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AUDE 5240 (AUD DIAG) > Study Guide 2 > Flashcards

Study Guide 2 Flashcards

1
Q

What is “patterning” and why must it be avoided?

A

Presenting the tones at the same rate
people will click and you don’t know what they are responding to

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2
Q

how to avoid patterning?

A

mentally count in your head and count to a different number each time

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3
Q

what is the psychometric function?

A

basis for all threshold measures
how many times a patient will respond at 50% of the time but they can still respond above and below their threshold

probability of a response, 50% criteria

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4
Q

For pure tone testing?
What is the psychoacoustic method used?
How is starting level determined?
What is the step size?
What is the stopping rule?
How is threshold calculated?

A

method of presentation: adaptive staircase
starting level: at their threshold or 30
step size: down 10 up 5
stop rule? stop at 2/4 ascending
what is threshold: where we stopped

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5
Q

How do you test for test/re-test reliability? What is acceptable variation for a test to be considered reliable?

A

Air conduction (adult) ±5dB
Do this by rechecking 1,000 Hz
Start at 1,000, most sensitive frequency so it is easy to hear
Then test 1,000 2,3,4,6,8 and redo 1,000 to check for this reliability

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6
Q

if reliability is not in agreement If not in agreement want to find out why?

A

could not be answering honestly
Why would we get different results? They could’ve learned the test better, could have a really conservative response when starting, could be an equipment issue, audiologist could be patterning or marked it incorrectly.

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7
Q

Is it ok to note the lower threshold when testing for test/re-test reliability?

A

yes

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8
Q

list several factors that adversely affect pure tone test results

A

Patient observing dials
Incorrect adjustment of headband/earphone placement
Vague instructions
Patterning
Overly long test sessions
Examiner giving visual clues
Noise in test area
Stimulus presentations too long or too short

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9
Q

Identify important factors for soundfield testing.

A

Need to use a warble tone and no reflections and need to be seated under calibration sticker and seated the way the headphones were calibrated
If they were calibrated for 90 degrees azimuth they need to be seated with the speakers there

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10
Q

how do you report an audiometric test?

A

Pure tone air and bone conduction testing indicated/revealed hearing thresholds were within normal limits at both ears. Speech recognition thresholds (SRT) were in agreement with pure tone testing.
Pure tone air and bone conduction testing indicated/revealed hearing thresholds within normal limits at the right ear with mild sensorineural hearing loss at the left ear. Speech recognition thresholds (SRT) were in agreement with pure tone testing.
Pure tone air and bone conduction testing indicated bilateral high frequency sensorineural hearing loss. Speech recognition thresholds (SRT) were in agreement with pure tone testing.

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11
Q

Why are maximum permissible ambient sound pressure levels different for different transducers?

A

the inserts attenuate more sound (block) than the supra-aurals and the supra blocks more sound than not being covered
if there is a little sound and you have inserts in it will be ok but for bone conduction there cannot be noise in the background

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12
Q

why dont we use pulsed or steady tones for sound field?

A

so we can avoid standing waves

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13
Q

On an old audiometer, if signal is being sent to a headphone but you have them wearing inserts, what happens?

A

calibration is off
thresholds would be lower than what they have

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14
Q

List several disadvantages of supra-aural earphones

A

Possibility of a collapsed ear canal
Creation of an occlusion effect
Leakage of sound
Narrow frequency response (relative to
circumaurals)
Poor ambient noise attenuation
Awkward during bone conduction masking

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15
Q

List specifically when supra-aural earphones would be indicated

A

situations where insert earphones are contraindicated
structural abnormalities (atresia, stenosis)
a draining ear
presence of substantial cerumen

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16
Q

When are circumaural headphones required to be used?

A

extended high frequencies, have better noise attenuation than supras

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17
Q

List several advantages of insert earphones

A

Fit/comfort
Because the insert earphone uses a foam insert it can fit all but the most unusual (very small or very large) ear canals
Ambient noise attenuation
Better for masking
These benefits (other than comfort) are only present with proper placement (next slide)

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18
Q

What is the necessary insertion depth for insert earphones?

A

past the opening
Because it is calibrated based on the volume from the ™

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19
Q

What is the likely consequence of shallow insert insertion?

A

Elevated thresholds, especially in low frequencies
Masking benefits disappear

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20
Q

Explain how to interpret sound field testing results

A

The thresholds you get only pertain to the better ear and we don’t know about the other ear and we don’t know which ear is which based on sound field alone.

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21
Q

why do we not test bone above 4,000?

A

because of the response of the frequency of the bone oscillator
doesn’t transmit sound above 4,000 Hz

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22
Q

Why should you perform otoscopy yourself before placing transducers on a patient?

A

To ensure the ear canal is clear & normal appearing
Helps tell us if we need to use inserts vs supras, health of the ear, the shape of the canal, etc.

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23
Q

what is the occlusion effect?

A

Amount by which the threshold gets better when you plug the ear canal

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24
Q

Why should you place transducers on your patient rather than letting them do it?

A

Make sure it is accurately placed because it does matter, validity of test results

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25
Q

Describe air and bone conduction transmission routes.

A

Air - ear canal, middle, cochlea auditory nerve
One side (same side as stimulated)
Bone - mastoid, both middle ears
Stimulate bone and it stimulates both sides through fluid of the skull and bone

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26
Q

Define and describe the three bone conduction mechanisms.

A

Distortional: Bony cochlea is vibrating and the traveling wave is created -Bones of skull compress and move in phase with stimulus, -Skull compression results in compression of otic capsule
Intertial-ossicular - bony middle ear vibrates and vibrate out of phase but at the same frequency and stapes creates traveling wave in cochlea
Ossicles vibrate in response to bone stimulation
-Greatest below 800 Hz
Ossicles are suspended
Ossicular chain vibrates if skull vibrates
Stapes moves in and out of oval window
Same as for airborne signal arriving at the tympanic membrane
Osseotympanic (ear canal) -Energy transmitted to bone and cartilage of outer ear
-Some of this energy vibrates TM
-Mechanism same as occlusion effect

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27
Q

Describe the differences in frequency response for bone conduction vs. air conduction transducers

A

Maximum levels and frequency range of the bone conduction transducer are smaller than for air conduction
Ac is a broader frequency response and the response we can do higher levels at these
More limited for bone

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28
Q

Which frequencies should be tested for bone conduction?

A

Review: air conduction thresholds
octave frequencies 250 to 8000 Hz and 3000 and 6000 Hz.
The upper limit of bone conduction testing is 4000 Hz (for some audiometers, 6000 Hz)
Test octave frequencies plus 3000 Hz
Some do not test 250 Hz
Do test 250 Hz for AUDE 5240

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29
Q

bone conduction transducer limits.

A

250 Hz 45 dB HL
500 Hz 60 dB HL
1000 Hz 70 dB HL
2000 Hz 70 dB HL
3000 Hz 70 dB HL
4000 Hz 70 dB HL

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30
Q

What should you do if bone conduction thresholds are poorer than air conduction?

A

Test-retest reliability
We write them in where we get them, even though we know it shouldn’t be, and not correct ourselves

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31
Q

Describe vibrotactile responses. Is this more likely in lower or higher frequencies?

A

Patient is responding but they feel it rather than hearing it, occurs more in the lower frequencies higher levels

Only relevant to bone conduction

32
Q

Conductive hearing loss

A

disorder in external and/or middle ear
Air conduction thresholds are elevated
Bone conduction thresholds are within normal limits
Air-bone gaps (ABG) of 15 dB or greater are present
At 3 or more frequencies ***

*** There is no formal guideline for this

33
Q

SNHL

A

Disorder in the cochlear, auditory nerve, and/or central auditory pathway
Air conduction and bone conduction thresholds are elevated equally (any air-bone gaps frequencies are less than 15 dB)
no air bone gaps
hearing loss outside of normal
Want bone and air within 10dB of each other??

34
Q

mixed hearing loss

A

Disorder of both conductive and sensorineural systems
Both air conduction and bone conduction thresholds are elevated
Air-bone gaps of 15 dB or more are present

bone outside of normal limits, so is air
35
Q

identify degree, type (conductive, sensorineural, mixed), description, and slope of hearing loss.

A

Degree (mild, moderate, moderately severe, severe, profound)
Description of configuration (flat, sloping, etc.)
Type of hearing loss (sensorineural, conductive, mixed)
Ear(s) involved

36
Q

Describe the general purpose of clinical masking

A

Want to make sure we are testing the ear we want to be testing
Bone - also identifying site of lesion
To eliminate any influence to the nontest ear

37
Q

define attenuation

A

The decrease (think attenuator dial on audiometer) or become less

38
Q

what is audibility

A

sound is audible or perceivable by the ear
If sound level is greater than or equal to the hearing threshold, it is considered audible

39
Q

how can attenuation occur

A

decrease due to distance or due to sound absorption

40
Q

If a sound level is 70 dB SPL at point A and it is attenuated by 40 dB as measured at point B, what is the sound level at point B?

A

30 dB

41
Q

Sound level at point A 50 dB SPL
Amount of attenuation 20 dB
Sound level at point B ?
who can hear this out of 15, 30 and 45 dB?

A

30 dB
only 15 and 30 can hear this

42
Q

components of a task that are observable when it is being implemented

A

procedural componenet

43
Q

knowledge, thinking, and decision-making

A

cognitive component

44
Q

Rules
Definitions
dB levels
Shortcuts

A

procedural components

45
Q

Transducer characteristics
Knowledge of attenuation
Audibility of signal
Based on sound delivery mechanism
Integrate case history and test results
SRT, tympanometry, OAE

A

cognitive components

46
Q

the amount of attenuation between presentation to test ear and sound level at the non-test ear (varies by transducer, frequency, and person)

A

interaural attenuation

47
Q

ear that is being tested

A

test ear

48
Q

ear not being tested

A

non test ear

49
Q

what is the first concept to clinical masking

A

Bone conduction oscillators AND head-worn air conduction transducers activate bone conduction mechanisms. One or both cochleas may be stimulated by an auditory stimulus presented via any of these transducers.

50
Q

How do we estimate if cross-hearing has occurred?

A

Based on
Presentation level of stimulus
Bone conduction thresholds of the NTE
Interaural attenuation
How much has the sound level attenuated from stimulus presentation level to opposite cochlea?

51
Q

IA for supra or circumaurals

A

40 dB

52
Q

IA for inserts

A

60 dB

53
Q

IA for bone conduction

A

0 dB

54
Q

what is the equation for crossover

A

Crossover level = PL – IA
Crossover: Presentation level to the TE – IA
Compare crossover level to NTE BC threshold and check for audibility

55
Q

what is a shadow curve

A

air conduction thresholds in poorer ear follow contour of thresholds in better ear

Sound is crossing over and the better ear is responding

56
Q

what is the second clinical masking concept

A

f there is a likelihood of cross-hearing occurring, masking noise is used to increase the threshold of the non-test ear

57
Q

what is masking

A

any sound that raises a threshold

58
Q

Increase in threshold/threshold shift in presence of another sound

A

masking

59
Q

Sound is perceived as softer but still audible

A

partial masking

60
Q

sound increasing threshold of other sound

A

masker

61
Q

Sound that is being masked

A

maskee

62
Q

what could be a consequence ot incorrect masking?

A

Incorrect diagnosis of the type and severity of hearing loss improper treatment
possible surgery
possible delay of amplification
false hope for the patient
and/or a lawsuit

63
Q

What type of noise is used to mask pure tones? Speech? How do the frequency responses differ?

A

Pure tones: NB
Speech weighted noise
With NB, the bandwidth is narrower and centered on frequency you are masking and with speech it is a broadband signal and has all the frequencies of speech

64
Q

What three factors influence the amount of interaural attenuation?

A

Frequency
Transducer
Individual person (skull size thickness etc.)

65
Q

not enough masking

A

undermasking

66
Q

Valid masked threshold obtaine

A

adequate masking

67
Q

too much masking, increase thresholds of the test ear because it is crossing over from the nte to the test ear

A

overmasking

68
Q

if you can increase the noise (15dV) without the threshold changing, (changing the tone) the masking is done properly

A

plateau

69
Q

Intensity of the masker that will mask a pure tone of the same intensity, how our noise is calibrated on the audiogram

A

effective masking level (dB EM)

70
Q

When is masking needed for air conduction?

A

PL – IA ≥ unmasked BC threshold
Estimated or measured BC threshold
** Estimate 10 dB better than AC

71
Q

What is the starting masking level for air conduction?

A

Based on air conduction threshold of the NTE.
AC threshold of NTE + 10 dB “safety” factor

72
Q

What is the starting masking level for bone conduction?

A

Also based on air conduction threshold of the NTE
AC threshold of NTE + 10 dB “safety” factor + occlusion effect

73
Q

When is masking needed for bone conduction?

A

When the difference bw unmasked air and bone is 15db or more

74
Q

When is masking needed for air conduction?

A

Air = a large asymmetry
Enough where we are worried the sound crosses over to the non test ear
Threshold of test and non test ear and subtract the values
60 for inserts and 40 for supras

75
Q

What is the starting masking level for air conduction?

A

Ac of the nontest ear plus 10

76
Q

What is the starting masking level for bone conduction?

A

Ac of nontest ear plus 10 plus occlusion

77
Q

What is the starting level of the tone?

A

Always unmasked threshold

AUDE 5240 (AUD DIAG) (4 decks)

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