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AUD fall 18 Diagnostic Audiology > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

probe ear principle

A

AR are absent when there is a conductive pathology in the probe ear

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2
Q

poor word recognition score is indicative of

A

retrocochlear loss

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3
Q

best way to identify conductive loss with reflexes

A

ipsilateral

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4
Q

effect of 5 dB ABG on reflexes with CHL in the probe ear

A

reflex has 50/50 chance of being observed

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5
Q

effect of a 10dB ABG (or greater) with CHL in the probe ear

A

reflex may be obscured as much as 80% of the time

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6
Q

reflexes with a unilateral conductive loss

A

all but ipsi on the side without the conductive component will be affected

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7
Q

stimulus ear principle (in other words the stimulus ear is the one with the CHL)

A

conductive loss in the stimulus ear attenuates the stimulus by the amount of the ABG

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8
Q

effect of ABG <30dB with CHL in stimulus ear

A

elevated reflexes–50% chance of recorded reflexes at 27dB ABG

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9
Q

effect of ABG>30dB with CHL in the stimulus ear

A

absent reflexes

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10
Q

what do you need to do to overcome an ABG?

A

raise the stimulus level by the amount of the ABG

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11
Q

possible causes of AR in unilateral CHL

A

1) ossicular discontinuity *medial to the stapedial muscle insertion
* or a fribrous tissue that enables reflex contraction to be conveyed to the TM
2) only the crus of the stapes disconnected
3) cholesteatoma that does not impinge on the TM or ossicular chain (localized)

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12
Q

what is more sensitive to ME changes? AR or behavioral audiometry

A

AR

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13
Q

two types of facial paralysis

A

lower motor neuron lesion

upper motor neuron lesion

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14
Q

lower motor neuron lesion

A

all the muscles of the same side of the face are affected

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15
Q

upper motor neuron lesion

A

affects only the muscles on the lower half of the contra side of the face

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16
Q

lesion at or proximal to (beyond) the stapedius nerve

A

abnormal AR when the probe is in the affected ear

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17
Q

lesion distal to the stapedius nerve

A

normal AR threshold when the probe is in the affected ear

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18
Q

VII nerve lesions

A

such as Bell’s Palsy

  • according to the course of the disease
  • *AR may start absent, proceed to elevated and then to normal as the disorder resolves
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19
Q

AR for sensorineural hearing loss depends on the __________

A

degree of hearing loss

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20
Q

if sensorineural loss with thresholds <50-55dB

A

normal ARTs

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21
Q

if sensorineural loss with thresholds between 50-80dB

A

elevated ARTs with low SLs

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22
Q

if thresholds are > or = to 80dB

A

absent ARTs

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23
Q

Stimulus ear principle with cochlear SNHL

A

Any time the stimulus is in the ear with the loss, there will be abnormal AR
(This would give a diagonal pattern of AR)
$ depends on the degree of hearing loss

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24
Q

Stimulus ear principle with retro cochlear SNHL

A

Abnormal AR when stimulus is in ear with loss

1) usually absent AR regardless of the degree of loss
2) or present AR but elevated with high SLs and
3) abnormal r flex decay (positive decay)

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25
Q

What constitutes as elevated ART?

A

An ART above 100 unless there is substantial hearing loss

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26
Q

Intraaxial lesion

A

Internal to pia mater
Brain parenchyma
Cells:neurons and glial cells
Location:involving brain tissue, cells, neurons
Cortex, deep white matter, deep gray matter

27
Q

Extra axial lesion

A

External to the pia mater
Meninges, nerve sheath, outside brain stem
Schwannoma
Locations: outside brain tissue, subarachnoid, subdural, epidural, calvarium (skull base), scalp (soft tissues)

28
Q

Stimulus ear principle with extra-axial lesion

A

Resembles Ipsi SNHL
Consider the degree of loss to interpret absent or elevated AR with high SLs
*basically everything you present through the ear with the loss, you will get abnormal AR
* pathologies:acoustic neuroma, CPA tumor, extra-axial tumor

29
Q

AR with intraaxial lesions

A

These lesions are central (brain stem) and lead to bilateral normal Ipsi and bilateral absent contra (crossed pathways) the reflex can’t travel from one side to other because problem with communication between sides
Examples: demyelination disease, neuromuscular diseases

30
Q

Positive reflex decay

A

If the response falls to 50% of its initial magnitude during the 10 second stimulus

31
Q

Controversy with reflex decay

A

5-10 seconds, 500 vs 1000hz (stronger at 5 seconds and 500hz), sensitivity improves if you consider 10 sec and both frequencies
* not everyone has decay at 2000 and 4000 so we don’t test them

32
Q

Using ART to predict hearing thresholds

A

ART for pure tone is independent of HL up to 50-60dB HL, then increases as a function of HL

ART for BBN increases with increasing SNHL up to 50-60db HL, then plateau

In other words it is hard to use ART to predict pure tone thresholds because of SNHL

33
Q

Most proximal auditory center in pathway

A

Is the highest which is the superior oil art complex

34
Q

Common causes of SNHL

A 
Ménière's disease
Noise induced hearing loss
Infections
Trauma
Ototoxicity
Presbycusis 
Autoimmune disease
Genetic
35
Q

Common causes of neural SNHL

A

Nerve tumors
Cochlear neuritis (infection)
Other disease processes such as diabetic neuropathy or demylinating disease

36
Q

One test which actually assesses the function

A

Speech testing

If speech scores are lower than hearing loss then it is retrocochlear

37
Q

Limitations of AR testing for differential diagnosis

A

AR may be absent in cases of SNHL above 60dB HL
Therefore can’t differentiate between cochlear and retrocochlear loss

With AR decay there is controversy over what is actually abnormal decay

38
Q

Three categories of behavioral tests for seeing if it’s a retrocochlear loss

A

1) word recognition tests such as PI/BI function
2) recruitment tests:
Loudness balance which is ABLB or AMLB
Short increment sensitivity index (SISI)
3) adaptation tests
Tone decay (TD)
Bekesy audio

39
Q

Objective tests for retrocochlear

A

Such as OAE and ERA
Maintain high specificity for cochlear disorders
Show higher sensitivity to 8th nerve problems

40
Q

Threshold tone decay

A

A reduction in the ability to hear a barely audible sustained tone

Use 500 and 1000hz

41
Q

Supra threshold tone decay

A

A loss of audibility as a result of presenting a sustained tone at a high presentation level

Use high HL such as 70dB HL

42
Q

Carhart tone decay

A

Present a continuous tone at threshold (or 5dB above) for 1 minute
Use 500 and 2000
If they don’t hear the tone, raise intensity by 5dB and reset stopwatch, continue until they hear tone for a full minute
Measure dB difference start to end and time to Inaudibility

43
Q

Tone decay considered normal

A

No decay which is 0-10dB from starting level

44
Q

Cochlear pathology amounts of tone decay

A

Mild pathology would give 15dB in 60 seconds

Moderate pathology would give 20-25dB in 60 seconds

45
Q

Retrocochlear amount of tone decay

A

Marked or rapid which is greater than 30dB

46
Q

Three types of perceptual phenomenon with tone decay

A

1) loss of tonality and audibility simultaneously meaning distortion occurs after increase in level due to tone becoming inaudible
2) loss of tonality but remains audible meaning it becomes distorted
3) loss of tonality and audibility but ones tone is withdrawn they know immediately (withdrawing gives neurons break so when it turns back on they can hear it again but it decays quickly)

47
Q

Olsen and noffsinger procedure

A

Tone decay modification (test of choice)
Start at 20dB above threshold
Continue until the is heard for one minute
Significant decay is above 15dB
Disadvantage is that you can’t test the rate of decay since you started at 20dB you don’t really know when decay began

48
Q

Rosenberg procedure

A

Shortened tone decay test
Tone is presented at threshold and raised 5dB every time it’s not heard but only for a total of 1 minute
Disadvantage: could miss some retrocochlear due to early test termination

49
Q

Green’s procedure

A

Increase in intensity every time the pt hears change in tonality instead of absence of tone
Advantages:increases sensitivity to cochlear vs retrocochlear lesion
Reduces missing rate
(Distortion is auditory brain stem problem)

50
Q

Owens procedure

A

Tests for amount and rate of decay
Begin at 5dB SL
If tone decay before the 60sec period, the stimulus is discontinued for 20 sec before introduction of the tone at 5dB increment
Procedure continues until the stimulus is perceived for 60 seconds or a level of 20dB SL is r ached

51
Q

Supra threshold adaptation test (STAT)

A

Begins at a high level like 100dB HL
Total time of 1 minute (cochlear=still heard, retro=decay)
Disadvantage: ignores amount of decay, ignores rate of decay, missed cases because of high intensity starting level
*this is more of a screening procedure

52
Q

Pros and cons of objective site of lesion testing

A

Pros: objective so less human error, higher sensitivity than behavioral tests

Cons: more expensive, low availability, can determine site but not type of loss (specific etiology)

53
Q

Hyperacusis

A

Hypersensitivity to normal sounds

54
Q

Phonophobia

A

Fear of normal sounds resulting in hypersensitivity to them

Can occur with normal hearing or with hearing loss

55
Q

Place principle of recruitment

A

Outer hair cells are more sensitive than inner hair cells

When OHC are damaged, then when intensity is increased the IHC are excited with a concomitant rapid increase in loudness

56
Q

Summation principle of recruitment

A

The total number of cells excited

As intensity increases, larger areas of the basilar membrane are stimulated

57
Q

Loudness decruitment

A

A slow growth of loudness aka a summation deficit

58
Q

ABLB

A

Alternate binaural loudness balance
Unilateral HL
Compare loudness growth between the same frequencies for the two ears

59
Q

AMLB

A

Alternate monaural loudness balance
Bilateral symmetrical HL with some normal hearing at some frequencies
Compare loudness growth between two different frequencies in the same ear

60
Q

What frequencies to test for loudness balancing

A

500, 1000, 2000, not 4000 because there will be recruitment

61
Q

When might you see recruitment with VIII nerve lesion?

A

Reduced cochlear blood supply
Size of tumors
Test contamination: coincidental high frequency hearing loss (cochlear loss)

62
Q

Using the poor ear as reference ear for ABLB

A

Determines the presence or absence of recruitment
Is quick (requires less balances) to make a diagnosis
Easy

63
Q

Using the good ear as a reference ear for ABLB

A

Determine the presence or absence of recruitment and plot loudness growth function
More sensitive to changes in intensity =less variable
Requires more balances

64
Q

Difference limen for intensity

A

DLI is smallest change in intensity of a pure tone that can just be detected
Normal listeners have problems close to threshold
Cochlear loss have smaller DLI for pure tones due to recruitment, this is premise of the SISI test

AUD fall 18 Diagnostic Audiology (5 decks)

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