OAEs

Question 1

Typically takes much less time

Answer 1

screening

Question 2

Fewer frequencies assessed, usually higher frequencies

Answer 2

screening

Question 3

A component of a comprehensive test battery

Answer 3

diagnostic

Question 4

Requires interpretation from audiologist

Answer 4

diagnostic

Question 5

Completed to distinguish those who do not have significant auditory dysfunction from those who need further evaluation

Answer 5

screening

Question 6

OAE outcomes will always fall within one (1) of three (3) general categories. Which of the following are those three (3) categories?

OAE amplitude is normal (relative to normative data)

Amplitude is abnormal, but OAEs are present

The noise floor is less than the amplitude of the response

The noise floor is equal to the amplitude of the response

OAEs are absent

Answer 6

OAE amplitude is normal (relative to normative data)

Amplitude is abnormal, but OAEs are present

OAEs are absent

Question 7

The most important contributor to OAE production is the motility of the outer hair cells. Please elaborate on this idea, explaining how they produce OAEs (from stimulus delivery to recording).

Answer 7

The stimulus is presented into the external auditory canal. It then passes through the tympanic membrane into the middle ear where it acts as an impedance matcher through the ratio size between the tympanic membrane and the stapes footplate in the oval window, the lever action of the ossicles, and the buckling of the tympanic membrane. Once the stapes footplate pushes into the oval window into the fluid in the cochlea, this creates a travelling wave. This traveling wave reaches the part of the basilar membrane that is most susceptible to movement from the frequency of the original stimulus wave. Once the basilar is displaced to its maximum displacement, the stereocilia on the outer hair cells are sheared, causing potassium ions to rush in, activating calcium ion channels to open and let calcium in. This rushing in of ions causes the outer hair cells to elongate and shorten, which is the electromotility. This electromotility of the outer hair cells produces OAEs. The OAEs that is produced from the outer hair cell travels back out of the oval window at the stapes footplate as a reverse wave. This then pushes through the middle ear losing its amplitude because the mechanisms that acted as impedance matchers are now impedance mismatchers and cause the spiked heel effect on the OAE. The OAE then reaches the tympanic membrane and back out to the external auditory canal to be measured and picked up by the probe.

Question 8

Generally speaking, slight middle ear disorders that may not entirely obscure OAEs affect responses first for the lower frequencies.

Answer 8

t

Question 9

Please list for me three (3) non-pathological ear canal factors that can affect OAE measurement. One of them must be standing waves

Answer 9

1) age

2) women

3) in proper probe placement

Question 10

What role(s) does the external auditory meatus (or canal) play in OAE measurement?

Answer 10

both inwaard and outward propagation

Question 11

In collection of TEOAE responses, the No. Hi. (number of rejected samples) refers to the number of runs that were rejected because the incoming noise peaks exceed the Rejection Level in dB SPL.

Answer 11

t

Question 12

Which medical red flags contraindicate the recording of OAE responses?

Active drainage in the ear canal
A foreign body in the ear canal
A history of middle ear dysfunction
Active bleeding in the ear canal

Answer 12

Active drainage in the ear canal
A foreign body in the ear canal
Active bleeding in the ear canal

Question 13

The amplitude of OAE responses are typically larger with greater reproducibility in adults when compared to children and infants.

Answer 13

f

Question 14

In ears with a perforation or a patent ventilation tube, which of the following is true?
OAE responses will always be absent in ears with tympanic membrane perforation or ventilation tube.

OAE responses will always be present in ears with tympanic membrane perforation or ventilation tube.

Tympanic membrane perforation and ventilation tubes are medical red flags and OAE testing should not be attempted.

Present OAE, absent OAE, partial OAE, or reduced amplitude OAE responses may be observed in dry ears with tympanic membrane perforation or ventilation tubes.

Answer 14

Present OAE, absent OAE, partial OAE, or reduced amplitude OAE responses may be observed in dry ears with tympanic membrane perforation or ventilation tubes.

Question 15

What are the two (2) pure tones labeled as in DPOAE parameters?

Answer 15

f1 and f2

Question 16

What are the two (2) pure tones labeled as in DPOAE parameters?
When recording DPOAEs, we input two pure tones, and receive a third tone which we measure as the response from the cochlea. What do we call that produced, third tone?

Answer 16

The distortion product

Question 17

The frequency relationship or separation between the two (2) primary tones is critical in DPOAE measurement. A DP will not be recorded if the two (2) tones are too far apart or if they are too close together.

Answer 17

t

Question 18

With regard to f1 and f2, what is the most reliable frequency relationship of these two (2) primary tones? Please provide the number that expresses what that ratio should be.

Answer 18

F2 is the most reliable frequency of the two
The ratio should be 1.22

Question 19

The relative levels (intensity) of the two (2) primary tones (L1 and L2) is another critical stimulus parameter in DPOAE measurement. To obtain results most sensitive to cochlear function, what should L1 and L2 be in intensity?

Answer 19

65 and 55 dB SPL

Question 20

What are the four regions of the auditory system that either contribute to the generation of OAEs, or can influence OAE recording?

Answer 20

Outer ear,
middle ear,
inner ear,
efferent system

Question 21

Please explain the Crosscheck Principle and include an example.

Answer 21

using electro-physiological or electroacoustical tests to confirm a subjective test (like pure tones)
ex: if you get absent or abnormal OAE’s you do not diagnose a HL, OAE are not a test of hearing you would use the information collected by the OAE to run a audiologic evaluation and then compare and see if it supports or does not support your original findings.

Question 22

How is a DPOAE determined to meet passing criteria?
The absolute amplitude of the DP should be at least -20 dB SPL
The DP-NF (the SNR) should be at least 10 dB SPL
Passing responses should be seen in 1 frequency
None of these responses are correct

Answer 22

None of these responses are correct

Question 23

Why should we NOT use intensity levels in DPOAE testing (L1 and L2) that are over approximately 70-75 dB SPL? For example, if we do use high intensity levels, and we get a response, how does that relate to cochlear function?

Answer 23

The reason for that is now you are using passive cochlea processing. With a higher db you are by passing the outer hair cells and stimulating the inner hair cells. when you do this you may vibrate the basilar membrane but you are not measuring the correct outer hair cell motility. meaning you are not getting an accurate representation of outer hair cell and cochlear function.

Question 24

There is now considerable evidence that noise- or music-induced cochlear damage is detectable with OAEs before it becomes apparent in the audiogram

Answer 24

t

Question 25

Which of the following best describe the clinical applications of OAEs for adults? Please choose all that apply. Monitoring tinnitus and noise or music exposure Differentiation of cochlear vs. retrocochlear site of lesion Newborn hearing screenings Monitoring hyperbilirubinemia Assessment in suspected functional hearing loss

Answer 25

Monitoring tinnitus and noise or music exposure Differentiation of cochlear vs. retrocochlear site of lesion Assessment in suspected functional hearing loss

Question 26

What is a Gorgagram? A version of a DP gram with normative values from the 5th percentile to the 95th percentile used to indicate if hearing is normal, abnormal or borderline. A version of a DP gram with normative values from the 5th percentile to the 90th percentile and tells us about auditory processing. An audiogram created by MIchael Gorga, Ph.D. that is only used at Boystown National Research Hospital. A DP gram we use to plot responses from the cochlea of a gargoyle.

Answer 26

A version of a DP gram with normative values from the 5th percentile to the 95th percentile used to indicate if hearing is normal, abnormal or borderline.

Question 27

What is the optimal dB SPL for the stimulus when recording a TEOAE?

Answer 27

74-83 dB SPL

Question 28

Passive cochlear processing (when a sound is loud enough) can directly stimulate which of the following? The semicircular canals The outer hair cells as biological amplifiers The inner hair cells stimulated through basilar membrane movement The forward propagation of soft sounds

Answer 28

The inner hair cells stimulated through basilar membrane movement

Question 29

OAEs can help you differentiate between a cochlear hearing loss and a retrocochlear hearing loss.

Answer 29

t

Question 30

The OAE loses energy on the way from the cochlea to the ear canal where it is measured. Which of the following supports this? Cerumen in the ear canal causes the OAE to lose energy As the OAE moves from the cochlea to the ear canal, this reverse transmission is just as effective as forward transmission As the OAE moves from the cochlea to the ear canal, this reverse transmission is much less effective than forward transmission OAEs do not lose energy as they travel from cochlea to ear canal

Answer 30

As the OAE moves from the cochlea to the ear canal, this reverse transmission is much less effective than forward transmission

Question 31

A pediatrician has referred his 2 year old female patient to you for testing. You choose to use TEOAEs. The parents report concerns that their child’s speech/language skills are delayed. The child uses about 5 single words expressively and “seems to understand” what they are saying. Results show passing responses in the 1000-4000Hz regions of both ears (6dB or greater above the noise floor, 99% stability, 90% reproducibility, stimulus at 83dB SPL). What will you report to parents and the referring pediatrician? What other, if any, additional tests will you recommend? Is OAE alone a test of hearing?

Answer 31

i would first let them know that the first test i ran she passed, but i would also break down the test for them and explain first, that OAE are not a diagnostic test nor does it show frequency specific information and that this test only tested 1-4K but i would explain to them how she passes in those frequencies but how i would need to do more testing to get more information especially in the higher frequencies since those are important for speech. I would also express when the most important time for speech and language development for a baby is birth to 3 (if they were reluctant for additional testing since she passed TEOAEs) and refer to a speech and language pathologist to be evaluated for a speech and language delay. 2) i would want to run Tymps, reflexs, and a full audiometric evaluation- I understand she is young so i would start with SRT and WRS first and go from there until she was no longer/tired and was done with the test. Also i probaly would done an DPOAE instead of TEOAE so i could get frequency specific information. 3) No, OAE alone is not a test of hearing.

Question 32

A 49-year-old patient comes to see you from the Department of Labor. He had been seeking compensation after saying he had been electrocuted and had noise exposure, which was why he lost his hearing. His audiogram shows 50 to 60 dB thresholds, worse for the right ear. Reflexes were present and normal for both ears. There was a significant difference between the pure-tone average and the speech reception threshold (SRT) with his SRTs being much better. You perform transient OAEs after the audiogram, which are normal for both ears for all frequencies tested. Is there anything you are suspecting at this point? What do you do next? What role did OAEs play in this case?

Answer 32

Yes, Abnormal audiogram and normal OAE i would consider Functional HL, Non organic, and phyogenic HL, Central Nervous system dysfunction, 8th nerve auditory dysfunction, and inner hair cell damage (cochlear dead regions). However looking further into his result, i would take note of abnormal Air and not supportng SRT with a much better result that what would be an agreeance with his AC threshold. from there i would take a step back and look at his whole case hsitory and the reason he came in would suppect. I would suspect a non- oroganic HL. i would also run Tymps to check middle ear status, I would first reinstruct the patient and give them a chance to try and be honest, i would let them know my data isn't adding up and ask them if they understand the directions and if that doesn't work i would follow up with the stenger test to see if i got a positive or negative. depending on the stenger test i would stick with my original suspicion move on to a differential diagnosis. (another option could be functional HL, this the other thing i would consider if the stenger test did not support my non-organic suspician) the role the OAE's played in this is it gave me a picture of how the outer hair cells and cochlea were functioning to see if there was any pathologies or any concerns with hearing sensitivity i should keep in mind when beginning the audio. Even though OAE's are not a test of hearing on its own, during this i would use the cross check principle to validate my data. which i was able to do for this case.

Question 33

You know I don’t like the word “robust”. Why?

Answer 33

becuase what exactly is robust, it cannont be quanified that is why you dont like it.

Question 34

What is the name of my son who appeared in our study guide Powerpoint?

Answer 34

Evan Alexander

Question 35

How long have Dr. Parent-Buck and I known one another?

Answer 35

33 yrs

Question 36

what is the spiked heel effect

Answer 36

Backward transmission is less efficient; oval window is smaller surface area sending signal to larger surface TM via ossicular chain, resulting in lost intensity during the transmission can decrease up to 15 db

Question 37

OAEs are more sensitive to early damage and may be absent/decreases PRIOR to showing on the audiogram

Answer 37

t

Question 38

why do we not want too loud of a stimulus

Answer 38

stimulate IHCs

Question 39

what are standing waves

Answer 39

Cancellations and reinforcements of some sound waves or interaction between stimulus sound wave moving toward TM and OAE sound wave moving outward from TM Only problem with DPOAE (usually at frequencies at or above approximately 6k) Only way to resolve: place microphone at TM; not clinically feasible

Question 40

present teoaes

Answer 40

Absolute emission > -10 dB SPL SNR (relative value) > 3-5 dB (varies) Reproducibility of 70% or greater If ALL of the above are met, you have a present TEOAE = normal or near-normal cochlear function and hearing better or equal to approximately 25-30 dB at frequencies where emissions are present

Question 41

present dpoaes

Answer 41

Absolute emission > -10 dB SPL SNR (relative value) >6 dB (3-5 dB some) Replicates IF ALL OF THE ABOVE ARE MET AND PLOTTED ON DP-GRAM OR GORGAGRAM AND FALLS IN THE PRESENT REGION (95TH PERCENTILE) = normal or near-normal cochlear function and hearing better or equal to approximately 25-30 dB at frequencies where emissions are present

Question 42

If F1 is 1000 Hz, what is f2 and dp

Answer 42

step 1: f1 times 1.22 = F2 Step 2: 2f1-f2 = dp f1 = 1000 Hz f2= 1220 Hz 2f1-f2 = 2000-1220 DP = 780 Hz

Question 43

what do present oae s tell us

Answer 43

External auditory meatus is clear. Middle ear function is normal / near-normal. Cochlear sensory function is normal. And by inference only!: Peripheral hearing sensitivity is normal. OAEs are NOT a test of hearing but we can infer some things about hearing status from them

Question 44

what do absent oaez tell us

Answer 44

May be blockage of EAM. May be Abnormal Middle Ear function. Otitis Media Severe negative ME resting pressure. If EAM and Middle ear are clear: There is cochlear outer hair cell damage.

Question 45

goal of use of oaes in NBHS

Answer 45

to use OAE in isolation to determine those that need further evaluation and those that have normal/near normal hearing

Question 46

What is the 1-3-6 as it pertains to NBHS

Answer 46

screen, identify, intervention

Question 47

what hearing losses can we miss with using OAE screenings

Answer 47

ANSD Mild losses atypical configurations (ex: LF loss or only HF loss) delayed onset or progressive losses neural and/or genetic IHC loss only (normal OHC) which is rare

Question 48

Four areas of efferent auditory function have been thus far identified. They are

Answer 48

Protection from acoustic trauma Hearing in noise Role in Attention Role in Auditory Training

Question 49

moc fibers go to

Answer 49

ohc

Question 50

loc fibers go to

Answer 50

ihc

Question 51

The efferent system plays a role in

Answer 51

1)protecting the cochlear from acoustic trauma 2)help with understanding speech in the presence of background noise 3)improve auditory attention 4)auditory training

Question 52

What role do OAEs play in the identification of ANSD?

Answer 52

almost always in beginning of present OAEs research shows about half will lose these over time due to compromised blood flow from a lesion in n or ihc or both that causes the neuropathy

Question 53

ANSD management

Answer 53

HA trial or FM/Bluetooth devices (GOAL: improve SNR) CI visual communicaton (asl, cued)

Question 54

guidelines for ototoxicity monitoring

Answer 54

1) Standard audiometry (500-8K) 2) HFA - 10K-16-18K 3)DPOAEs

Question 55

Why Monitor?

Answer 55

There are no “safe” levels of known (or unknown!) ototoxic drugs We may not know there is a hearing loss until the patient reports Severity of hearing loss is difficult to predict Gives physician the opportunity to modify/change medication(s) Allows audiologist to counsel parents/patients and patients to make informed decisions

Question 56

what causes hl from ototoxic medication: 4 things that are though to do it and can be a combo of these mechanisms that cause hl with ototoxic drug

Answer 56

metabolic stress concentration of something that throws metabolism off even in inner ear peri and endo get out of balance and ions get messed up due to toxicity of the drug accumulation platinum (cis) can hae accumulation of it and cannot get filter out of the ear and with so much it will cause damage this way ischemia stops blood flow because its toxic and hair cells die mechanical have toxic drug in there it breaks the hair cells & bm

Question 57

factors can influence the likelihood of ototoxicity

Answer 57

other drugs, other health comorbidities (e.g., renal failure), age, delivery (IV/pill), genetic factors

Question 58

Why are DPOAEs used over TEOAEs for Monitoring?

Answer 58

DPOAE have higher frequency range, thus more sensitive to frequency area affected first Can be recorded in the presence of more hearing loss than TEOAE, thus if a loss already exists can still monitor, making more persons eligible for monitoring this way Can provide some indication of degree and configuration

Question 59

What is Oto-Protection/Protective Agents

Answer 59

Medications or supplements given concurrently or prior to exposure to potentially ototoxic drugs to reduce likelihood or severity of hearing loss pedmark

Question 60

in sig neg me pressure, frequencies affected most are LFs why?

Answer 60

If we have fluid in the middle ear, we have a negative middle ear pressure which in turn is an increase in the stiffness of the system in the middle ear because the eardrum is retracted. This in turn doesn’t allow the middle ear to vibrate the way it needs to. Stiffness in a system will affect LF more than the higher negative middle ear pressure: middle ear can still move; Stiffness is retracted sucking the eardrum back in and will still give us responses at the high frequencies but the lows are decreased in amplitude

Question 61

what is hear

Answer 61

History, relevant background Evaluation--what you did Audiological Findings--what you found Recommendations--what you want the recipient to do about what you found

Question 62

Efferent neurons from medial olivocochlear system innervate

Answer 62

ohc

Question 63

What is PedMark

Answer 63

injectable therapy for children to reduce risk of cisplatin ototoxicity

Question 64

1 issue seriously impacting NBHS data and protocols is no ANSI standards for use in calibration of OAE equipment

Answer 64

t

Question 65

Negative ME pressure can affect OAE response in which of the following ways decrease amp especially in LF decrease probe stability both increase and decrease response amp increase amp of lf response

Answer 65

decrease amp especially in LF

Question 66

How do ototoxic meds damage inner ear? ischemia due to compromised blood flow toxicity: platinum or other metal accumulation formation of free radicals and metabolic stress all of these

Answer 66

all

Question 67

The use of slaicytates can cause ototoxic hl which usually returns to baseline after drug cessation

Answer 67

true

Question 68

which type of oae occurs without external stimulation

Answer 68

SOAE

Question 69

efferent neurons from lateral olivary complex synapse near the inner hair cells

Answer 69

t

Question 70

which of the following is recommended for ototoxicity monitoring by AAA audiogram (standard) & TEOAE audiogram (standard), HFA, DPOAEs ` TEOAE, DPOAE, HFA ARTs, TEOAE

Answer 70

audiogram (standard), HFA, DPOAEs

Question 71

cisplatin based chemotherapy will cause hearing loss in approx. 1% of receipients

Answer 71

false, close to 83% based on cincinnati thing

Question 72

which of the following regarding OAEs and ototoxicity monitoring is false TEOAE have higher frequency range thus more sensitive area to affected 1st OAEs are time and cost effective OAEs have been shown to decrease simultaneously with HFA OAEs tend to show change before changes on the audiogram (250-8000 Hz)

Answer 72

TEOAE have higher frequency range thus more sensitive area to affected 1st

Question 73

Persons with ANSD have no efferent suppression of TEOAEs with binaural, contra, or ispi noise

Answer 73

t

Question 74

there is only 1 scale available to grade the degree of HL from ototoxic drugs

Answer 74

f

Question 75

efferent auditory system protects cochlea from acoustic trauma and is involved in hearing in the presence of noise

Answer 75

t

Question 76

which type of noise is most effective in suppressing TEOAEs

Answer 76

bb noise

Question 77

the absence of spontaneous OAEs is consistent with cochlear damage

Answer 77

f

Question 78

TEOAEs are preferred to monitor ototoxicity in PT receiving chemotherapy

Answer 78

f

Question 79

persons with ANSD have no efferent suppression of TEOAEs with forward or simultaneous masking paradigm

Answer 79

t

Question 80

which types of HL can we miss if we are using OAEs for newborn hearing screening

Answer 80

ANSD, mild losses, atypical configurations

Question 81

adding pressurization to OAE recordings to overcome negative ME pressure is routinely done clinically

Answer 81

f