Flashcards: Audiology Study Guide

•Someone wants to speak and verbally express information in an oral format.

•A listener picks up the acoustic information provided by the talker.

•The listener takes that information and transfers it to a neural signal, which is processed by their brain.

1) effective language use by the speaker: proper grammar, vocabulary, and sentence structure

2) speech detection capability by the listener: ability to detect and perceive speech sounds. They should have intact auditory perception and processing.

For a message to be discriminated and understood, the language used by the speaker needs to be comprehensible to the listener. They need to use the same language, grammar, syntax, and shared vocabulary.

Even if the language used by the speaker and listener is the same, a hearing impaired person can impede the listener's ability to understand the message.

American National Standards Institute (ANSI)

private, nonprofit organization that develops and accredits standards across various industries. They calibrate the equipment to ensure accurate measurements and consistent results.

Sound is energy that is transmitted through pressure waves that are a byproduct of force applied to sound.

waveform and spectrograms

vertical axis

horizontal axis

frequency, time, intensity

physical measurement of sound energy and it is objective.

in decibels (dB). It is a logarithmic scale.

No. It represents the reference level or threshold of human hearing.

the subjective perception of sound intensity by an individual

frequency or pitch

The objective measurement predetermined according to the audiometer dial

the psychological correlate to frequency. It is subjective of how high or low a sound is. It is affected by the individual's sensation, intensity, and patient's annoyance to the sound.

vowels, /m/, /n/

/l/, /r/, /w/, /j/

/sh/, /f/, /th/

the speech signal

1. Pinna (auricle)

2. Ear canal (external auditory meatus)

the visible, external part of the outer ear.

tube-like structure that extends from the opening of the outer ear to the eardrum (TM)

1) Risk perforating the eardrum (TM)

2) Wax prevents bugs from entering the canal

sound detection

2500 Hz

5000 Hz

sounds coming from one side of the head are partially blocked by the head itself, resulting in difference of sound intensity between the two ears

finding the sound

it helps them determine if the sound is in front or behind them

it can also aid in detecting the angle of origin in reference to the ear

cartilaginous portion, which is a continuation of the pinna

the bony part which leads to the skull

direct sound towards the eardrum and protection of the ear drum

S shape to protect against sand, bugs, etc.

a controlled temperature within the ear. It is an effective tool for identifying illness.

wax

1. tympanic membrane

2. ossicles

3. Eustachian tube

It is part of the chain of sound transmission

thin, semitransparent membrane

three layers

sound pressure

helps examine the ear canal and ear drum. The cone of light is light that can be seen on the eardrum's surface.

malleus, incus, stapes

attached to the eardrum and it vibrates in response to sound waves then transfers sound to the incus and stapes

closed

to chew, yawn, or swallow or to maintain pressure on either side of TM

1. cochlea

2. vestibular system

keeps the membranous labyrinth from bumping into the bony labyrinth

it is within the membranous labyrinth

semicircular canals, vestibule, cochlea

they are involved in balance

superior, lateral, and posterior

the sensory organ of hearing

snail-shape

scala vestibuli, scala media and scala tympani

the round and oval windows

tonotopically, which means that some regions are sensitive to different frequencies of sound. low frequencies on the inside and high frequencies on the outside.

Sound enters the ear canal, then reaches the tympanic membrane. The sound waves cause the TM to vibrate which causes the ossicular movement of the incus, malleus, and stapes. The stapes bone hits the oval window, which is connected to the cochlea. Inside the cochlea is the organ of corti which has hair cells which turn the vibration of sound into electrical impulses. The electrical impulses are sent to the brain to be discriminated.

1) sound waves enter the pinna

2) They travel down the ear canal

3) They reach the tympanic membrane/ ear drum

4) They reach the ossicles and vibrate

5) They reach the cochlea

- it bypasses the outer and middle ear and sends sounds directly to the outer ear

- it does not go through the ear canal or vibrate the TM

- it directly stimulates the cochlea

directly stimulating the temporal bone

anatomical structures involved in the transmission of sounds from the outer ear to the cochlea. Outer, middle, inner ear.

a central auditory processing deficit

central hearing loss

the sound is being transmitted through the outer and middle ears effectively, but once it leaves the cochlea, the message gets disrupted

a variety of tests need to be completed

Hearing aids primarily amplify sound and enhance the audibility of speech and environmental sounds. However, individuals with central hearing loss may have challenges in processing and interpreting the amplified sounds effectively.

hearing loss or disorders that occur in the outer, middle, or inner ear.

1. conductive

2. sensorineural

3. mixed

Occurs when sound is unable to pass efficiently through the outer or middle ear due to blockages, malformations, or other conditions.

•Fluid

•Wax

•Foreign body

•Perforation

yes they are often treatable

a type of hearing loss that occurs due to problems in the cochlea, the neural pathways, or the sensory systems within the auditory system.

the cochlea, or the neural pathway from the cochlea to the auditory cortex, or a combination of both.

no it is typically untreatable and therefore permanent

the damage typically begins with the sensory receptors within the cochlea, which are the hair cells

•the hair cells (many many hair cells) are destroyed

•This is the first step- eventually, the destruction will continue along afferent nerve fibers, eventually rising up the pathway of the auditory system

no If the damage went from the organ of Corti, up the ascending pathways towards the auditory cortex, these individuals now have RETROCOCHLEAR pathology

•BEYOND the cochlea

•Dizziness

•Tinnitus

•Gait issues

VIII Auditory

IX Glossopharyngeal

XII Hypoglossal

1) carrying auditory information from the cochlea to the auditory cortex for sound discrimination and understanding.

2) transmitting information related to balance and equilibrium from the vestibular system to the brain

•VNG – balance test

•MRI

ABR - Auditory Brainstem Response

basal damage (outside of the cochlea)

apex damage (the inner portion of the cochlea)

an abnormal sense of loudness growth and altered production of speech sounds

•Infection

•Wax

•Perforation of TM

- Ossiculardysfunction

Pure-tone audiometry: Evaluates hearing sensitivity by measuring the softest sounds a person can hear at different frequencies.

Tympanometry: Assesses the movement of the eardrum and measures middle ear pressure.

Otoscopy: Visual examination of the ear canal and eardrum to identify blockages or abnormalities.

Medical intervention: In cases of earwax blockage or middle ear infections, appropriate medical treatment (e.g., earwax removal, antibiotics) may resolve the conductive hearing loss.

Surgical options: Some conditions, such as a perforated eardrum or ossicular chain abnormalities, may require surgical intervention (e.g., tympanoplasty, ossiculoplasty) to restore hearing.

Hearing aids: For persistent or permanent conductive hearing loss, hearing aids can amplify sound and improve auditory perception.

a combination of both conductive and sensorineural hearing loss. It means that there is damage or dysfunction in both the middle ear and the inner ear (cochlea) or auditory nerve pathway.

If the cochlea is independently stimulated, for example, through direct sound presentation, it may still yield better results compared to when sound has to pass through the compromised middle ear. This is because the cochlea itself may be functioning relatively better than the middle ear in this scenario.

Comprehensive audiological evaluation: Includes pure-tone audiometry to measure hearing thresholds, speech audiometry to assess speech understanding, and other tests such as tympanometry, otoacoustic emissions, or auditory brainstem response to determine the type and degree of hearing loss.

Medical intervention: In cases of conductive hearing loss components (e.g., earwax blockage, middle ear infections), appropriate medical treatment (e.g., earwax removal, antibiotics) may be necessary.

Surgical options: Some cases may require surgical intervention (e.g., tympanoplasty, ossiculoplasty, cochlear implant) to address conductive or sensorineural components.

Hearing aids or assistive listening devices: Depending on the degree of hearing loss and individual needs, amplification devices can help improve hearing and communication.

hearing loss occurred before the development of language, may have limited or no exposure to spoken language during critical periods of language acquisition.

knows how words should sound before losing hearing

it could cause them to be behind in school or cause a social and emotional boundary

•Isolation

•Depression

•Frustration

employment, family, and finance

They specialize in the study of hearing and disorders of hearing

They play a crucial role in the assessment, diagnosis, and intervention of various hearing-related conditions

•Promote healthy hearing, quality of life

•Hearing, balance, tinnitus, auditory processing, newborn hearing screening

•Intraoperative monitoring, CI programming, hearing aids, assistive devices

focuses on identifying the loss and then managing their educational needs

work primarily with noise-induced losses, or age-related losses, and providing amplification to these individuals

work for organizations such as OSHA to make sure that places of employment demonstrate safe listening levels

•Private practice

•ENT

•Hospitals

•Schools

•Manufacturer

•VA

University clinic

audiologists in New Jersey are no longer required to obtain a separate hearing aid dispensing license in addition to their audiology license in order to provide amplification services, such as fitting and dispensing hearing aids.

the New Jersey Board of Consumer Affairs and the New Jersey Board of Hearing Aid Dispensers.

A high school diploma and passing a national HIS exam.

Hearing Instrument Specialist

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

■Other diagnoses= ADHD, Autism, ODD, etc.

■Educational setting

–What questions are important for this topic?

■Other health history

–Vision

■Social skills

■Responses to sound

■Extra curricular activities

chief complaint, medical history, ear-related history (ear infections, ear surgeries, ear pain, dizziness, discharge), noise exposure, ototoxic medications, family history, communication difficulties, tinnitus

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.

Tympanometry is a diagnostic test used to evaluate the mobility and function of the middle ear and eardrum (tympanic membrane). It provides valuable information about the middle ear's pressure, compliance, and overall health.

0 daPa

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

middle ear effusion, otitis media, eustachian tube dysfunction, tympanic membrane perforations, or middle ear pathology.

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

Acoustic reflex testing is a diagnostic procedure that evaluates the integrity of the middle ear and the reflexive contraction of the middle ear muscles in response to loud sounds.

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.

The acoustic reflex threshold is the lowest intensity (sound level) at which the acoustic reflex is elicited.

The ART is typically measured by presenting a loud sound (usually around 85-100 dB SPL) to one ear while monitoring the contraction of the stapedius muscle in the same ear or the contralateral ear.

The stimulus and the measurement are presented to the same ear. This test assesses the integrity of the middle ear reflex arc on the same side.

The stimulus is presented to one ear, while the measurement is taken from the contralateral ear. This test evaluates the reflex pathway from the stimulated ear to the brainstem and back to the stapedius muscle of the opposite ear.

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.

Audiometric testing: Audiometers are used to measure a person's hearing thresholds at different frequencies (pitch) and intensities (loudness).

Diagnosis and evaluation: Audiometers help identify and characterize various types and degrees of hearing loss.

Treatment and intervention: They aid in the fitting and verification of hearing aids and assistive listening devices.

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

–Inserts

–Supra aural

–Bone oscillator

–Speakers

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.

This test measures a person's hearing thresholds or the softest sounds a person can hear at various frequencies, typically ranging from 250 Hz to 8000 Hz. The individual responds to tones by indicating when they can hear the sound.

Diagnosis and classification of hearing loss: It helps identify the type and degree of hearing loss (conductive, sensorineural, or mixed) and its configuration (flat, sloping, or steeply sloping).

Treatment and intervention: Pure-tone audiometry aids in the selection and fitting of hearing aids and other hearing assistive devices.

Speech tests assess a person's ability to understand and repeat spoken words or sentences presented at different loudness levels.

in a booth with an audiometer

The individual undergoing the test indicates when they hear a sound by pressing a button, raising their hand, or giving a verbal response.

bone conduction testing and air conduction testing

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

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

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.

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.

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.

When the responses from each ear are different or asymmetric.

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.

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

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

The 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.

an individual's ability to understand and repeat spoken words. It helps evaluate the clarity and discrimination of speech and is particularly useful in determining the impact of hearing loss on speech understanding.

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).

Words or sentences.

Multi-talker babble or broadband masking noise.

By subtracting the background noise level from the speech level.

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.

–Spondee picture card

–NU-CHIPS

–WIPI

sounds generated by the inner ear in response to auditory stimuli. They are commonly used in audiology to assess the integrity and function of the cochlea, the sensory organ responsible for hearing.

They are particularly useful in evaluating the hearing of infants, young children, and individuals who cannot provide reliable behavioral response

- –Transient Evoked (TEOAE): Transient evoked otoacoustic emissions (TEOAEs) are evoked by a brief click or tone burst stimulus.

–- Distortion Product (DPOAE): Distortion product otoacoustic emissions (DPOAEs) are generated when two tones of different frequencies are presented simultaneously to the ear.

In 2002, New Jersey passed a law mandating that all newborn babies receive a hearing screening before they leave the hospital. This ensures that every newborn has the opportunity for early detection of hearing loss and access to appropriate interventions.

EHDI stands for Early Hearing Detection and Intervention. It is a program that oversees newborn hearing screening efforts, follow-up services, and intervention programs for infants identified with hearing loss. In New Jersey, EHDI is responsible for managing the statewide newborn hearing screening program.

The "1-3-6" guidelines are a set of recommended timeframes for newborn hearing screening and intervention. It suggests that infants should have their initial hearing screening before one month of age, receive a full evaluation by three months if they receive a referral on the initial screening, and be enrolled in early intervention services by six months of age if diagnosed with hearing loss.

An Otoacoustic Emission is a low-intensity sound that is recorded in the external ear canal. It is produced within the cochlea in response to a sound stimulus.

To measure an Otoacoustic Emission, a microphone is placed inside a probe tip, which is inserted into the external ear canal. The emission is recorded as a response to a sound stimulus presented to the ear.

If the middle ear is compromised or if there are issues with the sound transmission to the cochlea, the Otoacoustic Emission may be absent or reduced. Therefore, the absence of an Otoacoustic Emission can indicate problems in the middle ear or sound transmission pathway.

The presence of an Otoacoustic Emission tells us about the function of the cochlea and the outer hair cells. It does not provide information about the function of the auditory nerve (8th cranial nerve) or beyond.

TEOAE stands for Transient Evoked Otoacoustic Emissions.

The stimulus used in TEOAE is a very brief click or toneburst presented at a level of 80dB SPL (sound pressure level).

High frequency responses are elicited first in TEOAE because of the tonotopic organization of the cochlea. The hair cells responsible for high-frequency hearing are located on the outermost part of the cochlea, so their responses are detected first.

Mid- and low-frequency components of TEOAE occur a bit later, at around 10 milliseconds (ms) after the stimulus presentation.

DPOAE stands for Distortion Product Otoacoustic Emissions.

DPOAEs are generated by presenting two different tones to the ear. The resulting emission is a third tone, which is a distortion product of the first two tones.

OAEs can help differentiate between different types of hearing loss. If a patient has moderate to profound hearing loss but has present OAEs, it suggests that the outer hair cells are intact. This finding can be helpful in diagnosing conditions such as retrocochlear loss or pseudohypacusis.

Retrocochlear loss refers to hearing loss caused by issues beyond the cochlea, typically involving the auditory nerve or central auditory pathways. When OAEs are present in a patient with moderate to profound hearing loss, it suggests that the cochlea is functioning normally, pointing to a potential retrocochlear cause.

Pseudohypacusis, also known as functional hearing loss or nonorganic hearing loss, refers to a condition where individuals intentionally feign or exaggerate hearing loss. OAEs can help identify pseudohypacusis by demonstrating intact outer hair cell function despite behavioral tests suggesting hearing loss.

–They can assist in differential diagnosis

–Aids in determining cochlear implant candidacy

No, OAEs do not directly indicate hearing thresholds. They are used as a pass/refer screening tool and are typically utilized alongside full audiometric batteries for a comprehensive assessment.

Yes, if there is an issue with the outer or middle ear, such as a blockage or dysfunction, it can alter the OAE response. Therefore, OAEs may be affected in the presence of such conditions.

No, OAEs may not be present in individuals with moderate or greater hearing losses. The presence of OAEs is more likely in individuals with milder hearing losses.

OAEs enable us to monitor changes in cochlear function over time. By comparing OAE responses at different points, we can assess any alterations or improvements in cochlear health.

The three categories that OAEs can typically fall into are:

Normal: OAEs are present with strong emissions.

Present: OAEs are present but with low amplitudes.

Absent: No measurable OAE responses.

ABR stands for Auditory Brainstem Response, and it refers to the electrical activity of the auditory system in response to an acoustic stimulus.

Auditory evoked potentials are electrical responses generated by the auditory system in response to a sound stimulus.

Waves I-V

High repeatability

Earphones

Click or tone burst

Tone burst

One on each mastoid and two on the forehead.

Natural sleep is encouraged for the patient during this test.

The patient should be seated in a comfortable chair or lying down.

Patients need to be as quiet and still as possible, avoiding eyeblinks, coughing, heavy breathing, and muscle movement.

Baby bottles and pacifiers should be avoided as they can introduce artifacts.

A sedated ABR is performed under anesthesia for patients who may not be able to cooperate or remain still during the test.

Wave V is the specific wave that is typically observed and analyzed in ABR testing.

Switching to a bone oscillator can help determine if the hearing loss is conductive (CHL) or sensorineural (SNHL).

VNG stands for Video Nystagmography.

diagnostic test used to evaluate and assess the function of the vestibular system, which is responsible for balance and spatial orientation

VNG was previously referred to as ENG, which stands for Electronystagmography.

The three portions of VNG testing are ocular motor testing, positional testing, and caloric testing.

The patient wears infrared video goggles during VNG testing.

Visualizing the patient's eye movements is crucial because it allows the examiner to accurately assess and analyze the characteristics and patterns of nystagmus, which is an involuntary rhythmic eye movement. By observing the eye movements, the examiner can gather important information about the function of the vestibular system and diagnose any underlying vestibular disorders or abnormalities causing dizziness or balance issues.

Nystagmus is an involuntary eye movement that can cause the eyes to move up and down, side to side, or torsionally (in a twisting motion).

Nystagmus can be caused by various factors, including vestibular stimulation, intoxication, spinning in circles, and riding in the back seat of a car.

When nystagmus is observed, it suggests that the inner ear is involved in the underlying cause of the patient's dizziness.

The case history is vital in assessing nystagmus as it provides valuable information about the patient's symptoms, medical history, and potential triggers or contributing factors. This information helps in determining the possible causes and appropriate management of nystagmus.

Some symptoms associated with nystagmus include double vision, blurry vision, and difficulty focusing. These visual disturbances can be experienced by individuals with nystagmus.

It is important to determine whether the dizziness is episodic (occurring in discrete episodes) or constant (persisting continuously). Additionally, knowing the duration of each episode is valuable, such as whether it lasts for seconds, minutes, hours, or even days.

It is important to inquire about specific movements that may trigger or worsen the dizziness. These can include getting up out of a chair, laying down, turning the head, or tilting the head back. Understanding the relationship between these movements and the onset or exacerbation of dizziness helps in the diagnostic process.

Assessing the frequency of dizziness helps in understanding how often the episodes occur. This information provides insights into the impact on the patient's daily life and helps in determining the urgency of the evaluation and management.

–Gaze

–Saccades

–Smooth pursuit

–Optokinetics

Gaze refers to the ability to fixate and maintain a steady gaze on a stationary target. Assessing gaze helps determine if there are any abnormalities in the ability to maintain stable eye position, which can be indicative of vestibular or neurological disorder

Saccades are rapid eye movements that redirect the line of sight between different targets. Assessing saccades helps evaluate the accuracy, speed, and coordination of these eye movements, which can provide insights into the integrity of the ocular motor system and its interaction with the vestibular system.

Smooth pursuit refers to the ability to smoothly track a moving target with the eyes. Assessing smooth pursuit helps evaluate the coordination and accuracy of eye movements during tracking tasks, which can provide information about the integrity of the vestibular-ocular reflex and the smooth tracking system.

Optokinetics involve visual stimuli that move across the field of view to elicit eye movements. Assessing optokinetics helps evaluate the ability to visually track moving objects and the corresponding eye movements, providing information about the interaction between visual stimuli and the vestibular system.

- Supine - lying the patient down flat on their back. It helps evaluate if changes in head position while lying down provoke nystagmus or dizziness

–- Dix Hallpike - quick movement of the patient's head from an upright sitting position to a head-hanging position, typically with the head turned to one side.

–- Head left

–- Head right

–- Body left

- Body right

A test in which the patient lies down with their head at a 30-degree angle and receives four separate irrigations of air.

Two cool and two warm air irrigations.

The air is in their ear for 60 seconds each time.

To induce dizziness and observe nystagmus in order to assess the functioning of the vestibular system.

Dizziness indicates a normal response of the vestibular system to the temperature-induced stimulation.

It is a reduced or weaker nystagmus response in one ear compared to the other, indicating a possible vestibular dysfunction

It involves comparing the nystagmus response between warm and cool irrigations in the same ear to assess the asymmetry of vestibular responses.

To assess the function of the semicircular canals in detecting rotational movement.

It measures the response of the canals to rapid acceleration, deceleration, and turns of varying speeds.

Rotational movements, such as turning the head or saying "no" with the head.

To assess how the body utilizes somatosensory, vestibular, and visual inputs for balance control.

Yes, posturography can help determine whether a vestibular impairment is central (related to the central nervous system) or peripheral (related to the inner ear or vestibular nerve).

Individuals who have gait issues, a history of falls, or balance problems without experiencing dizziness can benefit from posturography assessment.

The potential courses of action may include vestibular rehabilitation, medication, home exercises, and canalith repositioning maneuvers.

Insurance companies may not typically reimburse for vestibular rehabilitation when provided by audiologists. However, reimbursement may be possible when the services are provided by physical therapists (PTs).

Referring back to an ENT (Ear, Nose, and Throat) physician is important to ensure comprehensive evaluation and management of the patient's vestibular condition, as the ENT physician can provide medical expertise and necessary treatments.

Medication may be prescribed to manage symptoms associated with vestibular disorders, such as vertigo or nausea. The specific medication and dosage depend on the individual's condition and should be determined by a healthcare professional.

These maneuvers aim to reposition displaced calcium crystals in the inner ear to alleviate symptoms.

VNG (Video Nystagmography) is less commonly used for children compared to other tests.

Pediatric case histories can be less accurate due to the challenges in obtaining reliable information from young children, their limited ability to communicate symptoms accurately, and potential difficulty in recalling and describing their experiences.

The primary goal of screening for hearing impairment in children is to identify those who have hearing loss that may impact their speech/language development and educational progress. By detecting hearing impairment early, appropriate interventions and support can be provided to minimize the impact of hearing loss on a child's communication skills and academic performance. It is crucial to ensure that follow-up assessments and interventions are implemented for children who do not pass the initial screening to address their specific needs effectively.

to identify those children with a hearing disorder who would not otherwise be identified

Failure to identify individuals may result in lifelong complications, such as difficulties in acquiring speech and language, articulation problems, issues with sound localization, poor academic performance, feelings of isolation and depression, and a negative self-concept.

In a screening program, the children being screened are sorted into two groups: those who have the problem (fail) and those who don't have the problem (pass). It is a pass/fail situation where the goal is to identify individuals who may require further evaluation or intervention.

No, passing a screening does not guarantee that a child is free of the problem. The underlying problem, such as hearing loss, falls on a continuum, and the impact can range from no problem to a severe problem. Passing a screening simply indicates that the problem, if it exists, is not severe enough according to the screening protocol to warrant further testing.

Passing a screening indicates that the problem, if it exists, is not severe enough according to the screening protocol to warrant further testing. However, it does not guarantee the absence of the problem, as the disorder and its impact can vary in severity.

The tetrachoric table shows the agreement between a screening test and a "gold standard" diagnostic test. This table is used to measure the validity of the screening test by comparing its results to the results of the diagnostic evaluation, which serves as the gold standard. The tetrachoric table allows for an examination of the agreement between the two tests, providing insight into the accuracy of the screening test in correctly identifying individuals with the problem.

The tetrachoric table can also be used to examine the reliability of the screening test. This can be done by studying the agreement between different examiners or the same examiner administering the test twice. By breaking down the results in the tetrachoric table and comparing the outcomes, the consistency and reliability of the screening test can be assessed. This helps ensure that the screening results are consistent and not influenced by factors such as examiner variability.

Intratester reliability refers to the consistency of the test when administered by the same person to the same individual on multiple occasions.

Intertester reliability assesses the consistency of the test when administered by different individuals to the same individual.

Test-retest reliability is another term for the consistency of the test across multiple administrations.

Validity refers to the extent to which the results of a screening tool align with the presence or absence of the disorder being screened for.

Using pure tones to screen for middle ear disease is not the most valid approach because it has been shown to miss approximately half of the children with middle ear pathology. Mild hearing loss may not be detected by pure tone screening conducted at higher dB levels.

A true positive represents children who failed the screening and were found to have hearing loss.

False positives refer to children who failed the screening but were found to have normal hearing.

True negatives represent children who passed the screening and were found to have normal hearing.

False negatives represent children who passed the screening but were found to have hearing loss.

The outcomes or costs of a false positive include the cost of rescreening or retesting, distress associated with wrongly identifying a problem, the potential for unnecessary treatment, and increased costs for individuals due to unnecessary visits to healthcare professionals.

A false positive can cause distress and anxiety for individuals who are wrongly identified as having a problem when they don't.

It is important to keep false positives at a low rate in screening programs to minimize unnecessary costs, avoid unnecessary treatments, and maintain public satisfaction with the screening process.

The costs of false negatives include missing out on the benefits that come from early identification and intervention for a problem.

False negatives can delay the identification of a problem, which may prevent individuals from receiving timely support and intervention.

False negatives can lead to the misattribution of certain behaviors to unrelated causes, as the presence of a problem may be overlooked or dismissed due to the false reassurance of a lack of problem.

In the context of a contagious and fatal disease, the significance of false positives and false negatives increases.

In such screening programs, a higher false positive rate may be acceptable to ensure that more testing is conducted and potential cases are identified.

Prioritizing the reduction of false negatives in a screening program for a contagious and fatal disease will likely increase the false alarm rate, as more individuals are flagged for further testing or intervention.

Increasing the sensitivity of a screening test can be achieved by setting a stricter passing criterion.

By setting the passing criterion at a lower threshold, such as 10 dB HL instead of 20 or 25 dB HL, the likelihood of identifying individuals with a hearing problem that could impact speech/language and academic development is increased.

By setting the passing criterion at a lower threshold, such as 10 dB HL instead of 20 or 25 dB HL, the likelihood of identifying individuals with a hearing problem that could impact speech/language and academic development is increased. Answer: Adjusting the passing criterion to a lower threshold will result in more individuals failing the screening (increased false positives) and fewer individuals passing the screening. This trade-off is necessary to enhance the sensitivity of the screening test.

The desired characteristics in a screening tool include sensitivity, specificity, and a low number of false positives and false negatives.

The goal when selecting a screening tool is to find a test that is valid and reliable, meaning it accurately identifies individuals with the condition (validity) and consistently produces consistent results (reliability).

When selecting screening procedures, it is important to consider the goal of the screening. For example, if the goal is to identify hearing loss, using tympanometry may not be appropriate. Similarly, if the goal is to identify middle ear pathology, using a pure tone screening test may not be effective. The choice of screening procedures may involve a combination of impedance or immittance screening and pure tone screening, depending on the goals of the screening protocol.

The goal of the screening can vary depending on the population being served. For example, children in Head Start programs may be screened using both immittance and pure tones, while in the grade school age group, only pure tone screening may be used. The screening procedures may be tailored to the specific needs and characteristics of the population being screened.

The first line of screening for neonatal and infant populations is usually done by examining the baby, the mother's pregnancy, the delivery, and the immediate post-natal period. These observations can be made at any time, but it is more effective to provide some structure to the observations. This is where a High Risk Register comes in.

A High Risk Register is a formal screening tool used to identify children who are at risk for hearing impairment. It consists of categories that are associated with hearing loss, and children with these problems are considered to be at risk for hearing problems.

A High Risk Register helps in reducing the pool of candidates for further screening by identifying those children who are at a higher likelihood of having a hearing problem. By categorizing and flagging children with specific risk factors, the High Risk Register helps prioritize their screening and ensures that those who are most likely to have hearing impairment receive further assessment and intervention, while reducing unnecessary screening for those who are not at high risk.

ABR is commonly used for infant screening. In this method, automated ABR is employed where click stimuli are presented at a fixed intensity level, typically around 30 to 40 dBnHL. If a response is detected, indicating normal hearing function, the infant passes the screening. If no response is observed, the infant is referred for further evaluation to assess their hearing status.

ABR screening is typically conducted in the NICU (Neonatal Intensive Care Unit) or newborn nursery.

ABR screening has a somewhat high false-positive rate (where a child fails the screening when they should not), but a very low false-negative rate (where a child passes the screening when they actually have a hearing impairment).

The advantage of using evoked OAE testing for newborn hearing screening is that it is quick, taking as little as 15-20 seconds per ear, and does not require sedation.

Evoked OAE testing can be used in newborns of any gestational age because it is not affected by neuromaturation.

One limitation of OAE testing is that it may not be effective if there are outer or middle ear problems, even if there is no sensorineural hearing loss (SNHL).

The infant should be asleep for at least 15 seconds prior to the presentation of the signal in behavioral observation audiometry.

In behavioral observation audiometry, at least 2 out of 8 responses are required, and there should be agreement by 2 independent observers.

No, the expected responses in behavioral observation audiometry vary according to the age of the child.

The goal of screening children aged 2-4 years is to look for medical problems that may be the cause of hearing loss, assuming that severe/profound hearing losses have already been identified.

The recommended screening methods for this age group are immittance testing (90-95% significant ear pathology) and pure tone screening (50%).

The test method likely to be used for screening children aged 2-4 years is play audiometry.

The state of New Jersey has a hearing screening protocol for students.

Each district board of education is required to conduct audiometric screening according to the protocol.

The screening protocol includes students enrolled in pre-school programs, grades kindergarten through 4, grades 6, 8, and 10, as well as students entering the district with no recent record of audiometric screening.

Students may be included in the screening if they are at risk for hearing impairments, referred to the child study team for evaluation, or referred for screening by a teacher, parent, or at the student's own request.

The medical inspector, certified school nurse, or health care personnel are responsible for conducting the audiometric screening.

If a pupil fails the first screening, the school nurse may examine the external ear canal with an otoscope to identify any condition that could interfere with hearing. If a problem is suspected, the pupil and parent will be notified, and a recommendation for a medical examination will be made.

A pupil who fails to respond to any one frequency in either ear should be screened again in four to six weeks.

If a pupil fails to respond to the same frequency or frequencies in the same ear on the second valid screening, the pupil is considered to have failed the screening and should be referred for further evaluation.

A pupil who fails to respond at a different frequency or different frequencies on the second screening should be screened a third time within two weeks.

If a pupil fails to respond at any one frequency on the third screening, they shall be considered to have failed the screening and will be referred for further evaluation.

The school nurse is responsible for notifying in writing the parents or guardians of pupils who fail audiometric screening about the necessity for additional evaluation by a physician or family health care provider.

•Prepare test area – table for equipment, chair for student (with back to audiometer)

•Listening check (to be sure equipment is working properly & noise levels are not too high)

•Tell the student to raise his/her hand if he/she hears the tone

The tone should be left on for about 1 second during audiometric screening.

The right ear is tested first during audiometric screening in the State of New Jersey.

The tone is presented at 20 dB HL at 1000 Hz during audiometric screening in the State of New Jersey.

The frequencies are tested in the following order in the right ear: 2000 Hz, 3000 Hz, 4000 Hz, and 500 Hz (in that order), all at 20 dB HL.

The examiner should inform the student that they are changing ears when switching from testing the right ear to testing the left ear.

If a student fails the screening, the examiner should indicate the frequencies on the form and do an otoscopic exam

If a student fails the screening, the examiner should indicate the frequencies on the form.

The guidelines provide background information, principles, definitions, program development, and specific screening guidelines.

The ASHA guidelines cover both the pediatric population (birth through 18 years) and the adult population.

The pediatric section is further divided into guidelines for screening for outer and middle ear disorder among older infants and children, as well as guidelines for screening for hearing impairment in different age ranges.

DPOAE stands for distortion product otoacoustic emission.

Otoacoustic emissions originate from the outer hair cells of the inner ear. The presence of these emissions indicates the normal functioning of the ear's outer hair cells.

The main challenge is the influence of external noise in a school setting, which can interfere with the accuracy of OAE measurements.

Otoacoustic emissions screening can be conducted by a speech-language pathologist (SLP), school nurse, audiologist, or any other trained professional.

The results are typically categorized as "pass" or "refer," making it relatively easy to determine whether further evaluation is needed.

An audiologist is often responsible for developing a protocol that outlines the procedures and guidelines for SLPs and nurses to follow in otoacoustic emissions screening.

Otoacoustic emissions screening can be particularly beneficial for children who have sensory disorders preventing the use of supra-aural headphones, are too young to provide accurate responses, have cognitive impairments, are non-verbal, or may attempt to fake their responses.

Otoacoustic emissions screening may miss mild impairments, as they may not produce detectable emissions.

Otoacoustic emissions screening is generally less sensitive to external noise, making it useful in environments with ambient noise. However, it can be more sensitive to internal noise, such as fidgeting, breathing, or chewing sounds.

Otoacoustic emissions screening equipment is easier to carry around, which can be beneficial for screenings conducted in various locations or settings.

Otoacoustic emissions screening equipment can be expensive to purchase. However, it typically operates on batteries, eliminating the need to be near an electrical outlet during screenings.

A complete otoscopic or visual inspection should be performed to check for impacted cerumen, drainage, foreign bodies, infection, or structural abnormalities of the pinna, canal, or tympanic membrane.

The next step is to place a small probe in the ear canal to deliver the sound stimuli for otoacoustic emissions testing.

Automated OAE screening units will analyze the emissions and provide a result of either "pass" or "fail/refer." Diagnostic units require interpretation by audiologists, and screeners who are not audiologists should not independently change test parameters or interpret findings.

The role of SLPs in hearing screening includes collaborating with audiologists in the development of screening protocols, equipment selection, and quality improvement. They also perform hearing screenings, refer children who do not pass screenings for further evaluation, and refer difficult-to-test children to an audiologist. SLPs communicate screening results to families, provide recommendations for timely follow-up, and share results with relevant program/school representatives and healthcare professionals. They also provide counseling and education for families, educators, and other service providers, and collaborate with audiologists, school nurses, teachers, physicians, and other professionals to ensure appropriate follow-up and outcomes.

The timeline is based on the timeline for spontaneous recovery of middle ear effusions and the prevalence of middle ear effusions in children.

A child with OME and no other significant risk can be managed with watchful waiting for up to 3 months from the date of onset or diagnosis.

It allows the clinician to provide information about the persistence of possible middle ear effusion to the primary care provider or other medical professional.

The referring clinician should document the effusion duration, history of acute otitis media (AOM), and developmental status of the child.

The possible over-referral of children who may have a middle ear effusion in the process of resolution.

Otitis media, including otitis media with effusion (OME).

Exhaustive electroacoustic calibrations should be performed annually.

Calibration activities should be conducted by a trained audiologist or an external company/individual who is properly trained in performing such tasks.

Functional inspection, performance checks, and bioacoustic checks should be conducted to verify equipment performance.

Parental permission is required before conducting the screening.

The date of the screening should be provided, giving them the opportunity to opt out if desired.

The results should be documented in the client's chart or record.

The results should be provided to the legal guardians or parents of the child.