audiology exam

Frequency

Number of cycles (Hz) per second

Wavelength

Distance

Period

time

Amplitude

pressure

intensity

A measurement of sound energy, related to the
amplitude of the wave and the perception of loudness

db

dB SPL

Decibels Sound Pressure Level

Typically used to characterize noise levels in an
environment
• Measuring level of loud noise in a factory
• Ambient sound level in quiet spaces

dB HL

Decibels Hearing Level

Measurement scale used by audiologists to
describe hearing thresholds

dB SL

Decibels Sensation Level

Measurement scale used by audiologists
to equate audibility across patients
• Based on the
individual’s hearing threshold

Useful for testing speech recognition

10 ABOVE threshold

ranges of hearing

Normal: -10 to 15 dB HL
Slight: 16 to 25 dB HL
Mild: 26 to 40 dB HL
Moderate: 41 to 55 dB HL
Moderately Severe: 56 to 70 dB
Severe: 71 to 90 dB HL
Profound: 90+ dB HL

degree

Normal, mild, moderate, moderately-severe, severe, profound

configuration

Flat, sloping, rising, notched

type

Sensorineural, conductive, mixed

SRT

speech Recognition Threshold
• Measure of the softest word that the patient can
correctly repeat about half the time
• Use “spondee” words, two-syllables with equal
stress
• Examples: Baseball, hotdog, airplane, toothbrush

SRT agreement

“Good agreement” = PTA and SRT are within +/- 6 dB
• “Fair agreement” = PTA - SRT difference is > 6 and < 12 dB
• “Poor agreement” = ≥12 dB difference

WRS

A measure of speech recognition at a
comfortable and audible intensity level

40db SPL above SRT

Pure-Tone Average

PTA average of hearing thresholds at 500 Hz,
1000 Hz, 2000 Hz
• Add hearing thresholds at these frequencies and then dividing by 3

type A

observed in an individual with normal middle
ear pressure

normal hearing ,sensorineural hearing loss

Type B

patient with middle ear fluid

conductive hearing loss,big airbone gaps

Type C

patient with an obstructed Eustachian
tube

negative pressure and small conductive hearing loss

Type As

short compliance seen in patients with otosclerosis

middle ear is not conducting sound well

Otoacoustic emissions (OAEs)

measure the movement of Outer hair cells

OAEs are generated by the movement of fluid in the cochlea, creating a traveling wave that travels back through the ME and ear canal

OAEs will be absent

in patients with conductive hearing loss,
moderate sensorineural hearing loss, or hearing loss greater than moderate will have absent OAE’s (no response) or no outer hair cells

OAEs are measured within a frequency range of 1000 Hz to 4000 Hz.

If a patient has present OAEs but absent ABR

they may have an acoustic neruoma

auditory brainstem response

measures the path of electrical potentials
from the cochlea to the cortex, like an EEG

The normal latency for wave V in an ABR test is approximately 5 ms

x=time y=electrical impulses

detection brainstem tumors-are able to compare good ear to bad ear

Hearing aids

Hearing aids amplify sounds at a specific increment at specific frequencies

List three styles of hearing aids

a. In the ear (ITE)
b. Behind the ear (BTE)
c. Completely in the canal (CIC)

What do CROS hearing aids do?

Sound from the bad ear is sent through a
microphone and travels to the good ear via receiver.

hearing level technology

basic vs advanced

advanced -more features

hearing aid selection

a. Manual dexterity issues
b. Need for amplification
c. Cost considerations
d. Need for discretion
e. Bluetooth connectivity

manual controls

Bluetooth, volume, switch b/w programs

battery

powers hearing aid

amplifier

amplifies sound signals

microphone

picks up sound

sound transmission within a hearing aid

sound enters microphone ---> sounds amplified by amplifier ---> sent to receiver ---> sounds delivered to ear

receiver

sends sound to ear

hearing aid fitting and verification

Enter patients audiogram into the hearing aid software --> program HA settings/programs --> conduct real ear measurements to verify amplification --> adjust based on patient feedback

Real Ear Aided Response (R E A R)

The output of the hearing aid while it’s on the patient’s ear

Real – Ear - Measurement

Measuring the output of a hearing aid while the patient is wearing it

Unaided Response (R E U R)

The patient’s natural ear canal resonance

Insertion Gain (R E I G)

The amount of gain provided by the hearing aid

Private practice

independently owned small business

What types of patients can be treated in private practice

Patients with sensorineural hearing loss

What financial considerations are associated with starting and managing a private practice

a. Equipment costs / maintenance
b. Rent/utilities
c. Employee salaries/benefits
d. Office supplies
e. Marketing expenses

hearing aid orientation

a. Proper insertion/removal
b. Battery handling/charging
c. Volume/program controls (speech mode, restaurant mode, music,
etc.)
d. Cleaning and maintenance
e. Common troubleshooting (check battery, remove wax, ensure
properly inserted)
f. When to wear / not wear them

Don't wear hearing aids

1. While sleeping
2. In the shower or swimming
3. During excessive sweating

KEEP AWAY FROM PETS

hearing aid troubleshooting

Check if battery is dead
• Inspect for wax blockage
• Verify correct insertion
• Use a hearing aid stethoscope to listen to sound output

• Reprogram device

utricle

detects movement in the horizontal plane

saccule

detects movement in the vertical plane

semicircular canals

filled with endolymph
8. Fluid in the semicircular canals will flow through the ampulla at the base of
the canal, deflecting the hair cells and sending a signal to the brain that the
head is in motion.
9. The semicircular canals are aligned with the muscles of the eye muscles

canals

anterior (superior) canal detects movement in the sagittal plane (nodding yes)

Lateral (horizontal) canal detects movement in the transverse plane (shaking no)

Posterior (inferior) canal detects movement in the coronal plane (tilting side to side)

videonystagmography (VNG)

Patient wears VNG goggles with cameras inside to monitor eye movement

• The computer tracks the position of the pupils throughout testing
• Nystagmus looks like a saw-tooth pattern on the VNG tracing

Rotary Chair and Velocity Step Test

measures the vestibular response to different head movements -bilateral horizontal semicircular canals

caloric irrigations

1. introduce warm/cool air or water into the ear canal to stimulate the
lateral semicircular canals
2. endolymph heats or cools
3. deflects hair cell stereocilia in the ampulla
4. activates the hair cells
5. Sends signal to brain = feeling of spinning

provides ear- specific results, allowing each ear to be tested independently and compared for vestibular function assessment.

cochlear implant

A cochlear implant replaces the cochlea by directly stimulating the auditory nerve via
electrical impulse

what four parts make up the cochlear implant

a. 1. Sound processor / Microphone
b. 2. Transmitting coil
c. 3. Internal receiver
d. 4. Electrode array

tonotopic organization

aspect of cochlear physiology that a cochlear implant relys on to facilitate speech perception

Where each place of the basilar membrane is specifically tuned to a different frequency based on stiffness and mass

CI candidacy in adults

a. 1. Adults aged 18+
b. 2. Moderate to profound SNHL
c. 3. Limited benefit from amplification; <50% speech recognition (w/ hearing aids)
d. 4. Speech material used: Sentences or word tests

CI candidacy in children

a. 1. Children aged 2-17 y/o
b. 2. Severe to profound SNHL
c. 3. Limited benefit from amplification; <30% speech recognition (w/ hearing aids)
d. 4. Speech material must be age-appropriate

CI candidacy in infants/toddlers

a. 1. Infants/toddlers aged 9-24 months, earlier if cochlea may become ossified
b. 2. Profound SNHL, both ears
c. 3. Limited benefit from amplification (case dependent)
d. 4. Limited opportunity for speech-based testing

T-Level

the lowest current level required for a cochlear implant patient to perceive sound

M-Level

refers to the current level required for a cochlear implant patient to perceive a loud, but comfortable sound

list medical indicators/red flags for a medical referral

1. Sudden hearing loss

4. Ear pain/drainage
2. Sudden onset of tinnitus

5. Asymmetric hearing loss
3. New conductive HL

presentation of acoustic neuroma

Auditory/Vestib portion of the 8th CN

ABR diagnostic test that is most sensative

noncancerous

tinnitus, hearing loss, dizziness
(presses on 8th nerve)

Abnormal ABR on affected, normal ABR on unaffected

otosclerosis

Abnormal bone growth on the stapes

Type A_{s tympanogram}

carhart notch

1-3-6 rule

By 1 month: Infants should be screened for hearing loss by 1 mo.
By 3 months: Infants that failed screening should have a diagnosis evaluation by 3 mos.
By 6 months: Infants with a hearing loss dx are enrolled in early intervention

diagnostic tests that are most appropriate for diagnosing congenital hearing loss

otoscopy,tympanometry,OAE,contioned play ,visual reinforment

visual reinforcement audiometry

a. Patient age range: 6-24 mos. old
b. Briefly, how is the test performed? Audiologist plays a loud sound, and the infant will look toward the sound.
i. Once they look toward the sound, a toy will light up and dance/move to confirm that they heard the sound.
ii. The audiologist/parent will divert their attention back to the center (E.g.,toys on a table), and repeat until the child continues to turn their head
when they hear sound.
iii. Audiologists will play sound softer until they find the threshold.(Hughson-Westlake method)

conditioned play audiometry

c. Patient age range: 2-5 yo

d. Briefly, how is the test performed? Discuss with the child that if they hear a beep
in their headphones, perform an act (E.g., When you hear a beep... Put a ball in
the bucket. Stack a block on the tower. Put a ring on the peg.)
i. The audiologist will play a sound and demonstrate the game
ii. The assistant to the audiologist will instruct the child to wait and listen until they hear a beep
iii. Repeat until the child learns the rules
iv. Find the child’s thresholds

how to confirm that hearing devices are working properly?

Picture pointing & Ling-6 sounds

Ling -6 sounds

A broad range of speech sounds that can be imitated by children

i.m iv. ah
ii. oo v. sh
iii. ee vi. s

picture pointing

Speech recognition can be
assessed through picture pointing
• Speech reception threshold
• Word recognition score

nystagmus

The involuntary rhythmic movement of the eyes

fast nystagmus= more dizzy

slow nystagmus=less dizzy

vertigo

false sensation of spinning

Hughson-Westlake method of testing

Start where the patient may hear (50-70 dB) and proceed to play sound. If they respond,
decrease by 10 dB. No response, increase by 5. Repeat process after 2 out of 3 times until you fill
the audiogram at different frequencies.
“Up 5, down 10”

Symbols

1. Air conduction:
Right ear: O Left ear: X
2. Bone conduction:
Right ear: < Left ear: >

Electromotility

OHC stimulation pulls the basilar membrane closer to the tectorial membrane, causing shearing and allows for amplification of sound (Electro)

Mechanotransduction

Where IHC movement sends electrical impulses that send sound
waves to the auditory nerve in the brain... allows for sound recognition

Solve wavelength

What is the period? 1/freq = 0.5 sec
What is the frequency? 2 Hz
What is the amplitude? 1