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SHS 450 > exam 2 > Flashcards

exam 2 Flashcards

1
Q

what is a nucleus and what can they do

A 
nucleus can:
-send projections to more than one place
(to one or more other nuclei)
-receive projections from more than one place
(from one or more other nuclei)
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2
Q

auditory cortex

A

-transverse temporal gyrus of Heschl

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3
Q

brainstem structures

A
  • medial geniculate body
  • *thalamus underneath
  • inferior colliculus
  • *midbrain
  • lateral lemniscus
  • *pons
  • superior olivary complex
  • cochlear nucleus
  • *medulla
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4
Q

middle ear muscles and innervation

A
  • tensor tympani
  • trigeminal CN V
  • stapedius
  • facial CN VII
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5
Q

specificity and sensitivity of behavioral site of lesion tests is

A

not always high

**absent in todays audiology

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6
Q

acoustic immittance

A
  • have become routine as pure tone and speech audiometry
  • guides the diagnostic audiologist in identifying abnormalities in the auditory system
  • procedure is basic to the test battery

**impedance + admittance

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7
Q

acoustic impedance

A
  • in plane of TM

- variety of impedance meters used today

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8
Q

compliance

A

related to dimensions of an enclosed volume of air as expressed on a scale of different units of measurement

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9
Q

immittance

A

used as an all-encompassing term to describe measurements made of tympanic membrane impedance, compliance or admittance

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10
Q

three measurements made on acoustic immittance meters

A
  • static acoustic compliance
  • tympanometry
  • acoustic reflex
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11
Q

static acoustic compliance

A
  • static acoustic admittance
  • the mobility of the membrane as a function of various amounts of positive and negative air pressure in the external ear canal
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12
Q

tympanometry

A

a procedure in acoustic immittance testing which measures the ease which sound flows through the tympanic membrane while air pressure against the membrane is varied
-the purpose is to determine the point of maximum compliance of the eardrum membrane

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13
Q

acoustic reflex

A

-contractions of the ME in response to intense sounds which has the effect of stiffening the ME system and decreasing its static acoustic compliance

decreased mobility - decreasing compliance - increasing impedance

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14
Q

procedure for SAC

A
  • first clear ear canal of all debris
  • ear tip pressed with tight seal and positive pressure increased with air pump
  • once seal is obtained pressure increased to +200 daPa
  • next decrease pressure in external ear canal until TM reaches maximum compliance = when pressure on both sides of membrane are approximately equal and eardrum is most mobile
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15
Q

c1

A

first measurement, made with the TM immobilized by positive air pressure and represents compliance of outer ear

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16
Q

c2

A

reading taken at maximum compliance which represents SAC of OE and ME combined

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17
Q

cx(ME)

A

c2(EAC+ME) - c1(EAC)

*to cancel out compliance

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18
Q

normal compliance range

A

0.28 - 2.25cm3

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19
Q

maximum compliance for normal ears

A

0 daPa

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20
Q

high compliance

A

flexible, extra mobile, interruption in chain of bones, or abnormal elasticity of TM

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21
Q

low compliance

A

change in stiffness, mass, resistance of ME, fluid accumulation, immobilized osciles

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22
Q

SAC is the

A
  • weakest in terms of clinical value

- because of overlap in static compliance between normal and pathologic ME

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23
Q

tympanogram

A

a graph showing compliance, impedance, of the ME as a function of air pressure against the TM

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24
Q

tympanometry procedure

A
  • *purpose is to determine the point and magnitude of greatest compliance of the TM
  • obtain air tight seal
  • introduce +200 daPa of air pressure into external auditory canal
  • take compliance reading
  • gradually decrease the air pressure and take successive measurements of compliance as the air pressure is reduced
  • decrease air pressure until at least -200 daPa
  • plot these readings on a tympanogram
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25
Q

type A

A
  • represents normal middle ear function
  • pressure peak near 0 daPA and -/+ 100 daPa
  • normal static compliance
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26
Q

type As

A
  • same peak in normal range
  • low compliance represents a stiff middle ear system
  • pressure peak much shallower
  • stapes immobilization, otosclerosis
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27
Q

type Ad

A
  • same peak in normal range
  • high compliance
  • eardrum in very mobile represents a hypermobile eardrum or middle ear system
  • amplitude of curve is very high
  • flaccidity of TM or separation of the chain of the ME bones
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28
Q

type B

A
  • ME pressure not normal
  • no visible peak
  • no point of maximum compliance
  • very stiff middle ear system
  • fluid in ME
  • earwax or debris occlude ear canal or probe
  • tiny hole in TM
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29
Q

type C

A
  • pressure in the ME falls below normal
  • TM becomes most compliant when the pressure in the ear canal is negative thus equaling ME pressure
  • when maximum compliance occurs it is beyond -100 daPa
  • problem in ET
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30
Q

tympanograms of people with normal hearing loss might be identical to people with

A

sensory/neural hearing loss

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31
Q

acoustic reflex

A

contraction of one or both of the intra-aural middle ear muscles in response to a loud sound creating an increase in stiffness of the ME system (change in compliance)

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32
Q

intra-aural muscle reflex

A

most normal hearing individuals demonstrate this bilaterally when pure tones are introduced to either ear at 85 or 100 dB SPL

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33
Q

acoustic reflex threshold

A

the lowest intensity at which a stimulus can produce acoustic reflex

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34
Q

reflex activating stimulus

A

RAS

  • signal used to produce acoustic reflex
  • any kind of sound from a pure tone to a noise band
  • 500 - 4000 Hz
  • 70-100 dB SPL
  • no higher than 115 dB SPL
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35
Q

within normal limits

A

70 - 100 dB HL/SL

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36
Q

cochlear loss

A

20-60 dB SL

-reduced SL

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37
Q

pseudohypacusis

A
  • faker, no hearing loss

- below 10 dB SPL

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38
Q

absent reflex

A

indicitive of a conductive component, severe to profound sensorineural involvement, or absence of stapedius muscle

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39
Q

elevated reflex

>100 dB HL

A

possible minimal conductive componant or sensorineural involvement
-possible sign of VIII nerve lesion

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40
Q

characteristics of acoustic reflex

A
  • individual variability in amplitude of acoustic reflexes
  • tend to last for duration of stimulus
  • latency period between presentation of the stimulus and reaction of muscles
  • 3-10 msec for high
  • 100 msec for low
  • on and off responses observed
  • acoustic reflexes show relatively little adaptation
  • as stimulus intensity increases, the amplitude of the acoustic reflex increases up to a maximum contraction at 15-20 dB above ART
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41
Q

R -normal hearing

L - normal hearing

A

contralateral - present at normal SL

ipsilateral - present at normal SL

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42
Q

R - normal hearing

L - conductive HL

A

R contralateral - absent
L ipsilateral - absent

L contralateral - absent or present at high SL
R ipsilateral - present at normal SL

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43
Q

R - conductive HL

L - conductive HL

A

contralateral - absent

ipsilateral - absent

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44
Q

R ipsilateral

L contralateral

A

phone left

probe right

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45
Q

R contralateral

L ipsilateral

A

phone right

probe left

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46
Q

R - normal hearing

L - cochlear HL (mild to moderate)

A

R contralateral - present at normal SL
L ipsilateral - present at low SL

R ipsilateral - present at normal SL
L contralateral - present at low SL

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47
Q

R - cochlear HL (mild to moderate)

L - cochlear HL (mild to moderate)

A

contralateral - present at low SL

ipsilateral - present at low SL

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48
Q

R - cochlear HL (severe)

L - cochlear HL (severe)

A

contralateral - absent

ipsilateral - absent

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49
Q

R - VIII (AN) HL (mild to moderate)

L - normal hearing

A

R contralateral - absent or present at high SL
L ipsilateral - present at normal SL

R ipsilateral - absent or present at high HL
L contralateral - present at normal SL

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50
Q

R - normal hearing
L - normal hearing
(brain stem lesion)

A

R contralateral - present at normal SL
L Ipsilateral present at normal SL

R ipsilateral - present at normal SL
L contralateral - absent

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51
Q

R - normal hearing
(cortical lesion)
L - normal hearing

A

R contralateral - absent
L ipsilateral - present at normal SL

R ipsilateral - present at normal SL
L contralateral - absent

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52
Q

if there is a disorder/lesion about acoustic reflex arc

A

reflex will appear normal

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53
Q

R normal hearing
(VII nerve pathology)
L normal hearing

A

R contralateral - present at normal SL
L ipsilateral - present at normal SL

R ipsilateral - absent
L contralateral - absent

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54
Q

acoustic reflex decay

A

with constant tone, stapedius muscle will gradually relax following contraction to a loud sound

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55
Q

loudness growth

A

normal steady rise of loudness vs. intensity

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56
Q

loudness recruitment

A

-very rapid and quicker than normal loudness growth

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57
Q

loudness decruitment

A

slower than normal increase in the loudness of a signal as intensity is increased

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58
Q

ABLB test

A

alternate binaural loudness balance

  • best way to test for loudness recruitment in patiesnt with unilateral hearing loss
  • compare increase in loudness in normal ear to increase in loudness in abnormal ear
  • *rarely used today
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59
Q

patients with lesions in cochlea

A

are able to detect extrememly small changes in intensity

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60
Q

SISI

A

short increment sensitivity index

  • test ability of patient to detect the presence of a 1 dB increment superimposed on a continuous tone presented at 20 dB SL
  • patients with cochlear lesions can detect and get scores close to 100
  • *patients with retrocochlear and conductive hearing loss as well as normal hearing get scores close to 0

rarely performed

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61
Q

tone decay

A
  • tones that are sustained above a threshold fade rapidly to inaudibilty in those with cochlear lesion
  • no tone decay in normal and conductive hearing loss
  • lesions in auditory nerve show dramatic tone decay at all frequencies
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62
Q

AEPs

A

electrical potentials or activity caused by a signal

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63
Q

electrodes

A

electrical activity evoked by sound is picked up by electrodes

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64
Q

non-inverting (active) electrode

A

p/u signal + noise

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65
Q

inverting (reference) electrode

A

ideally p/u noise only

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66
Q

latency

A

-time period that elapses between the introduction of a stimulus and the occurrence of the response

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67
Q

amplitude

A

the strength, or magnitude of the AEP

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68
Q

EcochG

A

electrocochleography

  • procedure for measuring electrical responses from the cochlea of the inner ear
  • primary use is diagnosis and monitering of conditions of inner ear
  • 2-3 milliseconds
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69
Q

AMLR

A

AEP occurring from 10-100 milliseconds in latency

  • originates in the cortex
  • low frequencies
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70
Q

LER/ALR

A
  • auditory late responses, cortical auditory evoked potentials
  • occur between >100 milliseconds and presumably arise in cortex
  • stimulus can be speech or tones
  • identify upper brain lesions
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71
Q

P300/EPR

A

auditory event related potentials

  • 300 miliseconds
  • involve association areas of the brain
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72
Q

SOAEs

A

spontaneous otoacoustic emissions

  • produced without any acoustic stimulation
  • not all people have SOAEs
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73
Q

evoked OAEs

A
  • produced following some acoustic stimulation
  • most people with normally functioning cochleas have evoked OAEs
  • 3 ways to measure
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74
Q

TEOAEs

A

transiently evoked OAEs
-stimulus: brief click
normal response: broadband emission
-signal emenate from cochlea 5-20 msec after sound received

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75
Q

DPOAEs

A
  • used in clinic
  • stimulus: brief simultaneous presentation of 2 pure-tones
  • normal response: emission at the frequency of the distortion product of the presented tones
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76
Q

pinna

A 
auricle
-helix
-antihelix
-concha
-tragus
lobule
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77
Q

osseo cartilaginous junction

A

-pinna
-auditory canal
-tympanic membrane
-2/3 cartilage
where cartilage meets bone is junction

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78
Q

tympanic membrane

A
  • pars flaccida
  • pars tensa
  • umbo
  • cone of light
  • healthy
  • pearly white
  • semi-transparent
  • cone of light
  • cone shaped
79
Q

microtia

A
  • ears of very small size
  • with normal canal, unlikely to be associated with hearing loss
  • twice as frequent in males as in females
80
Q

anotia

A
  • no ear

- rare congenital deformity characterized by total absense of pinna

81
Q

atresia

A
  • entirety of external auditory ear canal never formed
  • congenital abnormality
  • may occur in one or both ears
  • may occur alone or with other issues
  • *often associated with microtia
82
Q

macrotia

A

-outstanding pinna

83
Q

stenosis

A
  • collapsed canal
  • narrowing of a EAM
  • easily becomes impacted with cerumen
  • can lead to conductive loss if lumen clogged
84
Q

external otitis

A

cysts and tumors
-infection that occurs in the skin of the EAC
“swimmers ear”
-water trapped in ear or fungus

85
Q

myringitis

A
  • inflammations of the TM

- blood blisters on surface of TM

86
Q

osteoma

A
  • bony or cartilage tumor in the ear canal
  • do not cause hearing problem unless growth is larger than lumen of canal and conductive hearing loss results
  • may result in serious infection of EAC
87
Q

perforation of TM

A
  • excessive pressure buildup
  • response to infection
  • direct trauma
  • pressure from explosion
  • traumatic perforations show better spontaneous closure
  • place cigarette paper over to help close
  • easy to retear
88
Q

myringoplasty

A
  • surgical repair of a perforated TM
  • vein grafts, not skin grafts
  • *prefer to use fascia
89
Q

tympanosclerosis

A
  • TM becomes thickened and scarred
  • deposits of calcium
  • response to infection
  • disorders of ME
  • sometimes hearing loss
  • stiffening effect
  • do not respond well to treatment
90
Q

pinnaplasty

A

reconstruction of pinna

-repair with rib cartilage grafts

91
Q

negative pressure

A

retraction of TM

-colds, allergies, sinus infection

92
Q

barotrauma

A

-sudden changes in air pressure as in flying, or diving

93
Q

chloesteatoma

A
  • disease in which skin cells/debris collect & grow in ME cavity
  • epidermal cyst
  • keratin protein mixed with squamous epithelium and fats such as chlosteral
  • best treatment is surgery
  • otorrhea - foul smelling discharge
  • elevated AC levels
  • acquired
  • ET dysfunction
  • recurrent
94
Q

necrosis

A
  • death of the mucosa, submucosa and TM

- if condition furthers TM may rupture

95
Q

otosclerosis

A
  • common cause of hearing loss
  • hereditary in 70% of all cases
  • more common in women
  • progressive disorder causing conductive hearing loss
  • otospongiosis
  • immobilizing stapes footplate fixing to oval window
  • tinnitus
  • ear discomfort
  • bone conduction loss
96
Q

schwartze sign

A

-rosy glow seen through TM

97
Q

paracusis willisii

A

speech is easier to understand in presence of background noise

98
Q

disarticulation of the ossicles

A
  • common cause is trauma
  • subluxation - partial dislocation
  • conductive hearing loss
  • mild
99
Q

tympanoplasty

A
  • surgical reconstruction of ME
  • myringoplasty
  • attach ossicles together
  • improvement varies
  • dependent on ET
100
Q

Pressure equalizing tube

A
  • inserted through incision in TM to normalize ME pressure
  • remain for several weeks to several months
  • used with fluid pressure
  • new tubes can stay in place permanently
  • successful
101
Q

myringotomy

A

-incision in TM to suction and remove fluid and relieve fluid pressure

102
Q

stapedectomy

A
  • success rate - 90-95%

- removal of the stapes

103
Q

impedance componants

A
  • frictional resistance
  • reactance - mass & stiffness
  • frequency
104
Q

equivalent ear canal volume

A

estimate of volume of air between probe tip & TM

105
Q

PB max and PBmin

A

phonetically balanced

106
Q

retrocochlear hearing loss

A

decline in word recognition as levels get louder

107
Q

normal rollover ratio

A

0.0 - 0.44

108
Q

retrocochlear

A

0.45-1.0

109
Q

rollover ratio

A

PBmax-PBmin/PBmax

110
Q

purpose of behavior site of lesion

A

locate the lesion

111
Q

anterior ligament

A

attached to head of malleus

112
Q

posterior ligament

A

short process of incus

113
Q

exotoses

A

many bony growths need to be removed

114
Q

I

A

distal portion of AN

115
Q

II

A

proximal portion of AN

116
Q

III

A

CN

117
Q

IV

A

SOC

118
Q

V

A

lateral lemiscus

119
Q

ABR threshold

A

lowest intensity for ABR V to show

120
Q

lesion in retrocochlear

A

no waves
prolonged wave V
or long interpeak latencies

121
Q

VII nerve tumor

A

peaks after wave I absent or delayed

122
Q

stacked ABR

A
  • uses amplitudes
  • neural response strength
  • easier to identify tumors
  • uses high pass
  • division of ABR into 5 frequency bands
123
Q

ASSR

A

auditory steady state resposnse

  • no neural generator
  • stimulus AM/FM
  • focus on frequency and latency
  • children
  • stimuli that are most frequency specific may be used to obtain thresholds
124
Q

intraoperative monitering

A

-when under surgery do AEP

125
Q

inner hair cells

A

3500

  • pear shaped
  • dont move
  • limited stimulation w/out outer hair cells
  • 1:1 innervation
  • u shaped formation
126
Q

outer hair cells

A

12000

  • long and skinny
  • sharpening wave
  • enhance reception of sound
  • 1:10 innervation
  • v shaped
127
Q

possible failure

A

-vernix can block canal

128
Q

limitations

A
  • conductive hearing loss

- interpreted with caution

129
Q

normal hearing

A

-10 - 15 dB

130
Q

slight hearing loss

A

16-25 dB

-possibly hearing aid in children

131
Q

mild hearing loss

A

26-40

-possible aid in adults, definite in children

132
Q

moderate hearing loss

A

41-55 dB

-hearing aid

133
Q

moderately severe

A

57 - 70 dB

-hearing aid

134
Q

severe hearing loss

A

71-90 dB

-hearing aid

135
Q

profound hearing loss

A

> 91 dB

-cochlear implant

136
Q

impedance

A

the opposition to sound wave transmission

  • more dense object opposing greater impedance
  • as mass and frequency increase, stiffness decreases
137
Q

immittance instrumentation

A
  • earphone
  • computer
  • probe - loudspeaker, air pump, microphone
138
Q

purpose of immitance tests

A

tell if ME is functioning properly, and if not show how

139
Q

AEP basic equipment

A
  • elctrodes
  • electrode box
  • stimulus generator
  • amplifiers
  • signal averaging computer
  • filters
  • oscilloscope
  • plotter
  • disk storage
140
Q

electrode impedance

A
  • low balanced impedance

- below 5K ohms

141
Q

band pass filter settings

A

-30 or 100 Hz - 3000 Hz

142
Q

normal response occurs

A

5-6 msecs after stimulus

143
Q

stimulus

A

-brief click

144
Q

AEP measures reveal

A
  • lesions, tumors, or impairment in AN or brainstem

- measures neuroelectric events that occur once and after sound hits cochlea

145
Q

signal averaging

A

because AEPs are embedded in EEGs

146
Q

signal vs noise

A

signal - stimulus response

noise - unwanted electrical activity

147
Q

ABR abnormal if

A
  • interpeak intervals prolonged
  • wave latency is significantly different between ears
  • amplitude ratios are abnormal
  • wave V is abnormally prolonged or disappers
148
Q

latency vs intensity

A

as intensity increases latency decreases

149
Q

clinical applications of ABR

A
  • newborn auditory screenings
  • estimation of auditory sensitivity in young or difficult to test patients
  • diagnosis of AN or brainstem dysfunction
  • intraoperative monitering
  • ICU
150
Q

clinical limitations of ABR

A
  • click only estimates 1000-4000 Hz

- ABR is not test of hearing

151
Q

ABR parameters influenced by

A
  • age
  • gender
  • body temp
152
Q

who discovered OAE

A

-kemp

153
Q

DP

A

2F1 - f2

154
Q

DP gram

A

x - frequency
y - sound level dB SPL
-shows cochlear function

155
Q

function of ME

A
  • carries sound from OE to IE

- match impedance of air in external auditory canal to impedance of fluid in the inner ear

156
Q

chorda tympani

A
  • branch of facial nerve in ME
  • often in way in surgery
  • carries taste sensation
  • when cut taste changes recovers after several months
157
Q

parts of ME

A
  • malleus
  • incus
  • stapes
  • oval window
  • promontory
  • round window
158
Q

joints of ossicles

A

malleoinductal

inductostapedial

159
Q

eustachian tube

A

connects ME to back of throat
opens in nasopharynx
-malfunction can lead to negative pressure in ME and infection

160
Q

impedance mismatch

A
  • larger TM to 17 times smaller oval sindow
  • able to put 23 times more pressure on than sound alone would do
  • value is 30 dB
  • almost exactly 28 dB loss of air to fluid impedance mismatch
161
Q

eustachian tube in adults and children

A
  • children horizontal and shorter

- adults down at 45 degrees and longer

162
Q

otalgia

A

pain in ear

162
Q

otalgia

A

pain in ear

163
Q

otorrhea

A

dischare

163
Q

otorrhea

A

dischare

164
Q

superior olivary complex

A

located on pons

-receives input from cochlear nuclei

164
Q

superior olivary complex

A

located on pons

-receives input from cochlear nuclei

165
Q

cochlear nuclei

A
  • on pons
  • lowest
  • AN fibers terminate on cochlear nuclei
165
Q

cochlear nuclei

A
  • on pons
  • lowest
  • AN fibers terminate on cochlear nuclei
166
Q

medulla

A
  • cochlear nuclei
  • SOC
  • lateral lemniscus
166
Q

medulla

A
  • cochlear nuclei
  • SOC
  • lateral lemniscus
167
Q

lateral lemniscus

A
  • major pathway for transmission of impulses of ipsilateral lower brainstem
  • from SOC to inferior colliculus
167
Q

lateral lemniscus

A
  • major pathway for transmission of impulses of ipsilateral lower brainstem
  • from SOC to inferior colliculus
168
Q

inferior colliculus

A
  • midbrain
  • receives stimulation from both SOC
  • neurons connect to medial geniculate body
168
Q

inferior colliculus

A
  • midbrain
  • receives stimulation from both SOC
  • neurons connect to medial geniculate body
169
Q

medial geniculate body

A

-thalamus

169
Q

medial geniculate body

A

-thalamus

170
Q

otalgia

A

pain in ear

171
Q

otorrhea

A

dischare

172
Q

superior olivary complex

A

located on pons

-receives input from cochlear nuclei

173
Q

cochlear nuclei

A
  • on pons
  • lowest
  • AN fibers terminate on cochlear nuclei
174
Q

medulla

A
  • cochlear nuclei
  • SOC
  • lateral lemniscus
175
Q

lateral lemniscus

A
  • major pathway for transmission of impulses of ipsilateral lower brainstem
  • from SOC to inferior colliculus
176
Q

inferior colliculus

A
  • midbrain
  • receives stimulation from both SOC
  • neurons connect to medial geniculate body
177
Q

medial geniculate body

A

-thalamus

178
Q

otalgia

A

pain in ear

179
Q

otorrhea

A

dischare

180
Q

superior olivary complex

A

located on pons

-receives input from cochlear nuclei

181
Q

cochlear nuclei

A
  • on pons
  • lowest
  • AN fibers terminate on cochlear nuclei
182
Q

medulla

A
  • cochlear nuclei
  • SOC
  • lateral lemniscus
183
Q

lateral lemniscus

A
  • major pathway for transmission of impulses of ipsilateral lower brainstem
  • from SOC to inferior colliculus
184
Q

inferior colliculus

A
  • midbrain
  • receives stimulation from both SOC
  • neurons connect to medial geniculate body
185
Q

medial geniculate body

A

-thalamus

SHS 450 (2 decks)

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