Unit 2 Flashcards
1
Q
What is speech audiometry testing?
A
The presentation of standardized samples of speech through a calibrated system in attempt to quantify the patients ability to perceive complex information at threshold and supra threshold levels (ability to understand speech a different levels)
2
Q
Detection
A
The level at which one becomes aware of the presence of speech
3
Q
Discrimination
A
The level at which one is able to distinguish between individual speech stimuli
4
Q
Identification
A
The level at which one is able to label what has been heard
5
Q
What are the 2 parts of identification?
A
Reception and recognition
6
Q
Reception
A
Threshold measure: focus is on assessing audibility not vocab
7
Q
Recognition
A
Supra-threshold measure: focus is on intelligibility
8
Q
Why do we do speech audiometry testing?
A
Communication is essential to life, high face validity (valid measure of real world task), rehabilitation( test before and after treatment), cross check for pure ton measure, differential diagnosis (HL differences contribute to different speech recognitions scores)
9
Q
What are the types of speech perception tests?
A
Speech detection/awareness thresholds (SDT/SAT), speech reception thresholds (SRT), Speech recognition in quiet, speech recognition in noise
10
Q
Purpose of SDT
A
To determine the lowest level that the patient can just detect the presence of speech 50% of the time
11
Q
Stimuli of SDT
A
Spondaic words
12
Q
Who do you test with SDT?
A
Children who don’t have large vocabulary and those with severe hearing losses
13
Q
What are spondaic words
A
2 syllable words where both syllables are stressed (2 monosyllable words put together)
14
Q
Examples of spondaic words
A
Baseball, hotdog, airplane, birthday, toothbrush, sunshine
15
Q
Procedure for SDT
A
Patient instructed to listen for a word presented at a level above threshold, if response is given the level decreases 10 dB, if response occurs level is increased 5 dB, this continues until the patient response half the time and you record the threshold for speech detection
16
Q
Is it hard or easy to determine the presence of HL on the basis of SDT?
A
Yes
17
Q
What is the purpose of SRT?
A
To determine the lowest level at which the patient can perceive (repeat) words with 50% accuracy
18
Q
What is the stimuli of SRT?
A
Spondaic words
19
Q
What is the procedure for SRT?
A
The patient listens and repeats a word presented at a level above threshold, if if response is correct level decreased 10 dB, is response s incorrect the level is increased 5 dB, this continues until the patient responses correctly half the time so it is the patients threshold for speech perception
20
Q
What is the interpretation of SRT involving PTA?
A
SRT should be within 5 dB of patients pure tone average
21
Q
PTA
A
Pure tone average (DBat 500, 1000, and 2000 divided by 3)
22
Q
If there is a steep sloping loss where should the SRT be>
A
Within 5 dB of the best hearing threshold
23
Q
What is the purpose of WRS (quiet)?
A
The determine how well a patient perceives speech at levels experience in day-to-day communication
23
Q
Can you determine the presence of a HL on the basis of SRT alone?
A
No
24
What is the stimuli of WRS (quiet)?
Words or sentences (phonetically balanced lists comprised of phonemes in the frequency with which they generally occur in conversational speech)
25
Procedure of WRS (quiet)?
The patient repeats each word or sentence presented above threshold, the percentage of words correctly repeated by the patient is recorded, performance for one or more presentation levels can be determined by descriptors of excellent, good, fair, poor, and very poor
26
Expectations for WRS (quiet)
At comfortable listening levels most patients should do well, these tests are very sensitive to pathologies that disrupt the integrity of the acoustic signal (something is going on past the inner ear)
27
Performance-Intensity function testing for normal hearing?
The scores get better and the sound singal increases
28
Performance-Intensity function testing for cochlear problem?
Performance increases to some maximum and remains there at higher presentation levels - still below normal
29
Performance-Intensity function testing for patient w neural disorders/rollover?
Rollover occurs when performance may decrease after a maximum (turn up volume) is reached
30
What the 2 effects of HL on speech intelligability
Audibility and distortion
31
Audibility
Sounds are quieter than they should be. Any time of hearing loss will cause this problem
32
Distortion
There is a static noise accompanying sound. Accompanies sensorineural hearing loss
33
Consonants determine
Clarity of speech (high pitch)
34
Vowels determine
Loudness/power of speech (low pitch)
35
High Frequency Sloping Configuration
can hear vowels and not consonants
36
Low Frequency Rising Configuration
can hear consonants by not vowels as well
37
Is outoacoustic emission objective or subjective?
Objective
38
What are we measuring with otoacoustic emission?
We are measuring the low-level sound that is generated by the cochlea
39
How do we measure and otoacoustic emission?
Place a sensitive microphone in the ear canal
40
What are the types of autoacousic emission?
Spontaneous & Evoked
41
Do we need an active cochlea for autoacousic emissions?
Yes
42
What are the types of evoked emissions?
Transient Evoked and Distortion Product
43
What is the generator of sound in autoacoustic emmission?
Outer hair cells
44
Transient Evoked
Short Stimulus
45
Distortion Products
Played 2 tones different pitches and played together to make a 3rd sound
46
What are the 2 components that the signal needs to have?
Forward Transmission, Backward Transmission
47
Forward Transmission
The signal proceeds through the auditory system toward the brain in an efficient manner
48
Backward Transmission
When the signal reaches the cochlea, the active process generated by the outer hair cells cause a ripple that moves backward along the traveling wave
49
Where does the ripple go when it is transmitted back?
Through the ossicular chain in the middle ear and then converted to an acoustic signal by the TM
50
With a louder click will the emission be bigger?
Yes
51
What protein helps activate the OHC by expanding and contracting?
Prestin
52
What is the acoustic signal/emission that is backwards trasmitted?
0 to 20 db
53
What is the technology used to detect the backwards OAE in the ear canal?
The probe assemble is in the ear canal and contains a loudspeaker (tone generator) and a microphone
54
What does the microphone measure?
The low level acoustic emissions coming back from the cochlea and routes them to a computer for signal averaging
55
Transient OAE
OAE's that use a click stimulus to stimulate a wide range of frequencies along the basilar membrane
56
How long to transient OAE's occur?
4 msec after the onset of the stimulus and last about 10 msec
57
What are the frequencies presented for transient OAE's?
1000 to 5000 Hz
58
Where are transient OAE's absent?
Thresholds >30 dBHL (If greater than 30 bd then we know there are some OHC damage)
59
Distortion Product OAE
Evoked by presenting 2 tones simultaneously that interact on BM to produce a third tone
60
What is the formula for Distortion OAE
2F1-F2
61
What are the frequencies presented for distortion OAE's?
1000 to 8000 Hz
62
Where are distortion OAE's absent?
>40 dB
63
What are OAE's best use for?
Screening tool and part of the diagnostic test battery such as new born hearing screening, difficult to test patients, and suspect of functional HL. It is also good for monitoring changes in cochlear function such as otoxicity, progressive HL, and noise exposure
64
What is the limitation of OAE?
Won't give you an actual threshold because you only know that thresholds are better than 30 or 40 dbhl for specific regions
65
If there is an absent OAE what is the problem?
ME or OHC problem (use tymp to see if ME is working- type a ohc problem and type b middle ear problem)
66
Is the elecrophysicolocial assessment an objective test?
Yes
67
What is electrophysiologic assessment?
Recording of electrical signals of cells
68
What are auditory evoked potentials?
Waveforms that arise from synchronous electrical activity of neurons is various parts of the auditory nervous system
69
Does electrical activity imply hearing?
No
70
Auditory evoked potentials are measure of the amount of ___?
Electrical activity as a function of time
71
What is the set up of electrophysiologic assessment?
Electrodes are placed on the patients skull and a reciever is seated in the ear canal
72
What is the procedure of electrophysiologic assessment?
A series of brief tones, clicks, or other sound presented. the amplitude of the electrical activity that occurs after each stimulus is recorded at each electrode
73
What are the final results of electrophysiologic assessment?
The resulting wageform (amplitude as a function of time) is typically examined in epochs
74
Epochs
Time periods
75
0-1.5 ms
Electrocochleography
76
1.5 - 10 ms
Auditory brainstem response
77
10-50 ms
Middle latency response
78
50+ ms
late latency response
79
In the clinic what is the most common evoked potential used?
Auditory Brainstem response (ABR)
80
Where does the ABR originate?
8th nerve (cranial auditory nerve) to inferior colliculus
81
What is the generator of wave 1?
Auditory Nerve
82
What is the generator of wave 2?
Cochlear Nucleus
83
What is the generator of wave 3?
Superior Olivary Complex
84
What is the generator of wave 4?
Lateral Lemniscus
85
What is the generator of wave 5?
Inferior colliculus
86
What are the diagnostic implications?
Can make inferences about hearing and sight of lesion and used often for screenings and when the pathology beyond the cochlea is expected
87
What are the 2 ways we diagnostically use ABR?
Neurodiagnosic and Treshold
88
Neurodiognositc ABR
Looking at intergrety of the neyral pathways
89
Threshold ABR
Looking to estimate hearing threshold
90
How is the ABR waveform evaluated?
Amplitude and latency of the individual peaks
91
How is amplitude related to the peaks?
Directly related to the level of the stimulus because it increases as the level increases
92
How is latency related to the peaks?
Inversely related to the level of the stimulus because as the stimulus level increases, latency decreases (loud moves fast and soft move slow)
93
If all dots are inside of the latency intensity function
Normal hearing
94
Wave 1 normative data
1.88 msec
95
Wave 3 normative data
4.15 msec
96
Wave 5 normative data
6.02 msec
97
I-III
2.51 msec
98
III-V
2.31 msec
99
I-V
4.54 msec
100
How to know if there is a tumor?
If waves are pushed out further than their norms or if there are flat lines across the graph
101
How can we confirm and detect a tumor?
MRI
102
2 areas being tests with pediatrics
Screening and diagnostics
103
Does an SLP in school have to do hearing screenings too?
Yes
104
The purpose of diagnostic testing in children is to ...?
Determine the child's hearing sensitivity and auditory function, the etiology of hearing loss, and appropriate intervention
105
What are the intake procedures from a child?
Observe, Interview parents, Review medical history
106
How to observe child?
Look for nonverbal behavior, physical characteristic, motor skills, balance, and verbal communication
107
How to interview the parents?
Get their specific concerns and level of concern
108
How to review medical history?
Family history of HL, reoccurring illness, complications during pregnancy, results of newborn hearing screening, developmental milestones
109
Objective tests for children
(good for all ages) Acoustic Immittance, OAE, ABR
110
Can we make a conclusion with just objective tests?
No we need subjective tests as well
111
Subjective tests for children
Visual Reinforcement Audiometry and conditioned play audiometry
112
What ages are VRA for?
9-12 mo
113
What ages are CPA for?
2-4 yr
114
Tympanometry
For children 7 mo or older we use a 226 probe tone byt for infants younger than 7 mo we need to overcome resonance differences in infant ears we use a higher frequency probe tone of 660 or 1000 HZ
115
Acoustic Reflex
Can be measured in infants less than 7 mo and require 1000 HZ probe tone
116
OAE
The OAE in newborns is larger than in adults and this continues to increase for the first 2 months of life and then decreases throughout life we need to recognize different normative data
117
ABR
Conventional ABR are appropriate for 12 mo and older but adjustments must be made for younger children to accomodate for the developing auditory brainstem
118
When does the latency of wave V mature to the adult values?
12 mo
119
What is the prominent wave in infants?
Wave I
120
Visual Reinforcement Audiometry (VRA)
Examiner outside the room operating audiometer and another is inside the room directing the childs attention to the midline. A tone is played through a loudspeaker or ear phones to one ear. The child indicates they heard the sound by turning towards the sound. Reinforcement happens through a toy and encouragement/cheers when they look.
121
Considerations for VRA
The room must be free of distracters and the reinforcement must be appropriate (only when they are actually responding to the stimulus)
122
Conditioned Play Audiometry (CPA)
The child is conditioned to respond to a stimulus by playing a game. One examiner is outside the room and another is inside the room playing with the child. A tone is presented through a loudspeaker or earphone and the child indicates that they heard the sound by putting the ball into the bucket. They are reinforced through encouragement (stage 1 kids will play with the examiner and stage 2 kids will do it by themselves)
123
Considerations for CPA
Must include control trails and the more variety of games available the longer the child will play and may need to reinstrcct or pause to make sure they are actually responding to you
124
How many new borns will have a mild to profound degree of permanent HL
1-6 per 1000
125
If a infant recieves accurate diagnosis and intervention by 6 mo then....?
They will develop and perform as well as his or her peers in speech, language, cognition, socially, and emotionally
126
Goals 1-3-6
Screening all infants no later than 1 mo, diagnostic evaluation by 3 mo, appropriate intervention by 6 mo
127
When does localization develop?
6 mo
128
What are the health related factors we need to consider as we age?
Cardiovascular, bond densitiy & muscle tone, skin, eye sight, cognitive
129
What happens to cardiocascularly as we age?
Stiffening of blood vessels and arteries- potential for hypertension or other cardiovascular problems. Changes in blood flow and supply to the ear can damage and hearing loss in the inner ear
130
What happens to bone density and muscle tone as we age?
There is a loss of overall bone density and cartilage joints and a stiffening of ligaments and tendons so there is larger potential for injuries
131
What happens to our skin as we age?
Skin becomes less elastic and more fragile and there are less natural productions of oils that make the skin drier. The loss of fatty tissues looses the structure of the ear so if something is heavy and put on it, it will collapse. Also there is more cerumen glands.
132
What happens to our eyesight as we age?
Loss of near vision because the lens stiffness. There is also a need for more light and there is a change in color perception.
133
What happens cognitively as we age?
There are changes in attention, memory, executive cognitive function, language, and visuospatial abilities, and overall sensory and processing speech is declining
134
consider cardiovascular into our practice?
Be more concerned in monitoring and have an accessible office. Speak louder and turn things up
135
consider bone density and muscle tone into our practice?
Have railing and support systems in the office space. Build ramps and have markers and potentially modify the hand raising process.
136
consider skin into our practice?
Be careful with what you place over the ears and do not use headphones
137
consider eyesight into our practice?
Make the room brighter and avoid a dim facility. Have big written material and make hearing aids bigger.
138
consider cognitive into our practice?
Slow down and have clear speech. talk louder and have written explanations following the visits
139
What are the 2 main components of the balance system?
Sensory & Motor
140
Sensory componant
What the body tells us about our surroundings
141
Motor componant
What we do to keep our body balanced
142
What makes up the sensory component?
Eye sight, vestibular system, somatosensory/proprioception
143
What makes up the motor component?
Muscle tone/flexibility, reaction time
144
Issues with all or any sensory, motor, or other systems result in ____
balance disorder or dizziness
145
What is your role with dizziness?
To work as a multidisciplinary team in identifying the cause and managing it
146
Dizziness
A range of sensation encompassing many of the feelings such as off balance, room spinning, unsteady, head spinning, faint, swimming, floating, not all there, weak, dissociation, woozy, lightheaded
147
Vertigo
Specific sub-type of dizziness feeling that the individual or their surroundings are moving (head and room spinning) which is associated with inner ear or nerve problems
148
What are the the A&P of balance disorders
Inner ear structure, brainstem, nerves, cerebellum
149
Semicircular canals
3 tubes of angular acceleration in appropriate plane
150
Utricle
linear acceleration of the horizontal plane
151
Saccule
linear acceleration of the vertical plane
152
Do the utricle and saccule have hair cells?
Yes
153
What happens to the hair cells in the SSC?
hair cells embedded in cupula and when you turn your head to the right the fluid will move to the left and go into the cupula which will bend and move sending the signal to the brain
154
What happens to the hair cells in the utricle and saccule?
hair cells are in a membrane that has heavy rocks so the rock will pull the membrane forward and back when you tilt your head in different directions
155
What happens with the hair cells if you have verdigo?
One of the sides is broken so it will send no info where the other side will be sent normal info so there is an output in balance so your brain thinks you are moving
156
What happens when auditory hair cells are at rest?
There is no signal or info being sent
157
What happens when the vestibular hair cells are at rest?
there is a steady amount of info being send on both sides to the brain
158
What nerve is the VIII?
Vestibular cochlear nerve
159
On the vestibular side of the nerve how many branches are there?
2
160
Superior branch
utricle, anterior ssc, horizonal ssc
161
Inferior branch
saccule, posterior ssc
162
What makes there be a potential issue in these branches?
If there is a bad signal to the superior or inferior branch we know there is damage
163
Vestibulo-Occular Reflex
Maintain stable gaze during head movement
164
Vestibulo-Spinal Reflex
Stay upright during movement (below head)
165
Vestibulo-Collic Reflex
Keep head upright during movement
166
Case History
History taking is crucial aspect in diagnostic process for vestibular system. Description of the sensation, time course of attacks, associated events, exacerbating factors
167
Videonystagmography
The golden standard in the diagnostic process for vestibular disorders focusing on the eye movements through oculomotor testing, positional testing, and caloric testing
168
Rotary Chair Testing
Testing will allow for evaluation of the peripheral vestibular system at multiple frequencies through sinusoidal harmonic acceleration, velocity step test, and test of the utricle
169
Vestibular Evoked Myogenic Potential Testing
Testing of the vestibular reflex pathway in response to a loud sound and measures the change in muscle activity in that is synchronized with a particular stimulus (electrodes and measuring change in muscle activity in that is synchronized with a particular stimulus)- test on eyes or neck
170
Computerized Dynamic Posturography
Provides an objective, repeatable, quantifiable measure of standing balance that isolates and quantifies the functional contribution of different sensory systems and mechanisms for integrating these sensory input for maintaining balance (static or dynamic conditions, response to disturbances, different sensory conditions)
