SLHS-340 Exam #3

What are otoacoustic emissions? pre or post-neural?

pre-neural potentials generated by the cochlea that can be recorded by the ear canal

What do otoacoustic emissions measure?
A. inner hair cell function
B. outer hair cell function
C. basilar membrane function

B. outer hair cell function
OAE's occur in a healthy cochlea

T/F: Normal OAE's \= Normal Hearing

FALSE: Normal OAE's do not equal normal hearing
*OAE's are not a hearing test

what does the microphone within the probe that records OAE's do?
what happens with the data collected?

the microphone within the probe records the low level OAE's and sends them to a computer for SIGNAL AVERAGING

*signal averaging: takes measurements across frequencies

Describe DPOE's

Distortion Product Otoacoustic Emissions
elicited by two pure tone frequencies, F1 and F2

What is the relationship between f2 and f1 in DPOAE's? what is the formula for the largest DPOAE?

f2 \> f1
f2 + f1 create an interaction within the cochlea producing a 3rd tone

Largest DPOAE: 2f1-f2 \= \_____ Hz

At which frequencies do we test DPOAE's?
A. 1000-1800 Hz
B. 250-2000 Hz
C. 100-4000 Hz

A. 1000-1800 Hz

Why don't we test DPOAE's below 1000 Hz? What does this look like on the DPOAE graph?

we don't test frequencies below 1000 Hz because we can not eliminate biological background noise (i.e. breathing), BUT we can compensate by shifting frequencies up higher

this creates a NOISE FLOOR on the DPOAE graph

When are DPOAE's absent?
A. absent in individuals with sensorineural HL \> 55 dB HL
B. absent in individuals with conductive HL
C. absent in individuals with pure neural/retrocochlear hearing loss
D. both A & B

D. both A & B

A. absent in individuals with sensorineural HL \> 55 dB HL
B. absent in individuals with conductive HL

Where are DPOAE's present?
A. in individuals with sensorineural HL \> 55 dB HL
B. individuals with conductive HL
C. in individuals with pure neural/retrocochlear hearing loss

C. in individuals with pure neural/retrocochlear hearing loss

want to always check middle ear function BEFORE DPOAE's
*absent OAE's are reflected when there is a middle ear problem

Describe TEOAE's

elicited by a click stimulus (multi-frequency) with acoustic energy between 2000-5000 Hz

when do TEOAE's occur relative to the stimulus level? how long do they last?
A. occur 10 msec after the stimulus and last 10 msec
B. occur 4 msec after the stimulus and last about 10 msec
C. occur 4 msec after the stimulus and last 4 msec

B. occur 4 msec after the stimulus and last about 10 msec

when are TEOAE's absent?
A. in individuals with sensorineural HL \>30 dB HL
B. in individuals with conductive hearing loss
C. in individuals with pure neural/retrocochlear HL
D.. Both A & B

D.. Both A & B

A. in individuals with sensorineural HL \>30 dB HL
B. in individuals with conductive hearing loss

when are TEOAE's present?
A. in individuals with sensorineural HL \>30 dB HL
B. in individuals with conductive hearing loss
C. in individuals with pure neural/retrocochlear HL

C. in individuals with pure neural/retrocochlear HL

T/F: OAE's tell you the degree of hearing loss

FALSE

OAE's do not tell you the degree of hearing loss, only measure outer hair cell function

what are some of the clinical operations of OAE's?

1. newborn hearing screening
2. pediatric assessment
3. functional hearing loss
4. monitor outer hair cell function after ototoxic medications (i.e. chemo)
5. intraoperative monitoring

what do auditory evoked potentials measure?
A. degree of hearing loss
B. auditory neural function using various time windows
C. otoacoustic emissions

B. auditory neural function using various time windows

what is latency?

how long it takes you to understanding something (short, medium, and long latency)

what are ABR's? where are they generated?

auditory brainstem responses
auditory neural activity generated within the 8th nerve and the brainstem pathway in response to a sound

what do ABR's allow us to check the integrity of?
A. OHC's
B. IHC's
C. the basilar membrane

B. IHC's

*not a hearing test

what does ABRs being "time locked" to a stimulus mean?

neurons within a structure are firing together in tune with a stimulus, which creates a clean ABR wave

each wave originates from a single anatomic site

what are the ABR generator sites IN ORDER?

1. 8th nerve as it exits the cochlea
2. proximal portion of the 8th wave (toward the top)
3. lateral side of the cochlear nucleus, mostly the ventral cochlear nucleus
4. superior olivary complex
5. lateral lemincus and inferior colliculus

ABR's demonstrate...
A. degree of hearing loss
B. neural function up to the level of the brainstem
C. cochlear function

B. neural function up to the level of the brainstem

what kinds of stimuli are used for ABRs?
A. clicks (TEOAE's)
B. tone pips
C. DPOAE's
D. both A & B

D. both A & B

A. clicks (TEOAE's)
B. tone pips

what is the spread of excitation? how do we avoid spread of excitation when administering ABR's?

spread of excitation \= unwanted BM response

solution \= masking
*risk spread of excitation when you use tone pips for ABRs

T/F: the amplitude of an ABR is measured between the positive peak and later negative trough and it demonstrates how many neurons are firing

TRUE

what is the difference between interpeak latency responses and absolute latency responses?

absolute: from the onset of the stimulus to the peak of the wave

interpeak: absolute latency between two peaks

how do you calculate the threshold for ABR measures?

reduce the presentation level until a measurable wave V (lateral lemniscus and inferior colliculus) is ABSENT

what are MLR's? when do they occur?
A. mild little responses, they never occur
B. mild latency responses, 50-250 msec after stimulus presentation
C. middle latency response, occur 10 to 15 msec after the stimulus presentation

C. middle latency response, occur 10 to 15 msec after the stimulus presentation

*represent neural activity from thalamus and part of the auditory cortex

what are LLR's? when do they occur?
A. long latency responses, 50 to 250 msec after stimulus presentation
B. late latency responses, occur 10 to 15 msec after stimulus presentation
C. lame latency responses, never occur

A. long latency responses, 50 to 250 msec after stimulus presentation

*only determines processing in the cochleaT/F

T/F: ABR's will not be affected with conductive hearing loss

FALSE

with conductive HL, all waves will be prolonged, but the interpeak latencies will remain normal

T/F: with cochlear hearing loss, ABRs will exhibit a decrease in waveform morphology and prolonged waves at lower presentation levels, but normal range at higher presentation levels

TRUE

describe the pattern of ABR's with retrocochlear hearing loss
A. prolongation of all waves
B. loss of waveform morphology
C. delay that resembles conductive HL, only wave V prolongation, absent waves, or prolonged interpeak latencies

C. delay that resembles conductive HL, only wave V prolongation, absent waves, or prolonged interpeak latencies

describe microtia

outer ear pathology
malformed or smaller pinna (smaller ECV)

what does ONLY microtia present as on an otoscopy/tympanogram?

if ONLY microtia, the otoscopy and tympanogram will present as normal (use pediatric inserts)

describe microtia with atresia (complete)

no ear canal opening
conductive hearing loss, "built in ear plug"

what are the symptoms of microtia with atresia?

issues with localization
will present as a clear air-bone gap

T/F: you can perform otoscopy and tympanometry on microtia with atresia

FALSE
can't perform otoscopy or tymponometry

microtia, atresia, & anotia: describe grade I, grade II, and grade III, and anotia

Grade I: normal, only missing ear lobe
Grade II: very small opening, will likely occur as a conductive HL
Grade III: still have an outer ear, but very minimal
ANOTIA: absence or closure of the ear canal

describe anotia

outer ear pathology
absent pinna (NO pinna)

what are the management strategies for anotia?

usually fixed surgically (reconstruction, prosthetic ears)

describe atresia

outer ear pathology
absence or closure of the ear canal

what are the management strategies for atresia?

surgery is a possibility
bone-anchored hearing aids, depending on the condition of the cochlea

describe external otitis

outer ear pathology
inflammation of the external canal caused by virus, fungus, and most likely bacteria

what are the symptoms of external otitis?

red external auditory canal
itching in the ear canal or pinna
SMELLS BAD

what are the management strategies for external otitis?

topical antibiotics
clean and flush the ear canal regularly

describe excessive cerumen

more prevalent in older adults
build up needs to be significant before hearing becomes affected

what is the difference between excessive vs. impacted cerumen?

separated by tympanometry

excessive: will have a normal tympanogram, so the tymp can move normally
impacted: pressure can't go around wax to move the middle ear

is there hearing loss associated with excessive cerumen?

yes, likely conductive

what are the management strategies for excessive cerumen?

remove the cerumen via ear drops, irrigation, or by an ENT

what are the symptoms for a foreign object?

outer ear pathology
likely pain

T/F: otoscopy reveals the problem for a foreign object

TRUE

will there be hearing loss with a foreign object in the ear?

likely no hearing loss unless the object is COMPLETELY blocking the ear canal

describe stenosis

narrowing of the ear canal

who does stenosis impact?
A. older adults
B. children
C. individuals with down syndrome

C. individuals with down syndrome

is there hearing loss associated with stenosis?

no hearing loss associated
*less wax is needed in stenosis for the E.C. to become impacted

who does a collapsing ear canal impact the most?
A. children
B. older adults
C. middle aged adults

B. older adults

T/F: a collapsing ear canal can only be unilateral

FALSE
a collapsing ear canal can be unilateral or bilateral

describe exostosis

outer ear pathology
bony growths in the external auditory canal

who is likely to exhibit exostosis?
A. cold water swimmers
B. older adults
C. young children

A. cold water swimmers

is there hearing loss associated with exostosis?

no hearing loss unless occlusion

what are the symptoms of a tympanic membrane perforation?

middle ear infection
painful, eustachian tube swelling

how does a tympanic membrane perforation usually develop?

aggressive Q-tip use
flying with a bad cold
acoustic trauma (blast injuries, barometric pressure changes)

can otoscopy reveal a tympanic membrane perforation? what will the tympanograms resemble?

otoscopy may reveal proferation
flat, high ear canal volume with absent acoustic reflexes
(repeat proferations \= scar tissue)

is there ALWAYS hearing loss associated with a TM perforation?

may or may not have hearing loss

what are the treatment options for TM proferations?

usually heal by themselves, but repeat perforations can weaken the TM's ability to heal

surgery may be necessary
myringoplasty - graft used to close perforation; tympanoplasty- surgical reconstruction of ME system

describe tympanosclerosis

middle ear pathology
white plaque in the tympanic membrane, stiffens the TM

is there hearing loss associated with tympanosclerosis?

often no hearing loss, but enough plaque can lead to mild HL

describe otitis media/middle ear infection

middle ear pathology
inflammation or infection of the middle ear
*caused by eustachian tube dysfunction

which of the following describes serious otitis media...
A. thin liquid free of bacteria (watery)
B. thick liquid free of bacteria
C. fluid that contains cellular debris or bacteria

serious otitis media \= A. thin liquid free of bacteria (watery)

which of the following describes secretory otitis media...
A. thin liquid free of bacteria (watery)
B. thick liquid free of bacteria
C. fluid that contains cellular debris or bacteria

secretory otitis media \= B. thick liquid free of bacteria

which of the following describes purulent or suppurative otitis media...
A. thin liquid free of bacteria (watery)
B. thick liquid free of bacteria
C. fluid that contains cellular debris or bacteria

suppurative otitis media \= C. fluid that contains cellular debris or bacteria

which group is otitis media more prevalent?
A. children within the first two years of age
B. middle aged adults
B. older adults

A. children within the first two years of age
*language delays
*75%-95% of children will have at least one episode by 6 years of age

T/F: girls are at more of a risk for otitis media than boys

FALSE
boys are at more of a risk for otitis media than girls

*overall, children in more germy environments are at a higher risk for otitis media

T/F: children who are bottle fed are more likely to develop otitis media than children who are breastfed

TRUE, the eustachian tube is impacted with bottle feeding

what does the tympanogram appear as in otitis media?

flat tympanogram with absent reflexes
TM retracts w/stuffed up nose
air bubbles

what does the otoscopy reveal in otitis media?

vascularization of the TM (blood)
fluid behind the TM
bulging TM, discharge

is there hearing loss associated with otitis media?

may or may not have hearing loss
related to the volume of liquid in the middle ear space

what are the treatment options for otitis media?

antibiotics
P.E. tubes if it is a chronic condition
tonsillectomy or adenoidectomy to prevent swelling that leads to PE tube blockage

how can otitis media affect language development?

miss critical language development milestones
auditory deprivation

describe otosclosis

middle ear pathology
growth of spongy bone that grows along the ossicular chain and the stapes footplate

what happens to the stapes footplate during otosclerosis?

the stapes footplate becomes immobilized at the oval window

ankylosis: stapes footplate becomes fixed

who is the most susceptible to otosclerosis?
A. children
B. pregnant women
C. older men

B. pregnant women

*cause is unknown

T/F: otosclerosis is usually unilateral

FALSE: otosclerosis is bilateral 90% of the time

what kind of hearing loss does otosclerosis result in?

bilateral, conductive, progressive hearing loss

what is the cohort notch with otosclerosis?

worsening of bone conduction thresholds by 10-15 dB at 2000 Hz

what does the tympanogram look like for otosclerosis?

shallow or flat tympanograms (immobilization of stapes)
absent reflexes

what are the treatment options for otosclerosis?

Surgical treatment:
-Stapes mobilization: loosening of stapes with chisel-like instrument
-Stapedectomy: replacement of all of part of stapes with prosthesis

what are the causes of an ossicular chain discontinuity?

middle ear pathology

can occur with...
-a proferation (blast injury)
-chronic otitis media can wear down the bone
-otosclerosis can "eat way" through
-acoustic trauma

T/F: ossicular chain discontinuity is usually sudden/noticeable

TRUE
ex: dislocations of the incudostapedial joint

is there a hearing loss associated with ossicular chain discontinuity?

YES
large, flat conductive HL

what does the tympanogram look like for ossicular chain discontinuity?

high peak immitence (bone can be extremely pushed in)
absent reflexes on affected side

describe cholesteatoma

middle ear pathology
a cyst filled with keratin fills the middle ear

T/F: cholesteatoma occurs as a result of chronic otitis media

TRUE

describe the tympanograms for cholesteatoma
(hint: initial vs. eroded)

initial: type As (stiffness of the middle ear)
erosion: type Ad, middle ear bones break

absent reflexes on the affected side
vascularization (blood) occurs as a protective mechanism

what type of hearing loss is associated with cholesteatoma?
A. sudden conductive
B. progressive conductive HL
C. sensorineural HL

B. progressive conductive HL

what are the treatment options for cholesteatoma?

removal of cyst
*still can grow back

describe Meniere's Disease

inner ear pathology
pressure equalization problems with the cochlea and the semicircular canals (endolymphatic hydrops)

which of the following are impacts of Meniere's disease?
A. impact on hearing + nerves
B. will have episode of vertigo
C. the organ of corti and the semicircular canals collapse on themselves
D. all of the above

D. all of the above

T/F: Meniere's disease is usually unilateral

FALSE

Meniere's disease is usually bilateral