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hearing tests & measures > exam 3 > Flashcards

exam 3 Flashcards

1
Q

what detects linear acceleration

A

utricle and sacule

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2
Q

saccule

A

detects vertical linear acceleration

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3
Q

utricle

A

detects horizontal linear acceleration

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4
Q

superior/anterior semicircular canal

A

sideways rotational acceleration

(doing a cartwheel, holding phone between ear and shoulder)

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5
Q

posterior semicircular canal

A

front or back rotational acceleration (backflip/forward roll)

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6
Q

horizontal semicircular canal

A

horizontal rotational acceleration
(turning head, spinning in an office chair)

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7
Q

what surrounds the vestibular system

A

it is surrounded by a membran that has perilymph around it and then bone

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8
Q

balance disorder symptoms

which are always present, and which are sometimes

A
  • vertigo (always present in vestibular disorders)
  • nystagmus (usually present in vestibular disorders)
  • anxiety
  • rapid heard rate
  • nausea & vomiting
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9
Q

what are the vestibular disorders

A
  • BPPV (benign paroxysmal positional vertigo)
  • vestibular neuritis
  • labyrinthitis
  • meniere’s disease
  • perilymph fistual
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10
Q

BPPV (benign paroxysmal positional vertigo)

(cause, symptoms, HL?)

A
  • cause: dislodged otolith in the semicircular canals
  • symptoms: brief attacks of intense vertigo with changes in head position
  • hl?: nope
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11
Q

vestibular neuritis

(cause, symptoms, HL?)

A

cause: inflammation of vestibular nerve
symptoms: veritgo or dizziness
hl?: nope

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12
Q

labyrinthitis

(cause, symptoms, HL?)

A

cause: viral inner ear infection affecting both branches of VIII nerve
symptoms: vertigo and dizziness
hl?: usually

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13
Q

meniere’s disease

(cause, symptoms, HL?)

A

cause: excessive endolymph (endolymphatic hydrops)
symptoms: episodes of vertigo, nausea
hl?: roaring tinnitus, aural fullness, yes hl (starting especially in lower frequencies, unilateral)

  • hearing loss is fluctuating and progressive, with very poor word recognition
  • attacks become more severe and hearing continues to get worse (doesn’t return to baseline)
    - reissner’s membrane will tear and that causes an attack (can last hours to days)
    - it will eventually flatten out to moderate/severe SN HL
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14
Q

treatment options for meniere’s disease

A
  • low salt diet
  • low caffeine
  • and surgery to drain excessive endolymph with a shunt
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15
Q

perilymph fistual

(cause, symptoms, HL?)

A

cause: leakage of perilymph from inner ear, usually due to trauma
symptoms: vertigo
hl?: yep

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16
Q

how to treat vestibular disorder for those who have permanent damage to the vestibular system

A

**VRT: **vestibular rehabilitation therapy-> performed by specially trained occupational and physical therapists, some audiologists
- goals of VRT:
- speed up central compensation
- improve functional balance
- decrease intensity of dizzy episodes
- includes balance activities and eye movement exercises

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17
Q

what is the helicotrema

A

where the scala tympani and vestibuli meet

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18
Q

can you imagine where all these structures are?

A
  • outer hair cells
  • tectorial membrane
  • basilar membrane
  • 8th nerve fibers
  • osseous spiral lamina
  • inner hair cells
  • scala vestibuli and tympani
  • spiral limbus
  • osseous spiral lamina
  • stria vascularis
  • spiral ligament
  • reissner’s membrane
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19
Q

inner hair cells structure

A
  • flask shaped
  • afferent (going away from cells- towards brain)
  • ~3,500 in one row (we have 1 row)
  • modiolar side of organ of corti
  • ratio of 1 nerve fiber per IHC
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20
Q

outer hair cells structure

A
  • cylindrical
  • direct afferent and efferent innervation (more efferent though)
  • 3 rows, 12,000 OHC total
  • ratio of many nerve fibers to each outer hair cell (and the nerves innervate more than 1 outer hair cell themselves)
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21
Q

what are the functions of the cochlea

A

transduction & frequency analysis

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22
Q

cochlear transduction

A

converts mechanical energy to nerual information
- basilar membran motion
- tectorial membrane motion shears stereoiclia of OHC
- motility of OHCs expand and contract–> enhances motion of basilar and tectorial membrane creating the cochlear amplifier
- shearing of IHCs

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23
Q

frequency analysis

(as a cochlear function)

A

tonotopic organization
- place coding: basilar membrane (high freq @ base, low freq @ apex); hair cells; nerve fibers

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24
Q

what are the 3 hereditary syndromes that can affect the inner ear

(that we talked about)

A
  • usher syndrome (3 types)
  • waardenburg syndrome
  • branchial-oto-renal (BOR) syndrome
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25
Q

usher syndrome

A
  • autosomal recessive inheritance (both parents have to have a mutated gene, but neither has the disorder [carriers], child has to recieve a gene from both parents)
  • 3 types: hearing loss is greatest in 1 and least in 3
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26
Q

type one usher syndrome

A
  • profound deafness in both ears at birth
  • severe balance problems at birth
  • problems with vision typically begin in early childhood
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27
Q

type two usher syndrome

A
  • hearing loss varies form moderate to sever at the time of birth
  • do not usually encounter vision problems until teenage years
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28
Q

type three usher syndrome

A
  • born with normal hearing and balance
  • don’t encounter problems until puberty
  • vision problems are common and progressive
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29
Q

waardenburg syndrome

A
  • sensorineural hearing loss
  • unusual pigmentation patterns (eyes: 2 different colors, or very bright blue) (hair: white forelock; premature graying)
  • distinctive facial structure: eyes appear farther apart than normal
  • extremely variabel expression
  • genetic type: autosomal dominant
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30
Q

branchial-oto-renal (BOR) syndrome

A

symptoms:
- ear malformations (preauricular pits & tags common)
- cysts in the neck
- hearing loss (type and degree vary)
- kidney malformations (usually not problematic)

characterized by variabe expression
- patients vary in which symptoms occur, how severe

autosomal dominant inheritance
- if you get the mutated gene from one parent you will have it

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31
Q

prenatal congenital hearing loss causes

A

passed from the mother before baby is born (but not genes)
- rh incompatibility
- prenatal viral infections (TORCH)

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32
Q

what is TORCH

A

a group of diseases that cause congenital conditions if a baby is exposed to them during gestation
- Toxoplasmosis (undercooked meat and cat feces)
- Other (syphilis, chicken pox, HIV, fifth disease)
- Rubella (most have had vaccine)
- Cytomegalovirus (CMV-> if you get it for the first time when you are pregnant)
- Herpes simplex

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33
Q

perinatal congenital hearing loss causes

A
  • anoxia (baby deprived of oxygen; damages cochlea and central nervous system-cns)
  • toxemia (mother has severe high blood pressure; restricts blood flow to the baby)
  • premature birth (often goes with toxemia)
  • head trauma
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34
Q

what are later causes of inner ear disorders

A
  • presbycusis and noise induced are the two most common
  • infections (viral infections or meningitis)
  • ototoxicity (on audiogram-> steep dip at very high frequencies)
  • sudden hearing loss (considered a medical emergency)
  • meniere’s disease
  • temporal bone fractures
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35
Q

presbycusis

pathologies; audiogram; etc

A

hearing loss due to aging (2 underlying pathologies)
- loss of hair cells
- deterioration of the stria vascularis

  • more prevalent in men than in women
    audiogram
  • sloping high-frequency sensorineural hearing loss
  • gradual onset and progression (more rapid in men)
  • difficulty understanding speech in noise
36
Q

viral infections that can cause hearing loss

A

(vaccines for these)
- measles (rubeola)
- mumps
- chicken pox

37
Q

meningitis

A

infection of the lining of the brain
- can be a complication of otitis media
- infection can spread to the labyrinth through round or oval window and destroy the membranous structures
- —–can ossify the cochlea (need to get an implant before that)
- hearing loss occurs in 20% of cases

38
Q

recruitment

definition and cause

A

abnormal growth of louness of hearing
- the perceptual phenomenon of sounds becoming rapidly louder with increasing sound level
- caused by cochlear damage
- the comfortable loudness level and uncomfortable loudness level are abnormally close to each other

leading to the somewhat paradoxical but common request of people with cochlear disorders “to speak louder” followed by the complaint to “stop shouting”

39
Q

ascending pathway

7 steps

A
  1. cochlea converts mechanical energy (fluid motion) to neural info (electrochemical impulses)
  2. individual nerve fibers receive neurotransmitter signal from inner hair cells
  3. afferent (ascending) fibers leave the organ of corti and exit the cochlea via the modiolus
  4. as they leave organ of corti, they form a bundle of fibers (modiolus), arranged tonotopically
  5. the auditory nerve (VIII) passes through the internal auditory canal (with vestibular and parts of facial nerve and internal auditory artery)
  6. the auditory nerve (CN VIII) enters the brainstem at the cerebellopontine angle (CPA-> junctions of cerebellum, pons, and medulla
  7. neurally coded acoustic information then proceeds up the auditory brainstem
40
Q

central auditory pathway functions

A
  • all structures are involved in conducitng auditory information to the cortex
  • some structures are also involved in recoding or processing the information (frequency, temporal, and spatial analysis)
  • how do central auditory pathway lesions affect hearing?
  • —-lower will affect audiogram, higher wont (but they can’t understand what they hear)
41
Q

peripheral auditory system disorders

A

disorders of the outer and middle ear and disorders of the cochlea

42
Q

disorders of the outer and middle ear cause…

A

sensitivity loss
- you just need to make the sound loud enough to get it to the inner ear

43
Q

disorders of the cochlea cause…

A
  • sensitivity loss
  • recruitment
  • reduced frequency resolution (tuning curves of the outer hair cells are smoothed out)
  • reduced suprathreshold speech recognition
44
Q

what is another name for central auditory pathway disorders

A

disorders of the CANS (central auditory nervous system)

45
Q

disorders of the CANS…

A

sensitivity loss may or may not occur, less likely for higher level lesions than lower level

suprathreshold speech recognition is poorer than you would expect based on the audiogram
- especially poor with any kind of noise or distortion
- normal hearing with bad word rec and speech in noise scores

46
Q

acoustic neuroma

(short answer question)

what is it; how to identify; special tests; treatment

A

tumor on the CN VIII (starts on the schwann cells) –> slow growing and benign; treatable if caught early

how to identify:
- face drooping/weakness, taste problems
- unilateral high frequency hearing loss (bc high freq neurons on the outside of the nerve bundle)
- if blood supply gets cut off then sudden hearing loss
- poorer than expected word recognition (expecially at high presentation levels)
- —-ie. rollover
- absent or elevated acoustic reflexes–> with a normal tympanogram (even with sloping hearing loss
special tests:
- OAEs: normal oaes indicate normal cochlea (any sensorineural hearing loss must therefor be due to a retrocochlear problem)
- ABRs: look closely at the interpeak latencies and interaural latencies (delays of asymmetries suggests retrocochlear problem)
treatment:
- almost always surgery
- intraoperative. monitorying with ABR is needed (the audiologist will also monitor facial nerve function)

REFER any time you see retrocochlear signs!!!

47
Q

ANSD (auditory neuropathy spectrum disorder)

A
  • normal oae and abnormal abr
  • believed to reflect inner hair cell or synaptic or viii nerve dysfunction
  • variable audiograms in degree, config, and word rec
  • hearing loss is sensorineural
  • speech understanding in noise is generally very poor regardless of quiet presentation
    other diagnostic criteria:
  • no lesion found in an MRI or CT scan
  • ABSENT acoustic reflexes
  • occurs at all ages
  • patient with auditory neuropathy show littel if any benefit froom hearing aids (its a problem with the synapse)
  • some have shown benefit from cochlear implants (bypass inner hair cells)
48
Q

APD (auditory processing disorder) symptoms

A
  • generally have normal hearing thresholds
  • many symptoms overlap other disorders (ADHD/learning disabilities)
  • hard to follow up conversation
  • may mix up sounds
  • localization issues
  • **difficulty in noise, **or if more than one person is speaking
  • must be formally diagnosed by an audiologist
49
Q

APD causes

it can be LINKED TO

so not technically causes ig

A
  • illness (meningitis, lead poisoning, multiple sclerosis)
  • premature birth/low birth weight
  • head injury
  • genes (hereditary)
  • chronic otitis media in childhood

anywhere along the pathway could be causing the problem

50
Q

4 levels of erber’s model of auditory skill development

A
  1. awareness (overcome with hearing aid or ci)
  2. discrimination (difference between m & n)
  3. identification (m is m and n is n)
  4. comprehension
51
Q

signs of an auditory processing disorder

A
  • difficulty following conversation in background noise
  • needs subtitles to follow dialogue
  • struggled to learn as a child (not able to understand what people are saying)
52
Q

what is HHIA

A
  • hearing handicap inventory for adults (available in a 10 or 35 item questionnaire and not specific to APD)
  • a higher score means thie hearing issue is really impacting thei daily life
  • –ex. does it cause you to feel embarrassed, cause difficult, cause arguments, etc
53
Q

what tests make up the central test battery in the buffalo model?

A
  1. speech in quiet and in noise (struggle with 5 db snr)
  2. staggered spondaic word test (ssw)
  3. phonemic synthesis
54
Q

staggered spondaic word test (ssw)

A
  • test of binaural integration
  • the stimuli you hear is normally delivered to each ear in this order
    1. right ear: 1 up 2 stairs
    2. left ear: 3 down 4 town
55
Q

phonemic synthesis

A
  • presented in the free field at a comfortable level
  • words are split into phonemes and the patient ahs to put them together
  • decoding: the ability to quickly and accurately understand speech
56
Q

quantitative vs qualitative error

A

Quantitative error: did they respond, yes or no, what was their exact answer

Qualitative error: what did it take for that person to respond (was there a delay)

  • Marked to describe the way in which a person responds (Did they pause? Did they rehearse it before repeating it back? Did they say it back before the stimulus was finished presenting?)
57
Q

what types of auditory training are available in the buffalo model

A
  1. phonemic training program
  2. words in noise test
  3. short term auditory memory
  4. phonemic synthesis therapy
58
Q

phonemic training program

type of auditory training in the buffalo model

A

presents a sound and describes it, has the patient point to the phoneme when they hear it, helps them differentiate phonemes from each other, then adds words in

59
Q

words in noise training

A
  1. lists of 80 words, say it back as soon as you hear it, and the noise level keeps going up
    1. the SNR goes down every 10 words

type of auditory training in the buffalo model

60
Q

short term auditory memory

A
  1. want to increase it by at least one unit
  2. repeating numbers, words, and sentences back
    • lists of numbers (chunking strategies), with a child roll a ball and they repeat list after it gets to them

type of auditory training in the buffalo model

61
Q

phonemic synthesis therapy
1. adding the phonemes together; they are presented separately and the patient makes them into a word
2. given options of which word it was if it’s too hard
3. then given words that are more similar (differ by one phoneme)

A

type of auditory training in the buffalo model

62
Q

how many listed apd provides auds and slps in 2020

A

334

63
Q

what % of audiologists do apd treatment

A

1.4%

64
Q

how many english speaker in the world coudl possibly have and apd

A

300,000,000

65
Q

terminology of non-organic hearing loss

A
  • mean the same thing
    • pseudohypacusis
    • functional
    • non-organic
  • psychogenic: loss or disorder arising from physiological conditions
  • malingering: deliberately faking a loss
66
Q

first signs of non organic hearing loss

A
  • exaggerated behavior
  • disagreement between srt and pta
  • lack of crossover
  • odd results (repeating half a spondee; wrong word for wrs)
  • referral source (insurance co. etc)
  • threshold variability (should be w/in 5 db over time)
67
Q

3 behavioral tests for non-organic hearing loss

A
  • stenger
  • delayed auditory feedback
  • varying intensity story
68
Q

behavioral tests for children for non-organic hearing loss

A
  • variable intensity pulse count methods
  • yes/no method
69
Q

stenger test

A
  • for unilateral losses only with at least 25 dB between ears (preferably higher)
  • can be done with pure-tones or spondees
  • if you put two tones in the ears at the same time, the one with the louder db SL will be the only one that hears it
    1. if you do ten db above their threshold in their good ear and ten below in their bad ear then they will only hear it in their good ear because it is the only ear that could hear it at all so they would perceive it there
      • called a negative stenger
    2. if you do this and they are faking then they would actually still here it in the ear that they are faking it on and so they will only hear it in that ear and they will ignore it falsely
      • called a positive stenger if they didn’t respond when they should (ten db above better ear and 10 db below the worse ear) cuz they should hear it in their better ear
70
Q

3 functions of the vestibular system

A
  1. knowing where you are in space
  2. maintaining a clear visual image during movement of the head or of the target
  3. maintaining an upright stance
71
Q

electronystagmography (ENG)

A

using electrodes placed around teh eyes to pick up muscel activity (up and down and side to side eye movement)

72
Q

videonystagmography (VNG)

A

using an infrared/video system
- keeping eyes on a dot
- lay down with the goggles for the caloric test

73
Q

vHIT

A

video head impulse test
- measures VOR in response to head movement
- uses infrared goggels
- can test ALL six semi-circular canals (3 on each side)

74
Q

VEMP test

A

vestibular evoked myogenic potential
- sound evoked muscle reflex
- recorded from trapezius muscles or sternocleidomastoid muscles

75
Q

types of posturography tests

A
  1. sensory organization test: measures sway while varying visual and/or proprioceptive information
  2. motor coordination test: sees how patient reacts when platform shifts or tilts abrupty
76
Q

ototoxicity

what causes it

A
  1. aminoglycosides: the ‘mycins’ –> especially neomycin, kanamycin, tobramycin (cf), and gentamycin (NOT erthromycin- that’s fine)
    • in most developed countries, these are given only when absolutely necessary
    • permanent loss
  2. chemotherapy drugs (cisplatin especially)
  3. other drugs can cause a temporary hearing loss (loop diuretics, salicylates (heavy does of aspirin), anti-malarial drugs
77
Q

monitorying ototoxicity

A
  • high frequencies are affected first
  • DPOAEs are often used for monitoring because they are affected before puretones
  • we measure much higher frequencies than 8,000 if we suspect ototoxicity
78
Q

pathway of neural information to the auditory cortex

A

after leaving cochlea, going through internal auditory canal and entering the brainstem at the cpa (Cerebellopontine angle), it synapses with:
1. Cochlear nucleus
2. SOC (superior olivary complex)
3. Lateral lemniscus
4. Inferior colliculus
5. Medial geniculate body
6. Auditory cortex

can cute seagulls live in minnesota alone?

cochlear nucleus is last place to get ipsilateral info (cuz soc is first to get bilateral)

79
Q

management of patient with non-organic hearing loss (nohl)

A
  • avoid hostility and confrontation (they are faking it for a reason)
  • shift blame to own shoulders (i must not have explained that very well)
  • the computer says… (i’m getting a discrepancy, let’s retest)
  • with children, have informal discussion with parents (if behavior continues, recommendation for other services)
  • be careful in reporting with terms you use (don’t use the term malingerer in their official report)
80
Q

what does soap notes stand for

A
  • s: subjective
  • o: objective
  • a: assessment
  • p: plan
81
Q

what goes under subjective (in soap notes)

A

anything the patient tells you (the case history)

82
Q

what goes under objective (in soap notes)

A

type, degree, configuration of loss, ART, tympanogram, OAE, WRS, SRT

all of the actual results from your tests

83
Q

assessment (soap notes)

A

how the testing was performed, reliability etc
- “testing was performed in a booth…etc”

84
Q

what goes under plan (in soap notes)

A
  • what are we recommending (what are you referring for)
  • counseling about communication strategies and protection etc.

  • refer to ent: any conductive loss (or abnormal otoscopy), or retrocochlear)
    • hearing aids: you do, same with cochlear implants (along with ent)
    • alzheimer’s: referred to cognitive clinics
    • tinnitus: to psychologist
85
Q

where to refer and when

A
  • any conductive loss, abnormal otoscopy, or retrocochlear problems –> refer to an ENT
  • alzheimer’s–> refer to cognitive clinic
  • tinnitus–> maybe to psychologist
  • hearing–> you do this! and cochlear implants with the help of an ENT

hearing tests & measures (3 decks)

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