Written COMP Flashcards
disorders, speech, amp 1 & 2, OAE, pharmacology, peds, counseling, CAPD, aural rehab, vestib 1, implantables, evoked responses, (509 cards)
1
Q
If you are looking at an ABR for retrocochlear and conductive, how do you tell the difference?
A
You can not tell from just the graph, you must do bone conduction or reflexes. If they add bone to the graph and it falls into the gray range, then it would be a conductive hearing loss because of the air-bone gap.
2
Q
Tell me how latency and amplitude change with intensity (ABR) ?
A
Louder Intensity = higher amplitude & shorter latency
Smaller Intensity = shorter amplitude & longer latency
3
Q
The latency of wave 5 between ears should differ by no more than?
A
0.2 to 0.4 msec
4
Q
Why is latency important?
A
it is the most robust parameter in the clinical interpretation of the ABR
5
Q
The ABR is not sensitive …
A
to all central nervous system disorders, it is only sensitive from the ear to the brainstem
6
Q
Tell me about an OAE Screening
A
- typically takes much less time
- fewer frequencies assessed, usually higher frequencies
- completed to distinguish those who do not have significant auditory dysfunction from those who need further evaluation
7
Q
Tell me about an OAE Diagnostic Test
A
- A component of a comprehensive test battery
- Requires interpretation from an audiologist
8
Q
OAE outcomes will always fall within 1 of 3 general categories. What are they?
A
- OAE amplitude is normal (relative to normative data) 2. Amplitude is abnormal, but OAEs are present
- OAE’s are absent
9
Q
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).
A
The outer hair cells have electromotility which is their ability to change lengths, aka the “dancing of the outer hair cells.” When the stimulus for an OAE is put into the external auditory canal it then travels through the middle ear then to the cochlea. This sound causes the basilar membrane to move and the outer hair cells to move as well. When the outer hair cells move it allows ions to rush in. Followng this a singal is sent back out of the ear to be collected and recorded by the probe.
10
Q
True or False: Generally speaking, slight middle ear disorders that may not entirely obscure OAEs affect responses first for the lower frequencies.
A
True
11
Q
What are 3 non-pathological ear canal factors that can affect OAE measurements?
A
- age
- gender
- noise - standing waves
12
Q
What role(s) does the external auditory meatus (or canal) play in OAE measurement?
A
Both inward and outward propagation
13
Q
True or False: 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.
A
True
14
Q
What are the medical red flags that contraindicate the recording of OAE responses?
A
- Active drainage in the ear canal
- A history of middle ear dysfunction
- Active bleeding in the ear canal
15
Q
True or False: The amplitude of OAE responses are typically larger with greater reproducibility in adults when compared to children and infants.
A
False
16
Q
In ears with a perforation or PE tube, what results are possible?
A
Present OAE, absent OAE, partial OAE, or reduced amplitude OAE responses may be observed in dry ears with tympanic membrane perforation or ventilation tubes.
17
Q
What are the two (2) pure tones labeled as in DPOAE parameters?
A
f1 & f2
18
Q
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?
A
the distortion product
19
Q
True or False: 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.
A
True
20
Q
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.
A
f2/f1 = 1.22
21
Q
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?
A
65 and 55 dB SPL
22
Q
What are the four regions of the auditory system that either contribute to the generation of OAEs, or can influence OAE recording?
A
- external auditory canal
- middle ear
- cochlear
- efferent auditory system
23
Q
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? Active/passive processes should be included in your answer.
A
If you use a intensity level greater than 70 the passive process which is the inner hair cells will respond. If you keep the intensity under 70 it is the outer hair cells also known as the active process responding. An OAE is meant to test the function of the outer hair cells and in order to do that and not be testing the inner you must keep the intensity under 70.
24
Q
True or False: There is now considerable evidence that noise- or music-induced cochlear damage is detectable with OAEs before it becomes apparent in the audiogram
A
True
25
What are some of the clinical applications for OAE's in adults?
- monitoring tinnitus and noise or music exposure
- differentiation of cochlear vs. retrocochlear site of lesion
- assessment in suspected functional hearing loss
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.
27
What is the optimal dB SPL for the stimulus when recording a TEOAE?
74-83 dB SPL
28
Please look at the click stimuli in the following displays. Which one of these is a good stimulus?
The 1st image is a good stimulus because it has a peak then flattens out.
29
Passive cochlear processing (when a sound is loud enough) can directly stimulate which of the following?
The inner hair cells stimulated through basilar membrane movement
30
True or False: OAEs can help you differentiate between a cochlear hearing loss and a retrocochlear hearing loss.
True
31
The OAE loses energy on the way from the cochlea to the ear canal where it is measured. Which of the following supports this?
As the OAE moves from the cochlea to the ear canal, this reverse transmission is much less effective than forward transmission
32
Please look at the following OAE:
a) What type of OAE is this?
b) Is this a passing response?
c) Why or why not?
d) What can you say about hearing levels?
a. TEOAE
b & c. No the stimulus is too low and the reproducability isnt present at 3000,4000, or 5000
d. An OAE is not a hearing test so i can not say what hearing levels would be however I think further testing is needed because results are consistent with a outer hair cell problem
33
What type(s) of hearing loss can be missed if we are using OAEs for newborn hearing screening?
ANSD, mild losses, atypical configurations
34
Describe OAE responses in a person with ANSD
OAE responses in a person with ANSD will be present early on but eventually the compromised blood flow to the lesion will cause a neuropathy making them absent.
35
When we record OAEs in the presence of abnormal negative middle ear pressure, the low frequencies will show decreases in amplitude (when compared to OAEs in an ear without negative middle ear pressure). Please explain to me why the low frequencies are affected most.
When we record OAE's in the presence of abnormal negative ME pressure the lows will decrease because as the sound travels through the ear the TM and middle ear system are stiff. This means that the vibration of the ossicles will slow causing the wave to reach the high frequency areas but not the lows. Thus causing a decrease in the amplitude of low frequencies.
36
True or False: Patients with ANSD have no efferent suppression of TEOAEs with binaural, contralateral or ipsilateral noise.
True
37
True or False: The absence of spontaneous OAEs is consistent with cochlear damage.
False
38
What criteria must be met when determining if a DPOAE is a pass/present? Please describe at least two (2). Include words such as "absolute", "f2", "SNR".
The absolute ampitude must be greater than -10 dB SPL, the SNR must be greater than 6 dB, and there must be reproducability. If all of these are present it means the patient has normal or near normal cochlear function.
39
If you plot the amplitudes of a DP response on a Gorgagram, and they fall in the "N" (Normal) area, what can you say about hearing levels?
- Hearing is better than or equal to approximately 15-20 dB HL
- Cochlear outer hair cell function is normal or near normal
40
The HEAR Report is an acronym to guide you when writing a report. What does H.E.A.R. stand for?
- H: history, relevent information
- E: evaluation, what tests you did
- A: audiologic results, what are the results of the test you ran
- R: recommendations, who are you sending it to and what do you want them to do with this info.
41
True or False: OAEs have been shown to decrease simultaneously with high frequency audiometry (HFA)
True
42
True or False: OAE amplitude often has considerable intersubject and inter-patient variability, even among persons with similar pure-tone audiometric findings.
True
43
Normal OAEs may be recorded in patients with abnormal audiograms, including patients with?
VIIIth nerve (neural) auditory dysfunction & functional, non-organic, psychogenic hearing loss
44
Abnormal OAE findings may be recorded in a variety of patients with normal audiograms yet some cochlear dysfunction, including patients with?
hazardous noise/music exposure & ototoxicity
45
How do ototoxic drugs damage the inner ear? There are 4 mechanisms we discussed.
- ishchemia due to compromised blood flow
- toxicty - platinum or other metals
- formation of free radicals and metabolic stress
- mechanical damage
46
True or False: The CPT codes 92587 and 92588 are used to either bill a "limited" (3-6 frequencies) or a "comprehensive" (>/= 12 frequencies). Both are listed as requiring interpretation and report. There is a third CPT code, 92558, which is used for a "screening" and gives an automated analysis (Pass/Fail) and does not require interpretation and report.
True
47
Which of the following is not a clinical advantage of using OAEs?
Is not affected by middle or outer ear function
48
List 3 functions of the efferent auditory system
- protect from loud sounds
- hearing speech in noise
- auditory attention
49
The American Academy of Audiology Position Statement and Clinical Practice Guidelines for Ototoxicity Monitoring recommends what assessment/monitoring of patients receiving ototoxic medications?
- Pure tone audiometry in conventional test frequencies
- High frequency audiometry
- Otoacoustic Emissions
50
True or False: Most ototoxic drugs first damage the basal end of the cochlea and the OHCs (the high frequencies) and this is why DPOAEs are the preferred type of OAE (can evaluate higher frequencies).
True
51
True or False: The ability to suppress OAEs is an indicator of a normal phenomenon and a normally functioning efferent, or descending, auditory system.
True
52
True or False: Standing waves are a potential problem when recording OAEs, but the only way to completely eliminate them is to place the probe at the tympanic membrane, which is typically not clinically feasible.
True
53
True or False: It is important to use normative data that was collected from the device being used for testing when interpreting OAE test results.
True
54
For the table below, assume each test is evaluating for the same condition. According to the information in the table, which test is the most sensitive measure?
According to this table Test A is the most sensitive because the d' is higher. d' is less sensitive when it is lower and more sensitive when it is higher.
55
Explain how the TEN test is able to identify a cochlear dead region.
The TEN test is able to identify a cochlear dead region by using calibrated masking to tell us if the response is coming from the actual place (on frequency) or not (off frequency). The noise played will mask any of the off frequency lsitening so the tone must be louder than the noise. Off frequency means the tone is detected away from the region of peak BM vibration meaning the tone is detected by the IHC at the edge of the dead region. On frequency means the frequency presented is the place on the BM that is actaully responding.
56
What is categorical perception?
perceiving either one phoneme or another when VOT is gradually increased or decreased?
57
What is segmentation of speech into meaningful units?
the ability to identify words in a stream of speech (if one is familiar with the language)
58
What is perceptual learning?
the ability to understand a speaker with a previously unheard foreign accent especially with repeated exposure to that accent
59
what is bottom up processing?
All information necessary to recognize sounds is contained in the acoustic signal and analyzed in the auditory pathway
60
What is perceptual grouping of speech sounds?
stream of acoustic information is interpreted as speech and not just random sounds
61
what are the parts of cognition?
- understanding information
- mental activities or processes
- storing and retrieving information (memory and recall
62
what is top down processing?
- Higher level cognitive operations are involved in identifying and analyzing speech sounds
- Prior knowledge and expectations are involved in speech perception
63
Provide a short definition for each of the cognitive abilities below:
- Attention
- Processing Speed
- Inhibition
- Short-term memory
- Working memory
- Executive function (as commonly applied in cognitive hearing science)
- Semantic knowledge
- Attention; the ability to tend to a desired targetfor , example listening in noise
- Processing Speed ; amount of time it takes to process a stimulus, reaction time
- Inhibition ; ability to inhibit extranous info when repsoning to a target stimulus, example is the stroop test
- Short term memory ; memory stores for a short period of time, example seeing how many numbers you can remember correctly in a row
- Working memory ; memory stored for a long period of time, that you can use to help you understand
- Executive funciton ; control of cognitive processes, example trail making (following a path of #'s in order)
- Semantic Knowlede ; accumulated through lived experiences, example naming things by looking at pictures
64
what cognitive ability is: sorting pictures into categories?
semantic knowledge
65
what cognitive ability is: the stroop task?
inhibition
66
what cognitive ability is: measuring the number of words that can be recalled while also identifying if the word is a noun or a verb?
working memory
67
what cognitive ability is: measuring the numbers of letters that can be recalled accurately and in order?
short-term memory
68
what cognitive ability is: the trail-making task?
executive function
69
what cognitive ability is: the reaction time task?
processing speed
70
what cognitive ability is: the task is to respond to all the black letters; participant sees images containing letters and numbers. The task is to press the space bar whenever they see a letter.
attention
71
True or false: Cognitive decline is a separate consideration from normal variation in cognitive abilities
true
72
List three ways a speech signal could be distorted or difficult to understand prior to reaching a listener's auditory system.
- environmental noise
- accent
- predictability - if you know the person and how they speak
73
Explain the predictive and postdictive role of working memory in speech/language processing.
The predicative role in working memory helps us when we are talking to people we are familiar with.
The postdicative role in working memory is more challenging and comes into play when we are talking to unfamiliar speakers or people with accents. If i meet someone from a place where the dialect is different I will struggle more to figure out what they are saying if I miss something. This is because I dont know them well and am unable to predict how they speak. The postdicative role helps me piece together my prior knowledge from past experiences and context to figure out what they were saying.
74
As used in the Ease of Language Understanding model, how do implicit and explicit processing differ?
We use implicit processing to look for matches in our long term memory, if there is a match we will have automatic understanding, if there is not a match we will struggle to undersand unless there is context. Then we use explicit processing to pull information to understand. Implicit processing is automatic, example the speaker is familiar and therefore we can predict their speech. Explicit takes effort, it can be an unfamiliar speaker and we will have to use our working memory.
75
For a dual-task paradigm, the primary task must always be a speech task (if measuring listening effort). What can be used as a secondary task when measuring listening effort?
- recall task
- tracking task
- reaction time task
- attention task
76
What are the three categories of measuring listening effort?
Physiologic - pupil response during listening
Self reporting - answering questions
Behavioral measures - 2 tasks performed individually then simultaneously, listening effort performance will decrease simulateously
77
What is the TEN noise designed to do?
mask an off-frequency response
78
What is the advantage of using d’ as a measure of test sensitivity?
d-prime is independent of pass-fail criteria
79
Which value of d' (d-prime) indicates a more sensitive test, a higher value or a lower value?
higher value
80
Consider the wave forms below. The top panel shows a speech sample in quiet. The lower panel shows speech in noise with a 0 dB SNR. Explain why a listener with threshold independent deficits associated with cochlear synaptopathy (one type of "hidden hearing loss") would be able to understand the speech in quiet with high levels of accuracy but would have difficulty with the speech in noise.
With hidden hearing loss/cochlear synaptopathy hearing in noise if affected and the fibers repsonsible for higher level inputs. The listener would be able to hear in quiet situations because they are able to to get soft input for the brain to process. They would struggle in noise because in noise you are no longer able to hear those soft sounds so the brain can not process them.
81
Describe two-tone suppression and distortion products. How are these affected by cochlear outer hair cell loss? How does this affect speech processing?
Two-tone suppression is when one tone is supressed when a second tone is present. It affects vowel perception and you lose the peaks meaning everything becomes a flat line. Distortion products is a 3rd tone is added when 2 tones are present together. These are caused by loss in the OHC and it affects speech because the OHC are our amplifiers so when these are lost if causes problems with our hearing. A person with this kind of damage will struggle with hearing speech in noise.
82
what is energetic masking?
- masker evokes stronger neural excitation than target speech
- takes place in the peripheral auditory system
83
what is informational masking?
- linguistic content interferes with speech perception
- takes place at the auditory processing or cognitive level
84
what is affected in "hidden hearing loss" also referred to as cochlear synaptopathy.
- affects speech in noise processing
- pure tone thresholds are unaffected
- speech in quiet is not significantly impacted
- affects the ability to process complex auditory information at suprathreshold levels
85
Tell me about the predictive role of working memory in speech processing
- implicit process
- fast
- component of RAMBPHO (initial processor of multimodal sensory information)
- part of implicit processing
86
Tell me about the postdictive role of working memory in speech processing
- explicit process
- thought to be in play after a mismatch has already occurred
- slow, deliberate
- part of explicit processing
87
Which of the following regarding epidemiology and population demographics of dizziness / balance disorders is FALSE?
- Dizziness is one of the most common complaints in outpatient clinics
- Dizziness is the #1 complaint to medical providers for individuals over 70 years of age
- The number of older individuals (those over 65 years of age) is expected to decrease by 2030 driving healthcare costs down
- Falls are one of the leading causes of brain injury (TBI) and fractures
- 50% of individuals over age 70 will experience BPPV at some point
The number of older individuals (those over 65 years of age) is expected to decrease by 2030 driving healthcare costs down
88
Balance depends upon sensory information gathered from what 3 systems?
vision, somatosensory, vestibular
89
When discussing vestibular anatomy, "peripheral" refers to which of the following?
Labyrinth & 8th nerve up to the point it enters the brainstem
90
When discussing vestibular anatomy, "central" refers to which of the following?
Brainstem to cortex
91
True of False? "Vision denied" refers to eyes closed (ENG) or eyes covered (VNG) or the scenario where the patient is without a visible target?
True
92
What are the two sensory structures within the peripheral vestibluar system and what type of stimuli does each respond to?
The two sensory structures in the peripheral vestibular system are the crista ampullaris and the maculae. The crista ampularis is responsive to angular (rotational) movement and the maculae is responsive to linear (translational) movement and to gravity.
93
Match the correct structure below with the corresponding letter.
A- Common Crus of SCC
B- Scarpas Ganglion
C- Superior Vestibular Nerve Branch
D- Inferior Vestibular Nerve Branch
E- Posterior/Inferior SCC
F- Saccule
G- Utricle
H- Horizontal/Lateral SCC
I- Ampulla
J- Anterior/Superior SCC
94
True or False? The semicircular canals are located within the membranous labyrinth, contain periplymph and are surrounded on the outside by endolymph and the bony labyrinth?
False
95
The semicircular canals work as complimentary pairs during head/body rotation. What are the pairs?
Left anterior SCC & Right Posterior SCC
Left Horizontal SCC & Right Horizontal SCC
Left Posterior SCC & Right Anterior SCC
96
For the horizontal SCCs, endolymph movement toward the ampulla (i.e., ampullopetal) results in an __________ response, whereas endolymph movement away from the ampulla (i.e., ampullofugal) results in an __________ response.
excitatory, inhibitory
97
For the anterior and posterior SCCs, endolymph movement toward the ampulla (i.e., ampullopetal) results in an __________ response, whereas endolymph movement away from the ampulla (i.e., ampullofugal) results in an __________ response.
inhibitory, excitatory
98
What are the 3 vestibular reflexes?
Vestibuloocular Reflex (VOR) - produced equal and oppsite reactions to the direction of the head movement. The purpose it to stabalize gaze during head and body movement.
Vestibulocollic Reflex (VCR) - works with the muscles in the neck to stabalize the head
Vestibulospinal Reflex (VSR) - maintains posture
99
If an individual was reporting oscillopsia, which vestibular reflex would you expect to be impaired?
VOR
100
What are the 3 cranial nerves involved in eye movement?
Oculomotor (III), Trochlear (IV) and Abducens (VI)
101
Describe this nystagmus type.
Jerk Nystagmus
102
Describe this nystagmus type.
Pendular Nystagmus
103
Describe this nystagmus type. Which eye is being displayed?
Left-Beating & Left eye
104
Is this nystagmus occurring in a vision allowed (goggles open) or vision denied (goggles closed) condition?
Vision Denied
105
What is the phenomena denoted by the red arrows in the recording?
Eye blink artifact
106
How fast do you need to move the head during headshake or head impluse testing to ensure that you are testing only the peripheral system (VOR) and not the central system?
2Hz (120 bpm) or faster
107
What is the difference between a active and passive head rotation test?
For active head rotation the pateitn is directed to move their oown head and for passsive the examiner or moter driven chair moves the head
108
Tell me about the video head impulse test (vHIT)
- it can be performed in all planes to evaluate all SSC's
- the test is based upon the Halmagyi head thrust screening
- Head acceleration must be rapid (>200 deg/sec)
109
What are the two parameters we evaluate when interpreting vHIT results and give a brief description of each? Be sure to include both types of saccade abnormalities also in your description (that is, which can we see with the naked eye and which required high speed video)?
gain: eye movement (VOR) relative to head movement
re-fixation saccades: saccades which occur in response to those with abnormal VOR. Types are covert and overt.covert = saccades that occur during the head movement, difficult to impossible to see with the naked eye. overt = saccades that occur after the head movement, can be seen with the naked eye.
110
The image shows vHIT data from a patient who had a severe onset of vertigo several momths prior with symptoms now mostly resolved. what is your interpretation of the data?
normal gain without re-fixation saccades for rightward impulses, reduced gain with both covert and overt re-fixation saccades for leftward impulses
111
What are the advantages and disadvantages to performing vHIT versus traditional caloric testing?
Advantages: faster, more tolerable to patient, provides high frequency information (more natural), can be used on kids, can be used on people with ear pathology, can test all canals and bbith vestibular nerves, & gives us information about central compensation phase
Disadvantages: can miss milder hearing loss, may not be sensitive to certain pathologies such as meniere's disease, most systems are monocular (single eye), technique can be challenging, & currently no CPT code for 3rd party reimbursement
112
what does H.I.N.T.S. stand for and briefly what is it being reported to be useful for?
Head Impulse
Nystagmus
Test of Skew
Used to diagnose stroke from vestibulopathy in acute settings such as the ER, is more sensitive to and less costly than MRI for ear (<24 hours) stroke
113
True or False: Currently there is no CPT code approved for use with vHIT testing?
true
114
What are the 3 rotational chair tests that we discussed?
1. Sinusoidal Harmonic Accelerations (SHA)
2. Impulse Accelerations (Step Velocities)
3. Visual Fixation (VFx) / Visual Enhancement (VVOR)
115
why would you perform rotational chair testing on a patient?
- to confirm of rule out bilateral vestibular hypofunction/loss
- to evaluate central compensation
- to evaluate rehab potential
- serial monitoring for vestibulotoxicity
- to gain more information regarding central vestibulopathy
- to be used when calorics can not be performed such as in young children, handicapped, and atresia
116
True or false: a rightward (clockwise) rotation will generate a left-beating nystagmus and a leftward (counterclockwise) rotation will generate a right-beating nystagmus
false
117
what are the limitations of rotational chair testing?
- only tests VOR at low to mid frequencies with standard paradigms
- only tells us about function of HSCC and SVN branch
- cant be performed on some patients (clausetrophobic or greater than 300 lbs)
- can miss mild to moderate unilateral HL
- takes up a lot of space
- costly and not readily available
118
Vestibular abnormalities can occur following head injury/mTBI often mimicking post-concussive symptoms and confounding diagnosis and treatment. What condition is most likely to occur following a head injury?
Post-traumatic BPPV
119
true or false: when analyzing nystagmis, we "describe" nystagmis based upon the direction of the slow phase (peripheral componenet) but "measure" nystagmus based upon the direction of the fast-phase (central component)
false
120
true or false: for paretic lesions nystagmus typically beats away from the affected ear and for irritative lesions (like meniere's) nystagmus often beats toward the affected ear
true
121
what is BPPV? describe the 2 variants?
Benign Paroxysmal Positional Vertigo
Otoconia become dislodged from the utricle and end up in the SCC's. Movement of the head causes otoconia to shift and stimulates the vestibular system causing false sense of vertigo.
Canalithiasis = otoconia freely moving in the endolymph
Cupulothiasis = otoconia in contact with the cupula
122
in order for static positional nystagmus to be considered "abnormal" it has to meet specific criteria, what are the criteria?
- nystagmus is present in ALL positions
- nystagmus changes direction in any single head position
- nystagmus is equal or greater than 6 deg/sec in any head position
- nystagmus is persistant in atleast 3 head positions
123
What is the proper way to bill a VNG exam using correct CPT codes? Assume you completed a full VNG exam with 4 caloric irrigations.
CPT 92540 (basic vestibular evaluation) & CPT 92537 (caloric irrigation bilateral bi-thermal)
124
What is denoted by the red arrows (blue lines) in the caloric pod images? What do they tell us?
The red arrows (blue lines) represent where the caloric values were measured (the maximum SPV of the response). It is significant because you want to be certain that you measure at the peak of the response which they did properly in these examples
125
true or false: water caloric irrigations have greater variability and are more prone to operator error than air caloric irrigations?
false
126
list 2 reasons why you might perform ice water caloric irrigations
- may be used when traditional bi-thermal irrigations are very low or to help confirm diagnosis of bilateral loss
- may be useful for confirmation of successful abalative procedures such as gentamycin injections or vestibular nerve section
- may be useful when there is a strong pre-existing spontaneous nystagmus (reversing the bias in the system)
- may be useful to determine if there is any residual vestibular function in the system (even minimal) which may help determine further course of treatment either surgically or rehab
127
The image below shows nystagmus recorded during caloric stimulation. What is your interpretation of this image.
Left beating nystagmus that is suppressed with visual fixation (normal)
128
true or false: hyperactive caloric responses are uncommon and when they do occur are more likely to be attributable to technical error (such as incorrect temperature irrigation) or due to abnormal middle ear space. CNS pathology is rare
true
129
true or false: caloric reversal is the phenomena where oblique or vertical nystagmus is recorded with caloric irrigation
false - caloric perversion
130
true or false: a unilateral caloric weakness (UW) helps to pinpoint the EXACT site of lesion within the system?
false
131
true or false: the CNS exerts control over the vestibular end organ/nuclei and should therefore be able to attenuate any caloric induced nystagmus when the eyes are open and gaze is fixed on a target. We call this metric fixation suppression or fixation index
true
132
what is the caloric position?
supine head elevated 30 deg
133
why do we place patients in the "caloric position?"
the caloric position (supine head elevated 30 degrees) brings the horizontal SCC into an orthogonal relationship with the gravity vector thereby ensuring maximum amount of stimulation during irrigation. perpendicular to the floor for max stimulation.
134
what are the BSA recommended temperatues and irrigation time for AIR caloric irrigations. Warm air _____ degrees. Cold air ______ degrees. Irrigate for _____ seconds.
warm air = 50 degrees
cold air = 24 degrees
irrigate for = 60 sec.
135
what are the BSA recommended temperatues and irrigation time for WATER caloric irrigations. Warm water _____ degrees. Cold water ______ degrees. Irrigate for _____ seconds.
warm air = 44 degrees
cold air = 30 degrees
irrigate for = 30 sec.
136
what does COWS stand for? what does it mean?
COWS = Cold Opposite Warm Same
a cold irrigation will produce a nystagmus that beats in the opposite direction of the ear being stimulated and warm irrigation will produce a nystagmus that beats in the same direction of the ear being stimulated. this has to do with the direction of endolymph flow (ampullopetal=less density = excitatory flow) (ampullofugal = more dense = inhibitory flow). the stimulus doesnt transfer to the other side of the head. it only tells you direction of the nystagmus based upon endolymph movement toward or away from ampullla (occurs on same side as irrigation).
137
Below are results of caloric testing on a patient. Use Jongkee's formula to calculate unuilateral weakness. Is there a unilateral weakness and if so, what percentage and what side is affected?
RW= 30 deg/sec
LW= 15 deg/sec
RC= 20 deg/sec
LC= 10 deg/sec
(RW+RC) - (LW+LC) divded by (RW+RC+LW+LC) times 100
yes there is a left unilateral weakness of 33% which is abnormal
138
Below are results of caloric testing on a patient. Calculate the total eye speed for this individual. Is this normal or abnormal?
RW= 5 deg/sec
LW= 4 deg/sec
RC= 2 deg/sec
LC= 2 deg/sec
Total eye speed = RW+RC+LW+LC = 13 deg/sec
this is low overall caloric repsonse (total SPV <26 deg/sec) concerning for bilateral vestibular hypofunciton or loss. I would recommend rotary chair or vHIT to conform results.
139
true or false: caloric inversion is defined as having an entire caloric response that beats in the opposite direction of what is expected (for example, a right warm irrigation yielding a left-beating nystagmus and a right cool irrigation yielding a right-beating nystagmus).
true
140
what are some limitations of caloric testing?
- only tests VOR at very low frequency and non-natural head movement (0.002-0.004 Hz)
- only tells us about function of HSCC function and superior vestibular nerve function with no information from other canals or otolithic organs
- variable and slightly uncomfortable for patients
- cant be performed / evaluated on some patients such as young kids, those with microtia/anotia, surgical ears (perforation, PE tube, otorhhea)
- can infer but not definite for bilateral vestibular loss (BVL) diagnosis
141
a patient has a VNG exam performed at your office which was normal. the following week he has an MRI study that shows a small vestibular schwannoma arising from his left inferior vestibular nerve. how is this possible?
VNG testing only addresses horizontal SCC function and superior vestibular nerve branch function it is therefore possible to have lesions in other parts of the labyrinth that will not show up on VNG (otolithic or IVN branch dysfunction).
142
for the horizontal SCC's, endolymph movement toward the ampulla (ampullopetal) results in an ________ response, wheras endolymph movement away from the ampulla (ampullofugal) results in an ________ response. for the anterior and posterior SCC's, endolymph movement toward the ampulla (ampullopetal) results in an ________ response, endolymph movement away from the ampulla (ampullofugal) results in an ________ response.
excitation
inhibition
inhibition
excitation
143
what syndrome is this? give me the transmission and facts about this syndrome
treacher-collins syndrome or mandibulofacial dystosis
- 40% of cases are autosomal dominant
- 100% pentrances
- 60% of cases are new mutations (majority are deletions or nonsense mutations)
- abnormal facial structures from first pharyngeal arch syndrome
- hypoplasia of zygomatic bones and mandible
- coloboma of iris
- larger fish like mouth
- intelligence is typically normal
- atresia
- complete absence of ME implant
- mild to moderate conductive HL
144
what syndrome is this? give me the transmission and facts about this syndrome
branchio-oto-renal (BOR)
- autosomal dominant
- affects structures developing from branchial arches
- renal abnormalities including polycystic kidneys
- oligohydraminos (too little amniotic fluid during pregnancy)
- HL can be conductive, SNHL, or mixed
- brachial fistulas on the lower 1/3 of the neck
- stenosis
- can be delayed onset, rarely progressive
- unilateral or bilateral pre-auricular pits
145
what syndrome is this? give me the transmission and facts about this syndrome
oculo-auricular-vertebral (OAV)
- multifactoral inheritance
- may not be inherited but cases appear in clusters within a family
- facial asymetry
- cardiac and vertebral anomalies
- deafness/blindess can be unilateral/bilateral
- internal organs can be unilateral absent or underdeveloped
- conductive HL is common, SNHL is rare
- craniofacial structures developing from 1st and 2nd branch arches
146
what syndrome is this? give me the transmission and facts about this syndrome
CHARGE
- Coloboma of the eye
- Heart defects
- Atresia of nasal choanae
- Retarded growth and/or development
- Ear anomalies and/or deafness (SNHL & progressive)
also infertile, intellectual disabiltiy, and renal issues
147
what syndrome is this? give me the transmission and facts about this syndrome
ushers syndrome
- autosomal recessive
- mild to severe SNHL
- progressive blindness (retinitis pigmentosa which typically develops in the 2nd decade)
- difficulty seeing at night, tunnel vision, then blindness
- Type 1: severe to profound SNHL, traditional amplification is ineffective, abnormal vestibular function, delayed motor milestones, gait ataxia
- Type 2: mild to severe SNHL, hearing aids are effective, normal vestibular function
- Type 3: (rare) progressive HL and vestibular function, possible founders effect in Ashkenazi jews and finnish
148
what is charot-marie-tooth syndrome?
- autosomal dominant, autosomal recessive, and X-linked
- neurological disorder (affects motor & sensory)
- absent limb reflexes
- muscle wasting below the elbows and thighs
- 100% penetrance
- age of onset 12-20 (not life-threatening)
- slow SNHL progression from childhood (looks like ANSD)
149
what is ANSD?
- autosomal recessive
- etiology is genetic or environmental (meaning infectious disorder due to viral involvement like mumps & measles)
- present OAE's
- present cochlear microphinic
- abnormal/absent reflexes
- severe impairment of speech perception especially in noise due to disruption of synchonrous CN8 firing
150
what syndrome is this? give me the transmission and facts about this syndrome
jervell & lange-neilsen syndrome (JLNS)
- autosomal recessive
- long QT syndrome
- potassium channel causes congenital deafness and long QT
- can have syncope, seizures, and sudden death, require a cardiologist to monitor them
- genetic counseling is super important
- avoid elevated heart rate
151
what syndrome is this? give me the transmission and facts about this syndrome
friedrich's ataxia
- autosomal recessive
- neurodegenerative
- manifests before adolescence
- hypoactive knee reflex, incoordination, nystagmus, dysarthria, absent babinski reflex, scoliosis, and large heart
152
what syndrome is this? give me the transmission and facts about this syndrome
waardenburg's
- autosomal dominant
- deficit of neural crest cells
- 4 types , type 4 is very rare
- different colored eyes
- white strip of hair
153
what is otosclerosis?
- autosomal dominant
- incomplete pentrance
- more commonly a complex genetic disorder (many genes, hormones, the environment)
- more common in white females
- worse after pregnancy
154
how is nystagmus described?
described by the fast phase and meausred by the magnitude of the slow phase
155
what is the equation for unilateral weakness?
(RW+RC) - (LW+LC) ÷ (RW+RC+LW+LC)
156
what is the equation for directional preponderance?
(RW+LC) - (LW+RC) ÷ (RW+RC+LW+LC)
157
what do these head impulse results tell us?
normal
- everything is in the white which is normal
- no refixation saccades
158
what do these head impulse results tell us?
left unilateral vestibular loss
- the left side has low gain, putting it in the gray area which indicates abnormal
- the left also has covert (during head movement) and overt (after head movement) refixation saccades
159
what do these head impulse results tell us?
The left side superior vestibular nerve is affected
- the left is low so are the left anterior canal (LA) in the second row, telling us the superior vestibular nerve is affected because that nerve is connected to the anterior canals
- the left also has covert (during head movement) and overt (after head movement) refixation saccades
160
what are the vestibular nerve and canal connections?
SVN: lateral and anterior canals
IVN: posterior canals
161
what do these head impulse results tell us?
bilateral loss vestibular loss
- left and right are in the gray
- covert and overt saccades in both ears
162
what do these head impulse results tell us?
the right inferior vestibular nerve is affected
- Right posterior canal (RP) is affected which is linked to the inferior vestibular nerve
- covert and overt saccades in the right ear
163
what is sound localization? how does it affect academics?
ADD
- difficulty in spatial awareness, following multi-speaker conversations and maintaining attention in a classroom
164
what is temporal processing? how does it affect academics?
ADD
- deficits can lead to problems with auditory discrimination or resolution, difficulty with reading, spelling, and writing
165
what is auditory figure ground? how does it affect academics?
ADD
- deficits lead to difficulty understanding speech in noisy environments leading to challenges in classroom discussions or group learning
166
what is auditory closure? how does it affect academics?
ADD
- deficits may affect understanding in noise affecting language learning, and academic success
167
what is auditory analysis? how does it affect academics?
ADD
- challenges with decoding, crucial for reading and spelling, reading difficulties
168
what is frequency resolution? how does it affect academics?
ADD
- deficits may affect phonemic processing, suprasegmental cuesand therefore language learning
169
who is eligible for a diagnostic CAPD evaluation?
- age (how young can we test and why)
- hearing loss
- cognitive issues
- ADHD
- speech and language issues
- autism
- other confounding factors such as executive function, developmental delays, behavioral problems, etc
- age: 7, because this is where our norms are
- can not test with a hearing loss
-
ADD**
170
which diagnostic criteria for CAPD do we use? MUST KNOW
intermediate criteria
171
what is lax criteria? MUST KNOW
172
what is intermediate criteria? MUST KNOW
173
what is strict criteria? MUST KNOW
174
what are the causes and outcomes of concussions? how do concussions effect the auditory system?
175
what is chronic traumatic encephalopahty (CTE)? what causes it? what is the clinical presentation?
176
what is central deafness? causes? site of lesion? signs and symptoms?
177
what is the age for the SCAN-3C?
5-13 except for gap detection thats 8-13
178
what are the differential diagnoses for central deafness with justifications?
179
what is the age for ACPT?
6-12
180
what is the age for PSI?
3-6
format 1 = 3-4
format 2 = 5-6
181
what is the age for PPST?
7+
182
what is the age for GIN?
7+
183
what is the age for DPT?
9+
184
what is the age for SSI?
8+
185
what is the age for dichotic digits?
5+
186
what is the age for LiSN-S?
6-30
187
what is the age for MLD?
5+
188
what is the age for RGDT?
5-12
189
what is the age for SSW?
5-70
190
what are the CAPD differential diagnoses
central deafness, ANSD, ADHD, DLD, dyslexia
191
what is the ease of language understanding model?
192
what is bottom up processing?
193
what is top down processing?
194
what is the active model of speech perception?
195
what is the passive model of speech perception?
196
what is implicit processing?
197
what is explicit processing?
198
what is the predictive vs. postdictive role of working memory?
199
how does hearing loss affect speech perception?
200
why do we assess speech in noise?
- most common complaint and probably the reason they are in your office
- gives us a more accurate understanding of how they do in real life
- makes them feel like you care about their problem and are taking the time to test it
201
what information does speechreading give us? how does it contribute to the bimodal perception of speech?
202
how is working memory involved in processing speech in simple vs. complex environments?
203
what is the difference between listening effort and listening fatigue?
204
what is our role as a professional vs. when we would refer out to a counselor?
if they are having problems not related to their hearing loss/balance problems then refer out. ex: a divorce
205
what is psychosocial adaptation? what are some of the stages?
denial, anger, bargaining, acceptance, guilt, etc.
not linear you can bounce back and forth on how you feel
206
what multicultural considerations should be used when counseling?
207
what is motivational interviewing?
208
when would we use scale questions with patients?
209
what does resisting the writing reflex mean?
210
Carbon mic function: describe the process of converting an acoustic signal to an analog electric signal.
211
What was the name of the first hearing aid that contained an amplifier to increase the amplitude of the
analog electric signal?
212
Differentiate high vs. low viscosity impression material and describe clinical applications for each.
213
Explain why it is important to stretch the aperture.
214
List case history questions to ask prior to every EMI and explain the clinical relevance of each question.
215
Describe impression precautions to consider based on case history, anatomy and otoscopic findings.
216
List the benefits associated with earmold canal that extends 2 mm beyond 2 nd bend.
217
What is the clinical purpose of using an open-jaw impression technique.
218
How does hearing loss impact audibilty?
219
How does hearing loss impact dynamic range?
220
How does hearing loss impact frequency resolution? Explain why changes to frequency resolution impact speech intelligibilty in noise.
221
How does hearing loss impact temporal resolution? Explain why changes to temporal resolution impact speech intelligibilty in general.
222
How does hearing loss impact spatial awareness?
223
What is ILD reliance of high frequency signals vs. low frequency signals?
224
What is the impact of the head shadow affect on HF signals?
225
How does lack of HF audibilty impact binaural loudness summartion and binaural squelch/suppresion?
226
What is ITD relaiance on low frequency signals vs high frequency singals?
227
What is the impact of monaural spatial cues (HRTF) has on spatial awareness?
228
Explain the six benefits associated with the use of bilateral amplification. Recognize how each benefit
supports improved speech intelligibility in quiet or in noise.
229
Explain the term binaural interference, its cause, its prevalence and the population it impacts
230
*******
At this point you should have a basic understanding of the fitting ranges associated with each
style including a style’s ability to release low frequency energy, or supply needed high frequency
gain.
o Associated pros/cons of each style
231
Acoustic benefits associated with CIC and IIC microphones and receiver depth
232
Clinical use of CROS vs. BiCROS vs. AmpCROS and how each style impacts localization ability
233
Acoustic benefits associated when sound bores and receivers are placed close to the TM
234
Meaning and clinical usefulness of ingress rating
235
Clinical use/limitations of each earmold material
236
Retention benefit associated with each custom mold style.
237
LF and HF output limitations of open, closed and power domes.
238
What is the purpose of venting?
239
What is the primary frequency range effected by vent effect?
240
Clinical selection of vent size based on 500 Hz threshold
241
How standing waves within a vent impact the output signal
242
Impact of vent size on high frequency output
243
Describe solutions for occlusion effect complaints.
244
What is a sound bore?
245
Impact of standing wave resonances in earhooks, and sound bores on the output signal
246
Understand how a tube's internal diameter alters the frequency response curve. Specifically, the difference b/w standard tubes and thin tubes
247
Describe the benefits associated with thick-walled tubing.
248
Names and describe uses of each specialty tube.
249
Describe the impact of hardening tubes on frequency response output signal.
250
Name of bonding agent appropriate for each earmold material
251
What is the purpose of damping?
252
Be prepared to explain the function of a Microphone
o How does it collect compression (+) and rarefaction (-) soundwaves and then convert them to an analog electrical wave.
253
What is the piezoelectric effect and what were the limitations of microphones that used this principle.
254
Describe the differences between an electret microphone and a MEMS Microphone. What are the benefits and limitations?
255
What input frequency range can a microphone collect?
256
Define internal microphone noise How much internal noise is acceptable?
257
Define front end-distortion in a digital device. What causes it? Can it be managed in modern hearing aids?
258
What are directional microphones?
259
How do directional mics function to create a polar plot null?
260
Be prepared to calculate and understand the meaning of signal to noise ratio (SNR).
261
What SNR-50 is associated with normal hearing sensitivity
262
Directivity index measures directional mic SNR improvements of up to +6 dB in acoustic
chambers. How much SNR improvement can be expected in the real world?
263
What are the limitations of directional microphones?
264
Directional roll off- cause and clinical solutions
265
Importance of parallel mic port placement
266
What is microphone drift?
267
How does a telecoil use the induction principle to collect a signal and convert it to an analog electrical
signal?
268
Define amplifier
269
Define compressor
270
What is AGC-o- output limiting compression (OLC)? What is the purpose? What are the compression rations and TK?
271
What are the limitations associated with peak clipping; how does OLC improve these limitations?
272
What is AGC-i- WDRC? What is the purpose? What is the associated compression ratio and TK?
273
Explain how WDRC helps to restore loudness growth function of the hearing-impaired
patient
274
What is Expansion? What is the purpose? What are the associated compression ratios?
275
Impact adjustments to TK have on output signal and its practical applications
276
How output signal is impacted by fast/slow attack and release time
277
Explain the difference b/w frequency shaping bands vs. compression shaping channels
277
Define curvilinear compression
278
What is the purpose of ADC?
279
Define sampling and Nyquist frequency
280
Limitations of 16-bit processing, added distortion during conversion
280
Define quantization relationship to bit size and what happens when there is quantization error
281
What is DAC? What is the primary function? What does it do?
281
What is DSP?
282
What are the methods of sound cleaning technology used in the spatial domain?
282
Function/clinical purpose of adaptive directional mics (Broadband and multiband)
283
Function/clinical purpose of automatic switching mics
283
Function/clinical purpose of beamforming mics. Differentiate its function from a standard directional mic.
284
Practical programming decisions related to adaptive vs. fixed directional microphones.
285
Methods of sound cleaning technology used in the temporal domain
285
Differentiate modulation rate and depth for speech and noise.
286
How is poor SNR determined in a hearing aid?
287
Digital noise reduction: describe the attenuated signal
288
Describe the benefits and limitations of digital noise reduction
289
Methods of sound cleaning technology used in the spectral domain
- The theory and limitations associated with low frequency output reduction
290
Digital feedback suppression
- Understand both non-digital and digital methods for reducing feedback
290
Digital wind noise reduction function
291
Frequency lowering: types, uses, limitations
292
Uses and benefits associated with wireless binaural processing technology
- Explain how wireless binaural processing restores ILDs when WDRC is in use?
293
Receiver and soundbore impact on final output frequency response
294
Describe how a receiver works
295
How receiver size impacts HF output. Why does this impact occur?
296
Receiver limitations: saturation and shock damage, moisture, and debris
297
Define and explain the practical use of OSPL90/MPO
298
Define and explain the practical use of HF-Average SSPL 90
299
Define and explain the practical use of Total harmonic distortion
299
What is TMFS and what is the purpose in telecoil measurements?
Be prepared to interpret test findings
299
What is SLIV and what is the purpose in telecoil measurements?
Be prepared to interpret test findings
299
What is SPLITS and what is the purpose in telecoil measurements?
Be prepared to interpret test findings
300
What is RSET and what is the purpose in telecoil measurements?
Be prepared to interpret test findings
300
Recall the meaning of the WHO descriptors: functional limitations, activity limitation, participation
limitations
301
Are audiometric thresholds a good predictor of activity limitations and participation restrictions?
Why not?
302
SII- explain measure and its clinical uses
302
The rationale for identifying systemic health conditions linked to progressive loss
303
Rationale, test protocol, scoring and clinical use of LDL
303
Rationale, test protocol, scoring and clinical use of QuickSIn
304
Rationale, test protocol, scoring and clinical use of ANL
304
Rationale, test protocol, scoring and clinical use of Binaural Interference
305
List the multidimensional factors audiologists should assess in a functional and communication needs
protocols which support patient specific decision making.
306
Clinical use of HHIE, APHAB, Social Network Index, ECHO, HASP, COSI
307
Differentiate cognitive vs. affective goals. What is the benefit of including both types of goals in your plan of care?
308
What is the rationale for screening dexterity, vision, motivation, general health, depression, anxiety
309
Rationale for investigating occupation, lifestyle, support systems
309
Describe the Federal Drug Administration (FDA) Packaging warnings of 8 red flags of ear disease.
310
Differentiate and describe the use/limitations of Type 1 and Type 2 test signals
310
REM Acronyms: Understand the meaning and use of each
310
Describe how the substitution method of calibration is performed
311
Describe how each modified methods of calibration are performed (Concurrent equalization and
substitution method) and differentiate their uses
311
What does the phrase “reference microphone contamination” indicate. What is the impact of this
concern and how is it resolved?
312
What is the impact will standing waves have on the measured output? How is this resolved?
312
Describe each probe tube insertion technique: Acoustic method
312
Describe each probe tube insertion technique: Constant depth method
313
Describe each probe tube insertion technique: Geometric positioning method
313
Describe each probe tube insertion technique: Proximity to tympanic membrane
314
Describe each probe tube insertion technique: Consequences assosiated with standing waves
314
Name all the tests that would allow you to use the CPT-4 code named “conformity evaluation”
315
What is RECD? How is it performed What is its practical purpose?
316
What is the protocol for verification with probe microphone measures?
317
What is the protocol for verification using aided functional gain measures? What are the limitations associated with this verification protocol?
318
Recognize what kind of information can be visualized in the Speech spectrum envelope
318
Rationale for use of various prescriptvie meausres:
- Loudness equalization/ NAL NL 2
- NAL-RP
- Loudness normalization / DSL
- Audibility
319
What speech envelope crest factors and acoustic valleys are associated with average speech?
319
Define LTASS
320
How do crest factors and acoustic valleys differ in music?
321
What special fitting considerations should you make for these circumstances?
- Asymmetric hearing loss
- Reverse slope loss
- NIHL loss
- Severe to Profound loss
- Conductive loss
- Chronic perforation
322
Describe the difference between occlusion and ampclusion and the different strategies used to
determine which is causing your patients complaints
323
Describe programming changes to gain you might make to alleviate common user complaints
324
Recall the physiological changes that occur in aging auditory processing systems
324
Differentiate functional, activity, and participation limitations based on real-world examples
324
Differentiate fluid vs. crystallized intelligence, understanding how they change with age
325
Validation/Outcome measures: provide examples of objective and subjective assessments and explain
the purpose of each
325
What role do standardized questionnaires play when you're completing a communication needs
assessment (HAE)
326
Describe the core principles of patient-centered care
326
Describe the evidence-based benefits of group Aural Rehabilitation
326
Review each type of facilitative strategy. Whats involved and how does each benefit communication
327
Understand the concepts supporting the Lexical Neighborhood Activation Model
327
Describe when an audiologist may use the CPT-4 code 92626, Evaluation of Auditory Function (specific
services)
327
Differentiate the meaning of the terms Viseme and Homophene stating their relevance to Audiologic
Rehabilitation
328
What is the candidacy criteria for a middle ear implant?
329
When do you recommend a middle ear implantable device to a patient?
329
What are the differeent types of middle ear transducers and how do they differ?
330
What are the differences between partitally and totally implantable middle ear hearing devices?
331
Put in pics of different ME devices and what they are used for
332
What are the contraindications for a middle ear implant?
-conductive HL
-retrocochlear or central auditory disorders
-active or history of recurrent ME infections
-TM perforations
-disabling tinnitus
-any skin or scalp conditions/sensitivities
333
What are the advantages and limitations of middle ear implants?
advantages: greater gain, improved comfort, higher fidelity sound, not needing as much gain due to the nature of the implants, aesthetic appeal, and good for patients who want continuous wear
disadvantages: surgical procedure, cost is high as insurance does not often cover the devices, hearing implications as a result of disarticulation potentially needing to occur, not MRI compatible beyond 1.5 T and there are troubles with verification as there is no acoustical output to measure within the canal
334
What is the bone conduction device candidacy criteria for patients with a CHL/MHL?
-average BC of less than or equal to 65 dB HL
-average ABG of greater than 30 dB HL (additional consideration and not necessary)
335
What is the bone conduction device candidacy criteria for patients with SSD?
-poor ear has profound SNHL of greater than or equal to 80 dB HL
-good ear has a PTA of less than 20 dB
336
What are the componenets of a bone conduction device and their functions?
337
Bone conduction: what is skin drive vs. direct drive?
skin drive: vibrations are transmitted to the bone through the skin using an external device that is placed on the skin surface
direct drive: vibrations are directly transmitted to the bone through an implanted transducer, without the need for skin transmission
338
Bone conduction: what is active vs. passive?
active: transducer is implanted and the generated vibration is directly applied to the bone. gives optimum BC sound transmission as it is not attenuated. transducer is within the implant
passive: transducer is within the speech processor and the stimulation is applied from the outside onto the skin.less optimal as the skin attenuates the signal before it reaches the bone. transducer is within the speech processor on top of the skin
338
Bone conduction: what is percutaneous vs transcutaneous?
percutaneous: the skin is not intact as the implant is penetrating the skin. titanium fixture is implanted into the skull and protrudes outward
transcutaneous: the skin is intact and the vibrations from the sound processor are transmitted across the skull. titanium component is coupled to a magnetic plate that rests on top of the skull
339
Bone conduction: What is osseointegration? What is the process? What are the surgical approaches?
the process in which bone cells attach/adhere to the surface of a metal titanium surface
-the bone cells adhere to the surface of the fixture
implant screw is surgically placed and eventually will become osseointegrated to the temporal bone
-one stage process occurs when implant and abutment is placed as a single piece
-two stage process occurs when the implant is implanted first then at another date the abutment is placed after osseointegration has taken placed
340
Bone conduction: Differentiate between percutaneous and transcutaneous implants in terms of design, sound transmission, and indications for use?
341
Bone conduction: Differentiate between the percutaneous and transcutaneous advantages and disadvantages
342
Bone conduction devices: current devices and their classifications (I think she means percutaneous vs trans)
343
Bone conduction devices: what are the listening test protocols for patients with CHL, MHL, & SSD?
344
What are the external components of a cochlear implant and their functions?
345
What are the internal components of a cochlear implant and their functions?
346
What is the basic operation of cochlear implant devices?
347
What are the types of stimulation modes for cochlear implants?
348
CI: what are speech coding strategies? what is their purpose?
349
What are the FDA-approved indications for traditional CI candidates in adults and children?
350
What are the FDA-approved indications for SSD CI candidates in adults and children?
351
What are the FDA-approved indications for EAS CI candidates in adults and children?
352
What are the contraindications for a cochlear implant?
353
CI: what is the difference between FDA labeled and off-label use?
354
When to refer patients based on the 60/60 guideline?
355
What procedures are required prior to conducting a CI candidacy assessment?
356
What are the procedures and protocols for determining candidacy in traditional CI candidates and those with good low-frequency hearing (EAS), SSD, & AHL?
357
Tell me about pre and post CI implantation counseling, goals, and elements?
358
CI: What are lower stimulation levels?
359
CI: What are upper stimulation levels?
360
CI: What is pulse width?
361
CI: What is current amplitude?
362
CI: What is pulse rate?
363
CI: What is channel gain?
364
CI: What is DR?
365
CI: What is frequency allocation?
366
CI: What are the consequences of improperly setting lower and upper stimulation levels?
367
CI: What are signs of overstimulation in children?
368
CI: Tell me about the use of ESRT and ECAP in CI fitting including their utility in determining over or under stimulation
369
CI: What are strategies for managing facial nerve stimulation?
370
CI: What is a soft surgery?
refers to the techniques designed to minimize intracochlear trauma, preserve residual hearing and to optimize electrode placement within the scala tympani
370
CI: What are the indicators that the map is optimized and the patient is ready to transition to the maintenance phase?
371
CI: What is the ratioanle for electrode placement in the scala tympani?
-larger diameter which avoids damage to the nerve fibers
-allows for insertion below the cochlear duct
-closer proximity to the round window
-less intracochlear trauma
-better preservation of residual hearing
-better implantation outcomes and reduced postoperative vertigo
372
CI: What are the definitions and signs of soft and hard device failure?
373
CI: What is impedance?
374
CI: What causes impedance and how do we identify it?
375
What is an open circuit?
incomplete path for current to flow, a discontinuous circuit
-infinite resistance, prohibiting the flow of current
-anything greater than 30
376
What is a short circuit?
low resistance between two points in a circuit that differ in potential which are separated by higher resistance resulting in an increase in current flow
-anything less than 1
377
What is a partial short circuit?
characterized by relatively low resistance resulting in increased current flow, but less so than for a true short circuit
-impedances decreasing over time and those impedances changes relative to the other electrodes
378
What is voltage complianace?
there is a fixed amount of current that is specified within the software, and if those impedances are using an amount of fixed voltage that agrees with the battery, then it is in compliance
-this level cannot be exceeded, and if it is, then the device is out of compliance
378
What are the complications and management of voltage compliance?
379
What are the factors that influence impedance?
380
What is an ABI?
380
What are the FDA-approved indications for an ABI?
381
What is the site of electrode placement for an ABI?
382
What are non-auditory sensations associated with ABI programming?
383
What are the factors contributing to the complexity of programming ABIs compared to CI devices?
384
What re the overall outcomes of ABIs versus CIs and reasons for differences?
385
Define "oxidation" & "reduction" as they relate to oxidative stress
386
What is oxidative stress?
387
What is the enzyme-substrate complex?
388
Identify important neurotransmitters and their roles in the body
389
Tell me about the process of inflammation
390
What is the role of the FDA in regulating drug safety and efficacy?
391
What are the major factors that influence the development of new drugs?
392
What is pharmacokinetics?
393
Describe the routes by which drugs are administered in the body and their pros and cons
394
Discuss the different memebrane barriers that can affect drug absorption
395
Discuss the differences in drug absoprtion between oral and different forms of parental administration
396
Discuss phase 1 & 2 of drug metabolism and the role of the CYP enzyme
397
What is "first pass effect" ?
398
What are potential barries to drug distribution in the body
399
Describe the mechanism of drug transport from the plasma to tissue sites
399
What is bioavailabilty?
400
What is drug biotransformation?
400
Describe the concept of drug redistribution for termination of drug activity
400
How are drugs eliminated from the body?
401
Differentiate first order and zero order drug elimination kinetics
401
What is the "half-life" of a drug?
402
What is a loading dose?
402
How do drugs interact with receptors?
402
Differentiate between agonist and atagonist receptors
402
What is a maintenance dose?
403
What is drug efficacy?
403
What is a ligand?
404
What is drug potency?
404
Differentiate between drug potency and drug efficacy with regard to the relationship between drug dose and effect
405
Differentiate between a therapeutic and advverse drug reaction?
405
What is the difference between graded and quantal dose-repsonses?
406
List adverse drug reactions by eyetem with examples of common causes/risk factors
407
What is the difference between a toxicity reaction and a drug side effect?
407
Tell me about the immune system and the major immunoglobulins
407
What is the difference between a drug allergy and anaphylaxis shock?
407
What are drug hypersensitivty reactions?
408
What is drug teratogenicity?
409
What is the role of the FDA in regulating teratogens?
409
Describe the field of pharmacogenetics
409
Provide examples of how gene mutations affect drug actions including SNP mutations
410
What are the potential benefits/limitations affecting the field of pharmacogenetics?
410
Discuss how to conduct a good medical history review to facilitate audiologic testing
411
What are the signs and symptoms of drug ototoxicity and vestibulotoxicity?
412
What are patient, disease, and metabolic factors that can affect adverse drug reactions including ototoxcity?
413
What is compliance? What factors affect patient compliance with drugs?
414
What polarity should you not use when diagnosing ANSD?
Alternating because it will cancel out the cochlear microphonic
415
How does having multiple care providers/prescribers affect compliance?
416
How does medicaiton management affect compliance?
416
How does cognitive status affect compliance?
416
How does physical status affect compliance?
417
How does disease status affect compliance?
417
How does drug administation mode affect compliance?
417
What are important physiologic differences in pharmokinetics in children and elderly patients? How do they afect drug dosing and drug effects?
418
Discuess the use of medicaitons in pregnant and lactating women
419
What is the difference between ED50 & LD50?
419
Descibe the issue of polypharmacy and ints impact on quality of life in medicatied patients
419
What is ototoxicity?
420
What is the thearapeutic index?
421
What is vestibulotoxicity?
421
What is hepatoxicity?
421
What is nephrotoxicity?
422
What is neurotoxicity?
423
What is the rationale for HF SNHL related to ototoxicity?
423
What are antibiotic anergism and synergism?
423
What are the risk factors for ototoxicity?
423
What are the signs/symptoms of ototoxicity?
423
What is the difference between gram-positive and gram-negative bacteria?
424
What are the risks and benefits of antimicrobial combination therapy?
424
What are the sites of lesions and cells affected (pathophysiology) in ototoxicity/vestibulotoxicity?
424
Which antibiotics are most often associated with ototoxicity?
aminoglycosides
macrolides (generally reversible)
Loop diuretics (generally reversible, irreversible when given with IV aminoglycosides)
424
Which antibiotics are commonly used to treat otitis media?
penicillin
cephalosporin
macrolides
425
Describe the challenges associated with antineoplastic combination chemotherapy
425
Identify the most ototoxic antineoplastic drugs and why
425
What are the clinical indications for the use of platinum-derived compounds, folate analog inhibitors, and vinca alkaloids?
426
What are the common clinical systemic and ototoxic manifestations associated with salicylates (tinnitus)?
426
What are the common clinical systemic and ototoxic manifestations associated with non-steroidal anti-inflammatory analgesics (NSAIDS) (tinnitus and renal damage)?
426
What are the common clinical systemic and ototoxic manifestations associated with quinine (cinchonism)?
427
What are the common clinical systemic and ototoxic manifestations associated with acetaminophen (rare and not significant ototoxic effects, hepatotoxic)?
428
What are the common clinical systemic and ototoxic manifestations associated with diuretics (worse in combo with aminoglycosides)?
429
What are the common clinical systemic and ototoxic manifestations associated with heavy metals (mercury and lead) (affects the CANs more)?
430
What are the ototoxic effects of systemic exposure to industrial solvents/chemicals (more vestibulotoxic than ototoxic)?
431
Tell me about pediatric ototoxic monitoring
431
What is the need for ototoxic monitoring?
431
How can blood thinners, bleeding disorders, and diabetes impact the management of an audiologic patient?
432
What is the role of different audiologic tests in detecting/monitoring ototoxicity?
432
What is the timeline for ototoxic and radiation monitoring as recommended by ASHA (1994)?
433
What is the typical type of hearing loss and audiometric configuration reported with ototoxicity?
434
List the criteria used to detect significant change in hearing sensitivity based on ototoxicity.
435
What potential damage is caused to the audiotry system with radiation therapy?
