Flashcards: Audiology Lecture 2

Age of patient, cause of the loss, severity of loss

Impairment refers to a structural abnormality, while disability refers to a functional limitation

Handicap refers to the inability to function at the same level as peers

It provides valuable information about the patient's concerns and reasons for seeking help

Self-perceived difficulty, disgruntled family member, teacher complaints

Pre/postnatal history, NICU stay, newborn hearing screening (NBHS), ear infections, family history, speech/language development, developmental milestones

It provides valuable information about any potential risk factors or complications that may have affected the child's hearing

a) It helps determine if there are any underlying medical conditions that may be related to the child's hearing or communication difficulties.

b) It helps establish a baseline for the child's overall health and well-being.

c) It allows the audiologist to make appropriate referrals to other healthcare professionals if necessary.

a) It helps determine if the child has any hearing difficulties or auditory processing issues.

b) It helps establish a baseline for the child's auditory abilities and sensitivity to sound.

c) It allows the audiologist to assess if there are any behavioral or emotional reactions to specific sounds.

a) It helps determine the child's level of physical activity and overall engagement in recreational activities.

b) It allows the audiologist to assess if there are any potential exposure to noise or activities that may impact the child's hearing.

c) It provides insight into the child's interests and hobbies, which may have an impact on their communication needs.

a) Are they single, married, or do they have small children?

b) Are there any specific communication challenges or difficulties in the home environment?

c) Are there any noise or environmental factors that may impact the individual's hearing or communication abilities at home?

a) It helps determine if the individual's hearing or communication difficulties are affecting their work performance or job responsibilities.

b) It provides insight into the communication demands and settings the individual encounters in their workplace.

c) It allows the audiologist to assess if there are any potential noise or occupational exposure risks that may impact the individual's hearing.

a) What hobbies or recreational activities does the individual engage in?

b) Are there any specific situations or environments where the individual struggles with hearing or communication?

c) Does the individual use any assistive listening devices or strategies during their extra activities?

a) It helps determine the duration and progression of the hearing or communication difficulties.

b) It provides a baseline for tracking any changes or improvements over time. c) It allows the audiologist to assess if there are any potential underlying causes or factors contributing to the problem.

a) It helps identify if there are any fluctuating or progressive components to the hearing loss.

b) It provides insight into the potential causes or triggers for the changes in hearing.

c) It allows the audiologist to determine if there are any specific patterns or factors influencing the variability in hearing.

a) It helps establish a baseline of their previous hearing assessment results and interventions.

b) It provides insight into the progression or changes in their hearing status over time.

c) It allows the audiologist to determine if any previous recommendations or interventions were implemented and their effectiveness.

a) It helps determine if the individual is already using amplification to address their hearing loss.

b) It provides information about their experience with hearing aids and any specific challenges they may have encountered.

c) It allows the audiologist to assess the effectiveness of the current hearing aids and if any adjustments or upgrades are needed.

a) It helps identify if there is a genetic predisposition to hearing loss or other related conditions.

b) It provides insight into potential environmental or lifestyle factors that may contribute to hearing difficulties.

c) It allows the audiologist to assess if other family members have sought treatment for hearing loss.

a) It helps determine if the hearing difficulties are specific to certain environments or situations.

b) It provides insight into the communication challenges the individual encounters in their daily life.

c) It allows the audiologist to assess if there are any specific factors or triggers that contribute to the difficulty.

a) It allows us to visualize the external ear canal and assess its condition.

b) It helps identify any abnormalities, such as wax buildup, foreign objects, or inflammation, in the ear canal.

c) It provides a view of the tympanic membrane (eardrum) and helps evaluate its integrity and appearance.

a) Wax or debris accumulation in the ear canal

b) Signs of infection or inflammation, such as redness or swelling

c) Presence of a foreign object in the ear canal

d) Condition and appearance of the tympanic membrane (eardrum)

a) Bracing ensures a steady hand and prevents accidental injury to the ear canal or tympanic membrane.

b) It helps maintain a clear view of the ear and improves the accuracy of the examination.

c) Bracing minimizes the risk of discomfort or pain for the patient during the procedure

Dispose of otoscope tips after each use to minimize the risk of cross-contamination.

0 daPa

a) The pressure in the ear canal is equal to the pressure in the middle ear.

b) The Eustachian tube is functioning properly, allowing for equalization of pressure.

c) It suggests normal middle ear function and proper Eustachian tube opening and closing.

a) To ensure accurate measurement of pressure in the ear canal.

b) To prevent any air leaks that could affect the results.

c) An airtight seal helps create a closed system for pressure measurement.

a) To differentiate between different sizes of probe tips.

b) To allow for easy identification and organization of probe tips.

c) Different colors may be used for different patients or for infection control purposes.

Probe assembly - The probe goes into the eardrum

transducer - to give the probe tone output

air pump - to change the pressure in the ear canal

microphone - to measure the sound that is reflected back from the ear drum

the mobility of the middle ear in response to a change in pressure.

+200 to -400 daPa.

The X-axis in tympanometry represents the air pressure, ranging from negative to positive values.

The Y-axis in tympanometry represents compliance, which is a measure of the middle ear's mobility.

Within normal limits, the compliance should fall between -150 and +150 daPa.

A compliance value less than -150 daPa indicates an issue with equalizing pressure on both sides of the eardrum.

Eustachian tube dysfunction and resolving otitis media can be associated with a compliance value less than -150 daPa.

A Type A tympanogram indicates a nice, normal response. The compliance is within the range of normal, and the pressure falls between -150 and +150 daPa.

A Type C tympanogram indicates that the compliance is normal, but the pressure is greater than -150 daPa, indicating negative pressure in the middle ear.

A Type B tympanogram indicates zero compliance, with no eardrum movement at all. This can be associated with conditions such as fluid or a perforation.

A Type B tympanogram can be associated with conditions such as fluid in the middle ear or a perforation of the eardrum.

A Type Ad tympanogram indicates that the pressure is normal, but the compliance is hypercompliant, meaning it is higher than the normal range.

A Type As tympanogram indicates that the pressure is normal, but the compliance is hypocompliant, meaning it is lower than the normal range.

The typical range of ear canal volume for adults is 0.6-1.5 cm3.

The typical range of ear canal volume for children is 0.4-1.0 cm3.

Factors such as earwax blockage or narrowing of the ear canal can result in a lower ear canal volume.

Factors such as inflammation or swelling of the ear canal, presence of a foreign object, or abnormal growths can lead to a higher ear canal volume.

An acoustic reflex is an involuntary response of the stapedius muscle in the middle ear to an external sound stimulus.

Measuring the acoustic reflex can provide information about the integrity of the auditory system and help in the diagnosis of certain hearing disorders.

The sound is delivered through the probe into the ear canal and reaches the tympanic membrane (TM). The sound stimulation then travels through the middle ear, cochlea, and eighth nerve to the brainstem. Specifically, it reaches the ventral cochlear nucleus and the superior olivary complex. From there, the signal is transmitted to the facial nerve (CN VII), which ultimately controls the movement of the stapedius muscle.

In the measurement of acoustic reflex thresholds, we are determining the lowest intensity level of sound required to elicit a contraction of the stapedial reflex.

The stapedial reflex, when activated, causes the stapedius muscle in the middle ear to contract. This contraction stiffens the ossicular chain and reduces the transmission of sound through the middle ear, protecting the inner ear from loud sounds.

The stapedial reflex is typically triggered by a loud sound. It contracts in response to intense acoustic stimulation, serving as a protective mechanism against potentially damaging sound levels.

This means that a loud sound presented in one ear can elicit a reflexive contraction in both ears. The contraction occurs on the same side (ipsilateral) as the ear where the sound stimulus is presented and also on the opposite side (contralateral).

The acoustic reflex threshold in normal ears typically falls between 65-95 dB HL (hearing level).

Conductive losses may result in either no response or a higher than normal threshold in the acoustic reflex test. The increased mass and impedance of the middle ear system in conductive losses make it more challenging to stimulate the stapedial reflex.

In cases of sensorineural hearing loss, the acoustic reflex may be elevated or absent. Due to the elevated thresholds in sensorineural loss, higher presentation levels are required to elicit the reflex response. If the thresholds are already elevated, the intensity limits of the measurement equipment may be reached before a response can be obtained.

Adults and individuals over the age of 3 typically use a 226Hz probe tone to obtain a tympanogram.

Pediatric patients under the age of 3 require a 1000Hz probe tone for obtaining a tympanogram.

The middle ear in young children is not fully developed, and the acoustic properties differ from those in adults. Therefore, a higher probe tone frequency (1000Hz) is used to better assess the middle ear function in pediatric patients.

An audiometer is used to generate pure tone signals for the purpose of conducting hearing tests and evaluations.

An audiometer typically has 2 channels.

The ability to send two different signals to each ear simultaneously. This allows for independent testing of each ear and enables binaural hearing assessments.

The stimulus options in an audiometer include pure tones, warbled tones, frequency modulated "FM" tones, speech signals, and the ability to connect external stimulus sources.

–Inserts

–Supra aural

–Bone oscillator

–Speakers

The routing options on an audiometer allow the operator to select whether the signal will be presented to the right ear, left ear, or both ears simultaneously. This allows for independent testing of each ear or binaural testing when necessary.

The attenuator dial on an audiometer is used to control and adjust the intensity or loudness of the signal that is being delivered to the patient. It allows the operator to increase or decrease the sound level according to the patient's responses or specific testing requirements.

The presentation button on an audiometer is used to introduce the signal or stimulus to the patient. When pressed, it initiates the delivery of the sound or tone to the earphones or speakers, allowing the patient to respond to the stimulus during the hearing test.

The frequency selection button on an audiometer is used to choose the specific frequency or pitch of the pure tone that will be presented to the patient during the hearing test. It allows the operator to select different frequencies to evaluate the patient's hearing sensitivity at various points across the audible frequency range.

A sound-treated booth.

It has double walls with double doors and sound-attenuating materials between the walls.

Lighting that does not buzz or hum.

They are equipped with sound attenuation.

To reduce reverberation and echo.

It is slightly elevated to reduce vibrations from the ground.

To enhance sound insulation and minimize external noise.

To determine the lowest threshold of hearing for the patient at different frequencies.

The softest level is the one detected 50% of the time by the patient.

The audiometer can change frequency from 250Hz to 8000Hz.

The dial allows for the adjustment of stimulus presentation, increasing or decreasing the intensity of the sound.

Pure tones, modulated tones, and pulsed tones can be used as stimulus options.

Audiologists can talk to patients through the headset connected to the audiometer.

Audiologists can hear patients using a talkback microphone connected to the audiometer.

To ensure they respond even if the sound is very faint.

No, they should respond even if the sound is very faint.

Suprathreshold.

Their hearing loss may be perceived as more severe than it actually is.

They can use hand raising, button pressing, or verbal responses.

1-2 seconds.

More than 2 seconds.

An intensity that is audible to the patient, typically 30 dB.

Increase the intensity to 50 dB.

Increase the intensity by 10 dB until the patient responds.

Clinically, we use 5 dB steps (e.g., 35, 40, 45 dB, etc.).

It involves a "down 10, up 5" procedure. The intensity is decreased by 10 dB after the patient responds and increased by 5 dB after the patient does not respond.

The goal is to obtain 2 out of 3 responses on the ascending search.

The intensity should be decreased by 10 dB and the tone should be presented again.

The intensity is increased by 5 dB to find the threshold.

The frequency range is usually from 250 Hz to 8000 Hz.

We start the testing at 1000 Hz.

The frequencies tested after 1000 Hz are 2000 Hz, 3000 Hz, 4000 Hz, 6000 Hz, and 8000 Hz.

Retesting at these frequencies helps to ensure accurate results and verify the patient's hearing thresholds.

The pure tone average is calculated by averaging the hearing thresholds at 500 Hz, 1000 Hz, and 2000 Hz.

1.Headphones/Insert earphones

2.Bone conductor

3.Speech

Bone conduction testing assesses the hearing thresholds by directly vibrating the skull and stimulating the cochlea, bypassing the outer and middle ear.

During bone conduction testing, a bone oscillator is placed on the patient's forehead or mastoid process behind the ear to deliver the vibrations to the skull. The vibrations travel through the skull bone and stimulate the cochlea, allowing the assessment of hearing thresholds.

Bone conduction testing typically covers frequencies ranging from 250 Hz to 4000 Hz.

Interaural attenuation refers to the reduction in sound energy when it crosses from one ear to the other. It typically ranges from 40 to 55 dB, depending on the type of transducer used.

nteraural attenuation is important because if there is a significant difference in hearing sensitivity between the ears that exceeds the interaural attenuation, the better ear may "hear" the sounds intended for the worse ear during testing.

Masking is the introduction of noise or other sounds to the better ear during testing to prevent it from responding to sounds presented to the worse ear. This allows for accurate evaluation of the threshold in the worse ear.

Masking noise is introduced into the better ear at a level high enough to "mask" or prevent it from responding to sounds, but not so loud that it crosses back over to the worse ear. The level of masking noise should not exceed the sum of the interaural attenuation and the best bone conduction score.

When the responses from each ear are different or asymmetric.

To remove the response of the better ear, which may be stimulated by the intense signal presented to the worse ear.

It means that the signal is intense enough to stimulate the better cochlea and produce a response from the better ear.

To obtain accurate threshold measurements for the worse ear without the interference of the better ear's response.

Within Normal Limits

25-40 dB HL

Difficulty hearing soft speech

40-55 dB HL

Hearing everyday speech, especially in complicated listening situations

55-70 dB HL

Difficulties hearing even very loud speech

70-90 dB HL

They can only hear if speech sounds are significantly amplified

90 dB HL and above

Individuals with profound hearing loss cannot understand speech at any intensity.

A flat hearing loss configuration refers to a pattern where there is no significant change in hearing thresholds across frequencies.

In a sloping hearing loss, the severity of the hearing loss increases as the frequencies get higher, resulting in a more significant loss at higher pitches.

In a rising hearing loss, the severity of the hearing loss decreases as the frequencies get higher, leading to better hearing ability at higher pitches.

A precipitous hearing loss is characterized by a sharp decline in hearing sensitivity, often resulting in a severe to profound level of hearing loss.

A cookie bite hearing loss configuration refers to a pattern where there is a significant loss of hearing sensitivity in the mid-frequency range, resembling a "bite" taken out of the middle portion of an audiogram.

A notched audiogram refers to a specific pattern observed on an audiogram, where there is a significant drop in hearing sensitivity at a specific frequency or frequencies, creating a distinctive "notch" shape.

asymmetrical hearing loss can occur in both ears, meaning that each ear has a different degree or configuration of sensorineural hearing loss.

False responses in hearing testing refer to inaccurate or incorrect patient responses during the evaluation. They can be categorized as false positives and false negatives.

A false positive occurs when a patient responds to a sound stimulus even when they did not actually hear the tone. It may result from factors such as misunderstanding the instructions, guessing, or being overly attentive.

A false negative occurs when a patient intentionally chooses not to respond even when they did hear the tone. It can be due to factors such as lack of cooperation, fatigue, or motivation to perform poorly.

Issues such as collapsing canals, reduced elasticity of the outer ear and external auditory meatus, and supra aural headphones that press on the ear canal can contribute to false responses. Additionally, tactile responses, where the patient feels a response rather than hears it, can occur, especially at lower frequencies.

UCL stands for Uncomfortable Listening Level, which is the highest level of sound a person can tolerate without discomfort. MCL stands for Most Comfortable Level, which is the level of sound that is most comfortable for an individual to listen to.

Speech audiometry is used to assess an individual's ability to understand and discriminate speech. It provides information about their speech recognition threshold, most comfortable level, and uncomfortable listening level.

The purpose of SRT testing is to determine the minimum level at which the patient recognizes 50% of the speech material.

The SRT stands for Speech Reception Threshold.

SRT testing typically uses a closed set of ten bisyllabic words known as spondees.

Having equal stress on each portion of the word ensures that the patient's response is not influenced by the emphasis on a specific syllable.

During cross-checking, the SRT results should be within +/- 10dB of the Pure-Tone Audiometry (PTA) results.

he procedure for conducting the SRT test according to the Ventry Chaiklin method involves familiarizing the patient with visual cues, using 10 words at 30 dB re: PTA, and then proceeding with the actual test.

The initial step in the Ventry Chaiklin SRT procedure is familiarizing the patient with visual cues.

Typically, 10 words are used during the familiarization phase of the SRT test.

After removing visual cues, the next step in the SRT procedure is to decrease the intensity by 10 dB until the patient makes an incorrect response.

The response criterion for determining the SRT threshold is achieving a score of 3 correct responses out of 4 presentations at a particular intensity level, followed by decreasing the intensity by 5 dB.

The patient is instructed to repeat the words after the examiner, even if they are not sure, as the examiner's voice gradually gets softer and softer.

The expected responses from the patient during the SRT test are repetitions of the words they hear.

The SRT test uses a closed set of words, meaning the patient's responses will come from a predefined list of words.

Typically, the patient is familiarized with 10 words before the SRT test begins.

WRS stands for Word Recognition Score.

The WRS test measures how well an individual can understand and repeat words at a comfortable listening level.

The words are typically presented at a level that is 30-40dB above the Speech Reception Threshold (SRT).

Typically, 25 words are presented to each ear during the WRS test.

Monosyllabic words are commonly used during the WRS test.

MCL stands for Most Comfortable Level.

It is important to know the patient's MCL to understand their limit of comfort in reference to speech.

MCL helps in hearing aid fittings by adjusting the maximum output of the hearing aid to match the patient's comfortable listening level.

The two methods used to determine MCL are asking the patient if your voice is good, too loud, or too soft, and using a numeric scale to rate the loudness of your voice.

LDL-SRT represents the dynamic range, which is the difference between the patient's Loudness Discomfort Level (LDL) and Speech Reception Threshold (SRT).

Routine testing of speech in noise.

Words or sentences.

Multi-talker babble or broadband masking noise.

By subtracting the background noise level from the speech level.

It helps determine the lowest SNR at which the patient can correctly identify speech, which is essential for understanding how well they perform in real-world listening situations and optimizing hearing aid settings or assessing classroom listening conditions.

Audiologists are responsible for conducting speech and language screening as part of their scope of practice.

Making appropriate referrals based on the results of the screening and collaborating with other professionals, such as speech-language pathologists, when necessary.

VRA (Visual Reinforcement Audiometry), BOA (Behavioral Observation Audiometry), and play audiometry.

Children have a smaller range of normal hearing, typically 15dB or lower, compared to adults.

Play audiometry is a method of testing hearing in children where they are asked to perform a task when they hear a sound.

Examples of tasks used in play audiometry include putting a block in a bucket, placing a piece on Mr. Potato Head, or fitting a puzzle piece.

The purpose of conditioning the child during play audiometry is to teach them to wait for the sound and perform the task only when they hear the specific sound.

It is important to keep the child quiet during play audiometry to ensure they can hear the softest sounds and accurately respond to the auditory stimuli.

To create a suitable environment for play audiometry, set up a child-sized table and chairs, and ensure there is minimal stimulation or distractions.

It is beneficial to separate the child from their parents during play audiometry to encourage independent engagement and minimize potential distractions.

Activities that are too engaging or stimulating should be avoided during play audiometry to ensure the child's focus remains on the auditory stimuli being presented.

VRA is a method of testing hearing in children where they turn their head towards the origin of a sound stimulus in response to a visual reward. It helps determine the child's ability to localize sounds and is typically observed around 6 months of age.

BOA is a method of testing hearing in children where the audiologist observes the child's behavioral changes in response to the detection of a sound stimulus. These changes may include stopping sucking on a pacifier, opening the mouth, pointing, or showing signs of joy.

During VRA/BOA, it is important for the child to remain seated on a parent's lap facing forward so that the speakers are directly in front of them on the left and right sides. This positioning ensures that the child is in the optimal position to detect and respond to the sound stimuli from both sides.

VRA and BOA tests are preferred for pediatric audiometry because they take significantly less time compared to traditional audiometry. Children have shorter attention spans and may get bored of tone stimuli quickly, making these behavioral response tests more suitable.

Alternative stimuli that can be used during VRA/BOA testing include white noise, warbled tones, and speech stimuli. These stimuli help maintain the child's interest and engagement during the testing process.

It is important to consider the child's attention span and potential for fatigue during testing. Children tire more quickly than adults, so prioritizing the testing of important frequencies first, such as 500, 2000, 1000, and 4000 Hz, ensures that the essential information is captured within the child's optimal attention span. On an audiogram, soundfield testing results may appear as an "S" symbol to indicate that it was conducted using VRA or BOA methods in a soundfield environment.

Traditional speech audiometry can be challenging for young children because they may not have developed the language and cognitive skills necessary to understand and respond to specific speech stimuli.

Alternative methods used to assess speech detection threshold in pediatric testing include using vocalization tasks, such as repeating simple syllables like "babababa," and engaging the child in tasks that involve body part identification or pointing.

Body part identification and vocalization tasks can be used to assess a child's response to speech stimuli. For example, the child may be asked to point to their nose, ear, or mouth when they hear certain speech sounds or syllables. Their ability to correctly identify and respond to these cues indicates their detection of speech.

The speech detection threshold in pediatric testing refers to the lowest level of speech stimuli at which the child reliably responds or demonstrates a behavioral reaction. It helps determine the child's ability to detect and perceive speech sounds at different intensity levels.

spondee picture cards

–Spondee picture card

–NU-CHIPS

–WIPI