before having direct contact with patients
  5. Decontaminate hands after contact with a patient's intact skin (e.g., when taking an earmold impression, placing hearing aids in the ear, etc.)