hearing assessment Flashcards
1
Q
Electronic device that generates pure tones to determine thresholds across a range of frequencies
A
Pure tone audiometer
2
Q
Two types of pure tone tests
A
AC and BC
3
Q
Threshold testing environment
A
Sound treated environment
4
Q
Patient: raising a hand, pressing a response button, dropping a block in a bucket
A
Patient response modes
5
Q
Patient fails to respond when tone is presented
A
False negative
6
Q
Patient responds when no tone is presented
A
False positive
7
Q
Provide clear and concise instructions; minimize visual cues
A
Clinician’s role in pure tone audiometry
8
Q
Used to determine the degree of hearing sensitivity in both ears- only degree, not type
A
AC audiometry
9
Q
AC frequency order
A
1k, 2k, 4k, 8k, 500, 250 Hz
10
Q
Avg of thresholds at 500, 1k, 2k Hz used to determine degree of HL thru AC
A
PTA
11
Q
16-25 dB
A
Slight HL
12
Q
56-70 dB
A
Moderately-severe HL
13
Q
> 90dB
A
Profound HL
14
Q
Used to determine sensorineural sensitivity
A
BC audiometry
15
Q
Skull vibrates>shearing of hair cells> VIII nerve
A
Distortional bone conduction
16
Q
Skull vibrates> column of air in the EAC vibrates> some sound waves escape while others strike TM
A
Osseotympanic BC
17
Q
While skull vibrates>ossicular chain vibrates> strapes moves in and out of oval window
A
Inertial BC
18
Q
Frequencies tested for BC
A
500, 1k, 2k, 4k Hz
19
Q
Softest level an individual can detect the presence of a tone 50% of the time
A
Threshold
20
Q
Determine HL by AC; determine HL by BC; determine air bone gap
A
Audiogram interpretation
21
Q
Abnormal bone; abnormal air; gap 10dB/less
A
Sensorineural HL
22
Q
Abnormal bone; abnormal air; gap +10dB
A
Mixed HL
23
Q
Normal bone; gap +10 dB
A
Conductive HL
24
Q
Normal air; normal bone; gap 10dB/less
A
Normal hearing
25
Any hearing threshold +15 dB
Abnormal
26
Air conduction can never be better than BC
Myth
27
Vibrotactile response during BC testing in low frequencies
Tactile responses
28
Non-test ear picks up tone being presented to test ear when there is a 40 dB difference in thresholds between L and R ears
Cross hearing in AC
29
Loss of energy as the sound travels from one side of the head to the other
Interaural (between) attenuation
30
Interaural attenuation is 0dB/ gap is more than 10 dB
Cross hearing in BC
31
Solution to possible cross hearing
Masking
32
Purpose of masking
Determine the true auditory threshold in the ear being tested
33
Masking using a critical bandwidth around frequency being tested; maximum masking w/ minimum intensity
Narrowband noise
34
Technique used for applying masking
Plateau method
35
Dr. Holguin: "It's not just about the _."
Tones
36
Chief complaint in hearing impaired patients
Not understanding speech
37
Oral reply; identification of a picture; written reply
Patient's role
38
Provide concise, accurate instructions; make sure patient cannot see clinician's face during examination
Clinician's role
39
Softest level an individual can BARELY detect the presence of speech 50% of the time
Speech-detection threshold SDT/SAT
40
Softest level an individual can correctly identify spondaic/spondee 50% of the time
Speech recognition threshold SRT
41
Use _ dB steps to obtain SRT and record on audiogram
5
42
Cross hearing in speech reception threshold testing occurs when there is a _dB difference or greater between SRTs of each ear
40
43
Masking for SRT
Speech noise which is more broad band of frequencies
44
Speech recognition test
WRS, Word Recognition Score
45
In WRS, words are presented at _or_ dB above SRT sensation level (SL)
30/40
46
WIPI (young children)
Word Intelligibility by Picture Identification
47
Cross hearing when intensity level is _ dB/greater than SRT of non test ear
40
48
WRS > 90
Normal; conductive HL
49
WRS <90
Mixed; sensorineural HL
50
Intensity level at which speech is comfortably loud
MCL, Most Comfortable Loud Level
51
Intensity level at which speech is uncomfortable, especially important in SNHL
UCL, Uncomfortable Loudness Level/ TD, Threshold of Discomfort
52
UCL-SRT
dynamic range
53
part of the routine test battery used to assist in differentiating between middle ear, inner ear, and retrocochlear pathologies
Acoustic Immittance /Impedance Audiometry
54
Acoustic Immittance is based on the following knowledge:
The middle ear is a stiffness dominated system.
55
applies pressure to EAC
Air Pressure Transducer
56
226 Hz tone presented through a probe
Probe Tone
57
measures reflection of energy from TM
Microphone
58
used to present tones to measure the contralateral acoustic reflexes
Earphone
59
volume of air present in the EAC
Ear Canal Volume
60
normal ear canal volume values range
.2cc-2.0cc
61
values greater than normal range from ear canal volume is an indication of
TM perforation
62
measurement of the outer/middle ear mobility
static compliance
63
normal static compliance values range
.2cc-1.8cc
64
lower than .2cc (static compliance range)
stiffness of the system
65
higher than 1.8cc (static compliance range)
hypermobility of the system
66
dynamic measurement of the the compliance of the ear, condition of middle ear structures, and amount of pressure in the middle ear
tympanometry
67
normal range for middle ear air pressure
-150 - +100
68
ECV= .2 to 2.0; static compliance= .2 to 1.8; middle ear pressure= -150 to 100
Type A
69
static compliance= below .2cc
Type As
70
static compliance= greater than 1.8cc
Type Ad
71
middle ear pressure= greater than -150 (e.g. -170)
Type C
72
static compliance= no peak; middle ear pressure= no peak; ECV= .2 to 2.0
Type B (causes include otitis media or cerumen impaction)
73
static compliance= no peak; middle ear pressure= no peak; ECV= greater than 2.0
Type B (causes include TM perforation or Pressure Equalizing Tube dysfunction)
74
Type As causes include:
otosclerosis or recurrent middle ear infections
75
Type Ad causes include:
disarticulation of the ossicular chain or chronic OM with TM perforation
76
Type C causes include
eustachian tube dysfunction or possibly some fluid
77
lowest intensity level that elicits contraction of the stapedius muscle in the stimulated ear (contraction-reflex)
acoustic reflex threshold
78
meter picks up change in compliance; measurement begins at _ dB; no response, decrease intensity by _ dB; response, increase by _ dB
70; 10; 5
79
acoustic reflex is mediated in the _
superior olivary complex (where sound is localized for both ears)
80
measured by introducing a continuous tone fro 10 sec at 10 dB above AR threshold and looking for 50% decay within 5 sec; tested at 500Hz and 1000Hz
Reflex Decay
81
Causes of reflex decay
acoustic tumors on auditory nerve or facial nerve dysfunction (e.g., facial palsy)
82
sounds that originate in the cochlea that can be detected from the EAC (used to determine outer hair cell function)
Otoacoustic Emissions, OAE
83
OAEs are present in the absence of any external stimulus; present in about 40-60% of normal ears at 1k-3k Hz
Spontaneous
84
two different primary tones are presented that cause cochlea to produce energy at additional frequencies(distortion)
Distortion Product OAE
85
uses short click or tone pip; OAE DISAPPEARS when threshold is about 40 dB
transient
86
hearing sensitivity doesn't exceed 30 dB
normal OAEs
87
outer hair cells are damaged; conductive HL; excessive cerumen
absent OAEs
88
Newborn hearing screening
OAE and/or ABR
89
electrical responses that are generated after the presentation of auditory stimuli and recorded using computerized equipment
auditory evoked potentials
90
early auditory evoked potential; occurs 10-15 sec after auditory signal (click); generates waveforms each representing neuroelectric activity along the central auditory brainstem
Auditory Brainstem-evoked Response or BEAR, Brainstem Evoked Auditory Response
91
VIIIth nerve
Waves I & II
92
superior olivary complex
Wave III
93
lateral lemiscus
Wave IV
94
inferior colliculus
Wave V
95
undetermined
Waves VI & VII
96
clinical use of ABR testing
determine if hearing loss is cochlear or retrocochlear
97
Waves I, III, & V
absolute latencies
98
Waves I-III, I-V, & III-V (between peaks)
interpeak latencies
99
Wave V between ears
interaural latencies
100
delays in speech & language development; affects psychosocial development; affects academic achievment
delay in identification
101
early intervention; lessen affects of hearing loss that increase chance for child to be successful
early identification
102
1 in _ babies are born with a hearing loss
1000
103
before newborn hearing screening, avg age of identification was _
2
104
Neonatal screening types (2)
OAE & ABR (if OAE fails)
105
good program for childhood HL (4)
follow-up; diagnostic evaluation for infants who fail; intervention program; fitting of appropriate hearing aids
106
eyes shift; cessation of activity; stops sucking bottle to attend to stimulus (BOA)
Behavioral Observation Audiometry
107
warbled tones and speech stimuli
SAT
108
No responses in the soundfield does not mean _
child cannot hear
109
behavioral testing in children 2-6yrs (limits)
limit instructions; limit # of frequencies tested
110
significant HL when testing children (alternative testing)
BC; use low frequency stimulus
111
excuses from parents concerning their child's delayed development
they're ignoring me; they're daydreaming; boys develop later than girls; they'll grow out of it
112
good case history
illnesses; birthweight; family history of HL; developmental delays in other areas
113
first thing to consider contributing to speech & language delay
possibility of HL
114
individuals with normal hearing who have difficulty processing auditory information
APD, Auditory Processing Disorder
115
APD behaviors (confused with ADHD)
poor listening skills; poor reading comprehension; poor auditory memory; short attention span; difficulty understanding speech in the presence of background noise
116
enhance the signal to noise ratio through the use of _
FM system, preferential seating, etc.
117
frequencies tested during hearing screenings in the schools
1k, 2k, 4k Hz
118
obtain certification through the _
Texas Dept of Health
119
Intensity level used during school hearing screenings
25dB
120
type of criterion for school hearing screenings
pass/fail
121
population screened (schools)
K, 1st, 3rd, 5th, 7th, and first time entrants
