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screening vs. diagnostic
screening involves quick, preliminary tests to identify potential hearing loss (pass/fail)
diagnostic allows the audiologist to determine the type and severity of the hearing loss
what does the outer ear do?
collects sound waves from the environment and directs them to the eardrum
what does the outer ear include?
the pinna and the external auditory meatus
what does the middle ear do?
amplifies the sound from the ear drum and sends to the inner ear
what does the middle ear include?
the ossicles: malleus, incus, stapes
tympanic membrane
what does the inner ear do?
the cochlea converts sound waves into electrical impulses
the auditory nerve sends those impulses to the brain
what does the inner ear include?
the cochlea
the auditory nerve
when does conductive hearing loss occur?
when sound waves are prevented from reaching the inner ear due to damage to the outer or middle ear
when does sensorineural hearing loss occur?
when there is damage to the inner ear
what is db spl?
decibels sound pressure level
what does db spl measure and estimate?
measures the magnitude of air molecules
estimates how loud or soft a sound will be percieved by a human
what is db hl?
decibels hearing level
what does db hl measure?
the intensity at which sound can be heard
what is db sl?
decibels sensation level
what does db sl measure?
how intense a sound is relative to a person's hearing threshold
what does 0 db hl mean?
the softest sound at which a person aged 18-35 with normal hearing can hear
why do we use db hl?
as a consistent baseline to compare a person's hearing threshold at certain frequencies
what is represented on the y-axis of an audiogram?
how loud a sound needs to be for a person to hear it (measured in db)
what is represented on the x-axis of an audiogram?
pitches or frequencies (measured in Hz)
how is the right ear air conduction unmasked represented on an audiogram?
red "O"
how is the left ear air conduction unmasked represented on an audiogram?
Blue "X"
how is the right ear bone conduction unmasked represented on an audiogram?
red "<"
how is the left ear bone conduction unmasked represented on an audiogram?
Blue ">"
how is right ear air conduction masked represented on an audiogram?
red "🔺"
how is left ear air conduction masked represented on an audiogram?
blue ""
how is right ear bone conduction mastoid masked represented on an audiogram?
red "["
how is left ear bone conduction mastoid masked represented on an audiogram?
blue "]"
how is right ear bone conduction masked forehead represented on an audiogram?
red "⸣"
how is left ear bone conduction masked forehead represented on an audiogram?
Blue "⸢"
how is left ear bone conduction forehead unmasked represented on an audiogram?
blue "v"
how is right bone conduction forehead unmasked represented on an audiogram?
red "v"
what is the purpose of tynpanometry?
evaluates the function of the middle ear by measuring how the eardrum responds to changes in air pressure
what does tympanometry detect?
middle ear fluid
eardrum perforations
eustachian tube dysfunction
ossicular chain abnormalities
what is the purpose of otoacoustic emissions (OAE)?
measures sound produced by the inner ear (cochlea) in response to external sound stimulus
what does OAE detect?
cochlear function
hair cell activity
what is OAE used in?
newborn hearing screenings and detecting cochlear hearing loss
what is the purpose of auditory brainstem response (ABR)?
assess the hearing nerve and brainstem's response to sound
what does ABR detect?
neural pathway integrity
retro cochlear disorder
hearing thresholds in infants or children who cannot undergo traditional hearing tests
how is ABR performed?
electrodes are placed on the scalp to record responses
what is the purpose of speech audiometry?
measures the ability to hear and understand speech at different volumes
what does speech audiometry detect?
speech recognition thresholds (SRT)
word recognition scores (WRS)
what does speech audiometry help with?
assessing the practical impact of hearing loss on communication
what is the purpose of acoustic reflex testing?
evaluates the reflexive contraction of the middle ear muscles in response to loud sounds
what does acoustic reflex testing detect?
middle ear integrity
cochlear integrity
auditory nerve integrity
what can acoustic reflex testing help with?
diagnosing conditions like bell's palsy or acoustic neuromas
what is the purpose of vestibular testing (VNG and ENG)
assesses balance and dizziness
what can VNG and ENG detect?
vestibular system disorders (inner ear balance issues)
what can VNG and ENG testing cause?
dizziness, vertigo or balance problems
what is the purpose of pure tone testing?
standard part of an audiogram where pure tone of various frequencies and intensities are played
what does pure tone testing detect?
specific frequencies at which a person has hearing loss
what is the purpose of bone conduction testing?
measures the inner ear's response to sound delivered through the skull bones
what does bone conduction testing detect?
differentiates between conductive and sensorineural hearing loss
how is bone conduction testing performed?
by placing an oscillator on either the mastoid bone or forehead to bypass the outer and middle ear
what is sound?
a condition of disturbance of particles in a medium
the mediums particles...
remain relatively fixed
what are the 3 necessary components to make up sound?
an energy source
a body capable of vibration
a transmission medium
what is the anatomy of a sinusodial (sin) wave?
amplitude
wavelength
what is intensity?
the strength and power of a sound (measured in dB)
what is loudness?
how we perceive the intensity of a sound
what is frequency?
the number of waves that pass a given point per second (measured in Hz)
what is pitch?
How high or low a sound is
what is phase?
the position of a sound wave at a particular point in time
what is in phase?
when 2 waveforms are perfectly aligned in time, and their cycles begin at the same time
what is constructive interference?
when 2 waves are in phase, they add together to create a sound wave with an amplitude that is the sum of 2 waves' amplitudes
what is out of phase?
when 2 waveforms are time-shifted and one wave begins at a different time than the other
what is destructive interference?
when 2 waves are out of phase, they cancel each other out when added together
what is constructive?
complex sounds (speech)
is sound physically quantifiable?
yes, we can measure sound
what does "no sound" mean?
the absence of sound waves or vibrations in the air
what would we need for "no sound" to occur?
no vibrations
vacuum environment
soundproofing
why do we use soundproof/sound treated booths?
to try to get reliable thresholds, so we can control the sound
what is the mastoid process?
a bone located just behind the ear
what does the mastoid process help with?
anchoring the muscles of the neck and jaw
what do we use the mastoid process for?
a point to test bone conduction hearing
what is the air conduction pathway?
acoustic energy --> mechanical energy --> neuroacoustic energy --> neurological energy
what is air conduction?
the normal means of sound transmission in day-to-day situations
what does pure tone air conduction audiometry determine?
the degree of hearing (loss or normal) at each frequency individually
what is the result of bone conduction testing?
differentiate between conductive and sensorineural hearing loss, providing the etiology of the loss
where are low frequencies and high frequencies in tonotopic organization of the cochlea?
low frequencies at apex, high frequencies at base
what are the anatomical components of the conductive mechanism?
outer ear (pinna, ear canal)
middle ear (tympanic membrane, ossicles)
eustachian tube
what are the anatomical components of the sensorineural mechanism?
inner ear
Cochlea
basilar membrane
hair cells
auditory nerve
auditory brainstem
auditory cortext
which pathway contains the outer ear, middle ear, inner ear, 8th nerve and brainstem?
air conduction pathway
what type of hearing loss is caused by fluid in the space that contains the malleus, incus, and stapes?
conductive hearing loss
what type of hearing loss is caused by eustachian tube blockage?
conductive hearing loss
what type of hearing loss is caused by damage to the inner hair cells?
sensorineural hearing loss
what type of hearing loss is caused by damage to the outer hair cells?
sensorineural hearing loss
what type of hearing loss is caused by blockage of the external auditory meatus?
conductive hearing loss
what type of hearing loss is caused by damage to the stapes and outer hair cells?
mixed hearing loss
which anatomical components and mechanisms are measured by air conduction testing?
outer ear
middle ear
inner ear
auditory nerve
which anatomical components and mechanisms are measured by bone conduction testing?
inner ear
auditory nerve
central auditory pathways
what do air conduction responses tell you about the severity of hearing/hearing loss?
reflects how well the entire auditory system is functioning
what do bone conduction responses you about the severity of hearing/hearing loss?
reflect the function of the inner ear and auditory nerve, bypassing the outer and middle ear
what type of hearing loss is determined if bone conduction thresholds are normal, but air conduction thresholds are elevated?
conductive hearing loss
what type of hearing loss is determined if bone conduction thresholds are elevated?
sensorineural hearing loss
what is the difference between air conduction. and bone conduction thresholds? (greater than 10 dB)
air-bone gap
what does air-bone gap suggest?
conductive hearing loss
what is speech reception threshold (SRT)?
the lowest level at which a person can correctly recognize and repeat 50% of simple spoken words (spondee words)
what is the range for normal hearing?
-10 - 15 dB
what is the range for slight hearing loss?
16 dB - 25 dB
what is the range for mild hearing loss?
26 - 40 dB