Speech Pathology HI Child Exam 2

Visual inspection regarding otoscopy

information regarding basic anatomical normality

• happens before performing otoscopy

• during the case history gathering process

• structure of pinna and parts of ear canal

what is the importance of the visual inspection before otoscopy?

to monitor the external health of the outer ear, report changes to the managing physician, audiologist

what do you look for during a visual inspection?

• examine the shape and size of the pinna

• pits

• tags

• atresia/microtia

• keloids

What is an example of a skin tag?

What is an example of a preauricular pit?

What is an example of a keloid on the pinna?

What is an example of microtia of the pinna with atresia of the external auditory canal?

Questions to consider for visual inspections

• facial features symmetrical?

• head proportional to body?

• forehead protruding?

• eyes appropriately apart?

• eyes sunken?

Otoscopy includes:

• the otoscope

• choosing a speculum

• positioning the otoscope

• positioning the pinna

What is an example of an otoscope?

What are the otoscopy Dos

Do

• earn patients’ trust

• exercise precautions when coming in contact with the patient

• explain the process (I’m going to take a look in your ear)

What are the otoscopy Don’ts

Don’t

• perform otoscopy on ear with drainage

• push the process if there is ear pain

• perform otoscopy on a child first if child is hesitant about testing process

Although you might speculate or have a good idea of otitis media, it is NOT within the scope of practice to diagnose those medical conditions audiology or slp

true

What are some common physical findings of otoscopy?

• bug in ear

• perforated ear drum

• excessive wax

• drainage

Tympanometry

Nonbehavioral direct measurement of the function of the middle ear system

• evaluates functional properties such as ear canal volume and mobility of the tympanic membrane and ossicles

• provides information regarding health of middle ear structures

Tympanometry regarding pressure

• decapascals

• referenced to atmospheric pressure

• provides info regarding the function of the eustachian tube

tympanometry regarding compliance

• units: cc or mL

• measurement of mobility

• provides information regarding ossicular chain, TM health, and ME pathology

tympanometry regarding ear canal volume

units: mL

measurement of physical volume of ear canal

provides information regarding outer ear pathology, TM perforation, pressure equalization tube patency

When not to perform tympanometry

• surgery

• drainage

• visual obstructions

The audiogram

• interpreting is a skill every SLP should have

• help understand degree and type of hearing loss

• allow you to educate that specific loss may impact child’s education/ comm.

• sometimes you are the hearing expert

Audiogram in a nutshell

scaled graphic description of a person’s hearing perceptibility

• dB SPL to dB HL for clarity of understanding intensity by function of frequency

What is the lowest level at which normal hearing people begin to detect sound?

audiometric zero (does not mean no sound)

It is inappropriate to describe hearing loss as percentage as it is a scale of hearing.

true

How are audiograms described?

degrees

• normal

• slight

• mild

• moderate

• moderately-severe

• severe

• profound

Components of the audiogram

frequency

• number of cycles of vibration per one second of time

• Hz

intensity

• measure of pressure per unit area

• dB HL

What transducers are used to test sound field, ear specific, bone?

• headphones

• insert earphones

• speakers

• oscillator

Plotted thresholds softer than (below) 20 dB HL are normal thresholds

true

Plotted thresholds louder than (higher) 20 dB HL are deemed part of hearing loss and described by degree.

true

review of symbols

(no response: recorded as downward arrows in the direction of the ear that is being test)

Pitch is the perception of

frequency

Loudness is the perception of

intensity

What does air conduction test?

the entire system

• outer, middle, inner, neural

What does bone conduction test?

the inner ear and neural

What transducers does masked bone conduction use?

both insert and headphones

What is the anticipated speech ability between around a mild hearing loss at 20 dB HL?

the sound S at about 21 dB HL

What is the anticipated speech ability around a mild hearing loss between 21 and 40 dB HL?

• oo at about 30 dB HL

• ee at about 40 dB HL

What is the anticipated speech ability around a moderate hearing loss between 41 and 70 dB HL?

• m at about 41 dB HL (oo again)

• sh at about 45 dB HL

• ah at about 50 dB HL

For a normal hearing sensitivity, hearing losses should be symmetric meaning

the same in both ears

What does air and bone conduction look like for normal hearing sensitivity?

What is the range for a normal hearing loss?

-10 to 20 dB HL

What is the range for a mild hearing loss?

20-40 dB HL?

What is the range for a moderate hearing loss?

40-50 dB HL

What is the range for a moderately severe hearing loss?

55 ish to 70 dB HL

What is the range for severe hearing loss?

70-90 dB HL

What is the range for a profound hearing loss?

90-120 dB HL

Degrees on hearing loss on the audiogram

What is asymmetric hearing sensitivity?

it is not the same hearing sensitivity in both ears

what is sloping on the audiogram?

when the hearing loss continuously goes down creating a slope on the graph

Explain the results of this audiogram?

• the right ear has normal hearing

• the left ear has mild sloping to profound hearing loss

What is a conductive hearing loss?

a hearing loss in the outer or middle ear

• abnormal air conduction

• normal bone conduction

• presence of air-bone gap

What type of hearing loss is this ad describe the results?

• bilateral mild conductive hearing loss

What is a sensorineural hearing loss?

hearing loss in the inner ear or neural pathways

• air and bone gap aligned exceeding 20 dB HL

• no air-bone gap

What type of hearing loss is this and what are the results?

bilateral mild sensorineural hearing loss

What is a mixed hearing loss?

hearing loss in the outer or middle ear along with the inner or neural pathways

• combination of abnormal air and bone conduction

• air conduction is significantly worse than bone

• are bone gap present

What type of hearing loss is this and describe the results?

bilateral mild to severe mixed hearing loss

What is normal hearing sensitivity for a child?

-10-15 dB HL

When should you screen for hearing loss?

25 dB HL

What is the conversation level for 35-45 dB HL?

soft

What is the conversation level for 55-65 dB HL?

normal

what is the conversation level for 75 dB HL and greater?

loud

conversation level for speech in dB HL

speech sounds in relation to audiogram and hearing loss

slight hearing loss regarding speech understanding abilities

• not hear the endings of words

mild degree of hearing loss regarding speech understanding abilities

• significant delays in development

• difficulty in early reading skills

• can mis 24- 40 %of speech signal

moderate degree of hearing loss regarding speech understanding skills

• can miss up to 80% of average level conversational speech

• flat voice quality, atypical speech production, bad syntax, limited vocabulary

moderately severe hearing loss regarding speech understanding skills

• miss 100% of average conversational speech

severe and profound hearing loss regarding speech understanding abilities

• can miss 100% of ALL speech

What is high frequency hearing loss?

greater loss in higher frequencies than in lower

What is the word recognition score?

it determines how well a person can recognize and repeat words when presented in an ideal listening environment.

What is speech audiometry?

the assessment of awareness and identification of a speech signal

speech audiometry is used as a cross check to confirm hearing sensitivity by pure tone thresholds.

true

What is the purpose of speech audiometry as it relates to hearing sensitivity?

a sound is presented to the patient at descending levels until the patient can indicate repetition or awareness of the word or sound 50% of the time

What are other methods of obtaining speech thresholds if the patient does not want to speak?

• picture boards

• toys

• pointing to body parts

What are the stimulus types for speech audiometry?

• words

• speech sounds

• warble tones

What is the Speech Recognition/Reception Threshold (SRT) ?

repeat words at barely audible level

What is Speech Awareness Threshold (SAT)?

indicates awareness of words at barely audible level

What is Word Discrimination Testing (WDT)?

determines clarity of word understanding given the hearing sensitivity level

Word discrimination testing/ word recognition testing

• different btw detection and discrimination/recognition ability

• relationship btw pure tone thresholds and discrimination/recognition ability

• hearing and understanding

What is the purpose of pure tone audiometry?

it determines loudness or intensity threshold in dB HL where a sound is barely audible

Air conduction testing represents entire auditory system including

outer, middle, inner ear

Air conduction audiometry represents

how we are hearing day to day

During pure tone audiometry, instructions for the patient are important in obtaining accurate information

true

For pure tone audiometry, what are the air conduction testing instructions?

1. indicate the purpose of the test

2. emphasize that it is necessary to sit quietly

3. indicate that the participant is to respond whenever tone is heard

What are patient responses that are appropriate in air conduction testing?

• hand raising

• response button

• play audiometry

• visual reinforcement

What does bone conduction testing represent?

how sound is transduced through the cochlea and neural pathways

In bone conduction audiometry, regardless of the oscillator placement, the better cochlea will always respond first.

true

Auditory disorder

abnormality of the anatomical structures of the auditory system

Auditory impairment

loss of function of the auditory system

Disability

any restriction of lack of ability to perform an activity in the manner or within the range considered normal for a human being

Hearing Handicapped

difficulty an individual experiences as a result of an impairment

What is the purpose of audiologic screening?

to identify those who need further treatment

When should you refer for audiologic screening?

• failure for any part of the screening

• concerns from professional

• concerns from family

How do you test otoacoustic emissions function?

sound is presented to the ear via a probe, in response the ear produces a sound and sends it back. The probe records the sound sent back

Are otoacoustic emissions function tests sensitive enough to determine mild ear loss?

no

It is within the scope of an SLP to conduct OAE and ABR screening.

yes

What do electrophysiological measures do? (like ABR)

determines transduction of sound beyond the cochlea via electrodes

• recorded in dB nHL (neural hearing level)

• predominant waveforms correspond with specific points along neural pathways

Electrophysiological measures are used in conjunction with other tests to identify hearing loss.

true

What is the best tool for newborn hearing screening regarding electrophysiological measure?

automated auditory brainstem response

Hearing aids made into earrings

body style hearing aid