Audiology Exam 1 Study Guide
Audiology Exam 1 Study Guide 458
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This 6 page Study Guide was uploaded by Susie Nam on Monday February 9, 2015. The Study Guide belongs to 458 at University of Oregon taught by Katherine Swem in Fall. Since its upload, it has received 119 views. For similar materials see Audiological Assessment in Language at University of Oregon.
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Date Created: 02/09/15
Physiological testing Immittance measure of how well a system can be set into vibration by driving force via TM impedance admittance or compliance asses the manner in which energy ows through the outer amp middle ears to the cochlea how well the ear is doing in the impedance matching system Impedance vs admittance o Impedance resistance of the medium TM amp middle ear space to the energy signal high impedance would require higher intensity or dB loudness o Admittance opposite of impedance in which vibrations are stimulated with minimal force 0 ligaments control the impedance Parts of a tympanometer 0 Probe tone generator measures the energy that bounces back and returns from the TM 0 Re ex signal generator presents loud tone to measure acoustic re ex of middle ear and records the de ectionstrength of middle ear re exes o Stiff TM means the sound will bounce back with high intensity while exible TM means the energy from tone continues through the middle ear and the least amount of energy will be left in the ear canal Why do we measure EAC volume 0 To determine abnormalities in the ear PE tubes wax impaction Normative ranges for static compliance admittancecompliance amp volume 0 Children 25105 0309 0 Adults 0317 092 Static acoustic compliance measure from 200 daPa to 0 to 200 daPa and determine where the middle ear has the highest admittance TPP tympanometric peak pressure I when the middle ear pressure and the ambient pressure are equal Types of TPP o A normal peak is within the normative range 0 Ad deep amp exible I ossicular discontinuity 0 As shallow and stiff I otosclerosis o B no peak pressure could be found because TM is too stiff Look at V Normal uid More hole Less cerumen impaction o C negative pressure under 100 daPa I ET dysfunction or cholesteatoma retraction pocket Acoustic re ex method in which you present a loud sound to stimulate amp measure re exes no acoustic re exes in auditory neuropathy in childreninfants used to determine if HL is conductive retrochoclear Speech Audiometry MLV monitored live voice using VU meter hit 0 every time Prerecorded speech same room operation possible Patient s role cognitive and linguistic abilities respond Clinician s role clear instructions appropriate seating so that clinician s face isn t visible False positives are theoretically impossible Speech testing types 0 SDT speech detection threshold how well individual can detect speech connected speech lowest level individual can detect speech 50 of the time o SRT speech recognition threshold how well individual can recognize speech spondees softest patient can recognize word correctly 50 of the time o SRS speech recognition scores how well individual understands speech and its phonemes Spondee bisyllable word with emphasis on both syllables Purpose of SRT 0 Good indicator of where pure tone threshold should be 5 10 dB within 0 Malingering Speech range 5004000 Hz SRT test procedures 0 5 dB stair stepping increase 5 dB every time it s wrong SRT results should be 0 PTA of 5001000 Hz 2 dBHL SRT via bone conduction 0 Con rm conductive loss 0 Faster in determining ABG in children Loudness levels and their usefulness o MCL most comfortable loudness conversational level is 4550 dB 0 UCL uncomfortable loudness raise dB until it s uncomfortable 0 Useful in tting hearing aids Speech recognition TESTING SCORES 0 Seeing how well patient can understand amp discriminate sound Purpose of SRS 4 0 Determine ampli cation candidacy 0 Determine type of hearing loss site of lesion retrocochlear I acoustic neuroma or Meniere s disease 0 Determine patient s speech understanding ability 0 Provide prognosis for success with treatment Word lists 0 Phonetically balanced o CVC 0 High frequency emphasis I kids after chemo o Nonsense words Pic ID test 0 Picture identi cation task 0 WIPI word intelligibility o NUCHIPS children s perception of speech Speech in noise tests and their usefulness o SPIN speech perception in noise 0 Quick SIN 1 min and common for tuning hearin airds o Hint Hearing in noise test 0 Connected speech Presentation levels for SRS 4 o MCL 510 dBHL o 90 dBHL for tumor PIPB rollover 0 Present at optimal sensation level for speech 0 Swem 10 dB above 4000 Hz threshold Limitations of SRS 0 Low reliability for SNHL in the middle range 0 Not representative of everyday hearing Degree of impairment in word recognition ability 5 0 Normal 10090 0 Slight 9075 0 Moderate 7565 0 Severe 6550 0 Very severe gt50 AI audibility index I count the dot audiogram of conversational speech audible from 36ft and speech banana Air amp Bone Conduction Intensity and units the force per unit of area in decibels Frequency and units the number of cycles per second of a sound wavelength over period of time in Hertz dBSPL sound pressure level how we measure intensity on a sound level meter dBHL hearing level threshold dBnlIL normed hearing level for ABRs dBeHL equivalent hearing level translate nlIL as if it were on an audiogram dbSL sensation level for SRS I most comfortable level for hearing diff btwn speech threshold and comfortable hearing What is HL Hearing level the threshold in which the person can hear Types of hearing loss SNHL auditory nerve and inner ear and CHL middleouter ear Air conduction vs bone conduction air conduction is measuring sound via air transmission from outer l middle l inner l auditory nerve BC measures inner I auditory nerve Distortional bone conduction vibrates and distorts the cochlear structures which sets off electrochemical activity of the auditory pathway of the brain Inertial bone conduction middle ear activity inertia causes stapes to move Osseotympanic BC ear canal and TM activity vibration of skull vibrates ear canal Tuning fork tests 4 o Schwabach compare BC of patient and examiner o Rinne AC vs BC normal and SNHL positive CHL negative 0 Bing measures occlusion effect plug in ear and see if they notice an occlusion o Weber determines type of HL for unilateral losses based on the Stenger principle BC tone heard in better ear for normal and SNHL tone heard in poorer ear for CHL Stenger principle when 2 identical stimuli are presented to each ear and one tone is increased in intensity the increased intensity ear will only hear the sound Occlusion effect if there is a conductive loss occlusion the tone will be heard in that area because the sound will ring in that lesion Pure tone testing standard bxal procedure for describing auditory sensitivity Start I 30 dB NR I 50 dB R l 10 dB 23 times correct Factors affecting threshold of audibility intrinsic and extrinsic o Intrinsic motivation confidence age mental capacity head noise attention o Extrinsic temperature light ambient noise calibration test methods instructions Standard audiometer test frequencies 12520000 Hz test battery 2508000 Hz Interoctaves 1500 3000 6000 Hz BC test frequencies 2504000 Hz Patient response 4 0 True positive HIT responds to a stimulus 0 True negative doesn t respond to an absent stimulus 0 False positive responds to an absent stimulus 0 False negative MISS doesn t respond to a stimulus Stimulus types 5 0 Pure tone 0 Pulse 0 Warble frequency modulated tone 0 Narrowband frequency focused 0 Speech noise Threshold test technique steps if difference is more than 20 dB you test the inter octaves PTA avg of thresholds at 500 1000 2000 high frequency PTA for 1 2 4 Masking Cross hearing can occur via 2 0 BC 0 Via sound leaking out of the headphone and being heard by the better ear When hearing is symmetrical you don t do masking since there isn t a better ear yet IA interaural attenuation loss of intensity of a sound introduced to TE and heard by the NTE TDH IA 40 dB Insert IA 70 dB BC IA 0 dB IA levels are transducer amp frequency dependent Types of masking noise 2 0 White noise broadband noise noise that has a broad spectrum across most frequencies wequal energy at all of the frequencies 0 Narrowband noise noise band using only the quotcritical band of frequencies surrounding the pure tone to be masked EML effective masking level average of 12 people Initial masking de nition and formula level at which you begin masking for each frequency that needs it AC of NTE CE Plateau increase masking 5 dB for 3 steps if patient responds if no response move TE 5dB and masking 5 dB and plateau again start over Overmasking put too much masking in NTE that the sound travels back to TE I arti cially in ated TE thresholds Central masking decrease in 5 dB in masking because of the in uence of the central auditory pathway BC masking considerations occlusion effect and formula AC NTE CE OE Need to add even more masking to make up for the occlusion effect to know that you re truly reaching BC threshold
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