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Diagnostics 2 > Mid Term > Flashcards

Mid Term Flashcards

1
Q

Impedance (Za) = resistance (Ra) + reactance

A

Impedance (Za) = resistance (Ra) + reactance

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2
Q

Admittance (Ya) = Conductance (Ga) + Susceptance (j or -jBa)

A

Admittance (Ya) = Conductance (Ga) + Susceptance (j or -jBa)

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3
Q

Impedance

A

resistance of flow of sound energy

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4
Q

what affects impedance?

A

acoustic resistance, compliant acoustic reactance, mass acoustic reactance

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5
Q

Compliance susceptance

A

ease of flow through a system

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6
Q

what freq. is compliant susceptance greatest?

A

low freq.

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7
Q

Mass Susceptance

A

ease of sound flow through a mass or inertial elements

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8
Q

what freq. is mass susceptance greatest

A

high freq.

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9
Q

Stiffness contributions to ME function

A

TM, round window, ossicular ligaments, ME muscles, air within EAC & ME

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10
Q

Mass contributions to ME function

A

ossicles, air movement in ME, frictional properties inherent to air movement within the system

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11
Q

Resonance

A

compliant acoustic susceptance and mass acoustic susceptance are equal and cancel each other out

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12
Q

Components of tympanometer

A

probe, pneumatic system (changes air pressure), acoustic immittance measurement system (converting difference between driver and mic), acoustic reflex activator system (ipsi & contra)

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13
Q

Type 1 Tympanometer

A

manual & auto, ipsi & contra, noise & pure-tone

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14
Q

Type 2 tympanometer

A

manual & auto, ipsi & contra, pure-tone, what we use

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15
Q

Type 3 tympanometer

A

static immittance & tymps, acoustic reflex at specified levels, used for screenings

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16
Q

Type 4 tympanometer

A

can separately do static immittance, tymps, or reflexes

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17
Q

What systems need calibration?

A

probe signal, acoustic immittance measurement system, pneumatic system, acoustic reflex activating system

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18
Q

What do we look at when calibrating probe signal?

A

output level, freq. accuracy, harmonic distortion

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19
Q

What do we look at when calibrating acoustic immittance measurement system?

A

calibration cavities equals admittance magnitude–> 0.5 cc=0.5 mmhos, 2.0cc=2.0 mmhos, 5.0cc=5.0mmhos

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20
Q

What do we look at when calibrating pneumatic system?

A

pressure changes: type 1 & 2= +200 and -600 daPa, Type 3= +100 and -300 daPa

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21
Q

What do we look at when calibrating acoustic reflex activating system?

A

freq. accuracy, output levels, attenuator linearity, harmonic distortion, temporal characteristics of instrument (initial latency, rise time, terminal latency, fall time, drift)

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22
Q

What due admittance measures tell us?

A

about ME function, Eustachian tube function, and indicates ME effusion, patency of PE tubes, and TM perforations

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23
Q

What do reflex measures tell us?

A

function of ME pathway (stapedius muscle), sensory pathway, neural pathway, and motor pathway

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24
Q

Parts of tymp tubes

A

manometer, mic, speaker

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25
Q

What do LF (226/220 Hz) tymps tell us?

A

assess stiffness of ME (effusion affects stiffness)

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26
Q

Importance of ECV

A

provides insight to etiology of flat tymp.

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27
Q

Norms for Tymps ECV–> Birth to 4 months

A

0.3 cc

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28
Q

Abnormal Tymps ECV–> Birth to 4 months

A

greater than 1.0 cc

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29
Q

Norms for Tymps ECV–> 2.8 to 5.8 years

A

0.4 to 0.9 cc

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30
Q

Abnormal tymp ECV–> 2.8 to 5.8 years

A

greater than 1.0 cc

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31
Q

Norms for tymp ECV–> 6 weeks to 6.7 years

A

0.3 to 0.9 cc

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32
Q

Abnormal tymp ECV–> 6 weeks to 6.7 years

A

1.0 to 5.5 cc with PE tubes

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33
Q

Norms for tymp ECV–> Adult

A

0.63 to 1.46 cc

34
Q

Abnormal tymp ECV–> Adults

A

greater than 1.5 cc

35
Q

Normal tymp ECV–> 5th decade

A

1.41 cc

36
Q

Norms for tymp ECV–> 8th decade

A

1.28 cc

37
Q

Norms for tymp ECV–> Female

A

1.28 cc

38
Q

Norms for tymp ECV–> Male

A

1.50 cc

39
Q

Tympanic Peak Pressure (TPP)

A

measure at peak of tymp, point where pressure of EAC is equal to ME pressure (0= EAC pressure is equal to atmospheric pressure), most admittance at this point

40
Q

Factors that influence tympanic peak pressure (TPP)

A

positive change with negative EAC pressure, direction of pressure change (+ to - = lower admittance, - to + = higher admittance), rate of pressure change, sneezing, coughing

41
Q

What does tympanic peak pressure tell us?

A

about Eustachian tube function, monitors otitis media (negative pressure associated with fluid= reduced tymp height)

42
Q

Peak Compensated Static Acoustic Admittance

A

ear canal admittance contributions removed, combo of acoustic admittance of TM and ME system

43
Q

Admittance Norms–> Adult

A

0.72 mmhos

44
Q

Abnormal Admittance–> Adults

A

less than 0.3 mmhos

45
Q

Admittance norms–> 4 month old

A

0.45 mmhos

46
Q

Abnormal Admittance–> 4 month old

A

less than 0.02 mmhos

47
Q

Admittance Norms–> 2.8 to 5.8 years

A

0.5 mmhos

48
Q

Abnormal Admittance–> 2.8 to 5.8 years

A

less than 0.2 mmhos

49
Q

What could a reduced admittance peak mean?

A

ME effusion, effects of chronic otitis media (cholesteatoma, polyps, granuloma tissue), otosclerosis, impacted cerumen, TM perf

50
Q

What could an increased admittance peak mean?

A

ossicular chain discontinuity, mononumeric TM (one layer TM), atrophic scars

51
Q

What should not be used to diagnose otitis media?

A

peak admittance: only correct 56% of the time

52
Q

Sensitivity

A

test truly identifies those that have the problem

53
Q

Specificity

A

truly identifies those that do not have the problem

54
Q

Tympanometric Gradient

A

describes the steepness of the slope near the peak, height and width of the tymp, draw line where width is 100 daPa–> hp/ht

55
Q

Abnormal Gradient

A

0.2 or less

56
Q

What could a lower gradient mean?

A

ME fluid

57
Q

Tympanometric Width

A

flatness of tymp, 1/2 of admittance, connect the legs and draw lines down to x-axis, distance between legs

58
Q

Abnormal width for infants less than 12 months

A

235 daPa or greater

59
Q

Abnormal width for children 1-18

A

equal to or greater than 200 daPa

60
Q

Abnormal width for adults

A

greater than or equal to 155 daPa

61
Q

What could an abnormal width mean?

A

ME fluid

62
Q

Type A tymp admittance, pressure, and meaning

A 
admittance= 0.3 to 1.4 mmhos
pressure= -100 to +100 daPa
Meaning= normal ME function
63
Q

Type As tymp admittance, pressure, and meaning

A 
admittance= less than 0.3 mmhos
pressure= -100 to +100 daPa
meaning= shallow or stiff, could be minimal ME effusion or ossicular chain fixation
64
Q

Type Ad tymp admittance, pressure, and meaning

A 
admittance= greater than 1.4 mmhos
pressure= -100 to +100 daPa
meaning= flaccid TM pathology (mononumeric TM), ossicular chain disarticulation
65
Q

Type C tymp admittance, pressure, and meaning

A 
admittance= 0.3 to 1.4 mmhos
pressure= less than -100 daPa
meaning= Eustachian tube dysfunction, minimal ME effusion
66
Q

Type B tymp admittance, pressure, and meaning

A 
admittance= no peak
pressure= no peak
meaning= ME effusion, canal/probe occlusion, perforation, PE tubes, cholesteatoma
67
Q

Type D tymp admittance, pressure, and meaning

A 
admittance= 0.3 to 1.4 mmhos with 2 peaks
pressure= -100 to +100 daPa with 2 pressures
meaning= flaccid TM, ossicular chain disarticulation
68
Q

Explain process of simple Eustachian tube test

A

run tymp
perform valsalva
repeat tymp
TPP should be more positive

69
Q

Explain process of Pressure Swallow Test for Intact Tympanic membrane

A

run tymp
add +400 daPa pressure (pushes TM back, pressure inc.)
have pt. swallow (ET opens & closes, pressure becomes more neg)
repeat tymp
add -400 daPa pressure
have pt. swallow (pressure enters ME)
repeat tymp (should be more positive)

70
Q

Norms for pressure swallow test

A

+400 daPa: want 15 to 20 daPa negative shift
-400 daPa: want 15 to 20 daPa positive shift
ET dysfunction: shift will be less than 15 to 20 daPa

71
Q

Eustachian tube testing for perforated tympanic membrane

A

introduce +400 daPa or -400 daPa

have pt. swallow

72
Q

Norms for eustacian tube testing for perf

A

healthy ET open at +150 daPa

ET dysfunction requires +350 daPa

73
Q

What will Eustachian tube testing tell us?

A

pressure change will tell us if there is normal ET function, but will give us no info concerning physiology of ET

74
Q

Interpreting B/G tymps

A 
look at shape & configuration
named according to peaks
meet width criteria
226 Hz normally has single peak
668 Hz normally has multiple peaks
75
Q

What does it mean if susceptance notch is above the tail value?

A

total susceptance is positive
ME is stiffness dominated
admittance vector is in upper quadrant

76
Q

What does it mean if susceptance notch is equal to tail value?

A

admittance vector is 0 degrees

ME is in resonance

77
Q

What does it mean if susceptance notch is below the tail value?

A

total susceptance is negative
ME is mass controlled
admittance vector now is in the lower quadrant

78
Q

Abnormal criteria for B/G tymps

A

have too many peaks
being too wide (75 daPa greater than or equal for 3B tymps, 100 daPa greater than or equal for 5B tymps, peak to tail magnitude B is greater than G in 1B1G- considered abnormally stiff)

79
Q

Clinical significance of B/G tymps

A

helps distinguish between ossicular discontinuities and other disorders
gives more info than 226 Hz tymp

80
Q

Screening tympanometry protocol

A 
for 7 months to 18 year old
visual inspections of outer ear & TM
226 Hz tymp measures
look at ECV, admittance, and TW
abnormal initial screening
repeat in 6-8 weeks
abnormal second screening
medical referral
81
Q

Abnormal results for B\G tymps for infants

A

admittance < 0.2 mmhos

width > 235 daPa

82
Q

Abnormal results for B\G tymps for 1-8 year olds

A

admittance < 0.3 mmhos

width > 200 daPa

Diagnostics 2 (3 decks)

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