Audio Final Exam Flashcards
Les mesures électrophysiques permettent d’évaluer:
1) la qualité de ______
2) l’intégrité de ____
1) la qualité de la transmission entre le cerveau et les organes ciblés
2) l’intégrité de certains organes
Vrai ou Faux: la diagnostique fait partie du rôle de l’audiologiste pendant les mesures électrophysiologiques
Faux
Vrai ou Faux: Le système auditif central utilise une transmission électrique
FAUX - électro-chimique
The cochlear duct is also called the ____
Rampe médiane
What type of fluid is in the rampe médiane?
Endolymphe (rich in K+)
From the basilar membrane and moving upwards, you have the CCE, then _____ then _____
Cellules ciliées externes
Stéréocils
Kinocils
Vrai/Faux: La membrane tectoriale est rigide/ne bouge pas.
Vrai
Describe the sequence of events creating action potentials in the cochlea
- From the vibration of the oval window, waves propogate through the cochlea, causing the basilar membrane to move with them
- The movement of the cilia at the top of the hair cells against the rigid tectoral membrane opens K+ selective channels
- Since the surrounding fluid (endolymphe) is rich in K+, it enters the channels
- Depolarisation occurs, ++neurotransmitters, and the action potential leaves via the auditory sensory cells that travel via auditory nerve
- This “danse” of the cilia” occurs rythmically and at different frequencies
When was the first hypothesis about the presence of emissions in the cochlea?
1940
When was the technology for measuring cochlear emissions available in clinics?
1990s
Vrai/Faux: Les ÉOAs sont des sons peu intenses générés par le mvmt des CCEs
Vrai
What level of intensity are ÉOAs?
1-2dB
In general, ÉOAs are present if the person’s hearing threshold is better than __dB
40dB
ÉOAs can be affected by (4)
- State of the middle ear
- Background noise
- Noise from the person
- State of the CAE
The stimulus for ÉOAs is presented at about __dB SPL
80dB SPL
The difference in the level of the sound produced and the level of the stimulus should be _dB or higher (RSB)
6dB
Name 4 advantages of ÉOAs
- Fast to administer, non-invasive, objective
- Able to perform differential diagnosis (cochlear vs. retrocochlear problem)
- Able to detect hearing loss above moderate degree right from birth
- Able to test each ear separately
Vrai/Faux: Les ÉOAs peuvent détecter des dommages cochléaires avant qu’elles soient perceptibles sur l’audiogramme
Vrai
What populations are ÉOAs especially advantageous for?
- Malingering
- Children/adults on the spectrum
- Chemotherapy patients
- Those with cognitive issues/post-stroke/aphasia (who can’t respond verbally)
Les PÉATC should be completed within _ to _ ms
1.5 - 10ms
PÉALM should be completed in _ to _ ms
10 - 80 ms
PÉALL should be completed within _ ms
> 100+ms
Les PÉATC correspond to what part of the brain?
Hindbrain (bulbe rachidien)
- includes cochlea, auditory nerve, superior olives, cochlear nuclei
Les PÉALM correspond to what part of the brain?
Midbrain (mésencéphale)
- includes inferior colliculus
Les PÉALL correspond to what part of the brain?
Forebrain (cortex auditif)
- Medial Geniculate nucleus (thalamus)
- Primary Auditory Cortex
- Lateral Fissure
- Longitudinal fissure
Onde I - 1.5 - 2ms
II - 2.5 - 3ms
III - 3.5 - 4ms
IV - 4.5 - 5ms
V - 5.5 - 6 ms
In what population would you expect to see waves that appear late?
Premature infants
Name the generators of each wave in the PÉATC (5)
I - partie distale du nerf auditif
II - partie proximale du nerf auditif
III - noyau cochléaire + complexe olivaire supérieur
IV - lémnisque latéral
V - lémnisque latéral + colliculus inférieur
What is latence absolue?
Interval between the beginning of the presentation of the stimulus and the peak of any given wave
- this is the most reliable/robust
What is an interlatence?
Time between the peaks of two waves
Which wave do we use for the différence de latence interaurale?
Onde V (la plus solide)
What might PÉATCs help diagnose? (70-80dB click, supra-seuil)
Neurinome acoustique (8e nerve) or neuropathie auditive (problem with the synchronisation of nerve fibers - causes issues with understanding)
How can we use PÉATC for la recherche des seuils auditifs?
- 30 - 50dBHL click
- Looking for the lowest level that wave V will show up
Who might be a good candidate for recherche de seuil by PÉATC?
a child who failed their screening at birth;
someone in a coma; non-verbal patients;
some other medical state where they can’t participate in a normal audiogram
If PÉATC isn’t a test of hearing, what kind of test is it?
Test électrophysique
Name 5 clinical applications of PÉATC
- Prediction of auditory sensitivity
- Screening of newborns
- Evaluation of hearing with young children and babies
- Evaluation of central auditory pathway (e.g. screening for retrocochlear issues like a neurinome)
- Peri-opératoire assessment of the function of the auditory nervous system (e.g. during cochlear implant)
Describe where the electrodes go for PÉATC
- Active (+) on the forehead
- Reference (-) on the ear lobe or mastoid ipsilateral to the stimulated ear
- Ground electrode on the contro ear lobe
Vrai/Faux: Les PÉATC are looking at the function of the CCI
Faux - au delà du ganglion spiral; on cherche la réponse du nerf auditif
Vrai/Faux: Si possible, l’évaluation va utiliser la même batterie de tests qu’une évaluation typique (audiométrie tonale, vocale et mesures objectives)
Vrai
What tests are typically used for children ages 0-8 to 12 months?
PÉATC, ÉOA and immitance with some reservations (?)
What tests are used for children aged 6-8 months to 2.5 years?
- Behavioural Observation Audiometry
- Visual Reinforcement Audiometry
What tests are used for children aged 2 to 4.5 years?
Play Audiometry (the child participates)
What information can you gain from a test battery for children 0-8 to 12 months?
ÉOAs - loss or no
PÉATC - degree of loss (by searching for wave V), profile of the loss, hints as to the type of loss (NS or conductive)
Immitance - objective evaluation of the middle ear
Why would we move to BOA?
At a certain point, infants are no longer sleeping deep enough for us to perform electrophysical objective tests.
Vrai/Faux: BOA uses visual reinforcement.
Faux
What are the criteria for a response in BOA?
Usually it’s a motor behaviour (e.g. turning the head in response to a sound); parameters need to be established for each test
Vrai/Faux: BOA is not a recherche de seuil
Vrai
What is the main benefit of BOA?
We can identify children with a severe-profound hearing loss (although it’s difficult to identify the configuration of the loss)
Between 8 and 12 months, __% of infants can complete VRA in a reliable manner (Widen et al., 2000)
95%
What situations might VRA be used for a client?
- Anyone with the mental age of 6-8 months to 2-2.5 years (e.g. Down’s syndrome, ASD)
- Evaluating the benefit of hearing aids or CI
What are some possible problems with VRA? (5)
- Tester bias
- False positive/false negative
- Hints given by distractor or parent
- Inappropriate choice of toys
- Poor time management
Name 4 signs that a child does not have the maturity for play audiometry.
- Impatience
- Too many false positives/negatives
- Turns head to the speaker instead of playing the game
- Impossible to complete conditioning
At what age do we use SDP (children)?
6 months - 2 years
What age do we usually start using SRP with children?
2 years +
What is something to consider for niveau d’identification des mots with children?
May need to correct their chronological age (e.g. premature)
Define universal newborn screening and advantages.
The assessment of a large population to identify a proportion of affected newborns.
* Reliable, precise, fast, easy, cheap
* Able to reduce the amount of referrals
Name risk factors that would qualify a patient for screening approach 2
- Family history
- Family observations (e.g. never jumping at loud sounds; absence of language)
- 5+ days in intensive care (e.g. medication, jaundice)
- Congenital infections (e.g. herpes, rubella, toxoplasmose)
- Syndromes ass’d with hearing loss (Usher, Waardenburg)
- Sensory-motor neuropathies (e.g. ataxia)
- Post-natal infections ass’d with hearing loss (e.g. meningitis)
- Cranio-facial anomalies
- Head trauma
- Chemotherapy
En dépistant uniquement les bébés ayant un ou plusieurs
facteurs de risque, on peut identifier __% des pertes
auditives, mais __% des bébés ayant une perte ne seont pas identifiés à la naissance
50%
What is the prevalence of hearing loss?
1 - 3-4 in 1000
Following hearing screening, we can… (2) in relation to speech/language
- Prevent or reduce communication delays
- Improve the results of communication development
Ontario implemented universal hearing screenings in ____
2002
What are the requirements for a permanent loss according to the IHP?
- > 30 dB HL or more (500, 2000 and 4000 Hz) in one ear
- Presence of auditory neuropathy
- Presence of a brainstem hearing disorder
- Neuropathy and a disorder detected with PÉATC
What is the order of tests for a baby without risk factors? (4)
- ÉOAs
- ABR (PÉATC) same day
- ABR in a meeting
- Audiometry
Name the order of tests for a baby with risk factors (e.g. born premature)
- ABR
- Audiometry
The most significant reductions in the age of diagnosis due to universal screening are found in those with ___ hearing loss
Moderate hearing loss
Why was it problematic that we weren’t universally screening in terms of children’s language development?
- Parents not using the right strategies to encourage communication
- More than 2 years without appropriate sensory input
Perte de la sensibilité auditive peut engendrer plusieurs
problèmes (4)
- Difficulties with communication
- Problems with hearing
- Low self esteem
- Limitations on social activity
Quand est-ce que l’audiologiste va proposer les appareils, en général?
Quand le problème auditif est permanent et ne peut être traiter defaçon médicale ou chirurgicale
Déficience
Degré et configuration de la parte d’audition
Incapacités
Problèmes de l’écoute dans le bruit
Handicaps
Effet de la perte sur les aspects psychosociaux (e.g. travail, estime de soi)
But de l’amplification (AAA)
- Augmenter l’intensité pour les rendre perceptibles
- Amplifier les sons en leur appliquant un gain
- Améliorer la perception et l’identification de la parole dans différents enviros
Why is the process of appareillage with children more difficult than with adults? (6)
- Limited audiologic info
- Little semantic/phonemic experience
- Unable to give feedback
- Otites
- Other comorbidities that complicate
- Critical period for learning language
“No age is too young” for hearing aid candidacy - ideally, we want to give hearing aids by ___
6 months
Vrai/Faux: A child needs to have a hearing loss of > 30dB to qualify for hearing aids
Faux - > 25dB les pertes de tous les types et degrés pourront être appareillées
What two frequencies need to be acquired during eval for hearing aids?
500 and 2000Hz
What are important points to cover during education of parents vis-a-vis hearing aids?
- Explain the degree of hearing loss + pull out important info from audiogram
- Parts of the hearing aid, description of how it works and how to clean them
- Importance of daily hearing stimulation; what you can expect now and later
- Their role
Why are BTE hearing aids better for children?
- Won’t break as easily
- Harder to swallow
- Not going to cause as much damage if hit
- More power
- Gets new tips more frequently
- Less feedback than ITE
- Flexibility with FM system
- More convenient for parents
How often (at minimum) do the embouts need to be changed for children?
1x per year
What are the two kinds of tests we can use to verify optimal functioning of hearing aids?
- Verify if it’s meeting the targets from Real Ear
- Verify speech perception tests
Quels sont les défis avec les appareils auditifs chez les enfants? (Things to be aware of, things to tell the family)
- Les parents et les attentes réalistes
- L’attitude de l’enfant: différents stades au cours de l’enfance
- L’appareillage est un processus: les bénéfices de l’appareillage ne surviennent pas du jour au lendemain
- Les otites
- Les troubles concomitants
3 factors to consider for the frequency of audiology follow-ups with hearing aids for children
- L’âge de l’enfant
- Le degré de la perte
- Le remplacement de l’embout
What level of hearing loss is required for an implant?
Severe to profound bilaterally
What are the requirements for a TTA diagnosis chez une adulte?
2 écart-types sous la moyenne pour au moins deux évaluations
What are the diagnosis criteria for TTA chez un enfant?
plus de 3 écart-types sous la moyenne à un test, avec des difficultées fonctionnelles significatives
Nommez des causes de TTA
- Inconnues (majorité - aucun facteurs de risque/étiologie) “Idiopathique”
- Neurologiques
- Maturation (prefrontal cortex developping until 25)
- Anomalies dans le dev
- Acquise (AVC, TCC, toxicité)
- Secondaire (otite, presbyacousie)
Nommez des symptômes d’un TTA
- Fait souvent répéter
- Comprend mal ce qui est dit
- Réponses inappropriées
- Comprend difficilement dans enviro bruyant
- Délais de réponse aux questions
- Facilement distrait par stimuli sonores
Minimum age for a CI?
8-12 months
Les signaux codés sont transmis à l’antenne, puis à l’implant par ondes _________
Radioélectriques
What objective measures are used to predict the comfort thresholds in a CI?
- NRI / NRT (neural response imaging/telemetry)
- ESRT (electric stapedian reflex threshold - seuils réflexes contro)
Factors that affect the results from a CI
- Age of implantation
- Length of deafness pre-implant
- Etiology of the hearing loss
- Residual hearing before implant
- Family support
- Technology
- Amount of usage
- Comorbidities
- Programming and regular adjustments
- Communication btwn audio and SLP
Benefits of bimodal implants, according to research:
- Spatial localisation
- Improved frequency selectivity
- ## Speech-in-noise recognition
Quelles sont les critères d’admission pour un implant cochléaire? (6 +1)
- Age 8-12 mois+
- Perte binaurale (unless special circumstances)
- Perte sévère à profonde
- Peu de bénéfices avec les appareils
- Vouloir communiquer oralement avec le monde entendant
- Absence de contre-indications (médicaux, chirurgicales)
- Décision multidisciplinaire (audio, SLP, ORL, psycho-social)
How long after implantation does programming of electrode take place?
2-4 weeks
When do control evaluations take place after cochlear implantation?
- Contrôle à 1 semaine
- Contrôle à 1 mois
- Contrôle à 3 mois
- Contrôle à 6 mois
- Contrôle annuellement
Name 3 reasons why we wouldn’t continue with bilateral hearing aids? (Other than unilateral hearing loss)
- Parents report that child does better when wearing one hearing aid
- One ear clearly rejects hearing aid
- “Preuves” que le port binaural est pire que le port monaural
Name 3 reasons why hearing aid + implant on other side would be beneficial
- Better localisation
- Better speech in noise recognition
- Maintaining stimulation of that ear for subsequent implantation
Name the parts of the internal and external components of a CI
External: Microphone + Émetteur-antenne
Internal: Récepteur-stimulateur
