Brainscape's Knowledge GenomeTM

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


See full index

AUD fall 18 Diagnostic Audiology > rest of what is on the midterm > Flashcards

rest of what is on the midterm Flashcards

1
Q

normal length and diameter of Eustachian tube

A

31-38mm long and 2-3mm in diameter

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

how is the eustachian tube in children different from adults?

A
  • it is shorter in children
  • more horizontal and less angulated
  • the bony portion is relatively longer and wider in diameter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

normally ET is ______ at rest

A

closed

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

muscle that causes active dilation of the ET

A

tensor veli palitini

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

muscle which assists in active dilation and provides support

A

levator veli palitini

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

muscle of the ET with undefined function (control pressure in the ME)

A

salpingopharngeus, it is located at the end of the ET

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

muscle of the ET not thought to play a role in ET function

A

tensor tympani muscle

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

physiologic functions of the ET

A

1) ventilation of the middle ear- through repeated opening
2) drainage of middle ear secretions via mucociliary transport system
3) protection from excessive nasopharyngeal secretions

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

ET dysfunction

A

failure of the et to open when swallowing which prevents pressure equalization and creates an optimal condition for the development of OME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

5 causes of ET dysfunction

A

1) mechanical obstruction (intrensic or extrinsic)
2) functional obstruction (common in infants; poor tensor veli palatini muscle function)
3) temporary (acute upper respiratory tract infection-utri)
4) intermittent (allergies)
5) permanent/craniofacial defects (cleft palate, orofacial malformations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

more causes of ETD

A

ET function changes with age

  • ascending in aircraft= high ME pressure which sucks nasopharyngeal secretions into ME
  • descent in aircraft or scuba= negative ME pressure; stagnation of secretions in the ME
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

otorrhea

A

occurs when there is a reflux of nasopharyngeal secretions into ET; caused by TM perforation or after mastoid surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what happens when valsalva is performed

A

breaks the negative pressure in the ME and clears effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

politzerization

A

inflates the middle ear by blowing air up nose and swallowing at the same time; same effect as valsalva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

two types of tymps with intact TM

A

1) normal ET function would have intact TM and normal TPP

2) ET dysfunction and intact TM would have abnormally negative TPP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

perforated TM

A

tymps are flat with large volume

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

when to do ETF tests?

A

if there is abnormal MEP

*ask pt to swallow and repeat tymp; if swallowing does not work, perform ETF tests

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

photoelectric technique of examining ET

A

measure light transmitted through ET by putting a light in by ET opening and measuring in the EAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ET catheterization method of examining ET

A
  • normal blowing= patent ET
  • whistling sound= partial blockage of ET
  • no sound = complete obstruction of ET
  • bubbling sounds = middle ear catarrh
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

causes of Patulous ET

A
  • alteration of anatomic components
  • chronic ME diseases
  • radiation therapy
  • hormonal contraceptive pills
  • pregnancy
  • fatigue and stress
  • weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

patulous ET treatment

A
  • reassurance
  • weight gain
  • injection of meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

purpose of multifrequency tymps

A

to use 2+ probe frequencies to meausure Ya or Ba/Ga characteristics across a broad spectral range

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

normal control of middle ear

A
  • stiffness controlled at a frequency below the RF

* mass controlled at a frequency above the RF

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

effect of otosclerosis on Ya tymp

A
  • ear is stiffness controlled over a wider range of frequencies
  • an increase in RF
  • Y vector will be recorded in the lower quadrant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

effect of ossicular discontinuity

A
  • mass controlled at a lower frequency range

* decrease in RF compared to normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is the purpose of multifrequency tymps?

A

to determine if the ME is mechanically normal by determining the

1) RF of the middle ear
2) the B/G pattern
* ***we want to know if the middle ear is not normal if the ME is charaterized by a high or low RF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

resonant frequency

A

the frequency where Bm=Bc (susceptance from mass= susceptance from compliance/spring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

normal resonant frequency values

A
  • using Ba measures: 800-1200Hz
  • —-normal middle ear RF is 1000Hz, but the range of normal is very wide thus it can be difficult to use the RF to diagnose ME pathology
  • using Ya measures: 800-2000Hz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

how to determine RF

A

you want to use an array of tymps and see the change in tymp shape as a function of the probe frequency

  • *look at:
    1) admittance tymp (Y)
    2) susceptance tymp (B)
    3) phase angle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

how to identify the RF

A

again use an array of tymps (as frequency increases, the shape of the component progresses from single peaked to notched)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

RF on an admittance (Y) tymp

A

the RF is the lowest frequency at which the Ya tymp notches, the disadvantage of this is because the Ya tymp is a combo of B and G tymps which leads to an error in notching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

RF on a susceptance (B) tymp

A

the RF is the lowest frequency at which the B tymp notches

* the center of the notch is below the negative tail of the tymp and is at 0daPa?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

RF based off of phase angle

A

the RF is the frequency where the phase angle is =0 degrees
*this is found by sweeping frequencies from 500-2000HZ while holding the pressure in the ear canal constant, the phase angles are then plotted as a function of frequency (this is of little value and have unreliable measures due to artifacts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

interpretation of number of peaks based of the Vanhuyse Model

A

1B1G and 3B1G=stiffness

3B3G and 5B3G=mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Ya vector between 90-45 degrees

A

1B1G; ME is stiffness dominated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Ya vector between 45-0 degrees

A

3B1G; Ya is calculated at the center of the notch; ME is stiffness dominated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Ya vector between 0- negative 45 degrees

A

3B3G; ME is mass controlled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Ya vector between negative45 and negative 90 degrees

A

5B3G; Ba tymp develops a 2nd notch; ME is mass controlled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

vanhuyse types that may be seen with ME pathology

A
  • B tymp with more than 5 extrema
  • G tymp with more than 3 extrema
  • abnormal notch width
  • -if the distance b/t the outermost B extrema is greater than 75daPa for a 3B pattern or greater than 100 daPa fro a 5B3G pattern
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

how B and G should look at lower frequencies

A
  • @ low freq up to 452:
  • —B&G single peaked
  • —B is higher than g
  • Above 452:
  • —B&G amplitudes are = (cross)
  • Around 565 &678:
  • —expect B to notch -B falls below G
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

the higher the probe frequency, the ______ _______ the patterns

A

more complex (the greater the # of extrema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

pressure sweeping from _______ to _______ will result in less complex tymps

A

positive to negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

two most commonly used probe freq

A

226Hz and 678Hz

*many are beginning to include 1000Hz as a third freq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

sweep of pressure

A

recommend
frequency of the probe is held constant and the pressure is varied (uses the conventional method to acquire tymp but also uses additional frequencies)
**lower RF
***good if you expect a stiffness-related pathology

45
Q

sweep of frequency

A

frequency of the probe is varied while pressure is held constant

  • higher RF
  • *faster if a # of tymps must be collected
  • *preferable for infants and children if 2-3 tymps are needed
  • **preferable in cases of mass related pathology
46
Q

high impedance pathology

A

higher freq tymps are important to reveal impedance changes in some stages of OME

47
Q

low impedance conditions

A

a pt with a history of TM atrophy

  • 226 Hz tymp is type Ad
  • multifrequency tymp to exclude the possibility of ossicular disarticulation
  • **with ossicular disarticulation, patterns occur at low frequencies
48
Q

disadvantages of high frequency tymps in identifying mass pathology of ME

A

1) not commonly used
2) senstitivity as diagnostic test for otosclerosis is not high
3) multiple pathological conditions may coexist and obscure the true cause of hearing loss
* the more lateral and less significant pathological condition dominates the tymp

49
Q

limitations to multifrequency tymps that Wideband helps overcome

A

can only measure to 2000Hz max, but this is not representative of all the frequencies we measure in tone tests

50
Q

who developed energy refelctance (ER) and energy absorbance (EA) tymps

A

douglas H Keefe

51
Q

equiptment for WBER and WBA measures

A
  • mimosa’s middle ear power analyzer (wbMEPA)

* research system from Interacoustics

52
Q

WBA/WBR

A

wide band reflectance and wide band absorbance

*these measurements are not pressurozed

53
Q

WBT

A

wide band tympanometry

*pressurized

54
Q

WB acoustic reflex

A

wide band AR
*can be recorded at a lower level so they are less painful/invasive than normal reflexes
*mean of 13 dB lower than clinical reflex threshold
(72dB as opposed to 85dB for typical threshold)

55
Q

what does power reflectance measure?

A

middle ear inefficiency

*normal ear the acoustic power/energy is absorbed by the cochlea

56
Q

what does power absorbance measure?

A

middle ear efficiency

*the transmission of sound

57
Q

is refelctance tymp affected by ear canal properties?

A

no, pressure is not used and so the ear canal is not distorted and the stimulus (chirp from 125-10700HZ is measured in how much is reflected from the TM

58
Q

energy reflectance equation

A

energy reflectance= reflected power/incident power

  • if all energy is reflected. ER=1
  • if all energy is passed into middle ear ER=0
59
Q

wideband reflectance

A

power reflected as a function of frequency; expect low frequencies to be reflected more and speech frequencies to be reflected the least

60
Q

why use reflectance?

A
  • without pressurization there is greater reliability in infant ears to control for the effect of canal wall distensibility
  • insensitive to probe location in the ear canal
  • potentially greater sensitivity to ME function and disorders than tympanometry
  • frequency-domain (measuring reflectance as a function of frequency): simple interpretation of efficiency of ME
61
Q

how is reflectance measured

A

data acquisition using computer averaging techniques in sec. reflectance of each click is averaged
*chirp of 82 msec? but she said 32 chirps/sec?

62
Q

clinical applications of energy reflectance/Energy absorbance

A
  • newborn hearing screening: reduce false positives also also differentiate between middle ear and sensorineural loss if oae’s are failed
  • middle ear disorders:
  • acoustic reflex measure (less loud)
63
Q

normative reflectance data

A

varies by frequency:

  • <1000Hz is high reflectance
  • 2000-4000Hz is low reflectance
64
Q

reflectance pattern for those with TM perforation

A

lower energy reflectance across frequencies (makes sense because everything can get into the middle ear)

65
Q

reflectance pattern for those with otosclerosis

A

higher than normal energy reflectance (ER) at frequencies under 1000Hz

66
Q

reflectance pattern for those with ossicular discontinuity

A

deep, low frequency notch (low reflectance in low tones)

67
Q

reflectance pattern for those with down syndrome

A

have low reflectacne for high frequencies when reflectance normally is high again

68
Q

variables affecting ER

A

1) age- babies have less reflectance b/c they have more mass; they are more driven towards high frequencies
2) gender
3) ethnicity

69
Q

energy absorbance equation

A 
energy absorbance (EA)= 1-ER 
*this is because ER is a ratio
70
Q

WBA without pressurization

A

wide band absorbance

* will be mirror image of energy reflectance off the x-axis (will go up instead of down)

71
Q

WBA with pressurization

A

wide band tympanometry

*3D graph showing tymps at each frequency as well as absorbance at each pressure

72
Q

effect of age on WBT

A

no significant difference between groups?

(presumably this is as long at they are <6mo

73
Q

ER/EA advantages

A

provides info about the power transfer to the middle ear across a broad frequency range

  • uses signal averaging (32 clicks?)
  • improved microphone sensitivity: more sensitive to middle ear pathology and acoustic reflex threshold
74
Q

the three primary acoustic reflex characteristics

A
  • the presence or absence of the reflex
  • the reflex threshold
  • reflex decay
75
Q

stapedial (acoustic) reflex

A

reflexive contraction of the middle ear muscles in response to an intense sound

  • stapedius and tensor tempani muscle
  • *measured using immittance techniques (how much the contractions lowered the admittance
76
Q

origin

A

point of attachment of a muscle on a stationary bone

77
Q

insertion

A

point of attachment of a muscle on a moving bone

78
Q

tensor tympani muscle

A

origin: wall of the ET
insertion: manubrium of the malleus
innervation: V nerve
* contraction occurs mainly by tactile stimulation (not acoustic)
* contraction pulls the malleus inwards tightening the TM and increasing Za

79
Q

non-acoustic reflexes

A

non-acoustic reflex arc depends on where the stin is stimulated
*trigeminal (V), facial (VII), glossopharyngeal (IX), and vagus (X) nerves send info to the reticular formation which controls muscle tone and piosture, communicates and activates the VII motor nucleus, activating the stapedius muscle

80
Q

stapedius muscle

A

origin: around the facial canal in the pyramid (posterior wall of the ME)
insertion: head of the stapes
innervation: stapedial branch of the facial (VII) nerve
smallest muscle in the body (6mm long and 5mm^2 wide)
*contracts by acoustic and nonacoustic stimulation
*contraction pulls stapes down and out of the oval window increasing Za (bilateral response)
**acoustic is auditory reflex
**a tactile response results from stimulation around the pinna

81
Q

both of the middle ear muscles do this

A

stiffen the ME transmission system and increase the impedance

82
Q

three theories for the importance of the ME muscle reflexes

A

1) protection theory= protect cochlea from damage from loud sounds (low freq)
2) interference prevention= separate signal and noise
* **nonacoustic reflex response to chewing, talking, head movement serving to attenuate low freq body noise allowing high freq sensitivity to remain unchanged
3) desensitization= unimportant sounds such as eating, talking, yelling, and internal sounds

83
Q

right contra with probe reference

A

probe in the right ear, stimulus in the left (clinic)

84
Q

right contra with stimulus reference

A

stimulus in the right ear, probe in the left (Kaf)

85
Q

four neuron ipsi pathway

A

primary pathway:

1) cochlea to ventral cochlear nucleus
2) VCN to superior olivary complex
3) SOC to VII motor nucleus
4) VII to stapedius muscle

86
Q

three neuron ipsi pathway

A

secondary pathway/ fewer fibers:

1) cochlea to ventral cochlear nucleus
2) VCN to VII motor nucleus
3) VII to stapedius muscle

87
Q

primary contra pathway

A

1) cochlea to ventral cochlear nucleus
2) vcn to medial soc on the contra side
3) soc to facial nerve nucleus
3) facial nerve VII to contralateral stapedius muscle

88
Q

secondary contra pathway

A

1) cochlea to ventral cochlear nucleus
2) VCN to ipsi soc
3) soc crossover to Facial nerve neclues
3) facial nerve to stapedius

89
Q

to have an acoustic reflex, all these must work

A
  • middle ear and conchea
  • VIII nerve afferent
  • brainstem neurons (CN and SOC)
  • facial nerve
  • stapedius muscle
90
Q

how to determine site of pathological involvement with reflexes

A

the comparison of ipsi and contra responses

91
Q

threshold to know that what you are seeing is a reflex

A

0.02-0.03 deflection; reflexes should be done at TPP, and an airtight seal is very important

92
Q

normal range for reflex thresholds

A

70-100dB HL with an 85 dB HL mean for tones

  • 20dB less for BBN
  • normally thresholds are present for stimulus levels 70-80dB SL (in other words above the hearing threshold for that test frequency)
93
Q

difference in dB between ipsi and contra thresholds

A

contra thresholds are 3-5dB higher than ipsi with the exception of 2000Hz. (note: ears should be symmetric; in other words there should be less than a 10dB difference between right and left contra, and less then a 10dB difference between right and left ipsi

94
Q

effect of age on ART

A

no effect with tones, art increases with advancing age ( must be louder)

95
Q

non-acoustic reflex

A

tactile; is larger than the acoustic reflex, can interfere with accurate ART with a wiggly child

96
Q

monophasic response (for ART)

A

increase in Za

97
Q

biphasic response for (ART)

A

decrease in Za at the onset of the response, the increase in Za

  • momentary contraction of the stapedius
  • changes the coupling between the stapedius footplate and cochlear fluid
  • stiffness pathology such as early otosclerosis, Cogan’s syndrome, stapes fixation (elasticity changes in the stapes and annular ligament associated with fixation of the footplate)
  • **normally may occur in healthy ears when using high frequency tones (600-700Hz)
98
Q

when not to do reflex testing

A
  • severe recruitment
  • hyperacusis
  • tinnitus
99
Q

what is acoustic reflex decay

A

admittance (Ya) measured over time

  • measures the ability of the stapedius muscle to maintain sustained contraction
  • also called adaptation
  • decline in acoustic reflex contraction for a sustained acoustic activating signal
100
Q

how to present AR decay

A

at 500 and 1000Hz

  • normals no not show decay at these frequencies but everyone decays at 2000 and 4000Hz
  • stimulus is 10dB above ART
  • present for 10 seconds duration
101
Q

reflex half-life

A

the time required for the response magnitude to decline to 1/2 (decay half-life of 10 seconds or less is a positive sign for a retrocochlear lesion

102
Q

AR latency

A

how long it takes for the AR to occur after the stimulus is presented

  • aka the time interval between the onset of an intense sound and onset of ME muscle contraction
  • delay is measured from the onset of the stimulus until the beginning of the reflex response
  • **the point at which the AR magnitude rises from baseline to 10% of its eventual max amplitude
103
Q

ARLT stands for

A

Acoustic Reflex Latency Test

104
Q

normal latency at 500,hz 1000, 2000, and 4000

A 
500=102.8ms
1000=101.9ms
2000=127.7ms
4000=147.3ms
*these would be seen with normal, cochlear HL, and cortical lesion?
105
Q

long latency for ARLT

A

anything over 200ms

*this shows retrocochlear pathology

106
Q

when is ARLT most effective?

A

when both ipsi and contra measurements were made

*both absolute latency and ILD were considered

107
Q

ARLT advantages

A

a valid, cost-effective, simple clinical procedure

*requires only minor modifications of tympanometers

108
Q

ARLT limitations

A
  • age effect
  • averaging techniques
  • test-retest reliability

AUD fall 18 Diagnostic Audiology (5 decks)

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