Audiology: Exam 2 Flashcards

1
Q

What is a pure tone threshold?

A

The lowest level at which a person responds to a tone

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2
Q

At how many frequencies is a pure tone threshold taken?

A

It is obtained at different frequencies to determine whether hearing loss is present

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3
Q

How can pure tones be obtained?

A

1 - air conduction

2 - bone conduction

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4
Q

What is used during air conduction?

A

headphones, insert phones, or speakers

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5
Q

What is used during bone conduction?

A

A bone conduction oscillator that is placed on either mastoid or head

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6
Q

What is the method used during pure tone testing?

A

You can either have the patient do a hand raise, press the button, or says “yes”

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7
Q

What is a true response?

A

The client accurately responds - they hear it, raider their hand or they don’t hear it and don’t raise their hand

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8
Q

What is a false response?

A

They inaccurately respond - they hear it and don’t raise hand or they don’t hear ir and raise hand

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9
Q

What is a positive response?

A

A response that you heard it (hear it and raise hand; tinnitus - hear own and raise hand; vibrating and raise hand but don’t really hear it; IA - raise hand because the good ear heard it)

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10
Q

What is a negative response?

A

When you don’t respond (faking it, misunderstood, asleep, too young, hearing tinnitus)

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11
Q

What is a true positive response?

A

when they accurately say they heard it

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12
Q

What is a true negative response?

A

when they accurately don’t respond

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13
Q

What is a false positive response?

A

inaccurately responded - said they heard it when they didn’t

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14
Q

What is a false negative response?

A

inaccurately say they didn’t hear sound (faking it, did not understand directions, sleeping)

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15
Q

Where do you start for the beginning of an evaluation?

A

ASHA says to begin at 30dBHL at 1000Hz or a level a person can hear

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16
Q

How long should you present the tone during an evaluations?

A

One to two seconds in duration

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17
Q

For the start of an evaluation, if the patient does not respond at 30dBHL, what should you do?

A

Increase to 50dBHL and increments of 20dBHL until you receive a response.

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18
Q

When do you begin a threshold search?

A

When the patient responds to the first tone

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19
Q

What is the ascending-descending approach?

A

When you are searching for threshold, we use the down 10dBHL, up 5dBHL method.

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20
Q

When a patient responds to the initial tone, what do you do?

A

You drop 10dBHL until you get no response

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21
Q

What do you do after you drop 10dBHL and get no response?

A

You ascend 5dBHL until you get a response

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22
Q

What is the lowest level at which a patient responses?

A

You must repeat the down 10, up 5 until the patient responses 2 or 3 times, giving you the lowest level

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23
Q

What frequencies are tested for air conduction?

A

1000, 2000, 4000, 8000, 1000, 500, 250

Also inter-octaves: 750, 1500, 3000, 6000

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24
Q

What frequencies are tested for bone conduction?

A

1000, 2000, 4000, 500, 250
Sometimes 6000
Also inter-octaves: 750, 1500, 3000

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25
Q

What is the symbol on the audiogram for the left ear, air conduction?

A

X

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26
Q

What is the symbol on the audiogram for the right ear, air conduction?

A

O

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27
Q

What is the symbol on the audiogram for the left ear, air conduction?

A

>

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28
Q

What is the symbol on the audiogram for the left ear, bone conduction?

A

<

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29
Q

What is the three frequency pure tone average?

A

the average of the thresholds at 500, 1000, and 2000Hz

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30
Q

What is the two frequency pure tone average?

A

the average of the two best threshold of 500, 1000, and 2000Hz

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31
Q

How do you interpret an audiogram?

A

You look at each ear separately and you describe: degree of hearing loss, nature of hearing loss, and audiometric configuration

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32
Q

What are the degrees of hearing loss?

A

normal, slight (children only), mild, moderate, moderately-severe, severe, and profound

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33
Q

What is a normal degree of “hearing loss?”

A

0-15dBHL

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34
Q

What is a mild degree of hearing loss?

A

26-40dBHL

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35
Q

What is a moderate degree of hearing loss?

A

41-55dBHL

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36
Q

What is a moderately-severe degree of hearing loss?

A

56-70dBHL

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37
Q

What is a severe degree of hearing loss?

A

71-90dBHL

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38
Q

What is a profound degree of hearing loss?

A

91dBHL+

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39
Q

What is the nature of hearing loss based on?

A

presence or absence of air-bone gap

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40
Q

What is a normal hearing loss?

A

When the BC agrees with AC and both are within normal limits

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41
Q

What is a conductive hearing loss?

A

When the BC is within normal limits and AC shows a loss

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42
Q

What is sensorineural hearing loss?

A

When the BC agrees with the AC and both show a hearing loss

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43
Q

What is a mixed hearing loss?

A

When the BC shows a loss but AC also shows loss even greater than BC

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44
Q

What are the audiogram configurations?

A

Flat (each threshold is within 10dB), gradually sloping, steeply sloping or markedly sloping, rising, and ski-slope or precipitously sloping

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45
Q

What are the ASHA guidelines for a pure tone screening?

A

Test frequencies 1000, 2000, and 4000Hz at 25dBHL (adults)

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46
Q

What does a failure of a pure tone screening consist of?

A

A lack of response to any one frequency in either ear

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47
Q

What is speech detection threshold (STD)?

A

the lowest level speech can be barely detected; also called speech awareness threshold (SAT)

48
Q

COME BACK TO SLIDE 25

A

.

49
Q

What is the speech recognition threshold?

A

lowest hearing level speech is understood

50
Q

How much louder is the SRT then the STD usually?

A

10dB and should agree with the PTA by 10dB

51
Q

How do you classify the degree of hearing with SRT?

A

the same as pure tones

52
Q

How is the SRT obtained?

A

by using spondaic words or “spondees;” two-syllable, compound words (doormat, cupcake, mousetrap, football) with equal stress

53
Q

What should you remember when using SRT words?

A

make sure the client is familiarized with all the words before the threshold search, make sure you are using age-appropriate words, and discard unfamiliar spondees

54
Q

What is a speech recognition score?

A

Phonetically based (PB) list of monosyllabic words presented at comfortable level for the patient (30-40dBSL) such as you, could, what, bathe, ace

55
Q

What must you use when giving the PB list of words?

A

a carrier phrase

56
Q

What categories do the SRS% scores have?

A

excellent, good, fair, poor, and very poor; usually 25 or 50 words - score is percent correct

57
Q

Excellent SRS% score

A

90-100%

58
Q

Good SRS% score

A

80-89%

59
Q

Fair SRS% score

A

70-79%

60
Q

Poor SRS% score

A

50-69%

61
Q

Very Poor SRS% score

A

Less than 50%

62
Q

What is the most comfortable loudness (MCL)?

A

continuous discourse is ideal to obtain MCL - ask patient to rate level of speech in terms of comfort

63
Q

What is the normal listeners range of MCL?

A

40-55dBHL

64
Q

What is the range for hearing loss given MCL?

A

it depends on the degree of hearing loss

65
Q

What is uncomfortable loudness (UCL)?

A

continuous discourse is ideal to obtain UCL - can also use tones; ask the patient to rate the level of speech in terms of comfort

66
Q

What is a normal listeners range of UCL?

A

100-110dBHL

67
Q

What is a hearing impaired range of UCL?

A

it varies based on degree of loss but often lower levels than normal hearing listeners (those with senorineural loss)

68
Q

What is dynamic range (DR)?

A

difference between SRT and UCL; it is also known as range of comfortable loudness (RCL)

69
Q

What is the DR for normal listeners?

A

100dB

70
Q

What is the DR for hearing impaired-sensorineural loss?

A

usually much less than normal hearing listeners

71
Q

What is masking?

A

presenting a signal to one ear to mask its ability to respond when a signal is presented to the other ear

72
Q

Why do we mask?

A

we want to make sure the ear we are testing is actually responding

73
Q

When do we mask?

A

whenever a response is potentially attributable to the non-test ear; must first obtain threshold and consider inter aural attenuation

74
Q

What is Interaural Attenuation (IA)?

A

When the loss of intensity of sound introduced to one ear and heard by the other ear

75
Q

What is the IA of circumaural headphones?

A

40dBHL

76
Q

What is the IA of insert headphones?

A

55dBHL

77
Q

What is the IA of bone conduction?

A

0dBHL

78
Q

When should you mask with air conduction?

A

When the AC threshold is greater than or equal to the AC or VC of the non test ear

79
Q

When should you mask with bone conduction?

A

When the air bone gap of the test ear is greater or equal to 15dB

80
Q

When to mask for SRT testing

A

SRT of test ear is greater than or equal to SRT or best BC of non test ear

81
Q

When to mask for suprathreshold of speech testing?

A

if you had to mask for SRT you will have to mask for suprathreshold (slide 39)

82
Q

How does it work?

A

only when we occupy the non-test ear, can we assume we are truly measuring the test ear

83
Q

Stenger Effect

A

.

84
Q

Narrowband noise

A

.

85
Q

Masking for speech

A

.

86
Q

What is effective masking?

A

sufficiently masking the non-test ear and allowing the test ear to be measured accurately without the risk of under or over masking

87
Q

What is minimum masking?

A

minimum intensity of noise required to effectively mask

88
Q

What is maximum masking?

A

The maximum intensity allowed before risking overmasking

89
Q

What is undermasking?

A

not enough noise is presented to the non-test ear and they still are responding to the tone in the non-test ear

90
Q

What is overmasking?

A

The masking noise level is too intense in the non-test ear and is crossing back to the test ear and interfering with threshold measurement

91
Q

What is central masking?

A

Threshold becomes 5dB poorer; increase of threshold by 5dB due to inhibition central auditory system; any time you mask, you may see a 5dB change just because you masked even if masking was not necessary

92
Q

What is the symbol for left ear masked air conduction?

A

.

93
Q

What is the symbol for right ear masked air conduction?

A

.

94
Q

What is the symbol for left ear masked bone conduction?

A

}

95
Q

What is the symbol of the right ear masked bone conduction

A

{

96
Q

What is the objective tests of the auditory system?

A

Immittance testing (tympanometry, acoustic reflex threshold, acoustic reflex decay), otoacoustic emissions (OAEs), and auditory brainstem response (ABR)

97
Q

What is tympanometry?

A

a measure of the pressure of the air contained in the middle ear space; 226 Hz probe tone presented while the pressure in the ear canal is changed from positive to negative; the probe tone is used to measure ear canal volume (ECV) and static compliance

98
Q

What is static acoustic compliance?

A

a measure of how the tympanic membrane in response to pressure changes

99
Q

What are the normal peak static acoustic compliances?

A

Infant: 0.25-0.92mmho
Child: 0.25-1.5mmho
Adult:0.3 - 1.7mmho

100
Q

What is pressure?

A

the pressure at which the tympanic membrane is at maximum static compliance

101
Q

What are normal pressures?

A

+50 to -100daPa

102
Q

What is ear canal volume (ECV)?

A

a measure of the volume of the ear canal

103
Q

What are the normal levels of ECV?

A

Young children: 0.3 to 0.9 cc
Older children: 0.6 to 1.5 cc
Adult: 0.6 to 2.0cc

104
Q

What is a type A tympanogram?

A

Normal

105
Q

What is a type As tympanogram?

A

s - stiff or shallow; stiff middle ear system (peak is less than normal) but normal pressure

106
Q

What is type Ad tympanogram?

A

d = disarticulated or deep; flaccid or hypermobile ear system (peak is greater than normal) and normal pressure

107
Q

What is a type B tympanogram?

A

flat; extreme stiffness or immobility of the middle ear (no peak or pressure)

108
Q

What is a type C tympanogram?

A

negative pressure but normal compliance

109
Q

How is acoustic reflex (AR) measured?

A

uses the same equipment as tympanomertry

110
Q

How is acoustic reflex threshold (ART) found?

A

tone presented to elicit stapedius muscle; ipsilateral and contralateral stimulation

111
Q

How is acoustic reflex decay (ARD) found?

A

tone presented to elicit the stapedius muscle at 10dB above ART

112
Q

What levels is ARTs obtained?

A

500, 1000, 2000, and 4000Hz; measured at peak compliance

113
Q

Do many normal hearing have ART at 4Hz?

A

no

114
Q

How is contralateral stimulation possible?

A

because at the superior olivary complex it crosses over to other side causing AR via the facial nerve

115
Q

What is normal hearing given the ART score?

A

85dBSL

116
Q

What is a mild to moderate SNHL?

A

ART at Low ST

117
Q

What is a severe SNHL or 7th nerve problem?

A

absent ART