Hearing loss and Audiometry test 4

subjective

pure tone testing

objective

tymps and reflexes

amittance

same bridge to do tymps and reflexes

impedance change

what are you looking for when testing reflexes

muscle contraction

what is happening so the stapes isnt continuously pounding into the cochlea with loud noises

base

high pitches

high pitches

what is lost with noise-induced hearing loss

hearing loss

what can be correlated with reflexes

reflexes

results are used to set levels for cochlear implants

low

what frequency is not good for reflex activation

low-frequency stimuli

sensitive to changes in middle ear stiffness

high-frequency stimuli

not sensitive to changes in middle ear stiffness

high

what frequency is good for reflex activation

obtaining the seal

hardest part of reflex testing

loudspeaker, air pump, and microphone

what are the aspects of the probe for reflexes

high and low

which frequency stimuli do you use for reflexes

500, 1000, 2000, 4000

what frequencies are used for reflex testing

low level probe tone alone

stapedius muscle relaxed; middle ear has relatively low impedance; most of the sound energy passes into cochlea

high level activator tone

stapedius muscle contracts, middle ear stiffens, producing higher impedance at low frequencies

high

what kind of intensity sound is used for a short period

bilateral phenomenon

acoustic reflex is a what; that both right and left ear contract

loud tone

what starts the reflex

middle ear

where is the impedance change that is measured

brainstem

contraction of the ear is controlled by what

stimulate, middle ear, cochlea, 8th, brainstem, 7th, stapedius muscle contraction, impedance change

acoustic reflex arc

unilateral, bilateral

activation is what and its muscle contraction is what

ipsulateral

measured on same side as stimulated

which ear gets the sound

name of right or left is based on what

right ipsy, left contra

if someone has bells paulsy on the right side, what are their expected reflexes

contralateral

sound in one but opposite ear is measured

low-frequency sound transmission

reflexes reduce what

left ipsy

sound and probe left

left contra

sound left, probe right

right ipsy

sound and probe right

right contra

sound right, probe left

5

reflexes are done in steps of what

time-locked, repeatable, has to grow

what do reflexes need to be

70-100 dBHL

normal threshold reflexes

sensation level

how much do we need to increase to get to presentation level

audiogram thresholds

in order to interpret reflexes, what is needed

recruitment

faster (steeper) than normal growth of loudness

loudness in dynamic range; recruitment

if you have SNHL; you are more susceptable to what

reduced

when you do reflexes, the sensation level is what

70-100 dBHL

for a sensorineural loss, AC thresholds of 30-50 dB should get a reflex of what

likely wont have a reflex

for a sensorineural loss, AC threshold at 85-100 dB should get a reflex of what

20-45 sensation level above reflex (in HL)

for a sensorineural loss, AC thresholds at (55-80 dB should get a reflex of what

no relfex

for a conductive loss, if the probe is in the ear with the loss, what reflex should you get

size of air bone gap

size of reflex with a conductive lost is dependent on what

ABG plus threshold

for a conductive loss, if the probe is in the ear without the loss, what reflex should you get

sensorineural

there is currently no cure for which hearing loss

age, degree of loss, expensive, stigma

reasons why people don’t choose to use hearing aids

conductive

which loss normally uses hearing aids

mild to severe

which degree of loss normally uses hearing aids

social, occupational, safety

motivation for hearing aid canidates

noise induced hearing loss and presbycusis

with these, one is a candidate for hearing aids

1900

first electric hearing aid breakthrough was when

big and poor frequency response

drawbacks from the first electrical hearing aid

first programmable hearing aid

could switch channels and still remember

first digital hearing aid

1995, still seen today

microphone, amplifier, and receiver (listener)

components of a hearing aid

microphone

picks up sound

analog to digital

the switch from microphone to amplifier

amplifier

converts the signal; depends on where we need help; the computer

digital to analog

the switch from amplifier to receiver

receiver

gives the person sound

standard, open-fit, rice

behind-the-ear hearing aid styles

separate units

in behind-the-ear hearing aids, what are the hearing aid and earmold

in-the-ear, in the canal, completely-in-canal, invisible in canal

custom hearing aid styles

all one unit

in custom hearing aids, what are the hearing aid and earmold

advantages to BTEs

powerful amplification, durable, appropriate for children, room for features, cheapest, long battery life, not prone to cerumen

disadvantages to BTEs

visibility/large size, requires earmold and tubing

open-fit BTE

small dome tip in ear canal instead of earmold; tip doesnt occlude ear canal, low frequency enters naturally, helping with sloping loss; slim tube intead of standard tubing, transmits high frequencies, less visible

open-fit BTE advantages

no occlusion effect, cosmetic appeal, no earmold required

open-fit BTE disadvantages

only appropriate for mild to moderate high-frequency loss

receiver-in-the-canal advantages

smaller, more discrete no occlusion effect, no earmolds

receiver-in-the-canal disadvantages

more prone to damage from wax/moisture in the ear canal

ear molds

purpose is to couple the hearing aid to the persons ear canal to deliver sound, ensure secure and comfortable fit, occlude ear canal to prevent feedback

ear molds

frequent remakes needed for young children due to growth of ears; may have pressure vent to reduce occlusion; different styles, materials, and colors available

phonak sky

very popular hearing aid for kids

BTE

what style of hearing aids is best for kids

durable and large fitting range if loss is progressive

BTE for children, why is it best

silicon ear molds kids hearing aids

will create a good seal while still being soft enough to not cause injury, so if they fall it wont damage or break the ear

tamper proof battery doors and disabled volume and program buttoms

what aspects of hearing aids for children are changed for beneficial use

FM boost

attached to kids hearing aids; to connect wirelessly to FM system at school worn by teachers

in-the-ear advantages

less visible than BTE, may have room for features

in-the-ear disadvantages

less powerful, more expensive, and shorter battery life than BTE; prone to cerumen, dexterity required to manipulate

in-the-ear hearing aids

more upkeep in general

completely-in-canal advantages

least visible type of hearing aid

completely-in-canal disadvantages

typically not powerful, no room for volume/other features, most expensive style, difficult to fit, expose to cerumen, shortest battery life

hearing aid features

volume control, program button, telecoil, direct audio input, directional microphone, noise reduction and feedback cancellation

size

what is a limiting factor for features in hearing aids

volume control

allows for adjustment of output level; available range set by audiologist; standard for BTE, may or may not be available for customs; some demand others are fine with automatic controls

programs of hearing aids

settings designed to optimize performance in different environments; may change amount of amplification microphone settings, turn other features on/off

tones

what is presented to indicate program change when button is used to cycle through its programs

telecoil/t-coil

coil of wire inside hearing aid amplifies electromagnetic waves emitted by phone; designed to improve listening on phone and connected assistive listening devices; typically disables hearing aid mic, so only input is from telecoil

telecoil advantages

does not amplify acoustic background noise like a hearing aid mic does, no feedback when holding phone up to hearing aid, can use with assistive listening device

telecoil disadvantages

prone to interference (fluorescent lights, computers, etc) sensitive to position of phone

direct audio input (bluetooth)

allows for connection between audio signal and hearing aid; common use for FM systems; other inputs include TV, ipod, microphone

direct audio input advantages

does not amplify acoustic background noise; input is processed by hearing aid for persons hearing loss

BTEs

typically, direct audio input is only available for which type of hearing aid