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aural rehab > test 1 > Flashcards

test 1 Flashcards

1
Q

2 types of protocols for auditory information

A

behavioral and electrophysiological

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2
Q

behavioral test

A

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

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3
Q

electrophysical test

A

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

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4
Q

special test

A

behavioral or electrophysiological

used to provide info that could not be obtained through the standard audiological battery

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5
Q

Standard audiological battery

A

SAB
diagnose presence of, degree of, and type of hearing loss
determine possible etiology
determine possible treatment strategies

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6
Q

SAB provides

A

differentiation between normal and abnormal hearing (presence of loss)
differentiation between conductive and sensory-neural losses
severity of loss
indication of middle ear status

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7
Q

SAB does not provide

A

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

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8
Q

Special test include

A

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

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9
Q

differential diagnosis

A

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

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10
Q

acoustic neuroma

A 
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
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11
Q

signs and symptoms of CNVIII tumor (acoustic neuroma)

A 
unilateral loss or asymmetrical loss 
usually gradual 
discrepancy between degree of loss and word recognition score 
elevated acoustic reflexes 
tinnitus 
vestibular symptoms
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12
Q

signs and symptoms of Meniere’s disease

A

progressive fluctuating Sensory-neural loss
vertigo
tinnitus

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13
Q

similarities between Meniere’s and Acoustic neuroma

A

hearing loss is typically unilateral can be bilateral
tinnitus
dizziness balance problems

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14
Q

inner ear

A

Meniere’s

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15
Q

CNVIII

A

acoustic neuroma

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16
Q

2 types of behavioral tests for site of lesion

A

assessing for presence of recruitment and or adaptation

altered speech tests

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17
Q

auditory adaptation

A

is the inability of the auditory system to maintain a sustained stimulus

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18
Q

auditory adaptation AKA

A

auditory fatigue

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19
Q

Adaptation

A

is a retrocochlear sign suggesting the presence of an acoustic neuroma

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20
Q

recruitment

A

abnormal growth of loudness
cochlear sign
AKA maybe Meniere’s disease

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21
Q

site of lesion tests evaluate

A

the presence of auditory adaptation or for the presence of recruitment

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22
Q

Adaptation test

A

Tone decay

STAT

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23
Q

tone decay test

A

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)

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24
Q

different methods to assess tone decay

A

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

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25
Q

the Suprathreshold Adaptation Test STAT

A

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

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26
Q

how stat is performed

A

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

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27
Q

recruitment tests

A

SISI
ABLB
AMLB
SBLB

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28
Q

Short Increment sensitivity index (SISI)

A

patient listens to a continuous tone with small (1dB) intensity increments superimposed on it
the cochlear ear will hear the small jump in loudness

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29
Q

Alternate binaural loudness balance test (ABLB)

A

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

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30
Q

Alternate Monaural loudness balance test (AMLB)

A

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

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31
Q

simultaneous binaural loudness balance test (SBLB)

A

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

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32
Q

most behavioral test for recruitment and adaptation have been replaced by electrophysiological measures

A

tend to be more for screening rather that diagnostic

reports will include mention of one or more of these tests

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33
Q

performance-intensity-function of phonetically balanced words

A

AKA articulation gain
patient is presented with several lists of phonetically balanced words at varying levels about the speech reception threshold

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34
Q

PI-PB graph

A

charted with vertical axis for % correct and horizontal axis is increasing intensity

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35
Q

PB max

A

the maximum score achieved at a particular intensity

normal ears meet PB max about 35-40 dB above SRT

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36
Q

PB min

A

lowest word recognition score obtained at intensity required for PB max

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37
Q

rollover ratio

A

PB max - PB min divided by PB max

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38
Q

rollover ratio indicates

A

40% or less cochlear lesions
45% or greater suggests retrocochlear lesions CNVIII
elevated rollover can happen with elderly

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39
Q

intrinsic/internal redundancy

A

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

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40
Q

extrinsic/external redundancy

A 
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
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41
Q

how can extrinsic redundancy be compromised

A 
by altering the speech signal 
filtering 
changing speed
dichotic task 
competing messages
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42
Q

altered speech tests

A

designed to tax the auditory system using speech stimuli by eliminating redundancy in the speech signal

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43
Q

filtering speech

A

eliminates some of the frequencies presented in the speech signal
may eliminate perceptual cues (formants, formant transitions)
eliminates some external redundancy

44
Q

changing speed (AKA time altering the signal)

A

taxes the auditory system by eliminating some perceptual cues and increasing task difficulty

45
Q

time-compressed speech

A

signal delivered in less time than normal

46
Q

time-expanded speech

A

signal delivered in more time than normal

47
Q

time-compression/time-expansion

A

are done electronically so that frequencies are not altered

48
Q

band-pass filter

A

is a device that passes frequencies within a certain range and rejects (attenuates) frequencies outside that range.

49
Q

band-reject filter

A

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.

50
Q

cochleopalpebral reflex

A

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.

51
Q

cut-off point

A

Point separating two opposite states, such as ‘yes’ and ‘no.’

52
Q

DPOAE

A

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.

53
Q

fixed width filter

A

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.

54
Q

high pass filter

A

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.

55
Q

low pass filter

A

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.

56
Q

otoacoustic emission

A

is a sound which is generated from within the inner ear.

57
Q

percentage filter

A

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.

58
Q

stapedial reflex

A

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.

59
Q

startle reflex

A

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)

60
Q

testing differential diagnosis

A

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

61
Q

ipsilateral competing messages

A

same side competition may be presented to one earphone and signal presented in the other ear

62
Q

contralateral competing messages

A

opposite

63
Q

signal to noise ratio

A

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

64
Q

several types of noises/competition

A

steady state- fan
quad-steady-state- speech babble
time-varying- airplanes taking off
competing messages- competition of speech just like the symptom

65
Q

altered speech tests can be presented two way

A

dichotic

diotic

66
Q

dichotic

A

sending different signals to each ear

requires central processing to put the signal back together

67
Q

dichotic signals can be separated by two methods

A

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

68
Q

dichotic signals can be 2 completely separate signals

A

one word/sentence to one ear
different word/sentence to other ear simultaneously
-dog -cat

69
Q

synthetic sentences

A

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

70
Q

synthetic sentences eliminate the expectancy issues in extrinsic redundancy

A

person can not rely on familiarity with topic, expected word order, etc to get what might be missed

71
Q

altering conditions are often combined to further reduce extrinsic redundancy

A

synthetic sentences may be combined with competing messages
filtered speech might be combined with competing messages
synthetic sentences might be time altered

72
Q

vertigo

A

sensation of spinning

73
Q

subjective vertigo

A

the person has the sensation of spinning

74
Q

objective vertigo

A

person has the sensation of the environment spinning

75
Q

disequilibrium

A

balance disorder with out sensation of spinning

76
Q

vertigo/disequilibrium can be associated with a variety of disorders

A

meniere’s disease- cochlear
acoustic neuroma- CNVIII
disorders of vestibular- labyrinthitis health issues- blood sugar, blood pressure

77
Q

electrostagmography

A

is a series of subtests that evaluate eye movements to assess balance mechanic,

78
Q

balance

A

dependent upon an interaction between vestibular system and kinesthetic feedback
ENG measures & evaluates the nystagmus movements to assess the vestibular system

79
Q

nystagmus

A

when a posterior s dizzy, the visual system sometimes compensates

80
Q

posturography

A

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

81
Q

functional hearing loss

A

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

82
Q

malingering

A

faking a disorder, usually for some type of compensation
monetary
psychological
avoidance of some type of action

83
Q

red flags to a possible functional hearing loss

A

referral source possible comp case
behavior during conversation/interview
inconsistencies or questionable results o hearing test findings.
behavior during interview

84
Q

inconsistencies in hearing test finding

A

poor test/ ratest reliability on pure tons and inconsistent responses during pure tone test

85
Q

acoustic reflex

A

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

86
Q

special profile for children with functional loss

A

difficulty in school

hx of middle ear disorders

87
Q

2 general purposes of testing patient with functional losses

A

very nonorganic loss (catch’em)
establish the true hearing level (make them come clean)
some tests accomplish only one purposes others not purposes

88
Q

2 types of tests to assess for functional hearing loss

A

electrophysiological and behavioral

89
Q

electrophysiological test for functional hearing loss

A

ABR (auditory brainstem response)
OAE (otoacoustic emission)
AR (acoustic reflex)
SPAR (sensitivity prediction from the acoustic reflex)

90
Q

behavioral test for functional hearing

A 
yes/no method (children) 
counting the tones 
stenger test 
defiler-stewart
lombard 
DAF (delayed auditory feedback )
VIST (vary intensity story test ) 
swinging story test
91
Q

ABR testing

A

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

92
Q

ABR testing protocols

A

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

93
Q

ABR one electrobe on earlobe or mastoid

A

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

94
Q

ABR signal typically click stimulus

A

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

95
Q

ABR testing tone pips can be used in place of clicks

A

AKA tone bursts
Stimulus must have a rapid rise time to generate a response
Will give some frequency specific info

96
Q

ABR testing yields

A

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

97
Q

Wave location

A

Waves 1&2- CNVIII
Waves 3&4- pons
Waves 5- midbrain
Waves 6&7- undetermined

98
Q

ABR wave 5

A

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

99
Q

Otoacoustic emission

A

Small sounds produced by the normal cochlea

Can give and indication is the status of the cochlea and consequently of hearing

An electrophysiological measure

100
Q

oAE requires

A

Remain still
Allow probe to stay in place
Essentially quiet

101
Q

oAE to occur and be measured

A

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

102
Q

The primar OAE testing

A

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

103
Q

Acoustic reflex

A

Reflexive contraction of the stapedius muscle occurring in the presence of a loud sound

Normal 85 db spl

Not that reliable

104
Q

SPAR sensitivity prediction from the acoustic reflex

A

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

105
Q

Spar cont

A

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

aural rehab (1 decks)

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