SLHS460 Exam 3

behavioral tests

tests in which the patient must respond and participate (pure tone audiometry, speech audiometry)

objective test

test in which the patient does not need to respond (otoscopy, tympanometry)

impedance

resistance to the flow of energy

admittance

ease of the energy flow (same as compliance)

acoustic immittance

purpose of this testing is to objectively describe how well the middle ear is working

tympanometry

estimates the external ear canal volume, document the integrity of the TM, describe the mechanical properties of the middle ear

acoustic reflex testing

measures the function of the reflex loop from the brainstem

boyle’s law

volume of a gas and pressure are inversely related (having a smaller residual volume increases the sound pressure level)

infant tympanometry

ear canal wall is compliant and will likely expand in response to the positive pressure changes; infant ears have lower resonant frequency

1000 hz probe tone is used

type A tympanogram

tympanogram with:

• peak pressure: normal

• static compliance: normal

  • ear canal volume: normal

type As tympanogram

tympanogram with:

• peak pressure: normal

• static compliance: low

• ear canal volume: normal

shallow, suggesting excessive stiffness of middle ear

type Ad tympanogram

tympanogram with:

• peak pressure: normal

• static compliance: high

• ear canal volume: normal

deep, suggests reduced stiffness (excessive compliance)

type B tympanogram

tympanogram with:

• peak pressure: no peak

• static compliance: no peak

• ear canal volume: varies

ear canal volume helps diagnose issue

type C tympanogram

tympanogram with:

• peak pressure: negative

• static compliance: normal

  • ear canal volume: normal

acoustic reflex

a sonomotor response that is an involuntary muscle contraction in response to sound stimulation; high intensity sound activates the stapedius muscle in the middle ear

• normal reflex threshold: 60-90 db SL

startle reflex

occurs in response to sudden onset sound and impacts multiple skeletal muscles, including the tensor tympani

probe tone

acoustic reflex measurement tone for measuring the change in compliance

• low frequency, usually at 226 hz

stimulus tone

acoustic reflex measurement tone used to elicit reflexes

• frequency of 0.5, 1, 2, and 4 khz

acoustic reflex threshold

deflection is > (greater than or equal to) 0.02 mmhos

contralateral acoustic reflex

stimulus tone in one ear and probe tone in the other ear

• left contra means stimulus in left ear

acoustic reflex decay

site of lesion test that differentiates between cochlear and retrocochlear lesions

• abnormal decay is the reflex strength decreases by 50% in the first 5 seconds

acoustic reflex screenings

assess an acoustic reflex threshold at only one frequency and a single intensity (95 or 100 db)

probe effect

reflexes absent when probe is in one ear

• cannot measure change in compliance whenever the probe is in one ear

stimulus effect

reflexes absent when stimulus is in one ear

• the loudness is turned down by the problem in the stimulus ear

malignant disease of outer ear

growth found on pinna during otoscopic inspection; basal cell carcinoma accounts for over 90% of cutaneous lesions around the head and neck

• refer to physician

malignant disease of ear canal

ear canal carcinoma, much rarer but more difficult to treat; early diagnosis and referral is key

cauliflower ear

common in wrestlers due to blunt trauma leading to hematomas in the ear

• results in cosmetic deformity and potential hearing impairment

congenital malformations

issues present at birth that range from mild variations to absence of the pinna or ear canal

• craniofacial anomalies are a risk factor for infant hearing loss

preauricular pits and tags

depressions or protrusions of skin in front of the pinna

• risk factor for hearing loss because the inner ear forms embryologically at the same time as the external ear

protruding ears

caused by lack of, or malformation, of cartilage during fetal development; unilateral or bilateral external ears with think skin and resilient cartilage with abnormal helical folds that grows laterally or outwards

otoplasty

surgical correction of prominent ears

microtia

absence of portions of the pinna or the entire pinna

• sometimes associated with conductive hearing loss; significant risk of renal abnormalities

stenosis

narrowing of the ear canal, leading to more prone to otitis externa and impacted cerumen

• as long as ear canal is unobstructed, hearing is normal

atresia

absence of the ear canal which leads to conductive hearing loss

cerumen impaction

ear wax completely blocking the ear canal; can be removed by audiologists with training or physicians

• can cause a flat, conductive hearing loss

otitis externa

bacterial, viral, or fungal infection of the outer ear; can be caused by injury or moisture trapped in the ear canal

• most common waterborne disease in the US

  • redness & swelling, pain, drainage, itchiness, feeling plugged or full

osteoma

bony growth in the ear canal, sometimes related to exposure of the ear canal to cold water or wind

patent eustachian tube

the eustachian tube remains open

acute otitis media

viral or bacterial infection in the middle ear space

painful and may lead to fever

lasts less than 6 weeks

otitis media with effusion

otitis media with fluid in the middle ear space

no pain or fever

otoalgia

ear pain that may be localized to the pinna, ear canal, tympanic membrane, and/or middle ear

serous

type of effusion that is thin, watery, and sterile fluid

purulent

type of effusion that is pus, and indicates an infection

mucoid

type of effusion that is thick, viscid, and mucus-like

recurrent otitis media

otitis media with 3 episodes in the last 6 months or 4 episodes in 1 year, with one episode in the last 6 months

pressure equalization tube

tube made of plastic or metal placed in the TM to aerate the middle ear; inserted into TM to create an airway that ventilates the middle ear and prevents the accumulation of fluids

TM perforation

hole in the tympanic membrane that can be caused by acoustic trauma, physical trauma, blows to the ear, otitis media with effusion

• may cause conductive hearing loss

monomere

area on the tympanic membrane with fibrous tissue

cholesteatoma

an epithelial pocket caused by epidermal invasion through a perforation or retraction of the pars flaccida, resorption of air by adjacent bone, erosion of the ossicles, invasion of the inner ear in serious cases

• otalgia, tinnitus, foul-smelling discharge

otosclerosis

progressive bone growth around stapes footplate locks the stapes in place; increases stiffness, so creates low frequency hearing loss

schwartz’s sign

pinkish glow on TM in otoscopy that indicates otosclerosis

carhart’s notch

elevated bone conduction at a single frequency between 500-4000 hz due to alteration of ME resonance (indicative of otosclerosis)

cochlear otosclerosis

leads to deterioration of hair cells, stria vascularis, and spiral ligament; adds a sensorineural component to conductive loss so hearing loss is mixed

tympanoplasty

reconstruction of the TM and/or ossicles

ossicular discontinuity

separation of the ossicular chain (usually between incus and stapes) or a break in one of the ossicles

immittance meter

an electroacoustic instrument used to measure the transmission characteristics of the middle ear mechanism

probe

acoustic immittance device sealed into the external ear canal with a tip, consisting of three tubes; emits a tone at 85 db SPL

ear canal volume

the space enclosed within the ear canal between the probe tip and tympanic membrane

tympanometric peak pressure

the pressure at which the static compliance is maximum (when the air pressure in the external ear canal is the same as that in the middle ear)

static compliance

the air pressure in the external ear canal is changed