Comprehensive Otoscopy and Puretone Audiometry in Audiology

What is the primary objective of an otoscopic examination?

To examine the outer and middle ear for health and pathology.

What is the difference in technique for pediatric vs. adult otoscopic examinations?

For pediatrics, pull down, out, and back; for adults, pull up, out, and back.

What are some common external ear findings reported in otoscopy?

Microtia, skin tags, pre-auricular pits, tenderness, redness, edema, drainage, and odor.

What does a clear tympanic membrane look like?

Translucent, pearl grey with a light reflex pointing towards the nose.

What is a puretone threshold?

The softest intensity a patient can hear tonal stimuli.

What frequency range do young individuals typically hear?

20 Hz to 20,000 Hz.

What is the primary frequency range for speech understanding?

1,000 Hz to 6,000 Hz.

What does dB HL stand for?

Decibels Hearing Level, indicating the median threshold for young adults with no otologic history.

What is the reference level for dB SPL?

20 µPa, which is a sound pressure level reference.

What are the two main types of hearing loss indicated by puretone thresholds?

Conductive (outer and middle ear) and sensory/neural (cochlea and auditory nerve).

What is the significance of tonotopic organization in the cochlea?

It reflects how different frequencies are processed at different locations within the cochlea.

What are some uses of puretone thresholds?

Determining degree of hearing handicap, monitoring changes in hearing acuity, and hearing aid candidacy.

What does air conduction (AC) audiometry measure?

softest sounds heard / Hearing thresholds along the entire auditory pathway.

What is the purpose of bone conduction (BC) thresholds?

To measure responses from the cochlea, bypassing the outer and middle ears.

What is the maximum intensity for Type 1 diagnostic audiometry?

Up to 120 dB HL for some frequencies.

What is the main feature of Type 4 screening audiometry?

It has only screening capabilities and uses earphones.

What is the function of an audiometer?

To generate puretones, select transducers, and vary intensity for hearing tests.

What is the significance of the light reflex in otoscopy?

It indicates a healthy tympanic membrane and proper alignment of the ear canal.

What does otorrhea refer to?

Drainage from the ear, which can indicate infection or other pathology.

What is atresia in the context of otoscopy?

A condition where parts of the ear canal, tympanic membrane, or ossicles are not formed or are missing.

What does a retracted tympanic membrane indicate?

It suggests negative pressure in the middle ear, often due to eustachian tube dysfunction.

What are the key landmarks to identify during otoscopy?

Pinna, ear canal, and tympanic membrane.

What is the purpose of earphones in audiometric testing?

To test air conduction (AC) thresholds.

What type of earphones are used to test AC thresholds with extended high frequencies?

Circumaural earphones, such as the Sennheiser model HDA200.

Where should bone vibrators be placed during testing?

Behind the pinna on the mastoid process area.

What does a 15 dB or greater difference between AC and BC indicate?

There is a conductive (or mixed) component of hearing loss.

What is a sound field used for in audiometric testing?

uses loudspeakers to test AC thresholds, but it does not isolate ears.

What are preferred tones for sound field testing?

Frequency modulated warble (FM) tones, and narrowband noise (NBN). (good for pediatrics)

What should be marked on an audiogram if testing is done outside a sound treated booth?

Indicate that testing was done at bedside.

What frequency is typically used to start threshold searching for adults?

1000 Hz.

What is the recommended instruction to give patients before testing?

Inform them they will hear beeps in each ear and should respond when they hear them.

How should earphones be placed for testing?

Align the diaphragm with the ear canal and tighten the headband for stability.

What does the 'down 10/up 5' method refer to in audiometric testing?

A procedure for obtaining thresholds by decreasing intensity by 10 dB and increasing by 5 dB based on patient responses.

What should be checked if two adjacent frequencies differ by 20 dB or more?

Intra-octave thresholds should be tested.

What is the definition of a flat configuration in hearing loss?

Less than 5 dB rise or fall across frequencies.

What characterizes a sharply falling hearing loss configuration?

A 15-20 dB increase per octave.

What is a notched hearing loss configuration?

20 dB or greater at one frequency with recovery at nearby frequencies.

What does 'S' signify when writing thresholds for pediatric evaluations?

It indicates sound field testing was used for young children who will not accept headphones.

What is the significance of the ANSI guidelines in audiometric testing?

They provide permissible ambient noise levels for various octave bands.

What is the first frequency to test in the left ear after testing the right ear?

1000 Hz.

What should be done if a patient does not respond at 30 dB HL?

Increase the intensity by 20 dB until a response is obtained.

What is the purpose of masking in audiometric testing?

To keep the better ear busy so the worse ear can respond.

What type of hearing loss is indicated by bilateral conductive hearing loss?

Hearing loss due to issues in the outer or middle ear.

What is the classification for a hearing loss that shows a trough configuration?

ex; 20 dB or greater loss in mid frequencies but not at 500 or 2000 Hz. (cookie bite)

What does the term 'mixed hearing loss' refer to?

A combination of conductive and sensorineural hearing loss.

What does 'BC' stand for in audiometric testing?

Bone Conduction.

What color coding is used for earphones in audiometric testing?

Red for the right ear and blue for the left ear.

What is the recommended duration for tonal presentation in audiometric testing?

1 to 2 seconds.

What is the significance of the term 'response' in audiometric testing?

It indicates the patient's reaction to the presented sound.

What is audiology?

The study of hearing and hearing disorders, dedicated to helping individuals with dysfunction of the auditory and vestibular systems.

What are the main components of audiology?

Evaluation, habilitation/rehabilitation, counseling, education, research, and screening/prevention.

How is audiology described in terms of art and science?

As a blend of art (providing information and support) and science (making precise measurements to determine issues).

When did audiology begin?

After World War II, to help service members with hearing loss.

Who were the initial practitioners of audiology?

Audiologists initially practiced at military hospitals, universities, and university clinics.

What professional organizations are associated with audiology today?

American Academy of Audiology and International Society of Audiology.

What testing methods were used before WWII?

Testing was performed by physicians using tuning forks and whispered speech.

What tests were added to audiology shortly after WWII?

Puretone audiometry, bone conduction testing, and speech audiometry.

What additional services were introduced in audiology post-WWII?

Lip/speech reading, auditory training, counseling, and hearing aid fittings.

What advancements in audiology occurred after military service?

Physiological assessments were discovered, aiding in the assessment of cortical responses and the auditory system.

What are some auditory specialties that emerged in audiology?

Auditory processing disorders, educational audiology, vestibular function, and intraoperative monitoring.

Who is known as the Father of Audiology?

Raymond Carhart (1912-1973) from Northwestern University.

Why is calibration important in audiology?

ensure the accuracy of the equipment for audiometric tests and the transferability of test results across different clinics and countries

What are the calibration standards in audiology?

Standards set by ANSI, IEC, and ISO ensure equipment performs consistently across regions. (ex: ANSI S3.6: defines electroacoustic performance, reference equivalent threshold sound pressure levels (RETSPLs), and tolerances for audiometers.)

What parameters should be checked during calibration?

Parameters should be checked at acquisition, annually, and older equipment biannually, with daily listening checks advised.

What instruments are used in calibration?

Multimeter, frequency counter, sound level meter, oscilloscope, and spectrum analyzer.

What is a biological check in calibration?

Listening to signals with various settings and transducers, checking for sound quality and equipment functionality.

What should be checked during a biological check?

Cords for damage, sound intermittency, proper functioning of dials, and thresholds within 10 dB HL of typical levels.

What is the aim of newborn hearing screening?

To screen by 1 month of age, diagnose by 3 months, and treat by 6 months.

What is the critical period for development in audiology?

The critical period refers to the early years when diagnosis and intervention are crucial for effective auditory development.

What role did military audiologists play post-WWII?

They trained others at the university level and motivated improvements in diagnostic evaluations.