audiology exam 1

Deaf community

Does not view deafness as a disability or disorder; separate culture with its own language

Sensitivity

Sensitivity is how good your test can identify someone who is actually at risk

Specificity

How accurately the test measures true negative or true positive

True positive

Tool has successfully identified a disorder

False negative

Individual has disorder but they passed screening

False positive

Individual without disorder failed screening

True negative

Passed hearing screening and no disorder

Test at 10 dB

Increases sensitivity to catch everyone; specificity decreases; decreases chance of true negative and increases chance of true positive; increases false positives

Test at 30 dB

Sensitivity decreases; specificity increases; catches true negatives; increases false negatives

Higher dB of testing

Parameters end up passing people who have subtle hearing loss

No screening tool is perfect

Will never correctly identify everyone

Maico pilot sensitivity

Sensitivity of screener is down because it can grab higher/lower frequencies in a complex tone

Air conduction screening

VRA is done with an audiologist, not an SLP on their own

Air conduction screening response

Raise hand at tone after about 4.5 years

Air conduction screening test sequence

15 dB HL; 500, 1000, 2000, 4000 Hz; 6000 Hz for suspected hearing loss

Houston Westlake

Down 10, up 5 for threshold; best 2 out of 3

Screening level

Test if they can hear 15 dB HL; start higher

Referral

Refer if there is no response at any one frequency in either ear using a maximum frequency of 20 dB HL

Rescreening

If they do not respond at 15 dB HL but do at 20 dB HL, can rescreen

Audiologist referral

Even if the individual passes, refer if there is a gut feeling or suspicion of a problem or if there is no reliable response

Transient evoked OAE

More sensitive; can rule out anything greater than moderate loss but will not rule out moderate loss; very susceptible to external movement

Distortion product OAE

More resistant to external movement but not as sensitive

OAE screening limitation

Both rule out severe hearing losses but do NOT rule out mild hearing losses; does not wholly indicate normal hearing

Otoscopy restriction for OAE

Do not probe in if ear looks abnormal

OAE assumption

We are measuring oval window movement from an air-filled middle ear

Middle ear pathology and OAE

OAEs are not present if there is middle ear pathology

Tympanogram screening

if it is anything but a type A, refer

Michigan screener

Good self-report for more severe hearing loss

Outer ear pathology

Visual signs include bright red ear, wax, keloid, and microtia

Keloid

Growth of cartilage

Microtia

Deformed pinna

Otitis externa

Swimmer's ear from swimming in water with bacteria

Glossopharyngeal nerve CN 9

Innervates pinna and ear canal

Conductive hearing loss

Air-bone gap; air conduction outside normal range; bone conduction within normal limits

Normal hearing

15 dB HL is normal hearing

Visual inspection

First visual inspection, then otoscopy

Otitis externa definition and 2 symptoms

Infection and inflammation of the external ear canal; swimmer's ear; severe otalgia; active drainage or inactive dry crusty drainage

Otitis externa testing

Do NOT do a tympanogram or otoscopy

Otitis externa audiogram

Elevated thresholds in lower frequencies

Air to liquid difference

Lower frequencies are harder to get through liquid than high frequencies

Microtia

Deformed pinna

Altman's classifications

1 is less severe; 3 is most severe

Atresia

Deformed or absent ear canal

Anotia

No pinna and typically no outer ear canal

Atresia/microtia occurence

Usually occur together

Atresia/microtia testing

No tympanometry; still do audiometry

Atresia/microtia hearing loss

Usually maximum severe conductive hearing loss; 70 dB HL in lower frequencies and 65 dB HL in higher frequencies

Bone anchored hearing aid/system (BAHA)

Osseointegrated and implanted in the bone; uses bone-conducted amplification

Atresia/microtia treatment

Bone anchored hearing aid/system and surgical intervention

Occluding cerumen tympanometry

Y axis is compliance; X axis is pressure; volume will be low

Normal ear canal volume

Should be 1.0

Occluding cerumen tympanogram

Type B tympanogram; low-volume flat type B is a telltale sign

Occluding cerumen audiogram

30 dB flat conductive hearing loss

Occluding cerumen treatment

Plastic loop; ear lavaging

Foreign body; 2symptoms & treatment & tympanogram

Flat type B tympanogram; 30–40 dB hearing loss on one side; professionally removed

Collapsed ear canal

Not considered pathology; physical finding

Collapsed ear canal cause

Loss of cartilaginous support of pinna can close off ear canal

Collapsed ear canal testing

Use insert earphones

Collapsed ear canal tympanogram

Type A tympanogram with conductive hearing loss

Collapsed ear canal headphones

Conductive loss would only be seen with overhead headphones, not insert earphones

Myringosclerosis

Scar on eardrum from infection, trauma, or inflammation

Myringosclerosis tympanogram

Type As (stiif)

Myringosclerosis audiogram

Normal audiogram

Myringosclerosis

Clinical finding but does not impact hearing

Perforation

Flat type B tympanogram; huge ear canal volume

Perforation ear canal volume

Measures the entire system; normal ECV is 1.0

Tympanoplasty

Skin graft to patch eardrum

Perforation visual finding

May lose light reflex or ability to see head of malleus

Clogged PE tube symptoms

Flat type B tympanogram; normal ECV; mild conductive hearing loss

Otitis media

Types include acute, with effusion, chronic suppurative, adhesive, and silent ear infection

Acute otitis media

otitis media that happens occassionally

Otitis media with effusion

Middle ear system filled with fluid

Chronic suppurative otitis media

Recurring or long lasting

Adhesive otitis media

Glue ear; fluid has been present so long that it turns to a gluey substance

Silent ear infection

No outward symptoms because body has adapted to it; only symptom child exhibits is hearing loss

Chronic silent ear infection impact

can cause speech and language delays

Otitis media symptoms

Type B flat tympanogram; normal ECV; mild bilateral conductive loss

Otitis media laterality

Most otitis medias are bilateral

Otitis media treatment

Amoxicillin; chronic cases may receive PE tubes

Myringotomy

Suck out the fluid and place PE tubes

Acute otitis media recovery

Antibiotics do not speed up acute recovery

Ear infection treatment timing

Doctors might not treat for 3 months if it is the first ear infection

Untreated ear infection

Possible language or articulation delays

Eustachian tube

Middle ear to nasopharynx connection that equalizes pressure

Eustachian tube sphincter muscle

Helps control the Eustachian tube

Eustachian tube dysfunction process

Eustachian tube swells shut and becomes blocked; middle ear pressure cannot be equalized to atmospheric pressure. Epithelial cells ingest oxygen; oxygen is used up and creates negative pressure

Negative middle ear pressure

Causes the tympanic membrane to bulge inward

Eustachian tube dysfunction complications

Can cause chronic ear infection

Eustachian tube fluid

Can be a buildup of fluid from blowing the nose

Epithelial cells role in infection

Excrete fluid to stop swelling of the Eustachian tube

Antibiotics and middle ear fluid

Sterilize fluid by killing bacteria, after which the body can reabsorb it

Middle ear fluid reabsorption

Can take up to 8 weeks

Eustachian tube dysfunction in children

More common because a child's Eustachian tube is more horizontal and does not drain as well

Eustachian tube angle

Almost 90 degrees in kids; 45 degrees in adults

Adult Eustachian tube angle advantages

More effective at draining and venting

Eustachian tube dysfunction treatment

No treatment until it becomes an ear infection

Barotrauma process

Existing pressure from Eustachian tube dysfunction plus further pressure imbalance can perforate the round window

Barotrauma hearing loss

Endolymph and perilymph drain out, causing profound unilateral hearing loss

Cholesteatoma

Growth in attic of middle ear caused by chronic ear infection

Cholesteatoma hearing loss cause

May cause hearing loss because it adds mass in the cavity