Exam 2 Flashcards
1
Q
What is the “normal” hearing range in children?
A
-10 to 15
2
Q
What is the “Normal” hearing range in adults?
A
-10 to 25
3
Q
What is the “slight” hearing loss range in children
A
16 to 25
4
Q
The range for mild hearing loss
A
26 to 40
5
Q
The range for moderate hearing loss
A
41 to 55
6
Q
The range for moderately severe hearing loss
A
56 to 70
7
Q
The range for severe hearing loss
A
71 to 90
8
Q
The range for profound hearing loss
A
> 91
9
Q
On an audiogram, this means it is conductive hearing loss
A
Normal bone conduction, impaired air conduction and a greater than 10dB difference
10
Q
On an audiogram, this means it is sensory/neural hearing loss
A
Impaired bone conduction, impaired air conduction and less than or equal to 10 dB difference.
11
Q
On an audiogram, this means it is mixed hearing loss
A
Impaired bone conduction, impaired air conduction and a greater than 10 dB difference.
12
Q
Graphic representation of audiometric findings showing hearing thresholds as a function of frequency
A
Audiogram
13
Q
Generally speaking, what is an audiogram testing?
A
How soft of an intensity at different frequencies can someone just be able to hear
14
Q
List the information that an audiogram provides
A
- Degree of hearing loss
- Type of hearing loss
- Configuration of hearing loss
- Inter-aural symmetry
15
Q
What is inter-aural symmetry?
A
How the ears compare to each other. Is the hearing loss the same or different in each ear? Is it bilateral?
16
Q
To find degree of hearing loss you…
A
Put the earphones on and present various frequencies at various intensities and try and find the softest intensity at a certain frequency a person can hear.
17
Q
The auditory nervous system is primarily a ____ system.
A
Afferent. Away from the Cochlea.
18
Q
The auditory nervous system is _______. Meaning the right ear goes to the left cortex and the left ear goes to the right cortex.
A
Functionally crossed
19
Q
(start of the auditory pathway)
_____ leave the _____ in an ______ and ______ at the _______
A
NEURONS leave the COCHLEA in an ORDERLY FASHION and then SYNAPSE at the LOWER BRAINSTEM
20
Q
(also start of the auditory pathway)
_____ exit the _____ and then move ______ toward the ______
A
NERVE FIBERS exit the COCHLEA and then move CENTRALLY toward the MODIOLUS
21
Q
This is where the cell bodies for the spiral ganglion
A
Modiolus
22
Q
This is the central core of the Cochlea
A
Modiolus
23
Q
After the cell bodies form the spiral ganglion, they then form _______
A
The cochlear branch of the auditory (VIII) nerve
24
Q
Where are the nerve fibers from the apical turn of the cochlea located?
A
The middle of the bundle of the auditory nerve aka CN8
25
Where are the nerve fibers from the basal end of the cochlea located?
On the outside of the bundle of CN8 (The auditory nerve)
26
Why are the nerve fibers from the basal end and the apical end separated?
It keeps low frequency information together and High frequency information together
27
What is tonotopic arrangement?
The spatial representation of the frequency layout of the cochlea in retrocochlear structures
28
The auditory pathway goes from the ______ to the ______
Cochlea; auditory cortex
29
Nerve fibers from the cochlea pass through the ______
Internal Auditory Canal
30
Where does the internal auditory canal begin and terminate?
It begins at the cochlear modiolus and terminates at the base of the brain
31
The nerve fibers of the vestibular portion of the VIII cranial nerve are innervated by
the utricle, saccule, and semicircular canals
32
Other than CN8, what passes through the internal auditory canal?
The facial nerve and the internal auditory artery
33
How many cochlear neurons carry info to the brain?
30,000
34
After passing through the internal auditory canal, where does CN8 attach?
To the brainstem, at the cerebellopontine angle
35
This is where the cerebellum, medulla and pons are located
The cerebellopontine angle
36
CN8 attaches to the cerebellopontine angle, what happens here next?
The auditory and vestibular portions of VIIIth CN separate
37
One part of the cochlear bundle descends to the ______ and the other ascends to the ______
Dorsal cochlear nucleus; ventral cochlear nucleus
38
After separating from the vestibular portion of CN8, all nerve fibers move _____ into the ______
ipsilaterally; cochlear nucleus
39
Nerve fibers may pass from the _________ to the _______
Ventral Cochlear Nucleus; reticular formation
40
This is the center of the brainstem that communicates with just about all areas of the brain.
Considered a primary CNS control center
Reticular formation
41
From the cochlear nuclei, about ___ percent of nerve fibers ___ to the _____ side of the brain to the _____
75%; crossover; contralateral; Superior Olivari Complex
42
What is done in the Superior Olivary Complex?
Sound localization &
| Control of the reflex muscles of the middle ear is regulated here (tensor tympani and stepedial muscles)
43
The point at which the crossover to the superior oliveri complex happens is called the...
Trapezoid body of the pons
44
From the superior oliveri complex, neurons proceed to.....
The lateral lemniscus
45
The lateral lemniscus is a major pathway for...
The transmission of impulses from the lower brainstem
46
This area receives ipsilateral and contralateral impulses from the lateral lemniscus as well as the superior oliveri complex
The inferior colliculus
47
The last subcortical relay station
The medial geniculate
48
After the medial geniculate, impulses ______ in ____ to the _____ in the ______
fan out; auditory radiations ;auditory complex; temporal lobe
49
CCSLIMA is
Cochlea, Cochlear nerve, Superior olivary complex, lateral lemniscus, inferior colliculus, medial geniculate, Auditory complex
50
Where is the primary auditory complex located? What is another name for the area?
Superior surface of the temporal lobe; Heschels gyrus
51
what kind of organization/ representation is seen in the primary auditory complex?
Tonotopic arrangement/ selective representation of frequency
52
Where does processing of speech information occur?
Throughout the central auditory system
53
Primary location for processing speech
left temporal lobe (for most)
54
white matter that connects the left and right hemispheres of the brain
Corpus callosum
55
The dominant ear for processing speech is ____. Why?
The right ear. The left temporal lobe is where speech is processed for most people. Speech information travels contralaterally from the right ear to the left temporal lobe. Information from the left ear has further to go since it will be sent to the right hemisphere then have to travel through the corpus callosum to the left.
56
Explain the efferent system
Parallels the afferent system but in reverse from the brain to the cochlea. Some end at the medial geniculate, some continue on to Inferior colliculate and the lateral lemniscus, Project ipsilaterally and contralaterally. Olivocochlear bundles come from the Superior olivary complex and run down the internal auditory canal and end at the inner and outer hair cells of the organ of corti
57
Processing in the auditory system occurs ___ and ____ the ____ and _____ tracts
up; down; afferent; efferent
58
Vestibular Schwannoma
Neoplasms Usually; unilateral;
Begins in IAC (internal auditory canal) and may grow out into cerebellopontine angle;
Very slow growing
Usually benign
59
What are two early signs of vestibular schwannoma?
Facial numbness
| tinnitus with no hearing loss
60
What are 4 symptoms of vestibular schwannoma?
Facial numbness
Tinitus
HL
Vertigo
61
Name 5 tests for Vestibular schwannoma
```
PET scan
CAT scan
MRI
Basic audiologic test battery
ABR
```
62
What is the go to test for vestibular schwannoma?
ABR
63
What is ABR?
specialized objective test an audiologist would use to look at latency times of CNVIII and relay stations
64
What is used to treat smaller vestibular schwannomas? Larger?
Gamma knife, Cyber knife (3-5 treatments); surgery for larger
65
Inflammation of CNVIII
| HL, some vertigo
Acoustic neuritis
66
Plaque swarm on nerves in your body and slow the transmission down
Can affect CNIII translation of stimuli
Multiple sclerosis
67
Normal outer hair cell function but absent CNVIII responses.
When otoacoustic emissions testing is done there are responses (otoacoustic emissions) but when hearing evaluation is done there is at least moderate HL.
Auditory neuropathy spectrum disorder
68
Bile deposits in the CNS and that includes the cochlear nuculi.
Product of the liver
Results in degeneration of the nerve cells coming in contact with that bile.
Kernicterus
69
Could cause damage to cochlear nuclei
Cerebra vascular accident (stroke)
70
Deprivation of oxygen and blood supply to the cochlear nuclei
Anoxia
71
Syndrome that is linked to learning disabilities
| Mild hearing loss that occurs from chronic OM affects speech and language skills.
Minimal auditory deficiency syndrom
72
Explain Central Auditory Processing Disorder
Difficulty understanding speech when there is background noises present in the environment.
There is no hearing loss.
Not ADHD but could have ADHD along with CAPD
No intellectual difficulties or disabilities.
Delays in speech and language, learning to read, and spelling.
73
What are some risk factors of CAPD?
```
prematurity
History of chronic OM
CMV
Metabolic disorders
Family history
Meningitis
Lime disease
```
74
What are the 4 SCAN screening subtests?
Random Gap Detection
Filtered words
Auditory figure ground subtest
Competing word free recall
75
Scan subtests where there are 2 beeps very close together, ask if they hear 1 or 2. screens for timing/ processing disorders
Random Gap detection
76
monaural test of degraded speech with single syllable words
Filtered words
77
Monosyllabic words are presented within the background noise
Auditory figure ground subtest
78
A different word presented to each ear simultaneously, child instructed to repeat words in any order
Competing word free recall
79
How many sub-tests do they need to not pass in order to continue with test battery?
1
80
different word presented to each ear simultaneously; but child has to say one word first as directed “Repeat the word you hear in the right ear first then the left”
Competing words directed ear
81
2 sentences presented at same time to each ear, instructed to repeat only one sentence depending on which ear is being tested
Competing sentence test
82
60%-time compressed stimulus (20 sentences in the right ear and then 20 sentences in the left ear) then asked to repeat the sentence at a regular rate
Time compressed sentences
83
Recorded test with words repeated multiple times over 15 minutes and every time they hear ”dog” they raise their hand
Auditory continuous performance test
84
Dichotic with words in a sentence being alternated ear to ear “I (left ear) love (right ear) to (left ear) play (right ear) outside (left ear)”
Rapidly alternating speech perception
85
Patient has to respond with the duration descriptions, “long, short, long”, “short, short, long”, “long, short, short”
Duration pattern sequence
86
What are the 2 ways sound can be defined?
psychologically and physically
87
What is the psychological definition of sound?
An auditory experience
88
What is the physical definition of sound?
A series of disturbances of molecules within and propagated through an elastic medium (air, liquid, solid)
89
Sound is a ___ ____ transmitted by ___ ___ through a _____
Sound is a VIBRATORY ENERGY transmitted by PRESSURE WAVES through a MEDIUM
90
Hearing is the _____ of sound
perception
91
What happens when air molecules are set into motion?
They bounce off nearby molecules ten, because of their elasticity, return to their original resting place
92
What is it called when all molecules are pushed closely together?
Condensation (compression)
93
What is it called when all the molecules are spread out?
Rarefaction (spaces between condensation)
94
This is a graphic representation of compression and rarefaction graphed as a function of time
Sine Wave
95
A cycle is...
one complete compression and rarefaction
96
When a variety of frequencies are occurring together
Complex waves
97
What are complex waves?
When a variety of frequencies are occurring together
98
Sound can be characterized by....
its intensity and frequency
99
Related to the perception of loudness
Intensity
100
This is a unit of power
Bel
101
Relative unit of measure of intensity
Decibel (1/10 of a bel)
102
What are the 5 important aspects of decibel?
1. calculation involves a ratio.
2. uses a logarithm
3. it is non-linear
4. Several reference levels which must be specified
5. It is a relative unit of measure
103
What is dB IL?
intensity level
104
What is dB SPL?
Sound pressure level; what we hear in everyday life
105
What is dB HL?
Hearing level
106
When is dB HL used?
Only used when you are talking about hearing evaluations with an audiometer.
107
The human ear is more sensitive to...
Speech Frequencies
108
Why does the audiometer have different intensities?
In the hopes of obtaining a person's threshold
109
What is dB SL?
Sensation level
110
This is related to perception of pitch
Frequency
111
How is frequency measured?
of complete oscillations per unit of time (usually one second)
112
What 2 units are used to measure frequency?
cps or Hz
113
As wavelength ____ , frequency _____.
As wavelength decreases, frequency increases
114
As mass ______ , frequency _____.
As mass increases, frequency decreases.
115
What is considered low frequency in Hz?
below 1000 Hz
116
What is considered "middle of the road" frequency in Hz?
1000Hz
117
What is considered high frequency in Hz?
2000Hz and above
118
What frequency range is speech?
500-2000Hz
119
audiometer
An electronic instrument used to quantify hearing
120
What kind of tone does an audiometer produce?
Pure tone
121
What are the two types of audiometers?
Diagnostic and Screening
122
This type of audiometer can deliver speech signals either recorded or via microphone?
Diagnostic Audiometer
123
This audiometer can produce masking
Diagnostic audiometer
124
What are the 3 main components of audiometers?
Oscillator, Attenuator, and interrupter switch
125
This generates pure tones at specific frequencies in audiometers
Oscillator
126
This controls the intensity level of the signal in audiometers
Attenuator
127
This is what presents and controls the duration of a signal in audiometers
Interrupter Switch
128
Name 3 transducers
Insert earphones, supra-aural earphones, and bone oscillator
129
What is a sound level meter?
An electronic instrument used to measure environmental sound intensity
130
Why would a client require a sound level meter in therapy?
To monitor the intensity of their voice
131
Describe a sound treated room
Free standing units that have no contact with room walls, ceiling and floor. It is not sound proof.
132
What are the types of hearing loss?
Conductive, Sensory/Neural, and mixed.
133
This type of test assumes examiner's hearing is normal and does not provide numerical data
Tuning fork tests
134
This tuning fork test compares tester's hearing to the patient's hearing
Schwabach test
135
This tuning fork test compares the patient's hearing by air conduction to bone conduction
Rinne Test
136
This tuning fork test is based on the occlusion effect
Bing Test
137
This tuning fork test is a test of lateralization
Weber test
138
What is a biologic test?
When you put the earphones on yourself to make sure they are working before putting them on the client
139
What are considered false negative/ positive responses?
Raising hand without hearing sound/ hearing sound without raising hand. Trying to fake it.
140
During testing, what should you consider for the clients reaction time?
Cognition
141
On headphones, what color represents the right ear?
Red
142
On headphones, what color represents the left ear?
Blue
143
When should testing instructions be given?
Prior to earphone placement
144
During testing, should hearing aids be removed?
yes
145
During the testing procedure, what are 2 things you should do before you begin?
Get a case history, Do an otoscopic examination
146
Lowest dB level at which the patient is able to perceive the tone 50% of the time it is presented
Threshold
147
What ear should you start with during testing?
The better ear. If unknown, start with the right ear.
148
What Hz and dB should you begin testing at?
1000Hz with 30dB
149
If there is no response at 1000Hz with 30dB what do you do?
Increase by 10dB
150
If there is a response at 1000Hz with 30dB what do you do?
Decrease by 10dB
151
If there was a response at 1000Hz with 30dB and you then decreased by 10dB but there was no response what do you do?
increase by 5dB
152
During testing, how long should you continue the "bracketing procedure"?
Until you have a response at the same dB 2 out of 3 tries
153
This is an example of threshold testing
Present 1000Hz to Right ear at 30dB, response, decrease by 10*
Present at 20dB, no response, increase by 5
Present at 25dB, no response, increase by 5
Present at 30dB, response, decrease by 10**
Present at 20dB, no response, increase by 5
Present at 25dB, no response, increase by 5
Present at 30dB, response***
30dB is threshold at 1000Hz, Right ear
154
What symbol represents right ear air conduction on an audiogram?
O
155
What symbol represents left ear air conduction on an audiogram?
X
156
Define audiogram
A graphic representation of audiometric findings showing hearing thresholds as a function of frequency
157
I a pure tone easier to hear as a pulse or at a steady state?
A pulse
158
What is SRT?
Speech recognition threshold
159
What is PTA?
Pure tone average
160
How do you calculate PTA?
500, 1000, and 2000Hz averaged
161
What is calculating PTA useful?
It is useful for predicting SRT
162
This is determined by Air conduction thresholds
Degree of hearing loss
163
This part of testing can describe the entire auditory system (outer, middle and inner ears)
Thresholds by Air conduction
164
What is air conduction testing?
Signal is presented through the air via the earphones
165
This is determined by bone conduction testing
type of hearing loss
166
What is the occlusion effect?
Enhancement of low frequency sound when the ear is covered
167
Where is a bone oscillator placed?
Mastoid or forehead. Cannot be touching pinna.
168
Is the activation of the cochleas separate or simultaneous during bone conduction testing?
When you stimulate the skull via bone conduction, both cochleas are activated simultaneously
169
This type of conduction has acoustic separation
Air conduction
170
This type of conduction lacks acoustic separation
Bone conduction
171
What 3 ways does hearing by bone conduction occur? Are they happening all at once or just one at a time?
1. Inertial BC
2. Distortional BC
3. Osseotympanic BC
All 3 happen not just 1
172
When the bones of the skull vibrate/move and they cause air in the EAC to vibrate. Some of those sound waves/ vibrations will move out of the EAC and some will move down the EAC and hit the TM.
What type of bone conduction is this?
Osseotympanic BC
173
When the bones of the skull become distorted as the bones of the skull are vibrating and this causes the inner ear structures to become distorted in the same way as they are stimulated via air conducted sounds.
What type of bone conduction is this?
Distortional BC
174
When the ossicular chain, owing to its inertia, lags behind so that the stapes moves in and out of the oval window into the cochlea.
What type of bone conduction is this?
Inertial BC
175
Describe conductive hearing loss
outer and middle issues: ex. too much wax, otosclerosis, otitis media, canal atresia; usually medically treatable
176
Describe sensory neural hearing loss
Inner ear and beyond; outer hair cells, inner hair cells, leak in fluid, nerve damage.
Usually not medically treatable.
177
Name 3 types of ear phones
supra aural, circum aural, and insert
178
how often does a diagnostic audiometer require calibration?
annually
179
Describe infection control procedures for a test environment
wipe off everything with an appropriate disinfectant. Not alcohol because it will dry out cushions
There is a fan/vent to circulate air
Disposable tips- one set per person
180
How does bone conduction testing work?
it stimulates the cochlea by bypassing the outer and middle ear
181
What does an audiometer do?
Produces Pure tones, attenuates (vary the level of intensity) them, delivers them to various transducers
Consistent so you can actually quantify a persons hearing
