week 2

Question 1

Audiology sub specialties

Answer 1

• Adult hearing testing and hearing aid rehabilitation
• Diagnostic testing (including intraoperative monitoring)
• Paediatric hearing testing and hearing aid rehabilitation
• Tinnitus assessment and rehabilitation
• (Central) Auditory Processing Disorder (CAPD)
• Hearing implants
• Vestibular assessment & rehabilitation
• Hearing loss prevention
• Newborn hearing screening

Question 2

The eustachian tube

Answer 2

• Eustachian tube (ET) connects with nasopharynx and aerates the middle ear cavity & drains fluid (mucous)
• Blockages in ET cause middle ear infection (otitis media), build up of fluid, and mild to moderate hearing loss

Question 3

types of Audiometric Testing

Answer 3

• Case History
• Otoscopy
• Tympanometry
• Hearing testing
• Electro-Physiological tests

Question 4

otoscope visual landmarks of the ear

Answer 4

Otoscopy: 
Auricle/ Pinna
Canal
Tympanic membrane
- Landmarks - Colour

Question 5

Hearing testing types

Answer 5

Pure Tone Audiometry (Adult, Paediatric) 
Speech Audiometry (Adult, Paediatric)Screening

Question 6

Electro-Physiological test types

Answer 6

Oto-acoustic emission testing (OAE)
Brainstem evoked response audiometry (BERA)/ auditory brainstem response (ABR)
Electro-cochleography (ECochG or EcoG)

Question 7

Tympanometry: Testing the outer and middle ear

Answer 7

• Objective test of the middle ear mobility or movement in response to a change in calibrated pressure
• Tympanometry gives information about the volume of the ear canal, movement (compliance) of the ear drum and function of the middle ear system.
• Tympanometry also tells us if grommets are patent (not blocked) or if there may be a perforation (hole) in the ear drum.
• Tympanometry: Pressure testing
- Peak compliance: When the air pressure in the ear canal equals air pressure in the middle ear.

Question 8

Normal tympanometry results: In search of the Type A tympanogram

Answer 8

• Compliance: 0.3 – 2.6cm3
• Canal volume: 0.5 – 2.0ml
• Middle ear pressure: -150 - +150daPa

Question 9

Interpreting tympanograms Abnormal tympanometry results

Answer 9

• Type B: there is no peak, usually means middle ear effusion
• Type C: negative middle ear pressure, consistent with eustachian tube dysfunction
• Type Ad: (Deep) Hypermobile system
• Type As: (Shallow) Hypomobile system

Question 10

Audiograms: hearing thresholds

Answer 10

Minimal hearing loss 0-20 dB.
Mild hearing loss 20–40 dB. 
Moderate degree hearing loss 40–70 dB.
Severe hearing loss  70–90 dB.
Profound hearing loss 90–120 dB.

Question 11

Explaining the audiogram

Answer 11

an audiogram is a graph of hearing. Along the horizontal axis are the different tones of sound – from low to high pitched. Along this vertical axis is volume. The mark indicated the loudest the sound had to be before you detected it. Your right ear is marked with the circles.” BLUE to signify the LEFT RED to signify the RIGHT

Question 12

interpreting audiograms

Answer 12

Symmetrical : degree and configuration same in each ear Asymmetrical : degree and configuration different in each ear Bilateral: hearing loss in both ears
Unilateral : hearing loss in one ear
Progressive: Hearing loss has become worse over time Sudden: Hearing loss has happened quickly Fluctuating: Hearing loss that changes over tzime Stable: Hearing loss remains the same over time

Question 13

Incidence of Sensorineural hearing loss in childhood

Answer 13

> Infancy
- 1 per 1,000 live births
- No risk factor is established in ~40% of children with diagnoses
School-aged children
- 9 per 1,000 with disabling loss.
- 1 in 25, if mild degree of loss included.

Question 14

cause of Sensorineural hearing loss in childhood

Answer 14

• Genetic transmission= ~50% of cases.
• 70-80%autosomal recessive gene (i.e., hearing parents) in non- syndromic cases. Remainder follow complex inheritance patterns
• 30% syndrome-related.
  > Over 400 syndromes associated with hearing loss

Question 15

syndromes with Sensorineural hearing loss in childhood

Answer 15

Syndromes with HI (Jones, 2006)

• Waardenburg: Present in 1.4% of congenitally deaf children.
• Usher: Deafness present in all types, progressive loss associated with Type III.
• Goldenhar (hemifacial macrosomia, oculo- auriculo-vertebral syndrome). Microtia with variable deafness (often unilateral).
• Down syndreome: Hearing loss all types (66%) ME fluid accumulation (60-80%

Question 16

environmental causes of prenatal Sensorineural hearing loss

Answer 16

> Maternal infections in the first trimester.

• Congenital rubella syndrome: hearing loss, microcephaly, IUGR, meningoencephalitis (Caserta, 2015)
• Congenital syphilis: hearing loss due to abnormalities of otic capsule and cochlea. (Arnold and Ford-Jones, 2000)
• Cytomegalovirus: varying degrees of hearing loss; antiviral treatment associated with improved hearing in some cases.
• Foetal alcohol syndrome and other use of ototoxic agents.

Question 17

environmental causes of perinatal Sensorineural hearing loss

Answer 17

• Perinatal trauma (e.g., forceps damage), infection or anoxia
• Jaundice
• Low birth weight (Cristobal & Oghalai, 2008).
  > Preterm birth:
• Multiple factors, including low birth weight, longer periods of oxygen treatment, medications.
• Incidence between 0.7-1.5%. (Cristobal & Oghalai, 2008; Marlow, Hunt & Marlow, 2000)

Question 18

environmental causes of postnatal Sensorineural hearing loss

Answer 18

(relevant in adult hood also)
> Prolonged administration, and/or higher doses, of ototoxic drugs. 
>  Infectious diseases: 
- Meningitis
- Mumps
- Measles 
- Encephalitis

Question 19

Sensorineural hearing loss Intervention.

Answer 19

•	Family counselling
-Information-sharing 
-Advocacy 
•	Provision of amplification device
- Appropriate to nature and extent of hearing loss 
•	Selection of appropriate assistive technologies 
•	Communication - habilitation 
- Speech perception training 
- Language development 
- Communication modality 
- Educational approach

Question 20

types of amplification

Answer 20

ling test