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Date Created: 11/01/15
S110 Survey of Communication Disorders Fall 2009 Exam lll Review Outline 1 Lecture 13 Anatomy of the Auditory System a b C d D r on 3quot Peripheral Components i Conduction of sound amp Sensory transduction and neural transmission ii Conductive outer and middle ear Transmission inner ear and auditory nerve Central Components i Brainstem Brain The Outer Ear i Pinna concha ear canal cerumen ii Protects the outer and middle ear The Middle Ear i An airfilled cavity lined with mucous membrane ii Components 1 Tympanic membrane 2 Eustachian tube 3 Ossicles a Malleus b lncus c Stapes 4 Oval window 5 Round window Eustachian Tube i Maintains the air pressure within the middle ear space and opens during yawning and swallowing Why is there interdependence i If the cochlea were on the interior side of the tympanic membrane rather than the middle ear system 999 of sound energy would bounce off the TM and never reach the inner ear The malleus is longer than the incus so the difference in the length creates leverage so that less energy is needed to move the incus and hence the stapes Middle Ear Functions i Overcome the difference in impedance between air and the fluidfilled head protection from loud sounds The Inner Ear i Components Organ of Corti Basilar membrane lnner and oter hair cells Vestibule Semicircular canals Scala vestibule tympani and media Modiolus Stereocillia mwmwewwe 2 i Cochlea i Components Helicotrema Reissner s membrane Basilar membrane Scala vestibule media tympani Organ of Corti Auditory nerve j quotTraveling Wa e i A vibration that occurs along the basiar membrane and when stimulated by sound and ultimately determines the response of the organ of Corti to sound k Tonotopic Representation in the Cochlea i Low frequencies 1 Maximum displacement in the apex ii High Frequencies 1 Maximum displacement in the base lnner and Outer Hair Cells i lHC responsible for producing our sensation of hearing ii OHCcontain stereocillia nd ion channels but do not send information to the auditory nerve move to push and pull the basiar membrane cochlear amplifier m Tonotopic and Binaural lnfo Representation i Tonotopic maintained throughout ALL auditory nerve fibers from cochlea end in cochlear nucleus ALL fibers end at MCB before going to cortex ii Binaural begins at SOC mmprNI l Lecture 14 Diagnosing Hearing Loss a Know how to read an Audiogram b Conductive Sensorineural and Mixed Hearing Loss i Conductive HL indicated problems with sound transmission through the outer andor middle ear BC normal and AC elevated ii Sensorineural HL indicated problem with inner andor auditory nerve AC and BC are elevated relative to normal iii Mixed HL hearing loss has both conductive and sensorineural components difference in AC and BC BC thresholds are elevated c 5 Hearing Evaluation Components i Case History ii Otoscopic Examination iii Puretone Audiometry iv Speech Audiometry v lmmitttance Measurements d Abnormal Otoscopic Findings Microtia deformed pinna Skin pits or tags Flaky and dry lining of the ear canal iv lnflamed and swollen canal v Stenosis narrowing of the canal vi Atresia absence of an ear canal vii Cerumen obscuring the eardrum viii Abnormal growths e Air and Bone Conduction Testing Air Conduction AC sound travels through outer and middle ears before entering the cochlea 1 Tests sensitivity to sound transmitted through the outer and middle ear before arriving to the inner ear 2 Performed with headphones or insert earphones 3 Tests frequencies 25050010002000300040006000 and 8000 HZ Bone Conduction BC sound bypasses outer and middle ears and travels directly to the cochlea via skull vibrations 1 Tests sensitivity of the inner ear and beyond to sound bypassing transmission through the outer and middle ear 2 Performed with the bone conduction vibrator 3 Tests frequencies 250500100020003000 and 4000 HZ f Transducers i Ear phones headphones loud speakers or bone vibrator g Plotting Hearing Thresholds i Thresholds are at or below 15dB at all test frequencies h Degrees of Hearing Loss 39 Normal Mild 2039 dB HL Moderate 4054 dB HL ModeratelySevere 5569 dB HL Severe 7089 dB HL v Profound gt89 dB HL Flat Sloping and Notched Configuration i Flat relatively flat line ii Sloping slopes downward iii Notched slopes down then back up upsidedown mountain j Tests for Speech Audiometry i Speech Reception Threshold SRT what is the lowest level at which speech can be recognized 50 of the time ii WordRecognition Score WRS how good is speech recognition and in noisy situations Tests of lmmitance iv Tympanometry measurement of middle ear mobility v Acoustic Reflex Thresholds measure of the lowest level at which the acoustic reflex occurs find a lesion beyond the inner ear ie in the brainstem 3 Lecture 15 Pediatrics ltE39 b ii Toxoplasmosis iii Other iv Rubella v Cytomegalovirus vi Herpex simplex c Why test early for HL i Must be tested early if there is any chance of stimulating the auditory system and avoiding a speech language andor cognitive delay 1 Input to the brain is critical for developing and maintaining connections in the central auditory system 2 The sooner there is input the greater the chance of the auditory system developing normally d Two ways to measure HL in infants i Electrophysiologicaltests 1 Otoacoustic Emmissions OAE s a Sound goes through cochlea and generated by the action of the outer hair cells b Determine the integrity of the auditory system c A very fast test easy for children d Can only detect moderate or worse hearing losses 2 Auditory Evoked Potentials a llbrain waves measured in response to sound b Can assist in determining if a quotneuralquot lesion is present in auditory pathways of brainstem c Can determine threshold to within 15 dB e Visual Reinforcement Audiometry i Used for children 5 months to 2 years ii The child is conditioned to turn their head to a reinforcing object in response to an acoustic stimuli infants and toddlers learn that when they hear a sound and turn their heads they get reinforced by the quotreinforcequot which is often a moving lightup toy iii Can test speech pure tones or noise stimuli f Conditioned Play Audiometry i Assess hearing acuity using conditioned responses 0 sound by engaging in play oriented activities ii 24 months through 5 years iii The child is conditioned to perform a play activity whenever he or she hears a sound iv Results define the nature and degree of hearing impairment g Most Common Cause of HL in Children i Genetic HL is rarely genetic ii Congenital present at birth but not genetic iii Acquired normal hearing at birth with HL acquired sometimes after otisis media 4 Lecture 16 Hearing Loss in Adults a HL remediated surgically or medically Conductive HL 1 Treated by antibiotics or surgery ii Mixed HL 1 Conductive can be corrected 2 Sensory loss wont be recovered c Common Causes for Sensorineural HL i Noise exposure and aging d Retrocochlear HL disorder i A tumor acoustic neuroma e Hallmarks of HL etiologies NoiseInduced HL Notch between 46 Khz 5 Lecture 17 Hearing Aids and Cochlear Implants a Goal of Hearing Aids i Hearing aids attempt to compensate for the hearing loss by amplifying sound in frequency regions that correspond to the region of hearing loss b Selecting Hearing Aids or Cochlear lmplants i Hearing aids is best for mild to severe HL ii Cochlear lmplants is best for severe to profound HL c Hearing Aids to Improve Speech Recognition i HL is mainly in the high frequencies te hearing aid boosts or amplifies only those frequencies d Adv amp Dis Of BTE ITE and CIC i Fds e Components of a Hearing Aid i Microphone ii Receiver iii Amplifier iv Battery v Earmold f Dynamic Range and Frequencies i Dynamic range is decreased in patients with hearing loss amplified sound must fit into patient s dynamic range ii Cant amplify all frequencies the same g Reasons for Rejecting a Hearing Aid i Lack of money ii Attracts unwanted attention iii Overstimulation iv Pain in ear canal v Bad experience h Objective and Subjective Benefits i Objective aided and unaided speech recognition syllables words sentences ii Subjective Hearing aid use diaries subjective scales assessment of CHANGE from Unaided to Aided i Cochlear lmplants Surgically implanted that bypasses the damaged part of the inner ear to electrically stimulate the remaining neural fibers of the auditory nerve 1 Must be 12 months or older 2 For Severe to profound HL 3 Limited benefit from hearing aids j When is the best for the implantation for the best chances of hearing i Before the age of 35 k Cochlear Implant Components i lnternal Device 1 Surgically implanted under the skin 2 Electronic package with magnet 3 Electrode array placed inside the cochlea ii External Device 1 Worn on the body or at ear level 2 Soundspeech processor 3 Microphone 4 Coil with magnet How do the Internal and External Devices Work Together i The external components of the Cl system pick up sounds analyze them and convert them into an electrical signal that is sent to the internal device located under the skin m Tonotopic Mapping Maintained i Number of frequency channels into which sound is divided has been increasing with technology n Cochlear Implant vs Hearing Aid i Cl is at 3OHZ while HA is at 7OHZ ii Cl allows more pure tone audiometry than a HA
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