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AUDE 5460 OAEs > Exam 1 Study Guide > Flashcards

Exam 1 Study Guide Flashcards

1
Q

what is the current and excepted definition of OAEs

A

low level sounds emitted by the cochlea, either spontaneously as an echo or other sound evoked by an auditory stimulus, related to the fxn of the OHC of the cochlea

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2
Q

two types of noise

A

body & environmental

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3
Q

why is energy lost during backward transmission

A

impedance mismatch
backward transmission is less efficient; the oval window is a smaller surface area sending signal to a larger surface (TM) via the ossicular chain that results in a loss of intensity during the transmission
spiked heel effect

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4
Q

what is the spiked heel effect

A

Sound goes from a big area (TM) to a tiny one at the oval window which creates more pressure or the spiked heel effect (pretty sure it relates to the area size difference we learned in anatomy)

Stepping on your foot with more surface area doesn’t hurt as much as stepping on it with less surface area like a stiletto heal
So the stiletto has more pressure on it because it’s a smaller area than if you were to step on it with the ball of your foo

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5
Q

describe inward propagation of OAEs

A

stimulus is presented in teh EAM with a probe & delivered to the TM then the ME

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6
Q

role of the ME in OAEa

A

both stimuli sent in and OAEs coming back out travel to and from the cochlea via this space therefore the health of ME influences OAE recordings TWICE

in: has mechanical advantages like the area ratio bw tm and oval window, lever action of ossicles, and the geometry and placement of the eardrum

out: not efficient coming out, systems that act as an impedance matcher hinders the reversal transmission

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7
Q

describe the outward propagation

A

it is an impedance mismatch; distortion picked up is so small because of the force it takes to push back out because it doesn’t have the ME impedance matching to assist it

backward transmission is less efficient becaues the oval window is a smaller surface area sending the signal to a larger surface (TM) through the ossicles, resulting in a loss of intensity during transmission

spiked heel effect

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8
Q

Impedance mismatch on outward propagation can decrease up to

A

15 dB.

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9
Q

what is a travelling wave

A

Displacement wave traveling along the BM from base to apex

cancellations and reinforcements of some sound waves or interaction bw stimulus sound wave moving toward the TM and OAE sound wave moving outward from the TM

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10
Q

Describe the importance of basilar membrane to OAEs

A

OAEs are generated by the movement of the BM

BM is displaced to its max displacement with different stimuli frequencies

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11
Q

describe the role of OHC in OAEs

A

lower intensity levels activate ohcs (65/55 DPs & 79-83 for TEs)

bm moves from stim causing OHCs to be deflected and stereocilia bending in one direction

ions rush in and out changing the membrane potentials in the hair cells

voltage change across plasma membrane causes electromotility (lengtheneing & shortening of OHCs)

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12
Q

how do OHCs become absent

A

when electromotility is blocked

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13
Q

what is electromotility

A

the shortening and elongating of OHCs

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14
Q

generators of OAEs

A

OHCs

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15
Q

what is the fxn of the OHCs

A

improve sensitivity to sound (100 fold increase, 40dB)
make thresholds lower
AMPLIFY
damage results in mild to mod-severe SHNL

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16
Q

3 rows in a v pattern

A

OHCs

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17
Q

what happens to IHC after activation from OHCs

A

traveling wave in cochlea that moves the BM from stapes pushing into oval window finding the best movement, (vibrates best at apex for this 500 Hz example), IHC gets its stereocilia sheared shortest to tallest (tip links fanning open) potassium rushes in (high in endolymph), depolarizes causing the triggering of calcium to rush in from opening of calcium ion channel ,calcium rushing in causes which causes the neurotransmitter (ligand/chemical) vesicle to rush to the edge of the cell and dumps out onto the synaptic cleft (glutamate). NT binds to receptor sites on CN VIII causing ligand gated ion channels to open and depolarize the cell (excitatory post-synaptic potential).

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18
Q

describe what happens after NT is dumped onto the CN viii

A

stimulated enough starts ap, ap - voltage gated channel opens to allow for sodium to rush in and depolarize spot on cn 8, spot resets itself after absolute and refractory period and is maintained by sodium potassium pump, action potentials move forward to next node etc., process repeats. propagates down cn 8, cn 8 enters cns at cerebellopontine angle synapsing on cn (AVCN, PVCN, DCN)

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19
Q

the actual sensory receptors of hearing

A

IHC

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20
Q

damage causes severe to profound SNHL

A

ihc

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21
Q

1 row in linear pattern

A

ihc

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22
Q

this allows the cell to signal the VIIIth Nerve

A

Hair cells in the cochlea turn mechanical energy of sound waves into a change in membrane potential

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23
Q

what is the role of the efferent system

A

Don’t need them to get outer hair cell motility/ cochlear amplifier
May modify motility or cochlear amplifier.
Reduction in masking
Selective attention
Protection from intense sound
Adjust input to two ears to maintain balance

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24
Q

Not clear why efferent innervation of OHCs affects cochlear responses

A

true

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25
Q

active processing

A

OHCs

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26
Q

passive processing

A

IHC

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27
Q

when is passive processing activated

A

activated with stimulus of 70dBSPL (75 dB) or higher
Likely vibration of the basilar membrane
Not measuring the actual motility (lengthening and shortening) of OHCs

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28
Q

Negative middle ear pressure can affect OAE measurements by

A

reducing amplitudes or entire responses

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29
Q

how does ME pressure affect TEOAEs

A

as little as -35 to -65 daPa can affect

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30
Q

how does ME pressure affecct DPOAEs

A

DPOAEs >-100 daPa or less can affect

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31
Q

worse in ____ frequencies with less effect, if any at _____ frequencies

A

low frequencies (<1000-2000 Hz)
high frequencies

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32
Q

what is not often done clinically with ME pressure

A

Consider adding pressurization to OAE recordings to overcome suboptimal middle ear transfer mechanism

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33
Q

do we still test OAEs with neg me pressure

A

yes may result in reduction of OAE amplitude or be absent

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34
Q

should you do OAEs with perfs

A

yes they can be recorded if ME is otherwise normal

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35
Q

Will the stimulus be strong enough without the vibration of the ™ to get to the inner ear to record an oae?

A

sometimes
varies by individuals

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36
Q

Which frequencies are most affected by a perf or tube?

A

LF

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37
Q

can you still do OAEs with Tympanostomy / Ventilation tubes

A

OAEs may be recorded if there is a patent tube and no active middle ear pathology but the likelihood of OAE presence <50%.

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38
Q

If OAEs are reliably present and, in particular, within the normal region, it can be concluded also that:

A

the tubes are patent,
there can be little or nor middle ear dysfunction, and
Significant cochlear dysfunction is effectively ruled out.

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39
Q

otosclerosis and OAEs

A

OAEs typically not detected at any frequency for any degree of hearing loss though much like immittance presentation may vary slightly based upon stage of disease

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40
Q

Why wouldn’t you have OAEs with otosclerosis

A

with the stiffness, it cannot get through the ME efficiently to stimulate the cochlea and get an OAE

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41
Q

neonatal fluid and OAEs

A

persists in ME space around a day
48hrs after birth, ME usually aerated and ™ mobile

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42
Q

what is mesenchyme? how does it affect OAEs

A

form of connective tissue located between epithelium and bone
fetal ME contains this and it is usually reabsorbed at the end of pregnancy or soon after birth but can persist up to a year after birth

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43
Q

if you see fluid line in ME on otoscopy

A

can run OAE and see

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44
Q

bulging tm that is yellow

A

do not perform OAE

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45
Q

2 clinical advantages of oaes

A

site-specificity of OAEs to auditory dysfunction

high degree of sensitivity specifically to cochlear impairment

46
Q

what is high degree of sensitivity specifically to cochlear impairment

A

Considerable evidence shows that noise or music induced cochlear damage is detectable with OAEs before it becomes apparent in the audiogram

47
Q

what is site-specificity of OAEs to auditory dysfunction

A

is loss purely sensory (cochlear), purely neural (retro) or does it involve sensory and neural structures?
can be answered with OAEs and ABRs

48
Q

why does she hate robust

A

you cannot quantify it

49
Q

what are the differences between diagnostic and screening OAEs

A

you use fewer frequencies with the screening, you get an automatic result, and you went to screen from highs to Lows

50
Q

What are 3 ways OAEs are affected by the efferent system

A

protects cochlea from trauma
improved ability to detect stimuli in background noise
attention

51
Q

how does age affect OAE

A

decrease in OAE amp
abnormal findings in adults should consider aging as a factor

52
Q

why does age change OAEs

A

intensity level and ear canal anatomy

ear canal resonances changes

ME status changes

maturation of efferent function

53
Q

what are non pathological subject factors

A

age, gender, ear differences, noise
noisy rooms, right ears are better, women are better, declines over age

54
Q

how does gender affect OAEs

A

males are less sensitive, lower, and slower responses to signals than females

DPOAE latencies are longer in males

TEOAE amps and reproducibility values are higher in females than males

55
Q

what are 4 factors that may explain the gender differences

A

differences in cochlear length

differences in hearing sensitivity

tinnitus

more SOAEs in females

56
Q

how do ear differences affect OAEs

A

right ear hears better especially for higher frequencies

57
Q

how does noise affect OAEs

A

the success of an OAE measurement and the accuracy of OAE interpretation is highly dependent on noise

58
Q

describe TEOAEs

A

has a probe with 2 ports - one delivers click & other records emission

look for >75% reproducibility

stim between 78 to 83, not exceeding 83-85

min 40-50 sweeps
SNR of >/= 6dB spl

non linear, 800-5000 Hz

59
Q

what does a pass TEOAE mean

A

normal or near normal peripheral hearing for the specified frequency region which pass occurred

hearing is </= 30-35dB

60
Q

if there are present TEOAEs what does the information look like

A

SNR >/= 6dB

75% or > reproducibility

61
Q

what is the stimulus for teoae

A

80 microsecond , brief click

62
Q

what is the fast fourier transform analysis

A

.8-5 kHz

takes the broadband signal that comes back out and puts it into frequency specifics to analyze

63
Q

what is the presentation level of TEOAE

A

80-85dB or 74-83 dB

64
Q

what is reproducibility in TEOAE

A

correlattion

a and b waveforms should approximate 100%

two waves should overlap

65
Q

what relates to lower correlation

A

too much noise or probe fit is incorrect

66
Q

what does the response look like in TEOAE

A

alternating responses are stored in alternating computer memory banks, a and b

want them to overlap

67
Q

describe DPOAEs

A

3 ports in the probe - f1 f1 and recording

2 pure tone stimuli

measures 2f1-f2 (abs amp, dp)

500-8000 Hz

L1 - 55, L2 - 65, L1-L2 = 10 dNB

F2/F1 ratio = 1.22

68
Q

what criteria is a pass DPOAE

A

absolute emission/absolute amp/DP - >/= neg 10
SNR >/= 6dB
can be plotted on dp gram or gorgagram

69
Q

if criteria is met for DPOAE and polotted on gorgagram at normal

A

hearing is better or equal to approximately 15-20 dB HL

70
Q

if criteria is met and did not use a gorgagram

A

hearing is expected to be better than or equal to approximately 25-35 dB HL

71
Q

what does 2f1 - f2 represent

A

DP value

72
Q

if f1 is 2000, what is f2, dp, and where is it plotted at?

A

2000 x 1.22 = 2440 (f2)
2(2000) - 2440 = 1560
DP = 1560
Plotted at 2440 (f2)

73
Q

when plotted on the graph, where is it plotted? why?

A

F2 because it is the main contributor to basilar membrane movement that creates the distortion product from research

74
Q

what is the stimulus of DPOAE

A

2 pure tones

F2 is the higher frequency, F1 is the lower frequency

75
Q

what is the stim intensity of DPOAE

A

L1 = 65
L2 = 55

76
Q

what is the largest dp evoked by tones in humans

A

defiend by 2f1-f2

77
Q

what is the difference between screening and diagnostic OAEs

A

screenings are fast, portable, not as expensive, get an automatic result, screen from highs to lows, fewer frequencies used

diagnostic provide valuable info in assessment and diagnosis

78
Q

diagnostic OAEs provide valuable info in assessment and diagnosis of

A

PT that cannot complete behavioral testing

non organic HL

noise induced HL

ANSD

cochlear vs retro

ototoxic medictation

79
Q

are OAEs a direct measure of hearing

A

no
only tells us the fxn of cochlea’s oHC from which we determine cochlear function
ALMOST direct measure of OHC integrity but not because of ME fxn as a factor in OAEs

80
Q

OAE amp within normal range

A

0-15dB hl

81
Q

OAE amp below normal limits but >6dB above the noise floor

A

15-30dB HL

82
Q

OAEs probably not observed

A

35-50dB HL

83
Q

OAEs are not observed

A

> 50 dB HL

84
Q

OAE outcomes fall in 1 of 3 categories. what are they

A

amp is normal (relative to an appropriate normative region)

amp is abnormal (OAE is present but below normal limits)

no evidence of reliable OAE activity above an acceptable low noise floor (abs)

85
Q

Objective in most applications is to

A

describe cochlear function

86
Q

what are 2 clinical advantages to OAEs

A

site specificity: determine retro vs cochlear or both

cochlear impairment sensitivity: noise/music induced cochlear damage is apparent on OAEs before in an audio

87
Q

abnormal thresholds but normal OAEs could have 3 possibilities

A

pseudohypacousis
retro pathology
pt may superimpose fxnal HL on pre existing sensory impairment

88
Q

what are the clinical applications of OAEs in adults

A

assessment in suspected fxnal hl

tinnitus

noise/music induced

differentiate cochlear vs retro

monitoring ototoxicity

meneire’s disease

89
Q

_____% of retro path had normal OAEs
associated with higher chance of hearing preservation post op

A

20-25

90
Q

how does tinnitus affect OAEs

A

originates in cochlea and cas

cannot conclude that absent OAEs give objective evidence of tinnitus

see present OAEs, but not entirely normal

91
Q

measurable SOAEs are not linked to tinnitus but some PTs tinnitus frequencies coincides with

A

frequencies of the SOAEs

92
Q

how can OAEs help with noise/music induced

A

can provide an early and reliable warning sign of cochlear dysfunction before it shows on the audio

can provide objective confirmation of even mild cochlear dysfunction in PTs with normal audios

93
Q

what are the two patterns of OAEs seen in Meniere’s

A

majority with snesory hL secondary to meniere’s - OAEs are abnormal with HL >/= 25-35 dB - do not expect OAE activity

some have TEOAEs or DPOAEs w/ normal or even greater than expected amplitude values with thresholds exceeding 30 dB HL or up to 60 dB HL

94
Q

what is the crosscheck principle and examples for OAEs

A

a single test may not be accepted or used in a diagnosis of hearing loss until it is confirmed by one or more other measures

behavioral audiometry, immittance, abr

95
Q

why does cunningham hate robust

A

cannot quantify the term

96
Q

what is a gorgagram

A

type of dp gram

goes into hearing levels - normal, borderline, abnormal

plots dp amp as a fxn of f2

97
Q

what is a dp gram

A

plots SNR at F2

nothing about HL

graphs dp as a fxn of stimulus frequency, usually f2

98
Q

can we estimate hearing when we only use a dp gram

A

NO
can only state that HL if passing the criteria is expected to be better than or equal to approx. 25-35 dB HL

99
Q

what is cunningham’s occupation

A

pediatric audiologist
currently clinical and educational audiologist

100
Q

where does cunningham live

A

indiana

101
Q

has been friends with buck for

A

over 30 yrs

102
Q

how long has cunningham taught OAEs

A

20 yrs

103
Q

what is her favorite team

A

colts
peyton manning

104
Q

what animals does cunningham have

A

cats and dogs

105
Q

what is significant about Cunningham’s dog

A

barks at 6:25 when her husband comes home

her and the dog are a certified therapy team and go to libraries and the Peyton Manning Hospital

106
Q

does she have children

A

yes
1 girl and 3 boys

107
Q

where did she get her phd in audiology

A

cincinnati 2000

108
Q

where is cunningham a pediatric audiologist at

A

Deaf and Hard of Hearing Education/Indiana State Department of Health

109
Q

where was her ba from

A

speech and hearing sciences 1991 indiana university

110
Q

where was her masters of audiology from

A

Purdue universityn1993

AUDE 5460 OAEs (3 decks)

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