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Audiology Diagnostics 2 > Midterm 2 > Flashcards

Midterm 2 Flashcards

1
Q

what are we now learning about high frequency audiometry?

A

We learning that high frequency audiometry is more of a sensitive measure for detecting damage to the auditory system. (however there is still a lot of research being done in this area) However it has been used of ototoxic monitoring for a long time.

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2
Q

What is a common use of high frequency audiometry?

A

monitoring for ototoxicity
or
ototoxicity monitoring

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3
Q

What transducer type must be used for high frequency audiometry?

A

circumaural headphones

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4
Q

Does the transducer type matter for high frequency audiometry?

A

Yes, circumaural headphones

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5
Q

What is the IA value for circumaural headphones?

A

Same as Supras
40

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6
Q

Briefly describe the AAA protocol for OME screening.

A

o Calibrate equipment daily
o Screen with OAE or tones before doing tymps
o Refer if TW and/or static admittance suggest flat tymp (you could look up the specifics as needed)
o NPP greater than -200 (do not refer on this criterion alone)

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7
Q

Define the term acoustic immittance

A

How well energy flows though a system

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8
Q

Define the term acoustic impedance

A

Opposition to the flow of energy

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9
Q

Define the term acoustic admittance

A

Ease with which energy flows through the system

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10
Q

What are the three components of the probe for tympanometry?

A

The probe its self has 3 components
1. Tone that is played when tymp is ran
2. Microphones picks up sound in my space while running it.
3. Air pressure- changes air pressure

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11
Q

Probe looks like what

A

Probe is the one with the three tubes it is used for
Tymps
Air pressure generator
Microphones
Tone generator

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12
Q

Stim looks like what

A

Acoustic reflexs - black tube only generates just a tone. also known as (stim)= sound

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13
Q

Describe the instrumentation for immittance measures.

A

Sound goes in the ear, changes the pressure and measure the sound in the ear as the pressure changes by the microphone.
X= pressure
Y= admittance

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14
Q

How is a tympanogram derived?

A

Derived: It is changing pressure, and it is plotting admittance.
- Increase impedance
- Decrease admittance
- Measure sound transmission at each pressure point and compare to norms

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15
Q

What is the premise underlying tympanometry?

A

Premise: The admittance is greatest when the ear canal pressure matches the middle ear pressure.

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16
Q

what is the adult norm for static admittance

A

Peak Compensated Static Admittance (Ytm)
0.3 – 1.7 mL

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17
Q

what is the adult norm for Equivalent Ear Canal Volume

A

Equivalent Ear Canal Volume
0.9 – 2.0 ml

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18
Q

what is the adult norm for Tympanogram Width (TW)

A

Tympanogram Width (TW)
50 – 115 daPa

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19
Q

what is the adult norm for Tympanometric Peak pressure

A

Tympanometric Peak pressure:
-100 to +50 daPa

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20
Q

Name the values for a normal tymp

A

Peak Compensated Static Admittance (Ytm). 0.3 – 1.7 mL
Tympanogram Width (TW) 50 – 115 daPa
Equivalent Ear Canal Volume 0.9 – 2.0 ml
Tympanometric Peak pressure: -100 to +50 daPa

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21
Q

What is Tympanic peak pressure

A
  • point where middle ear system is operating most efficiently
  • Peak approximates but does not measure middle ear pressure
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22
Q

What is Static Admittance

A

Static Admittance
- tympanogram peak height
- Static admittance - Ytm
- Frequently referred to as compliance or peak compliance
- Measures stiffness or “floppiness” of the ossicular chain/middle ear system

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23
Q

What is Ear Canal Volume

A

Ear Canal Volume
– literally tells you the “volume” size of the ear canal
- Ear canal volume provides useful information about the status of the TM such as….
o Intact TM
o Patent PE tubes
- Ear canal volume provides information about the ear canal such as…
o Estimate blockage
o Surgical ear

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24
Q

Why do we report numbers over shape?

A

We use the numbers to compare to the norms and it is more precise and gives a clearer picture than just giving A or B etc.

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25
Q

Describe Type A

A

A
○. normal range
○ Peak is in the box

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26
Q

Describe Type As

A

A(s)
○ very shallow peak
○ Peak is below the box
○ Associated with otosclerosis
○ Can also occur with otitis media

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27
Q

Describe Type Ad

A

A(d)
○ very high (deep) peaks
○ Peak is above the box
○ Found in otherwise normal ears that had scarred or flaccid eardrums
○ Also found in cases of ossicular interruptions it above 1.7 it’s a d or dd

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28
Q

Describe Type B

A

● Essentially flat across the pressure range
● Characteristic of patients with middle ear fluid and cholesteatoma
● Could also be caused by eardrum perforations or impacted cerumen (or other obstructions) in the ear canal

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29
Q

Describe Type C

A

● Negative pressure peaks beyond -100 daPa
● Indicating negative ear pressure
● Peak is to the left of the box
● Associated with eustachian tube disorders
● Also found in cases of middle ear fluid

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30
Q

Name the Tymp type

A

Type A

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31
Q

Name the Tymp type

A

Type C

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32
Q

Name the Tymp type

A

Type Ad

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33
Q

Name the Tymp type

A

Type As

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34
Q

Name the Tymp type

A

Type B

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35
Q

Does it matter how you measure a reflex? If yes explain.

A

Yes, You have to run a tymp first to pressurize the ear canal because you want to measure a reflex at the patients peak pressure because admittance is greatest at peak pressure.

35
Q

what measure from the tympanogram changes when an acoustic reflex is present?

A

Admittance is what changes with a present acoustic reflex. The admittance decreases during the reflex because the reflex causes the ossicular chain to stiffen causing a decrease.

36
Q

What is the minimum amount of change required to consider if a reflex is present?

A

.02
admittance, performed at the peak pressure (amount of reflex)

37
Q

What are the five criteria for a reflex to be considered valid?

A
  1. Lowest level that elicits “criterion change”
  2. Time locked to stimulus onset
  3. Replicable
  4. Growth- stronger response present 5dB above/ Reflex is stronger the further you go above threwshsold.
  5. A decrease of admittance.
38
Q

What is considered a normal ASR (Acoustic Stapedial Reflex) ?

A

70-90 dB SL

39
Q

An acoustic reflex would be expected with hearing loss up to what level (cochlear)?

A

60 dB HL

40
Q

identify reflex patterns associated with normal hearing

A

Acoustic reflex norms are considered in dB SL
70 – 90 dB SL is considered “typical”
If clinic uses norms from a study, must use same procedures as study

41
Q

what is considered “reduced” reflex

A

If the reflex less then < 70 dB SL it is considered “reduced”

42
Q

What is considered “elevated” reflex

A

If the reflex is greater then > 90 dB SL it is considered “elevated”

43
Q

What is considered “NR”

A

If the reflex is NR it is considered “absent”
NR = you tested but there was no reflex at the maximum level of testing

44
Q

Calculating dB SL

A

Reflex threshold in dB HL – air conduction threshold for the stimulus ear.

45
Q

ANSD:

A

bilateral, you would see this with a sensorineural HL, retrocochlear and you would have absent reflexes at a level where you would expect a reflex. It is retrocochlear

46
Q

SSCD

A

is when you have a conductive loss but all your reflexes are normal and your admittance is normal as well. It a vestibular system but its changing your sensitivity of air conduction and bone conduction. It makes your air conduction sensituvity worse and bone better. Normal tymp and normal reflex.

47
Q

ascending =

A

Stim ear
cochlear, retro, middle hl - stimulus ear will be abnormal

48
Q

descending =

A

Probe
every time the probe ear is the right ear, the reflexes are absent

49
Q

crossover =

A

brainstem

50
Q

Reflex patterns for Sensorineural Hearing loss

A

Ascending pathway is affected with sensorineural hearing loss. For both cochlear and retrocochlear
Descending pathway is not affected with sensorineural hearing loss

51
Q

Different pattern for cochlear vs. retrocochlear

A

dB SL of the reflex when the affected ear is the stimulus ear
Cochlear : < 70 dB SL
Retrocochlear: > 90 dB SL or ABS/NR

52
Q

Reflex patterns for Cochlear

A

● Sensorineural hearing loss
● Reflexes are affected when the affected ear is the stimulus ear
● Smaller < 70 dB SL
● “stimulus effect”
● “stim effect”
● “sound effect”
● Generally, you should expect a reflex for hearing losses up to ~ 60 dB with cochlear hearing loss
● If AC thresholds are larger > 60 dB, absent reflexes are not diagnostic. (above 60)

53
Q

Name the reflex

A

Cochlear

54
Q

Reflex Patterns Vestibular Schwannoma

A

● Sensorineural hearing loss (or NH)
● Reflexes are affected when the affected ear is the stimulus ear
● Larger/above >90 dB SL (usually absent)
● “stimulus effect”
● Likely absent unless hearing thresholds are very low
● If AC thresholds are > 60 dB, absent reflexes are not diagnostic
○ Remember there are sometimes conditions for interpreting test results?

55
Q

Name the reflex

A

Vestibular Schwannoma

56
Q

Reflex patterns for Conductive HL

A

● Conductive pathology affects the descending pathway
● Reflex (typically) can not be measured in ear with middle ear condition
● Reflex will be absent when the affected ear is the probe ear.
○ “probe effect”
○ The contralateral reflex for the affected side will be 70-90 dB above the hearing thresholds at that ear
■ will be near the limits of the equipment or absent

57
Q

Name the reflex

A

Conductive HL

58
Q

Name the reflex

A

Brainstem Pathology

59
Q

Reflex patterns for Brainstem Pathology

A

● Contralateral reflexes will be absent with ipsilateral reflexes present
● “crossover pattern”
● Cannot differentiate type of brainstem pathology on reflexes alone

60
Q

What type of pathology is suggested here based on AC thresholds and reflexes?

A

Facial Nerve - affecting the probe ear and there is no HL

61
Q

What type of pathology is suggested here based on air conduction thresholds and acoustic reflexes?

A

Cochlear - SL is lower than 70 indicative of cochlear HL of the RE stim

62
Q

What type of pathology is suggested here based on air conduction thresholds and acoustic reflexes?

A

Cochlear

63
Q

What type of pathology is suggested here based on air conduction thresholds and acoustic reflexes?

A

Retrocochlear - NR on the left ear as stim and it is in the same ear suggestive of retro and because HL is 60 or better, they should have reflexes

64
Q

What type of pathology is suggested here based on air conduction thresholds and acoustic reflexes?

A

Conductive - probe side is on the left and with probe no response + HL = conductive

65
Q

What type of pathology is suggested here based on air conduction thresholds and acoustic reflexes?

A

Brain stem. - it is the contras that are affected and no HL

66
Q

Fill in table

A
67
Q

How many people total are positive for the disease (have the disease?

A

100 - total that tested positive and total that had it but tested negative (30+70)

68
Q

How many people total are negative for the disease (do not have the disease)?

A

525 500+25=525

69
Q

How would you calculate sensitivity? (How good is our test at identifying those correctly who have the disease)

A

30/100 (30+70=100)
Number of true positives / total number who have it

70
Q

How would you calculate specificity? (how good our test is at identifying those who do not have the disease)

A

500/525 (500+25=525)
Number of true negatives / total number who do not have it

71
Q

Is standard low frequency tympanometry good at differentiating between otosclerosis and a normal middle ear?

A

No, it is not very good. You can have a normal tymp with otosclerosis.
It is good at determining middle ear fluid.

72
Q

What is a primary factor that influences sensitivity and specificity for a specific test?

A

Is where your cut off is what you consider a pass or fail.
How you set your screening criteria. (if you have it more sensitive or not.)

73
Q

Briefly describe the AAA protocol for OME screening. You do not have to memorize the entire thing because clearly you could look it up if needed.

A

o Calibrate equipment daily
o Screen with OAE or tones before doing tymps
o Refer if TW and/or static admittance suggest flat tymp (you could look up the specifics as needed)
o NPP greater than -200 (do not refer on this criterion alone)

74
Q

What is a common use of high frequency audiometry?

A

Ototoxicity monitoring

75
Q

What is high frequency audiometry good for?

A

We learning that high frequency audiometry is more of a sensitive measure for detecting damage to the auditory system. (however there is still a lot of research being done in this area) However it has been used of ototoxic monitoring for a long time.

76
Q

what is a more sensitive measure for detecting damage to the auditory system.

A

We learning that high frequency audiometry is more of a sensitive measure for detecting damage to the auditory system. (however there is still a lot of research being done in this area) However it has been used of ototoxic monitoring for a long time.

77
Q

What transducer type must be used for high frequency audiometry?

A

circumaural headphones

78
Q

What is the IA value for circumaural headphones?

A

Same as Supras- 40

79
Q

An abnormal static admittance volume reading suggests a disorder where?

A

TM and/or ossicular chain

80
Q

An abnormal peak pressure reading suggests a disorder where?

A

ET, Eustachian Tube (not functioning)

81
Q

An abnormally low ear canal volume reading suggests a disorder where?

A

Ear canal (blockage)

82
Q

An abnormally high ear canal volume reading suggests a disorder where?

A

TM (perforation)

83
Q

Which measure is outside of normal limits for one or both ears?

A

Static admittance (abnormally low) - As right ear
Normal Peak Compensated Static Admittance (Ytm) 0.3 – 1.7 mL

84
Q

Unimpaired auditory system

A

Hearing thresholds are WNL AU
All reflexes present at 70-90 dB SL

Audiology Diagnostics 2 (1 decks)

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