Audiology exam 2

atresia

absence or closure of the ear canal

Microtia

when the pinna does not develop fully

Ear Tags

small mass near the opening/cheak of the ear

Ear pits

a little indentation in the ear near the opening/cheak

keloid

extra mass from trauma to the ear, can occur anywhere

tympanometry

dynamic measure of the acoustic immitance in the external ear canal as a function of ear canal air pressure change

What is the purpose of tympanometry?

provide mobility of the TM, gives the status of ME, and cross check assessments

Immittance

measurement of the outer middle ear function, composed of impedance and admittance

impedance

opposition to the flow of energy (blockage or resistance)

admittance

measurement of how much energy passes through a system

high admittance means

greater flow of energy through a system

a bouncy trampoline would come from

high impedance and low admittance

when you jump but sink to the ground

low impedance and high admittance

low admittance means

less energy is able to flow through a system

what happens in immittance?

wave strikes TM, some is absorbed and some is sent back

what is measured in immittance?

ear canal size and pressure

What does tympanometry measure?

pressure, compliance, ear canal volume

Vea can be measured...

the value at +200 daPa

Large Vea means

perforation of ear drum, PE tube, surgical alteration of ear canal

Small Vea means

wax, atresia, inaccurate probe placement

compliance

the amount of mobility of the TM, ossicle chain, TM membrane health, middle ear

if ME is filled with air

energy is absorbed of TM, ossicles, and inner ear structures, normal peak

if ME is filled with fluid

most of the sound is reflected back from the stiff TM, flat tympanogram

disruption of the ossicles

large amount of energy is absorbed, abnormally high peak

Type A tympanogram

normal middle ear function

what are the 3 measurements in tympanogram?

Vea (volume), Ytm (compliance/admittance), TPP (air pressure)

type Blv tympanogram

no peak (TPP), large Vea, low Yea

What might cause type Blv?

perforation or TE tube

Type Bsl tympanogram

no peak (TPP), low Vea, low Yea

what might cause a Bsl?

occlusion in the ear canal, atresia, cerumen, foreign impact

when might you have an abnormally long width on a tympanogram?

middle ear fluid accumulating or resolving, its the beginning or end of an ear infection

Type B tympanogram

Vea is nomal

what is the cause of a type B tympanogram with normal Vea?

middle ear effusion, extreme negative pressure

Type As tympanogram

Normal middle-ear pressure (TPP), reduced admittance Ytm, normal width

cause of a type As tympanogram

middle ear fluid, ossicular chain dysfunction

Type Ad or Add tympanogram

normal middle ear pressure (TPP), high admittance, normal width

cause of an Ad or Add

disarticulation of ossicles, abnormally thin TM

type C tympanogram

negative pressure (TPP), normal admittance and TW

cause of a type C

eustation tube dysfunction

what is the ideal condition for sound to go through?

low impedance and high admittance

Otoacoustic Emissions (OAEs)

objective measurement of the outer hair cells

Auditory brainstem response (ABR) testing

objective measurement of the auditory system including the nerves up to the brainstem

OAE testing

low-intensity acoustic vibrations in the ear canal and outer hair cells

preauricular tags or sinuses

small growth of skin or hole

What are the disorders of the auricle/pinna

anotia, microtia , low set ears , preauricular tags or sinuses

anotia

absence of pinna

microtia

small malformed pinna

congenital disorders of the ear canal

atresia (absence of ear canal) and stenosis (narrowing of ear canal)

acquired disorder of the pinna

Auricular hematoma, melanoma, herpes zoster

perichondrial hematoma

cauliflower ear

acquired disorder of the ear canal

impacted cerumen, foreign objects, otitis externa, exostosis, osteoma

exostosis

bony growth under ear canal skin due to repeated exposure to cold water

osteoma

round bony growth that's a benign tumor in the EC

otitis media with effusion

accumulation of fluid in the middle ear space

serous otitus media

fluid is present without infection

acute otitis media

when fluid is present and infection is present

Chronic Otitus Media

effusion remains in the ear for an extended time

mucoid otitis media

middle ear is filled with mucus or puss

glue ear

effusion becomes highly viscus and can bind to structures

the types of otitis media with effusion

serous, acute, chronic, mucoid, and glue ear

perforation of the TM can be due to

trauma or barotrauma (due to extreme pressure changes)

myringotomy

incision into the tympanic membrane to suck the fluid out

tympanoplasty

surgical repair of the tympanic membrane to cover a hole

cholesteatoma

benign tumor of dead skin and keratin in the middle ear

otosclerosis

bony outgrowth of the bony wall of the inner ear

what type of hearing loss does otosclerosis have?

Carhart's notch, small dip in BC at 2000 hx

ossicular discontinuity

disarticulation of ossicular chain

glomus tumor

benign and slow growth tumor that is highly vascularized, requires surgical removal

NIHL

begins with Temporary threshold shifts and then permanent threshold shifts being between 3000 to 6000 hz resulting in a notch, at 4,000

presbycusis

age related hearing loss, lose high frequencies first

menieres disease (endolymph hydrops)

excessive build up of the endolymph in the scala media and vestibular labyrinths

Menier's disease symptoms

unilateral, low frequency SNHL

ototoxicity

damage to inner ear from medications

What drugs cause ototoxicity

chemotherapy drugs, aminoglycosides, loop diuretics, salicylates (aspirin), anti-malaria drugs

where is the noise notch for NIHL

between 3000 and 6000 Hz

what is NIOSH max dose of noise

8 hours at 85 dB with an increase of 3dBA cuts exposure in half, more conservative

what is OSHA max dose of noise

8 hours at 90 dB with every increase of 5 dBA cuts exposure in half, less conservative

four components of meniere's disease

episodes of vertigo (spinning), low frequency SNHL, aural fullness, low pitch tinnitus

what are the types of post-natal exposures for inner ear infections?

bacterial meningitis, untreated otitis media or cholesteatoma

what are the types of in-utero exposures for inner ear infections?

cytomegalovirus, herpes zoster, syphilis

Neural disorders

retro cochlear lesion (behind cochlea), distal neural lesion (beyond cochlea but not to brainstem), peripheral lesion

acoustic neuroma

benign tumor on the auditory nerve (8th cranial nerve) that causes vertigo, tinnitus, and hearing loss

What are the 3 skill sets of the auditory processing?

auditory discrimination, temporal processing (timing), and binaural processing

What is the cause of CAPD?

lesion along either retro cochlear, brainstem, r & l hemisphere

CAPD symptoms

understanding speech in noisy environment, localize, talk on phone, rapid speech, follow directions, poor musical ability, academic difficulties

How do you diagnose CAPD?

detailed case history, behavioral test batteries, electrophysiologic test

different behavoiral tests

temporal processes, dichotic listening, monaural low-redunency, lateralization, auditory discrimination tests

temporal processes

pattern perception, gap detection

dichotic listening

different words or sentences presented to each ear

monaural low-redundancy

Filtered speech, compressed speech

auditory discrimination tests

Frequency, intensity, and duration of speech stimuli

What does battery of tests consist of?

over working the system, age matched norms, define the specific nature of the problem

Types of behavioral tests

temporal processes, dichotic learning, monaural low redundancy, lateralization, localization or binaural functions, auditory discrimination

What happens if only one tests or all the tests shows deficits?

probably not APD

What are the three major CAPD profiles?

decoding deficits, integration deficits, and prosodic deficits

decoding deficits

unable to extract pitch, located in left hemisphere or high brainstem

integration deficits

unable to combine info and synthesize meaning, hard to process into, deficit in communication between left an right hemisphere

prosodic deficits

unable to process the rise and fall in pitch and loudness, right hemisphere problem

What is the treatments for ADP?

bottom up stimulus driven, and top down strategy driven

bottom up treatment for APD

auditory training, skills remediation, environmental modifications (assistive tech)