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AUDE 5240 (AUD DIAG) > Study Guide > Flashcards

Study Guide Flashcards

1
Q

What is the role of the audiologist in a diagnostic assessment for a medical condition?

A

Audiologists administer and interpret diagnostic tests
Audiologists do not provide medical diagnosis

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2
Q

What DOES an audiologic diagnosis include?

A

Opinions on cause of hearing loss
Impact of hearing loss on communication
(source: Roeser et al.)

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3
Q

What is site of lesion testing? What are the three main areas addressed in this course?

A

Isolate the portion of the auditory system that is affected
Identify where in the pathway there is a problem
Middle ear (conductive), cochlea (SN), auditory nerve (retrocochlear) (nerve or SN)

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4
Q

What are the goals of a basic audiologic assessment?

A

Assess peripheral auditory system
Detection of presence of hearing loss
is hearing sensitivity within normal limits?
Audiogram
Determination of degree of loss across frequency
Determination of type of loss
Estimate potential impact and outcomes
What is recommended line of treatment?
medical …rehabilitative …psychosocial

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5
Q

How does hearing assessment vary in a diagnostic evaluation vs. an evaluation for treatment?

A

Diagnostic
Assess physical auditory system
Assess need for medical treatment
Audiologists do not treat medically
Treatment
Assess impact on communication and other areas of living
Audiologists do this kind of treatment

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6
Q

How can the referral source provide clues to your approach to patient management? Give examples.

A

Self-referrals or referrals from family members
Aware of communication needs
Physician and other health care professional referrals (specialists or general practitioners)
Medical diagnosis or management
SLP or other educational/development-related
Rule out/address hearing loss
Need help with school in different ways
Legal
Lawsuit, did they injure themselves on the job
Workers compensation
Employment

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7
Q

What should an audiology address at each diagnostic visit, regardless of initial complaint?

A

Always address potential medical concerns/need for medical referral
Always address potential communication concerns
Always address potential vestibular concerns
** even if the stated reason for the visit does not include one or more of the above
*I came in for hearing aids but see a perforation, would refer

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8
Q

What are two key ingredients to correct differential diagnosis?

A

Excellent case history
Thorough physical examination

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9
Q

What are some advantages to taking at least part of the case history orally?

A

Establish rapport with patient
Establish environment where patient feels his/her needs are paramount
Ask for clarification and probe further as needed from written history
Estimate cognitive level and hearing level to guide instruction and test procedures

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10
Q

List six “probing questions” that should be asked to learn more about a patient’s symptoms (from slides under case history)

A

How long has the complaint been occurring?
Is it in one or both ears (if auditory complaint)
Is it constant, fluctuating, or intermittent?
If it fluctuating or intermittent; describe
How long does it last?
Trigger(s)?
What makes it start/when do you notice it?
Can you do anything to make the symptom stop or lessen?
What do you do when you notice <complaint>?</complaint>

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11
Q

Define “review of systems”

A

List of questions arranged by organ or system

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12
Q

What are three important factors with regards to developing a case history form?

A

Keep it at a simple reading level
Keep it as concise as possible
Translate it into other languages common to your region

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13
Q

What are the 6 indicators from the case history that a medical referral is warranted?

A

Fluctuating hearing loss
Chronic middle ear infections
Sudden hearing loss
Recent onset tinnitus
Recent onset vertigo
Family history may indicate need for medical referral

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14
Q

What is the general format of reporting the case history?

A

Patient characteristics:
Patient name and age and what type of evaluation was done
Description of patient status (alert and cooperative, or otherwise)
Who provided the case history information
Who accompanied the patient, if anyone
Chief complaint:
Why was the patient referred? Include any relevant information
Other history:
Describe similar conditions together- start with audiology-related and particularly any history that may be relevant to the chief complaint
Include details from your probing questions

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15
Q

How would you report a normal otoscopic examination?

A

The normal tympanic membrane should appear
pearly grey
with a light reflex
generally concave
and you should be able to make out the malleus
Upon otoscopic examination, both pinnas appeared fully formed without obvious abnormalities. No abnormalities were noted in the area surrounding the pinna. Both of the tympanic membranes showed a cone of light at the anterior inferior quadrant. Both of the tympanic membranes were semi-translucent with a typical shape. The umbo and manubrium of the malleus were visible.

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16
Q

What is included when reporting on the tympanic membrane?

A

Shape of the eardrum – bulging or retracted
Colour of the eardrum – red (infection), yellow (glue ear), brown (blood), presence of blood vessels
Light reflex present or not? (usually absent in bulging EDs)
Umbo
Manubrium of the malleus
Things that should not be there (next slide)

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17
Q

What are the components of a basic audiometric assessment?

A

air bone speech

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18
Q

What are the 3 elements of evidenced-based practice?

A

evidence
clinical expertise
client perspective consideration

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19
Q

How do you know if you are referencing quality research evidence?

A

Systematic reviews
Clinical practice guidelines (one of our orgs (ADA, ASHA, AAA)
Peer-reviewed journals
Textbooks, maybe

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20
Q

What are the two types of speech threshold tests?

A

Speech recognition threshold (SRT)
speech detection/awareness threshold

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21
Q

What is the definition of the Speech Recognition Threshold/SRT?

A

being able to repeat the word back 50% of the time at their absolute threshold (softest sound)

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22
Q

What stimuli are used to measure SRT?

A

with spondaic words - equal stress and 2 syllables

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23
Q

What is the psychoacoustic method used for SRT?

A

adaptive staircase

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24
Q

How is starting level determined for SRT?

A

start at 30 or a level expected to be audible to them, estimating

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25
Q

What is the step size?

A

Down 10 up 5, have to get 2/4 on an ascending run

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26
Q

What are two possible response modes for SRT?

A

pointing or repeating the word

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27
Q

How should SRT be measured for a patient who is not a native speaker of English?

A

test in their own language and make sure to know how to identify a correct response

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28
Q

What is the stopping rule?
How is threshold calculated?

A

wherever we stopped

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29
Q

Why is it necessary to calibrate speech material each time a speech test is done?

A

because we need to give the audiometer information about the amplitude of the stimulus

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30
Q

How often do you need to monitor the VU meter during MLV (monitored live voice) testing?

A

the whole time you’re testing

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31
Q

Why is it necessary to calibrate each CD every time you change discs?

A

because each CD is different

32
Q

Why does the audiometer have two external input controls (external A and external B)?

A

We have both input controls because the CD has 2 different channels to use for 2 different stimuli. One can present the test stimulus and the second input the other stimulus.

33
Q

What is the primary clinical use of the SRT?

A

cross check

34
Q

What are the two secondary clinical uses of the SRT?

A

provides general index of hearing sensitivity for speech
serves as baseline for determining suprathreshold speech testing level

35
Q

Explain what RETSPL is and why it is different for different transducers

A

ear canal volume is different with each of these transducers
reference equivalent threshold sound pressure level

36
Q

Know how to convert from dB SPL to dB HL and vice versa using a table of RETSPL values

A

dB HL = dB SPL – RETSPL
dB SPL = dB HL + RETSPL

37
Q

If your headphone stops working, can you plug in a headphone of the same type and still have a valid test? Why or why not?

A

No, because they are calibrated depending on where they were plugged in

38
Q

Understand dB SL (dB sensation level)

A

Difference bw threshold and presentation level

39
Q

explain how you would check Frequency switch

A

listening start at 250 Hz at 40dB and increase the frequency at a steady rate, we are listening for wavering or pitch changes

40
Q

What is the SDT/SAT?

A

threshold for 50% of words they can hear at a certain level, doesn’t have to repeat back they just have to hear it

41
Q

How is the SDT/SAT estimated?

A

same as pure tone, using speech as stimulus (live voice or recorded)
start at 30 etc.

42
Q

The SDT/SAT should be within how many dB of the PTA?
In either direction or in just one direction?

A

15-20 dB, just one direction (better) - cannot be worse because it is just detection

43
Q

explain how you would check attenuation dial?

A

listening check start at 20dB at 1,000 Hz and slowly increase in 10 dB steps, listening for non-linearity of the dial

44
Q

explain how you would check cross-talk

A

listening check, checking to see if the sound bleeds over to the non-test ear during frequency and intensity checks (present to R and have L headphone on to listen and etc.)

45
Q

explain how you would check
Integrity of cord

A

visual check, check cords (kinks, insulation) jacks (plugged in, correct cords) amd connection (corrosion)

46
Q

What is the “cross-check” principle?

A

using one test to validate the results of another test
“no auditory test result should be accepted and used in the diagnosis of hearing loss until it is confirmed or crosschecked by one or more independent measures

47
Q

What is the primary clinical use for the SRT?

A

The cross check
Secondary - General index of their hearing sensitivity for speech
baseline for suprathreshold speech testing - SRT serves as baseline for determining suprathreshold speech testing level

48
Q

What is the definition of the SRT?

A

being able to repeat the word back 50% of the time at their absolute threshold

49
Q

Describe the materials used for SRT testing.

A

spondee words with 2 syllables
Pictures for pointing to
Word list for the PT to repeat back

50
Q

If you were administering a speech test and the instructions were to present at 60 dB SPL, where would you set the audiometer dial if using supra-aurals? If using inserts?

A

40 dB
47 dB

51
Q

If you had a patient who wanted you to show them what speech at 80 dB SPL sounds like, where you would you set the audiometer dial if using supra-aurals? If using inserts?

A

60 dB
67dB

52
Q

Describe the SRT procedure.

A

Before beginning:
Familiarize patient with spondee list
“at level that is easily audible” – Katz (30-40 dB SL re: PTA if known)
Let the patient know they will be hearing words and their task is to repeat the word that they hear. Instruct patient to repeat the words, even if they are very faint, even if they have to guess
After familiarization and giving instructions, present one spondee at 30 dB HL or at a level estimated to be above the pure tone thresholds at 500 Hz and 1000 Hz
For correct response, “down 10, up 5” until 2 out of 4 correct responses are received at the same level
For incorrect response, increase in 10 dB steps until a correct response is given, then proceed to “down 10, up 5” until 2 out of 4 correct responses are received at the same level

53
Q

What frequencies are used for calculating the pure tone average (PTA)?

A

500, 1,000, and 2,000

54
Q

What frequencies are used for calculating the Fletcher PTA? When would you use this?

A

The best 2 frequencies of 500 1000 and 2000
We use this if 3 frequency wasn’t in agreement (can happen in a sloping hearing loss)

55
Q

SRT and PTA are considered to be in good agreement when they differ by no more than how many dB?

A

10 dB of each other
PTA 40, SRT should be between 30 and 50 but SAT will always be better never worse

56
Q

How should SRT be measured if the patient is not a native speaker of English?

A

test in their own language and make sure to know how to identify a correct response
Have recordings available and be familiar with what the correct response would be
Could do an SAT second if SRT didn’t work

57
Q

What is the SAT/SDT and how is it measured?

A

Speech awareness/detection threshold (SAT/SDT) - Softest level a person can detect speech (50% criteria)
No repetition of words
measured the same way as pure tones

58
Q

PTA and SAT/SDT are in good agreement when they differ by no more than how many dB?

A

15-20 dB better

59
Q

What are the RETSPL values for speech for supra-aurals and inserts?

A

20 dB SPL for supra-aurals
12.5 dB SPL for inserts (sometimes rounded to 13)
Audiometers are calibrated so that 0 dB HL for speech signals = 20 dB SPL (ANSI-1989) for supra-aurals and 12.5 dB for inserts

60
Q

List the frequencies to be tested in a standard audiogram per ASHA 2005

A

start at 1,000 2, 3 4 6 8
do 1,000 again and then 250 and 500
that is where hearing is the most reliable and test retest is the best at 1,000
Noise induced gives a notch around 3,000 Hz so it is better to include these in the testing

61
Q

When would you test the interoctave frequencies not specified as a standard test frequency?

A

750 and 1500 when we have a slope of 20 dB or more

62
Q

Which ear should be tested first? Why?

A

The better ear should be tested first, if no better ear, test right ear first because we can condition them to the test on the better ear and is easier to talk to that ear

63
Q

what is car hart’s notch

A

notch at 2,000 (bc has a notch here for otosclerosis)

64
Q

why do we get a notch at 3,000

A

noise induced

65
Q

What is included in an otoscopic examination?

A

Tympanic membrane, pinna, ear canals, surrounding areas

66
Q

In the hierarchy of evidence from the slides, what are the top three highest levels of evidence?
Are the lower levels of evidence valuable?

A

yes, sometimes that’s all you have available! (don’t need ot know lower levels)
Systematic review, randomized controlled trial, cohort studies (people of different groups)
case control (control group)

67
Q

what is typically included in audiologic assessment?

A

Case history
Otoscopy
Typical
Atypical (refer and/or suspect hearing loss)
Immittance testing
Speech Threshold Testing
Puretone testing
Suprathreshold Speech Testing (word recognition)
Documentation and coding
Other tests

68
Q

The “extended high frequencies” are the frequencies above which frequency?

A

above 8,000

69
Q

Explain how to interpret sound field test results

A

The thresholds you get only pertain to the better ear and we don’t know about the other ear and we don’t know which ear is which based on sound field alone.

70
Q

Explain the difference between decibels of
hearing level (dB HL) and decibels of sound
pressure level (dB SPL).

A

Hearing level considers each reference
dB SPL value to be 0 dB HL. This way
there is a straight line representing the
hearing values instead of a curved line
with dB SPL representing normal hearing
thresholds

71
Q

Why do we calibrate audiometers, and what is
the difference between electroacoustic and
biological calibrations?

A

They need to be calibrated so that we
can be sure what sound is actually being
presented to the patient.
Electroacoustic calibration is done
annually and completed by a licensed
specialist. It is set by an international
standard that specify the physical haracteristics of the sounds that are
produced by the audiometer
Biological calibrations should be done as
often as possible. This is done to make
sure the instrument is working overall.

72
Q

Why is it necessary to calibrate
speech material each time a speech
test is done?

A

We have to calibrate it each time because you are putting
something through the audiometer that it doesn’t know.

73
Q

How often do you need to monitor
the VU meter during MLV
(monitored live voice) testing?

A

The whole time you are testing MLV

74
Q

Why is it necessary to calibrate
each CD every time you change
discs?

A

because each cd is different

75
Q

Why does the audiometer have
two external input controls
(external A and external B)?

A

We have both input controls because the CD has 2 different
channels to use for 2 different stimuli. One can present the test
stimulus and the second input the other stimulus

76
Q
A

AUDE 5240 (AUD DIAG) (4 decks)

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