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OSCE PREP > Clinical 14: Audiometry > Flashcards

Clinical 14: Audiometry Flashcards

1
Q

What are the two broad reasons why people suffer from hearing loss?

A

Impaired conduction of sound through the outer/middle ear (conductive hearing loss)
Impaired responsiveness of receptors (haris cells) or cochlear nerves within the inner ear (sensorineural hearing loss)
May be partial complete or in combination.

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2
Q

What are the red labels on the following image?

A

Pinna
External auditory canal
Lobule

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3
Q

What are green labels on the following image

A

Malleus
Eardrum
Incus
Stapes

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4
Q

What are the blue labels of the following image?

A

Semicircular canals
Vestibular cochlear nerve
Cochelea
Eustachian tube

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5
Q

What are the three main anatomical divisions of the ear?

A

External ear
Middle ear
Inner ear

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6
Q

What are the features of the external ear?

A

The pinna and the external auditory canal
Ends of the tympanic membrane

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7
Q

What is included in the middle ear?

A

Lies within the temporal bone
Contains the ossicles (malleus, incus and stapes)
Also contains the eustachain tube and the facial nerve

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8
Q

What is the main function of the middle ear?

A

Transmit sound from the tympanic membrane to the oval window of the cochlear (inner ear)

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9
Q

What is the function of the eustachian tube?

A

Equalises pressure in the middle ear

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10
Q

What is contained within the inner ear?

A

The cochlea
The vestibule
The semi-circular canals

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11
Q

What is the function of the cochlea?

A

Spiral shaped structures that converts mechanical sound vibrations into electrical signslas that are transmitted to the auditory cortex via the cochlear nerve. (CN8)

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12
Q

What is the function of the semicircular canals in the inner ear?

A

Detect changes in the speed and direction of head movement - aiding balance processing.

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13
Q

How is sound transmitted from the air to the cochlear?

A

Sound waves are vibration in the air.
Directed from the pinna into the external auditory canals
At tympanic membrane vibrations are transfer to the ossicular chain, then the oval window of the cochlear.

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14
Q

How is sound processed within the cochlear?

A

Sound waves vibrate the oval window of the cochlear
Produces waves in the endolymphatic fluid and the perilymphatic fluid in the cochlear
These waves disrupt the basilar membrane.

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15
Q

Describe how sound waves are turned into depolarisations in the cochlear?

A

Contains microscopic hair which are mechanoreceptors.
Stereo cilia project from hair surface, these hend in response to basilar membrane movement and slide over the tectorial membrane.
Cilia are arranged in order of height, bending towards tallest opens ions channels causing depolarisation, bending away closes channels (preventing depolarisation), straight in the absence of sound keeps a constant level of depolarisation.
Changes in the level of depolarisation produce sound.

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16
Q

What are some different methods of testing hearing?

A

Free field hearing tests
Tuning fork tests
Pure tone audiometry

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17
Q

What is a free field hearing test?

A

The level of hearing loss is estimated by assessing ability to hear normal voice, raised voice and whisper.
Useful when technology is not available

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18
Q

What is the purpose of different tuning fork tests to assess hearing?

A

Rinnes and Weber tests can distinguish between conductive and sensorineuronal deficits by comparing air and bone conduction.
Normally air conduction should be more effective than bone conduction.
If not it is called a conductive deficit.

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19
Q

What is pure tone audiometry?

A

A subjective behavioural measurement of air conduction and bone hearing thresholds across a range of thresholds.
The patient is asked to listen to pure tones with a audiometer through headphones or a headband.
Used to establish the quietest sound a patient can hear across a range of audible frequencies.

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20
Q

How should you perform a free field hearing test?

A

Mask one ear with a tragal rub
Speak double digit numbers into the patients other each from an arms length away and get them to repeat back to you.
Numbers should be spoken at certain volumes - whipser (30-40dB), normal conversational voice (50-60dB) and loud conversational sound intensity (80dB)

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21
Q

What tuning fork should be used for tuning fork tests in audiometry?

A

512Hz tuning fork
Or a 256Hz if above not available

22
Q

What is Rinne’s Test?

A

Vibrate fork
Place tuning fork onto mastoid tip (ask if can hear).(measure bone conduction bypassing the outer and middle ear.
Move to hold adjacent to the opening of the external auditory canal (measure air conduction).
Ask the patient what sound is louder.

23
Q

What does a Rinnes negative test result mean?

A

Bone conduction was better than air conduction
1. Conductive hearing loss - does not pass through ear canal or middle ear
2. Dead ear - false negative, as no recordable hearing in that ear.

24
Q

What does a Rinnes positive result mean?

A

Air conduction is greater than bone conduction - this is normal or sensorineural loss.

25
Q

How do you perform webers test?

A

Strike the tuning fork and place in middle of patients forehead
Ask if they can hear the sound?
Ask if louder in middle, right or left?

26
Q

How does conductive hearing loss present on webers test?

A

Best heard in the ear with conductive hearing loss
This is because less ambient sound reaching inner ear from environment (so less competing so tuning fork is heard better)

27
Q

How does sensorineural hearing loss present on Webers test?

A

Heard better in the better hearing ear
As better able to translate sound waves into depolarisations.

28
Q

How are audiometry results presented?

A

Hearing levels for each frequency are mapped out on an audigram
Bone and air conduction thresholds are plotted
The frequencies (pitch) are measured in Hz and the intensity (loudness) is measured in dB.

29
Q

What is the normal hearing threshold?

A

0-20dB

30
Q

How does sensorineural hearing loss present on an audiogram?

A

Equal reduction in bone and air conduction
As inner ear ability impaired - so more difficult to alter depolarisation.

31
Q

How does conductive hearing loss present on an audiogram?

A

Reduced air conduction and normal bone conduction
Gap between is called the air-bone gap.
External or middle ear (conducting portion) damaged, but vibrations of bones in the skull can bypass and into the inner ear directly.

32
Q

How does mixed hearing loss present on an audigram?

A

Reduced air and bone conduction
Air conduction is always reduced more than bone.
Air-bone gap.

33
Q

What is presbycusis?

A

Age related hearing loss, affects 30% of people over 60yrs.
Classically appears as bilateral, symetrical, sloping sensorineural loss on an audigram.
Appeats are reduced audigram responses, unable to understand and perceive speech in noisy environments.

34
Q

What are the risk factors for presbycusis?

A

Geneit risk, metabolic disease, diabetes, hypertension and other systemic disease such as as autoimmune disease
Noise exposure, ototoxic medication and diet.

35
Q

What is the pathophysiology of presbcusis?

A

Chronic neural degeneration in the cochlear nerve and dengeration of the hair cells within the cochlear
Reduced ability of cochlear to detect sound and transmit to auditory centre in the brain.

36
Q

How to use of otoscope?

A

Prepare scope and turn on.
Inspect patient external ear for any signs of damage or inflammation.
Check for pain, conditions or injury
Pull back on superior ear and place scope into ear - look down scope.

37
Q

What is clinical masking in audiology?

A

Introducing noise to teh non test ear during a pure-tone audiogram or free tone hearing test.
Ensures not being cross heard by the non test ear.

38
Q

What is an anterior rhinoscopy?

A

Examination of the anterior internal nose with a thudicums speculum in good light (ideally with a headlight)

39
Q

How to complete an anterior rhinoscopy?
(hand position)

A

Hold speculum from tip of index finger with projections facing the patient.
Use the middle and ring finger to open/close the speculum.
Thumb placed on top to support
Align light source with nasal cavity

40
Q

During the throat and neck examination what observations are you looking for?

A

Asymmetries
Swellings - lymph nodes or goiter
Skin changes - brusining, infections or scars
Hoarseness of voice
Dyspnoea, stridor or abnormal breath sounds.

41
Q

What should you palpate in the throat and neck exam?

A

Thyroid gland - x2 lobes and isthmus - below adams apple
Lymph nodes
Salivary glands - submandibular

42
Q

What else might you observe during the throat and neck exam that may indicate thyroid disease?

A

Weight changes
Exopathalmos (graves)
Fine tremor in hyper
Tachycardia
Sweating
Thinning of hair (hyper), brittle hair (hypo)
Dry skin (hypo)

43
Q

What lymph nodes should be palpated in the neck/throat exam?

A

Submental
Submandibular
Pre and post auricular
Superficial cervical nodes and deep cervical nodes on the anterior and posterior cervical chain
Occipital nodes
Supraclavicular nodes

44
Q

How do you palpate the submandibular salivary gland?

A

Gloved finger palpate the floor of the mouth whilst bimanually palpating underneath the mandible with the other hand.

45
Q

How should you exam the throat of patient?

A

Look systematically at the lips, teeth and gums, tongue, buccal mucosa and palate.
Ask patient to raise tongue to inspect the floor of the mouth.
Look for asymmetries, abnormalities in colour, swelling or significant lesions.

46
Q

What are some potential causes of a lump in the anterior triangle of the neck?

A

Lymph node (lymphoma, metastasis)
Branchial cysts
Cystic hygroma
Carotid body tumour
Laryngocele

47
Q

What are some potential causes of a lump in the inferior posterior triangle near the sternocladomastoid muscle?

A

Lymph node - supraclavicular
Tumour on lung apex
Cervical rib

48
Q

What cancers are most likley to metastasise to this location?

A

Squamous - nasopharynx, oral, larynx, sinus

49
Q

What are some potential causes of a lump in the midline of the neck?

A

Thyroglossal cyst (moves when protrude tongue)
Dermoid cyst
Thyroma

50
Q

What is the crib sheet for an otoscopy examination?

A

Look - external ear and mastoid - deformities, swelling, redness, scaring or discharge
Feel - peri-auricular and mastoid for tenderness and temp, feel the regional lymph nodes (auricular, parotid, tonsillar and occipital)
otoscope - hold like pen in dominant hand, handling pointing forwards (direction of patient eyes), non dom hand to pull - up and out pinna.
Complte - webers and rinnes test (when hear and when goes out)

51
Q

What is the crib sheet for the throat and neck examination?

A

Look - asymmetries, swellings, skin, voice change, breath change
Neck
Palpate - thyroid gland, lymph nodes, salivary and submandibular glands, may palpate mass if seen, ask to swallow water to observe or protrude tongue
Look for thyroid species features - weight changes, exopthalmos, tremor, tachycardia, sweating or thinning of hair.
Throat
Inspect open mouth, insepct saying ahh or use tongue depressor, raise tongue to inspect floow of the mouth, asymmetries and abnormalities in colour, swelling or lesions

52
Q

What happens in a nasal examination?

A

Observe nose - deviations, swelling, redness
Feel - ask about pain, feel skin over nose, gently press on tip of nose,
Assess nasal patency by placing a spatula under nostril and look to stream up.
Rhinoscopy - speculum and torch to view up nose
End of examination

OSCE PREP (21 decks)

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