Intro: Review of anatomy, Physical exam and General Terminology Flashcards
How many percent of the population have speech and/or hearing disorders?
10-15% of the population have speech and/or hearing disorders
Why do we have to know these Universal medical terms? (2)
- Conveys specific ideas, facts and concepts about a patient/client or condition
- Important in precise communication with other healthcare professionals
Give the anatomical terms in the list below:
Medial
Lateral
Proximal
Distal
Ipsilateral
Contralateral
Superior (cephalic)
Inferior (caudal)
Anterior (ventral)
Posterior (dorsal)
Unilateral
Bilateral
Medial
Lateral
Proximal
Distal
Ipsilateral
Contralateral
Superior (cephalic)
Inferior (caudal)
Anterior (ventral)
Posterior (dorsal)
Unilateral
Bilateral
What is the difference between the epidemiological terms of incidence and prevalence? (2)
Incidence
Number of new cases per certain time period
Prevalence
Number of cases present at a certain time
Which terms are used to evaluate a clinical test? (2)
Sensitivity and specificity
Complete this table in relation to True/False positive/negative
What does Sensitivy test? (2)
Test’s ability to identify positive results
Sn = TP / (TP + FN)
What does specificity test?
Test’s ability to identify negative results
Sp = TN / (TN + FP)
What does this table tell us?
Sn = 95 / (95 + 5) = 95% chance that positive means you have the disorder
Sp = 810 / (810 + 90) = 90%
Oto- =
ear
-itis =
infection/inflammation
-algia =
pain
-rrhea =
fluid
-ectomy =
remove/excise
-otomy =
cut into/incise
-plasty =
alter or change
Hypo- =
Hyper- =
Hypo- = too little
Hyper- = too much
Tumor =
Lesion =
Tumor = any growth or mass
Lesion = skin changes, masses,…
Why must we know about anatomy?
You must know normal anatomy in order to recognize abnormalities
What are the three parts of the ear?
EE ME and IE
What constitutes the EE? (2)
Auricle (pinna, outer ear)
External auditory canal (EAC)
What constitutes the ME?
Tympanic membrane
Ossicles
What constitutes the IE? (2)
Cochlea
Balance organs (SSCs and vestibular organ)
Fill in the blanks
What is so special about the ME?
It is an air filled cavity
The inner ear is a synonym of a
Labyrinth
What fluids are in the IE?
Perilympgh and Endolymph
What are some important parts of the Organ of Corti? Give 5
What are some important parts of the Organ of Corti? Give 5
What are the important locations of the CAP? (7)
.
What are the 12 cranial nerves?
Which cranial nerve is affected?
VI Abducens – turns eye laterally
Which cranial nerve is affected?
XII Hypoglossal – tongue movement
What are the steps in patient evaluation? (6)
History
Physical examination
Investigations/tests
Diagnosis
Treatment and referral
Follow-up
What are the steps in History taking? (2)
- General structure
(ex: History of present illness (otologic or speech history)
Past medical/surgical history
Medications/allergies
Family history
Birth/labour history -especially for kids) - Otologic History
Ex: Otalgia
Hearing loss
Aural fullness
Tinnitus
Vertigo
Otorrhea
(Ear tugging)
What are the steps of the Ear Exam? (2)
- Inspection
Masses
Skin changes
Symmetry
Abnormal shape
Abnormal position
Discharge - Otoscopy
What is otoscopy? (4)
Examine both the EAC, TM and middle ear space
Difficult skill to learn
Many ways to hold the otoscope
Steady yourself against the patient
What are tips for Otoscopy? (3)
Use the LARGEST size speculum that fits
Bigger aperture -> more light, wider view
Most 12 months old can accommodate 4 or 5 mm speculum
What are otoscopy tips for older children? (2)
Ideally patient is sitting
Your eye level should be at or below child’s ear
What are otoscopy tips for Younger children? (2)
Sitting on parent’s lap with hands being held
If uncooperative, parent hold forehead with one hand and arms with the other
What are Otoscopy tips related to the EAC (External Auditory canal)? (2)
Not a straight structure-make sure to gently pull the ear backwards
EAC usually lies in a slightly superior and anterior direction-point the otoscope in the same direction
What is the difference between Pneumatic otoscopy and Otomicroscopy?
Improved diagnosis with
Pneumatic otoscopy (which uses air)
Otomicroscopy (microscope)
How does a pneumatic otoscope work? (2)
Form a tight seal in the EAC
Insufflate the bulb to see TM movement
What do we typically see during otoscopy? (6)
EAC
Pars tensa (all 4 quadrants)
Pars flaccida (attic)
Color/thickness of TM
Translucency
Anatomic structures
What part is not always visible during Otoscopy?
Incus
What can we see in a normal LEFT TM for example? (4)
Malleus (umbo, lateral process, handle)
Pars tensa, pars flaccida (upper 1/5)
Long process of incus
Stapes
What can we see in a normal LEFT TM for example? (4)
Malleus (umbo, lateral process, handle)
Pars tensa, pars flaccida (upper 1/5)
Long process of incus
Stapes
What are important aspects in Mouth and throat exams? (3)
1- Bright light is very important
2- Use a tongue depressor to view throat, tongue and all mucosal surfaces (Remove dentures)
3- Press on only anterior ½ of tongue to minimize gag reflex (“ahhh” will raise the palate)
Which type of exam is this?
Endoscopic Exam
What are the two types of tuning fork tests and are done with how many Hz tuning forks?
Weber
Rinne
Usually done with a 512 Hz tuning fork
Describe the Weber test: (3)
Uses the occlusion effect
Normal = no lateralization
Sound lateralizes to side with
- CHL
- Contralateral ear with SNHL
Describe the Rinne Test: (3)
Normal
AC > BC (Rinne +ve)
CHL
AC < BC (Rinne –ve)
SNHL
AC > BC (Rinne +ve)
What are the differences between the Weber and Rinne tests?
In the Weber test, lateralization to one side can mean that the ear has better hearing or conductive loss
The Rinne test is mostly a Comparison of AC and BC
What is a deciBel? (3)
Sound pressure unit (intensity) based on a logarithmic ratio
It is nonlinear and is a relative measure
2 dB ≠ doubling of intensity
What is HL (hearing level)?
- Threshold dB based on normative hearing data as a reference
- 0 dB is the minimal intensity for average ear to perceive a specific frequency
- Reference used in most audiometers
What is SL?
Sensation level
Sensation level (SL)
Level in dB above an individual’s threshold
Eg, if someone’s threshold is 20 dB HL then 50 dB SL = 70 dB HL
What are the 3 parts of an Audiogram Testing?
Pure tone testing (frequency response)
Speech testing
Acoustic impedance
Describe the three parts of an Audiogram:
- Pure tone testing (frequency response)
Ability to detect sound - Speech testing
Ability to decode sound - Acoustic impedance
Helps define where problem is
What information could we see on an Audiological Evaluation?
Describe the Pure tone testing: (3)
- Pure tones (single-frequency) at 250, 500, 1000, 2000, 4000, and 8000 Hz
- Air conduction (AC)
- Bone conduction (BC)
Describe the Pure tone testing: (3)
- Pure tones (single-frequency) at 250, 500, 1000, 2000, 4000, and 8000 Hz
- Air conduction (AC)
- Bone conduction (BC)
Describe the Pure tone testing: (3)
- Pure tones (single-frequency) at 250, 500, 1000, 2000, 4000, and 8000 Hz
- Air conduction (AC)
- Bone conduction (BC)
Is this a recording BC or AC threshold?
BC
Is this a recording BC or AC threshold?
AC
Describe AC pure tones test: (2)
Lowest level dB HL at which the subject perceives 50% of pure tones introduced via ear/head phones or speakers (sound field)
Conduction from auricle to cochlea
Describe BC pure tones test: (3)
Lowest level dB HL at which the subject perceives 50% of pure tones introduced via bone oscillator
Conduction from skull bones to cochlea (bypassing the EAC and middle ear)
BC not tested at 8000 Hz
Describe PTA (pure tone average): (2)
Average threshold at 500, 1000, and 2000 Hz
Should be within 10 dB of speech reception threshold
What is speech audiometry?
Spoken voice serves as the sound stimulus
What is Air-bone gap (ABG)?
Decibel difference between BC and AC
What is Air-bone gap (ABG)?
Decibel difference between BC and AC
What is Mixed hearing loss?
CHL + SNHL
What is recruitment?
Increasing signal intensity leads to out-of-proportion perception of loudness
Suggests cochlear hearing loss (eg Meniere’s)
What a are the 4 types of curves in the diagram?
Flat
Rising
Sloping
Cookie bite
What is Rollover? (2)
Paradoxical decrease in discrimination ability with increasing stimulus intensity
Suggests retrocochlear disorder (eg acoustic neuroma)
What is tone decay and fatigue? (2)
Decrease in auditory perception with a sustained stimulus
Suggests retrocochlear disorder
What are the degrees of severity in hearing loss? (5)
What is Masking?
Noise introduced with AC into non-test ear to prevent crossover
What is crossover?
Perceived sound from an acoustic signal introduced to opposite ear
What is crossover?
Perceived sound from an acoustic signal introduced to opposite ear
What is AC crossover?
When test ear intensity is 40 dB or greater than BC of non-test ear
When does BC crossover occurs?
Occurs at 0 dB
What is Masking dilemma?
Bilateral ABG (Air-Bone Gap) of 50 dB cannot be masked
A masking dilemma occurs when energy from a non-test ear crosses over the head to a test ear. In cases of bilateral atresia, obtaining thresholds on the poorer ear is problematic.
What are the two ways to measure Acoustic impedance?
Tympanometry
Acoustic reflex testing
What is Tympanometry? (2)
- Indirect test of middle ear function by transmission/reflection of sound energy
- Tympanogram plots compliance changes of TM vs air pressure in the EAC
Which Tympanometry result Type is this?
A: normal (peak between -150 & +50 daPa)
Which Tympanometry result Type is this?
AS: “shallow” (reduced compliance)
Which Tympanometry result Type is this?
AD: “deep” (hypercompliant)
Which Tympanometry result Type is this?
B: flat (fluid, perforation, tube)
Which Tympanometry result Type is this?
C: -ve pressure (retracted TM, ETD)
What is an acoustic reflex? (2)
Reflexive contraction of stapedius muscle in response to high-intensity sound
Acoustic signal in one ear and TM mobility detected in both ears (ipsilateral and contralateral responses)
What are 3 conclusion we can see from Acoustic Reflex Testing?
- Test response: ipsilateral > contralateral
- Bilateral
- Occurs at the brainstem level
What could cause absent acoustic reflexes? (5)
minimal CHL, SNHL (> 60 dB), brainstem lesion, CN VIII impairment, CN VII dysfunction
What are otoacoustic emissions (OAE)?
Objective sound in the EAC emitted from outer hair cells
Presence of OAE -> normal cochlea (organ of Corti)
Normal with retrocochlear and central auditory disorders
What are Auditory brainstem response (ABR) tests?
Recording of the activity of 8th nerve and CNS response to auditory stimulus
Electrodes placed on head, mastoid, and ear to detect electrical signals with sound stimulus
What are the 5 ABR peaks? (HINT: E COLI)
I-II: Eight nerve
III: Cochlear nuclei
IV: Olive (superior)
V: Lateral lemniscus
VI-VII: Inferior colliculus
