Examination of the auditory system

Question 1

what does the question examination of the auditory system involve?

Answer 1

-classification of hearing disorders
-clinical examination of hearing by speech test and tuning fork
-pure tone threshold audiometry
-speech audiometry

Question 2

how are hearing disorders classified ?

Answer 2

-sensorineural deafness
-conductive hearing loss
-mixed hearing loss

Question 3

what are the results in sensorineural hearing loss?

Answer 3

-webber test is unto the better hearing ear
rinne test positive
schwabach test shortened

Question 4

what are the results in conductive hearing loss?

Answer 4

weber unto the worse hearing ear
rinne test negative
schwabach test longer

Question 5

what are the results in mixed hearing loss?

Answer 5

schwabach test is shorter
rinne test negative

Question 6

what are the symptoms of conductive hearing loss

Answer 6

short duration hearing loss
it can be treated
usually a mild/moderate hearing deficiency
rinne test negative
any kind of blockage in outer ear preventing conduction of sound into the inner ear
absolute bone conduction is normal

Question 7

what are the symptoms of sensorineural hearing loss?

Answer 7

permanent hearing loss
cannot be treated by or managed by hearing aids
absence or damage of sensory heair cells in the middle ear
rinne test is positive
can be mild, moderate profound and severe
absolute bone conduction

Question 8

what is the theory behind sensorineural hearing loss?

Answer 8

-there is a problem either in the inner ear or the auditory nerve which delivers sound to the brain
-sound heard but not perceived

Question 9

what is the theory behind conductive hearing loss?

Answer 9

-sound is not reaching the inner ear usually due to an obstruction or trauma
-sound not heard but perceived

Question 10

what are the conditions that display conductive hearing loss?

Answer 10

-otitis media with effusion
acute otitis media
perforated ear drum
cholesteatoma
wax
otitis externa
disease of ossicles
others

Question 11

Otitis media with effusion

Answer 11

-also know as glue ear

-most common cause of pediatric deafness
bilateral and self limiting usually
watchful waiting to allow resolution
grommets or hearing aids useful

Question 12

acute otitis media with effusion

Answer 12

common pediatric infection
pain fever , otalgia followed by discharge and resolution
viral then bacterial
self limiting
amoxicillin after 3 days

Question 13

cholesteatoma

Answer 13

-skin growing into the ear
benign but destructive
scanty foul discharge
later: CN VII palsy, meningitis , brain abscess
treated by mastoid surgery

Question 14

otosclerosis

Answer 14

-fuses the stapes
infections are trauma break them apart

Question 15

what conditions are associated with sensorineural hearing loss?

Answer 15

presbyacusis
noise induced hearing loss
acoustic neuroma
ototoxicity
trauma
merniers disease

Question 16

presbysacusis

Answer 16

increases with age
high frequency
bilateral and symmetrical

Question 17

acoustic neuroma

Answer 17

vestibular schwannoma
unilateral sensorineural loss
unilateral tinnitus
mid imbalance

Question 18

otoxicity

Answer 18

aminoglycosides
loop diuretics
asprin
erythromycin

Question 19

mernieres disease

Answer 19

low frequency loss
deafness, vertigo, tinnitus
bilateral in 40%

Question 20

what is involved in the clinical examination of hearing by speech test and tuning fork?

Answer 20

-conversation with patient
-whispered voice test
tunining fork tests (webber, rinnes schwabach’s)

Question 21

what do we identify in a conversation with a patient ?

Answer 21

-patient history and conversation
there are 4 different degrees:

1. pt doesn’t understand loud speech with lip reading
   patient understands loud speech with lip reading
   patient understands loud speech without lip reading
   patient understands silent speech with lip reading

Question 22

how is the whispered voice test carried out?

Answer 22

2 syllable words are whispered at a decreasing distance from the patient until the test words can be repeated correctly

the examiner can say numbers/words at a fixed distance with decreasing volume

each ear is tested separately thus it is neccessary to cover the contralateral ear

patient should not read the lips of the examiner

Question 23

what are the different tuning fork tests?

Answer 23

-weber
-rinnes
-schwabach

Question 24

what is the purpose of the weber test?

Answer 24

-compares the bone conduction on both ears

Question 25

how is the weber test carried out ?

Answer 25

the tuning fork is placed in the centre of the skull at the hairline

Question 26

what is the normal result of the weber test?

Answer 26

-a pt with normal hearing or symmetrical hearing loss localises the tone either in the centre of the head or EQUALLY IN BOTH EARS

Question 27

what occurs in the weber test in unilateral conductive hearing loss ?

Answer 27

localised sound in the affected ear -because the ear with the conductive hearing loss is only receiving input from the bone conduction and no air conduction

Question 28

why in conductive hearing loss is tone localised in the affected ear?

Answer 28

conduction problem of the middle ear masks the ambient noise in the room the inner ear however works fine so it picks up the sound by the bones of the skull. This causes the sound from the bone to be perceived louder than normal in the affected ear

Question 29

what occurs in the weber test in unilateral sensory hearing loss ?

Answer 29

-sound is localised in the healthy unaffected ear because the sensory -sensory organ in the affected ear cannot pick up any sound

Question 30

what is the principle of the rinnes test ?

Answer 30

-Rinnes test is based on the comparison of air conduction and bone conduction within one ear

Question 31

how is the rinnes test carried out ?

Answer 31

-first the tuning fork is pressed against the mastoid process seconds after it is held next to the ear -the patient is then asked which one he/she perceived as the loudest

Question 32

what is found in a positive rinnes test ?

Answer 32

-the sound is loudest when the tuning fork is held next to the ear -air conduction is better than bone conduction-> found in normal hearing loss or in sensorineural hearing loss (inner ear) -in sensorineural hearing loss-> air conduction is perceived louder or longer than bone conduction. the duration is shorter than in normal hearing

Question 33

what is found in a negative rinnes test?

Answer 33

the sound is loudest when pressed against the mastoid process -bone conduction is better than air conduction -found in conductive hearing loss (middle ear)

Question 34

what is the principle of schwabach's test?

Answer 34

compares the patients bone conductivity the the examiners uses the tuning fork to compare the hearing between the doctor and the patient -the test is dependent on the examiner having normal hearing

Question 35

what do the results of the schwabah test indicate?

Answer 35

if patient stops hearing before the examiner -> this implies a sensorineural hearing loss if patient hears for longer than the examiner->. this implies a conductive loss this all depends on the examiner having a normal hearing

Question 36

what is the procedure of schwabach test ?

Answer 36

the examiner pinches prongs or taps it against knucles too set off lightweight vibrations the ear that is not being tested is covered from being examined by providing a sound stimulant throughout the test -the tuning fork is held by its stem on the mastoid bone of the client who is taught to point whether or not the tone is detected -when they hear the tone the fork is then transferred to the mastoid bone of the examiner who listens for the tone the method continues back and forth between the client and also the examiner until the tone is no longer detected by one in each of them -the results are recorded and the method is then continued within the different ear

Question 37

what is the principle of pure tone audiometry ?

Answer 37

an audiometer is an electric tone generator used to determine the hearing threshold for pure tones the patient presses a button each time they think they hear a sound the hearing threshold is measured for both air (headphones) and bone (bone vibrator placed on mastoid process conduction in db steps

Question 38

what is the normal hearing threshold ?

Answer 38

hearing loss threshold is indicated by range between 0-20dB normal hearing loss threshold is indicated by a straight line at 0dB Hearing loss is measured in decibels relative to this threshold for all frequencies and is recorded on an audiogram

Question 39

what is the principle of speech audiometry?

Answer 39

-very similar to tone audiometry but instead of pure tones, speech is used instead ability to understand speech is more important in human communication than pure tones

Question 40

how is speech tone audiometry carried out?

Answer 40

- the test is similar to pure tone audiometry but the tones are replaced by 2 syllable words with varying levels of loudness

Question 41

what is the vocal frequency for men and women?

Answer 41

is between 125Hz for Men and 250Ha for women