Quiz 2

Question 1

probe ear principle

Answer 1

AR are absent when there is a conductive pathology in the probe ear

Question 2

poor word recognition score is indicative of

Answer 2

retrocochlear loss

Question 3

best way to identify conductive loss with reflexes

Answer 3

ipsilateral

Question 4

effect of 5 dB ABG on reflexes with CHL in the probe ear

Answer 4

reflex has 50/50 chance of being observed

Question 5

effect of a 10dB ABG (or greater) with CHL in the probe ear

Answer 5

reflex may be obscured as much as 80% of the time

Question 6

reflexes with a unilateral conductive loss

Answer 6

all but ipsi on the side without the conductive component will be affected

Question 7

stimulus ear principle (in other words the stimulus ear is the one with the CHL)

Answer 7

conductive loss in the stimulus ear attenuates the stimulus by the amount of the ABG

Question 8

effect of ABG <30dB with CHL in stimulus ear

Answer 8

elevated reflexes–50% chance of recorded reflexes at 27dB ABG

Question 9

effect of ABG>30dB with CHL in the stimulus ear

Answer 9

absent reflexes

Question 10

what do you need to do to overcome an ABG?

Answer 10

raise the stimulus level by the amount of the ABG

Question 11

possible causes of AR in unilateral CHL

Answer 11

1) ossicular discontinuity *medial to the stapedial muscle insertion
* or a fribrous tissue that enables reflex contraction to be conveyed to the TM
2) only the crus of the stapes disconnected
3) cholesteatoma that does not impinge on the TM or ossicular chain (localized)

Question 12

what is more sensitive to ME changes? AR or behavioral audiometry

Answer 12

AR

Question 13

two types of facial paralysis

Answer 13

lower motor neuron lesion

upper motor neuron lesion

Question 14

lower motor neuron lesion

Answer 14

all the muscles of the same side of the face are affected

Question 15

upper motor neuron lesion

Answer 15

affects only the muscles on the lower half of the contra side of the face

Question 16

lesion at or proximal to (beyond) the stapedius nerve

Answer 16

abnormal AR when the probe is in the affected ear

Question 17

lesion distal to the stapedius nerve

Answer 17

normal AR threshold when the probe is in the affected ear

Question 18

VII nerve lesions

Answer 18

such as Bell’s Palsy

• according to the course of the disease
• *AR may start absent, proceed to elevated and then to normal as the disorder resolves

Question 19

AR for sensorineural hearing loss depends on the __________

Answer 19

degree of hearing loss

Question 20

if sensorineural loss with thresholds <50-55dB

Answer 20

normal ARTs

Question 21

if sensorineural loss with thresholds between 50-80dB

Answer 21

elevated ARTs with low SLs

Question 22

if thresholds are > or = to 80dB

Answer 22

absent ARTs

Question 23

Stimulus ear principle with cochlear SNHL

Answer 23

Any time the stimulus is in the ear with the loss, there will be abnormal AR
(This would give a diagonal pattern of AR)
$ depends on the degree of hearing loss

Question 24

Stimulus ear principle with retro cochlear SNHL

Answer 24

Abnormal AR when stimulus is in ear with loss

1) usually absent AR regardless of the degree of loss
2) or present AR but elevated with high SLs and
3) abnormal r flex decay (positive decay)

Question 25

What constitutes as elevated ART?

Answer 25

An ART above 100 unless there is substantial hearing loss

Question 26

Intraaxial lesion

Answer 26

Internal to pia mater Brain parenchyma Cells:neurons and glial cells Location:involving brain tissue, cells, neurons Cortex, deep white matter, deep gray matter

Question 27

Extra axial lesion

Answer 27

External to the pia mater Meninges, nerve sheath, outside brain stem Schwannoma Locations: outside brain tissue, subarachnoid, subdural, epidural, calvarium (skull base), scalp (soft tissues)

Question 28

Stimulus ear principle with extra-axial lesion

Answer 28

Resembles Ipsi SNHL Consider the degree of loss to interpret absent or elevated AR with high SLs *basically everything you present through the ear with the loss, you will get abnormal AR * pathologies:acoustic neuroma, CPA tumor, extra-axial tumor

Question 29

AR with intraaxial lesions

Answer 29

These lesions are central (brain stem) and lead to bilateral normal Ipsi and bilateral absent contra (crossed pathways) the reflex can't travel from one side to other because problem with communication between sides Examples: demyelination disease, neuromuscular diseases

Question 30

Positive reflex decay

Answer 30

If the response falls to 50% of its initial magnitude during the 10 second stimulus

Question 31

Controversy with reflex decay

Answer 31

5-10 seconds, 500 vs 1000hz (stronger at 5 seconds and 500hz), sensitivity improves if you consider 10 sec and both frequencies * not everyone has decay at 2000 and 4000 so we don't test them

Question 32

Using ART to predict hearing thresholds

Answer 32

ART for pure tone is independent of HL up to 50-60dB HL, then increases as a function of HL ART for BBN increases with increasing SNHL up to 50-60db HL, then plateau In other words it is hard to use ART to predict pure tone thresholds because of SNHL

Question 33

Most proximal auditory center in pathway

Answer 33

Is the highest which is the superior oil art complex

Question 34

Common causes of SNHL

Answer 34

``` Ménière's disease Noise induced hearing loss Infections Trauma Ototoxicity Presbycusis Autoimmune disease Genetic ```

Question 35

Common causes of neural SNHL

Answer 35

Nerve tumors Cochlear neuritis (infection) Other disease processes such as diabetic neuropathy or demylinating disease

Question 36

One test which actually assesses the function

Answer 36

Speech testing | If speech scores are lower than hearing loss then it is retrocochlear

Question 37

Limitations of AR testing for differential diagnosis

Answer 37

AR may be absent in cases of SNHL above 60dB HL Therefore can't differentiate between cochlear and retrocochlear loss With AR decay there is controversy over what is actually abnormal decay

Question 38

Three categories of behavioral tests for seeing if it's a retrocochlear loss

Answer 38

1) word recognition tests such as PI/BI function 2) recruitment tests: Loudness balance which is ABLB or AMLB Short increment sensitivity index (SISI) 3) adaptation tests Tone decay (TD) Bekesy audio

Question 39

Objective tests for retrocochlear

Answer 39

Such as OAE and ERA Maintain high specificity for cochlear disorders Show higher sensitivity to 8th nerve problems

Question 40

Threshold tone decay

Answer 40

A reduction in the ability to hear a barely audible sustained tone Use 500 and 1000hz

Question 41

Supra threshold tone decay

Answer 41

A loss of audibility as a result of presenting a sustained tone at a high presentation level Use high HL such as 70dB HL

Question 42

Carhart tone decay

Answer 42

Present a continuous tone at threshold (or 5dB above) for 1 minute Use 500 and 2000 If they don't hear the tone, raise intensity by 5dB and reset stopwatch, continue until they hear tone for a full minute Measure dB difference start to end and time to Inaudibility

Question 43

Tone decay considered normal

Answer 43

No decay which is 0-10dB from starting level

Question 44

Cochlear pathology amounts of tone decay

Answer 44

Mild pathology would give 15dB in 60 seconds | Moderate pathology would give 20-25dB in 60 seconds

Question 45

Retrocochlear amount of tone decay

Answer 45

Marked or rapid which is greater than 30dB

Question 46

Three types of perceptual phenomenon with tone decay

Answer 46

1) loss of tonality and audibility simultaneously meaning distortion occurs after increase in level due to tone becoming inaudible 2) loss of tonality but remains audible meaning it becomes distorted 3) loss of tonality and audibility but ones tone is withdrawn they know immediately (withdrawing gives neurons break so when it turns back on they can hear it again but it decays quickly)

Question 47

Olsen and noffsinger procedure

Answer 47

Tone decay modification (test of choice) Start at 20dB above threshold Continue until the is heard for one minute Significant decay is above 15dB Disadvantage is that you can't test the rate of decay since you started at 20dB you don't really know when decay began

Question 48

Rosenberg procedure

Answer 48

Shortened tone decay test Tone is presented at threshold and raised 5dB every time it's not heard but only for a total of 1 minute Disadvantage: could miss some retrocochlear due to early test termination

Question 49

Green's procedure

Answer 49

Increase in intensity every time the pt hears change in tonality instead of absence of tone Advantages:increases sensitivity to cochlear vs retrocochlear lesion Reduces missing rate (Distortion is auditory brain stem problem)

Question 50

Owens procedure

Answer 50

Tests for amount and rate of decay Begin at 5dB SL If tone decay before the 60sec period, the stimulus is discontinued for 20 sec before introduction of the tone at 5dB increment Procedure continues until the stimulus is perceived for 60 seconds or a level of 20dB SL is r ached

Question 51

Supra threshold adaptation test (STAT)

Answer 51

Begins at a high level like 100dB HL Total time of 1 minute (cochlear=still heard, retro=decay) Disadvantage: ignores amount of decay, ignores rate of decay, missed cases because of high intensity starting level *this is more of a screening procedure

Question 52

Pros and cons of objective site of lesion testing

Answer 52

Pros: objective so less human error, higher sensitivity than behavioral tests Cons: more expensive, low availability, can determine site but not type of loss (specific etiology)

Question 53

Hyperacusis

Answer 53

Hypersensitivity to normal sounds

Question 54

Phonophobia

Answer 54

Fear of normal sounds resulting in hypersensitivity to them Can occur with normal hearing or with hearing loss

Question 55

Place principle of recruitment

Answer 55

Outer hair cells are more sensitive than inner hair cells | When OHC are damaged, then when intensity is increased the IHC are excited with a concomitant rapid increase in loudness

Question 56

Summation principle of recruitment

Answer 56

The total number of cells excited | As intensity increases, larger areas of the basilar membrane are stimulated

Question 57

Loudness decruitment

Answer 57

A slow growth of loudness aka a summation deficit

Question 58

ABLB

Answer 58

Alternate binaural loudness balance Unilateral HL Compare loudness growth between the same frequencies for the two ears

Question 59

AMLB

Answer 59

Alternate monaural loudness balance Bilateral symmetrical HL with some normal hearing at some frequencies Compare loudness growth between two different frequencies in the same ear

Question 60

What frequencies to test for loudness balancing

Answer 60

500, 1000, 2000, not 4000 because there will be recruitment

Question 61

When might you see recruitment with VIII nerve lesion?

Answer 61

Reduced cochlear blood supply Size of tumors Test contamination: coincidental high frequency hearing loss (cochlear loss)

Question 62

Using the poor ear as reference ear for ABLB

Answer 62

Determines the presence or absence of recruitment Is quick (requires less balances) to make a diagnosis Easy

Question 63

Using the good ear as a reference ear for ABLB

Answer 63

Determine the presence or absence of recruitment and plot loudness growth function More sensitive to changes in intensity =less variable Requires more balances

Question 64

Difference limen for intensity

Answer 64

DLI is smallest change in intensity of a pure tone that can just be detected Normal listeners have problems close to threshold Cochlear loss have smaller DLI for pure tones due to recruitment, this is premise of the SISI test