revision epa Flashcards

1
Q

Describe Ohm’s Law

and

its equation

A

There will be opposition to the flow resistance of current when a voltage is applied = electrical impedance (ohms(Ω).

CURRENT = VOLTAGE / IMPEDANCE 

or alternatively,

VOLTAGE = CURRENT x IMPEDANCE
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2
Q

What are the two components of Ohm’s Law and what do they mean?

A
  • Capacitive component: Large for low frequencies and reduces for high frequencies (like stiffness reactance in acoustics),
  • Inductance component: small for low frequencies and increases for high frequencies (like mass reactance in acoustics)
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3
Q

Provide an equation for Power

A

POWER = (CURRENT)2x IMPEDANCE.

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4
Q

Difference btw near field and far-field recording?

A

Near field testing unable to be completed, particularly in animals which obtains are larger voltage as the electrode is closest to the site of generation.

In humans use far-field recording. In far field electrode will ‘see; a small version of the electrical activity generated at the site of neural tissue in the auditory pathway.

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5
Q

Describe the electrode Montage for the four electrodes?

A

· Non-inverting (+ve) electrode is placed high on the forehead or vertex

Inverting electrode (-ve response, downward deflection is placed ipsilateral mastoid or earlobe (side receiving the acoustic stimuli)

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6
Q

• Describe the considerations for recording electrical activity from living tissue

A

Near filed and Far field testing
Near field testing unable to be completed, particularly in animals which obtains are larger voltage as the electrode is closest to the site of generation.

In humans use far-field recording. In far field electrode will ‘see; a small version of the electrical activity generated at the site of neural tissue in the auditory pathway.

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7
Q

Explain Time Domain Averaging Techniques, and what it is used for?

A

Time Domain Averaging technique

  • Used to eliminate extraneous noise (such as the EEG) from the recording so the results are accurate.
  • Involves presenting multiple signals many times and taking an average the response
  • TDA will average any part of the stimulus that is synchronised and reduce components not synchronised.
  • This works in the way that any BGN (such as EEG ) is random and not synchronised (unlike the ABR waves occurring at particular intervals). by averaging a signal with equal positive and negative voltages (extraneous noise) it will tend towards zero.
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8
Q

Why is the skin scrubbed before electrodes are positioned on the client?

A
  • To reduce the impedance of the skin to
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9
Q

Explain the Differential Amplification signal processing technique?

A

Taking the signal between the electrodes and subtracting this result from the response before amplifying it.

  • Looks at two separate signals and takes the difference of them. This means that external interference that is similar in both signals will cancel out, leaving the voltages that are different at the non-inverting and inverting electrodes (internal physiological signals) to be amplified.
  • Dependent on the skim impedance !!**
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10
Q

How does the polarity of an acoustic stimulus (rarefaction and condensation) affect the transducer?

A

A rarefaction polarity initially causes the pressure of the transducer to be negative, in turn causing the transducer diaphragm to deflect away from the tympanic membrane. When a condensation polarity is produced, the pressure of the transducer is positive, in turn causing the transducer diaphragm to move towards the tympanic membrane.

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11
Q

What frequencies is latency prolonged?

A

Lower frequencies. The lower the frequencies, the longer the latency as the travelling wave must travel further through to the apical portion of the cochlea.

(Extra Info)
▪ The travelling wave delay is approximately equal to the period of the signal
E.g. a 4 kHz wave has a period of 0.25 ms, so its travelling delay is also 0.25 ms. Conversely, a 250 Hz travelling wave will have a delay of 4 ms. Therefore, a higher frequency will have a shorter travelling wave delay, whereas a lower frequency will have a longer travelling wave delay.

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12
Q

Why are three electrodes placed onto the skin despite only two being necessary to measure an electrical signal?

A

Having three electrodes allows the differential amplifier to subtract out external interference.
In a differential amplifier, two signals are measured: one between the non-inverting and common electrodes, and the other between the inverting and common electrodes. These two signals are subtracted, which will tend to cancel signals that are similar (in phase) at the two electrode locations. This reduces the effect of external interference.

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13
Q

By scrubbing the skin with paste before placing electrodes, what are we trying to achieve?

A

To reduce skin impedance from 106 ohms to less than 5 kohms.
Also ensures accuracy when determining differential amplification.

(More info)
The electrical impedance of dry skin is very high, and this will make it difficult to measure small physiological responses. The typical scrub paste used contains an abrasive that removes the top layer of dead skin cells (high impedance), and a conductive saline solution (sodium chloride) that promotes an electrical connection between the skin and the electrode

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14
Q

The software provided a warning that the non-inverting electrode impedance was not ideal. What is this likely to mean?

A

The electrode impedance is too high
The aim is to lower impedance, so it is likely that a non-ideal impedance is too high. It is unlikely that the lead wire is broken, as this would prevent the test from running at all.

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15
Q

What could be the effect of an electrode impedance that is too high?

A

The differential amplifier will not work effectively, and the responses could be contaminated by external electrical signals
The differential amplifier relies on low and preferably similar impedances at all electrodes. If these conditions are not met, external interference may be increased in amplitude.

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16
Q

You have two stimulus rates to choose from: 11.1 Hz and 55.5 Hz. Which will you choose and why?

A

In a clinical setting, the best option is to use a slower stimulus rate (in this case, 11.1 Hz). Slower presentation rates ensure better neural synchrony.

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17
Q

You have two transducers to choose from: headphones and insert earphones. Which will you choose to use and why? Are there any considerations you need to factor in?

A

You could choose either, but the best acoustic properties occur with insert earphones, as the frequency response is better, and less ringing is created by the transducer. If you use insert earphones, you need to ensure that you factor in any insert earphone delays (due to the length of the transducer tubing).

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18
Q

The Audiologist would like to know frequency-specific information from their ABR. Before you place the electrodes on your colleague, you need to make a few decisions.
You have two stimulus types to choose from: click and tone burst stimuli. Which will you choose and why?

A

Given that the ‘patient’ would like frequency-specific information about the ABR, you would select tone burst stimuli, which will give you more specific information about the ABR at different frequencies.
Typically, click stimuli would be used to generate an ABR response, which is representative of high-frequency hearing levels.

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19
Q

Why does stimuli need to be brief? In ABR

A

To generate synchronous firing (many neurons firing) for successful observation of electrical activity

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20
Q

What are three methods to evaluate the location of ABR generators?

A

Simultaneous near and far-field recording-electrodes close to the site generation, high amplitudes

Lesion studies in animals – Lesion at particular site in brainstem and AMR recorded will show changes/losses

3D Imaging Techniques - (only one in humans possible). MRI, PET non-invasive, showing active brain regions.

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21
Q

What are some of the slower potentials (low frequency) thought to be generated by?

A

Dendrites

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22
Q

What measurements in ABR are most relevant clinically?

A
Absolute Latency (total conduction time)
Interpeak Latencies (neural conduction time)
23
Q

How early can you observe and ABR in infants?

A

26 weeks gestation age for high stimulus levels, yet the morphology of the way form can be quite different than what is seen at 40 weeks gestation age

  • Waveform is prolonged, the younger the person
24
Q

Which wave is most robust in adults and children?

A

Wave IIImost robust in children.

Wave V most robust in adults

25
Q

When do latencies reach adult latency timing?

A

Wave three reaches adult latency by two years, white one reaches I don’t latency by three months.

Greatest change of latency between -3 to 6 months

26
Q

Why are latency is prolonged in young children?

A

Likely to do with the myelination process occurring in nerves early in life

27
Q

When is ABR indicated?

A

When a patient presents with asymmetrical symptoms!!

  • SNHL asymmetry
  • Unilateral symptoms (Aural fullness, distortion, Tinnitus) - lasting over 3mo
  • Mild imbalance
  • Unusual reflex findings
  • Neurological indications where the VIIIth CN may be involved i.e. MS, diabetes, stroke
28
Q

ABO has a 90% hit rate for detection of what?

A

Retrocochlear pathology’s
– vestibular schwannoma’s/acoustic neuroma
- Neuro fibromas (bilateral symptoms and not restricted to VIIIth)
- Meningiomas

29
Q

Why does Abby are use alternating clicks with both condensation and rarefaction?

A

Minimises artefacts, and eliminate the cochlea microphone egg making earlier waves easier to identify.

(extra info)
- In some HF cochlear losses - rarefractions only, may allow for better identification of later waves

30
Q

Why are many sweeps indicated in ABR?

A

For sufficient signal averaging given the small amplitude of the response

31
Q

What is the benefit of Using a four electrode array?

A

Can obtain ipsilateral and contralateral recording simultaneously.

32
Q

Consider IPs prolonged latencies?

A

E.g. 29cm tube will cause a 0.85ms delay, whereas a shorter tube would cause a shorter delay

◊ Most ABR systems automatically correct the latency measurements obtained with IPs by subtracting the maximal 0.85ms so they can be compared directly with results and norms obtained using HPs.
33
Q

How do contralateral recordings differ from ipsilateral recordings in ABR?

A

Wave I absent

Wave II is usually larger and slightly later

Wave III is usually smaller and slightly earlier

Wave IV is usually earlier

Wave V is usually 0.1-0.2ms later

Differences btw Wave IV and V are larger

34
Q

What can interpeak intervals and interaural difference measures contribute to the result analysis?

A

Provide an internal control measure

– as absolute measures can be affected by equipment, presentation level, age, degree of hearing loss, gender.

35
Q

When do we use correction of the audiogram?

A

When we have difficulty interpreting latency of the waves of the response, we correct for Wave V.
A high-frequency hearing loss would cause the whole waveform to occur later than normal – should correct for the whole day form –

EFFICIENCY = correct for Wave V only, as this is the only wave we use to evaluate absolute latency

36
Q

Why might we not see WAVE3 in infants?

A

Likely due to having a shorter nerve compare to adults

37
Q

What are the advantages and disadvantages of click versus tone burst stimuli?

A

Click allows increase neural Synchrony, detection at lower sensation levels. However, cannot record frequency specific hearing thresholds – only overall threshold estimates in the mid to high frequencies (1-4kHz)

Tone burst allows frequency specific information

38
Q

Implications of increasing stimulus rate?

A

Recovery or refractory period when neurons are incapable of reactivating at the same threshold. Neurons cannot respond sufficiently! Thus, Wave five latency increases

39
Q

What are some of the limitations of ABR in infants?

A

Presentation levels-you will exceed the limit of the bone conductor more quickly for severe hearing loss is due to correction factor (dBnHL to dBSPL)

Electrical artefacts-particularly low frequencies

Placement problems

Tactile Sensation

40
Q

What are OAEs?

A

OAEs are air pressure changes that can be measured in the ear canal and caused by tympanic membrane vibrations, which are in turn driven by the cochlea.

Essentially sounds generated/emitted by the ear. What is measured represents a leakage of energy out of the auditory system.

41
Q

What is the contribution of the outer hair cells to the active process?

A

Meccano electrical transducers and electro mechanical transducers, responsible for amplifying the passive travelling wave. Outer hair cells displacement changes the shape of the organ of corti– feedback loop amplifying the travelling wave

42
Q

Describe the non-linear Paradine in relation to otoacoustic omissions And why is it useful?

A
  1. (In a Nonlinear system) This time in a nonlinear recording pattern, the first three clicks are identical in phase and amplitude. However, the fourth click is inverted in phase and is three times the amplitude of the preceding three clicks.
    As the power of this fourth click is equal to the power of the first three clicks combined, and is in the opposite phase, the sum of the linear components will be zero.
    All that remains is the nonlinear energy that results from the actual ear response and any transducer artefact. This nonlinear recording protocol enables linear elements of the stimulus to be removed from the system, leaving only the nonlinear activity from the outer hair cells in the cochlea to be recorded.
43
Q

What is the significance of insuring an appropriate depth and comfort for probe tube insertion during otoacoustic omissions?

A
  • Stability - ensure pt doesn’t need to hold it (movement - reduced quality recording)
  • Too shallow - risk of interference form external noise
  • Too deep - uncomfortable (reduce Pt’s compliance)
44
Q

How does caloric testing work?

A

Introduces a by thermal stimulus to the air canal of a fixed temperature either warmer or cooler than body temperature and create a caloric thermal stimulus by convection current (causing movement of endolymph, deflecting cupula) and creates a VOR. Most lateral part of the IE, thus closest to temp changes.

Assesses HORIZONTAL SCC function
and SUPERIOR VESTIBULAR NERVE

Typically in LOW FREQUENCIES

45
Q

At what degree does the patient need to lay down for caloric testing and why?

A

Patiently Supinder with had elevated at 30°-horizontal semicircular canals are aligned on a 30° angle and align with gravity (vertical plane)

46
Q

Describe the heat changes in caloric testing?

A

Heat changes the density of the endolymph make it lighter – rises and moves towards the nose.
AMPULOPETAL flow causes right HSCC to deflect towards the nose = excitation in the right HSCC.
= VOR = Right beating nystagmus.

47
Q

Describe the cool changes in caloric testing?

A

Changes the density of the Endo length making it heavier, moves downwards away from the nose.
AMPULLOFUGAL flow causes inhibition of R HSCC
= VOR (eyes move away from irrigated ear) = Left beating nystagmus

48
Q

Is it unusual for responses in caloric testing to have an increase to the Peake and then a decrease after that?

A

No, typically the magnitude of the response will gradually increase until the peak and then gradually decrease after the peak

49
Q

What is the purpose of calculating a unilateral weakness and directional preponderance?

A

To compare the responses between the ears.

UW - Can help determine whether there is canal paresis dysfunction. (compares btw R HSCC and L HSCC)

DP - compares the magnitude of the right beating nystagmus to the magnitude of the left beating nystagmus.

50
Q

Why do we test the fixation index in coloric testing?

A

Helps to determine the patients visual vestibular interaction – we need the Fischl system to be able to suppress the VO are visually in day-to-day life. For activities such as reading a book while a car is moving

51
Q

Why do head impulse test impulses need to be quick and unpredictable?

A

To ensure clients cannot predict the direction of the head turn and possibly predicts okay Tash voluntarily move their eyes to re-fixate on the target.

To ensure we are only assessing the VOR (not the visual system so it cannot compensate quickly enough for rapid movements/high-frequency)

52
Q

What are the differences between bedside HIT and VHIT?

A

The patient sits in front of the clinician, patient to maintain their gaze on clinicians nose. Subjective clinician observes I movements. Difficult to observe covert saccades.

53
Q

For head impulse testing, does it have good sensitivity and/or good specificity?

A
Both! 
High sensitivity (90 to 100%) for patients with complete canal paresis. 

High specificity meaning catch up saccades will indicate vestibular dysfunction of SCCs