Audiology test #2

What are the main purposes of speech audiometry?

measures how well a person hears and understands speech. It helps determine hearing loss, speech recognition, dynamic range, and comfortable/uncomfortable listening levels (MCL/UCL)

What environment is required for speech audiometry testing?

Testing is done in a sound-treated room with controlled noise, and recorded speech is preferred

What is the Speech Detection Threshold (SDT)?

Lowest level speech is detected, not understood, uses monotone

What is the Speech Recognition Threshold (SRT)?

Lowest level speech is understood 50% of the time, uses spondee words (baseball, hotdog), and checks reliability of pure-tone results, should be within ±10 dB of PTA

What is the difference between reliability and validity? 

Reliability: Consistent results over time and validity: Measures what it’s supposed to

What is the Count-the Dots Audiogram used for?

shows what percentage of speech is audible, helping visualize which sounds a patient can hear.

What is the MCL, UCL, and ANL?

MCL is the most comfortable loudness, UCL is uncomfortably loud, and ANL measures tolerance for background noise.

What is Dynamic range?

The difference between threshold and UCL and guides hearing aid fitting

Be able to explaine an OAE and the types

cochlear sounds that show outer hair cell function, with types including spontaneous (SOAE), transient-evoked (TEOAE), and distortion-product (DPOAE). ABR measures electrical activity in the auditory nerve and brainstem using electrodes, useful for newborn screening, retrocochlear testing, and estimating thresholds.

Be able to explain the ABR

a test that measures the electrical activity of the auditory nerve and brainstem in response to sound. Uses of ABR: Newborn hearing screening, estimating hearing thresholds when behavioral responses are unreliable

What is acoustic immittance?

An all encompassing term to describe measurements made of the tympanic membrane impedance, compliance or admittance and used to assess middle ear function

What three things can acoustic immittance measurments assess?

Static acoustic compliance, tympanometry, acoustic reflex

What are the three tubes of the immittance probe used for and what do they do?

Miniature loudspeaker (emits puretone)

microphone (measures sound reflected back)

air pump ( varies the air pressure in canal)

What is static acoustic compliance?

A measure of how mobile the tympanic membrane is by comparing ear canal volume and middle ear movement at different air pressures

How is middle ear compliance calculated?

By subtracting the first measurement from the second

(Cx = C2 - C1)

What does a very low compliance suggest?

A stiff middle ear system often due to fluid, infection, or increased stiffness of the eardrum of ossicles

What does a very high compliance suggest?

An abnormally flexible tympanic membrane or ossicular discontinuity(loose bones)

What is the normal range of middle ear compliance for adults and children?

Children: 0.25-1.05 cc

Adults 0.30-1.70 cc

What does no compliance on a tympanogram suggest?

an ear infection or fluid in the middle ear, no tympanic membrane movement

What is tympanometry used to measure?

The mobility of the tympanic membrane as a function of air pressure changes, to evaluate middle-ear pressure and function.

What do the classifications of tympanograms indicate?

A - Normal (Normal middle-ear function; peak near 0 daPa)

A_s - Stiff System (Shallow peak; indicates stiffness (otosclerosis, scarring)

A_d - Flaccid/ Disarticulation (High peak; indicates hypermobile TM or ossicular discontinuity)

B - Flat (No peak; fluid, wax, or TM perforation)

C - Negative Pressure (Peak below –200 daPa; eustachian tube dysfunction or recent cold)

What pressure range is considered normal for middle-ear pressure?

Between +100 and -100 daPA

What are the normal admittance/compliance ranges for children and adults?

Children: 0.25 – 1.05

Adults: 0.30 – 1.70

What are the tympanic ranges for children and adults?

Children: 80 – 159 daPa

Adults: 51 – 114 daPa

Why is the standard 226 Hz probe tone not sufficient for all tests?

Because their ear systems respond differently to low-frequency tones

What frequency is used for infants?

1000 Hz probe tone

What is acoustic reflex?

An involuntary contraction of teh stapedius muscle in response to loud sound, causing the TM to stiffen and reduce compliance

What are the four possible outcomes for acoustic reflex?

Present at normal level (~85 dB SL).

Absent at equipment limits (110–125 dB HL).

Present at low level (<60 dB above threshold).

Present at high level (>100 dB above threshold)

What structure supplies blood to the cochlea and when does it form?

Stria Vascularis, forms at 10 weeks

By what week is the cochlea fully coiled?

14 weeks

When do the cochlear hair cells connect to the brainstem?

20 - 30 weeks

Around what week is cochlear tonotopic organization complete?

35 weeks

Which organ systems develop at the same time as the auditory system?

The eyes, heart, and kidneys

What is the primary goal of the EHDI program?

Identify newborns with hearing loss

What is the secondary goal of the EHDI program?

Identify newborns with medical conditions or risk factors that require monitoring of auditory status

When did Missouri enact the newborn hearing screening programs?

2002, the last state to enact them

What is the 1-3-6 rule and what does each number represent?

Screening by 1 month, evaluation by 3 months, intervention by 6 months. (typically used in hospitals and pediatric clinics)

How does the 1-2-3 rule differ from the 1-3-6 rule?

Screening by 1 month, evaluation by 2 months, intervention by 3 months. Typically used in university clinics.

What type of Diagnostic testing is required before 9 months of age?

Diagnostic Auditory Brainstem Response (ABR)

Why are serial hearing evaluations important?

Because some hearing losses are progressive in nature

List at least five risk factors for hearing loss per the JCIH.

Family history of childhood Sensorineural hearing loss, chemotherapy, head trauma, NICU stay longer than 5 days, or Hyperbilirubinemia etc…

What are some examples of neurodegenerative disorders linked to hearing loss?

Hunters, Ushers, Alport, Pendred, Charcot-Marie-Tooth, Neurofibromatosis (type II in pediatrics)

Name three ototoxic medications that are used in NICU settings.

Gentamicin, Vancomycin, Furosemide

How many babies per 100 are typically found to have hearing loss in the U.S.?

1.4  out of every 1000

What are two main screening methods used in NBHS?

Distortion product Otoacoustic Emissions (DPOAEs) and Automated Auditory Brainstem Response (AABR)

What does DPOAE measure?

Cochlear function only, two tones in and the response is measure out

What does AABR measure?

Activity fromt he cochlea through the auditory nerve up to the brainstem

What are NBHS testing protocols?

Quiet environment; say refer not failed, one test per ear per day, screen twice in hospital, refer to diagnostic if they refer x3

Name three types of NBHS equipment

BERAphone, Traditional AABR, DPOAE system

What information should be gathered during case history?

Birth and medical history, risk factors, family hearing history, parental concerns

How should you phrase results when delivering a new diagnosis?

“Your child has a hearing loss that is ___ and requires further referrals” be clear and concise and family centered, read the room

What plan is createdd for children under 3?

Individualized Education Plan (IEP)

What plan is created for school aged children?

504 or an IEP

What programs or services apply over 3 years of age?

Early Childhood Special Education (ECSE), Preschool, Head start

What programs or services are available under 3 years of age in MO or KS?

Infant Toddler Services First Steps (Mo), Tiny K (Ks)

Who are members of a typical pediatric audiology care team?

Audiologist, ENT, Otologist, Slp, Early intervention specialist, OT, Educational audiologist, teachers

What type of hearing aid is used for most children up to high school age?

Behind-the-ear (BTE) with earmolds

What are examples of implantable auditory osseointegrated devices (AODs)

Cochlear BAHA, Cochlear OSIA, Oticon PONTO, Oticon Sentio

What are examples of cochlear implant brands used in pediatrics?

Cochlear Americas, Advanced Bionics, Med-EL