final exam new info Flashcards
how is an acoustic reflex decay administered
-present 10 dB above the reflex thresholds for ten seconds
-note if it is holds for the duration or not
-cannot play above 105 dB
reflex decay negative
no decay occurs or less than a 50% decay
reflex decay positive
crossing the 50% line for a decay
-greater than 50% decay
what does a positive reflex decay result suggest
suggestive of a retrocohlear pathololgy
why are you not likely to measure positive reflex decay even in cases of retrocohlear pathology
-it could be potentially hazardous presentation level due to having elevated reflexes
-with retrocohclear presentations, reflexes are elevated normally so if they are elevated and they are not able to present a decay tone of above 10dB of the reflex you cannot test it
functional/nonorganic HL
an apparent hearing deficits in the absence of an anatomic or physiologic explanation
-thresholds may be WNL but present as with HL
indications that a HL might be nonorganic
-within case history (financial compensation, referred by an attorney, difficulty in school and age)
-general behavior (exaggerates difficulty hearing, messes up speech testing in uncommon ways
-based on observable patterns (between behavior and test results, among audiology test results)
what age group is most likely to be seen with a nonorganic HL
pediatric ages 10-12 years old
audiometric indicators of nonorganic HL
threshold variability, absence of a shadow curve, atypical response to SRT and SRT-PTA discrepancy
shadow curve with HL
typically the “dead” ear shadows the better ear BC but within nonorganic HL we do not see this
-with one bad HL and one good hearing ear, the patterns should be followed due to crossover at some point
what is the stenger test
will use to confirm unilateral HL or if nonorganic HL is suspected
-can only be used with unilateral loses
what dB difference between ears is needed to do a stenger
at least 20 dB difference
how do you set up the stenger test
two tones are presented simultaneous one tone is at +10 dB above better ear thresholds and -10 dB below the poorer ear threshold
-there are two uses of the stenger test : determining if telling the truth and for estimating thresholds
stenger for determining if they are telling the truth
-when we play the tone above threshold, that ear should respond, expecting a response
-they will respond with them hearing it within the better ear due to the principle they will hear it in one ear or the other so with a true HL they should hear it in the better ear
-BUT if they are ‘faking’ they will hear the sound in the worse ear and they will respond that they do not hear the tone due to not hearing it in the better ear
stenger for estimating threshold
-present tone to better ear at +10 dB, present tone to poorer ear at 0 dB HL simultaneously
-if there is a response, increase level within the poorer ear by 5 dB until no response is obtained which this is the point where the assumption is made the the tone is heard in the poorer ear and the patient is unwilling to respond
-when they stop responding, it is to be assumed tat this is within 20dB of their accurate threshold
positive stenger
patient does not admit to hearing in poorer ear
negative stenger
patient admits to hearing the tone
-hearing thresholds are valid or the patient knows about the test and exaggerated the HL
what are some other tests or test modifications that suggets or confirm nonorganic HL
delayed auditory feedback (DAF), lombard reflex test and switching speech test
-not commonly used anymore
modifications to do if you have suspicion of having a patient with nonorganic HL
test bone conduction first, change step size, give word recognition at threshold, ascending-descending gap, or tell the patient to answer yes or no when they hear the tone
counseling tips for interacting with patients with a nonorganic HL
-avoid being judgemental or labeling
-give the patient an opportunity to correct it by resinstruction, pretend to check equipment
-explain the testing and that the results are not conclusive
what are some reasons someone might pretend to have better hearing than they actually do
to get into military services, employment or a license
how can you modify your testing to ensure thresholds when someone is pretending to have better hearing than they actually do
can start with immittance testing, can have patient count the number of beeps presented, can do bone conduction early, do not let anyone else in the room and take extra care not to cue
what are 3 asymmetries that could be suggestive of retrocochlear pathology
WRS, pure tone and tinnitus
how are asymmetries defined in each of the above
3 adjacent pure tones that differ by 15 dB+ or 20 dB at one frequency
tone decay
reduction of neural response to continuous stimulation
-there is threshold and suprathreshold testing
what is adaption? is it abnormal?
this is when the auditory system adapts to the noise overtime and it is no longer detected by the patient
-it is a sign of retrocochlear pathology
-must be with a continuous noise
olson and noffsinger tone decay test
presenting a tone for 60 seconds and marking if the patient hear it the whole time of if they stopped hearing it
-can have the patient hold the button for when they hear it and have them release it when they do not hear it
instructions for olson and noffsinger tone decay test
begin at 20 dB SL and present for 60 seconds, increase tone as needed but do not exceed 30 dB SL
restuls for olson and noffsinger tone decay
negative tone decay : the patient hears the noise for the 60 seconds without it adjusting the level (at 20 - 30 but indicate the level)
positive tone decay : the patient hears the tone decrease throughout the time of the 60 seconds
recruitment of loudness, different types of recruitment
no recruitment, complete recruitment, partial recruitment and decruitment
what type of loss is indicated if recruitment is seen
with recruitment it is associated with cochlear HL
bekesy audiometrey
method of constant stimuli, limits and adjustment
-continuous and interrupted tones and continuous will show adaptation because of long presentation
procedure for bekesy audiometry
-instruct listener to push the button when they hear the tone and have them release it when they no longer hear it
-continuous presentation
-decrease the presentation when they hear it and increase it when they do not hear it
type 1 bekesy
continuous and interrupted presentation’s overlap
-normal hearing and conductive HL
type 2 bekesy
continuos is behind the interrupted signal
-cochlear HL
type 3 bekesy
continuous has a dramatic drop below the interrupted
-retrocochlear HL
type 4 bekesy
significant decay
-retrocochlear disorders
type 5 bekesy
continuous is better
-nonorganic
SISI test
measures the intensity difference limen (JND) for a tonal stimulus
-present a continuous tone and increase 1 dB every 5 seconds over the span of a 20 second time frame
-ask the patient to signal when the tone changes
someone with a cochlear loss has a ________ JND
smaller
what is the role of the eustachain tube within a healthy middle ear
equalizes pressure, remains closes except to act out a function
eustachian tube dysfunction
what happens when the ET does not function when it should
how is ET dysfunction tested with an intact membrane
-gain baseline tymp’s
-swallow at negative pressure then run again
-swallow at positive pressure then run again
how can these ET dysfunction results be interpreted
you should see 3 difference tymp’s each with a shift to show you that the ET is working properly
-if the ET is not opening properly, you will not see the shift
patulous eustachian tube and how is it assesed
abnormally open at rest
-place probe in ear
-select test and pressurize canal
-record middle ear compliance with normal breathing
-repeat on other ear
what are some signs of a patulous ET
complains of hearing their own voice, breathing or chewing
what does the absorbance curve represents
it represents various curves of absorbance all together to compare to the absorbance gained from the testing
what is the WAI graph plotting
pressure at different frequencies
what is an advantage of running WAI at ambient pressure
can be helpful when testing babies or patients with a perforation
what is the range of resonant frequency within the middle
1,100 - 1,800 Hz
what does a low resonant frequency suggest? what does a high resonant frequency suggest?
low - stiffness such as OME or otosclerosis
high - decreased stiffness such as TM perforation or ossicular discontinuity
what is coding used for
internal data collection and medicare/insurance billing
what are the 3 coding systems that we use
current procedure terminology (CPT) - diagnostic test procedures, AMA publishes
ICD-10CM - diagnostic codes, CDC
HCPCS - items, supplies and services that surround them, centers for medicare and medicaid services
how to code the same HL in both ears
using a single bilateral code
how to code HL in one ear with no HL in the other ear
use one code
-__________ HL with unrestricted
how to code different HL in both ears
use two codes
-both are restricted codes
what procedures are required to be completed when using the code 92557
AC, BC and both speech testing
what are the two common modifiers and what are they used for
-22 : increased procedural service
-52 : reduced services
undermasking
not enough masking, still crossing over to the NTE in terms of the tone
-can happen if you do not start with enough masking
overmasking
occurs when masking noise to the NTE crosses over to the test ear
potential masking dilemma
under certain situations, our maximum masking level is less than the amount of masking needed so overmasking would occur
maximum masking level
the max level of noise that can be used within the NTE that will not result in overmasking
-TEBC + IA - 5dB
identify 3 conditions where a masking dilemma can occur
for air conduction: bilateral HL with large air bone gaps in both ears
for bone conduction : conductive HL in the NTE with large air bone gaps
for bone conduction : significant asymmetry with need to mask bone conduction in the better ear
what to do if a potential masking dilemma is encountered
you can try and present it but if there is no plateau, mark as MD and do not continue testing
sensitivity
identifying those with the disorder
- TP / (TP + FN)
specificity
identifying those without the disorder
- TN / (FP + TN)
positive predictive value
how likely that a positive test result is correct
- TP / total that tested positive
negative predictive value
how likely is a negative test result correct
- TN / total that tested negative
with increased prevalence, _______ increases and _______ decreases
PPV ; NPV
what is the underlying premise of NU-6 ordered by difficulty
by presenting the harder words in the first portion of the list, if they only miss 1, than the test can be complete
-if they miss more than 1, then 25 will have to be presented
what is a potential benefit of using this word list
it can save time as well as can lead to better attention span of the patient
what does no recruitment mean? associated HL?
there is a constant shift amount in both the normal ear and the affected ear
-conductive HL
what does complete recruitment mean? associated HL?
at first, there is a different is levels but by the end, there is no difference in UCL
-cochlear
what does partial recruitment mean? associated HL?
at first there is a difference, but as presentation increase, that amount decreases
-cochlear
what does decruitment mean? associated HL?
at first there is a difference, and as presentation increases there are bigger gap for the affected ear
-retrocochlear
