Unit 1 Flashcards
1
Q
What is the scope of practice for an audiologist?
A
Audiologists provide patient-centered care in the prevention, identification, diagnosis, and evidence-based intervention and treatment of hearing, balance, and other related disorders for people of all ages
2
Q
What are some important skills/traits audiologist should require?
A
Treatment services require audiologists to know existing and emerging technologies, intervention strategies, and interpersonal skills to counsel and guide individuals and their family members through the rehabilitative process
3
Q
Prevention
A
Hearing conservation- ex can use headphones/earplugs
4
Q
Identification
A
Newborn hearing screenings/school screening and fall risk assessment
5
Q
Diagnosis
A
Auditory and vestibular diagnostic batteries
6
Q
Intervention
A
Counseling/assistive strategies
7
Q
Treatment
A
Hearing aids/cochlear implants/auditory & vestibular rehabilitation
8
Q
What are some diverse practice locations for audiologists?
A
Private practice, ENT, schools, hospital, university clinic, VA hospitals
9
Q
Issues of hearing aids
A
They are expensive and are often not covered by insurance
10
Q
Issues with many types of hearing loss being caused by genetic mutations
A
Gene therapy treatments can prevent and cure some forms of hearing loss
11
Q
Issues of sensory cells in the inner ear not being able to regenerate
A
Drug therapies that can promote the regeneration or growth of new hair cells
12
Q
What is sound?
A
A vibration that propagates as a wave through a medium
13
Q
Long WL
A
Low sound
14
Q
Short WL
A
High sound
15
Q
What differentiates sound
A
Frequency/pitch & amplitude
16
Q
Big
A
Low pitch
17
Q
Small
A
High pitch
18
Q
Amplitude
A
Loud vs soft sound (the amount of energy put into an object)
19
Q
Sensory systems
A
Hearing, touch, smell, sight, taste
20
Q
How does the brain process information?
A
Sensory neuron responds to input from the environment, input is transmitted to the brain as electrical signals, in the brain the signals are received in categories and will be sent to specific regions in the brain that will decipher each message, the many types of input will be integrated allowing to merge the information back together to be interpreted
21
Q
2 main functions of the auditory system
A
- detect & locate sound 2. decode sounds into meaningful language
22
Q
How does the auditory system function as a transducer?
A
It converts energy from mechanical energy from vibration to electrical/chemical energy inside the body
23
Q
Major structures in the auditory system
A
Outer ear, middle ear, inner ear, auditory nerve, auditory brainstem, auditory cortex
24
Q
What is the function of the outer ear?
A
To gather, filter, and direct sound toward the middle ear. It is able to boost/amplify sound nad also differentiate where sound is coming from
25
Potential causes of HL in the outer ear?
Puffy ear, cauliflower ear, birth defect, born without pinna, something covering the ear canal, etc
26
What is the function of the middle ear?
To transmit sound to the inner ear. It is able to boost sound energy the bones vibrate the oval window
27
What is the HZ of the max boost of the middle ear?
1000-2000 HZ
28
Potential causes of HL in the middle ear?
Obstructions (ear wax), swimmers ear, ruptured ear drum (hole), structural damage of bones, ear infection, tumors, stiff bones
29
What is the function of the Inner ear?
It is the sensory organ for balance and sensory organ for hearing
30
Sensory organ for hearing
Represent information about incoming sound and transmit it to the brain
31
Sensory organ for balance
Represent information about motion and where my head/body is in space and transmit it to the brain
32
Potential causes of HL disorders in the inner ear?
Damaged or lost hair cells, no cochlea,
33
What is the function of the auditory nerve, brainstem, auditory cortex?
To conduct, refine, integrate, and process information
34
Potential causes of HL disorders in the auditory nerve, brainstem, and cortex?
Nerve damage, brain tumors, parkinson's disease
35
What is hearing loss?
Damage to the hearing structures
36
What is the audiometric "standard battery" order?
case history, otoscopic inspection, pure tone audiometry (AC and BC), immittance audiometry, speech audiometry
37
What are some additional and specialized tests?
otoacoustic emissions, auditory evoked potentials, tinnitus assessment, auditory processing assessments, balance assessments
38
Case history
A case history is a record of a person's history, environment, and relevant details. (gathering information and building rapport)
39
Case history serve what purposes?
diagnostic, treatments, rapport, and counseling purposes
40
FDA red flags
visible deformity of the ear, active drainage, rapid progressive hearing loss, dizziness, unilateral hearing loss, audiometric air bone gap greater than 15 at 500 1000 and 2000 Hz, foreign body in the ear canal, pain or discomfort in the ear
41
Why are the FDA red flags important to identity early?
Signs and symptoms could be associated with something serious like tumors
42
Otoscope
A scope that allows for visual examination of the ear cana; and the tympanic membrane
43
Configuration of the otoscope
handle with battery, light source, magnification, speculum, pneumatic system
44
Basic version of the otoscope
Some magnification
45
Pneumatic version of the otoscope
Adds puff of air into the ear to see if bones of ME are moving
46
Video version of the otoscope
Continuous video feed of ear canal
47
Otomicroscopy version of the otoscope
Operation microscope used for surgery and operation because it gives the best view of the TM but requires a sedated patient
48
Benefits of otoscope
Able to identify gross abnormalities of the outer or middle ear
49
Limitations of otoscope
Subtle lesions of the TM or ME are difficult to detect (perforations and clear fluid), interpreting pneumatic results is hard because there is different varability in pressure used
50
Proper technique to use the otoscope
Hold sidewards, anchor hand against patients head, patients head should be vertical, pull ear up and back, insert and position otoscope before moving into view it
51
What are we looking for through the otoscope?
How is the general condition of the ear canal (waxy. red, etc), is the appearance of the TM grey, look to see if there is a cone of light and umbo on the TM
52
Y axis of audiogram
DBHL (-10 to 110)
53
X axis of audiogram
Frequency (125 to 8000)
54
Is DBHL a normal/standardized scale?
Yes
55
Where is the biggest boost from the ME?
1000 Hz
56
What frequency are humans most sensitive to?
1000-4000 Hz
57
What are we testing w DBHL?
Trying to find the softest level that someone can hear (threshold)
58
If levels need to be turned up louder what does that mean?
You have worse hearing than the normal person
59
Speech in DBHL
30-60 DBHL
60
Vowels in frequency & DBHL
lower frequency and louder (more DBHL)
61
Consonants in frequency & DBHL
higher frequency and softer (lower DBHL)
62
Consonants effect
the clarity
63
Vowels effect
the loudness
64
More hearing loss in high pitch
struggle to hear consonants so they have less clarity
65
More hearing loss in low pitch
struggle to hear in general
66
X
Left unmasked air conduction
67
O
Right unmasked air conduction
68
Square
Left masked air conduction
69
Triangle
Right masked air conduction
70
>
Left unmasked bone conduction
71
<
Right unmasked bone conduction
72
Bracket to the left
Left masked bone conduction
73
Bracket to the right
Right masked bone conduction
74
Square w lines
Sound Field
75
Adding arrow
no response
76
Blue
left ear
77
Red
right ear
78
What things are we evaluating in a hearing test?
Degree of HL, type of HL, and configuration of HL
79
Above the line
Can't hear
80
Below the line
Can hear
81
Normal
-10-15
82
Slight
15-25
83
Mild
25-40
84
Moderate
40-55
85
Moderatley severe
55-70
86
Severe
70-90
87
Profound
90-110
88
Problem Conductive HL
outer or middle ear
89
Conductive HL
When the AC is outside of normal and the bone conduction is within normal (air bone gap)
90
Problem Sensorineural HL
inner ear
91
Problem Mixed HL
outer or middle AND inner ear
92
Sensorineural HL
When the air conduction is outside of normal and the bone conduction is outside of normal (AC=BC)
93
Mixed HL
Air conduction is outside of normal and bone conduction is outside of normal but there is an air bone gap
94
Flat
Flat line that changes less than 5-10 db
95
Rising
Start to end are more than 10 db apart (going up)
95
Sloping
Start to end are more than 10 db apart (going down)
96
Cookie-Bite
Hearing loss in the middle of the audiogram (mostly due to genetic hearing loss)
96
Notched
at 4000 HZ the db gets extremely worse due to noise exposure/damage (in the cochlea) and then it returns to normal
96
Fragmentary
There is a lot of no response so we only measure part of the line
97
Pure tone audiometry
Playing sounds to something to figure out if they can hear it
98
Purpose of pure tone audiometry
1. Quantify the listeners hearing levels at specific frequencies 2. Narrow the sight of the lesion (OE, ME, IE)
99
What is pure tone audiometry measure with?
Thresholds
100
What is a threshold?
The lowest level of a sound at which 3 responses are first obtained that can be heard by the individual
101
Is a threshold statistical concept or a direct property of a system?
Statistical concept
102
What are some things that thresholds do not tell us?
It does not tell us about the quality of the signal that the patient heard and it does not tell us about the patients ability to understand signals head at supra-threshold levels like speech
103
Can threshold change based on the day?
Yes
104
What are the ways that we measure threshold?
Air conduction and bone conduction
105
Air conduction
Tones are transmitted through the air from a transducer into the ear canal (headphones)
106
Bone conduction
Tones are transmitted through the bones of the skill to the cochlea. A small bone oscillator is placed on the skull behind the pinna
107
Needs for audiometric testing
A quiet place with special walls to dampen the outside noise
108
Audiometer
Controls the stimuli presented during audiometric testing (it measures the level, duration, frequency, type, ear separately, number of stimuli)
109
Types of transducerts
Supra-aural: fit over the pinna & inserts: fit in the ear canal
110
Benefits of inserts
More comfortable, prevent the ear canal from collapsing under the weight of the heavier supra-aural earphones, provide better attenuation of ambient noise and increase inter-aural attenuation
111
Cons of inserts
Cannot use inserts if patients do not have an ear canal & inserts are more costly than supra-aural
112
What frequencies do we test for air conduction?
250-8000 HZ
113
What is the frequency order when we test for air conduction?
1000, 2000, 4000, 8000, 500, 250
114
Why do we start with 1000 HZ
Because it is generally easy to hear
115
Why should we familiarize the patient before the testing process?
The listener should be familiarized with the task prior to the threshold determination by presenting a signal of sufficient intensity to evoke a sharp and clear response. This assures the examiner that the listener understands and can perform the task
116
What is the name of how we measure threshold?
Modified Hughson-Westlake Technique
117
What is the Modified Hughson-Westlake Technique?
Consists of a familiarization phase, a descending phase, and a threshold search phase (down 10, up 5)
118
Down 10
Response (hear it)
119
Up 5
No response (don't hear)
120
How do we approach the threshold?
It is an ascending approach to the threshold (we only mark the response when working our way up to a level)
121
Steps to testing threshold search phase?
1. Present tone 2. Pause between presentation 3. Adjust presentation level 4. Record threshold
122
Types of tones
Pulsed and continuous
123
How long should the tone duration be?
1-2 seconds
124
Why do we pause between presentations of the tone?
We want it to vary so people don't guess even when they didn't hear the sound
125
When do we stop recording threshold?
When 3 responses have occurred at one spot
126
What information does AC testing give me?
It goes through the OE, ME, and IE so helps us understand if there is something going on
127
Can I determine where a problem is (OE, ME, IE) with air conduction testing alone?
No
128
What does the bone conduction signal bypass?
It bypasses the OE and ME and stimulates the cochlea directly (IE)
129
What are the 3 primary methods for bone conduction?
Distortion, inertia, osseotympanic
130
What is distortion?
The bones of the skull (including the temporal bones) are set in motion. This motion generates a traveling wave within both cochlea (it stimulates both ears at the same time)
131
Where is the cochlea embedded?
In the temporal bone & is filled with fluid so the vibrations should cause the fluid to move
132
What is inertia?
The vibration of the bones in the skull cause the footplate of the stapes to move in and out of the oval window. This adds to the traveling wave generated in each cochlea. (the bones in the ear are sending a bit of information into the cochlea as well)
133
What is osseotypmpanic?
Vibration of the bones in the skill also vibrate the column of air in the ear canal. This then moves the TM which is transmitted to the cochlear through the states and adds to the traveling wave. (air molecules in ear canal are vibrated as the cartilage moves and vibrates the TM)
134
Why is the osseotymmpanic sensation greater if you cover your ears?
Because more energy cannot escape and it can only go in towards the TM (so your voice sounds louder when you plug your ears)
135
If air conduction thresholds are worse than bone conduction thresholds (ABG)...?
There is a conductive component (OE or ME problem)
136
Where are the set up placements for bone conduction?
On the forehead or mastoid
137
Advantage of forehead placement
Placement variability (is more stable)
138
Disadvantage of forehead placement
It takes more force and requires more power put in to stimulate
139
Advantage of mastoid placement
Max output is higher by 10-15 db (closer to the cochlea so needs less power to stimulate)
140
Disadvantage of mastoid placement
Placement variability (moves around and is less stable)
141
Bone conduction procedure
1. Place oscillator (should not be touching the ear or hair and should not be moving) 2. Same test procedure as AC (present first tone and go down 10 up 5 depending on if they hear or not) 3. limited test frequencies
142
What frequencies do we test for BC?
500-4000 HZ
143
Is test variability greater for AC or BC?
BC
144
What does the air-bone gap have to be to be considered significant?
at least 15db
145
Do we test AC or BC first?
AC
146
Should I leave the headphones in during BC testing or should I take them out?
Take them out because of we left them in it would make the BC threshold of low pitch better than it should be
147
What does immittance help us understand?
It helps us know if the conductive component of the HL is a pathology in the outer or the middle ear?
148
What is impedance?
The net opposition to the flow of energy created by resistance and reactance
149
Reactance
Mass (Xm) & stiffness (Xs)
150
If an object has more mass (massive system) what is the impedence?
There is greater impedance/opposition (needs more energy)
151
If there is a stiffer system what is the impedance?
There is greater impedance/opposition (needs more energy)
152
How is impedance measure?
We fine impedance by calculating admittance (which is the inverse)
153
What are the units for impedance?
Ohms
154
What are the units for admittance?
milli-mhos or mmhos
155
What is admittance?
The ease with which sound flows through a system (how much sound is being conducted)
156
What makes up admittance?
Conductance & susceptance (how we clinicallt measure admittance)
157
Conductance (G)
is the reciprocal of resistance
158
Susceptance
is the reciprocal of reactance
159
A system that offers low acoustic impedance also offers a correspondingly ____ acoustic admittance
high
160
A system that offers high acoustic impedance also offers a correspondingly ____ acoustic admittance
low
161
We we want high or low admittance?
high
162
We we want high or low impedance?
low
163
What effects stiffness & mass in the ME?
fluid, muscle tightness, arthritis of ME
164
What do we know if there is a low admittance?
That there is something that has mass or stiffness in the ear
165
How do we measure admittance?
We measure how much sound is reflected back after playing a sound into the ear (if there is lots of bouncing back it means that is is stiff & if not a lot of bouncing back we know everything is going into the ear properly)
166
What is the problem with immittance testing?
There is a large range of normal that can be reflected back (0.3-2.0)
167
What is the solution with immittance testing?
Take several measures and look at changes in compliance
168
Immittance subsets
1. Tympanometry (typanogram & physical volume test) 2. acoustic reflex
169
Instrumentation of tympanotry
Loudspeakers, microphone, manometer, earphone with second loudspeaker
170
What is the probe tone of the loudspeaker
226 HZ (low pitch)
171
Do we test one ear at a time with tympanotry?
Yes
172
Loudspeaker
Generates tone
173
Microphone
Sound travels back to it
174
Manometer
Varies the air pressure inside the ear canal
175
Earphone with second louspeaker
Used for acoustic reflex testing
176
What is the purpose of tympanometry?
To measure the mobility and compliance of the tympanic membrane (how well is our ear drum moving) - we can infer volume of the measurement space
177
How does tympanometry work?
The probe assembly creates and airtight seal at the opening of the ear canal, a loudspeaker presents a tone of 226 HZ, a pump reduces the air pressure in the canal below atmospheric pressure (0daPa) and then increases it above atmospheric pressure, a microphone finally measures the sound pressure level in the ear canal as the air pressure is changes
178
What pressure should we expect the ear to work the best?
0 daPa
179
What is the end result of tympanometry?
Acoustic admittance is measure & recorded as air pressure in the ear canal is changed from positive to negative, the results are then plotted o a graph
180
What is the tympanometry graph called?
Tympanogram
181
When there is lower pressure in the ear canal what happens?
You are taking air out of the ear canal, thus creating a lower pressure in the ear canal, your ear drum is pulled out towards the pinna which makes it stiff = we can expect a low admittance
182
When there is high pressure in the ear canal what happens?
You are putting air in to the ear canal, thus creating a higher pressure in the ear canal, your ear drum is pushed back towards the ME which makes it stiff = we can expect a low admittance
183
If you are on an airplane what do you expect to happen?
In an airplane there is less air around the environment, so there is more pressure in the ME, so the ear drum is pushed our towards the pinna and is made stiff
184
If you just landed after being on an airplane what do you expect to happen?
When you land the pressure has to equalize so there is more pressure outside the ear than inside, so the ear will be pushed back to equalize it
185
If there is a lot of sound reflected back to the microphone what do we expect?
There is a high impedance (heavy resistance to the flow of energy) and there is a low admittance
186
What are all the calculation you can make from a tympanogram?
Peak Ya, Peak Ytm, TPP, and TW
187
Peak Ya
The total acoustic admittance at the peak (includes the TM and the ear canal) - ml
188
At extreme high and low pressure levels is the acoustic admittance zero?
No, because the ear canal offers a small degree of acoustic admittance
189
Peak Ytm
The contribution of the tympanic membrane alone (admittance of just the TM)
190
What is Peak Ytm also referred to?
Compensated static acoustic admittance
191
How is Peak Ytm measured?
it is the Ya value at the peak minus the Ya value at either tail (measure from tail to peak and subtract those values by each other)
192
TPP
tympanometric peak pressure (daPA)
193
What is TPP?
The pressure at which Ya or Ytm is at its maximum value
194
TW
tympanometric width (daPa)
195
What is TW?
The width of the tympanogram at 1/2 the high of Ytm (peak to tail) - how wide the gap is (if it is really wide than something is not working correctly)
196
Vec
Ear canal volume (cm3)
197
What is Vec?
An acoustic estimate of the volume between the probe tip and the tympanic membrane
198
If there is a hole in your TM what is the Vec measurement going to be?
We would get a huge VEC value because it would be a measurement of both spaces available (ear canal and the middle ear because air is going through both of them)
199
If there is ear wax in you ear canal was is the Vec measurement going to be?
We would get a small VEC because there is not a lot of volume/space in between to measure
200
What is it called when we interpret tympanograms?
Jerger types
201
Type A (red)
Normal, Air pressure peak (tpp) is +50 to -150, admittance-0.3 to 1.4
202
As = green
Small peak (0.2)
203
Ad = blue
Big peak (2.0)
204
What does Ad tell us?
That the area is really loose and not stiff because it is admitting a lot of sound energy
205
What does As tell us?
The TM is sorta still and not letting a bunch of sound energy in (but it is not to significant of a problem)
206
Type B = flat
No air pressure peak (tpp), no admittance, diagnosis is that there is a middle ear obstruction, ear canal obstruction, or perforated TM (either nothing is going through or everything is going through)
207
How do we differentiate the diagnosis
With the ear canal volume
208
If the TM is perforated was is the ear canal volume?
large (because it measures the whole space)
209
If there is an ear canal obstruction what is the ear canal volume?
small (because only measures until the wall of wax)
210
If there is a middle ear obstruction what is the ear canal volume?
normal (because everything up to the TM is normal)
211
Type C
Air pressure peak is >50 or <-150, admittance is defined, diagnosis is that there is poor ME aeration (the pressure in the ME is bad - possibly because of eustachian tube disfunction)
212
Normative data for adult ear canal volume
0.6-1.5 ml
213
Normative data for adult peek pressure
-150 to +100 daPa
214
Normative data for adult admittance
0.3-1.4 ml
215
What kind of tympanogram is a conductive hearing loss?
Type B
216
If the ECV (ear canal volume) is 2.5 what is the problem?
Perforation of TM (type B tympanogram)
217
If a Peak Pressure is at -75 what is the problem?
It is normal
218
If the Peak Pressure is at -200 what is the problem?
type c (so poor ME aeration)
219
What is a reflex?
The process up to the brainstem and back down
220
What the 2 methods used to test immittance?
Typanometry & Acoustic reflex
221
What is the acoustic reflex?
A time-locked contraction of the stapedius muscle in response to an acoustic signal of sufficient intensity level and duration
222
Is the acoustic reflex bilateral?
Yes
223
What are the results of acoustic reflex?
Stiffening of the ossicular chain (which means admittance is low so sound is dampened as it goes into the ear)
224
Ipsilateral acoustic reflex testing route
ME--> Cochlea--> 8th nerve --> cochlear nucleus--> superior olivary complex--> 7th nerve (facial) --> stapedius muscle
225
How many times do we test the acoustic reflex total?
4
226
How many times do we test the acoustic reflex in each ear?
2 times in each ear (4 total)
227
What is ipsilateral testing?
Testing only the admittance in one ear
228
What is contralateral testing?
Testing the admittance in both ears (this includes where it crosses over to the other side of the brainstem)
229
With contralateral testing what are we measuring?
A continuous admittance value and a loud sound (so the ear is getting 2 sounds - playing loud sound to left ear and measuring response then playing loud sound to right ear and measuring response
230
Ipsilateral
A tone (activator) is presented in the ear while acoustic admittance is being measures (probe assembly) in the same ear
231
Contralateral
A tone (activator) is presented to one ear while acoustic admittance is being measure (probe assembly) in the other ear
232
If loud sound (activator) is being played in the left ear, what is the name of the reflex?
Left contralateral reflex
233
How do you name a reflex?
Always name by the ear receiving the tone
234
Acoustic reflex threshold
The level of the activator tone producing the smallest measurable change in acoustic admittance
235
On a graph how we do know the reflex happened?
If there is a large dip down in the graph, that means admittance decreased so the reflex happened (stiffened everything up)
236
Ipsilateral acoustic reflex testing route (right side)
Right side ME--> Right side cochlea--> Right side 8th nerve--> Right side cochlear nucleus--> Left side superior olivary complex--> Left side 7th nerve (facial) --> Left side stapedius muscle
237
Middle-Ear disorder
Patients with middle ear disorders (otitis media, perforated TM) will have absent reflexes for all measures involving that ear
238
Cochlear (bilateral) disorder
Patients with bilateral cochlear disorders >50 dbhl will have absents reflexes ipsilaterally and contralaterally in both ears
239
Cochlear (unilateral) disorder
Patients with unilateral cochlear disorders >50 bdhl will have absent reflexes ipsilaterally and contralaterally in the affected ear
240
Facial nerve disorders
Patients with a facial-nerve tumor will have conflicting acoustic reflexes in each ear
