CSD Exam 3

2 types of instrumental evaluation for assessment of voice

endoscopy, stroboscopy

endoscopy

allows clinician to visualize vocal folds and surrounding area

stroboscopy

a device that causes a light to pulsate at a particular frequency; the movement characteristics of the vocal folds can be carefully examined

assessment of voice

instrumental evaluation, assessment of face/oral mechanism, speech samples, impact on client

treatment of voice disorder - functional cause

teach vocal hygiene, unlearn bad batters, relaxation techniques, learn vocal exercises for better phonationtr

treatment of voice disorder - organic cause

eliminate harmful behaviors, vocal rest, surgery (for paralysis), recover with SLP

treatment options for carcinoma (cancer)

radiation, chemo, surgery

types of treatment after larynx is taken out:

artificial larynx, esophageal speech, tracheoesophageal speech

artificial larynx

mechanical device used to create a spectrum of tones which modulated by the articulators to produce intelligible speech; sounds more roboticesopha

esophageal speech

air supply for phonation originates in the upper portion of esophagus (almost like belching)

tracheoesophageal speech

air is routed from the lungs to the esophagus via a tracheoesophageal speech prothesis

dysphagia

disorders of swallowing, problem in any of the 4 phases

process of normal swallowing

oral preparatory (chewing, preparing the bolus), oral transit (transfer bolus towards pharynx), pharyngeal phase (move bolus through pharynx into esophagus), esophageal phase (peristalsis pushes food to stomach)

common signs of dysphagia

difficulty with initiating swallowing, difficulty chewing, reflux, choking when swallowing

penetration

when a bolus enters the airwayaspir

aspiration

bolus passes below the vocal folds into the lungs

assessment for dysphagia

bedside evaluation, instrumentation

bedside evaluation

eat, drink small trials and watch swallow

modified barium swallow

watch the swallow under x-ray in real-time

treating dysphagia - prep phase

work to increase efficient chewing, change texture of food if necessary

treating dysphagia - transit

postural changes, behavioral techniques, change thickness of liquids

treating dysphagia - pharyngeal

postural changes, exercises to increase muscle activation, change thickness of liquids

treating dysphagia - esophageal

work with gastrointestinal specialist, docs, etc. to manage issues; surgery, medication

process of hearing sound

1) sound wave from sound source travels to ear 2) ears need to collect the sound wave 3) wave needs to vibrate eardrum 4) vibration needs to be transmitted from eardrum to inner ear via middle ear 5) vibration needs to be encoded in a way our brain can recognize and interpret

pinna

outer ear, composed of skin over cartilage (what you get pierced)

external auditory meatus

outer ear, ear canal, houses ceruminous glands

ceruminous glands

produces cerumen (ear wax)

tympanic membrane

outer ear, ear drum; connected to ear canal and middle ear, highly receptive to vibration

function of pinna

collects sound waves, can amplify high frequencies

ear canal function

directs sound waves to the tympanic membrane (eardrum), adds some intensity and makes sound louder

other functions of outer ear

protects delicate deeper structures of the ear; cerumen prevents foreign bodies, hair follicles trap dust and dirt

the ossicles

middle ear, 3 tiny bones bridging outer and inner ears; has the malleus, incus, and stapes

malleus

comes in contact with tympanic membrane (eardrum), “hammer”

incus

middle ear, middle ossicle, “anvil”

stapes

middle ear, base of stapes sits in the oval window and sends energy into inner ear, “stirrup”

eustachian tube

mucus lined tube running from the nasopharynx to the middle ear; opens by yawning and coughing

purpose of the eustachian tube

allows aid to enter the middle ear, equalizing pressure

middle ear functions

amplify incoming signal, protect inner ear, transformer action, impedance matching, acoustic reflect (dampen vibrations at are too strong)

transformer action of the middle ear

intensifies pressure of the sound waves through physical forces before hitting the inner ear;

impedance matching function of middle ear

amplify the energy before the inner ear to get sound to pass through the fluid of the inner ear

inner ear consists of:

cochlea and semicircular canals

cochlea

snail-shaped bony structure in the temporal bone, contains a tube inside that is divided into 3 sections

middle section of the cochlea tube

scala media, houses the basilar membrane and organ of corti

organ of corti

in the basilar membrane, has hair cells on it

function of organ of corti hair cells

“ride the wave of the vibration”; the hair cells take the vibration information and synapse onto auditory nerves, send info to the brain

cochlea is where _______ occurs

transduction

transduction

a physical stimulus is converted into an action potential, sensational info gets turned into signal in the brain

the organ of corti is arranged __________

tonotopically, different areas respond to different tones/pitches

tonotopical arrangement of organ of corti

high pitch sounds are received at the base into the cochlea, low pitch sounds are received at the top (apex)

energy process that occurs when hearing sound

acoustic → mechanical (movement of ossicles) → hydraulic (traveling wave within cochlea) → electrical (firing of hair cells)

hearing loss

any loss of function in the process of hearing

hearing loss is characterized in terms of:

type, degree, configuration

threshold

the least intensity required for a patient to perceive an auditory stimulus 50% of the time

how do we get threshold info

from pure tone tests to determine degree of hearing loss

pure toen audiometry

hearing test with pure tones, used to determine degree of hearing loss

degree of hearing loss

used to describe the amount of hearing loss a patient has (normal, mild, moderate, moderately severe, severe, profound)

3 types of hearing loss

conductive, sensorineural, mixed

conductive hearing loss

sound cannot get through outer and middle ear, problem conducting sound to the cochlea, usually correctable by medical intervention

sensorineural hearing loss

damage in inner ear, problems with nerve pathways from inner ear to brain, not usually correctable by medical intervention

mixed hearing loss

damage in outer/middle ear and inner ear/nerve pathway

audiogram

chart that shows degree of hearing loss based on where threshold is, shows air vs. bone levels

air on audiogram chart

checks for conductive loss, outer/middle ear transmitting signal?

bone on audiogram chart

checking for sensorineural loss

configurations of hearing

shape/sensitivities of hearing, the line/shape on the audiogram, used to program hearing aids

unilateral vs bilateral

loss in both or one ear

symmetric vs asymmetric

is there a > 10 dB HL difference between ears

conductive hearing loss on audiogram

air-bone gap with bone level normal

sensorineural hearing loss on audiogram

no air-bone gap, not normal levels for both

mixed hearing loss on audiogram

air-bone gap with both irregular (bone not in normal range)

congenital hearing loss

present at birth

acquired hearing loss

developed after birth/during childhood

prenatal

before birth

perinatal

at the time of or right before/after birth

postnatal

more than 1 week after birth

3 etiologies/causes of hearing disorders

genetic, non-genetic, idiopathic

idiopathic

unknown cause

genetic hearing loss

70 from parents, 30 syndromic

non-syndromic genetic hearing loss types

recessive, dominant, x-linked, mitochondrial

autosomal recessive hearing loss

both parents passed down the recessive gene, 25% chance of being affected, usually sensorineural and permanent

dominant hearing loss

one parent has to have a dominant hearing loss gene and passes it down

non-genetic hearing loss

maternal health during pregnancy, premature birth, environmental factors (teratogens)

teratogen

toxins, chemicals, radiation that impact a baby

acquired hearing disorders in the pinna

irritative reactions, traumas (cauliflower ear), frostbite

genetic or congenital disorders to the pinna

macrotia, anotia, microtia

macrotia

large pinna

anotia

absent pinna

microtia

small pinna

external auditory meatus

pathology of ear canal, artesis, stenosis, or obstruction

artesis

complete blockage of the ear canal due to soft tissue or bone

stenosis

narrowing of the ear canal

obstruction

cerumen impaction (ear wax), foreign bodies

otitis media

active inflammation and/or infection of middle ear space; can be acute or chronic; causes conductive hearing loss; treated by antibiotics and pressure equalizer tubes

cholesteatoma

abnormal, non-cancerous skin growth in middle ear; caused by negative middle ear pressure and recurring infection; causes conductive HL, TM perforation, erosion of ossicles, facial paralysis

can inner ear pathologies cause permanent damage?

yes, once gone, certain vital parts of the inner ear cannot be repaired

one cause of inner ear pathologies

ototoxicity

ototoxicity

certain chemicals that damage the cochlea or vestibular portion of the inner ear; substances that reach the inner ear via bloodstream and accumulate in the inner ear fluids

noise induced hearing loss

hair cells in cochlea are damaged due to noise exposure, is a high frequency sensorineural hearing loss

2 types of noise induced hearing loss

gradual, acoustic trauma

gradual noise induced hearing loss

loss of hearing over time

acoustic trauma noise induced hearing loss

brief, intense exposure to noise