Midterm Exam

Question 1

Typically takes much less time

Answer 1

oae screening

Question 2

Fewer frequencies assessed, usually higher frequencies

Answer 2

oae screening

Question 3

A component of a comprehensive test battery

Answer 3

oae diagnostic

Question 4

Requires interpretation from audiologist

Answer 4

oae diagnostic

Question 5

Completed to distinguish those who do not have significant auditory dysfunction from those who need further evaluation

Answer 5

oae screening

Question 6

OAE outcomes will always fall within one (1) of three (3) general categories. what are they

Answer 6

OAE amplitude is normal (relative to normative data)

Amplitude is abnormal, but OAEs are present

OAEs are absent

Question 7

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).

Answer 7

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

Question 8

Generally speaking, slight middle ear disorders that may not entirely obscure OAEs affect responses first for the lower frequencies.

Answer 8

true

Question 9

Please list for me three (3) non-pathological ear canal factors that can affect OAE measurement. One of them must be standing waves

Answer 9

age, women, standing waves

Question 10

what role(s) does the external auditory meatus (or canal) play in OAE measurement?

Answer 10

Both inward and outward propagation

Question 11

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.

Answer 11

true

Question 12

Which medical red flags contraindicate the recording of OAE responses?

Answer 12

Active drainage in the ear canal
A foreign body in the ear canal
Active bleeding in the ear canal

Question 13

The amplitude of OAE responses are typically larger with greater reproducibility in adults when compared to children and infants.

Answer 13

false

Question 14

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.

Answer 14

Present OAE, absent OAE, partial OAE, or reduced amplitude OAE responses may be observed in dry ears with tympanic membrane perforation or ventilation tubes

Question 15

What are the two (2) pure tones labeled as in DPOAE parameters?

Answer 15

f1 and f2

Question 16

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?

Answer 16

distortion product

Question 17

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.

Answer 17

true

Question 18

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.

Answer 18

F2 is the most reliable frequency of the two
The ratio should be 1.22

Question 19

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?

Answer 19

65 & 55

Question 20

What are the four regions of the auditory system that either contribute to the generation of OAEs, or can influence OAE recording?

Answer 20

outer, middle, inner & efferent system

Question 21

Please explain the Crosscheck Principle and include an example.

Answer 21

using electro-physiological or electroacoustical tests to confirm a subjective test (like pure tones)

ex: 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

Question 22

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

Answer 22

none

Question 23

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.

Answer 23

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.

Question 24

There is now considerable evidence that noise- or music-induced cochlear damage is detectable with OAEs before it becomes apparent in the audiogram

Answer 24

true

Question 25

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

Answer 25

Monitoring tinnitus and noise or music exposure
Differentiation of cochlear vs. retrocochlear site of lesion
Assessment in suspected functional hearing loss

Question 26

What is a Gorgagram?

Answer 26

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.

Question 27

What is the optimal dB SPL for the stimulus when recording a TEOAE?

Answer 27

74-83 dB SPL

Question 28

Passive cochlear processing (when a sound is loud enough) can directly stimulate

Answer 28

inner hair cells stimulated through basilar membrane movement

Question 29

OAEs can help you differentiate between a cochlear hearing loss and a retrocochlear hearing loss.

Answer 29

true

Question 30

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

Answer 30

As the OAE moves from the cochlea to the ear canal, this reverse transmission is much less effective than forward transmission

Question 31

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?

Answer 31

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.

Question 32

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?

Answer 32

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.

(what I wrote in bullets)

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.

Question 33

why doesn’t she like robust

Answer 33

becuase you cannot quantify it

Question 34

what is the name of my son who appeared in our study guide Powerpoint?

Answer 34

evan

Question 35

How long have Dr. Parent-Buck and I known one another?

Answer 35

33 yrs