Audiology Final Exam (Exam1-4)

The designation of the clinical doctorate in audiology is the

Au.d

The time frame to complete most audiology doctoral programs is

4 years

During the Weber Test, the stem of the tuning fork is held against

The forehead

The air conduction and bone conduction pathways intersect at the

Cochlea

Bone conduction testing

Bypasses the conductive mechanism

When a tuning fork is held to the right mastoid of an individual with conductive hearing loss in their left ear and sensorineural hearing loss in their right ear, the tone

Will be heard in the left ear only

If a person hears a bone conducted tone and then plugs their ears, the tone will become louder if they have

Normal hearing

Conductive hearing loss may be produced by all of the following EXCEPT

Damaged outer hair cells

The term air bone gap suggests that

Bone conduction is better than air conduction

Which of the following does not belong with the other three

Endolymph

The purpose of a hearing screening is to

Identify the possible presence of hearing loss

The pressure reference for dBspl is

20 micropascals

All of the following are important aspects of a decibel EXCEPT

It is a linear scale

5 important aspects of a decibel

1. Involves a ratio

2. Utilizes a logarithm

3. Non-linear

4. Specified in terms of a reference level

5. A relative unit of measure

The Bing test

Determines the presence of the occlusion effect

In a mixed hearing loss

There is impairment in both the conductive and sensorineural mechanism

The conductive mechanism includes

The pinna, ear canal, ossicles, and eustachian tube

It is essential that the examiner have normal hearing when performing the

Schwabach test

A sensorineural hearing loss could be caused by disorder of the

Auditory nerve and inner ear

The air conduction pathway includes

Outer ear, Middle ear, Inner ear, Auditory nerve

Which of the following is FALSE?

Air conduction may be better than bone conduction

2 multiple choice options

Explain why air conduction cannot be better than bone conduction

When AC is impaired, it does not impair BC (conductive hearing loss) meanwhile in sensorineural hearing loss, BC is impaired, meaning AC must also be impaired. An ABG is only present when BC is better than AC.

According to OSHA, one can be exposed to a level of ____ for up to 8 1/2 hours after which hearing is at risk

90 dBspl

The dBA weighted scale

All of the above

A tuning fork test of lateralization when there is unilateral hearing loss is the

Weber

Tuning fork tests are able to

None of the above

The middle ear functions in each of the following ways EXCEPT

As a neural impulse generator

The formula for calculation of dBspl is

20 log PO/PR

TRUE OR FALSE: If the cochlea is normal in each ear for a person who has an ear infection, a bone conducted tone will most likely be heard in the ear that does not have the infection

FALSE

TRUE OR FALSE: Tuning forks are commonly used to test hearing today

FALSE

TRUE OR FALSE: According to NIOSH, exposure to 109 dBspl (such as in a nigh club) is potentially hazardous to your hearing after being exposed to such noise for 1 minute and 53 seconds

TRUE

TRUE OR FALSE: The air conduction pathway bypasses the middle ear

FALSE

TRUE OR FALSE: The occlusion effect is an enhancement of bone conduction when the ear is occluded

TRUE

TRUE OR FALSE: A bone conducted tone will be heard in better cochlea if the middle ear is normal in each ear and there is a difference in hearing between ears

TRUE

Its Cortaca, a housemate is playing music really, really loud; potentially hearing loss loud. To prevent possible damage to your hearing, there are three actions that you can consider taking. What are they?

1. Putting headphones on/ear plugs in

2. Moving away from the house for the day

3. Turn the music down

Conductive hearing loss (3 things)

1. Air conduction impaired

2. Bone conduction normal

3. Air bone gap

Sensorineural hearing loss (3 things)

1. Air conduction is impaired

2. Bone conduction is impaired

3. There is NO air bone gap

Mixed hearing loss (3 things)

1. Air conduction impaired WORSE

2. Bone conduction impaired

3. Air bone gap

You have normal hearing and a patient comes to you complaining of hearing loss. With a tuning fork, you alternate back and forth comparing their BC sensitivity to yours. They can still hear the tone after you cannot hear it anymore. What type of hearing loss and why?

Conductive hearing loss because of the occlusion effect that states that BC sensitivity is enhanced when there is an occlusion. If it were to be sensorineural, the patient would not hear the tone at all depending on severity.

If one has normal hearing and is listening to a low frequency bone conducted tone and then plugs their ears, what happens to the tone and why?

The tone would get louder due to the occlusion effect that states that bone conduction sensitivity is enhanced when there is an occlusion, which in this case is plugging the ears.

A patient complains that they cannot hear out of their right ear. You present a low frequency bone conducted tone behind their right ear. They hear the tone and then you ask them to plug their ear. The tone does NOT become louder. What type of hearing loss and why?

Conductive hearing loss because if there is already an occlusion in the ear, the occlusion effect is already happening and any further occlusion will not have an effect on sound intensity.

A patient complains that they cannot hear out of their right ear. You present a low frequency bone conducted tone to their forehead. They hear the tone in their left ear. What type of hearing loss and why?

Sensorineural hearing loss in the right ear because when one cochlea is damaged, the bone conducted tone will lateralize to the better working cochlea, which, in this case would be the left cochlea.

Define Audiologist

A person in the field of clinical practice devoted to the study of hearing disorders, assessment of hearing, hearing conservation, and aural rehabilitation.

Explain the difference between dBhl and dBspl

dBhl is the sound measurement of what we can hear with human ears and has a reference level of the audiometric zero whereas dBspl is sound pressure level which is measured and has a reference level of 2 X 10^1 micropascals

What is the difference between OSHA and NIOSH?

OSHA- government agency who has teeth and can fine companies for not following precautions that are set, although the time of exposure to certain sound pressure levels are much more lenient than NIOSH (Ex. 100 dBspl-2 hours for OSHA and 30 minutes for NIOSH)

NIOSH- does not have the same pull over companies and is strictly there to educate the public about hearing safety and how to prevent hearing loss

4 work settings where audiologists may be employed

1. Medical setting

2. School setting

3. Rehabilitation facility

4. Private practice/home setting

Right bone conduction unmasked no response

Right bone conduction masked

Right air conduction masked

Right air conduction unmasked

Left air conduction masked

Left bone conduction unmasked

Right air conduction unmasked no response

Left bone conduction masked

Left air conduction unmasked

Right bone conduction unmasked

The bracketing procedure for puretone threshold testing utilizes a

Down 10, up 5 approach

Puretone air conduction threshold test results will determine all of the following EXCEPT

Type of hearing loss

Given the procedure addressed in class, if you start a puretone air conduction test with 30 dB at 1000Hz and you know that the patient understands the directions but does not respond, you would then present the pure tone at

50 dB

Puretone thresholds are generally obtained at octave frequencies from 250Hz through 8000Hz. ASHA recommends that inter-octave frequencies be tested when adjacent frequencies differ by

More than 20 dB

Without bone conduction test results, one is unable to determine _________ by the audiogram alone

hearing loss type

The danger of cross hearing for air conduction presents itself when the following is true:

ACte - IA >= BCnte

Interaural attenuation for bone conduction is

0dB

Because interaural attenuation (IA) for AC differs by frequency, the most conservative approach when using standard supra aural earphones is to consider IA to be

40 dB

IA for insert earphones is estimated to be

70 dB

Failure to identify cross hearing for AC may result in

Underestimation of hearing loss severity

Failure to identify cross hearing for BC may result in

Diagnosing sensorineural hearing loss as being conductive hearing loss

A significant ABG is defined as the difference between AC and BC thresholds on the order of

Greater than 10 dB

TRUE OR FALSE: Bone conduction thresholds are frequently obtained at 8000Hz

FALSE

TRUE OR FALSE: We mask for bone conduction whenever there is an ABG of 10 dB or more

FALSE

TRUE OR FALSE: Under certain circumstances, masking noise can cross over to the test ear

TRUE

TRUE OR FALSE: BC testing assesses the sensitivity of the sensorineural mechanism

TRUE

TRUE OR FALSE: Masked BC symbols suggest the threat for cross hearing was identified and the non-test ear was removed from the test

TRUE

TRUE OR FALSE: It is possible for a person with normal hearing sensitivity to present with an ABG

TRUE

TRUE OR FALSE: A unilateral hearing loss assumes one ear is normal

TRUE

TRUE OR FALSE: When the threat for cross hearing is identified, masking noise is delivered to the test ear

FALSE

TRUE OR FALSE: BC testing is not typically performed at levels greater than 65 dB

TRUE

TRUE OR FALSE: Masking would not be necessary in the case of bilateral severe sensorineural hearing loss

TRUE

TRUE OR FALSE: Unmasked BC testing will reflect the BC sensitivity of the better cochlea

TRUE

Normal severity

-10dB to 25dB

Mild severity

26dB to 40dB

Moderate severity

41dB to 55dB

Moderately-severe severity

56dB to 70dB

Severe severity

71dB to 90dB

Profound severity

>90dB

Air conduction on audiogram tells you

Severity and configuration

Bone Conduction on audiogram tells you

Type of hearing loss

How to determine when the threat for cross hearing exists for AC

ACte - IA >= BCnte

How to determine when the threat for cross hearing exists for BC

Look for air bone gaps!

What is masking and why is it done?

In certain circumstances during initial testing, the BC sensitivity of the left and right ear will reflect as the same, because it is reflecting the BC sensitivity of the better cochlea. To avoid misdiagnosing sensorineural hearing loss as conductive hearing loss, we must put noise in the ear we are not testing to distract that cochlea from hearing the tone being presented to the other ear.

The type of tympanogram most likely to be found with sensorineural hearing loss would be a

Type A tympanogram

A flat tympanogram is considered a

Type B typmanogram

Ossicular discontinuity / disarticulation may be reflected in a

Type Ad tympanogram

Type B tympanogram is associated with

All of the above

A type C tympanogram would be most consistent with

Eustachian tube dysfunction

3 multiple choice options

The stapedius muscle is innervated by

Cranial nerve VII

Absence of an acoustic reflex is probable in

All of the above

The efferent pathway for the acoustic stapedial reflex originates at the

Superior olivary complex

Type As tympanogram would most likely be associated with

None of the above

Static acoustic compliance at C2 is reflective of

Outer ear + middle ear compliance