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Audiology and Speech Perception > Audiology - Middle Ear > Flashcards

Audiology - Middle Ear Flashcards

1
Q

What do Tympanograms measure?

A

Performance of the ear drum (Tympanic Membrane) and middle ear (Ossicles)

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2
Q

What is the stapedius reflex?

A

The acoustic reflex which protects the cochlea from intense sounds

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3
Q

What type of energy is transferred in the middle ear?

A

Mechanical energy

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4
Q

What type of energy is transferred in the inner ear?

A

Hydraulic energy

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5
Q

What type of energy is transferred in the central pathway and temporal lobe?

A

Bio-electrical energy

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6
Q

When does the tympanic membrane vibrate most efficiently?

A

When the pressure in the ear canal equals that in the middle ear

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7
Q

If the middle ear wasn’t functioning, what would happen to the acoustic energy?

A

It would be reflected off the oval window (not transferred to the cochlea)

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8
Q

What are the acoustic repercussions of a non-functioning middle ear?

A

The loudness of sounds will be attenuated

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9
Q

What are some of the middle ear disorders which result in conductive hearing loss?

A

OME,

Down Syndrome,

Otosclerosis

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10
Q

Can deaf adults/children also suffer from conductive hearing loss?

A

Yes (usually temporary)

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11
Q

What type of testing are Tympanometry and Acoustic Reflex Threshold?

A

Objective

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12
Q

What is meant by impedance of the middle ear system?

A

Stiffness of the system which stops the system from working efficiently

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13
Q

Does the system become more / less compliant as impedance increases?

A

Less compliant

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14
Q

What is meant by compliance of the middle ear system?

A

Flexibility of the system, allowing it to work efficiently

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15
Q

What are the acoustic consequences of impedance of the middle ear?

A

Sound waves will not be conducted efficiently and loudness will be attenuated

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16
Q

What does the Acoustic Reflex Threshold test measure?

A

The functionality of the middle ear, inner ear, auditory nerve and lower brain stem

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17
Q

Who is Tympanometry usually used with?

A

Children

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18
Q

How do Tympanograms measure the function of the middle ear?

A

By providing graphical illustrations of the change in movement of the ear drum as a result of variations in pressure

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19
Q

Which is a quicker and more reliable test - bone conduction or Tympanometry?

A

Tympanometry

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20
Q

What steps are involved in a Tympanogram test?

A
  1. Pressure in the outer canal is changed relative to the pressure in the middle ear
  2. Changes in compliance / impedance are measured using a probe tone
  3. Reduce pressure in ear canal in successive steps
  4. Measurements taken at each step
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21
Q

What pressure do Tympanograms usually start at?

A

200 daPa

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22
Q

What frequency is the starting probe tone usually?

A

220 or 226 Hz

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23
Q

What is known by maximum compliance in a Tympanogram?

A

The level at which the ear drum is operating at maximal capacity

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24
Q

What are the axis labels on a Tympanogram?

A

X is pressure (decaPascals - daPa)

Y is compliance / impedance (ml of water)

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25
Q

What is it important to note regarding magnitude of greatest compliance on a Tympanogram?

A

The pressure at which this is achieved

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26
Q

What does a Jerger Type A Tympanogram represent?

A

Normal hearing

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27
Q

What is range of greatest compliance in normal hearing?

A

Minus 100 to Plus 50 daPa

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28
Q

What is the normal range of compliance?

A

0.3 to 1.5 ml of water

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29
Q

What does a Jerger Type As represent?

A

A stiffened middle ear system

30
Q

What are the characteristics of a stiffened middle ear system (Jerger Type As)?

A

Normal middle ear pressure (middle ear pressure equal to ear canal) BUT low compliance

31
Q

What are some of the causes of a stiffened middle ear system (Jerger Type As)?

A

Otosclerosis

Transitional OME

32
Q

What does a Jerger Type As Tympanogram look like?

A

A flatter line - within normal range for pressure (daPa) but a lower level of compliance (ml)

33
Q

What does a Jerger Type Ad represent?

A

A hypermobile Tympanic Membrane

34
Q

What are the characteristics of a hypermobile Tympanic Membrane (Jerger Type Ad)?

A

Normal middle ear pressure (middle ear pressure equal to ear canal) BUT high compliance

35
Q

What are some of the causes of a stiffened middle ear system (Jerger Type Ad)?

A
  • Ossicular separation
  • Scarred or thinned Tympanic Membrane (from several burst ear drums / recurring infections)
36
Q

What does a Jerger Type Ad Tympanogram look like?

A

A pointier line - within normal range for pressure (daPa) but a high peak for level of compliance (ml)

37
Q

What does a Jerger Type B represent?

A

Middle ear effusion

38
Q

What are the characteristics of middle ear effusion (Jerger Type B)?

A

No point of greatest compliance!

39
Q

What are some of the causes of middle ear effusion (Jerger Type B)?

A

Wax / liquid in middle ear

40
Q

What does a Jerger Type B Tympanogram look like?

A

Low flat line - outside of normal pressure limits (daPa) and no point of greatest compliance (ml)

41
Q

What type of Tympanogram is common in the elderly?

A

Tympanogram Type B

42
Q

Why is the line relatively flat for middle ear effusion (Tympanogram Type B)?

A

Wax / liquid is stopping equalisation

43
Q

What does a Jerger Type C Tympanogram represent?

A

Negative pressure in the middle ear / Eustachian Tube dysfunction

44
Q

What are some of the causes of Eustachian Tube Dysfunction (Jerger Type C)?

A

Disease of the middle ear

45
Q

What does a Jerger Type C Tympanogram look like?

A

Compliance (ml) peak within normal limits, but peak towards start of the X axis as pressure (daPa) is low

46
Q

What is the most common middle ear pathology?

A

OME - Otitis Media with Effusion

47
Q

What is meant by normal Eustachian Tube function?

A

The Eustachian Tube is closed 95% of the time

  • Equalises pressure between the middle and outer ear
48
Q

Why is pressure equalisation between the middle and outer ear important?

A

For the efficient transfer of sound vibrations

49
Q

When does the Eustachian Tube open when functioning normally?

A

Yawning or swallowing

50
Q

What are the stages of OME?

A
  1. Negative middle ear pressure
  2. Ear drum retraction
  3. Effusion of sterile fluid (as no refreshing of the middle ear)
  4. Fluid is watery at first, then becomes thickened
51
Q

What is serous OME?

A

When the fluid in the middle ear is watery

52
Q

What is secretary OME?

A

When the fluid in the middle ear is thickened

53
Q

What is the Acoustic Reflex?

A

Reflex contraction of the stapedial muscle in response to loud sounds

54
Q

What happens to the Acoustic Reflex over time if exposed to loud sounds?

A

It weakens and decays quickly

55
Q

Where is the neural network for the reflex arc located?

A

The lower brainstem

56
Q

What is meant by an ipsilateral pathway?

A

When a sound is made in one ear and measured in the same ear (no cross over)

57
Q

Why can the Acoustic Reflex not protect the cochlea from loud impulse sounds?

A

It is too slow

58
Q

How is the Acoustic Reflex measured?

A

Indirectly - measuring slight changes in stiffness of the ear drum caused by the contraction of the middle ear muscles

59
Q

What is meant by Reflex Decay?

A

If the stapedius muscle does not maintain contraction during an above reflex threshold stimulus

60
Q

What can Reflex Decay be indicative of?

A

Retro-cochlear disorder

61
Q

What is meant by Reflex Latency?

A

The time difference between stimulus and response

62
Q

When does Reflex Latency decrease?

A

With increased intensity of stimulus

63
Q

What is the Acoustic Reflex Threshold?

A

The quietest sound level at which an acoustic reflex can be obtained (dBHL)

64
Q

What is the normal range for the Acoustic Reflex Threshold?

A

80 - 85 dBHL

65
Q

What is the procedure for measuring ART?

A
  1. Silence
  2. Use impedance measuring equipment
  3. Stimulus is a moderate to high intensity tone (must be audible to testee)
  4. Look for a decrease in Tympanic Membrane compliance in same/opposite ear
  5. Raise tone level until response seen
66
Q

What will happen to the ART if there is a pathology at any point on the reflex pathway?

A

It will be raised or absent

67
Q

What do ART results tell us?

A

The location of the pathology and an estimation of the patient’s dynamic range

68
Q

What will the ART results be for sensori-neural hearing loss that is greater than 80 dBHL?

A

The ART results will be absent

69
Q

What will the ART results be for sensori-neural hearing loss less than 50 dBHL?

A

Normal (80 -85 dBHL)

70
Q

When is loudness recruitment likely to be present?

A

When the threshold of hearing and the ART differ by less than 60dB

71
Q

What is a common feature of sensori-neural hearing loss?

A

A reduced dynamic range

72
Q

Why can ART often not be measured in conductive hearing loss?

A

Because of middle ear impedance (e.g. glue ear)

Audiology and Speech Perception (6 decks)

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