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Advance Audiology > BEHAVIORAL AUDIOMETRIC EVALUATION > Flashcards

BEHAVIORAL AUDIOMETRIC EVALUATION Flashcards

1
Q

Principles of Air and Bone Pure Tone Audiometry

A

Pathways of Sound
* Types of Hearing Loss
* Tuning Fork Tests

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2
Q

2 Pathways to Stimulate Hearing

A
  • __Air___ conduction pathway
  • Consists of __outer______, ____middle_______ (conductive mechanism) and
    ____inner______ ear. (sensorineural mechanism)
  • ___Bone___ conduction pathway
  • Consists of ____cochlea_______ and ___auditory nerve________. (sensorineural
    mechanism
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3
Q

Types of Hearing Loss

A
  • Sensorineural Hearing Loss
    Occurs along ____both_________pathway(s)
  • Conductive Hearing Loss
    Occurs along ___air_______pathway(s)
  • Mixed Hearing Loss
    Occurs along __both_______ pathway(s)
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4
Q

Tuning Fork Tests

A
  • Rinne
  • Weber
  • Bing
    Differentiates between CHL and SNHL
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5
Q

Rinne Tuning Fork Test

A

Compares hearing by BC to hearing by AC
* Physiologically air conduction is more efficient than Bone Conduction
* NH or SNHL
▫ AC is always more efficient than BC

  • CHL
    ▫ BC more efficient than AC
    (Conductive blockage prevents sound from
    being heard through AC.)
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6
Q

Weber Tuning Fork Test

A
  • Test of lateralization for unilateral hearing loss
  • TF is placed on midline (forehead or vertex) of head
  • Patient indicates ‘weber’ s/he hears the signal righ ear, left ear or
    midline.
    ▫ Unilateral SNHL – signal lateralizes to better ear
    ▫ Unilateral CHL – signal lateralizes to poorer ear
    ▫ Midline – signal heard in both ears.
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7
Q

Bing Tuning Fork Test

A
  • Measures the occlusion effect - Loudness of a low frequency bone conducted signal
    increases when the ear is occluded.
  • Vibrating TF is placed on mastoid while examiner alternatively closes and opens the ear canal
    by pressing the tragus inward and then releasing.
  • Normal Hearing or SNHL
    ▫ Positive Bing – pulsating sound
    ▫ Signal is louder when ear is occluded and softer when the canal is open
  • Conductive HL
    ▫ Negative Bing – no pulsating signal
    ▫ No change in loudness when opening and closing ear canal.
    .
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8
Q

Evaluation Process

A

▫ Case History – Process of Differential Diagnosis
▫ Otoscopic inspection
▫ Audiometric equipment
▫ Performing pure tone audiometry
 Air Conduction
 Bone Conducton

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9
Q

Referral Source

A

❖Self referral
❖Family Member
❖Professional referral
❖Physician
❖SLP
❖Educator
❖Insurance referral
❖Hearing Screening

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10
Q

Case History – Differential Dx

A
  • Autism Spectrum Disorder or severe
    – profound HL or both?
    ▫ Poor response when called
    ▫ Delays in language acquisition
  • ADHD/Hyperactivity or HL or both?
    ▫ Inability to listen or follow through with
    directions
    ▫ Difficulty with academic work
    ▫ Poor social skills

Depression or HL or both?
▫ Withdrawn and isolation
▫ Poor self esteem
▫ Trouble concentrating and paying
attention

  • Dementia or HL or both?
    ▫ Decline in memory, cognition,
    attention, languag
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11
Q

Case History

A
  • Patient interview, case hx form. Informal observation
  • Helps identify possible medical conditions that would require physician
    referral.
  • Influences which test procedures will be administered and how testing
    will be conducted
  • Provides the audiologist with the information necessary to diagnose the
    hearing los
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12
Q

Hearing Case History

A
  • Hearing/Communication
    History
  • Medical/Otological History
  • Noise History
  • Family History
  • Rehabilitation History
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13
Q

Pediatric Hearing Case History

A
  • Pregnancy/birth history
  • Speech and language development
  • Physical development
  • Psychosocial development
  • Academic Achievement
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14
Q

Interdisciplinary Collaboration

A

If significant medical history exists:
* Obtain signed release of records
* Contact primary care physician
* Contact any allied health professional

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15
Q

Otoscopy and Medical Referral Conditions

A
  • Inspection of EAM, TM and surrounding
    structures
  • Primary purpose is to ensure that the ear
    canal is clear and the tympanic membrane
    can be visualized in order to proceed with
    testing
  • Rule out ear canal collapse
  • Cerumen Impaction
  • Foreign Matter Blockage
  • Active Drainage
  • Blood in EC
  • Perforation
  • Growths
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16
Q

Pure Tone Audiometry

A
  • Measures degree and type of hearing loss
  • Air Conduction –Determines degree and
    configuration of HL
  • Bone Conduction – Determines type of HL
17
Q

Audiometer
Whats the range from frequencies that are tested ?

A
  • Electronic device that generates pure tone stimulus at varying
    frequencies and intensities
    ▫ Test Frequencies: 125 to 8000 Hz
    ▫ Test Intensities: -10 to 110/120 dB HL
  • Oscillator – Frequency Selector
  • Attenuator –dial to change intensity level
18
Q

Audiometer

A

Input
* Stimulus
▫ Pure Tones
▫ Narrowband Noise
▫ Speech

Output
* Transducer
▫ Earphones (R or L)
 Inserts
 Conventional earphones
▫ Bone
▫ Speaker (R or L)

19
Q

Patient Position

A
  • Avoid giving inadvertent visual cues to the
    participant.
  • Enable easy observation of participant
    responses to stimuli.
  • Allow for the monitoring and reinforcement
    of responses.
  • Permit observation of participant comfort,
    safety, and health.
20
Q

Instructions (ASHA 2005)

A
  • Indicate the purpose of the test, that is, to find the faintest tone that
    can be heard.
  • Emphasize that it is necessary to sit quietly, without talking, during the
    test.
  • Indicate that the participant is to respond whenever the tone is heard,
    no matter how faint it may be.
21
Q

My Instructions

A
  • You are going to hear some tones (or beeps).
  • Raise your hand as soon as you hear the tones and put your
    hand down when the tone goes away.
  • The tones will become very soft and sound far away.
  • No matter how faint or distant the tone is, if you think you
    hear it, raise your hand.
22
Q

Response Mode

A

Hand raising
 Index finger
 Signal button
 Verbal Response

23
Q

Response Difficulties

A
  • False Positive
  • False Negative
  • Inconsistent Responses
  • Reinstruction
  • Varying time between tones
  • Use pulsed or warbled tone
  • Present at supra threshold level
    to reinforce signal
24
Q

Air Conduction Testing

A
  • Determine degree of hearing loss
  • Tests the total auditory system
25
Q

Earphone Selection

A

NSERT EARPHONES
Increase comfort
Prevents collapsed ear canals
Reduces need for masking
Attenuates BGN

SUPRA AURAL HEADPHONES
False conductive HL with
collapsible canals
Does not attenuate BGN
Uncomfortable for extended
period of time

26
Q

Earphone Placement

A

RED – RIGHT EAR BLUE – LEFT EAR
Headphones (supra – aural)
Diaphragm of earphone should be directly over ear canal
Insert earphones
Compress foam and insert into ear

27
Q

Test Procedure

A
  • Familiarization
    ▫ 1000Hz @ 30dBHL
    ▫ If no response, present at 50dBHL
    ▫ If no response, raise in 10dB increments until response is achieved
  • Threshold Determination (Hughson-Westlake method)
    ▫ down 10, up 5
     When patient responds, ____10 down_________ dB
     When no response, ______5 up__________ dB
     Threshold - Level at which persons hears 50% of time or at least 2 out of 3 ascending
    trials
28
Q

Signal Presentation

A
  • Test better ear or right ear if no difference between the ears
  • Test in ascending order:
    ▫ 1000, 2000, 3000, 4000, 6000, 8000Hz
    ▫ Retest 1000Hz to confirm test reliability
    ▫ 500, 250Hz
  • Switch to other ear and repeat but do not perform 1000Hz retest.
  • Test inter-octave if there is a 20dB or greater difference between
    successive octave frequencies
29
Q

Signal Presentation

A
  • Tone duration
    ▫ present pure tone 1-2 seconds’ duration
  • Interval between tones
    ▫ Vary interval of successive tone presentations
  • Tinnitus Interference
    ▫ Pulse the pure tone stimuli
30
Q

Bone Conduction Audiometry

A
  • Evaluates inner ear status
  • Vibration of skull stimulates fluid-filled cochlea
  • Determines type of hearing loss
    ▫ Conductive, Sensorineural, or Mixed
  • Frequency sequence (ASHA 2005):
    ▫ 1000Hz, 2000Hz, 3000Hz, 4000Hz, 500Hz, 250Hz
31
Q

BC Oscillator Placement

A
  • Mastoid
  • Forehead
32
Q

Bone Oscillator Placement

A
  • No matter where you place the bone oscillator, both cochleas will
    be stimulated.
  • If there is a difference in hearing between cochleas, the better
    cochlea will respond.
  • Instructions and responses are the same as air conduction testing.
33
Q

Bone Conduction Audiometry
How it works

A

▫ Distortional Bone Conduction
 Compression / Distortion - Cochlea’s shape is distorted as the skull vibrates back
and forth, creating movement of the cochlear fluids

▫ Inertial Bone Conduction
 Ossicular lag – Movement of the stapes footplate lags behind the vibrating cochlear
shell

▫ Osseotympanic Bone Conduction
 BC by air conduction – Bony sides of the EAM are vibrating. This creates an air
conducted sound which travels outward and towards the TM and into the ME.

34
Q

Masking

A
  • Cross Hearing
  • Interaural Attenuation
  • Masker (Masking Noise)
35
Q

CROSSHEARING

A
  • Sound presented to the
    test ear (TE) crosses
    over and is perceived in
    the cochlea of the non
    test ear
  • Given enough intensity any transducer can stimulate the opposite cochlea
36
Q

Interaural Attenuation

A

Reduction of sound energy as it crosses from one ear to the other (via bone conduction)

Supra-aural headphones
IA = 40dB
Insert earphones
IA = 70dB
Bone Conduction
IA= 0dB
Clinically – 15dB

37
Q

When to Mask

A
  • Apply masking to NTE when the AC of the TE exceeds the BC for the NT
    cochlea by the amount of the minimum IA values.
  • Minimum IA values
    ▫ Supraaural phones: ABG = > 40 dB
    ▫ Insert phones: ABG = > 70 dB
    ▫ Bone conduction: ABG = > 15 dB
38
Q

MASKING DEFINITION

A
  • Masking in our Environment
  • The presence of noise that interferes with the audibility of another
  • Masking in Audiology
  • The presentation of noise to the non- test ear (NTE) to raise the
    threshold of audibility and thus eliminate its participation when
    testing the hearing threshold of the test ear (TE).
39
Q

Masking the NTE

A
  • Keep the non-test ear “busy” while establishing true threshold
    results for the test ear.
  • Present narrow band noise to the non-test ear (NTE) to eliminate
    cross hearing.
  • Narrow band noise – sound energy within a critical band of noise
    that is centered at a pure tone frequency.

Advance Audiology (5 decks)

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