Praxis Random Chp 5+6

What difference between ears do you need to do the Stenger?

at least 20 dB

What principle does the Stenger test rely on?

Binaural fusion for two tones presented simultaneously to the ears, the tone is only perceived on the side that would be better able to perceive it

Describe the Stenger test procedure and what a negative/positive result is

tone in ‘good’ ear presented 10dB above threshold

tone in ‘bad’ ear presented 10dB below threshold

negative Stenger: if HL in poorer ear is real, the patient will only hear the tone in their good ear and will respond

positive Stenger: if Hl in poorer ear is not real, patient will perceive tone in poorer ear only (it is louder than the tone presented in the ‘good’ ear) and the patient would not respond (because the patient is falsifying their threshold)

What is the Rinne test? What is a positive/negative Rinne result?

compares loudness of stimulus comparing AC to BC

Positive: normal or SNHL; tone is louder AC than BC

Negative: CHL; tone is louder BC than AC

In a positive Rinne test, why is AC perceived as louder than BC?

normal ear canal and ME functioning (no impedance of AC sound) with air being a less dense medium (thus easier transmission) compared to high density of bone

in a negative Rinne, why would BC be louder compared to AC?

outer and/or ME involvement attenuates AC signal

outer and/or ME involvement traps pure tones presented via BC, intensifies BC signal (occlusion effect)

What is the Weber test?

test of lateralization

For SNHL, what side will the Weber test lateralize to?

tone will lateralize to better ear

For normal hearing, what side will the Weber test lateralize to?

neither side, will be perceived at midline

For CHL, what side will the Weber test lateralize to?

tone will lateralize to poorer hearing ear (due to occlusion effect)

What change in admittance is needed to be a MEMR/AR threshold?

0.2-0.3 mmho

What are normal MEMR/AR thresholds? What are elevated? What are absent?

normal: 70-100 dB SPL

elevated: 105 dB SPL

absent: no response at limits of equipment levels

What activator tones can be used for AR decay testing?

500 or 1000

What level is the activator tone presented at for AR decay testing?

10dB above threshold

How long is AR decay tested for?

10 seconds

What is positive AR decay?

reponse decays by at least 50% within 10 seconds

What is negative reflex decay?

response decays less than 50% in 10 seconds

What is the mathematical relationship that yields the largest DPOAEs?

2f1-f2

What SNR is required for a DPOAE?

≥ 6 dB

What do you see on an ABR for someone with CHL?

waves I-V delayed

good morphology, amplitude

latency intensity function outside of normative range

What do you see on an ABR for sensory HL?

Poor morphology

Interwave within normal limits

Waves I-V slightly delayed

Waves I-III small to absent

latency intensity function: high intensity responses normal, all others outside

What would an ABR for neural HL look like?

poor morphology

delayed interwave latencies

waves III and V delayed

normal amplitude

latency intensity function: high intensity responses normal, all others outside

Describe single channel ABR montage

non-inverting at Fz (forehead, midline) or Cz (vertex)

inverting: ipsilateral earlobe or mastoid

ground: contralateral earlobe or mastoid

What change latency do you expect to see with a 10 click/s increase in stimulus rate?

0.1 ms delay per 10 click/s increase in rate

What are the normal latencies for ABR waves I, III, V and interwave latencies

I - 1.54

III - 3.70

V - 5.60

I-III - 2.20

III-V - 1.84

I-V - 4.04

What is the SP of the ECochG?

summating potential, response of IHCs, OHCs and spiral ganglions

What is the AP of the ECochG?

synchronous firing of CN VIII (same as Wave I of ABR)

What is the main measure of interest of the ECochG?

SP/AP ratio

How is the SP/AP ratio impacted in Meniere’s disease?

SP/AP ratio is going to be above normative ranges (if patient is having a Meniere’s episode, ratio may be normal if not)

What is the middle latency response?

AEP for thalamocortical function

What does the MLR look like?

2 positive and 2 negative peaks occuring between 15-75 ms after stimulus

Na (first neg peak, 15-20ms)

Pa (first pos peak, 25-35ms)

Nb (second neg peak, 40-50ms)

Pb (second pos peak, 50-60ms)

Compare MLR to ABR

MLR is thalamocortical test, more central than ABR

MLR uses slower stim rate

Electrode montage is similar between tests

MLR better for estimating lower frequency thresholds compared to ABR (less dependence upon neural synchronization) - ie may be better if neural synchronicity has been compromised (injury, stroke, neurodegenerative diseases

MLR matures later (8-10 yrs); Pb may not mature until 15

MLR requires patient arousal

What is the Auditory long/late latency response (LLR)? what is the response?

thought to be generated by primary aud cortex

Response is P1-N1-P2 complex

P1 - occurs 50 ms after stimulus, same as wave Pb of MLR

N1 - aud cortex in Heschl’s gyrus, 100 ms

P2 - multiple generator sites, 150-200 ms

LLR compared to ABR and MLR

LLR does not mature until late teens

LLR has larger response amplitude and can be obtained in fewer sweeps

LLR gives broader view of central aud system than ABR

LLR has no norms, ABR has a lot, MLR has more than LLR

What is the P300?

test of primary aud cortex, hippocampus and frontal cortex, response occurs around 300ms after stimulus onset

What are P300 latency and amplitude associated with?

latency = processing speed

amplitude = attentional resource allocation used in processing

Debate of clinical utility of P300

if patient can reliably do task to get P300 response, what is the diagnostic value as the patient can likely do behavioral testing?

What is the MMN?

mismatch negativity

reflects physiological function of the primary aud cortex, frontal cortex, hippocampus and the thalamus

occurs at 100-300 ms

P300 vs MMN?

P300 requires attention, MMN does not

What is primary tinnitus? What is secondary tinnitus?

Primary - unknown cause or SNHL

Secondary - identifiable cause (medical condition)

What is recent/acute tinnitus?

tinnitus that have been going on less than 6 mo

What are the four categories of hyperacusis?

loudness, fear, pain, annoyance

What is misophonia?

hatred of sound with strong emotional reaction

hearing disorder associated with a mental health condition/disorder

What are the JCIH risk factors for hearing loss?

Anoxia, NICU stay >5 days, hyperbilirubinemia treated with exchange transfusion, syndromes associated with HL, craniofacial anomalies, ototoxic medications, (s)TORCH infections, family hx, ECM

What is (s)TORCH

Syphilis

Toxoplasmosis

Rubella

CMV

Herpes

What is Little Ears?

parent questionnaire for children birth-24mo

What is the IT-MAIS?

infant-toddler meaning auditory integration scale

evaluates how/if child responds to sounds

What is the PEACH/TEACH?

Parents/Teachers Evaluation of Aural/Oral performance of children

Rates child’s communications in quiet and in noise

What are minimal response levels?

In behavioral testing, the softest intensity that the clinician observes a response, not necessarily true thresholds

What is the MRL for warble tones for infants up to 4 mo of age?

70-75 dB HL

What is the MRL for warble tones for infants from to 4-9 mo of age?

45-50 dB HL

Age range for VRA

ideal 4-6mo, can be done up to 24mo

Age range for CPA

24mo-3yrs or as developmentally appropriate

What is TROCA?

tangible reinforcement operant conditioning audiometry

child responds (pressing button, or giving a high five); child is reinforced with tangible object (stickers, candy)

used when cannot condition CPA

What is the WIPI? Age range?

Word intelligibility by picture identification

4-6yrs

What is NU-CHIPS? age range?

Northwestern University Children’s Perception of Speech

3-5yrs

What is the PSI?

Pediatric Speech intelligibility test

3-6yrs

What is the TAC

Test of auditory comprehension

4-17yrs

What is the PBK?

phonetically balanced kindergarten word list

6-12 yrs

What is the CID W-22? age range?

Central Institute for the Deaf W-22

12+ yrs

What is the NU-6? age range?

Northwestern university-6

12+ yrs

What is the BKB SIN? age range

Bamford-Kowel-Bench Speech in noise

sentence testing material

5-14 yrs

What is the HINT-C? age range?

Hearing in Noise Test for Children

sentence testing material

6-12 yrs

What is the HINT?

Hearing in noise test

sentence testing material

13+ yrs

What is the Quick SIN? age range?

Quick speech in noise

12+

What is the SPIN? age range?

Revised speech perception in noise

12+ yrs

What is the SSI? age range?

Synthetic sentence identification

12+ yrs

What is impedance?

resistance of energy flow, made of mass and compliance reactance and resistance which prevent movement of the system

What is mass reactance?

resistance of movement caused by mass of the system

What is compliance reactance

resistance to movement caused by stiffness of system

What is resistance?

opposition of movement caused by friction within a system

What is admittance?

how much movement a system will allow to pass through (made of mass and stiffness susceptance and conductance)

opposite of impedance

What is mass susceptance?

how much movement that the mass of the system allows to pass through

What is compliance susceptance?

how much movement that the stiffness of a system allows to pass through

What is conductance?

how much movement that the friction of a system allows to pass through

When do you use a 1000 Hz probe tone? Why?

Used for children < 9 mo or those with craniofacial abnormalities (Down Syndrome)

Due to resonant properties of small EAC

What stimuli is used in wideband acoustic immittance?

Wideband chirp signal up to 10 kHz

What is multi-frequency tympanometry?

varies frequency of probe tone and evaluating for the normal progression

used to determine whether middle ear abnormalities are due to mass (mucoid effusion) or stiffness (otosclerosis)

What are the B and G peaks on MFT?

B - susceptance of mass and stiffness of the ME system

G - conductance of ME system

What configurations are seen in MFT?

1B1G, 3B1G, 3B3G, 5B3G

should progress from 1B1G to 5B3G as probe tone moves from low to high frequency

What configuration should be seen at resonant frequency in MFT?

3B1G

Middle ear mass susceptance = stiffness susceptance

—> conductance is only force acting against the transfer of sound through ME space

For children what is the resonant frequency seen on MFT?

between 800-1800 Hz

For adults, what is the normal resonant frequency on MFT?

up to 2000 Hz

What does an abnormally low resonant frequency on MFT indicate?

ME is mass loaded or abnormally flaccid

Ex: Type Ad with low resonant frequency = abnormally flaccid (ossicular disarticulation, monomeric TM)

Ex: Type A with low resonant frequency = mass loading (mucoid effusion adhering to ossicles)

What does an abnormally high resonant frequency (>18000 Hz indicate)?

ME is abnormally stiff (otosclerosis; ossification and immobilization of stapes)

compare DPOAEs and TEOAEs

DPOAEs measured over larger frequency range

DPOAEs have better responses than TEOAEs at higher frequencies

DPOAEs absent with HL from 25dB HL up to 50-60 dB HL

TEOAEs absent with HL more than 40 dB HL

What is the ASSR?

auditory steady state response

AEP measuring neural responses to modulated auditory stimuli

ASSR compared to ABR

shorter testing time - ASSR can present multiple stimuli simultaneously

can differentiate between severe to profound HL better than threshold ABR

What are the frequencies associated with the ASSR?

CF - carrier frequency, the frequencies being tested

MF - modulation frequency

Where are the responses generated in ASSRs from stimuli with a modulation rate < 20 Hz?

primary auditory cortex

Where are the responses generated in ASSRs from stimuli with a modulation rate between 20-60 Hz?

primary auditory cortex, auditory midbrain, thalamus

Where are the responses generated in ASSRs from stimuli with a modulation rate > 60 Hz?

brainstem: superior olivary complex, inferior colliculus, cochlear nucleus

Pros of using a click for ABR?

response from large range of cochlea, represents part of cochlea with best hearing from 500-8000 Hz

What is a chirp?

brief tonal stimulus with frequencies adjusted in timing of presentation

ie low freq presented first so apical low freq regions of basilar membrane are activated at the same time as the high freq regions near the base

Pros/cons of using chirp for ABR

improves neural synchrony

gives larger Wave V amplitude compared to clicks due to how chirps simultaneously stimulate each frequency place along the basilar membrane

latency is longer than clicks

What are the ASHA guidelines for a ABR screening?

For operator-controlled ABR: click at 35 dB nHL at rate 37/s, minimum 1,000 repetitions

For automated ABR: chirp at 35 dB nHL, rates up to 92 clicks/s

What is the FFR?

the frequency following response

reflects sustained neural activity that is phase locked to the stimulus waveform

What is the eFFR?

envelope FFR

reflects phase-locking to envelope periodicity (slow varying amplitude oscillations) of stimulus waveform

When does the eFFR response occur?

after wave V of ABR, ≥ 5.5ms

What does the FFR reflect?

phase-locking to temporal fine structure