Final Exam Study Guide Flashcards
(189 cards)
1
Q
what is AAA guidelines for ototoxic monitoring
A
standard audio - 500-8000 Hz
HFA - 10, 16, 18 kHz
DPOAEs
some use ABR (above 4 kHz usually up o 8 kHz)
2
Q
how often do you assess during ototoxic monitoring
A
typically follows the drug schedule: Assessing hearing BEFORE each treatment (day of) and having a Baseline are imperative
3
Q
Depending on the ototoxic medication used, monitoring should occur after cessation for at least _____months up to _____ years
A
6 10
4
Q
what is considered a significant change in DP amplitude
A
(not the DP-NF) is typically between 3-6dB. Any change greater than that check test conditions
5
Q
what are the common ototoxicity rating scales
A
SIOP (Boston - International Society of Paediatric Oncology) and CTCAE (Common Terminology Criteria for Adverse Events)
6
Q
DPOAEs will often show a decrease in amplitude AFTER to hearing loss showing up on the audiogram
A
False, it shows prior
7
Q
what is pedmark
A
the only FDA approved treatment that is designed to decrease the risk of HL & protect children’s hearing after/during Cisplatin treatment (sodium thiosulfate)
8
Q
Incidence is difficult to determine but it is safe to say about ______ of pediatric patients undergoing chemotherapy with Cisplatin will have hearing loss
A
60-80%
9
Q
what are the ototoxic drugs
A
Cisplatin, Carboplatin, Aminoglycosides, Radiation therapy, Loop Diuretics and many many more
10
Q
describe stimulus frequency OAEs (SFOAE)
A
slicited with low level pure tone
not clinically used because it is expensive
likely the most sensitive to OHC damage of all the evoked OAEs
11
Q
why are algorithms and programming of the computer enabled with SFOAEs
A
becuase it is difficult to distinguish between the stimulus (pure tone) from the cochlea’s response
12
Q
why would we use pressureized OAEs
A
“pressurize” the ear canal in the presence of negative (or positive) middle ear pressure, essentially equalizing between the middle ear and ear canal - making daPa at 0
-By equalizing middle ear pressure and ambient pressure, we can obtain good OAEs despite the negative (or positive) MEP
13
Q
why does negative MEP reduce the amplitudes of OAES epsecially in LF
A
As little as -65-100 daPa can affect the amplitude
***look up rest of the answer
14
Q
what is the role of the efferent system in supression of OAEs
A
1)protecting the cochlear from acoustic trauma 2)help with understanding speech in the presence of background noise 3)improve auditory attention 4)auditory trainingf
15
Q
OAEs can be suppressed with ____, ____, ______ in healthy auditory systems.
A
ipsilateral, contralateral and bilateral noise presentations
16
Q
Contralateral suppressor stimuli is most often used
A
suppression of OAEs
17
Q
stimulus used for suppression OAEs
A
broadband noise
18
Q
The suppressor stimulus (BBN) should be at the same intensity level or slightly louder (5 dB) than the stimulus used to elicit the OAE
A
true
19
Q
which OAEs are used ot show suppression
A
TEOAEs
20
Q
what are the best test conditions for suppression of OAEs
A
Interleaving test conditions are best: OAEs recorded without the suppressor stimulus should be interleaved with conditions where the suppressors are present
21
Q
Forward masking can also be used (as opposed to simultaneous presentation of both the OAE eliciting stimulus (the click) and the suppressor stimulus (BBN))
A
suppression of OAEs
22
Q
describe the CANS system related to OAE suppression
A
the efferent auditory system controls the suppression of OAEs, specifically the medial olivocochlear bundle of the efferent fibers descending from the medial suprior olive in the brainstem at the base of the OHCs. MOC allows for the modulation of the response of oHCs and results in suppression of OAEs in the presence of masking noise
23
Q
what is the difference between simultaneous and foward masking
A
simulataneous masking is when masking noise is presented at the same time as the OAE stimuli
forward masking is when masking noise precedes OAE test stimuli (click or tone).
by separating masking noise from test stimuli, any acoustic interactions/artifacts of the two signals is reduced
24
Q
what is a result of OAE suppression testing that is considered to be normal
A
OAEs are reduced with masking noise added
suppression of 5-10 dB can be expected but smaller amounts of 1dB can also be significant
if OAE amplitude shows suppression/reduction in presence of noise, result is considered normal
25
what is a result of OAE suppression testing that is considered pathological
OAEs do not change with masking added
if OAEs are present in quiet and testing conditions are appropriate and OAEs don't reduce/show suppression with appropriate masking technique, the lack of suppression is considered to be pathological and can indicate dysfunction in the efferent auditory system/pathways
26
why is BB noise best masker for suppression measures
BB noise makes an effective masker because it contains energy at many frequencies and stimulates larger regions of the basilar membrane
27
what is the benefit of using pressurized OAE measures? What type of PT would this be helpful?
the benefit is to equalize the pressure and have their system at its peak pressure in order to get an OAE response.
this would be for someone with negative or positive middle ear pressure, like a ETD
28
Most important contributor to OAE prodution is the motility of the OHCs
Elaborate explaining how they produce OAEs (from stim delivery to recording)
*add more
Stim delivery (outer to middle to cochlea, basilar membrane, movement of sterecilia, ion exchange, back to bm, amplification, back out
29
generally speaking, slight ME disorders that may not entirely obscure OAEs affect response first for the lower frequencies
true
30
list 3 non pathological ear canal factors that can affect OAE measurement. One must be standing waves
**add more
Standing waves only happen above 6-8
Age, gender, ear, noise, ect was non pathological
31
what role does the EAC play in OAE measurement
both inward and outward propagation
32
In collection of TEOAE responses, the No. Hi (# of rejected samples) refers to the number of runs that were rejected because the incoming noise peaks exceed the rejection level in dB SPL
true
33
which med red flags contraindicate recording of OAE responses
active drainage in ear canal
foreign body in ear canal
history of ME dysfunction
active bleeding in canal
active drainage in ear canal
foreign body in ear canal
active bleeding in canal
34
what are the 2 pure tones labeled as in DPOAE parameters
f1 and f2
35
when recording DPOAEs we input 2 pure tones and receive a 3rd tone which we measure as response from the cochlea. What is the name of the produced 3rd tone
dp
36
frequencyy relationship or separation bw 2 primary tones is critical in DPOAE measurement. DP will not be recorded if 2 tones are too far apart or if they are too close together
true
37
why should we not use intensit levels in DPOAE testing (l1 & l2) that are over approx. 70-75 dB SPL? If we use high intensity levels and get a response, how does that relate to cochlear fxn. Use active and passive processes in the answer
*add more
You stimulate the ihc instead of the ohc
Bypass the ohc and doesn’t tell us what is going on with ohc at all and can record a response when teh OHC are not working well
38
OAEs can help you differentiate between a cochlear hearing loss and a retrocochlear hearing loss
true
39
Efferent neurons from medial olivocochlear system innervate
OHCs
40
what is pedmark
injectable therapy for children to reduce risk of cisplatin ototoxicity
41
1 issue seriously impacting NBHS data and protocols is no ANSI standards for use in calibration of OAE equipment
true
42
how can Negative ME pressure can affect OAE response
decrease amp especially in LFs
43
How do ototoxic meds damage inner ear?
ischemia due to compromised blood flow
toxicity: platinum or other metal accumulation
formation of free radicals and metabolic stress
44
The use of slaicytates can cause ototoxic hl which usually returns to baseline after drug cessation
true
45
which type of oae occurs without external stimulation
SOAE
46
efferent neurons from lateral olivary complex synapse near the inner hair cells
true
47
what procedure is recommended for ototoxicity monitoring by AAA
audiogram (standard), HFA, DPOAEs
48
cisplatin based chemotherapy will cause hearing loss in approx. 1% of receipients
false, close to 83% based on cincinnati thing
49
which of the following regarding OAEs and ototoxicity monitoring is false
TEOAE have higher frequency range thus more sensitive area to affected 1st
OAEs are time and cost effective
OAEs have been shown to decrease simultaneously with HFA
OAEs tend to show change before changes on the audiogram (250-8000 Hz)
TEOAE have higher frequency range thus more sensitive area to affected 1st
50
Persons with ANSD have no efferent suppression of TEOAEs with binaural, contra, or ispi noise
true
51
there is only 1 scale available to grade the degree of HL from ototoxic drugs
false
5
52
efferent auditory system protects cochlea from acoustic trauma and is involved in hearing in the presence of noise
true
53
which type of noise is most effective in suppressing TEOAEs
BB noise
54
the absence of spontaneous OAEs is consistent with cochlear damage
false
55
TEOAEs are preferred to monitor ototoxicity in PT receiving chemotherapy
false
DPOAEs
56
persons with ANSD have no efferent suppression of TEOAEs with forward or simultaneous masking paradigm
true
57
which types of HL can we miss if we are using OAEs for newborn hearing screening
ANSD
mild losses
atypical configurations
58
adding pressurization to OAE recordings to overcome negative ME pressure is routinely done clinically
false
59
what are the 4 areas that contribute to getting OAE results
External auditory canal, Middle ear system, Cochlea, and Efferent auditory system
60
slight me disorders that may not entirely obscure OAEs affect responses for LF first
true
61
most important contributor to OAE production is motility of OHCs. Pleae explain how they produce OAEs (from stimulus to delivery to recording)
stimulus is delivered
travels from outer ear in eac to the middle ear where the ossicles move the fluid in the cochlea by the stapes footplate in the oval window
the fluid movement causes the basilar membrane to shear the stereocilia atop of the outer hair cells
outer hair cell stereocilia shearing causes ion exchange to occur (K+ rushes in causing it to elongate and shrink)
OAEs are created from this dancing of OHC and is sent back out through the oval window pushing the stapes footplate thorugh the ossicles to the ME to the TM and out into the ear canal to be picked up by the mic and trnasmitted to the computer for analysis
62
what are 3 non-pathological ear canal factors that can affect OAE measurement
standing waves
age, gender, ear, noise, etc.
63
what role does the EAC play in OAE measurement
both inward and outward propagation
64
what are active processing
OHCs
responsible for low level threshold sensitivity and sharpened tuning
OAEs are a byproduct of OHC electro motility and are reflection of active mechanical processes in the cochlea
65
what is passive processing
IHC
passive system has to do with mass and stiffness of the cochlear partition which results in the tonotopic arrangement / filtering sound
The passive system stimulates the inner hair cells directly at levels above approximately 40 dB SPL
66
how does negative ME pressure affect OAE measurement
reducing amplitudes or entire responses
TEOAEs as little as -35 to -65 daPa can affect
DPOAEs >-100 daPa or less can affect
Worse in low frequencies (<1000-2000 Hz)
still test
67
Which frequencies are most affected by a perf or tube?
LF
68
Tympanic Membrane perforation
OAEs can be recorded if ME is otherwise normal
69
otosclerosis
vary slightly based upon stage of disease
70
Why wouldn’t you have OAEs with otosclerosis
with the stiffness, it cannot get through the ME efficiently to stimulate the cochlea and get an OAE
71
describe ME fluid and when you will or will not get OAEs
will you get an OAE if they have a flat tymp with normal volume/
depends on viscosity of fluid in the ME space
thin clear otitis media can get an oae
glue ear, will not get one
bulging ™ that is yellow will not perform an oae
if you can see the fluid line on the ™ you can run one to see
72
why do we not want too loud of a stimulus
stimulates IHCs
73
are OAEs a test of hearing
NO
only predicts function of the cochlea
74
why are OAE findings almost a direct measure of oHC fxn integrity
because ME function is also a factor in OAEs
where pure tones are dependent on status of cochlea, 8th nerve, CAS & auditory perceptual factors as well as ME
75
can see changes in OAEs over time (serial) before appearing on the 250-8000 hz audio
true
76
how do OAEs differ from an audio
can get close to thresholds, especially with DP and gorgas
helpful for site of lesion discrimination because it measures peripheral aud system (outer, midde, cochlea) so if we have them that these are indicative of typically functioning cochlea (normal/near normal) but if have normal OAE and abnormal other findings findings are retrocochlear
narrow to 15-20 dB range
transients or DP without gorga - hearing is bw 25-35 dB
77
normal OAEs with abnormal audios can mean
Functional, non-organic, psychogenic hearing loss
central auditory nervous system dysfunction
VIIIth Nerve (neural) auditory dysfunction
Those with exclusively inner hair cell damage (e.g., carboplatin toxicity or genetic abnormality)
78
what range is associated with no OAEs
when sensory (OHC) hearing exceeds approximately 25-35 dB
hearing loss ranging from 35-45dB to profound is similarly associated w/ the simple absence of detectable OAEs
79
abnormal OAEs but normal audios means
tinnitus
hazardous noise/music exposure
ototoxicity
vestibular pathology
80
Guidelines in Establishing the Clinical Relation between OAEs and Sensory Hearing Loss
OAE outcomes will always fall within one of three general categories
Amplitude is normal (relative to an appropriate normative region),
Amplitude is abnormal (OAE is present but below normal limits), or
There is no evidence of reliable OAE activity above an acceptably low noise floor (Absent).
3 outcomes
normal
amp abnormal
absent
81
what is a standing wave
problem in DPOAEs 6-8 kHz or higher
Cancellations and reinforcements of some sound waves or interaction between stimulus sound wave moving toward TM and OAE sound wave moving outward from TM
82
what is a pass for TEOAEs
Absolute emission > -10 dB SPL
SNR (relative value) > 3-5 dB (varies)
Reproducibility of 70% or greater
normal or near-normal cochlear function and hearing better or equal to approximately 25-30 dB at frequencies where emissions are present
83
presentation level of TEOAEs
80-85 dB SPL (74-83 dB SPL)
84
what is a pass for DPOAEs
Absolute emission > -10 dB SPL
SNR (relative value) >6 dB (3-5 dB some)
Replicates
IF ALL OF THE ABOVE ARE MET AND PLOTTED ON DP-GRAM OR GORGAGRAM AND FALLS IN THE PRESENT REGION (95TH PERCENTILE) = normal or near-normal cochlear function and hearing better or equal to approximately 25-30 dB at frequencies where emissions are present
85
what does dp measure
2f1-f2 (DP)
86
what frequency range is measured in DPs
500-8000
87
L1 and L2, 10 dB separation
(55 and 65 dB SPL tones)
88
F1 and F2 at ratio
1.22
89
f1 is the
lf
90
f2 is the
hf
91
what is F2 and DP if f1 is 1000 Hz
f1 = 1000 Hz
f2= 1220 Hz
2f1-f2 = 2000-1220
DP = 780 Hz
92
when plotted on the dp graph, where is it plotted? why?
F2 because it is the main contributor to basilar membrane movement that creates the distortion product from research
93
what is the objective in most with OAEs
to describe cochlear function
94
what is clinical advantage of OAEs
site specificity of OAEs to auditory dysfunction
is loss purely sensory (cochlear), purely neural (retro) or does it involve sensory and neural structures?
can be answered with OAEs and ABRs
high degree of sensitivity specifically to cochlear impairment
Considerable evidence shows that noise or music induced cochlear damage is detectable with OAEs before it becomes apparent in the audiogram
95
what do present OAEs tell us
External auditory meatus is clear.
Middle ear function is normal / near-normal.
Cochlear sensory function is normal.
And by inference only!:
Peripheral hearing sensitivity is normal.
OAEs are NOT a test of hearing but we can infer some things about hearing status from them
96
what do absent oaes tell us
May be blockage of EAM.
May be Abnormal Middle Ear function.
Otitis Media
Severe negative ME resting pressure.
If EAM and Middle ear are clear:
There is cochlear outer hair cell damage.
97
abnormal thresholds but normal OAEs could have 3 possibilities
pseudohypacousis
retro path
PT may superimpose fxnal HL on pre existing sensory impairment
98
what are clinical applications in adults with OAEs
differentiation of cochlear vs retro
monitoring ototoxicity
tinnitus
noise/music induced
Menieres disease
99
what are clinical applications of peds for OAEs
NBHS
pediatric audiologic assessment
diagnosis of ANSD/APD
assessment of functional HL
difficult to test patients
differential diagnosis
monitoring ototoxicity
Tinnitus Assessment and Evaluation
100
goal in NBHS
to use OAE in isolation to determine those that need further evaluation and those that have normal/near normal hearing
101
What is the 1-3-6 as it pertains to NBHS
screen, identify, intervention
102
what hearing losses can we miss with using OAE screenings
ANSD
Mild losses
atypical configurations (ex: LF loss or only HF loss)
delayed onset or progressive losses
neural and/or genetic IHC loss only (normal OHC) which is rare
103
describe two clinical uses of OAEs in adults in detail
tinnitus: goal is to see if OAEs are different than the tinnitus; often see present OAEs but not entirely normal OAEs
noise/music induced: OAEs can provide objective confirmation of mild cochlear dysfunction w/ PTs w/ normal audios
104
describe clinical applications in peds for OAEs in detail
pediatric audiologic assessment: do not require behavioral response from PT; can be recorded from sleeping or sedated kids; short test time; provide ear specific audiologic information
monitoring ototoxicity:
105
Non-pathological subject factors
noisy rooms, right ears are better, women are better, declines over age
standing waves
106
Typically takes much less time
oae screening
107
Fewer frequencies assessed, usually higher frequencies
oae screening
108
A component of a comprehensive test battery
oae diagnostic
109
Requires interpretation from audiologis
oae diagnostic
110
Completed to distinguish those who do not have significant auditory dysfunction from those who need further evaluation
oae screening
111
OAE outcomes will always fall within one (1) of three (3) general categories. what are they
OAE amp is normal (relative to normative data)
amp is abnormal but OAEs present
OAEs are absent
112
The most important contributor to OAE production is the motility of the outer hair cells. Please elaborate on this idea, explaining how they produce OAEs (from stimulus delivery to recording).
The stimulus is presented into the external auditory canal. It then passes through the tympanic membrane into the middle ear where it acts as an impedance matcher through the ratio size between the tympanic membrane and the stapes footplate in the oval window, the lever action of the ossicles, and the buckling of the tympanic membrane. Once the stapes footplate pushes into the oval window into the fluid in the cochlea, this creates a travelling wave. This traveling wave reaches the part of the basilar membrane that is most susceptible to movement from the frequency of the original stimulus wave. Once the basilar is displaced to its maximum displacement, the stereocilia on the outer hair cells are sheared, causing potassium ions to rush in, activating calcium ion channels to open and let calcium in. This rushing in of ions causes the outer hair cells to elongate and shorten, which is the electromotility. This electromotility of the outer hair cells produces OAEs. The OAEs that is produced from the outer hair cell travels back out of the oval window at the stapes footplate as a reverse wave. This then pushes through the middle ear losing its amplitude because the mechanisms that acted as impedance matchers are now impedance mismatchers and cause the spiked heel effect on the OAE. The OAE then reaches the tympanic membrane and back out to the external auditory canal to be measured and picked up by the probe.
113
Generally speaking, slight middle ear disorders that may not entirely obscure OAEs affect responses first for the lower frequencies.
true
114
list for me three (3) non-pathological ear canal factors that can affect OAE measurement. One of them must be standing waves
1) age
2) women
3.) standing waves
115
What role(s) does the external auditory meatus (or canal) play in OAE measurement?
both inward and outward propagation
116
In collection of TEOAE responses, the No. Hi. (number of rejected samples) refers to the number of runs that were rejected because the incoming noise peaks exceed the Rejection Level in dB SPL. True/False
true
117
Which medical red flags contraindicate the recording of OAE responses?
Active drainage in the ear canal
A foreign body in the ear canal
Active bleeding in the ear canal
118
The amplitude of OAE responses are typically larger with greater reproducibility in adults when compared to children and infants.
false
119
In ears with a perforation or a patent ventilation tube, which of the following is true
OAE responses will always be absent in ears with tympanic membrane perforation or ventilation tube.
OAE responses will always be present in ears with tympanic membrane perforation or ventilation tube.
Tympanic membrane perforation and ventilation tubes are medical red flags and OAE testing should not be attempted.
Present OAE, absent OAE, partial OAE, or reduced amplitude OAE responses may be observed in dry ears with tympanic membrane perforation or ventilation tubes.
Present OAE, absent OAE, partial OAE, or reduced amplitude OAE responses may be observed in dry ears with tympanic membrane perforation or ventilation tubes.
120
What are the two (2) pure tones labeled as in DPOAE parameters?
f1 and f2
121
What are the two (2) pure tones labeled as in DPOAE parameters?
When recording DPOAEs, we input two pure tones, and receive a third tone which we measure as the response from the cochlea. What do we call that produced, third tone?
distortion product
122
The frequency relationship or separation between the two (2) primary tones is critical in DPOAE measurement. A DP will not be recorded if the two (2) tones are too far apart or if they are too close together.
true
123
With regard to f1 and f2, what is the most reliable frequency relationship of these two (2) primary tones? Please provide the number that expresses what that ratio should be.
F2 is the most reliable frequency of the two
ratio should be 1.22
124
The relative levels (intensity) of the two (2) primary tones (L1 and L2) is another critical stimulus parameter in DPOAE measurement. To obtain results most sensitive to cochlear function, what should L1 and L2 be in intensity?
65 and 55
125
What are the four regions of the auditory system that either contribute to the generation of OAEs, or can influence OAE recording?
Outer ear,
middle ear,
inner ear,
efferent system
126
Please explain the Crosscheck Principle and include an example.
The technical definition is using electro-physiological or electroacoustical tests to confirm a subjective test (like pure tones)
if you get absent or abnormal OAE's you do not diagnose a HL, OAE are not a test of hearing you would use the information collected by the OAE to run a audiologic evaluation and then compare and see if it supports or does not support your original findings.
127
How is a DPOAE determined to meet passing criteria?
The absolute amplitude of the DP should be at least -20 dB SPL
The DP-NF (the SNR) should be at least 10 dB SPL
Passing responses should be seen in 1 frequency
None of these responses are correct
None of these responses are correct
128
Why should we NOT use intensity levels in DPOAE testing (L1 and L2) that are over approximately 70-75 dB SPL? For example, if we do use high intensity levels, and we get a response, how does that relate to cochlear function? Active/passive processes should be included in your answer.
The reason for that is now you are using passive cochlea processing. With a higher db you are by passing the outer hair cells and stimulating the inner hair cells. when you do this you may vibrate the basilar membrane but you are not measuring the correct outer hair cell motility. meaning you are not getting an accurate representation of outer hair cell and cochlear function.
129
There is now considerable evidence that noise- or music-induced cochlear damage is detectable with OAEs before it becomes apparent in the audiogram
true
130
Which of the following best describe the clinical applications of OAEs for adults? Please choose all that apply
Monitoring tinnitus and noise or music exposure
Differentiation of cochlear vs. retrocochlear site of lesion
Newborn hearing screenings
Monitoring hyperbilirubinemia
Assessment in suspected functional hearing loss
Monitoring tinnitus and noise or music exposure
Differentiation of cochlear vs. retrocochlear site of lesion
Assessment in suspected functional hearing loss
131
What is a Gorgagram?
A version of a DP gram with normative values from the 5th percentile to the 95th percentile used to indicate if hearing is normal, abnormal or borderline.
A version of a DP gram with normative values from the 5th percentile to the 90th percentile and tells us about auditory processing.
An audiogram created by MIchael Gorga, Ph.D. that is only used at Boystown National Research Hospital.
A DP gram we use to plot responses from the cochlea of a gargoyle.
A version of a DP gram with normative values from the 5th percentile to the 95th percentile used to indicate if hearing is normal, abnormal or borderline.
132
What is the optimal dB SPL for the stimulus when recording a TEOAE?
74-83 dB SPL
133
Passive cochlear processing (when a sound is loud enough) can directly stimulate
The inner hair cells stimulated through basilar membrane movement
134
OAEs can help you differentiate between a cochlear hearing loss and a retrocochlear hearing loss.
true
135
The OAE loses energy on the way from the cochlea to the ear canal where it is measured. Which of the following supports this?
Cerumen in the ear canal causes the OAE to lose energy
As the OAE moves from the cochlea to the ear canal, this reverse transmission is just as effective as forward transmission
As the OAE moves from the cochlea to the ear canal, this reverse transmission is much less effective than forward transmission
OAEs do not lose energy as they travel from cochlea to ear canal
As the OAE moves from the cochlea to the ear canal, this reverse transmission is much less effective than forward transmission
136
A pediatrician has referred his 2 year old female patient to you for testing. You choose to use TEOAEs. The parents report concerns that their child’s speech/language skills are delayed. The child uses about 5 single words expressively and “seems to understand” what they are saying. Results show passing responses in the 1000-4000Hz regions of both ears (6dB or greater above the noise floor, 99% stability, 90% reproducibility, stimulus at 83dB SPL).
What will you report to parents and the referring pediatrician?
What other, if any, additional tests will you recommend?
Is OAE alone a test of hearing?
1) i would first let them know that the first test i ran she passed, but i would also break down the test for them and explain first, that OAE are not a diagnostic test nor does it show frequency specific information and that this test only tested 1-4K but i would explain to them how she passes in those frequencies but how i would need to do more testing to get more information especially in the higher frequencies since those are important for speech. I would also express when the most important time for speech and language development for a baby is birth to 3 (if they were reluctant for additional testing since she passed TEOAEs) and refer to a speech and language pathologist to be evaluated for a speech and language delay.
2) i would want to run Tymps, reflexs, and a full audiometric evaluation- I understand she is young so i would start with SRT and WRS first and go from there until she was no longer/tired and was done with the test. Also i probaly would done an DPOAE instead of TEOAE so i could get frequency specific information.
3) No, OAE alone is not a test of hearing.
137
A 49-year-old patient comes to see you from the Department of Labor. He had been seeking compensation after saying he had been electrocuted and had noise exposure, which was why he lost his hearing. His audiogram shows 50 to 60 dB thresholds, worse for the right ear. Reflexes were present and normal for both ears. There was a significant difference between the pure-tone average and the speech reception threshold (SRT) with his SRTs being much better. You perform transient OAEs after the audiogram, which are normal for both ears for all frequencies tested.
Is there anything you are suspecting at this point?
What do you do next?
What role did OAEs play in this case?
1) Yes, Abnormal audiogram and normal OAE i would consider Functional HL, Non organic, and phyogenic HL, Central Nervous system dysfunction, 8th nerve auditory dysfunction, and inner hair cell damage (cochlear dead regions). However looking further into his result, i would take note of abnormal Air and not supportng SRT with a much better result that what would be an agreeance with his AC threshold. from there i would take a step back and look at his whole case hsitory and the reason he came in would suppect. I would suspect a non- oroganic HL.
Abnormal Audio
SRT better then Air not in agreeance
Normal OAEs
Reflexes are normal and present in both ear
Law suit
i would suspect non-organic HL
2) but i would also run Tymps to check middle ear status, I would first reinstruct the patient and give them a chance to try and be honest, i would let them know my data isn't adding up and ask them if they understand the directions and if that doesn't work i would follow up with the stenger test to see if i got a positive or negative. depending on the stenger test i would stick with my original suspicion move on to a differential diagnosis. (another option could be functional HL, this the other thing i would consider if the stenger test did not support my non-organic suspician)
3) the role the OAE's played in this is it gave me a picture of how the outer hair cells and cochlea were functioning to see if there was any pathologies or any concerns with hearing sensitivity i should keep in mind when beginning the audio. Even though OAE's are not a test of hearing on its own, during this i would use the cross check principle to validate my data. which i was able to do for this case.
138
You know I don’t like the word “robust”. Why?
You do not like the word robut becuase what exactly is robust, it cannont be quanified that is why you dont like it.
139
What is the name of my son who appeared in our study guide Powerpoint?
Evan Alexander
140
How long have Dr. Parent-Buck and I known one another?
33 years
141
what are ototoxic scales used for
globally used to detect significant change from ototoxicity
142
what is the goal of NBHSa
to determine who needs more testing
143
what are the 4 areas of the efferent auditory function/what does the efferent system play a role in
Protection from acoustic trauma
Hearing in noise
Role in Attention
Role in Auditory Training
144
What role do OAEs play in the identification of ANSD?
almost always present in the beginning
over time will lose them due to compromised blood flow from a lesion that causes neuropathy
145
what are management strategies for ANSD
ha or fm/bt devices (to improve SNR)
visual communication (ASL or cued speech)
CI
146
what are the AAA recommended guidelines for ototoxicity
1) Standard audiometry (500-8K) 2) HFA - 10K-16-18K 3)DPOAEs
147
what is the monitoring schedule for ototoxicity
typically follows the drug schedule:
Assessing hearing BEFORE each treatment (day of) and having a Baseline are imperative
148
what is a significant change in DP amplitude
3-6 dB
149
what % of those undergoing Cisplatin treatment are at risk of HL
60-80%
150
only FDA approved treatment designed to decrease the risk of hearing loss and protect children's hearing after/during Cisplatin treatment
PEDMARK
151
brand name of a drug Sodium Thiosulfate.
Pedmark
152
what are some ototoxic drugs
Cisplatin, Carboplatin, Aminoglycosides, Radiation therapy, Loop Diuretics and many many more
153
why do we monitor for ototoxicity
no safe levels of drugs are known
HL may not get caught unless PT reports
severity of loss is difficult to report
physican can change or modify meds
audiologist can counsel to PT/parents to make informed decisions
154
what are mechanisms with how drugs damage the ear/how do these drugs damage the cochlea
free radicals and metablic stress forms
platinum/other metal accumulation
ischemia because of compromised blood flow
mechanical damage
155
what is metabolic stress
concentration of something that throws metabolism off even in inner ear
peri and endo get out of balance and ions get messed up due to toxicity of the drug
156
what is toxicity accumulation
platinum (cis) can have accumulation of it and cannot get filter out of the ear and with so much it will cause damage this way
157
what is mechanical damage
have toxic drug in there it breaks the hair cells & bmf
158
what are permanent ototoxic substances
aminoglycosides, cisplatin, carboplatin
159
what are reversible ototoxic substances
salicylates, quinine, Viagra, methadone etc
160
what causes a risk of ototoxicity
cranial irradiation
other ototoxic drugs
PTs with renal impairment
age
delivery
161
what is always important with ototoxic monitoring
baseline
162
OAE show changes before they happen on standard audio
true
163
oae decrease simultaneously with _____
extended hf ( 10, 12, 16, 20000)
164
site-specific for cochlear (sensory) auditory dysfunction
OAEs
165
why use OAEs for monitoring?
time and cost efficient
patients may not feel well so this is a quick and objective measure
166
why are DPs used over TEs for monitoring
they have a higher frequency range and are more sensitive to frequency areas affected first
can provide an indication of degree and configuration
can be recorded in presence of more HL than TEs
167
What is Oto-Protection/Protective Agents
aka pedmark
meds or supplements given aside/prior to ototoxic drugs to reduce HL severity
168
what is suppression OAEs
Presentation of a sound ipsilateral or contralateral to a normal ear from which OAEs are being recorded reduces, or suppresses, the amplitude of the OAEs.
noise is at same level or 5dB louder than evoked stim
uses BB signal
suppression is mediated by the efferent auditory system and characterized by decrease in amp and peak phase of emission
lack of suppression is a pathological finding
169
what is the interleaving test conditions
tests are mixed with some having noise and some without going back and forth completing an average and comparing
170
what are some characteristics of supression
characterized by amplitude decreases as well as time shifts of emission peaks
greatest in the 8-18 ms time period
As the intensity of the suppressor noise increases, suppression amplitude increases and the frequency range broadens.
greatest for lower intensity stimuli than for higher intensity stimuli
better for lf than hf stimulus
better for binaural noise
short time intervals bw stim and suppressor
suppression is repeatable
171
What type of OAE is most commonly used for suppression OAEs
TE but DP can also be used
172
OAE amplitudes can be suppressed w/ ipsi, contra or bilateral noise presentation in normal ears and reflect healthy functioning efferent system
true
173
Some hyperacusis patients show abnormally large suppression effects
Tinnitus patients may show impaired efferent activity
true
174
what is forward masking
suppressor in, wait brief time then stim and still get masking affect
175
what is simultaneous masking
stim, mask at same time
176
MOC frequency specific
cochlea up is frequency specific/tonotopic
efferent system is more efficient at low and middle frequencies as opposed to thigh
right ears
pt with ANSD do not have suppression
true
177
MOC frequency specific
cochlea up is frequency specific/tonotopic
efferent system is more efficient at low and middle frequencies as opposed to thigh
right ears
pt with ANSD do not have suppression
SFOAE
178
what are pressurized OAEs
if you have negative MEP, applies pressure to the ear canal to equalize the pressure that is in the middle ear space; when measuring OAEs we want the pressure to be at 0 and this is the point in using pressurized OAEs and is done to obtain a normal OAE in the presence of negative pressure
179
limitations and advantages to pressureized OAEs
adv: can equalize pressure by putting into ear anal so you can get oae
lim: one piece of equipment that really does it,
180
in sig neg me pressure, frequencies affected most are LFs why?
negative middle ear pressure which in turn is an increase in the stiffness of the system in the middle ear because the eardrum is retracted. This in turn doesn’t allow the middle ear to vibrate the way it needs to. Stiffness in a system will affect LF more than the higher
middle ear can still move; Stiffness is retracted sucking the eardrum back in and will still give us responses at the high frequencies but the lows are decreased in amplitude
181
what does HEAR stand for
history
evaluation
audio findings
recommendations
& summary
182
goes 2-3 x a year to vegas
going in two weeks and is taking son
vegas where she is a silver member
183
what are 2 benefits of portable OAE screenings over diagnostic units
smaller
mobile
quick
pass/refer determine automatically
184
what are 2 benefits of a diagnostic OAE compared to OAE screeners
more control over parameters
selection of test protocols
can save and print data/reports easily
uses audiological clinical judgment for Dx protocols
185
what degree/configuration/type of HL will a pass OAE (whether screening or diagnostic)?
mild losses
unusual configurations
ANSD (anything retro)
186
write a basic instruction for PT for OAE testing
i am going to place this probe into your ear. You are going to hear a series of tones or clicks
(depending on the test). I just need you to sit quietly and still during this test. I will let you know
when the testing is finished. Do you have any questions?
187
when might OAE screening be used
to separate those with auditory dysfunction and those who do not
those that need further evals than those that do not
188
when would you use OAE diagnostic testing
to confirm function of OHCs & give a better representation about PTs auditory function
also used to get ear and frequency specific assessments especially in monitoring for ototoxicity
189
when might OAE response be absent in presence of normal hearing
Mild middle or outer ear obstruction could show normal hearing and absent OAEs. If the TM is bulging with a lot of fluid and infection, the hearing would not be normal.
