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AUDE 5340 AUD DIAG II > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

best ability/score the patient can do

A

PB max

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2
Q

highest percent correct score for a listener (using a phonetically-balanced word list)

A

PB max

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3
Q

What agreement do we want with PTA?

A

plus or minus 10

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4
Q

PTA frequencies

A

5, 1, 2

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5
Q

What are the three components of evidence-based practice?

A

client perspectives - MLV for a kid that cannot do the task vs recorded stimuli
clinical expertise - how we take shortcuts for tests
external scientific evidence

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6
Q

what test can point to a site of lesion?

A

pure tones (air and bone) - middle ear or retrocochlear
cannot differentiate cochlear vs retrocochlear
tymp - middle ear
word rec - differentiate cochlear vs retrocochlear

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7
Q

test stimuli for SRT?

A

spondee words
words getting softer and softer

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8
Q

test stimuli for pure tones?

A

pure tones
tone getting softer and softer

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9
Q

threshold measure

A

SRT

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10
Q

what does SRT stand for

A

speech recognition threshold

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11
Q

what does WRS stand for

A

Word Recognition Score

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12
Q

Percent correct of a given word list at a suprathreshold level

A

WRS

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13
Q

Referred to as
Word recognition
WRS
PBmax
Speech discrimination (old term)
Discrimination score

A

wrs

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14
Q

What are the two diagnostic uses of word recognition testing?

A

Site of lesion testing (cochlear vs. retrocochlear) (screenings)
Compare word recognition ability over time

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15
Q

What are four treatment uses of word recognition testing?

A

General sense of impact of hearing loss on speech understanding
Can give a sense of distortion in the cochlea (if cochlear)
Many listeners can identify most words at presentation levels above average conversational speech

One test to identify monaural vs. binaural amplification

Compare unaided vs. aided

Cochlear implant candidacy

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16
Q

Describe the speech material used for word recognition testing.

A

Single words
Monosyllabic
Often CNC (CVC) - like book

Phonetically balanced word list
The test is the recorded 50-word word list

Frequently presented with a carrier phrase (“say the word____”

Homogeneous
Word structure
Familiarity
Emotional loading

Can be closed set or open set

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17
Q

Differentiate between open-set and closed-set.

A

Refers to speech tests using single words

Closed-set:
Possible response choices are limited
Single digits
Picture-pointing or paper and pencil tests with limited number of foils
Familiarized spondee list

Open-set:
Possible response choices are one of many words with no context
Spondee list that is not already familiar
Single-syllable words

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18
Q

WIPI

A

Word Intelligibility by Picture Identification

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19
Q

Identify whether the following would be considered open set or closed set:
Test materials are single-syllable digits (and listener is advised of this)
Test of one-syllable words with the structure CVC
SRT after familiarizing with 8 words
SRT without familiarizing
WRS where a patient is shown 6 pictures and has to identify the correct one

A

closed
open
closed
open
closed

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20
Q

Which one is easier, meaning which one would yield a higher percent correct score?
Open or closed set

A

closed

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21
Q

How might a PBmax score underestimate a patient’s functional receptive abilities?

A

Monosyllabic words lack the linguistic redundancy and the contextual and situational cues found in conversational speech

Word recognition scores are usually obtained under an auditory-only listening condition rather than a bimodal (auditory-visual) condition

PBmax scores are typically established monaurally; conversational speech is most often processed binaurally (remember the binaural advantage)

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22
Q

How might a PBmax score overestimate a patient’s functional receptive abilities?

A

PBmax scores are typically obtained in quiet with the patient seated in a sound treated room. Conversational speech often occurs in varying levels of background noise

Word recognition tests may be administered at hearing levels that are significantly greater than the HL corresponding to normal conversational speech (50 dB)

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23
Q

why does someone do better than they normally would?

A

quiet, no competing noise with sound treated room and convo is usually in noise
done at a high level compared ot conversational speech

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24
Q

How is a word recognition test administered? Include example instructions.

A

Make sure speech materials are calibrated.

Determine presentation level

Confirm with patient that sound level is not too loud.

Determine whether masking is needed (covered later)

Instruct the patient: You are going to hear a list of words at this level. It will be a man’s/woman’s voice. He/she will say “say the word” followed by the word; you just say the word. For example, if he says “say the word book”, you say “book”. If he says “say the word kite”, you say “kite”. If you’re not sure of the word, please guess. Any questions?
Do not use words from the word list that you plan to use for your examples
Modify instructions based on word list/carrier phrase used

Present the list of words and keep track of the number of correct/incorrect responses

Note presentation level, amount of masking if used, percent correct score on audiogram. Also note word list used and recorded vs. MLV
Test using recorded materials

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25
Q

Describe the speech material used for word recognition testing.

A

Single words
Monosyllabic
Often CNC (CVC) - like book
Phonetically balanced word list
The test is the recorded 50-word word list
Frequently presented with a carrier phrase (“say the word____”
Homogeneous
Word structure
Familiarity
Emotional loading
Can be closed set or open set

26
Q

Closed-set

A

Possible response choices are limited
Single digits
Picture-pointing or paper and pencil tests with limited number of foils
Familiarized spondee list

27
Q

open-set

A

Possible response choices are one of many words with no context
Spondee list that is not already familiar
Single-syllable words

28
Q

How might a word recognition test overestimate communication ability?

A

quiet, no competing noise with sound treated room and convo is usually in noise
done at a high level compared to conversational speech
PBmax scores are typically obtained in quiet with the patient seated in a sound treated room. Conversational speech often occurs in varying levels of background noise

Word recognition tests may be administered at hearing levels that are significantly greater than the HL corresponding to normal conversational speech (50 dB)

29
Q

How might it underestimate? In other words, why is it not a test of communicative function?

A

no cue or redundancy/no context (say the word pig misses but if you say my daughters fav farm animal is pig, gets it)
no visual cues (lip reading)
established monaurally and convo speech is processed binaurally (binaural advantage)
no binaural advantage
Monosyllabic words lack the linguistic redundancy and the contextual and situational cues found in conversational speech

Word recognition scores are usually obtained under an auditory-only listening condition rather than a bimodal (auditory-visual) condition

PBmax scores are typically established monaurally; conversational speech is most often processed binaurally (remember the binaural advantage)

30
Q

Why is it important to find and report PB max? (As opposed to any word recognition score obtained? For example, if your WRS is 50%, why is it important to be highly certain that is the patient’s PB max?)

A

Important diagnostically is if you compare it with another score you want to make sure you are comparing the best possible score. If you don’t then you can’t detect any differences or changes

31
Q

Identify 4 common methods for determining WRS presentation level.

A

40 dB SL
Guthrie & Mackersie (2009) (table next slide)
MCL
UCL - 5
specific HL, 50 dB HL

32
Q

Is it ok to repeat words when administering word recognition testing?

A

No

33
Q

What two sites of lesions can (potentially) be differentiated based on word recognition testing?

A

cochlear vs retrocochlear

34
Q

what is the sprint chart used for

A

If this is really their pb max or not or if we need to retest it, test WRS at one level and matching with PTA

use to compare if speech scores are asymmetric or not, are the two scores significantly different?

35
Q

Rollover:

A

when speech performance gets worse as you increase the presentation level above their pb max

36
Q

What is the potential problem with giving a word list that is too short?

A

Too much variability and you cannot compare scores to another score (ear to ear, before/after treatment)

37
Q

Describe the way in which single-score from one ear only word recognition can be used to identify retrocochlear pathology. Are single-level word recognition scores a strong or a weak tool for differentiating cochlear from retrocochlear? Explain your answer.

A

3rd rule
If the score is less than 80% and PTA is 30 or greater it is suggestive of a retrocochlear sign
Weak because you’re only using one level, witch cochlear hl you can get anything from 0-100%, just because you have a low score doesn’t mean you have a retrocochlear hl you could also have cochlear hl
Conditions and disorders that give low wrs in the cochlea

38
Q

What is the potential problem with giving ½ of a 50-word word list?

A

It will no longer be phonetically balanced
Hard words could be in the first or second half and the score could bre too high

39
Q

Why do we want to minimize variability when testing word recognition?

A

Because we want to able to use the score to compare things

40
Q

List three conditions where variability is relatively high

A

List length (too short of word list),
mlv vs recorded,
closer to 0 or 100 there is low variability and if it is in the middle of this there will be more variability
The more subjects you have the more statistical power you have
Fewer words you give the more likely it is that the next time you give it, you will have a diff % correct

41
Q

How can using MLV instead of recorded materials affect word recognition scores?

A

Using mlv can give you a better score than you really have
Scores that are too good don’t allow candidates to get a device or hide a potential problem but it is vital to get the right score so they meet the criteria for the device

42
Q

Why does using MLV introduce variability into the test scores?

A

MCL
Most comfortable loudness level - hearing level at which the patient experiences speech to be most comfortable

UCL
Uncomfortable loudness level - hearing level at which PT experiences speech to be uncomfortably loud

43
Q

What is the difference between a quick UCL for speech testing and a UCL measurement for treatment?

A

Quick UCL - can administer for word recognition presentation
fine for doing a wrs at
Treatment - loudness contour test because it is replicable and valid
Have to measure individually and not use group trends
Too fast and there would be a lot of variability
Better more valid methods to use for hearing aids (have to use at all frequencies)

44
Q

Why would we measure UCL for speech?

A

Because we want to test at UCL - 5 and want to test for this
To do rollover
If person has a lot of hL we want to make sure we don’t exceed their comfort levels

45
Q

Describe the procedure for quick UCL

A

Start +40 dB above SRT value
Increase 5 dB until PT states it is too loud. Mark down UCL PL
Begin a second time. Note new UCL PL. If it is within 5dB of first PL, you can take the average of both. If it is not within 5dB, do a third run.
Make sure to find UCL on both ears if needed

46
Q

3 most common word lists

A

NU-6
CID W-22
Maryland CNC

47
Q

How does speaker voice (male vs. female) affect word recognition scores?

A

we get better scores with male voices

48
Q

What does it mean when we say we are concerned about variability for WRS scores?

A

want to make sure our scores are reliable and if they are highly variable they are not useful and we are making comparisons with our score so it is not useful with high variability

49
Q

How does decreasing the size of the word list increase variability?

A

the shorter the word list the greater the variability the less reliable it is

50
Q

Regardless of list size, which of the following scores has greater or less variability? 0%; 44%; 60%; 100%

A

we do a lot of comparisons so we need to make sure
44 and 60 have less

51
Q

Why is single-level percent correct score a weak indicator of retrocochlear pathology?

A
52
Q

What is a rule of thumb for single-level WRS as possible indicator of retrocochlear pathology?

A

Consider patients with symmetrical audiometric configurations and significant asymmetry between ears in PBmax scores at risk for retrocochlear pathology
What tool do we have to determine significant asymmetry in PB max?

Consider patients with pure tone averages equal to or better than 30 dB HL and PBmax scores below 80 % at risk for retrocochlear pathology

53
Q

two people that are twins and play soccer and identical in every way. run up stairs and time them. One twin is much slower. Would we be worried?

A

yes

54
Q

long term patient with hL and they come in with symptoms of a acoustic neuroma, which rule would you use?

A

first rule and use the SPRINT chart
see 20% difference, then would look at audio and are ears the same are the same or diff?

55
Q

An abnormal static admittance volume reading suggests a disorder where?

A

™ and/or ossicular chain

56
Q

An abnormal peak pressure reading suggests a disorder where?

A

ET (not functioning)

57
Q

An abnormally low ear canal volume reading suggests a disorder where?

A

Ear canal (blockage)

58
Q

An abnormally high ear canal volume reading suggests a disorder where?

A

™ (perforation)

59
Q

Which measure is outside of normal limits for one or both ears?
ECV - 1.5 and 1.8
Static admittance - .18 and 1.7
peak pressure - -45 and 5
width - 100 and 85

A

static admittance (abnormally low

60
Q

Why is it preferred to use numbers and not just tymp shape when describing them?

A

We use the numbers to compare to the norms and it is more precise and gives a clearer picture than just giving A or B etc.

61
Q
A

AUDE 5340 AUD DIAG II (9 decks)

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