test 1 Flashcards
2 types of protocols for auditory information
behavioral and electrophysiological
behavioral test
require some type of cooperative behavior on the patient/client
-raising hand
advantage- indicates some form of higher level processing
has to hear and receive and formulate response
electrophysical test
generally do not require a conscious response to an auditory stimulus on the part of the patient/client
may require patient to sit still
advantage- does not require much if any cooperation of patient
special test
behavioral or electrophysiological
used to provide info that could not be obtained through the standard audiological battery
Standard audiological battery
SAB
diagnose presence of, degree of, and type of hearing loss
determine possible etiology
determine possible treatment strategies
SAB provides
differentiation between normal and abnormal hearing (presence of loss)
differentiation between conductive and sensory-neural losses
severity of loss
indication of middle ear status
SAB does not provide
differentiation between sensory & neural loss (cochlear vs. retrocochlear
information about vestibular system in inner ear
info about hearing status who are unwilling to take the SAB
Special test include
test for differential diagnosis (site of lesion)
test of vestibular system
tests for functional/non-organic losses
electrophysiological tests to provide info regarding status of hearing
pediatric modifications to the SAB
differential diagnosis
the determination of which two or more diseases or conditions with similar symptoms is one from which the patient is suffering, by a systematic comparison and contrasting of the clinical findings
differentiating b/w cochlear (sensory) and retrocochlear (neural ) causes in a sensory-neural loss
acoustic neuroma
is a tumor on the auditory nerve CNVIII slow growing affects 1 in 100,000 most common in adults over 30 may be bilateral VON RECKLINGHAUSEN disease
signs and symptoms of CNVIII tumor (acoustic neuroma)
unilateral loss or asymmetrical loss usually gradual discrepancy between degree of loss and word recognition score elevated acoustic reflexes tinnitus vestibular symptoms
signs and symptoms of Meniere’s disease
progressive fluctuating Sensory-neural loss
vertigo
tinnitus
similarities between Meniere’s and Acoustic neuroma
hearing loss is typically unilateral can be bilateral
tinnitus
dizziness balance problems
inner ear
Meniere’s
CNVIII
acoustic neuroma
2 types of behavioral tests for site of lesion
assessing for presence of recruitment and or adaptation
altered speech tests
auditory adaptation
is the inability of the auditory system to maintain a sustained stimulus
auditory adaptation AKA
auditory fatigue
Adaptation
is a retrocochlear sign suggesting the presence of an acoustic neuroma
recruitment
abnormal growth of loudness
cochlear sign
AKA maybe Meniere’s disease
site of lesion tests evaluate
the presence of auditory adaptation or for the presence of recruitment
Adaptation test
Tone decay
STAT
tone decay test
is an adaptation test where the patient is asked to listen to a prolonged tone and indicate when the tone disappears or changes in quality
most significant tone decay considered retrocochlear sign (acoustic neuroma)
different methods to assess tone decay
how the test occurs
stimuli is presented near patient’s threshold
patient asked to indicate if he or she doesn’t hear stimulus anymore
stimulus is increased in intensity if when patient indicates it is no longer heard
results interpreted as a combo of time and intensity depending on the methods
the Suprathreshold Adaptation Test STAT
is a specialized tone decay test
stimuli is presented at a suprethreshold above threshold level (110 dB SPL) for 60 sec only
100 dB HL @ 500 & 2K
105 dB HL @ 1K
how stat is performed
patient either sustains the suprathreshold stimulus for 60 secs (no decay) or does not sustain the test stimulus (indicative of tone decay)
intensity of stimulus taxes system even more than standard tone decay
recruitment tests
SISI
ABLB
AMLB
SBLB
Short Increment sensitivity index (SISI)
patient listens to a continuous tone with small (1dB) intensity increments superimposed on it
the cochlear ear will hear the small jump in loudness
Alternate binaural loudness balance test (ABLB)
patient presented tones alternating between the better ear and the poorer ear and asked to judge loudness in each ear is balanced
recruitment ear takes small intensity increments
ladder gram
Alternate Monaural loudness balance test (AMLB)
compares loudness of 2 different frequencies both printed to the same ear.
requires patient o have some normal frequencies
loudness of frequency where hearing is normal compared to loudness of frequencies where hearing is normal
recruiting ear will still require small intensity changes
simultaneous binaural loudness balance test (SBLB)
compares loudness of the same frequency b/w the 2 ears (like the ABLB), but both stimuli are presented at the same time rather than alternating b/w the ears
most behavioral test for recruitment and adaptation have been replaced by electrophysiological measures
tend to be more for screening rather that diagnostic
reports will include mention of one or more of these tests
performance-intensity-function of phonetically balanced words
AKA articulation gain
patient is presented with several lists of phonetically balanced words at varying levels about the speech reception threshold
PI-PB graph
charted with vertical axis for % correct and horizontal axis is increasing intensity
PB max
the maximum score achieved at a particular intensity
normal ears meet PB max about 35-40 dB above SRT
PB min
lowest word recognition score obtained at intensity required for PB max
rollover ratio
PB max - PB min divided by PB max
rollover ratio indicates
40% or less cochlear lesions
45% or greater suggests retrocochlear lesions CNVIII
elevated rollover can happen with elderly
intrinsic/internal redundancy
redundancy present in the auditory system
binaural hearing
bilateral representation of fibers in central auditory nervous system
can be compromised by a lesion in the auditory nervous system
extrinsic/external redundancy
redundancy present in the speech signal expected word order- salt and pepper expected sound combinations formats and formant transitions situation specific speech familiarity of a topic
how can extrinsic redundancy be compromised
by altering the speech signal filtering changing speed dichotic task competing messages
altered speech tests
designed to tax the auditory system using speech stimuli by eliminating redundancy in the speech signal
filtering speech
eliminates some of the frequencies presented in the speech signal
may eliminate perceptual cues (formants, formant transitions)
eliminates some external redundancy
changing speed (AKA time altering the signal)
taxes the auditory system by eliminating some perceptual cues and increasing task difficulty
time-compressed speech
signal delivered in less time than normal
time-expanded speech
signal delivered in more time than normal
time-compression/time-expansion
are done electronically so that frequencies are not altered
band-pass filter
is a device that passes frequencies within a certain range and rejects (attenuates) frequencies outside that range.
band-reject filter
a band-stop filter or band-rejection filter is a filter that passes most frequencies unaltered, but attenuates those in a specific range to very low levels.
cochleopalpebral reflex
A form of the wink reflex in which there is a contraction of the palpebral part of the orbicular muscle of the eye when a sudden noise is made close to the ear.
cut-off point
Point separating two opposite states, such as ‘yes’ and ‘no.’
DPOAE
Distortion product otoacoustic emissions (DPOAE) are responses generated when the cochlea is stimulated simultaneously by two pure tone frequencies whose ratio is between 1.1 to 1.3.
fixed width filter
Auditory filter bandwidths were measured using nonsimultaneous masking, as a function of signal level between 10 and 35 dB SL for signal frequencies of 1, 2, 4, and 6 kHz. The brief sinusoidal signal was presented in a temporal gap within a spectrally notched noise.
high pass filter
is an electronic filter that passes signals with a frequency higher than a certain cutoff frequency and attenuates signals with frequencies lower than the cutoff frequency.
low pass filter
is a filter that passes signals with a frequency lower than a certain cutoff frequency and attenuates signals with frequencies higher than the cutoff frequency.
otoacoustic emission
is a sound which is generated from within the inner ear.
percentage filter
created by the cochlea, the sense organ of hearing within the inner ear. Roughly, the critical band is the band of audio frequencies within which a second tone will interfere with the perception of the first tone by auditory masking.
stapedial reflex
middle-ear-muscles (MEM) reflex, attenuation reflex, or auditory reflex) is an involuntary muscle contraction that occurs in the middle ear in response to high-intensity sound stimuli or when the person starts to vocalize.
startle reflex
Moro reflex is an infantile reflex normally present in all infants/newborns up to 4 or 5 months of age as a response to a sudden loss of support, when the infant feels as if it is falling. It involves three distinct components: spreading out the arms (abduction)
testing differential diagnosis
competing messages between two different signals to the patient
may be in the for of actual intelligible speech
may be in the form of noise
presented in ear phones
ipsilateral competing messages
same side competition may be presented to one earphone and signal presented in the other ear
contralateral competing messages
opposite
signal to noise ratio
ratio of 10dB means the signal is 10dB more intense than the noise
ratio of -5dB means the signal is 5dB less intense softer than the noise
several types of noises/competition
steady state- fan
quad-steady-state- speech babble
time-varying- airplanes taking off
competing messages- competition of speech just like the symptom
altered speech tests can be presented two way
dichotic
diotic
dichotic
sending different signals to each ear
requires central processing to put the signal back together
dichotic signals can be separated by two methods
divided by time
put together cup to one ear cake to the other ear to create cup cake
divided by frequency
phonemes in low pass filter rage go to one ear phonemes in high pass filter rage go to the other ear
purpose is to put together centrally
dichotic signals can be 2 completely separate signals
one word/sentence to one ear
different word/sentence to other ear simultaneously
-dog -cat
synthetic sentences
sentences that are grammatically correct but meaningless
created by determining what type of word would come next in the sentence
toy boat with a picture has become
synthetic sentences eliminate the expectancy issues in extrinsic redundancy
person can not rely on familiarity with topic, expected word order, etc to get what might be missed
altering conditions are often combined to further reduce extrinsic redundancy
synthetic sentences may be combined with competing messages
filtered speech might be combined with competing messages
synthetic sentences might be time altered
vertigo
sensation of spinning
subjective vertigo
the person has the sensation of spinning
objective vertigo
person has the sensation of the environment spinning
disequilibrium
balance disorder with out sensation of spinning
vertigo/disequilibrium can be associated with a variety of disorders
meniere’s disease- cochlear
acoustic neuroma- CNVIII
disorders of vestibular- labyrinthitis health issues- blood sugar, blood pressure
electrostagmography
is a series of subtests that evaluate eye movements to assess balance mechanic,
balance
dependent upon an interaction between vestibular system and kinesthetic feedback
ENG measures & evaluates the nystagmus movements to assess the vestibular system
nystagmus
when a posterior s dizzy, the visual system sometimes compensates
posturography
is a series of tests that evaluates person’s ability to deal with changes in posture
-part of the evaluation of patient’s with balance issues/dizziness
functional hearing loss
not all hearing loss is actual hearing loss
is actually faking or exaggerating a hearing loss
AKA nonorganic hearing loss
AKA pseudohypo acusis
apparent loss of hearing without an organic disorder with insufficient pathological evidence to explain the extent of the loss
malingering
faking a disorder, usually for some type of compensation
monetary
psychological
avoidance of some type of action
red flags to a possible functional hearing loss
referral source possible comp case
behavior during conversation/interview
inconsistencies or questionable results o hearing test findings.
behavior during interview
inconsistencies in hearing test finding
poor test/ ratest reliability on pure tons and inconsistent responses during pure tone test
acoustic reflex
stimulus has to be sufficiently loud to cause he brain to trigger the reflex. if a reflex occurs at a low sensation level based on reported threshold then it is doubtful
special profile for children with functional loss
difficulty in school
hx of middle ear disorders
2 general purposes of testing patient with functional losses
very nonorganic loss (catch’em)
establish the true hearing level (make them come clean)
some tests accomplish only one purposes others not purposes
2 types of tests to assess for functional hearing loss
electrophysiological and behavioral
electrophysiological test for functional hearing loss
ABR (auditory brainstem response)
OAE (otoacoustic emission)
AR (acoustic reflex)
SPAR (sensitivity prediction from the acoustic reflex)
behavioral test for functional hearing
yes/no method (children) counting the tones stenger test defiler-stewart lombard DAF (delayed auditory feedback ) VIST (vary intensity story test ) swinging story test
ABR testing
the patient is attached to 3 electrodes which monitor electoral activity of auditory brainstem
stimuli through earphones
average computer determines if change in electrical activity occurs in the presence in sound
ABR testing protocols
required to be still and quiet and leave the probes and headphones in place
used to asses for site of lesion testing and newborn screening
ABR one electrobe on earlobe or mastoid
nearest ear being tested, inverting or test electrode
1@ other ear- ground electron
1 electrode at vertex on forehead reference (non inverting ) electrode
red on left ear- means it is wrong
ABR signal typically click stimulus
broad band signal
many frequencies present
2000-4000 HZ
will not rule out either low frequency or higher frequency hearing losses
will not give frequency specific into the 2K-4K range will show best threshold in that range
ABR testing tone pips can be used in place of clicks
AKA tone bursts
Stimulus must have a rapid rise time to generate a response
Will give some frequency specific info
ABR testing yields
Tracing of 5-7 wavelets indicating neural response in the auditory system
Waveform response appears within first 10 msec, after signal representation
Exact location of wave length unknown
Wave location
Waves 1&2- CNVIII
Waves 3&4- pons
Waves 5- midbrain
Waves 6&7- undetermined
ABR wave 5
Most persistent and repeatable
ABR threshold is lowest intensity at which 5 can be elicted
Last intensity of the lowest click
10-20dB
Ex 2-4K hz for click designated frequency for tone pips
Used for assessing acoustic neuroma
Otoacoustic emission
Small sounds produced by the normal cochlea
Can give and indication is the status of the cochlea and consequently of hearing
An electrophysiological measure
oAE requires
Remain still
Allow probe to stay in place
Essentially quiet
oAE to occur and be measured
Stimulus must travel through the outer & middle ear to the cochlea
Cochlea must generate the OAE
oAE must travel back through the outer and middle ears to measure equipment
Can be used on newborn
The primar OAE testing
is to determine cochlear status, specifically to hair cell function
Problems in conductive mechanism can prevent OAEs from being elicited
Problems beyond the cochlea CNVIII will not be detected
Acoustic reflex
Reflexive contraction of the stapedius muscle occurring in the presence of a loud sound
Normal 85 db spl
Not that reliable
SPAR sensitivity prediction from the acoustic reflex
Compares reflex thresholds for pure tones
Average reflex @500, 1k, 2k hz) to reflex threshold for broadband noise
Reflexes are easier to elicit with broadband noise
Spar cont
Normal should show about 25db greater average reflex threshold for tones than for broadband
Mil-mod 10-20 db
Mod-sev less than 10 db
Severe to profound do not Have reflexes
