Midterm Flashcards
(92 cards)
1
Q
parts of the outer ear (3)
A
- pinna
- External Auditory Meatus
- Lateral Layer of TM
2
Q
Middle Ear
A
- Ossicles
- Muscles- Acoustic Reflex
- Eustachian Tube
- Where acoustic energy converts to mechanical energy
- Impedance Mismatch
3
Q
Parts of Ossicles
A
- Maleus
- Incus
- Stapes
4
Q
muscles of middle ear involved in acoustic reflex
A
- stapedius (7th cn)
- Tensor Tympani (5th cn)
5
Q
Eustachian Tube
A
- middle ear
- clear excess mucous
- equalize middle ear pressure
6
Q
Impedance Mismatch
A
- middle ear
- ossicles act as a lever system
- reduction in area from the TM to oval window, increasing force
7
Q
Inner Ear
A
Balance
Hearing
8
Q
Balance in the inner ear
A
- vestibule (linear acceleration)
- semicircular canals (rotational)
9
Q
Hearing in inner ear
A
Cochlea-organ of hearing
10
Q
Cochlea
A
- where mechanical energy converts to electrical energy
- membranous labyrinth encased in temporal bone
- Modiolus
- Osseous Spiral Lamina
- Basilar Membrane
- Reissner’s Membrane
11
Q
Modiolus
A
central axis of cochlea
12
Q
Osseous Spiral Lamina
A
shelf-like structure protecting from modiolus
13
Q
Basilar Membrane
A
projects from spiral lamina and connects to outer wall of cochlea, the spiral ligament referred to as floor of cochlea
14
Q
Reissner’s Membrane
A
projects from spiral lamina in an upward fashion to a region of outer wall (ceiling)
15
Q
Channels of the Cochlea
A
- Scala Vestibuli (Above Reissner’s)
- Scala Tympani (Below Basilar’s)
- Scala Media/ Cochlear Duct- btwn Reissner’s and Basilar’s, organ of corti
16
Q
Organ of Corti
A
- sensory organ of hearing
- rests on floor of BM
- sensory cells
17
Q
Sensory Cells of Organ of Corti
A
- Inner: single row, towards modiolus “U” shape, loud sounds
- Outer: 3-4 rows, towards spiral lamina, “v/w” shape, soft sounds
- Stereocili: project from both IHC & OHC, graded in length
- Tectorial Membrane: longest stereocilia are embedded in it.
18
Q
Pathways of Sound
A
- Conductive: outer & middle ear
- Sensory/Neural: inner ear & auditory nerve
19
Q
Conduction of Sound
A
Air
Bone
20
Q
Air Conduction
A
- sound travels through all 3 parts of ear: outer, middle, & inner
- how we hear in every day life
21
Q
Bone Conduction
A
- occurs through vibrating the skull
- sound BYPASSES outer & middle ear to directly stimulate nerve/inner ear
22
Q
Measurement of Hearing
A
Volume: Decibel (dB)
Pitch: Frequency (Hz)
23
Q
Air vs. Bone Conduction
A
- determines type of HL
- Air-Bone gap: difference of 15 dB or more btwn 2 methods of testing
- separates conductive HL vs. mixed vs. sensorineural
24
Q
Types of HL
A
- Conductive
- Sensorineural
- Mixed
25
Conductive HL
- problem exists w/in conductive/mechanical portion of ear (outer &/or middle ear)
- Air conduction-impaired
- Bone conduction- normal
- * Air-Bone Gap Present**
26
SNHL
- problem lies w/in inner ear &/or nerve
- Mechanical/Conductive portion- normal
- Air Conduction- impaired
- Bone Conduction- impaired
- Air & Bone are EQUALLY impaired- NO AIR-BONE GAP
27
Mixed HL
- damage occurs to both conductive & sensory/ neural pathways
- air conduction- impaired
- bone conduction- impaired, but BETTER THAN AIR
- **Air-Bone Gap Present**
- age related HL, but cerumen impaction
- congenital HL, but patient developed an ear infection
28
Cross Hearing
-when sound presented on 1 ear is so loud it sets skull into vibratory state, causing cochlea on other side to vibrate (bone conduction)
29
Masking
1. presenting 2 sounds at same time, where intensity of one causes other to be inaudible
2. shifts threshold- a sound now needs to be louder to detect
3. masker- noise that causes change of threshold, usually presented to better ear or ear you do not want a response from
4. eliminating an ear to contribute to a response
30
Test ear vs. non test ear
1. TE- ear you are testing/want response to come from this side
2. NTE- ear you are eliminating, masker presented to this side
31
Interaural Attenuation
1. Loss of energy from one side, but picked up from other side
2. energy transferred from TE to NTE
3. level at which sound will cause bone conduction/ IA
a. headphones = 40 dB
b. inserts = 70 dB
c. bone oscillator = 0 dB
32
When do we need Masking?
1. Air Conduction:
a. large difference btwn ears
b. Headphones: difference of 40 dB
c. Inserts: difference of 70 dB
2. Bone Conduction:
a. air-bone gap present
b. unmasked bone only tests better cochlea, should a difference exist
c. Thus, when BC is better than AC (air-bone gap) we do not know which ear is responding
33
Formula for masking
AC te - IA > BC nte
34
Masking noises used
1. Pure tone testing: narrowband noise
| 2. speech audiometry: speech noise
35
Pure tone testing & SRT/SAT
1. in general you need about 30 dB of noise above AC threshold of NTE
2. AC threshold NTE= 30 dB, you need to present masking at 60 dB
3. Before you reach full 30 dB above NTE, start using Plateau method first bc some will require more than 30 dB
36
WRT scores
1. present noise 20 dB less than that of presentation level in TE
2. Exp. Presenting words at 70 dB in TE requires 50 dB of speech noise in NTE
3. Note: some situations may require more noise
37
Pure tone testing
1. subjective measurement: pt. indicates what they can hear
2. threshold-softest sound heard 50% of time
3. measure at frequencies of 200, 500, 1000, 2000, 3000, 4000, 6000, 8000 Hz
38
position of patient with pure tone testing
1. 45 or 90 degree angle from audiologist
2. ensures no visual cues- looking up & down at audiometer, eye shifts, hand movements
3. should always be able to see pt.
39
pure tone testing: procedure
1. start w. air conduction
2. begin at 1000 Hz
3. present at 30 dBHL
- if respond go down in 10 dB, once no response, go up 5 dB until responds, then down 10 up 5 until reach 50% mark 2 out of 4
- no response go up 20 dB, if respond at 50 dB apply down 10 up 5 method
40
Pure tone average
threshold average at 500, 1000, and 2000 Hz
| ** if air conduction reveals a hearing loss, bone conduction MUST be performed
41
pure tone testing: bone conduction
1. place ossilator on either mastoid
2. search for threshold same way w. air conduction (down 10, up 5) start w. no masking
3. unmasked BC doesn't tell you which ear is responding it tells you:
- if there is an air-bone gap (conductive or mixed HL)
- if no air-bone gap present, masking is required to determine inner ear status (damage or no damage) on each side
42
Pure tone testing: false responses
1. False negative:
- fails to respond when hears a sound
- special needs, melingerer
2. False positive:
- responds when there is no signal
- pts. w. tinnitus, perform well for a job, school
43
Tactile Response
1. when presentation level exceeds certain intensity & pt. feels vibrations as opposed to hearing them
2. usually seen w. severe to profound HL
3. may need reinstruction
44
Speech Audiometry
1. determine degree of HL for speech
| 2. examine pts ability to recognize & discriminate speech sounds
45
VU meter
program on audiometer to monitor intensity of output (voice)
46
Live monitored speech
1. your own voice monitored by VU meter
| 2. most time efficient
47
Pre-recorded speech
1. cd w. recorded words or sentences
2. provides consistency among pts
3. more time consuming
48
Speech Awareness detection threshold SAT/ SDT
1. softest level at which pt can detect presence of speech
2. DO NOT need to UNDERSTAND
3. use w. pediatrics, special needs
49
Speech recognition threshold (SRT)
1. softest level a pt. can repeat back a closed set of words
2. NEEDS to UNDERSTAND
3. use spondaic words, spondees, a 2 syllable word, equal stress on each syllable
50
SRT & SAT/SDT
1. Threshold = 50%
2. SAT/SDT usually softer than SRT
3. SRT & SDT should agree with PTA w.in 10 dB
* * speech is usually measured by air but bone may be used in certain situations
51
Dynamic Range
1. measured from softest level one can detect to level of discomfort
2. normal DR is about 100 dB
3. LDL/UDL- loudness discomfort level
4. MCL- most comfortable level
5. DR= LDL- SRT
52
SNHL + DL
1. Reduced DR
2. recruitment- abnormal growth in loudness
3. due to damage in inner ear/ nerve
53
CHL + DR
normal range (healthy cochlea)
54
Mixed HL + DR
may have reduced range (damage)
55
Speech/ Word Recognition scores WRS
1. looking for clarity/ crispness of speech
2. how well can a pt discriminate btwn similar sounds
3. open- set of words: phonetically balanced
4. pt repeats a 50 or 25 word list
- 2 point word- 50
- 4 point word- 25
5. present words about 35-40 dB above SRT or MCL
6. use carrier phrase say the word
7. can perform in quiet or w. noise (realistic)
- SNR signal to noise ratio
- difference btwn noise & target signal (voice)
8. can use a closed set
- pediatric, special needs, severe/profound HL
- pt chooses a picture/ word from a set
56
P.B. Rollover
suprathreshold test, looking for retro-cochlear pathology taxing the nerve function)
57
EHDI 1-3-6 Rule
Screen hearing acuity prior to 1 month of age
Diagnosis (Diagnostic Evaluation) by 3 months of age
Enrolled in Early Intervention by 6 months of age
58
Early Hearing Detection & Intervention (EHDI)
Goal: Maximize linguistic competence and literacy development in children who are Deaf or hard of hearing
2. Hearing loss can lead to decreased communication, cognition, reading and social emotional development
59
Walsh Bill 1999
Newborn & Infant Hearing Screening & Intervention Act
2. Funding was provided to all 50 states from both CDC and Health Resources Services Administration (HRSA) to support the development, planning, implementation and monitoring of EHDI programs
3. Universal Newborn Hearing Screening Programs (UNHS)
a. Lead to reduction in age at which children are identified with HL
b. Receive intervention sooner
c. Ability to stay on or close to target w their hearing peers
60
UNHS screening tools
1. Well Baby – OAEs
| 2. NICU – ABRs
61
EHDI/UNHS – At Risk Patients
1. Audiological monitoring is required for pts who present w at risk factors for late onset HL
a. Min of complete audiological evaluation by 24 and 30 months of age
b. Certain risk factors require more frequent assessment throughout birth to age 3
2. Medical Home - health care provider, usually pediatrician or nurse practitioner, who oversees & coordination of comprehensive, family-centered, & accessible health care throughout a child’s lifetime
62
Role of the SLP in EHDI
1. Reinforce need for hearing screening if c did not pass UNHS, or for c who present w “at-risk” indicators
2. Responsible for reg reevaluation of hearing, monitoring of communication development, and educating families and early interventionists in how to help give children chance for success
3. Helping parents and family adjust when c has been diagnosed with a HL
63
Genetics and HL
1. Children Diagnosed with HL
a. 40% Infectious or environmental Factors
b. 60% Genetic
2. Genetic HL
a. 70% Non-syndromic
b. 30% Syndromic
3. 90% of hearing impaired children are born to hearing parents
64
Audiological Assessment 0-7 months
1. Objective Measures: OAE, Tympanometry, ABR
2. ABR
a. Screening Tool – pass/fail when presented at a specific stimulus level
b. Threshold – Estimation of hearing acuity with frequency specific tone bursts
65
Audiological Assessment 6-8 Months
1. Behavioral Observation Audiometry (BOA)
a. Examine behavioral responses to the auditory stimuli
i. i.e. Sucking, eye opening/widening/shifting, etc.
b. 2 Audiologists needed
c. Sound field measurement – no ear specific info
66
Audiological Assessment 8mo – 2 ½ yrs
1. Visual Reinforcement Audiometry (VRA)
a. Localization of Sound
b. Conditioned Orientation Reflex (COR)
i. When sound is presented, a reinforcer to look for stimuli is also introduced (toy, video, light, etc.)
ii. Once understand they will be reinforced when a sound is heard, present stimuli alone, if correctly identify its location, reward w reinforcer
2. VRA can be presented via…
a. Sound field (how the ear work together)
b. Inserts/headphones (ear specific information)
c. Hearing Aids or Cochlear Implants (functional assessment)
3. VRA Stimuli
a. Voice
b. Warble tones (never pure tones, due to possible standing wave)
c. Narrow band noise
4. 1 to 2 audiologists needed – depends on child’s behavior in the booth
67
Audiological Assessment 2/2 ½ yrs – 4 ½ / 5 yrs
1. Conditioned Play Audiometry (CPA)
a. Condition a child to perform a task every time they hear a sound
b. i.e. throw a ball in a bucket, build a tower with legos, etc.
c. 2 Audiologists Needed (one to test and the other to play/condition the child)
2. CPA can be done via…
a. Sound field (ears working together)
b. Headphones/Inserts (ear specific information)
c. Bone Conduction (better ear, or ear specific information when masking used)
3. CPA Stimuli
a. Speech
b. Warble or pure tone
c. Narrow band noise
68
Audiological Assessment 4-5 yrs and older
1. Traditional testing
2. Raise hand when hear a sound
3. Perform same tests you would an adult
a. SRT
b. WRS
c. Pure tones
69
Operant Conditioning Audiometry
reinforced with food to perform task (not commonly used)
70
Speech Audiometry & Pediatrics
1. Speech Awareness Threshold (SAT)
a. Used up until about age 2 ½- 3 yrs
b. Localize voice
c. Identify body parts or follow a command (“put the ball in the bucket”)
d. Sound field or headphones/inserts/bone oscillator
2. Speech Recognition Threshold (SRT)
a. Can start around 2 ½ yrs old, if a willing participant
i. Picture pointing task
ii. “Show me the cupcake,” etc.
b. By 3 yrs should start to repeat words independently
c. Performed via sound field or headphones/inserts/bone oscillator
3. Word recognition Scores (WRS)
a. Around age 2 ½ can perform via picture pointing
b. About age three will repeat words
c. Special list for WRS when using picture point and repeating
i. Picture Point – WIPI or NU-CHIPS
ii. Repeat – PB-K List
71
Pediatrics and Methods of testing
1. Need to assess where child is behaviorally and apply the tests that would be most appropriate (VRA vs. CPA, SAT vs. SRT)
2. The information presented above is simply a guideline, i.e. child with speech-language delay, or severe articulation errors (picture point), immature for their age, special needs, etc.
3. Note these tests are not just specific to children, an adult with special needs may need to be tests using the procedures mentioned above
72
School Screenings: NYS
1. All students tested w.in 6 months of admission to school, & in kindergarten, 1st, 3rd, 5th, 7th, & 10th grades
2. Screen via air condition – pure tone testing
3. Proper refers if fails – may test 2x’s before referring out to ensure it wasn’t background noise, pt not paying attention
4. Results must be in written format and provided to parent/guardian & teacher
73
CANS
- pathway from 8 CN to temporal lobe of brain
- enhances & interprets auditory signal
- 2 pathways:
- ipsilateral (same)
- contralateral (opposite)
74
Internal Auditory Canal IAC
1. begins at modiolus & terminates at base of brain
2. nerve fibers maintain tonotopic organization
3. 7CN also runs through space
75
Stations of the CANS
1. cochlear nucleus
2. superior olivary complex
3. lateral lemniscus
4. inferior colliculous
5. medial geniculate body
6. primary auditory cortex
76
cochlear nucleus
cochlear nucleus:
- enhances contrast
- first decussation occurs just after
77
superior olivary complex
- receives binaurl input (1st station)
| - localization and listening in noise
78
lateral lemniscus
-pathway from ipsilateral impulses of lower brainstem
79
IC inferior colliculous
-ascending relay pathway
80
medial geniculate body
- last subcortical station
| - radiation of nerve fibers out
81
primary auditory cortex
- temporal lobe
- interpretation and labeling
- maintains tonotopic organization
82
Auditory Provoked Potentials
1. Auditory Brainstem Response
2. ABR Applications
3. Auditory steady state response
83
Auditory brainstem response ABR
- assessment of how electrical impulses transverse along 8CN through brainstem
- objective measurement of 8CN funciton
84
ABR Applications
- Screening tool:
- pass/fail criteria
- preselect a stimulus level
- Threshold Estimation:
- softest level a response is obtained
- should agree w audiogram
- Retro-cochlear pathology:
- looking for lesion along 8CN
- search for any abnormalities when presenting a stimulus above threshold
85
Auditory Steady State Response ASSR
- interpretation relies on mathematical equation
- present at louder levels than ABR
- better at distinguishing btwn a severe or profound HL
86
Individuals with Disabilities Education Act (IDEA)
1. Guarantees a free appropriate public education (FAPE) to every c w a disability in every state
2. Established mandatory programs for c w disabilities from age 3-21
3. Supports extended programs to additional populations of children such as:
a. Early Intervention
b. Refined procedures for discipline of special education c
c. Preparation of students for vocational and transition programs
4. Based on a referral, evaluation, and eligibility process
a. Child Find - School districts MUST locate, identify and evaluate children suspected of having disabilities, including homeless children, highly mobile or migrant children, and wards of the state
b. Referral Made – Determine appropriate professional to evaluate that c
c. Before an evaluation occurs, you MUST receive consent from the parents/guardians (must occur w.in 60 days of consent)
d. IEP Team determines if c is eligible for services
e. If eligible – receives an Individualized Education Program (IEP)
87
IDEA – Least Restrictive Environment (LRE)
1. Children who present w disabilities have opportunity to be placed in a classroom w nondisabled c (public, private or other care facilities)
2. Removal from reg classroom only occurs if nature or severity of disability is such that education in reg classes w supplementary aids/services cannot achieve academic success
88
IDEA – Hearing Impaired Students
Regulations require that each school must ensure that hearing aids worn in school by c w hearing impairments are functioning properly and external components of surgically implanted devices are functioning properly
89
IDEA – Early Intervention (EI)
1. Part C of the IDEA
2. Still based on a referral, evaluation and eligibility process
3. If eligible, will receive an Individual Family Service Plan (IFSP) – birth-3 years
90
IDEA- 504 plan
1. When a child does not meet the specifications for an IEP
| 2. Modifications, assistive technology, etc. will be provided to the student
91
Americans with Disabilities Act
1. Expanded rights of a person with disabilities to private sector
2. Tile II: State and Local Government Activities
3. Tile II: Public Accommodations
4. Title IV: Television and Telephone Access
92
ANSI standards
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