Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OSCE prep > PTA and masking > Flashcards

PTA and masking Flashcards

1
Q

what is the room set up?

A
  • calibrated audiometer with appropriate transducers
  • a quiet room >35dB (preferably a sound booth)
  • a stable chair for both me and the patient
  • a computer
  • otoscope, with speculum
  • anything else needed to maintain god infection control
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the necessary testing conditions for PTA and masking?

A
  • adequate space
  • sufficient lighting
  • good room temperature
  • stable chair that is in the correct position
  • an alert patient who is prepared for the test
  • clean hands, surfaces and equipment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what procedure do you perform prior to otoscopy?

A
  • otoscopy according to current BSA guidelines
  • ask this usual pre otoscopy history
  • Do they have recent or current:
    pain,
    discharge or blood,
    infections,
    ear surgery (operations),
    perforations.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

contraindications to PTA and masking

A
  • Do not proceed with PTA if the following is discovered:
  • Occluding wax.
  • Foreign object.
  • Discharge or blood.
  • Collapsed ear canals (where inserts can’t be used)
  • Swelling or bruising of the pinna or surrounding area.
  • Excessive pain.
  • No consent is gained
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

special care considerations for PTA and masking

A
  • Have some pain but it is not excessive—keep checking their pain levels. Consider using inserts if it is more comfortable.
  • Have very narrow ear canals—consider using inserts
  • Have had recent ear surgery—check with ENT that they you are safe to proceed
  • Have a PVP shunt fitted— If safe to proceed, inserts will need to be used
  • Suffer with tinnitus—loud sounds might aggravate their tinnitus, so this needs to be checked and patient comfort observed thoroughly.

-phonophobia or hyperacusis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the PTA pre-test history?

A

-better ear?
-tinnitus?
-loud sounds in the last 24 hours?
-pvp shunt?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

why do you ask if they have a better ear?

A

start with the better ear.
no better ear = start with any

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

why do we ask about tinnitus?

A

clarify:
- is the tinnitus currently present?
- does it get worse with loudness?
- what sound is it? where is it?
- you can instruct the patient to ignore but if the struggle with distinguishing between tinnitus and pure tone, then you can consider switching to warble tone. (try reinstructing before)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

why do we ask if they’ve been exposed to loud sounds within the last 24 hours?

A
  • you might suspect temporary threshold shift, maybe rearrange the hearting test to make a note of it on their audiogram
  • further questions? where were you/ how loud was it? loudness have be determining by raising voice at 1 meter.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is a pvp shunt and why do we ask about it?

A
  • a surgically implanted device in your brain that drains excessive
  • inserts can be used
  • keep the transducer away from the mastoid where the shunt is by at least 5cm at all times
  • BC testing can be performed on the ear contralateral to the PVP shunt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

patient instructions for PTA

A

“I am going to test your hearing by measuring the quietest sounds that you can hear. As soon as you hear a sound (tone), press the button. Keep it pressed for as long as you hear the sound (tone), no matter which ear you hear it in. Release the button as soon as you no longer hear the sound (tone). Whatever the sound, and no matter how faint the sound, press the button as soon as you think you hear it, and release it as soon as you think it stops.”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how do we prep the patient for PTA and masking?

A

-Ensure the patient understands what they need to do.

  • Encourage them to interrupt the testing and inform you if they become uncomfortable.
  • Obtain verbal consent prior to testing.
  • Remove any hearing aids, glasses, large earrings or clothing that is covering the ears.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

describe headphone placement

A
  • make sure ears aren’t covered (speaker in line to ear canal) and the band is balanced on the head securely
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

describe bone vibrator placement

A
  • place on the mastoid of the worse ear according to the AC thresholds.
  • place as near as possible behind the pinna, without touching without resting on hair.
  • the vibrator is held firmly in place with the band against the temple with the required force
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how do we ensure patient care during testing?

A
  • Observe the patient’s comfort regularly, especially when presenting higher intensity sounds.
  • If test time exceeds 20 mins they may benefit from a short break as accuracy may be affected by fatigue.
  • Monitor patient responses for variability at certain frequencies, which may be attributed to factors such as tinnitus interference, difficulty distinguishing tones, or fatigue.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

why do we perform daily, weekly and yearly checks?
- consequences of not performing these?

A
  • safety of audiologist
  • safety of patient
  • local and national quality checks are met
  • testing is accurate
    CONSEQUENCES:
  • misdiagnosing
  • fail to refer patient for future checks
  • legal implications
  • lack of confidence in equipment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the daily checks?

A

1- check calibration dates
2 - check serial numbers
3 - untangles lead and examine wear and tear
4 - check leads are inserts into sockets
5 - check function of the button
6 - AC listening checks at 15dBHL and 60dBHL
7 - Masking listening checks at 60dBHL (without playing the pure tone)
8 - BC listening checks at
15dBHL and 40dBHL
9 - checks patient intercom
10 - assesses ambient noise levels (35dB) using sound level meter. and take measures if too high
11 - completed daily checks record log

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are you looking for when doing AC, BC and Masking sweeps?

A

checks for inconsistencies in sound levels between ears and particularly for distortion, hissing, buzzing, whistling or clicking sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what should you do after dally checks?

A

-remember to clean anything you have used on yourself during listening checks (e.g. headphones)

  • clean worktops and keyboards, chair etc
  • document the checks that have been completed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what action should be taken if a fault is found?

A
  • document on the checklist and report immediately to a senor staff member
  • if unable to remove the equipment from the room, clearly label the equipment as unfit so other staff know that it is not accurate/ safe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what equipment would you interchange f fault?

A

the response button as everything else is calibrated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are weekly checks for PTA and masking?

A
  • check keyboard is silent and not getting stuck
  • check tension for headband
  • check patient communication system is working
  • listening to soft levels for any unwanted sounds and tone quality
  • check the tone being delivered is free from electrical and mechanical noise
  • perform an audiogram on a known subject, check for significant deviation form previous audiogram (e.g. 10 dB or greater
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the yearly calibration?

A

external company visit once a year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

where do you start your audiogram?

A
  • start at 1Khz on the better ear at an audible volume (40dB)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how do you present the pure tone?

A

1-3 seconds
irregular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the test order for AC?

A

1k, 2k, 4k, 8k, 500, 250kHz

24
Q

when would you test additional frequencies for AC? and why?

A

-maybe necessary to also test 3k and 6k depending on the shape of the hearing test

  • it may also be necessary to test 750 and 1500 if there is a large difference between the adjacent frequencies
25
Q

how do you recheck AC? what do you do if you get different results?

A
  • only recheck 1k on the first ear, plot the better value (aiming to get the quietest sound heard).
  • if the retest value is no more than 5dB diff from the original value then keep the original quieter one

-if the retest value is more than 5dB then the original, try reinstructing, and retest the adjacent value.

26
Q

how do you make sure you’re being safe when thresholding?

A
  • once you reach 80dB, increase the volume by 5db and monitor your patient

-use 80dB as the safety barrier and only add 30dB if it will not take you past 80dB

26
Q

how do you determine the start levels when moving to the next frequency?

A

-add 30dB to the last frequency threshold

  • when testing 1k start at 40, when testing 2k add 30dB to 1k, when testing 4k add 30dB to 2k, when testing 8k add 30dB to 4k, when testing 500 add 30dB to 1k, when testing 250 add 30 dB to 500
27
Q

how do you establish a threshold?

A

the ascending technique
1 - present sound at an audible level (40dB)

2 - DECREASE the volume in 10dB steps until the patient does NOT respond

3 - from the non audible level, INCREASE the volume in 5dB steps until the patient responds (1st ascending response).

4 - repeat the previous steps until you get the 2nd ascending response

28
Q

which ear do you test BC? what frequencies do we test BC?

A
  • the bone vibrator is applied to the mastoid of the worse hearing ear( worse AC)
  • 1k, 2k and 500
28
Q

why do we not test BC at 3k and 4k? if you HAD to test them, what would you do?

A

BSA don’t recommend testing at 3k and 4k due to calibration issues and because airborne radiation can cause the test ear to hear by both AC and BC, making the BC threshold look better than it is.

  • if ENT told us to test them, it may be necessary to occlude the test ear with a headphone or earplug.
29
Q

what is the start level for AC?

A

BSA recommends an audible level, so 10dB above their AC threshold

30
Q

at what levels could cross over occur with: headphones, transducers, bone vibrator?

A

headphones = 40dB
inserts = 55dB
bone = 0dB

30
Q

why do we mask?

A
  • to acknowledge and counteract the possibility of transcranial transmission.
  • Where sound crosses through the bones of the skull, usually from the test ear to the non-test ear (but sometimes the other way too – this is then known as cross-masking).
30
Q

what is the correct order for an audiogram?

A
  • Test your patient/customer’s AC thresholds
  • Check for Rule 1 (apply masking if needed)
  • Perform BC thresholds on worse ear
  • Check for Rule 2 (apply masking if needed)
  • Check for Special Rule 2 (apply masking if needed)
  • Check for Rule 3 (apply masking if needed)
    Audio is now complete
31
Q

What happens if we don’t recognise we need to mask?

A

Inaccurate audiogram can lead to:

  • Failure to recognise a “dead” ear.
  • Incorrect prescription and programming of hearing aids.
  • Failure to recognise other referable conditions or the opposite i.e. referring unnecessarily.
  • Could lead to unnecessary further testing, operations or treatment by ENT.
32
Q

How can we identify from the audiogram that transcranial transmission could be happening?

A

masking rules are visual indicators

32
Q

what is rule 1 of masking? how do we mask for rule 1?

A

-its an AC rule, 40dB difference between the left and right ACs

  • recheck the threshold
  • masking noise is applied to the better ear and thresholds of the worse ear are rechecked by applying tones to the better ear
33
Q

what is rule 2 of masking and how is it performed?

A
  • 10dB difference between unmasked AC and unmasked BC
  • the difference is air bone gap
  • BC should not be worse than AC, if it is recheck it and if it remains worse don’t mask

1- recheck the BC threshold
2- apply masking to the better ear and BC to worse ear
4-recheck the BC tones whilst masking

34
Q

when would we do special rule 2 of masking and how?

A

-if after masking, the BC remains the same value or only differs by 5db (better or worse)

  • we can’t be confident whether they were originally from the better or worse ear (if it moves by 10dB or more we can truly say this is the true threshold

1 - perform not masked BC on the better ear (IF THE BETTER IS WITHIN NORMAL RANGE, DON’T DO SPECIAL RULE 2)

2 - if there’s a 10dB diff with the better ear BC, apply masking to the worse ear and recheck thresholds on the better ear.

34
Q

what types of hearing loss is a air bone gap indicative of?

A

a conductive or mixed hearing loss

  • so rule 2 is to check if its actually a air bone gap or if its a shadow effect that been created by transcranial transmission.
35
Q

how do you identify the masked threshold using the masking chart?

A

1- recheck the threshold
2 - increase masking level by 10 db each time
3- you need to do at least 4 levels of masking with a tone level plateau where the last 3 results are within 5db of each other

35
Q

what is rule 3 and how would you do it?

A
  • only apply if rule 1 hasn’t been applied.
  • 40dB or more difference between unmasked AC and BC on either ear
  • remove BC completely and apply masking via headphones to the better ear and recheck thresholds like you did in rule 1
36
Q

what if the tone level for masking doesn’t plateau?

A

-keep going until it does
- however remember patient comfort and crossover, at high intensities the masking could be too loud for the patient and there is also a risk of crossover of masking noise into the test ear, causing confusion.
- be careful with tinnitus patients - high levels of masking can exasperate the tinnitus

36
Q

what are patient instructions for masking?

A

“In this next test, you will hear the sounds (tones) again, just as before. I would like you to press the button as soon as you hear the sound (tone) start and release it as soon as it disappears. Do this even for the very faint sounds (tones), and no matter which side you seem to hear the sounds (tones). For some of the time, you will also hear a steady rushing noise, but I want you to ignore it and press the button only when you hear the sounds (tones). This steady rushing noise will get louder at times. I want you to tell me if any of the sounds become uncomfortably loud, or if you would like me to explain the test again.”

36
Q

at what point do we take caution with PTA and masking?

A

masking noise above 80dB or tones above or tones above 100dB should be use with caution

37
Q

what are some factors that could affect our results>

A
  • The patient/customer didn’t understand the instructions
  • We over/under mask
  • We don’t follow BSA guidelines and try to take shortcuts
    -The patient is fatiguing and responses are becoming inaccurate
38
Q

how do we counteract calibration issues when asked to test 3k and 4k by an ENT?

A

occlude the test ear (with headphone/ear plug)

38
Q

sensorineural hearing loss:
-audiogram
-part of pathway
- causes

A

audiogram- both abnormal with air bone gap
-effects inner ear
-noise induced
-presbycusis
-acoustic neuroma
-hereditary

39
Q

conductive:
-audiogram
-part of pathway
- causes

A

-abnormal AC, normal BC
-outer and middle ear
-Causes:
-any obstruction to the ear canal e.g. wax, foreign body
-perforation of TM
-otitis media and otitis externa
-disruption of ossicles
-collapsed ear canal

39
Q

Meniere’s disease
-audiogram

A

-sensorineural HL
-low freq HL but high frequency is OK

39
Q

presbycusis:
-audiogram

A

-bilateral and symmetrical
-bilateral hearing loss above 2k
-affects higher frequency sounds

40
Q
A
40
Q

noise induced hearing loss
-type of HL
-audiogram

A

sensorineural
notch/dip at 4k

40
Q
A
40
Q

Otosclerosis

A

-abnormal bony growth
-conductive loss
notch at 2k (caharts)

40
Q
A
41
Q
A
41
Q
A
41
Q
A
42
Q
A

OSCE prep (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions