Audiology Final Examination

What does ABR stand for?

Auditory Brainstem Response

Define ABR.

An electrical response to sound generated from 8th CN to the brainstem.

What does ABR determine?

Determines approximate sensitivity of hearing

What are the 2 clinical applications of ABR?

Latency/intensity function - determine the approximate hearing sensitivity. [0-6 MONTHS or children with severe developmental delay]

Neurodiagnostics - to determine if there's an 8th CN lesion. [ADULTS]

What does OAE stand for?

Otoacoustic Emissions

Define OAE?

Objective test assessing hearing to the level of the outer hair cells in cochlea; low intensity sounds though to be generated by outer hair cells

What is the clinical application for OAE?

Screening newborns

Objective measurement for kids or malingerers.

What does ENG stand for?

Electronystagmography

Define ENG?

A series of tests that assess the vestibular system through the measurement of nystagmus (REM).

Balance Test

What system of the body does ENG assess?

The vestibular system.

What is nystagmus?

Rapid Eye Movements

Pediatric Testing - Birth to 6 months?

Can obtain case history, developmental history, auditory behaviors, ABR, OAE, tymps, and ART’s must all point to the same audiological picture.

Tests Appropriate for 0-6 Months?

ABR - Objective test that determines approximate hearing sensitivity, by measuring the electrical response to sound generated from the 8th nerve to the brain stem. If over 6 months - sedation is needed.

OAE - Objective test that assesses hearing to the level of the outer hair cells in the cochlea.

BOA - Behavioral Observation Audiometry: A hearing test that observes a child’s behavioral response to sounds; tones or speech; unreliable alone - needs ABR or OAE; done in sound field - tests the better ear.

Procedure of BOA?

One Step - No conditioning

Present tone/speech at moderate intensity & watch for response (baby stops sucking)

Pediatric Testing - 6 Months - 2 ½ Years?

Same list as 0-6 months but do VRA instead of ABR. Try to get a threshold for low and high frequency in each ear. By 10-11 months try for a full audio for both ears.

Tests Appropriate for 6 Month - 2 ½ Years?

OAE - Objective test that assesses hearing to the level of the outer hair cells in the cochlea.

VRA - Visual Reinforcement Audiometry: Subjective hearing test where the sound is paired with a visual reinforcement to get a head turn; used with tones or speech; very reliable.

Procedure of VRA?

2 Steps:

1. Conditioning - a sound is played and a visual is shown 2-3 times.

   negative - not showing visual when no sound is played.

2. Testing - speech/tone is presented and when the child turns their head, the toy is lit up as a rewards. During the testing the audiology assistant is distracting them with toys.

Pediatric Testing - 2 ½ Years - 4 Years?

Now like a normal audio, just use play instead of traditional audiometry.

Tests Appropriate for 2 ½ Years - 4 Years?

OAE - Objective test that assesses hearing to the level of the outer hair cells in the cochlea.

Play Audiometry - Subjective test that uses play to obtain threshold response. Tones only; very reliable; use speech stimuli for testing; conditioned 2 steps.

Procedure of Play Audiometry?

2 Steps:

1. Positive Conditioning - Audiologist grabs a peg with the child and has them hold it up to their ear. Say “beep! Okay let’s put it on the board".”

2. Negative Conditioning - There is also negative conditioning where the audiologist takes a peg back if they put it on the board without the beep.

Testing: Child wears headphones. Child does what was taught to them when beep was heard.

What tests are used in pediatric testing?

Acoustic Brainstem Response

Otoacoustic Emissions

Behavioral Observation Audiometry

Visual Reinforcement Audiometry

Play Audiometry

What are the outer ear pathologies?

Cerumen impaction

What are the middle ear pathologies?

TM perforation

Cholesteatoma

Otitis Media

Ostosclerosis

What are the inner ear pathologies?

Presbycusis

Noise Induced Hearing Loss

Ototoxicty

Acoustic Schwannoma

Meniere's Disease

Malingering

Describe Cerumen Impaction.

Location: Outer ear

History/Symptoms: pain + itching, feeling of fullness, maybe slight loss, complete impaction will have decreased hearing and possibly tinnitus.

Audiological Picture: Type A tymp (incomplete), B (complete), EV is low, mild to moderate conductive loss (complete)

Treatment: Cleaning with vacuum, lighted curette, or ear savage (water)

Describe TM Perforation.

Location: Middle Ear

History/Symptoms: Caused by trauma or otitis media. Possible drainage. Hx of trauma or OME

Audiological Picture: decreased hearing. Type B tymp, Ad when healed. EV is large. Acoustic Reflex cannot be tested. Mild to moderate CHL.

Treatment: Most heal spontaneously, surgery, tympanoplasty.

Describe Cholesteatoma.

Location: Middle ear

History/Symptoms: cyst in middle ear space. Can develop after recurrent OME, long periods of (-) pressure, or healing TM perfs. May smell, continues to grow, feeling of fullness or pressure, decreased hearing

Audiological Picture: progressive conductive HL, type As or B tymp.

Treatment: surgical removal

Describe Otitis Media with Effusion

Location: Middle Ear

History/Symptoms: eustachian tube dysfunction. Inflammation of the mucosal lining is always the beginning, effusion MAY develop. Acute may cause pain, redness, negative pressure. Negative pressure sucks fluid from mucosal lining = effusion. Fluid can be watery or thick and can become infected. Decreased hearing, fullness, pain, pressure, possible tinnitus.

Audiological Picture: slight to moderately severe conductive HL. OM = type C, OME = B to C, to A

Describe Otosclerosis.

Location: Middle Ear

History/Symptoms: disease of the bony labyrinth inhibiting stapes footplate movement. Progressively decreased hearing. Hx of familiar HL. Tinnitus.

Audiological Picture: Type A or As. ART absent. Conductive HL with CARHART NOTCH. EV normal.

Treatment: surgery or hearing aids.

Describe Presbycusis.

Location: inner ear

History/Symptoms: decreased hearing over time, many have tinnitus

Audiological Picture: type A, slight to profound SN HL. Generally sloping, present reflexes

Treatment: aural rehab, hearing aids, cochlear implants

Describe Noise Induced Hearing Loss.

Location: inner ear

History/Symptoms: gradually decreased hearing, usually tinnitus

Audiological Picture: stereocilia are damaged, type A, present reflexes, present reflexes, notched audiogram. Progressive slight to severe SN HL.

Treatment: decreasing industrial noise, ear plugs or headphones, aural rehab, hearing aids, cochlear implants.

Describe Ototoxicity.

Location: inner ear

History/Symptoms: drug induced hearing loss. Loss in basal region of cochlea, decreased hearing, possible tinnitus, occasionally vertigo.

Audiological Picture: loss begins in high frequencies. Type A tymp. Present reflexes. High to profound SN HL.

Treatment: change of medication if possible. Aural rehab or hearing aids.

Describe Acoustic Schwannoma.

Location: inner ear

History/Symptoms: progressively decreased hearing in one ear. usually tinnitus and vertigo.

Audiological Picture: Type A tymp. absent reflexes, unilateral high SN HL. Speech discrim. is abnormally poor.

Treatment: surgery, aural rehab.

Describe Meniere's Disease.

Location: inner ear

History/Symptoms: episodic symptoms with vertigo, vomiting, unilateral HL, roaring tinnitus.

Audiological Picture: Type A tymp. Low Hz have more loss, rising audiogram, unilateral

Treatment: diet change, drugs, hearing aids

Describe Malingering.

Signs: strange behaviors, answers yes to all case Hx questions, something feels off, story doesn't match

Audiological Picture: type A tymp, SRT does not mathc MTA within 10 DB (typically better). Good SDS @ 0 or 10 dB SL. Present reflexes.

Treatment: generally reinstruction works.

Define tinnitus.

Ringing, roaring, hissing or other sound without external cause

Define recruitment.

Occurs with cochlear hearing loss and not with nerve loss. A resumption of normal loudness at high intensities.

Can't hear soft sounds, but hear loud sounds like normal ears.

Define vertigo.

A sensation that the room is spinning or you are spinning. Usually accompanied by nausea and vomiting.

How do you calculate PTA?

Sum thresholds at 500, 1000, and 2000 Hz.

Divide by 3.

Round to whole number.

Puretone Instructions?

“You are going to hear a series of beeping sounds. Every time you hear a sound, raise your hand. The purpose of this test is to find the softest sounds that you can hear. So even if you barely hear the sound, I want you to raise your hand.”

SRT Instructions?

“I am going to give you a list of words (10-36). Please repeat after me.” “I am no going to say the same words. Please continue to repeat as they get softer. I want you to take a guess if you are not sure which word I have said. It is okay to guess.”

SDS Instructions?

“I am going to give you another list of words. This time, my voice will not get softer. I would like you to repeat the words and take a guess if you need to.” Clinician will state “say the word…” before each word.”

How to write out results of an audiogram?

Results revealed a ____ (degree), _____ (type) hearing loss in the R/L ear or bilaterally.

-10 to 15 db?

Normal

20-25 dB?

Slight Hearing Loss

30-40 dB?

Mild Hearing Loss

45-55 dB?

Moderate Hearing Loss

60-70 dB?

Moderately Severe Hearing Loss

75-90 dB?

Severe Hearing Loss

95 + dB?

Profound Hearing Loss

Define sensorineural hearing loss.

Pathology in the inner ear or the acoustic nerve. There is equal loss by air and bone +/- 10 dB. No air bone gaps + equal loss by air + bone @ 1+ frequency.

Define conductive hearing loss.

Pathology in the outer or middle ear. air-bone gaps at 2+ frequencies and bone is normal. Loss by air only.

Define mixed hearing loss.

Pathology is in the outer/middle ear and the inner ear (8th nerve). Air bone gaps at 2+ frequencies. Loss by air and bone at 1+ frequency.

What is Jerger's classification?

Classification of tympanograms that describes the amount of movement of the TM.

What pathologies are associated with a Type A tymp?

Normal hearing

Malingering

Any SN HL pathology

What pathologies are associated with a Type Ad tymp?

Healed perf.

Disarticulated ossicles.

What pathologies are associated with a Type As tymp?

Otosclerosis

What pathologies are associated with a Type C tymp?

Eustachian tube dysfunction

Allergy, cold, healing OME.

What pathologies are associated with a Type B tymp?

Wax occlusion, OME, TM perf or PE tubes

SDS:

Excellent - 90-100%

Good - 80-90%

Fair - 70-79%

Poor - 60-69%

Very Poor - >59%

Static Compliance:

Normal - .28cc - 2.5cc

Equivalent Volume:

Normal - 1 - 1.75 cc

Wax - Small Volume

Perf - Big Volume

Fluid - Normal Ear Canal Volume, OME