exam 1 Flashcards
prevalence of hearing loss
- increases with age
- hearing loss over 65 = 13 million
- 35 million americans with hearing loss
- 6/1000 born with hearing loss
- 90% of children have at least 1 ear infection by age 6
impact of hearing loss
- financial burden priceless
- affects general health, psychosocial well being, and generated income
- 30% cant afford treatment
evolution of audiology
- began after WWII
- otology + SLP = aural rehab
- 1945 dr. raymond carhart
- grant fairbanks - u of i
- 1988 set gaols for doctorate level via academy of dispensing
why is audiology important in SLP
- hearing loss has a direct impact on speech and languare
- many communicative disorders involve hearing complicaitions
roles of audiologits:
specialties
- medical audiology
- educational audiology
- pediatric audiology
- dispensing/rehab audiology
- industrial audiology
- recreational audiology
- animal audiology
roles of audiologists:
employment settings
- hospitals
- physicians office
- private practice
- other
- schools
- college/university
- speech and hearing center
- home care
- industrial
roles of audiologists:
professional societies and organizations
- AHSA - set standards for practice of audiology and accreditation for academic programs
- asha - CCC - certificate of clinical competance
-AAA - american academy of audiology - increased public awareness of hearing and balance disorders and well as work with gov. on national level
roles of audiologists:
professional roles with in the scope of practice for audiologists
-set and receive practice standards, protocols and guidelines for the practice of audiology to ensure quality patient care. ASHA needs a CCC. AAA requires fellowsing (FAAA)
outer ear landmarks
- canal
- TM
- pinna
- meatus
- external auditory canal
Tympanic membrane landmarks
- umbo (point and center of TM at which it is most retracted)
- pars flaccida - loose folds of tissue above malleus
- pars tensa - remaining tissue portion of TM
- meniscus line - edge of ear drum
- manubrium of malleus
- long crus of incus
- cone of reflected light
middle ear
- malleus, incus, stapes
- mastoid process
inner ear
-cochlea, which serve to convert waves into a message that travels to the brain stem via the auditory nerve
auditory nerve
VIII cranial nerve which comprises auditory and vestibular branches passing from inner ear to brainstem
air conduction pathway
- transmission through outer ear, middle ear, and inner ear and higher up
- AC loss can occur in ME or outer ear
insert ear headphones
- cleanlier
- foam goes into the ear, increase inter-aural attenuation by around 80 dB
supra-aural
- transducer
- AC receiver
- rubber cushion fits over the ear
- increase iner-aural attenuation by 40 dB
inter-aural attenuation
IA
-loss of energy in a sound in either AC or BC as it travels from test ear to nontest ear
*number of decibels lost in cross-hearing
headphone placement and sound delivery
- ear canal should be checked for blockage or collapse
- earphones placed with grid directly across ear canal with hair/glasses out of the way
- test 250 - 8000 Hz
decibels
a unit for expressing the ratio between two sound pressures or two sound powers
cross hearing
the reception of a sound signal during a hearing test by either AC or BC in the NTE
bone conduction pathway
- transmission that stimulates IE directly through mechanical vibration of the skull
- BC impairment can occur in the IE or auditory nerve
bone vibrator placement and sound delivery
- cannot touch pinna or hair
- test ear never covered if using masking
- test 250 - 4000 Hz
- **must use masking if ABG is more than 10 dB
air bone gap
-the amount by which the air-conduction threshold of a patient exceeds the bone conduction threshold at any given frequency in the same ear
modes of vibration:
distortional
- leads to the distortion of the cochlea
- moves fluid and generates perception of a tone
- inner ear mainly
modes of vibration:
inertial
-middle earbones set into vibration and ligaments and tendons set ossicles into motion and movement will lag in and out of stimulation of the cochlea
modes of vibration:
osseo-tympanic
- air in ear-canal into vibration and then ear drum into motion, then ossicles then fluids
- primarily outer ear
advantages/disadvantages of BC testing from forehead
- more comfortable
- but gives a lower threshold by 10dB
advantages/disadvantages of BC testing from mastoid
- more reliable
- but possible cross-hearing
conductive portion of auditory system
- sound attenuation (a decrease in strength of a sound) is the result of a conductive hearing loss
- impaired air conduction with normal bone conduction
sensorineural portion of auditory system
-same amount of attenuation for both AC and BC but the main issue is in the IE
what info comes from BC that we cant get from AC
-info about if the IE and AN are correctly functioning
conductive hearing loss
- impairment of the outer ear or ME or AC testing
- normal BC testing, normal IE and AN function
attenuation
decrease in the strength of a sound
sensorineural hearing loss
- impairment in the IE or AN
- AC and BC EQUALLY impaired
- ABG < 10dB
mixed hearing loss
- impairment to the ME or IE
- results in loss of BC but even greater loss of AC
- ABG
bing test
- to determine the presence of the occlusion effect by examining AC and BC
- with SNHL and normal hearing there will be a positive bing
- for conductive hearing there will be no change or a negative bing
- place fork on mastoid and open and close tragus to occlude
rinne test
- compare hearing sensitivity of BC to AC
- rinne positive = normal hearing sensitivity as well as SNHL will hear tone longer with AC
- rinne negative = patients with conductive hearing loss will hear BC
- false rinne = response indicates negative when the dysfunction is in other ear
- opposite ear (better cochlea is responding)
- have to mask b/c of cross-hearing
schwabach test
- test BC and compare to examiners results
- place on mastoid and keep track of how long patient hears sound until it is inaudible
- normal results - can still suggest conductive hearing loss
- diminished - patient stopped before tester suggests SNHL
- prolonged - suggests conductive
weber test
- place fork in center of the forehead to determine which ear has the better cochlea
- tone will lateralize to the better cochlea
- UNHL - patient hears tone in poorer ear indicative conductive hearing loss
- SNHL - patient hears tone in better ear b/c this cochlea is more sensitive
- test used when assumption that hearing loss is present and asymmetrical
lateralization
-sound introduced directly to the ears is head in the right ear, left ear, or the midline if hearing is symmetrical
occlusion effect
-impression of increased loudness of a bone conducted tone when the outer ear is tightly covered (occluded)
problems and limitations of tuning fork tests
- provide only qualitative data
- only able to show that there is a loss not how much
stenger principle
when 2 tones are of the same frequency and presented to both ears simultaneously and only the louder one is perceived (weber)
brownian motion
-the constant random colliding movement of molecules in a medium with compression and rarefaction
complex sound
sounds composed of 2 or more tones that have a repeating or periodic time waveform (complex tone: more than 1 pure tone signal)
condensation and rarefaction: the difference
- condensation is the portion of sound wave where the molecules of the medium are compressed together and a decrease in pressure occurs
- rarafaction is that portion of sound wave where the molecules become less densely packed per unit of space
transverse vs. longitudinal
- longitudinal is a wave in which the particles of the medium move along the same axis as the wave
- transverse wave is a wave in which the motion of the molecules of the medium is perpendicular to the direction of the wave
sine waves
-waveform of pure tone showing simple harmonic motion
pure tones
-seen by oscillations of cycles, pure tones are the tones of only one frequency (no harmonics)
periodic vs aperiodic sound waves
- periodic repeats over time
- aperiodic varies randomly over time and doesnt have a fundamental frequency
oscillation
the back and forth movements of a vibrating body
spectrum
the sum of the components of a complex wave
vibration
the to and fro movement of a mass
- in a free vibration the mass is displaced from its position of rest and allowed to oscillate without outside influence
- in forced vibration the mass is moved back and forth by applying an external force
frequency
cycles per second
period
time to complete one cycle
physical effects of mass length and stiffness on frequency
-shorter length = higher frequency and lower mass
higher frequency, higher stiffness = higher frequency
amplitude
the extent of the vibratory movement of a mass from its position of rest to that point farthest from the position of rest
- magnitude of vibration of air particles
- distance of mass after force is applied
intensity
the amount of sound energy per unit of area
*proportional to pressure squared
pressure
force per unit area
-pascals Pa
phase
the relationship between 2 or more waves
- in-phase - 2 sinusoids are said to be in phase when the difference in phase degrees between 2 identical time points equals zero
- out phase - same frequency with different starting phases
wavelength
AMOUNT sound travels in 1 period or cycle
-as freq increase wavelength decreases
fournier analysis
the mathematical breakdown of any complex wave into its component parts consisting of simple sinusoids of different frequencies
fournier synthesis
rebuilding those complex sounds
fundamental frequency
the lowest frequency of vibration in a complex wave
ANSI
american national standards institute
- organization established to oversee the creation and use of guidelines that impact all centers of US business
- these include acoustical devices like audiometers, construction equipment and more
- also involved in accreditation of a variety of programs
ISO
- international organization for standardization
- world wide consortium of 148 nations who oversee and set guidelines for 1000s of devices including audiometers
equipment used to calibrate audiometer and transducers
- pure tone oscillator and noise generator
- frequency switch and spectrum swtich
- signal/input selector, tone switch, attenuator and outputs selector
- transducers: supra-aural earphones and insert earphones, speakers, etc
ambient noise and its effect on calibration and hearing sensitivity
ambient noise is noise from the environment and it can alter calibration and hearing sensitivity
biological check
- informal but careful evaluation of operational status of the audiometer
- carried out through direct observation and completed daily before used
- examine headphones, listen for static or clicks
- set attenuator to high intensity and listen for hum
- move attenuator in 5 dB increments for steady linear increase in loudness
- listen for cross-talk between headphones
- check BC vibrator cord
- listen for live-voice and tape recordings for quality of speech
axes
- y axis is hearing level in dB
- x axis is frequency in Hz
frequency
- pitch
- Hz
- typical range is 20 - 20,000 Hz
intensity
- loudness
- dB
what can we record on an audiogram
- degree type
- symmetry
- lateralization
- masking
- speech audiometry
- tympanometry
normal hearing
-10 - 25 dB
mild
26-40 dB
moderate
41-55 dB