APD/Tinnitus & Hyperacusis/TBI Flashcards
Define a TBI
An insult to the brain caused by an external physical force
What are the 2 major types of TBI?
- ) Open (penetrating) TBI
2. ) Closed TBI
What is an open (penetrating) TBI?
A TBI caused by a skull fracture or an object entering the skull (such as a bullet).
What is a closed TBI?
A TBI caused by a force on the skull not resulting in a broken, fractured, or penetrated skull.
How can TBIs be classified? What is the distinction between these classes?
Mild, moderate, severe
Alteration of consciousness, Loss of consciousness, post traumatic amnesia
What are the symptoms associated with a mild TBI?
- Normal imaging
- Tinnitus
- Dizziness
- Sound sensitivity
- Hearing loss
For a patient with sound sensitivity, intrusive tinnitus, and a history of a mild TBI (concussion), what tests besides an audiogram should be conducted?
- Tinnitus and hyperacusis evaluation
- APD evaluation–> trauma from accident may have resulted in injury to patient’s auditory cortex not present on imaging
- Speech-in-noise test such as QuickSIN (Duncan & Aarts, 2006)
- Acoustic reflex thresholds–> important to evaluate lower brainstem function
- ABR–> sensitive to central auditory legions of the brainstem
- MLR
- P300
What does the tinnitus and hyperacusis evaluation consist of?
- Audiogram including ultra-high frequency testing
- DPOAEs
- Tinnitus pitch matching
- Tinnitus loudness matching
- Loudness discomfort levels
- Minimal masking level
- Questionnaire such as the Tinnitus and Hearing Survey (THS)
What is the purpose of OAEs in the tinnitus and hyperacusis evaluation?
- Assesses OHC function
- Cochlear dysfunction present on DPOAE testing may indicate why patient is experiencing tinnitus
What is the tinnitus and hearing survey (THS)?
Measures how much of a problem on scale of 0-5 tinnitus, hearing, and sound sensitivity have been in last week
True or False: The THS is a reliable questionnaire to use
True
Henry et al., 2015
What results would be expected on tinnitus and hyperacusis evaluation?
- Would expect reduced loudness discomfort levels if the patient has hyperacusis
- Reduced DPOAE amplitude
Why is the central auditory nervous system important?
- Pitch identification
- Sound processing in noise
- Binaural processing including localization and auditory scene analysis
What is APD?
ASHA, 1996
A complex disorder with difficulties in processing information by the central nervous system.
What difficulties does someone with APD have?
- Sound localization and lateralization
- Auditory discrimination
- Auditory pattern recognition
- Temporal aspects of audition such as gap detection
- Auditory performance in competing signals
- Auditory performance with degraded signals
What are some common symptoms of APD?
- Difficulty understanding speech in background noise or in reverberation
- Localization difficulties
- Difficulty following rapid speech
- Difficulty following directions
- Difficulty with music perception
- A tendency to be easily distracted
- Academic difficulties including reading, spelling and/or learning problems
When designing an APD test battery, what considerations should be made?
1) Age-appropriate tests
2) individualized
3) inclusion of tests with variety of stimuli and test procedures
4) Should provide the most info in the shortest amount of time
For this patient, what tests should be included in the APD battery?
1) Dichotic digits test
2) Random gap detection test
3) Duration pattern sequence test
4) Low redundancy speech test
5) Masking level difference test (MLD)
What does the dichotic listening test evaluate?
Binaural integration and separation
What is the dichotic listening test sensitive to?
Lesions of the brainstem, cortex, and corpus callosum
Describe the dichotic digits test?
Patient hears a number pair in each ear and is asked to repeat everything heard (binaural integration) or direct their attention to one ear and repeat what is heard only in that ear (binaural separation).
Can also be completed using sentences instead of numbers, increasing the difficulty
What does the random gap detection test assess?
Temporal resolution
Describe the random gap detection test
Clicks and brief tones of octave frequencies from 250-4000 Hz are presented in pairs and the silent interval between each pair randomly increases and decreases in duration from 0-40 ms.
The patient is required to indicate whether they hear one stimulus or two and the gap detection threshold is defined as the smallest interval at which they consistently identify two stimuli.
What does the duration pattern sequence test assess?
Temporal sequencing
