Final Exam Flashcards
If setting up Stenger test, PT R thres is at 5 and L thres is at 45 at 2,000 Hz. How would you set the tone for L ear? How would you set tone for the right ear?
L: 35 (10-45)
R: 15 (5+10)
if the patient says they DID NOT hear the tone for the above example, were they likely faking?
yes
In the example above, if the patient reports that they DID NOT hear the tone, in which ear did they likely hear it in?
left ear
If you determined that the person was presenting with a nonorganic hearing loss and wanted to estimate a pure tone threshold at 2000 Hz, how would you set that up?
R ear: 15
L ear: 0
When using Stenger principals to estimate threshold, would you expect the patient to report that they DO or DO NOT hear the tone at your initial presentation?
they would say they do hear it at the first presentation
If the hearing loss at the the left ear were nonorganic and the hearing was actually symmetrical based on the right ear thresholds, would the patient be able to hear a 40 dB tone presented to the left ear?
yes
How would you set up a Stenger at 1000 Hz for PT with L thres at 0 and R thres at 45?
L ear: 10
R ear: 35
Assume the patient in the above case is giving you valid responses. Would this result in a negative Stenger or a positive Stenger?
negative stenger
If the patient in the previous case is giving you valid responses, in which ear would they have heard the tone during a Stenger test?
left ear
contra’s missing, ispi present, no HL
brainstem pathology
probe side absent, normal tymps, normal hearing, descending pathway
facial nerve pathology
conductive loss on audiogram (ABGs, Low frequ HL), normal tymps & reflexes
SSCD
bilateral, no reflexes on both sides
normal OAE, hearing below 60dB, BILATERAL, rare are stim effect, thresh varies, is retro, has to occur w/ SNHL
ANSD
thresholds normal & reflexes bw 70-90 SL
normal hearing
HL in one ear, same side probes - abs
stim - 70-90 ABOVE air thresholds (elevated)
conductive
SNHL, STIM ear reflexes affected, <70 dB SL, stim effect, generally expect reflex up to 60dB cochlear hearing, if AC thres >60 dB absent reflexes are not diagnostic
cochlear HL
SNHL/NH, STIM ear, >90dB SL/ABS
retrocochlear/vestibular schwanoma
what is sensitivity
correctly identifying those with the disease
TP/TP+FN
Number of true positives / total number who have it
what is specificity
correctly identifying those without the disease
TN/FP+TN
Number of true negatives / total number who do not have it
Is standard low frequency tympanometry good at differentiating between otosclerosis and a normal middle ear?
no because you can have a normal tymp with otosclerosis
What is a primary factor that influences sensitivity and specificity for a specific test?
how you set the screening criteria
Is high frequency audiometry more sensitive for detecting damage to the as?
could be, need more research
common use for high frequency audiometry
monitoring ototoxicity
What transducer type must be used for high frequency audiometry?
circumaural headphones
what is acoustic reflex decay
based on reflex adaptation
presented 10dB above reflex threshold
unimpaired system can hold this for longer than 10 seconds
retrocochlear pathology adapts and decays
+ decay
retrocochlear pathology sign
did not hold for the full 10 seconds
- decay
not indicative of retrocochlear pathology
holds for the full 10 seconds
difference between baseline admittance and admittance at the reflex
50%
How is a test for acoustic reflex decay administered?
Present 10 dB above reflex threshold (without exceeding 105 dB) for ten seconds
Note whether reflex is maintained for the ten seconds or if it decays
If reflex decays by 50% or more, this is considered “positive” for reflex decay and is an abnormal finding
Suggestive of retrocochlear
Decay less than 50% = negative for reflex decay
what is considered a + decay
If reflex decays by 50% or more
retrocochlear
what is considered a - decay
Decay less than 50%
what is the ideal condition for acoustic reflex decay
CONTRALATERAL
if cannot, ipsi is ok
only present at 500 or 1000 Hz
Why are you not likely to actually measure positive reflex decay even in cases of retrocochlear pathology?
Typically we have no response with retrocochlear (reflex threshold) so we won’t do it on them because it is too loud
Cochlear - can do it on them and could rule out retrocochlear this way
What are some indications that a hearing loss might be nonorganic?
Exaggerates difficulty hearing
Case history
Financial compensation (work injury, for example)
Referred by an attorney
Difficulty in school (pediatric)
Age (most common age for pediatric functional hearing loss is10-12 years old)
Based on observable discrepancies
Between behavior and test results
Among audiology test results
what is nonorganic
faking a HL
apparent hearing deficit in absence of an anatomic or physiologic explanation
What dB of difference between ears is needed to do a Stenger?
20 dB
How do you set up a Stenger test? What do the different results suggest?
+10 to better ear and -10 to poorer ear
Hear it = better ear
Didn’t hear it = hear in poor ear and are lying to you
How do you estimate thresholds using Stenger principles?
+10 to better ear and 0dB at worse ear
Present simultaneous and louder at better ear so they say they hear it
Increase in 5 steps to poorer ear and will stop responding to hearing it (threshold)
What are some other tests or test modifications that suggest or confirm nonorganic hearing loss?
Have them count the number of beeps, change step size, descending and ascending thresholds and compare them, test bone first
Modification of pure tone test procedure
Have them count the number of beeps, change step size, descending and ascending and compare them, test bone first, switch from side to side (different thresholds can tell they are faking because IA is close to zero)
modification of behavioral tests
Repeat words in noise, see if voice gets louder - lombard
Part of the story in each ear and ask them about it - switching speech test
modification of physiologic tests
ABR/OAE/Reflexes
How do you work with a patient you suspect is exaggerating (or feigning) a hearing loss?
What kinds of things do you say to them to let them know you are suspecting functional?
First thing you do is give them an out (pretend equipment isn’t working, make sure they understand the instructions) give an opportunity to be honest with you (maybe you didn’t understand my instructions and you are waiting until it gets loud, click it even if it is soft)
What are some reasons someone might pretend to have better hearing than they actually do?
Often motivated by financial gain
Wants cochlear implants instead of hearing aids
asymmetries that raise suspicion of retrocochlear
Word recognition scores (already covered)
Pure tone
Unilateral tinnitus
criterial for pure tone asymmetry
3 adjacent pure tones that differ by 15dB+”
Or 20 dB at one frequency
criteria for WRS asymmetr
criteria for unilateral tinnitus
what is loudness adaptation?
Reduction of neural response to continuous stimulation
How is the Olson and Noffsinger tone decay test implemented? What instructions do you give?
Begin 20 dB above their threshold (20 dB SL)
Present tone for 60 seconds
if PT hears the tone full minute = negative for tone decay
If PT cannot, increase 5dB and if PT holds minute = negative
if PT cannot increase 5 (10 total)
if pt hears it for the minute - negative
if they still cannot for the minute = positive
**Only increase 10dB above their threshold total
What results suggest normal, conductive, cochlear, retrocochlear?
> 30 dB after increasing and if they cannot hear tone for the minute after increasing by 10 total, it is positive for tone decay and retrocochlear sign
cochlear/normal/conductive = negative for tone decay, they heard it the whole time
Define recruitment of loudness. What type of hearing loss is indicated if recruitment is seen? Why does this happen?
Rfers to reduction of dynamic range
Smaller distance from threshold to UCL - this suggests cochlear HL
Test involving loudness perception, cochlear
Happens because of cochlear amplifier
what are the 3 asymmetries that are suggestive of retrocochlear
word rec scores
unilateral tinnitus
pure tones (3 adjacent ones that differ by 15dB or more at 1 frequency
people with cochlear hl have
reduced dynamic range
Which type of hearing loss exhibits recruitment of loudness?
cochlear
Define tone decay
Which type of hearing loss exhibits tone decay?
Which type of hearing loss exhibits reflex decay?
inability to perceive a continuous tone for a full minute
retrocochlear HL
when the PT has control
method of adjustments
bekesey audiometry testing conducted what two ways
sweep frequency tracing
fixed frequency tracing
type Iv bekesey is with what HL
retrocochlear
type III bekesey is with what HL
retrocochlear
type II bekesey is with what HL
cochlear
type I bekesey is with what HL
normal or condutive HL
overlapping of I and C tracings, with a tracing width of about 10 dB
role of the Eustachian tube in the healthy middle ear
To ventilate the middle ear, allows fluid to drain
Define Eustachian tube dysfunction
Describe how this is assessed without a perforation and with a perforation
Inflation, deflation
Run tymp, have them swallow (max negative pressure) swallow again (max positive pressure)
Serial tympanograms (one after another)
what do tymps show for ETD
left = neg pressure
right = pos pressure
if it doesn’t shift, ETD does not open when it should
Define patulous Eustachian tube and describe how this is assessed
Monitoring admittance and have the PT breathe (air will go in and out of ME, will see a definite definite increase and decrease that will show their breathing patterns)
normal = flatline
sinosoidal wave = abnormal and always open
advantages of multifrequency tympanometry and wideband acoustic immittance.
More sensitive because you are testing more frequency (to middle ear disorders)
You have different normative data you can compare it to (better at identifying the specific disorder)
Excessively low absorbance at low frequencies
Indicates increased stiffness such as OME or otosclerosis
Excessively high absorbance at low frequencies
indicates decreased stiffness such as a TM perforation or ossicular discontinuity
Know what the WAI 3D graph is plotting
Still plots tymp (changing pressure) plotting admittance, absorbance, how much sound is getting through the system
The resonant frequency (RF) of the middle ear ranges from what?
1100-1800
primary diagnostic utility of MFT is
ability to determine whether the ME is characterized by a RF that is typical or
Higher than normal as observed with otosclerosis
Or lower than normal as observed with ossicular discontinuity
Low resonant frequency
Ossicular discontinuity
High resonant frequency
Otosclerosis
ME effusion
What is an advantage of running WAI at ambient pressure?
don’t have to change the frequencies
What is coding used for besides billing?
Internal data collection
Medicare and insurance billing
Code for every patient encounter
Code what you did
Diagnostic appointment (testing performed, diagnosis/reason for test)
Treatment appointment
What are the 3 coding systems that we use?
CPT
ICD-10
HCPCS
What is CPT and who maintains it
AMA
current procedure terminology
tests that we do
what is ICD-10 and who maintains it
government
reason for the test
diagnosis code
developed by WHO
what is HCPCS and who maintains them
government
just for devices
What procedures are required to be completed to use the code 92557, comprehensive audiometry evaluation?
both ears
air bone and speech
What are the two modifiers discussed in class and what are they used for?
52 - reduced
22 - expanded
Identify the 3 conditions where a masking dilemma may occur
Bilateral conductive with significant abg
Large abg in NTE (same as first for air)
Large asymmetry and you need to mask the better ear
Calculate maximum masking level
Bone of te + IA - 5
Explain what to do is a potential masking dilemma is encountered.
Mask anyway because IA is different by frequency, transducer and individual person
As long as you have correct SL and you get a plateu you get a valid threshold
underlying premise for the NU-6 Ordered by Difficulty
If we put most diff words first we can identify who actually needs all 50 words and who we can only give 10 words to
Give as few words as possible without sacrificing reliability
Rule out\
exclude the possibility of a particular condition/disorder as part of a diagnosis
rule in
include the possibility of a particular condition/disorder as part of a diagnosis
When a disorder is rare it is easier to find the people who DON’T have the condition so the approach is to rule ____ rather than to rule _____
out, in
What is a potential benefit of using this word list?
It is a validated shortcut
What are the restrictions for administering WRS using NU-6 Ordered by Difficulty?
Has to be the exact recording in the same voice in that same order
You can’t read the list or take the words recorded by someone else has to be exact same recording
