Audiology Praxis 5343 copy

What is the relationship between fundamental frequencies and harmonics?

F0= lowest freq component of a complex periodic sound; harmonic is a regular and repeating multiple of the f0

In which frequencies and at what intensities are most speech sounds produced?

When applied to speech, the human voice spans a range from about 125Hz to 8kHz. 55-65 dB

Define threshold

"Threshold is defined as the lowest decibel hearing level at which responses occur in at least one half of a series of ascending trials. The minimum number of responses needed to determine the threshold of hearing is two responses out of three presentations at a single level ."

What is the relationship between sound pressure level (SPL) and hearing level (HL)?

dB HL normalizes SPL scale to 0 because we do not hear the same at all frequencies. Our ears do not perceive low- and high-frequency sounds as well as they do sounds between 500 and 4,000 Hz. Thus, normal hearing, if plotted on an audiogram using the SPL scale, would be a curved, wavy line.

Describe the function of each of the three major parts of the hearing mechanism

OUTER: Pinna-- Funneling of sound & localization. Ear canal-- Amplifies sounds & protects TM

MIDDLE: Reduces impedance mismatch & Protects from loud sounds (also, Eustachian tube equalizes pressure BC for the TM to vibrate, the air pressure needs to be equal on each side of the TM.)

INNER: amplify sounds, frequency selectivity, converts sound to electrical signal, maintain balance

Function of outer and inner hair cells?

OUTER: Amplification of displacement on the traveling wave & frequency selectivity (active processes are here)

INNER: Nerve excitation= send signals to auditory nerve

What are the fluids found in the labyrinths of the inner ear?

Scala vestibuli: Perilymph

Scala media: Endolymph

Scala tympani: Perilymph

What impacts can hearing loss cause for learning in children?

Delay in speech and language, reduced academic achievement and vocabulary, lessened literacy skills, social isolation and poor self-concept, vocational choices

Describe the differences in speech and language development between pre- and post lingually deafened children.

pre lingual- deafened before they learn speech

post lingual- deafened after they learn speech (about age 6)-effects are not as severe for post lingually deafened children; need to implant/amplify immediately for prelingual

What impacts can hearing loss cause for adults (ex: social isolation)?

fatigue, depression, social withdraw, impaired memory, reduced quality of life, headaches, increased stress and blood pressure

What are the etiologies of hearing loss present at birth?

50% Genetic (syndromic & Non-syndromic)

25% Environmental

25% Idiopathic

Genetic causes of HL? Non-syndromic and syndromic

Non-syndromic:

Connexin mutation related

BFN B4

Mitochondrial

Syndromic:

Alport syndrome

Branchio-oto-rental syndrome

CHARGE

Jervel and Lange-Nielson Syndrome

Pendred syndrome

Treacher Collins syndrome

Stickler syndrome

Ushers syndrome

Waardenburg syndrome

Down syndrome, Neurofibromatosis type 2

Environmental causes of hearing loss (pre/perinatal= present at birth)

TORCH (toxoplasmosis, syphilis, HIV, herpes, rubella, CMV)

Premature birth, low birth weight, asphyxia

Maternal- pre-eclampsia, gestational diabetes, RH incompatibility

Fetal alcohol syndrome

Characteristics of waardenburg syndrome

pigmentation abnormalities (gray spots in hair or different color eyes) and wide-set eyes, congenital SNHL, *can be progressive

Characteristics of Branchio-Oto-Renal Syndrome

Sensorineural, conductive, or mixed & can be progressive or permanent at birth. Can cause ossicular fixation or cochear hypoplasia. Kidney abnormalities!

Characteristics of CHARGE syndrome

Colomba of the eyes

Heart defects

Atresia or stenosis of the Chonae (nasal passage)

Retardation of growth/development

Genital abnormalities

Ear abnormalities/deafness

Stable, mixed severe-profound unilateral loss

Characteristics of Treacher Collins Syndrome?

Wonder movie. No cognitive delays! Poor speech articulation. Moderate-severe CONDUCTIVE loss onlt (anotia/microtia, atresia)

Characteristics of Usher's Syndrome

SNHL. Vision loss!! Type I in particular causes problems with VESTIBULAR system. Development & motor skills slow.

Characteristics of Jervell and Lange-Nielson Syndrome

SNHL and heart condition. Classic patient presentation: deaf child who experiences fainting episodes during stress, exercise, or fright. Can also have VESTIBULAR dysfunction.

Alport syndrome characteristics

Progressive loss of kidney function, SNHL, and eye abnormalities. Progressive SNHL (at first affects high frequencies). Usually occurs in LATE childhood

Pendred syndrome characteristics

Congenital bilateral SNHL and Goiter: a swelling of the thyroid gland which causes a lump in the neck. Mondini dysplasia: 1.5 cochlear turns (instead of 2.5 - 2.75) . Enlarged vestibular aqueduct, variable VESTIBULAR function. Gets worse with head injury so be careful!

Characteristics of Neurofibromatosis type 2

Unilateral/bilateral vestibular schwannomas!!!!

meningiomas, ependymomas, and peripheral neuropathy

Characteristics of Marfan syndrome?

Long arms, legs, fingers & toes. Heart defects. CHL & recurrent ear infections. Hypertention can also cause SNHL.

Characteristics of Goldenhar syndrome?

Abnormal development of the eye, ear and spine. Usually ONE SIDED atresia (missing ear canal) and MISFORMED OSSICLES! Usually normal inner ear.

Characteristics of Noonan syndrome?

Low-set ears. SNHL in up to 50% of patients. Short stature, heart defects.

What are the types of presbycusis? What parts of the hearing system are implicated in the different types and what are the effects on hearing?

Schuknecht's four types of presbycusis:

1. Sensory: hair cells. Initially affects the outer row of OHC in the basal turn. Secondary degeneration of auditory nerve fibers occurs.Lipofuscin (age pigment) accumulates in cochlea cells.

2. Neural: auditory nerve. Histology shows loss of >50% of cochlear nerve fibers, with greatest loss in the basal turn.

Speech recognition performance is lower than expected from audiogram. 90% of fibers must be lost before threshold decreases

3. Metabolic (atrophy of stria vascularis): Stria generates energy and nutrients for the cochlea; stria loss reduces cochlear function. Flat audiometric configuration

4. Mechanical (stiffening BM): cochlear conductive HL. The assumption is that structural changes in the basilar membrane and/or spiral ligament occur with age. Hearing loss has a shallow slope and no histologic evidence of cochlear or neural damage.

Why does fluid accumulate behind the TM in the middle ear space during otitis media?

An ear infection is caused by a bacterium or virus in the middle ear. This infection often results from another illness — cold, flu or allergy — that causes congestion and swelling of the nasal passages, throat and eustachian tubes. Swollen eustachian tubes can become blocked (eustachian tube dysfunction), causing fluids to build up in the middle ear (effusion). This fluid can become infected and cause the symptoms of an ear infection.

OM classifications

Chronic OM: Presence of fluid for more than 30 days

Recurrent Acute OM: 3 or more bouts within 6 months

Chronic Suppurative OM: Persistent inflammation and disease of the middle ear

Honey colored TM= chronic OM with effusion

Red & Bulging= acute OM

Name the condition associated with bony growth surrounding the bones of the middle ear and describe the type of hearing loss that accompanies it.

Otosclerosis. CHL.

Can be congenital or acquired (through perf or constant negative pressure)

NO CONSISTENT TYMP PATTERNS, DEPENDS ON DEGREE OF OSSICULAR CHAIN INVOLVEMENT

Bacteria often associated with the mass!

What's the surgery for cholesteotoma?

Tympanoplasty: removes disease from the middle ear and then perforated TM is repaired

OR

Mastoidectomy: remove disease out of mastoid air cells and sometimes do tympanoplasty as well

--Canal wall up mastoidectomy (CWU): Very careful removal of cholesteatoma and disease of ME but posterior wall is left intact. Can only have this if they have an aerated mastoid and reasonable eustachian tube function

Advantage: anatomy of ear canal and TM remain intact

How are aural atresia and cholesteotoma associated?

Pinpoint (very small opening of the canal) can lead to an external canal cholesteatoma (inflammation, pain, discharge)

Patulous ET?

When ET is always open

-associated with massive weight loss and pregnancy (after birth)

-stroke or degenerative neurological disorders that lead to muscle atrophy

-medical referral

Patients report: Hearing their own breathing, heart rate, speech tends to be very loud

Which commonly used pharmaceuticals are ototoxic?

There are currently over 200 drugs that are ototoxic, tinnitus-inducing, or vertigo inducing that are available by prescription or over-the-counter.

ototoxic:

1. Antibiotic aka saminoglycosides (-mycin)

2. Analgesics: Salicylates AKA aspirin & Quinine

3. Antimalarial

4. Antineoplastic: Chemo drugs aka Cisplatin

5. Diuretics: Used to treat things such as pulmonary edema and hypertension AKA high blood pressure

Which commonly used pharmaceuticals can affect balance?

antidepressants, antihistamines, blood pressure, pain relievers, dizziness

***check

What pathologies are associated with reports of dizziness?

acoustic neuroma, cholesteatoma, AIED, BPPV, concussion, PLF, SCD, meniere's, otosclerosis

**Check

What is the difference between reliability and validity for an assessment?

Reliability refers to the consistency of a measure (whether the results can be reproduced under the same conditions). Validity refers to the accuracy of a measure (whether the results really do represent what they are supposed to measure).

What features of an assessment will affect its reliability?

The length of the assessment - a longer assessment generally produces more reliable results.

The suitability of the questions or tasks for the students being assessed.

The phrasing and terminology of the questions.

The consistency in test administration - for example, the length of time given for the assessment, instructions given to students before the test.

The design of the marking schedule and moderation of marking procedures.

The readiness of a patient for the assessment.

What is calibration and what function does it serve?

It's required by law (OSHA) for instruments to be calibrated, but it's important for professionals to calibrate instruments to ensure safety and accuracy in threshold testing-no calibration standards currently for ABRs or OAEs

**check

What are the key precautions used to achieve infection control?

-appropriate personal barriers (gloves, masks, etc) worn when performing procedures that may expose you to infectious agents

-hand hygiene performed before and after patient contact and after glove removal, before and after eating

-touch and splash surfaces must be pre cleaned and disinfected-critical instruments sterilized

-infectious waste disposed of appropriately

-dispose of speculums

-disinfect equipment

What is the difference between disinfection and sterilization? When is sterilization required?

disinfection= eliminating/reducing harmful microorganisms (decontaminate surface and air)

sterilization= eliminating all microorganisms (food, medicine, surgical instruments)

What equipment is needed to measure noise in a classroom?

sound level meter, measure SNR and dBA

**check

Where can you find the guidelines for acceptable noise levels?

Occupational Safety and Health Administration (OSHA)

What are the guidelines for acceptable noise levels?

OSHA requires employers to implement a hearing conservation program when noise exposure is at or above 85 decibels averaged over 8 working hours, or an 8-hour time-weighted average (TWA), which is a combination of all the sound intensities throughout the work shift.

At 90 dB for 8 hours, the noise has reached the PEL (permissible exposure level), and hearing protection is warranted.

Describe testing instrumentation that can be taken into the workplace.

SLM: used for particularly noisy areas, near a machine. Type 2 can be used for most HCPs. Can be used to make a "noise map." Do not necessarily measure an individual's noise exposure.

Noise dosimeter: SLM that is worn on the body; log an employee's noise exposure.

What is dB-A and dB-C and when are they used?

A dBA is a weighted scale for judging loudness that corresponds to the hearing threshold of the human ear. Although dB is commonly used when referring to measuring sound, humans do not hear all frequencies equally. For this reason, sound levels in the low frequency end of the spectrum are reduced as the human ear is less sensitive at low audio frequencies than at high audio frequencies. This is used in most hearing conservation measurements/programs.

dB-C assesses the contribution of low frequency nosies, which may be of interest when assessing the efficacy of a hearing protection device.

Describe different types of hearing protection and the importance of their fit for effectiveness.

Disposable foam earplug: provides the most attenuation, but attenuation depends highly on fit.

Premolded, disposable earplug: attenuation depends on fit, correct size, can fall out when chewing/talking.

Banded earplugs: lower attenuation than most earplugs. Convenient to put around neck.

Custom earplug: lower attenuation. Can attach to radio.

Passive earmuff: Good for intermittent noise

Earmuffs with radio or amplification: Better compliance, allow communication, better for low levels of noise, manage impulse noise

level dependent devices: Communication and situational awareness in certain situations

Combined hearing protection and communication systems: allows for communication in loud environments

Three foot rule

If you're 3 feet away from someone and can't be heard, the noise is probably 85 dB A+

What is the value of a baseline audiogram?

Having a reference for future audiograms and can determine if the patient experiences a change in hearing sensitivity.

Should be obtained within 30 days of starting work in a noisy area.

Must be after 14 hours after a noise-free-period.

Define standard threshold shift.

A change in hearing threshold, relative to the baseline audiogram for that employee, of an average of 10 decibels (dB) or more at 2000, 3000, and 4000 hertz (Hz) in one or both ears.

Describe the screening protocols recommended for screening adults and children. How do they differ?

For those children who can be conditioned for visual reinforcement audiometry (VRA), screen using earphones (conventional or insert), with 1000, 2000, and 4000 Hz tones at 30 dB HL.

For those children who can be conditioned for play audiometry (CPA)--up to age 18--, screen using earphones (conventional or insert), with 1000, 2000, and 4000 Hz tones at 20 dB HL.

Adults: Position conventional earphones (or insert earphones) and present pure tones at 25 dB HL at the frequencies of 1000, 2000, and 4000 Hz.

Describe follow-up procedure for a person who has not passed a hearing screening?

ABR babies get re-screened once only. Never OAE screen after ABR because you'd miss ANSD.

OAE babies get one re-screen in hospital and one outpatient re-screen

What do the Joint Committee on Infant Hearing recommendations require in terms of timing and screening requirements?

1-3-6 screen, diagnose, intervention

What are the most common screening tools in newborn screenings? List pros and cons

OAE: Quick, Placement of probe prone to be failed compare to ABR.

ABR: Testing retrocochlear area. Neural function and more informations on hearing loss. Not recommended for NICU bc ANSD risk factor.

Describe the differences in results from OAEs versus ABRs in newborn screenings.

OAE: frequency specific >1k.

ABR: stimulus= clicks or chirps. click is 1-4k. Level is 35 dB (would not detect LF hearing loss.)

What different kinds of self-report measures can be used with patients and what patient factors should be taken into account in selection and interpretation?

COSI: open ended, choose listening situations

APHAB: disability by HL and reduction of disability with

HAsHAPI: assesses effectiveness of amp in everyday listening situations

SADL: 4 sub scales of cost, positive effects, negative features, and personal image

IOIHA: satisfaction and QOL changes with HA use

SSQ: several domains of auditory disability and handicap

Difference between TEOAEs and DPOAEs?

TEOAE: Stimulus is a brief click - response nature = "echo". Measures stimulus waveform and response waveform. Reproducibility of 50% or more (can be obtained for each frequency). SNR >6 dB at most frequencies

DPOAE: Stimulus: Two pure tones (f1, f2). Response:

Tone (2f1-f2). DPOAE frequency: 2*3278 - 4000 =2557 Hz. Criteria: >6 dB SNR & At least > -10 dB SPL DPOAE amplitude.

List the key components of a case history including information about family history, accidents, and medications

Chief complaint/reason for coming

Concerns with hearing: degree, onset, cause, length of time with HL, which ear, fluctuations/progression?

Dizziness & ringing?

Previous hearing tests?

Noise exposure

Family history of HL

Medical history: surgery on ears, pain, drainage, fullness, visual disturbances

HA history

How does a pediatric case history differ from adults?

Pre-natal history, birth history (born full term? complications?) and NICU stay, passed HBHS?, general health/ear infections, family history of childhood hearing loss, S/L development, global development, educational concerns, hearing concerns??

What steps need to be taken to verify the different kinds of assessment equipment?

#1: Annual electroacoustic calibration

#2: Biological checks... self-listening check & hearing threshold check (audiogram on someone with "known and stable" thresholds.

Daily biological/listening checks.... when should you do this? why should you?

When? Before using new equipments, daily or some other regular interval

Why? To detect problems prior to obtaining clinical data & monitor the status of your equipment

Steps for biological check

1) Phone check... play a continuous pure tone, reduce and increase (check for noise).

2) Bone oscillator check... across frequencies at 30 dB and 50 dB for distortion

3) Audiometer check (are dials loose? Listen for background noise in between signals)

4) Threshold check (on chair in booth)

5) Tymp: 2cc on volume measures on tymp. should easily obtain a seal

What patient factors determine appropriate assessment for...

Physiologic measures rather than behavioral assessment?

Use of different kinds of behavioral assessment?

Use of different kinds of stimuli?

Children who can not give reliable behavioral results

CPA, VRA, BOA. Children or adults with developmental disabilities

Tinnitus, bored children, people with CI need broadband noise

Degree of HL classifications

Normal: -10 to 15

Slight: 16 to 25

Mild: 26 to 40

Moderate: 41 to 55

Moderately severe: 56 to 70

Severe: 71 to 90

Profound: 91+

A primarily hereditary, progressive disorder where the stapes footplate becomes partially fixed to the oval window... what pathology is this and what is the audiogram like?

whats the treatment?

otosclerosis

carhart's notch: normal bone... air is worse at lower frequencies, rises to meet bone at 2k, and then get's worse again. Unilateral.

stapendectomy

Discuss headphone options and list the pros and cons of each

supraaural headphones: easy to calibrate, could cause collapsing ear canals. lower inter-aural attenuation (easier for sound to travel from one ear to the other). Worse for high frequencies. Better for lows.

Insert earphones: greater interaural attenuation (reduces risk of masking dilemma), greater ambient noise attenuation, no headband that may be uncomfortable and cause collapsed ear canals. Wider frequency response (better in high frequencies, which means better speech representation)!! Cons: replacement tips, max. output is lower.

circumaural earphones: approximates canal volume with coupler, can be erroneous for surgical/small ears

Soundfield: must use warbled tones to avoid stannding waves. Patient must sit in calibrated location in booth (look for "X" on ceiling). Does NOT provide individual ear thresholds.

What is the most significant limitation in audiologic findings when soundfield is used?

Not ear specific!

What is the warble tone? Why is the warble tone used when testing in the sound field?

A tone whose frequency varies periodically several times per second over a small range; used to prevent standing-wave patterns from forming in reverberation chambers: when the vibrational frequency of the source causes reflected waves from one end of the medium to interfere with incident waves from the source.

Define speech awareness threshold (SAT), speech recognition threshold (SRT), most comfortable level (MCL), and uncomfortable level (UCL). Describe the procedure for obtaining UCL.

SAT: The lowest level at which the listener can just detect speech (but not understand it). To compare with the best pure tone threshold (i.e., cross-check with audiogram). Use with young children or developmentally delayed patients who cannot point to pictures or repeat words for the SRT.

SRT: Reliability check on pure-tone thresholds. Baseline for presentation level of suprathreshold speech tests. Suspected pseudohypacusis (e.g., poor agreement with pure tone thresholds)

MCL: Some tests may be given at MCL. May use MCL and UCL in hearing aid selection and fitting.

Present words at different levels, and have the listener rate the loudness from 1 (extremely soft) to 9 (intolerably loud)

•Level that produces rating of "4" = MCL

•Level that produces rating of "7" = UCL

typically 100-110 dB HL for normal hearing listeners-cold running speech, or specific frequencies (ex: 500 and 4000 Hz)-level of speech is raised from below UCL by audiologist-patient indicates when speech becomes uncomfortable or intolerable

Having obtained a reliable SRT, how would you estimate MCL?

typically 50-55 dB above SRT

At what level is a word recognition test administered?

MCL/ 50-60 dB for normal hearing patients, for patient with hearing loss-- 20-30 dB SL the poorest air conduction threshold in the test ear from 1000-4000 Hz OR 20-30 dB SL the SRT

What are the phonetically balanced word lists used for?

Word recognition testing. Single-syllable words (CVC) that are phonetically balanced, meaning the beginning and ending phonemes are chosen according to their frequency of use in conversational speech

Discuss the pros and cons of MLV vs. recorded

*MLV can be personalized. Recorded is more consistent and more standardized. MLV can be paced however is needed. Accents are a barrier (could be different than local dialect with either presentation). Recorded voice presents normative data (helpful when fitting).

Make a list of age-appropriate testing methods used for infants to age 6. Behavioral & speech.

0-6 months: BOA (or ABR)

6 months-2.5 years: VRA

2.5-5 years: CPA

<2 years: Early speech perception test

2-5 years: NU CHIPS

4-6: WIPI

6+: PBK-50

How would you achieve SAT with a very young child who does not talk?

VRA, identify objects, point to body parts

What is the major difference between behavior observation audiometry (BOA) and visual reinforcement audiometry (VRA)

BOA: birth-4 mo; reflexive behaviors

VRA: 5 mo-2yrs, involves conditioning to stimuli (reinforce with video/items)

What are the different types of tympanograms and what do they indicate?

Type A= Normal

Type A(S)= Shallow (small peak). Thick, scarred TM; otosclerosis; cholesteatoma; fluid.

Type A(D)= Deep (high peak). Ossicular disarticulation; monomeric TM

Type B= Flat (no peak). Large ECV= TM perf or patent PE tube.

Normal ECV= ME effusion, blocked PE tube, cerumen occlusion.

Small ECV= Blocked probe, cerumen occlusion.

Type C= Negative (normal peak, negative pressure).

Fluid, ET dysfunction, beginning or resolution of ear infection.

Stiffness vs. mass in tymps.

More than normal energy reflected back and recorded at the mic, suggests stiff ME system (ossicular fixation, OM, cholesteatoma)

Less energy than normal reflected, back and recorded at the mic suggested flaccid ME system (discontinuity of ME ossicles, monomeric TM)

What is peak admittance?

A measure of the of ability of the middle ear system to accept acoustic energy. The tympanic membrane is in its position of rest; it is not forced medially or laterally. The pressure in the canal is equal to the pressure in the middle ear.

The peak tends to be large with "loosening" pathologies: ossicular discontinuities, atrophic TMs.

Admittance is small with stiffening pathologies: middle ear effusion, otosclerosis

What is Tympanometric peak pressure?

Middle ear air pressure. TPP is negative when middle ear pressure is below ambient. TPP is associated with eustachian tube malfunction. TPP varies widely in children's ears that are normal

What is gradient /tympanometric width (TW) is a measure of?

how "sharply peaked" vs. "flattened" the tympanogram is. Flattened tympanograms are associated with effusion. Gradient / TW are mainly an attempt to quantify this qualitative observation

Which muscle do we measure in acoustic reflexes?

What is the stimuli?

Stapedius

500, 1k, 2k, (not 4000Hz). Broadband noise. Should be 70-90 dB above threshold.

Elevated acoustic reflex levels in the presence of normal hearing might lead you to think what?

Tumor/other retrocochlear pathology

Review acoustic reflex pathway

:)

For what suspected condition would you obtain reflex decay?

Present activator continuously for 10 seconds and if the reflex rapidly decreases in strength, this is "fatigue" and it is often associated with retrocochlear pathology (e.g., 8th-nerve tumor)

What do rotational tests indicate about the patient?

bilateral weakness-- loss of function on both sides

Difference between VNG and ENG?

Purpose of caloric testing

Assessment of horizontal SCC. The only test to assess right and left individual peripheral systems.

When endolymph is heated, it will rise. When it's cooler, it will sink.

What should caloric responses be?

COWS (Cool stimulation should beat eyes in the opposite direction of stimulated ear. Warm---same direction)

Why use ice water in calorics?

Can determine if there is any residual function in the ear.

4 oculomotor assessments

Saccades: ability to refixate on a moving target. Measures velocity, accuracy, latency. Abnormalities indicate CENTRAL lesion.

Smooth pursuit: Track image on the fovea with smooth continuous eye movements. Different frequencies. Tests velocity gain, asymmetry, and phase. CENTRAL lesion if abnormal.

Optokinetic: Moving left and right at the same speed. OPK reflex response. Measures gain and symmetry. Really should be whole visual field-more than a light bar.

Gaze

The psychoacoustic evaluation may include, but is not limited to...

a full case history, audiological evaluation, tinnitus pitch matching, tinnitus loudness masking, minimum masking level evaluation, residual inhibition assessment, and subjective patient questionnaires.

Diagnostic audiometers generally provide one-third-octave noise bands for use in masking pure tones. Which of the following best explains why one-third-octave noise bands are used?

They are wider than critical bands. Narrow bands of masking noise on audiometers should be wider than a critical band because they provide more effective masking for the frequency being tested without requiring higher overall intensity.

Tinnitus pitch matching is most useful when the tinnitus assessed is described as...

Single or overlapping tones. Tinnitus pitch matching is useful with tonal tinnitus.

A patient in the early stages of Ménière's disease will have an increase in the amount of endolymph in the inner ear. Audiometric assessment is likely to show sensorineural hearing loss that primarily affects which of the following frequency ranges?

250-2000 Hz. The increase in the amount of endolymph in the inner ear expands the apical end of the cochlea because of a decreasing stiffness gradient of the basilar membrane. Since it is the low frequencies that are sensed in this location, it is the low frequencies that are diminished when there is too much endolymph.

For someone sitting 20 meters from a concert stage, the average intensity is 65 dB65 decibels SPL. Which of the following best indicates the average sound-pressure level at a seat 10 meters from the stage?

71 dB SPL. According to the inverse square law, the sound intensity decreases by 6 dB6 decibels when the distance from a sound source doubles. Conversely, the sound intensity increases by 6 dB6 decibels when the distance to the sound source is halved.

The cochlear implant signal-processing strategy in which brief pulses are presented to each electrode in a nonoverlapping sequence is known as...

continuous interleaved sampling (CIS)

What is current steering?

Current steering involves the simultaneous delivery of current to adjacent electrodes, where stimulation can be steered to sites between the contacts by varying the proportion of current delivered to each electrode in an electrode pair. Current steering may increase the number of spectral channels beyond the number of fixed electrode contacts.

A 60-year-old man has bilateral, moderate-to-severe, precipitously sloping sensorineural hearing impairment. During the hearing-aid trial period, he is extremely dissatisfied because he constantly reports that /s/forward slash, s, forward slash, /f/forward slash, f, forward slash, and /sh/forward slash, sh, forward slash sounds are not clear. Which of the following is the best method of addressing his concern?

Deactivating frequency lowering and performing probe microphone verification by measuring REAR. The best option is to deactivate frequency lowering in the hearing-aid settings and perform Real-Ear Aided Response (REAR). This process will allow the audiologist to rapidly identify maximum audible output across the frequency range and determine whether high-frequency sounds are inaudible or appropriate per the prescription targets.

Which of the following lists examples of technical safeguard options outlined by the Health Insurance Portability and Accountability Act?

De-identification of data, firewalls, mobile device management

Reduced visual function, which can complicate planning for aural rehabilitation, is most likely to be found in patients with hearing loss who present with....

Diabetes