Behavioural Testing

Question 1

what is tympanometry?

Answer 1

measures the compliance and mobility of the tympanic membrane.

by looking at the change of pressure.

Adults 226Hz Probe tube
infant older 6 months: 1000Hz probe tube

Question 2

what does admittance, impedance, suceptance, reactance:

Answer 2

admittance: acoustic energy that flows through the ME system. denoted as Y (mmhos)
impedance: total opposite of the middle ear system to the flow of acoustic energy. denoted as Z (ohms)
susceptance: sucebtilew to letting air enter, so compliment of the admittance.
reactance: opposition to allowing sound to enter, compliments of impedance (ohms)

Question 3

revise temp results

Answer 3

look at temp flashcard, what’s normal and abnormal.

Question 4

adults ear compared to a neonates ear?

Answer 4

really small TM
small ear canal
more soft tissue under the ear
less cartilage.
middle ear cavity, canal and mastoid all grow.

Question 5

neonate freq for objective testing?

Answer 5

1000Hz
use a rate of 600daPa/sec so a fast test can be obtained.
repeat trace so it is not an artefact.

Question 6

how to tell if neonatal test is abnormal or normal?

Answer 6

under the peak, draw a line from +200 to -400daPa. if it is a straight-line or a line going up the classification is normal.

Question 7

what is the purpose of behavioural testing?

Answer 7

you expect the child to respond to sound,
objective testing.

purpose
- screening for a hearing loss: pta
- diagnosing hearing loss: detect children with severe OME, or children that have SNHL that was not detected by newborn screening test.
- accessing impact of HL:
intervention
- infants with confirmed PCHI (PERMENANT CHILDHOOD HEARIGN IMPAIRMENT) to fit hearing aids, moniter hl, assess suitability for CI

Question 8

techniques wihtout reinforcement:

Answer 8

BOA
Distraction Testing

Question 9

techniques with reinforcement

Answer 9

VRA
Play audiometry

Question 10

what are the developmental age for observational tests:

Answer 10

BOA = up to 6 Months
DT = up to 12 months
VRA = 6 - 24 Months
Play Audiometry = 2-5 years
PTA = over 5 years

Question 11

why is distraction testing limited to 12 months?

Answer 11

they develop object permanence - they know the object is still their, so more distracted by that then the noise.

Question 12

why does VRA start at 6/7 months?

Answer 12

ability to have head control and objective permanence

Question 13

what does child need to developmentally need to do before play audiometry:

Answer 13

follow instructions and wait for an instruction.

Question 14

soundfield? what are the difficulties?

Answer 14

all test except for PTA can be tested in sound field.

difficulties:
ensuring that the level of the signal at the two ears is what we intended.
threshold measured in SF only refers to better hearing ear.

Question 15

CASE STUDY: 3 yo boy not conditioning to play aduimetry?

Answer 15

1) find out why? maybe not fining the game interesting? maybe upset about something else? see if we can fix the issue.
2) play audiometry is about reward. maybe have the parent involve to praise the child after doing one act.
3) the child is unable to hear. change the frequency or condition louder. speak louder
4) use BC to condition
5) take into account history.
6) move down to VAR

Question 16

why could we use been concussion to condition for play audiometry?

Answer 16

if the child is still unable to hear, you condition on a loud level and to the vibration of the sound. so yk if they have a hearing loss or if they don’t understand the game.

Question 17

Most appropiate test for a 7 month old child? what information do you need to try to obtain?

Answer 17

VAR: try to determine their audiogram. (AC, BC)

Question 18

How can you adapt testing for a patient with complex needs?

Answer 18

asking if there is anything you can do to adapt (lights, any preferable games, being patient, any head ups on games to not use)
might just do some objective testing instead

Question 19

what is a test battery approach?

Answer 19

when you do a mixture of objective testing (do not need the child to react, its automatic) and reactive tests.

Question 20

What is Visual Reinforcement Audiometry: (VAR)

Answer 20

6 months to 24 months.
use a conditioned response to sound with a visual stimuli (toys or lights as reinforcement).
train the child toward the sound source when sound is presented.

Question 21

VRA: What are advantages and limitations?

Answer 21

advantages: require head control and visual attention.
disadvantage - requires head control and may not work with severe delays in development.

Question 22

what is distraction testing?

Answer 22

6-12 months
use toys or maybe even your hands (not distract them a lot) to distract them from the sound or stimulus. child attention I shift towards the sound. second tester distracts the child to ensure a sound, not visual cues.

Question 23

disavnatge or advantage of distraction testing?

Answer 23

+ simple and quick for younger infants.
- limited freq information and less precise than VRA. Depends on the abilities of the second tester at distracting.

Question 24

Play audiometry

Answer 24

2 to 5 years.
involves a game (placing a block in a bucket when a sound hears a child.
helps measure frequency specific hearing threshold.

Question 25

advantage and limitations of PA:

Answer 25

+ Engaging form of play
+ provides freq and ear specific threshold.

Question 26

what is PTA

Answer 26

gold standard for children that are over 5+ years and adults. you measure a threshold across a range of frequencies (250hZ-8khz)

child reponds to the tone by pressing a button.

Question 27

what are the advantages and limitations of PTA?

Answer 27

+ detailed freq and ear specific threshold.
- full cooperation and understanding.
- development delays.

Question 28

what are PVP shunts:

Answer 28

surgically implanted in a ventricle where the patient had hydrocephalus.
magnetic valve placed next to the mastoid bone to allow shunt to be adjusted by an external magnet. external magnet can cause shunt to malfunction.

Question 29

PVP Shunt: Advise

Answer 29

Ask the patients.
Do not place the transducers BC, OAE, Tymps or super aural headphones.
use inserts. keep transducers at least 5 mm away from the shunt.
BC testing can be done on the ear contralateral to the valve.