Found. of Aud. Exam 2 — Deck 1: Case History, Screening, Pure Tones & Masking

Name four prenatal maternal conditions that put an infant at high risk for hearing loss.

Any four of:

• Maternal infections

• Gestational diabetes

• Cytomegalovirus (CMV)

• Rubella (German measles)

• Toxemia

• Herpes simplex virus

• HIV/AIDS

• Rh incompatibility

• Substance abuse (fetal alcohol syndrome disorder)

Name three perinatal or postnatal risk factors for infant hearing loss.

Any three of:

• Prematurity

• Low birth weight

• Lack of oxygen

• Prolonged labor

• Jaundice

• Complications from CMV

• Rh factor

• HIV or venereal diseases

A newborn hearing screening only rules out hearing loss above what level?

• 30 dB

• It mainly picks up moderate-to-severe loss, so a mild loss can still pass

When reviewing a newborn's hearing screening record, what four things do you look for?

• The type of testing

• When it was done

• Whether it was a pass or fail

• The recommendation for follow-up

About how long is a hearing test considered current before it should be repeated?

• About 6 months

What percentage of congenital hearing loss is genetic in origin, and what kind of gene is usually responsible?

• About 75%

• Usually a recessive gene

What does 'congenital' hearing loss mean?

• Hearing loss present at birth

Name four case-history items that point to possible hearing loss in a toddler or young child.

Any four of:

• Ear infections

• Allergies

• Medications

• Trauma

• Surgery

• Seizure disorder

• Inattentiveness

• TV too loud

• Trouble responding to questions

• Trouble following directions

• Academic or reading problems

• Excessive noise exposure

Why can repeated ear infections in early childhood affect reading later on?

• Fluctuating hearing during infections can cause language delay and missed phonics and phonemic awareness, the building blocks of reading

What is 'learned inattentiveness' in a child's case history?

• A habit of saying 'huh?' or 'what?' that started during a period of ear infections and continues after hearing has returned to normal

Name four sources of information used for a school-aged child's case history.

• Teacher interview

• Hearing inventories (school and home)

• Child study (IEP) team input

• Review of the IEP or IFSP

• Classroom work samples

• Having the child write '3 wishes'

On average, how long does an adult wait between noticing a hearing loss and getting hearing technology?

• About 7 years

Roughly what percentage of people who need hearing aids actually get them?

• About 30%

Name four situations an adult might describe when explaining their hearing problem.

• Trouble hearing in restaurants

• Missing the phone ringing

• Withdrawing from the community

• Feeling that everyone mumbles (lack of clarity)

Why does it matter whether an adult's hearing loss came on suddenly or gradually?

• A sudden onset points to a specific event or trauma (and can be a medical emergency)

• A gradual onset points to causes like aging or noise exposure

About what percentage of children who wear hearing aids have at least one aid not working properly?

• About 70%

Name four sources of occupational or recreational noise exposure to ask an adult about.

Any four of:

• Loud workplace

• Sporting events

• Concerts

• Gym

• Motorcycles

• Guns

• Woodworking

• Lawn work

Name four items to cover in an adult's medical history for a hearing evaluation.

• Current and past medications with dosages (including over-the-counter and herbal)

• Diabetes, high cholesterol, hypertension

• History of stroke, TIA, accidents or trauma

• Serious conditions needing ototoxic drugs, long hospital stays or cancer treatment

Frequent migraines in an adult's history put them at higher risk for what?

• Vestibular migraines

During informal observation, name four things you LOOK at.

• Eye contact

• Facial symmetry (facial paralysis, low-set ears)

• Grooming and hygiene

• Motor restlessness

• Self-stimulation

• Syndromic features (craniofacial differences, low-set or wide-set eyes)

During informal observation of a child, what do you LISTEN for?

• Clarity of articulation

• Whether the child knows their name

• Whether receptive and expressive language are age appropriate

Name four conditions that must be considered in differential diagnosis alongside hearing loss.

Any four of:

• Autism spectrum disorder

• Developmental language disorder

• Global developmental delay

• ADHD

• Depression

• Dementia

• Other medical conditions

How does untreated hearing loss relate to dementia?

• Untreated hearing loss speeds up cognitive decline

• The greater the hearing loss, the faster the decline

• Hearing aids slow it down

What should you do when a patient has a significant medical history?

• Get a signed release of records

• Contact the primary care physician

• Contact other allied health professionals

Why should you be cautious with a diagnosis reported by a patient or parent?

• Their interpretation of what they were told may not be accurate

Is finding a hearing threshold within an SLP's scope of practice?

• No

• SLPs can screen hearing but cannot establish thresholds

• Diagnostic evaluation must come from an audiologist

What must accompany any diagnostic speech-language evaluation?

• A hearing screening

Define 'sensitivity' as a property of a screening test.

• How well the test correctly identifies people who DO have the disorder (true positives)

Define 'specificity' as a property of a screening test.

• How well the test correctly passes people who do NOT have the disorder (true negatives)

Who should receive a pure tone hearing screening?

• Only people able to communicate that they heard a sound, generally age 2 and older

How do you check whether a room is quiet enough for a hearing screening?

• Have a person with normal hearing listen

• If they can't hear the screening tones, move to a different location

Which earphone color goes on which ear?

• Red goes on the right ear

• Blue goes on the left

Name three things to do when placing earphones for a screening.

• Push hair away from the ear

• Center the speaker over the ear canal opening

• Remove jewelry or hats that interfere

• Place the headphones yourself (don't let the patient)

Interfering jewelry, hats or glasses can affect earphone results by up to how much?

• Up to 15 dB

At what intensity is a pure tone hearing screening done?

• 20 dB HL

Why might you start a child's screening at a louder level before going to 20 dB HL?

• So the child learns what to listen for

• Then you drop back down to the screening level

How often must screening equipment be calibrated?

• At least once a year

• Uncalibrated equipment can't be used for testing

What results in a failed pure tone screening?

• No response at any one frequency, in either ear, at the screening level

What two referrals follow a failed screening?

• Referral to an audiologist

• Medical (otologic) referral

About what referral rate should a screening program expect?

• About 10%

• When in doubt, refer

During visual inspection before a screening, what should you do if you see redness or an obstruction?

• Note it and refer

• Don't diagnose or draw conclusions

Name three parts of a daily biological listening check on an audiometer.

• Inspect the wires and components

• Listen for intensity, hums and crackling

• Check the attenuator for dead spots

• Don't use the equipment if it grossly malfunctions

What response method is used for children about 2 to 3½ years old in a screening?

• Modified play

What response method is used for preschool through kindergarten children?

• Conditioned play

If a reliable response pattern can't be established in a screening, what do you do?

• Refer

What should you never do with an OAE probe if you see possible redness or abnormality?

• Never insert the probe

Why is a 'pass' on an OAE screening not a guarantee?

• A pass doesn't guarantee normal hearing, so any lingering concern still warrants referral

In a tympanometry screening, what result counts as a failure?

• A tympanogram that falls outside the shaded or boxed normal area

Name the hearing handicap screening tool for adults and the one for elderly patients.

• HHIA-S for adults

• HHIE-S for elderly patients

Name two hearing handicap screening tools for school-age children.

Any two:

• Preschool S.I.F.T.E.R. (ages 3–5)

• S.I.F.T.E.R. (elementary)

• Secondary S.I.F.T.E.R. (middle/high)

• Audiology Self-Advocate Checklist

What do SAC, SOAC and APHAB stand for?

• SAC: Self-Assessment of Communication

• SOAC: Significant Other Assessment of Communication

• APHAB: Abbreviated Profile of Hearing Aid Benefit

On the HHIE-S, how many points are given for 'yes', 'sometimes' and 'no'?

• Yes = 4

• Sometimes = 2

• No = 0

An HHIE-S raw score of 0–8 means what?

• About a 13% probability of hearing impairment

• No handicap and no referral

An HHIE-S raw score of 10–24 means what?

• About a 50% probability of hearing impairment

• Mild-to-moderate handicap, refer

An HHIE-S raw score of 26–40 means what?

• About an 84% probability of hearing impairment

• Severe handicap, refer

What does air conduction testing tell you about a hearing loss?

• Degree (how much)

• Configuration (shape)

What is the only thing bone conduction testing tells you about a hearing loss?

• Its type: conductive, sensorineural or mixed

Define 'threshold' in pure tone testing.

• The softest level at which a person can just detect a sound 50% of the time

Why can't air conduction results alone tell you where the damage is?

• Air conduction measures the whole auditory system

• Bone conduction is needed to separate conductive from sensorineural

Why should a patient not chew gum or candy during testing?

• Jaw movement interferes with hearing the tone

Name four behaviors to warn a patient against during air conduction testing.

• Drinking

• Eating

• Smoking

• Chewing

• Swallowing

• Talking

Which earphone type is most common in speech pathology, especially in schools?

• Supra-aural (over-the-ear) earphones such as the DD45

Which earphone type is most commonly used by audiologists?

• Insert earphones (such as the ER-3A) with disposable foam tips

When should insert earphones NOT be used?

• When there is drainage or a lot of earwax (occlusion)

What problem do insert earphones prevent?

• Collapsing ear canals

Name five response modes used in hearing testing.

• Hand raising

• Response button

• Play audiometry

• Visual reinforcement audiometry

• Behavioral observation audiometry

What does the y-axis of an audiogram show, and in what unit?

• Intensity (hearing level), in dB HL

What does the x-axis of an audiogram show?

• Frequency in Hz, from low pitch on the left to high pitch on the right

In what step size are hearing thresholds recorded?

• 5 dB steps

What is the softest level a human can hear on an audiogram?

• -10 dB HL

What is the range for normal hearing in adults?

• 0–20 dB HL

For what population is a 'slight' hearing loss category used?

• Children only

• Phonemes are around 15 dB, so even a small loss matters for them

What is the dB HL range for a mild hearing loss?

• 25–40 dB HL

What is the dB HL range for a moderate hearing loss?

• 45–55 dB HL

What is the dB HL range for a moderately severe hearing loss?

• 60–70 dB HL

What is the dB HL range for a severe hearing loss?

• 75–90 dB HL

What threshold level counts as a profound hearing loss?

• 90 dB HL and above

Where does the bone oscillator sit?

• On the highest point of the mastoid (or on the forehead)

Why doesn't it matter whether the bone oscillator goes on the left or right mastoid?

• Unmasked bone conduction vibrates the whole skull and stimulates both cochleae, so the better cochlea always responds first

What is needed to get ear-specific bone conduction results?

• Masking

Which part of the ear does bone conduction bypass?

• The outer and middle ear (the conductive mechanism)

• It measures the inner ear directly

Masking is required when the air conduction of one ear differs from the bone conduction of the other ear by more than how much?

• More than 40 dB (with supra-aural earphones)

What does masking do to the non-test ear?

• Presents a noise that keeps it 'busy' so it can't respond for the test ear

Behavioral observation audiometry is used up to what developmental age?

• Up to about 6–7 months

What kinds of responses are observed in behavioral observation audiometry?

• Reflexive responses such as eye blinks and startles

Why are behavioral observation audiometry responses not true thresholds?

• They're unlikely to reflect the softest sounds the child can actually hear

Visual reinforcement audiometry is used for what developmental age range?

• About 6–7 months to 24 months

What natural behavior does visual reinforcement audiometry rely on?

• A child's instinct to turn toward an interesting sound

Describe the room setup for visual reinforcement audiometry.

• Sound field, child seated between two speakers with visual reinforcers on top

• One tester faces the child to keep them engaged while the other runs the audiometer

Name three types of stimuli used in visual reinforcement audiometry.

• Warbled tones

• Narrow bands of noise

• Live or recorded speech

Conditioned play audiometry is used for what developmental age range?

• About 2½ through 5 years

Who developed the pure tone measurement method, and who revised it?

• Carhart and Jerger (1959)

• Revised by Hughson-Westlake (1960)

At what intensity and frequency does pure tone testing begin, and in which ear?

• 30 dB HL at 1000 Hz, in the right ear or the better ear

If a patient doesn't hear the starting tone, what do you do next?

1. Go up to 50 dB HL

2. If still not heard, keep going up in 10 dB steps until they respond

In the Hughson-Westlake method, how much do you change the level after a response, and after no response?

• Down 10 dB after a response

• Up 5 dB after no response

When is a threshold reached in the Hughson-Westlake method?

• When the patient responds at the same level 2–3 times on ascending trials

After 1000 Hz, in what order are the frequencies tested?

1. 2000 Hz

2. 4000 Hz

3. 8000 Hz

4. Retest 1000 Hz

5. 250 Hz

6. 500 Hz

Why are 250 and 500 Hz tested last?

• They're harder to hear because ambient noise covers the low frequencies

When are 3000 and 6000 Hz added to a standard hearing test?

• When there are concerns about noise exposure (noise-induced hearing loss)

Where does the 1000 Hz retest happen, and how close must it be?

• In the first ear only

• It should be within ±5 dB of the first result