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Audiology > Balance and Pure Tone Testing > Flashcards

Balance and Pure Tone Testing Flashcards

1
Q

Vestibular portion of the inner ear:

A
  • Semicircular canals

- Utricle and saccule

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2
Q

Semicircular canals are needed for:

A

angular movement and body in space information

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3
Q

Utricle and Saccule needed for:

A

linear movement and speed/direction

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4
Q

Stereocilia Parts

A
  • Kincocilium
  • Sterocilia
  • Otolithic membrane
  • Cupula
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5
Q

Kinocilium

A
  • longest hair cell at the top of the cell

- tubular with decreasing stiffness form bottom to top

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6
Q

Sterocilia

A

-bundle of hair cells (similar to the hearing mechanism)

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7
Q

Otolithic Membrane

A
  • gelatinous membrane in saccule and utricle

- contains otoconia (calcium carbonate crystals)

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8
Q

Cupula

A

-Gelatinous membrane in semicircular canals

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9
Q

Stereocilia Functions/uses

A
  • resting potential (firing rate)

- movement of stereocilia causes change in potential

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10
Q

Stereocilia movement toward the kinocilium will:

A

Excite nerve

increase firing rate

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11
Q

Stereocilia movement away from the kinocilium will:

A

inhibit the nerve

decrease the firing rate

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12
Q

True or False

The vestibular system is tied to the visual system

A

True

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13
Q

Vestibulo-ocular reflex:

A

-eyes move opposite of head turn or stay steady

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14
Q

Saccade System

A

Quick return of the eyes to direction of head turn

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15
Q

Smooth Pursuit

A

“tracking” an image with smooth eye movements

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16
Q

Optokinetic system

A

combination of saccade and smooth pursuit

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17
Q

Nystagmus

A
  • results from an abnormal neural connection between the vestibular and visual systems
  • can be symptomatic or benign
  • constant shifting of eyes
  • slow movement in one direction, fast return in opposite direction
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18
Q

Electro-oculography

A

-electrodes placed around the eyes, measures eye movements while turning the head

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19
Q

Proprioceptive/Somatosensory Kinesthesia

A

-info about posture, movement and body in space
-Supports balance via pressure sensors,
tactile cues,
muscular input (length, pressure, tension and noxious stimuli),
joint pressure, position and movement

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20
Q

Balance Testing

A
  • symptoms can be acute or chronic (ENT visit first, mud history)
  • Rule out neurological or cardiac involvement (MRI or cranial nerve testing)
  • Determine peripheral vs central etiology (spontaneous or evoked nystagmus, Fernzel glasses prevent fixation)
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21
Q

ENG/VNG

A

-electronystagmography or videonystagmography
1. electro-oculography tests the semicircular canals
2. Oculo-motor evaluation. Saccade, smooth pursuit, optokinetic and gaze fixation.
3. Dix Hallpike Maneuver
BPPV: benign paroxysmal positional vertigo
4. positional testing (9 positions and recordings)
5. Calorics (Warm/cool air or water interacts with the endolymph)

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22
Q

What is the only balance test that evaluates the posterior canal?

A

Dix Hallpike Maneuver (BPPV)

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23
Q

What is the only balance test that shows ear specific data on the horizontal canal and/or vestibular nerve?

A

-Calorics

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24
Q

Explain Calorics

A
  • warm/cold air or water is introduced into the ear canal and reacts with the endolymph.
  • Heat makes the endolymph less dense and it moves cupula toward utricle
  • Cool makes the endolymph thick and dense which moves cupula away from the utricle
  • this creates a very dizzying effect
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25
Rotational Chair Testing
- dark room - head attached/secured to chair - Record eye movements as chair moves
26
Postural Control Testing
- Assesses vestibular, ocular and proprioceptive systems - Floor sways/moves - patient is harnessed for safety
27
Describe self rating scales and why they are useful
- pre and post testing - patient perceives impact on their lives (functional psychological and physical) - used to quantify improvement after rehab services
28
7 parts of Rehabilitation:
- Home exercises - low sodium diet - Medication - Desensitization/habituation of vestibular responses - physical therapy to increase proprio-receptive system - Surgery - Vestibular Rehabilitation (increase central compensation)
29
Pure Tone testing
- Quantify auditory access to each frequency needed for speech perception - ear specific info - Helps us predict communication struggles (speech banana/articulation index) - Used to prescribe hearing aids, CI, etc.
30
Audiometer
- screening or diagnostic - Two channel allows for testing and masking - stimulus=puretone, live voice, recorded speech, noise, etc - Transducer=supra-aural headsets, inserts, speaker, bone oscillator - Routing=right, left, both
31
Types of transducers:
- Earphones (supra-aural) - Earphones (Circum-aural) - Insert earphones - Bone oscillator/Conductor - Speaker
32
Earphones (Supra-aural)
Pros -very easy to clean, -patient familiarity Cons -collapsed canal -more crossover sound (distance from earphone to eardrum can cause sound wave to cancel out)
33
Earphones (Circum-aural)
``` Pros -less constricting -more comfortable Cons -sound leaks around the headset -less accurate results ```
34
Insert Earphones
``` Pros -reduces "turtle effect" in children -no standing wave -less masking needed -no collapsed canals Cons -disposable and more costly -can't use if there is a drainage ```
35
Bone Oscillator/Conductor
-Placement is important! on mastoid bone but not touching pinna -Pitfalls: may fall off easily
36
Speaker
Pros -can be used with difficult patients Cons -no ear specific info
37
Attenuators of an Audiometer:
-Decibels: (-10 dBHL to 120 dBHL) some only go to 110 dBHL -Frequency (125-8000Hz) some capable to go to 12,000
38
Calibration of an Audiometer:
- annual assessment | - computer based equipment is more stable than portable equipment
39
Correction Factors for an Audiometer:
- dBHL to add/subtract per frequency - sticker placed on audiometer - Can be different for each transducer
40
Testing Environment:
- quiet room for screening - diagnostic in sound treated room (NOT SOUND PROOF) - double walled booth with sound absorbing material with holes to expose this material - floor is carpeted with padding and raised above the ground to reduce vibrational noise - double doors with thick molding - windows are insulated - fire alarms only if sprinkler goes off it ruins material - special lights - quiet ventilation
41
Pre Evaluation
- File review - case history - self rating scales - conversation - Otoscopy
42
Testing...
- seating - clear, concise instructions - mode of response - transducer selection
43
Threshold Search
- tone presentation - Ascending technique - descending technique - combo approach - threshold criteria - frequency progression
44
Tone presentation of a threshold search
- give one presentation at dBSL to alert - 1-2 second duration - pure tone, warble or pulsed tones - vary the wait time
45
Ascending technique
-start at 0 dBHL and work up in 10 dB steps
46
Descending technique
-start at alerting tone and work down in 10 dB steps
47
Combination approach
- give alerting tone and work down in 10 dB steps - missed response, go up in 5 dB steps - very common now
48
Threshold criteria (ASHA 2005)
- respond 50% of the time | - 2/3 presentations elicit response
49
Frequency Progression
- start at 1k, then 2-8k - however 3 and 6 are rarely tested - return to 1k for a reliability check then 250 and 500 Hz - More than a 20 dB difference between frequencies, add interoctave testing (750, 1500Hz)
50
When there is no response to 1K Hz tone...
- increase by 20 dBHL and try again - switch to 500 Hz at same dBHL and try again - reinstruct
51
False positives
- eager to please, ringing, nervous, afraid to fail - reinstruct, change wait time, change Hz - use another signal (Pulse, NBN or warble)
52
False negatives
- need to be sure, afraid, confused, malingering, ADD/ADHD | - reinstruct, change signal , give reassurance of correct answers
53
Pediatric testing
- use second tester to assit - try to get low frequency and high frequency info for each ear (500Hz 4000Hz) - Need to move quickly - keep child's attention - Use reinforcers
54
PTA
- pure tone average - 500 Hz + 1k +2k / 3 =PTA - may not reflect loss - may underestimate impact of loss
55
Tactile Responses
- low frequencies are affected (felt) - Transducer contact - Profound hearing loss
56
Bone conduction testing threshold search
- combination technique - frequency progression - unmasked thresholds could be a "better ear" response
57
Bone conduction testing placement options
- mastoid | - forehead
58
Masking
- 2 channel audiometer required - used when there is an asymmetrical loss - stimulus: speech or noise
59
Speech Stimulus
- babble - nonsense - speech weighted noise
60
Noise Stimulus
- narrow band noise - white noise - pink noise - fresh noise
61
Effective Masking
- interaural difference of 40 dB (earphones) - interaural difference of 50 dB (inserts) - just enough to occupy better ear - threshold of better ear (non test ear) +10 dBHL
62
Under masking
-insufficient masking, the better ear is still contributing
63
Over masking
- excessive masking noise crosses over into test ear | - over estimates the hearing loss in the test ear
64
Plateau Method
- add masking, no shift in TE means threshold is accurate | - if threshold shift by 5 dB or more, increase masking by 10 dB and re establish, continue until stable
65
Occlusion effect in masking
- decrease (improvement) in BC thresholds at 1K or lower frequencies because of tightly fitting earphones - seen only in normal listeners and sensorineural losses
66
Masking dilemma
- bilateral conductive hearing loss | - any attempt to mask the non test ear, bleeds into the test ear BC thresholds
67
What are the three main tests of balance testing?
- ENG/VNG - Rotational chair testing - Postural control

Audiology (8 decks)

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