Quiz 3 (Speech Perception, Immittance Testing) Flashcards
(241 cards)
1
Q
What’s important to remember about speech audiometry terminology?
A
it’s rarely agreed upon by all, varies from region to region
2
Q
What do we need to perform speech perception testing?
A
a DIAGNOSTIC audiometer
3
Q
3 portions of a diagnostic audiometer that are important for speech perception testing
A
- CD system to play recorded material
- microphone for monitored live voice (MLV) testing
- VU meter: ensures that all speech is being presented at the exact same intensity
4
Q
In speech audiometry, the patient must ____ and be able to ____
A
- know, respond to the word in the language of the test
5
Q
types of responses possible by patients in speech audiometry and advantages/disadvantages of each
A
spoken
- advantages: faster, rapport between client/clinician
- disadv: client can have fairly unintelligible speech
written
- advantages: takes out guessing associated with a pt w/ poor speech
- disadv: slower, have to score it
6
Q
clinician’s role in speech audiometry (3)
A
- must be able to convey to pt their task
- keep face from pt’s view
- understand pt responses
7
Q
3 measures you can get from speech perception testing
A
- speech recognition threshold
- speech detection threshold
- word recognition scores
8
Q
MLV is ______, however ____. So?
A
- easier and more flexible
- it’s not as accurate
- recorded speech is best to use
9
Q
when testing with recorded speech ____ tone is provided. what do you do with it?
A
1000 Hz
- balance calibration tone on VU meter at 0
10
Q
when testing using lvie voice testing, you must?
A
adjust microphone sensitivity to have the speech balanced at 0 dB on VU meter
11
Q
define speech recognition threshold
A
lowest hearing level at which 50% of presented words are correctly identified
12
Q
SRT should be in agreement with ____ by _____
A
PTA, +/- 10 dB
13
Q
If SRT and PTA are not in agreeance, what could be the reason for this?
A
- testing error (e.g., equipment not calibrated)
- false info (e.g., difficult for listener to tell how loud/soft sound is)
14
Q
In finding the SRT, it’s very important to do what?
A
familiarize the clients with the words using 9 or 10 words
15
Q
KNOW how to find SRT
A
slides 12-15
16
Q
In SRT, the stimulus is called _____. What’s important to remember about this? Examples include?
A
- a spondee (a word with 2 syllables, both syllables pronounced with equal stress and effort, each half will peak the VU meter at 0 equally)
- cowboy, baseball, cook book, ear drum
17
Q
closed set vs open set in SRT? (?)
A
don’t know
18
Q
Explain what speech detection threshold is
- is it typical?
A
- lowest hearing level at which a patient can barely detect the presence of speech. No understanding the word is involved. Simply, “I heard it”
- not typically conducted
19
Q
when would we use SDT?
A
- a child who can’t repeat back words or point to a pic
- person with so significant a hearing loss that it becomes painfully loud if we turn it up too much
- stroke victims who can’t point or speak
20
Q
difference between speech discrimination testing and word recognition testing
A
- word recognition tests person’s ability to understand the word, while detection only wants to know if they detect a sound or not
- hearing vs. understanding
21
Q
word recognition scores
- a ____ test
- what’s this mean?
A
- suprathreshold
- given above threshold at a comfortable loudness level
22
Q
word recognition scores provide? (2)
A
- info on real word speech communication function
- assists in dx of endocochlear pathology
23
Q
in word recognition testing, stimuli are ____ and ____
A
- monosyllabic
- phonemically balanced
24
Q
word recognition testing typically involves a _____
- example
A
carrier phrase
- Say the word ____
25
with WRS, present word ____ above SRT
| - test each ____
- 40 dBSL
| - ear
26
with WRS, make sure the volume unit?
peaks at 0 for all words
27
how to score WRS?
calculate percentage correct and record
28
how many words are typically in a phonemically balanced list used in WRS?
25 to 50
29
word recognition score aka?
speech discrimination score (?)
30
reasons for doing suprathreshold test (WRS)?
- gives info on whether a hearing aid will be beneficial
| - gives ability to look at different air patterns in speech recognition
31
interpretation of WRS scores
- 100% = excellent = little to no difficulty understanding speech
- 80 to 99% = good = little to no difficulty understanding speech
- 60 to 79% = fair = occasional difficulty
- 45 to 59% = poor to fair = moderate difficulty
- 0 to 44% = poor = difficulty following convo
32
If you suspect ____, conduct ____
- what does this do?
- what will it tell us?
- retrochoclear pathology, high intensity WRS
- this taxes the nerve
- If WRS degrades at high intensity, this is known as ROLLOVER = indicative of ret. pathology
(WRS gets worse the higher the intensity gets)
33
importance of dynamic range for hearing aid use
- if a person has a very small dynamic range, then you can only amplify the sound a little bit before they say it's too loud
34
what is MCL?
- most comfortable listening level
| - listener rates where listening is most comfortable
35
why are MCL levels valuable?
- inter-test reliability
- reference for recognition/discrimination testing
- indicatory for narrow dynamic range
- helpful for hearing aid fitting
36
UCL = ?
| - aka?
uncomfortable listening level
- loudness discomfort level (LDL)
- threshold of discomfort (TD)
37
why are UCL levels valuable?
- inter-test reliability
- indicatory for narrow dynamic range
- use in hearing aid fitting
- lower w/ people who have sensorineural hearing loss
38
Masking for SRT and WRS
- Compare presentation level of the ____ to the ____.
- If exceeds ____, add masking
- test ear, nontest ear bone threshold
| - IA (interaural attenuation)
39
Make sure that no ____ is happening during speech perception testing
lip reading
40
tests that give a measure of a person's sensitivity to sound across the frequency range important for speech communication
pure tone air conduction and bone conduction
41
test that gives a measure of the person's sensitivity to speech
SRT
42
test that gives a measure of how clear speech is for a person when it is loud enough for them to hear
WRS
43
What does the outer ear include?
- auricle/pinna
- external auditory meatus
- tympanic membrane
44
do all disorders of the auricle result in hearing loss?
NO
45
most common congenital malformations of the pinna
microtia and atresia
46
what is microtia? impact on hearing?
- abnormally small pinna
| - results in hearing loss only if there's something secondary to it
47
what is anotia? impact on hearing?
- a missing pinna/auricle
| - won't result in hearing loss if ear canal is intact
48
Microtia and anotia are both considered ____ and _____
- craniofacial abnormalities
| - non-syndromic hearing losses
49
non-syndromic hearing losses account for about ___% of all forms of inherited hearing loss
70
50
microtia and anotia - is surgery possible?
yes, can get a prosthetic
51
what is aural atresia? can affect? can be in ___ or ____?
- absences of an ear canal
- one or both of the ear canals
- isolation or with other abnormalities
52
aural atresia impact on hearing?
conductive hearing loss
53
aural atresia is common in who?
- people with Treacher Collins syndrome (inherited condition, issues with facial bones)
- people with Goldin Har syndrome (rare congenital defect where you have incomplete formation of ears, palate, mandible)
54
what is stenosis?
very small or narrow ear canal
55
list the disorders of the external auditory meatus
- aural atresia
- otis externa
- collapsing ear canals
- impacted cerumen
56
list the disorders of the auricle
- aural microtia
| - aural anotia
57
what is otis externa?
- can be?
- one of most common types?
- why could there be issues with performing a hearing test?
inflammation or infection of the external auditory meatus
- fungal, viral, or bacterial
- swimmer's ear
- because the pressure is so painful
58
impact of otis externa on hearing?
can cause a conductive loss if the pressure is great enough to cut off the ear canal
59
collapsing ear canals: more of a ___ than a _____
| - really important when testing who?
condition, disorder
| - children under age 7 and older adults
60
what is impacted cerumen?
a buildup of cerumen in the ear canal
61
who is susceptible to impacted cerumen?
- people who wear ear plugs all the time
| - people with small canals (petite adults)
62
impact of impacted cerumen on hearing?
- varies depending on the amount of blockage
63
what may impact cerumen?
cleaning ears with Q-tip
64
notes to get from Ky:
slide 8 on disorders PP
| slide 23 on disorders PP
65
list disorders of the tympanic membrane
atelectasis, perforation, tympanosclerosis/myringoclerosis
66
what is atelectasis
| - see when?
- ear drum sucked backwards due to negative pressure in the middle ear space
- when eustachian tube isn't working
67
possible causes of a TM perforation
- excessive pressure from middle ear infections, trauma (loud noises), forceful changing in air pressure (flying, diving and coming up too quickly, powerful sneeze)
68
does a perforation heal? explain
- sometimes it heals on its own. Tissue migrates over toward perforation.
- if it doesn't spontaneously close or heal itself, then something is put over ear canal to allow it to heal
69
impact of perforation on hearing
- depending on size, can produce a mild to moderate conductive hearing loss
- larger the perforation, greater the hearing loss
70
what is tympanosclerosis?
scaring of the ear drum
| - thickens/adds mass to the ear drum, calcium plaque gives ear drum a white chalky appearance
71
impact of tympanosclerosis on hearing?
- scaring in and of itself doesn't result in hearing loss, but if it's thick enough, then it can cause a conductive loss
72
list disorders of the middle ear
- otis media
- cholesteatoma
- otosclerosis
- ossicular disarticulation
73
number one disorder of the middle ear
otitis media
74
explain what otitis media is
- eustachian tube fails to open for various reasons
- negative pressure develops in middle ear
- mucous cannot drain (fluid)
75
what can cause the eustachian tube dysfunction seen in otitis media?
- structural issues (tonsils too large)
| - swelling from infection (upper resp infection)
76
number one cause of otitis media in children
upper respiratory infections
77
in children, eustachian tube is more ____. So?
horizontal and angled
| - won't drain out as easily as adult
78
otitis media can be classified in what 2 ways?
- based on duration/frequency
| - based on type of fluid (effusion)
79
ways to classify otitis media based on duration/frequency
- acute: single bout that lasts less than one month
- chronic: lasts longer than 2 mo
- recurrent: 3 or more acute episodes w/in a 6 mo period
80
if a kiddo has chronic or recurrent otitis media, make sure you look at?
speech and language developement
81
ways to classify otitis media based on type of effusion
| - explain each
- serous: thin, watery, sterile fluid w/ no bacteria in it
| - purulent: contains puss, bacteria. Signs may include fever, conductive hearing loss
82
sometimes, individuals with ___ otitis media may have no signs/symptoms at all
purulent
83
what does serous and purulent fluid look like?
- serious: clear and watery looking. Fluid bubbles visible through TM.
- purulent: mostly yellow fluid
84
a population who's extremely prone to otitis media?
children with down syndrome
85
why are children more susceptible to OM?
- adults have more vertical ET
| - adults have more cartilage support
86
% of kids who will have at least one episode of otitis media by age 6?
75-95%
87
what causes an earache?
- negative air pressure inside the middle ear causes TM to retract and stretch
- earache is in ear canal
88
otitis media impact on hearing
- conductive hearing loss that ranges from 15 dbHL to 45 dbHL
89
what else can otitis media cause?
TM perforation
90
is conductive loss usually permanent with otitis media?
NO
91
greatest amount of loss with otitis media is in the ____ frequencies
low
92
degree of loss with otitis media is dependent on?
- amount of fluid
93
If left untreated, what can otitis media lead to?
- ossicular erosion: ossicles erode bc they are sitting in fluid
- mastoiditis: infection of mastoid bone bc of fluid. untreated can lead to meningitis, possibly death.
- cholesteatoma
94
children with a history of otitis media before age 2 and a HL of 26 dB or greater - loss in ?
verbal ability, reading, math, language
95
where are PE tubes placed? how long do they stay there?
ear drum
| - 6 to 12 months
96
what is a myringotomy?
incision into ear drum to relieve pressure or drain fluid
97
what is a cholesteatoma?
| - characteristics?
a cyst/benign growth that appears as a large white mass behind the TM
- capable of reabsorbing bone that's adjacent to it
- will be a foul smelling infection
98
what is otosclerosis?
| - what does it result in?
fixation of the stapes into the oval window
| - fluid in ear doesn't move effiiciently. doesn't match impedance of air fluid
99
Otosclerosis has a ____ component
| - explain
genetic
- more common in females
- usually happens in 20s, associated with pregnancy
- usually occurs bilaterally
100
how do you treat otosclerosis?
- via a surgical procedure called a stapedectomy. Surgeon frees stapes, removes it from ossicular chain and replaces it with a prosthetic one that allows the ossicles to function again.
101
explain the audiogram of someone with otosclerosis in-depth
VERY TELLING
| - conductive loss until 2,000 Hz. Suddenly a bone gap, called Carhart's notch.
102
Telling symptoms of otosclerosis
- bluish tinge to white portion of eyes
- schwarts sign: flamingo pink/red TM
- paracusis willsii: say they can hear and understand speech better in noise
103
what is ossicular disarticulation?
break in ossicular chain
104
common cause of ossicular disarticulation?
- Closed head injury, trauma, especially if it's related to temporal bone
105
impact of ossicular disarticulation on hearing
- major conductive hearing loss between 30-60 dB
106
- ossicular disarticulation interrupts?
- often times, in conjunction with?
- if this happens?
- the normal flow of energy from the air filled middle ear to the fluid filled inner ear
- tear in TM
- hearing loss can be substantial and disabling
107
often see ossicular disarticulation in who?
people in military, especially soldier who've been exposed to loud sounds/bombs, etc.
108
surgery that helps form new ossicular chain in ossicular disarticulation?
ossicular reconstuction
109
3 categories of disorders of the inner ear
- prenatal disorders
- perinatal disorders
- postnatal disorders
110
disorders of inner ear result in hearing loss that's usually ____ in nature
sensorineural
111
prenatal disorders of inner ear
- syndromes and inherited disorders
| - maternal infections
112
perinatal disorders of inner ear
- prematurity
| - anozia
113
postnatal disorders of inner ear
- meningitis
- autoimmune diseases
- meniere's disease
- ototoxicity
- noise induced
- presbycusis
114
explain major differences between conductive and sensorineural hearing losses
CONDUCTIVE
- usually temporary
- can usually be treated medically or surgically
- simply reduces the volume of the signal
- maximum loss of 60 dB
SENSORINEURAL
- usually permanent
- usually cannot be treated medically or surgically
- reduces volume of signal AND reduces clarity of signal (i.e., reduced frequency resolution)
- can range from mild to profound
115
2 most common causes of sensorineural hearing loss in adults
1. noise exposure
| 2. aging
116
what is tinnitus?
ringing/buzzing in the ear that only the patient can hear
117
tinnitus is associated with?
conductive and sensorineural hearing loss
118
tinnitus can cause? explain
severe distress of it's severe
| - some patients will go to extreme measures to stop it (ex/ get auditory nerve snipped)
119
is tinnitus a disorder?
NO - it's a symptom of a hearing loss
120
unilateral tinnitus?
red flag that it could be an 8th nerve tumor
121
amount of people that tinnitus affects
1/5
122
objective tinnitus?
doctor can hear it too, extremely rare, caused by a blood vessel problem
123
if a hearing loss is in combination with other symptoms, it's referred to as?
a syndrome
124
congenital infections are often associated with what?
sensorineural hearing loss
125
maternal infections can result in? most damaging portion of pregnancy?
- sensorineural hearing loss
| - first trimester bc cochlea is developing during 6-12 weeks
126
maternal infections that can cause hearing loss
- CMV
- toxoplasmosis
- rubella
127
most common cause of congenital hearing loss?
cytomeglovirus (CMV)
128
characteristics of CMV
- caused by a herpes-like virus that's often symptomless for mom
- no vaccine
129
characteristics of toxoplasmosis
- parasitic infection due to raw meats, cat feces
| - mom often won't have symptoms, but will affect baby
130
characteristics of rubella
- viral cause
- last epidemic was in the 60s. vaccine created in 1969. people are now refusing vaccinations for different reasons, so there's more of an outbreak now
131
some of the common acquired viral infections that can cause hearing loss
- herpes zoster oticus (what causes hearing loss), mumps (if accompanied by encephalitis), syphillis (usually occurs in secondary or tertiary stage of disease
132
often prematurity is accompanied by? which can lead to? and cause?
- hyperbilirubemia (JAUNDICE: too much billirubin, made when body breaks down RBCs)
- kernicterus: too much billirubin in blood cause brain damage, which can lead to hearing loss
133
how can anoxia affect hearing?
- lack of oxygen
- affects cells in brain and inner ear most often
- usually related to trauma during labor or delivery
134
what is meningitis?
| - impact on hearing?
infection of meninges (protective layer of brain and SC)
| - usually results in complete deafness
135
with meningitis, why must a cochlear implant candidate take quick action?
- bony cochlear duct fills with puss. As healing takes place, membranes replaced by bone. SO when a kid has meningitis, needs to immediately get a cochlear implant before cochlea fills with bone
136
- what are autoimmune diseases?
- affect on hearing?
- treatment?
- when body produces antibodies against its own tissues
- extent ranges from mild to severe. SUDDEN hearing loss (wake up and can't hear). usually BILATERAL.
- steroids. If treated right away, hearing sometimes comes back
137
characteristics of ideopathic hearing loss
- sensorineural
- sudden, unilateral hearing loss
- no known cause
- usually accompanied by tinnitus
138
What is meniere's disease?
oversecretion of endolymph in the scala media
| - reisner's membrane ruptures, massive amount of fluid
139
symptoms of meniere's disease
- most common symptom: roaring tinnitus
- vertigo
- aural fullness
- FLUCTUATING UNILATERAL sensorineural hearing loss
- poor speech discrimination
- hearing loss in low frequencies
140
treatment for meniere's disease?
steroids (anti-inflammatory), then insert a shunt to remove some endolymph
141
what does a typical audiogram for someone with meniere's disease look like?
see slide 47
142
what medications are toxic to hair cells?
- chemotherapy (cisplatin, carboplatin)
- antibiotics (gentamycin, streptomycin)
- megadoses of aspirin, nicotine, diuretics
143
symptoms of ototoxicity include
- bilateral HIGH FREQUENCY sensorineural hearing loss
| - tinnitus
144
regularly test someone's hearing who's on _____
| - how?
chemotherapy
| - start testing at 16,000 Hz and work way down because high frequencies are lost
145
characteristics of noise induced hearing loss
- lose high intensity sounds
| - noise notch (3000-6000 Hz), loss of these frequencies = MAJOR SIGN
146
explain the different threshold shifts in a noise induced hearing loss
- temporary threshold shift: ex/ after a concert, don't hear as well for a few days, then you're back to normal
- permanent threshold shift: ex/ irreversible hearing loss from noise exposure
147
OSHA regulations to prevent noise induced loss?
85 dBA for an 8 hour day
148
noise induced hearing loss occurs more often in?
males, cuz they're typically exposed to noise more often than females
149
why can exercising lead to noise induced hearing loss?
leads to decreased blood to cochlea, so you'll turn up your music so you can hear
150
motorcycles occur at what dB?
93 dBA
151
see audiogram for noise induced hearing loss
slide 51
152
effect of noise is _____. explain
accumulative: dependent on frequency, duration of exposure, intensity, and individual
153
type of hearing loss rifle shooters have?
unilateral noise-induced loss
154
list some hearing protection devices
earmuffs, earplugs, musician's earplugs
155
what is presbycusis?
auditory system structures degenerate with age
156
characteristics of presbycusis?
| - percentage of population with this?
- bilateral high frequency sloping to sensorineural that occurs with advancing age
- poor speech discrim (lose CLARITY as well as intensity and volume)
- 25-40% over age 65
- 90% in 9th decade of life
157
list disorders of the central auditory system
1. acoustic neuroma (8th nerve)
2. auditory neuropathy (8th nerve)
3. auditory processing disorder (beyond 8th nerve)
158
what is an acoustic neuroma?
| - what type of disorder is it?
a benign tumor on the 8th nerve
- it's slow growing and varies in size from person to person
- retrocochlear
159
5 symptoms of an acoustic neuroma
1. unilateral tinnitus
2. unilateral high frequency sensorineural hearing loss (because these freq. are coded on the outside of the nerve)
3. speech understanding is usually REALLY poor
4. vertigo
5. abnormal auditory adaptation (abnormally high - audibility decreases rapidly)
160
why do acoustic neuromas occur?
no one really knows
161
what often comes along with acoustic neuroma?
a headache
162
how can you diagnose an acoustic neuroma?
- ABR, MRI, CT
163
neurofibromastosis and its link to an acoustic neuroma
neurofibromastosis: genetic disorder that causes tumors to grow in the nervous system
- could cause an acoustic neuroma
164
what is auditory neuropathy?
| - explain
OHCs are fine, but IHCs, 8th nerve, and lower auditory BS is abnormal
- sound is going through, but not in a correct way. doesn't enter nerve, brain, etc. in a correct way
165
will hearing aids help with auditory neuropathy? why?
NO - because increasing intensity can't fix the wrong functioning
166
symptoms of auditory neuropathy
- mild to moderate sensorineural HL
| - VERY POOR speech recognition abilities
167
what will diagnostic testing reveal with an auditory neuropathy?
- OAEs are present (cochlea is functioning fine)
| - ABR (neural results) will be poor
168
why will an auditory neuropathy often go undiagnosed?
because audiologists don't typically perform ABR on kids
169
what could help with auditory neuropathy? but?
cochlear implantation
| - usually not suggested unless hearing is very poor
170
children with auditory neuropathy?
will often have resulting speech and language issues
| - often need to supplement with cued speech or another visual
171
what is auditory processing disorder?
breakdown in the ability to interpret speech that's due to issues in the central auditory nervous system
172
site of lesion for APD
- almost any area of the central auditory system
173
symptoms of APD
not a typical pattern, depends on where breakdown occurs
- most common:
- normal hearing (AC and BC normal), but they'll act like they have a hearing loss
- difficulty when there's background noise
- difficulty paying attn when there are distractions
- ask for repetitions
- difficulty understanding sarcasm
- often confused with LPD or ADHD
174
is there a "pathology" with APD?
NO - no tumor or anything
175
what will diagnostic testing show with APD?
- normal audiogram
| - excellent word recognition in quiet
176
main spot in brain for processing speech in humans
left temporal lobe (heschl's gyrus)
177
speech that's directed to right ear goes?
directly to dominant contralateral left temporal lobe
178
order of transmission of sound through the nervous system
| see slide 59
1. auditory nerve
2. cochlear nucleus
3. superior olivary complex
4. lateral lemniscus
5. inferior colliculus
6. medial geniculate body
7. auditory cortex
179
give the 4 definitions of deaf
1. Social: auditory/verbal communication is impossible or nearly imposible
2. Medico-legal: avg threshold at 500, 1k, 2k is over 90 dB
3. Educational: primary mode of learning is not auditory
4. Cultural: written with a capital "D" - people who communicate with ASL consider themselves a minority group, not a handicapped person
180
difference between deaf and hard of hearing? are they mutually exclusive?
- HOH can function in hearing loss. Listen through auditory and communicate through verbal
- Deaf cannot appropriately function in hearing world (?)
- YES
181
- communication modality for deaf?
| - educational placement for deaf?
- ASL, signed/cued speech, total communication
| - self-contained or mainstreamed with interpreter
182
educational placement for hard of hearing?
- self-contained, mainstreamed, mainstreamed with interpreter, mainstreamed with hearing aid
183
what's an organic hearing loss?
hearing loss that has an anatomical, physiological, or metabolic etiology
184
what's a functional hearing loss? most common?
person presents with a hearing loss, but organic etiology is unknown. not consistent with clinical or audiological eval
- faking it?
- most common = teenage girls wanting attention
185
What are OAEs? Present when?
low level sounds generated by the motile respose of OHCs (when OHCs elongate and contract)
- when OHCs are healthy (not present when OHCs are damaged)
186
OAEs are recorded where using a sensitive microphone?
in the external ear canal
187
OAEs are really good for?
catching someone who is faking a hearing loss (a malingerer)
188
OAEs will be absent with what type of losses?
- conductive hearing loss
| - sensorineural loss (?)
189
- who hypothesized about OAEs? When?
| - who discovered them? when?
- Gold, 1942
| - Kemp, 1978
190
sound pathway
outer ear, TM, ossicles, oval window, fluid filled cochlea, organ of corti
191
crucial for generating energy needed for OHC movement?
stria vascularis
192
OAEs are generated by _____ auditory activity
EFFERENT
193
what do OHCs do?
- their motile properties either enhance or suppress the motion of the basilar membrane
- this action directly affects the amt of stimulation received by the IHCs (what we hear)
194
3 ways to measure OAEs
1. Spontaneous OAES (SPOAEs)
2. Distortion Product OAEs (DPOAEs)
3. Transient evoked OAEs (TEOAEs)
195
what's SPOAEs?
- measurement in outer ear with a sensitive microphone attached to an amplifier and a computer averaging device
- these emissions are estimated to be present in little LESS THAN HALF of all people w/ normal hearing and occur w/o external stimulaiton
196
SPOAEs more common? used clinically?
- in females
- in right ear
- NOT useful clinically
197
Explain EOAEs
the probe that's placed in the ear not only has a microphone to measure the emissions, but it also has a receiver that emits a stimulus to EVOKE an emission from the ear
198
An OAEs presence is defined by?
at least 6dB above the noise floor
199
TEOAEs are evoked by?
- stimulates a?
- if present, indicates?
- 2 cautions?
a broadband CLICK stimulus
- stimulates a wide frequency range on the basilar membrane
- NORMAL MIDDLE EAR FUNCTIONING. Hearing is NOT worse than 40 dB at frequence of click
- 1) NOT a hearing test, presence doesn't mean you don't have a hearing loss. 2) NOT frequency specific
200
frequencies of click for TEOAEs?
1k-3k Hz
201
TOAEs will disappear as soon as?
you have a HL greater than 40 dB. Could still have a mild HL if you have TAOAEs
202
OAE = what spike on picture?
first spike on left
203
usually present click for TEOAEs at what dB level?
80
204
distortion product OAEs are evoked by?
- stimulates a?
- if present, indicates ____?
- disadvantage?
- 2 pure tones presented simultaneously to the ear
- stimulates a SPECIFIC frequency region on the basilar membrane
- HL is not greater than 50 dB. Could still have moderate HL
- takes longer cuz you're presenting pure tones to each portion of the basilar membrane
205
Why measure OAEs?
1. they're pre-neural events from the cochlea - helps us distinguish between SENSORY and NEURAL HL in some cases
2. can be measured objectively in quote patients in less than 1 min per ear
3. non-invasive
4. repeatable and reliable
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reasons why you might have absent OAEs
cholestiatoma, stenosis, cochlear pathology, external otitis, otosclerosis, cyst
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What are people doing with OAEs now? (5)
1. newborn screening
2. screening individuals who can't respond behaviorally (e.g., developmentally delayed)
3. malingerer
4. ototoxic monitoring (industry, chemo, etc.)
5. differentiation between cochlear and neural losses
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what are electorphysiologic measures? essentially, we?
- measures of electricity generated by the physiologic response of the NS
- place electrodes on the person's head, stimulate the ear with sound, and measure the electrical activity that is triggered by introducing sound to the ear
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earliest electrophys. measure. associated with?
- cochlear microphonic
| - hair cell activity
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second electrophys. measure? called? happens when? comes from?
- summating potential (from cochlea)
- action potential (end of 8th nerve)
- electocochleography (ECochG)
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EcochG
- stimulated with?
- dependent upon?
- can be useful in?
- ratio of what is a critical measure
- is not?
- an abrupt, brief sound like a click
- hearing in 1k-4k Hz range
- dx Meniere's disease
- SP to AP
- a test of hearing and is VARIABLE
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summating potential and AP pic - slide 19
see slide
| - SP first, AP higher and second
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reasons why SLP student should learn about evoked potentials
- can understand results of ABRs
- can understand what type of test to make a referral for
- research implications
- clinical implications - is therapy working?
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what are auditory evoked potentials?
measure of the electrical voltages evoked in the brain in response to acoustic stimulation
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how do we measure auditory evoked potentials?
we place electrodes on a patient's head, stimulate the ear with sound, and measure the electrical activity
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3 different Auditory Evoked Potentials, what activity they reflect, and when they occur
1. Auditory BS response (ABR) - 8th nerve - 1st 10 millisec
2. middle latency - thalamus - 1st 50 millisec
3. late latency - auditory cortex - 1st 50 to 250 millisec
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study pic of AEP - slide 23
study
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what's ABR stand for? what is it?
auditory brainstem evoked response
- electrodes placed on MASTOID and 2 on forehead
- sound delivered to ears through headphones or oscillator
- measurement is made from 0 - 12 milliseond post stimulus and waveforms are observed that correspond to synaptic junctions along auditory pathway
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ABR measures integrity of aud system from ___ to ____
outer ear to BS
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ABR testing conditions
infants and kids have to be sleeping
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ABR stimuli presented through what type of conduction?
- if using clicks, tests what freq?
- if using tone bursts?
air or bone
- between 2k and 4k
- 500 to 4k
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ABR measures?
lower BS and 8th nerve
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ABR used to determine?
if there's an acoustic neuroma, another retrochoclear problem, or to estimate threshold
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ABR not a TRUE measure of?
hearing threshold, measures neural synchrony
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ABR is most common?
auditory evoked potential
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ABR has ___ major peaks that occur at ______
5, intervals (latencies)
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Later latency response = ____ amplitude. The shorter the latency, the more ____ proceeds
- greater amplitude
| - rapidly maturation proceeds
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stimuli used for ABR
clicks
| pure tones
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define latency
where waves occur in time
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what each wave of ABR gives info on******* and timing of each
1. distal end of VIII nerve or spiral ganglion, less than 1 ms
2. proximal end of VIII nerve and cochlear nuclei, 2 ms
3. superior olivary complex, 3ms
4. lateral lemniscus, 4 ms
5. inferior colliculus, 5 ms
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major components of ABR waves
1, 3, 5
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missing wave on ABR = ?
that's where site of lesion is
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latency ____ as intensity decreases
increases
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timing/distance between 1-3-5 should be?
about 2 milliseconds between each
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see pics on slides 36-39 of electrophysiology
look at them
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slower than normal latencies (grater than ____ SD from mean) = ?
2
| - medical referral for imaging studies to investigate cause
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another application of ABR results with children?
can be used for threshold estimation
| - reduce intensity of sound and observe how long Wave V is still measurable
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Wave 1 small amplitude or delayed or absent?
could indicate cochlear lesion
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wave 5 small amplitude or delayed or absent
upper BS lesion
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if interpeak latency between 1 & 3 is too long = ?
lower BS lesion
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if interpeak latency between 3 & 5 is too long = ?
upper BS lesion
