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CMED 312 ENT Module > Trans 29 Assessment of Hearing > Flashcards

Trans 29 Assessment of Hearing Flashcards

1
Q

the distance between crest is ?

A

wavelength

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2
Q

we measure wavelength in? what unit?

A

frequency; hertz

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3
Q

is the height of the crest or the depth of the trough. This corresponds to the pressure measured in decibels. That pressure in layman’s term is called the loudness. How loud is sound.

A

amplitude

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4
Q

a unit used to express the ratio of two values of a physical quantity, often power or intensity.

A

decibels

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5
Q

Smallest audible sound in the decibel scale?

A

0db

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6
Q

Humans can hear what hertz

A

20 to 20,000 hz

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7
Q

How does the sound travel in the ear

A

Tympanic membrane → ossicles → oral window → inner ear

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8
Q

trace the ascending auditory pathway

A

EColi MA

Eigth cranial nerve > Cochlear nucleus > olivary nucleus > Lateral Lemniscus > inferior colliculus >MGB > Auditory cortex

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9
Q

Most commonly used tuning fork has a frequency of

A

512 Hz.

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10
Q
  • Sounds delivered to the ear via AC will be attenuated
  • If the sound is delivered to the ear via BC, bypassing the OE & ME, then the sound will be heard normally assuming there is no disorder

what hearing loss?

A

Conductive

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11
Q

• Sounds delivered to the ear via BC will be attenuated

what hearing loss?

A

SNHL

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12
Q

Findings in weber in normal, CHL, SNHL?

A

Normal hearing person: Sound is heard equally in both ears.
• Conductive hearing loss (CHL): Lateralized to worse ear.
• Sens

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13
Q

What test?

  • AC is compared with BC.
  • Vibrating tuning fork is places on patient’s mastoid and when he stops hearing, it is placed erect in line with the EAC, about 2cm from the orifice.
  • If he still hears AC is more than BC. It is called positive when or those having sensorineural deafness.
A

RINNE

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14
Q

Negative Rinne (BC>AC) is seen in

A

Conductive deafness

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15
Q

3 instances when there is negative rinne?

A
  • Patient has no hearing in test ear.
  • BC stimulus may be perceived by contralateral ear.
  • No hearing by AC the result is labeled is Rinne negative.
  • This mistaken impression of function in a non-functioning ear is called false negative Rinne test.
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16
Q

What test?

  • Compares the bone conduction of patient with that of a normal hearing person (examiner).
  • Tuning fork is placed on the patient’s mastoid with the meatus blocked and when the patient no longer hears it, it is placed on the normal hearing person’s mastoid.
A

MODIFIED SCHWABACH TEST

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17
Q

FINDINGS IN SCHWABACH IN

Conductive, SNHL and Normal people?

A
  • Conductive hearing loss + Normal hearing person: Patient and examiner hear the fork for the same duration
  • Sensorineural hearing loss: Patient hears the fork for a shorter duration.
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18
Q
  • Test of BC and examines the effect of occlusion of ear canal on hearing.
  • Vibrating tuning fork is placed on the mastoid while the examiner alternately closes and opens the ear canal by pressing tragus inward.

what test?

A

BINGS

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19
Q

Bing positive? Bing negative?

A
  • Normal person + SN hearing loss: Hears louder when ear canal is occluded and softer when canal is open (Bing +)
  • Conductive hearing loss: No change appreciated (Bing -)
20
Q

We use pure tones. The px is in a sound proof booth and wearing earphones where the sound is delivered. There’s also an oscillator in the mastoid to test for the conductive mechanism. Ideally, the px should not be seeing the examiner because there might be visual cues.

what test?

A

Pure tone audiometry

21
Q

is an electronic device which produces pure tones, intensity of which can be increased or decreased in 5 dB steps.
• AC thresholds are measured for tones of 125, 250, 500, 1K, 2K, 4K, 8K Hz.
• BC thresholds are measures for tones of 250, 500, 1K, 2K, 4K Hz.
• It is charted in the form of a graph called the audiogram.

A

Audiometer

22
Q

what ear is tested first in PTA?

A

Better ear

23
Q

start at what hertz in PTA?

A

1000 Hz tone at a level above the threshold to allow easy identification of the tone. If the patient is suspected to be having a profound hearing loss then the testing should be started with 250Hz frequency. This is because of the fact that the individuals with profound hearing loss often have testable hearing only in the low frequency range.

24
Q

is defined as the faintest tone that can be heard 50% or more of the time, and is established after several threshold crossings.

A

Threshold

25
Q

If there is a difference in AC threshold exceeding 40dB at any frequency what should be used?

A

Masking

26
Q

WHO Classification degree of hearing loss?

A 
1 MILD 26-40db
2 MOD 41-55 db
3 MOD SEVERE 56-70
4 SEVERE 71-90
5 PROFOUND  >91
27
Q

What color is right ear?

A

red

28
Q

NORMAL HEARING THRESHOLD FOR AIR AND BONE CONDUCTION?

A

25 db

29
Q

especially you have a notch at 4k Hz, it’s typical in

A

noise-induced hearing loss, yung mga people who exposed in ships, and gunshot wounds bumagsak sa 4k Hz.

30
Q

In this one, both thresholds to the bone and air is bagsak (below 25), so if you have a 10dB gap between the air and bone, there will be a conductive problem. We term this as

A

Mixed hearing loss

31
Q

• Patient’s ability to hear and understand speech is measured.

A

Speech audiometry

32
Q

2 parameters studied in speech audiometry

A

o Speech Reception Threshold (SRT)

o Speech Discrimination Score (SDS)

33
Q

▪ Minimum intensity at which 50% of words are repeated correctly by the patient
▪ Set of spondee words is delivered to each ear.
▪ Intensity is varied in 5dB steps till half of them are correctly heard

A

Speech Reception Threshold (SRT)

▪ Normally SRT is within 10dB of the average of pure tone threshold of 3 speech frequencies (500, 1K, 2K Hz)
▪ SRT better than pure tone average by more than 10dB suggests a functional hearing loss

34
Q

▪ Measure of patient’s ability to understand speech.
▪ List of phonetically balanced (PB) words (single syllable) is delivered to each ear separately at 30 to 40 dB above his SRT and % of words correctly heard is recorded.

A

Speech Discrimination Score (SDS)

▪ In normal persons and with CHL1 score of 90 to 100% can be obtained.
 For example, 10 words, the patient can repeat 9 out of 10, then that’s 90%

35
Q

The primary purpose of impedance audiometry is to determine the status of the

A

tympanic membrane and the middle ear.

36
Q

Type A vs Type Ad vs Type As in impedance audiometry

A

 Type A – normal, at certain pressure
 Type Ad – super compliance, dislodge
 Type As – stiff compliance

37
Q

Type A in impedance audiometry

A

normal tympanogram, sensorineural hearing loss where conductive mechanism is normal

38
Q

Type B in impedance audiometry

A

Flat curve, no change in compliance with pressure changes. seen in fluid in middle ear.

39
Q

Type C impedance audiometry

A

Maximum Compliance in negative pressure. seen in eustachian tube obstruction

40
Q

Type As in impedance audiometry?

A

Compliance is lower at or near ambient air pressure. seen in otosclerosis or malleus fixation.

41
Q

Type Ad in impedance audiometry?

A

High Compliance at or near ambient pressure. seen in ossicular discontinuity

42
Q

Acoustic reflex measurements/testing?

A

▪ Based on the fact that a loud sound 70-100dB above the threshold of hearing of a particular ear causes bilateral contraction of the stapedial muscles which can be detected on tympanogram.

43
Q

• Elicited by very sensitive microphone placed in external ear canal and analyzed by a computer.
\• Help to detect function of cochlea (OAEs produced only when outer hair cells are healthy)
• Do not disappear in VIII nerve pathology
 It tests the cochlear function not the nerve function
Commonly used for newborn screening

A

OTOACOUSTIC EMISSIONS (OAE)

44
Q
  • Elicit brainstem responses to auditory stimulation by clicks or tone bursts
  • Non-invasive technique to find integrity of central auditory pathways through the VIII nerve, pons, and midbrain.
  • Measures the hearing sensitivity in the range of 1KHz – 4 KHz.
A

Audiometry Brainstem Response aka BERA (brainstem evoked response audiometry)

45
Q

normal person how many waves in ABR/BERA?

A
  • Normal person – 7 waves are produced in the first 10ms
  • First, third, and fifth waves are most stable and are used in measurement.
  • The waves are studied for absolute latency, interwave latency (wave I and V) and the amplitude.
46
Q

Electrophysiological test which uses steady state pure tone signals (instead of transient signal of tone bursts in ABR)
• Steady state signals are modulated rapidly in amplitude and frequency and thus give a frequency specific audiogram
• Detect hearing losses > 80db
• Detect hearing sensitivity in severe to profoundly deaf infants
• Helps in selection of children for cochlear implantation at an early age

A

AUDITORY STEADY STATE RESPONSE (ASSR)

CMED 312 ENT Module (16 decks)

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