Audiology Assessment Review Flashcards

Vocabulary practice flashcards covering aud assessment, diagnostic audiological procedures, equipment calibration, immittance evaluations, and speech testing tools.

ASHA and AAA

American Speech-Language-Hearing Association (ASHA) and American Academy of Audiology (AAA) are two professional organizations that have developed the scope of practice statements for audiology.

Weber Test

A bone conduction test providing feedback about sound localization via forehead placement of the tuning fork; used for patients with unilateral hearing loss.

Schwabach Test

A bone conduction test using mastoid placement that compares a patient's hearing duration to that of the examiner.

Rinne Test

A test assessing both air and bone conduction by comparing a tuning fork placed on the mastoid versus in front of the pinna.

Bing Test

A bone conduction test using mastoid placement and alternate opening/closing of the tragus to check for occlusion effects.

Degree

mild, moderate, severe, and profound

Configuration

sloping, rising, or flat

Loudness Balancing

One of the first diagnostic audiological tests developed, performed to determine whether recruitment is present or absent in an ear with hearing loss.

Recruitment

The rapid growth of loudness in an ear with sensorineural hearing loss; its presence suggests a cochlear site of lesion, while its absence suggests a noncochlear (retrocochlear) site of lesion.

Bekesy Type I Pattern

A Bekesy audiometry pattern associated with normal hearing, conductive hearing loss, and sensorineural hearing loss of unknown origin.

Bekesy Type II Pattern

A Bekesy audiometry pattern indicating sensorineural hearing loss caused by a cochlear site of lesion.

Bekesy Type III Pattern

A Bekesy audiometry pattern indicating a retrocochlear site of lesion, often caused by an acoustic neuroma or cerebellopontine angle tumor.

Bekesy Type IV Pattern

A Bekesy audiometry pattern associated with a cochlear or retrocochlear site of lesion.

Bekesy Type V Pattern

A Bekesy audiometry pattern indicative of pseudohypoacusis.

(SISI)

Short Increment Sensitivity Index: A test determining the ability of a patient to detect a $1\,\text{dB}$ change of intensity in a pure-tone stimulus superimposed on a continuous tone presented at $20\,\text{dB SL}$.

(TTD)

Threshold Tone Decay: A diagnostic test measuring the ability of a patient to perceive and maintain a pure tone presented continuously to quantify auditory fatigue at or near threshold sensitivity.

TTD can provide differential diagnostic information regarding:

Cochlear vs Retrocochlear pathology

Pure Tone Average (PTA)

An average calculated using the formula: $\frac{500\,\text{Hz} + 1000\,\text{Hz} + 2000\,\text{Hz}}{3}$.

Pseudohypoacusis

Literally meaning falsely reduced hearing, applied to cases where patients have exaggerated hearing loss (also termed nonorganic, functional, or psychogenic hearing loss, hysterical deafness, and malingering).

Reliability

If the test is administered and then repeated (test-retest) at a different time by the same or a different individual, to what extent will the test results be the same?

Validity

A measure of the ability of a test to detect the specific disorder for which it was designed.

Sensitivity

The accuracy of a test in correctly identifying disordered subjects.

Specificity

The accuracy of a test in correctly rejecting patients without a disorder.

Predictive Value

A test metric directly related to the number of false-negative results.

Efficiency

A measure of a test's overall accuracy.

Evidence-Based Practice (EBP)

Integration of the best research evidence with clinical expertise and patient values to validate clinical effectiveness.

General procedures of EBP

• Framing the clinical question

• Finding the evidence

• Assessing the evidence

• Making the decision

(ANSI)

American National Standards Institute: An organization establishing standards for audiometric instrumentation and test rooms, with standards reviewed every $5\,\text{years}$.

What are the components of a pure tone audiometer (and what are the types called)?

pure tone generator, interrupter switch, amplifier, attenuator, output selector switch, earphones; type 1, 2, 3, or 4 (smaller number = more features)

Pure tone generator

Produces pure tones at discrete frequencies selected with a frequency control

Interrupter switch

Turn the tone on and off before it is routed to the amplifier

Amplifier

Each pure tone is amplified to its maximum and then directed to the attenuator

Attenuator

The tones are attenuated with the HL control, which is numbered in decibels relative to normal hearing

Output selector switch

Used to direct the tone to either the right or left earphone

Supra-Aural Earphones

Transducers consisting of an earphone mounted in a circular cushion attached to a headband, featuring high sensitivity, low distortion, and limited output above $8000\,\text{Hz}$.

Insert Earphones

Transducers consisting of a shoulder-mounted transducer coupled to the ear canal via sound tubes and disposable foam eartips.

Circumaural Earphones

Transducers consisting of an earphone attached inside a plastic dome cushion, most commonly used for testing hearing above $8000\,\text{Hz}$.

Loudspeakers

• A bandwidth between 100 and 10,000 Hz

• A smooth frequency response

• Be housed in an enclosure

• Be capable of producing a sound pressure level (SPL) from 0 to 120 dB at a reference point in the sound field

• Be electrically isolated so that circuit or line noise is not amplified

•  Have very low distortion at very high output levels

Bone vibrators

• Bone vibrators differ in size, shape, weight, input impedance, encapsulation, and frequency response

• Most common is the Radioear B-71

• Can be placed on the mastoid or forehead using a headband

Electroacoustic Calibration

The measurement of performance characteristics of an audiometer and transducers using couplers and electronic instrumentation to verify ANSI compliance.

Coupler

A standardized device used for measuring the output of transducers.

Sound Level Meter (SLM)

An instrument combining a microphone, amplifying and filtering circuits, and a meter to measure sound pressure level (SPL) in an acoustic coupler or sound field.

Voltemeter

• Used to measure the output of an electronic device

• Can be used to determine whether a problem exists with a transducer, a cord, or the audiometer

• The voltage is typically measured between the audiometer and transducer so that the audiometer continues to be loaded by the transducer

Electric counter/timer

Oscilloscope

An instrument primarily used for measuring tone-switching performance characteristics such as rise/fall times, overshoot, and pulse durations.

Why do we use FM signals in the soundfield? 

FM signals are most commonly used for sound field testing to avoid standing wave

How do we measure harmonic distortion?

Harmonic distortion for each earphone type is measured by mounting the earphone on an appropriate coupler, with the coupler microphone connected to an SLM having one-third octave band filters

Explain how to do an inspection check

• Power Cord and Light: The entire length of the power cord should be checked before it is plugged in. Check the power light that comes on when the audiometer is turned on

• Transducer Cords: Visual inspection should be made of each transducer to look for signs of wearing and cracking

• Cushions and Headband: On supra-aural headphones, the cushion should be tightly connected to the earphone or the plastic housing covering the earphone

•  Controls and Switches: All of the dials, switches, and pushbuttons must be tightly connected, move through their entire function and be in proper alignment

Explain how to do a listening check

• Performed for many of the performance characteristics measured during an electroacoustic calibration

• Should be completed with a normally hearing listener and the audiometer and transducers in their customary locations

Audiometer noise

Unwanted noise from the audiometer could invalidate the test results. Any sound that results from the operation of any control or sound radiated from the audiometer should not be audible

Frequency

Completed by setting the frequency control to its lowest setting and directing a continuous 70 dB HL tone to one earphone. Slowly move the frequency control through its entire range for both earphones. A nonwavering tone should be heard at each frequency in each earphone

Attenuator Linearity

Performed by setting the HL control to its lowest level and directing a continuous 1000 Hz tone to one earphone, then moving the HL control through the entire range and repeating for the other earphone. Result should be hearing a tone that increases in loudness without any other noises at or between the HL steps

Transducer Cords

Directing a continuous 1000 Hz tone at 70 dB HL into each transducer. Result should be hearing a steady-state 1000 Hz tone in each transducer

Interrupter Switch and Static/Hum

Directing a tone at 70 dB HL into one earphone at each frequency from 125 to 8000 Hz and pressing the interrupter switch, then repeating for the other earphone. Result should be hearing a smooth tone onset and off-set

Crosstalk

• Completed by wearing each earphone but one earphone is disconnected from the audiometer and replaced with a dummy resistance load. Listener should not hear a tone in the earphone connected to the audiometer

Acoustic Radiation

Unwanted sound from a bone vibrator can occur from sound leaking or radiating from the enclosure housing the electromagnetic transducer. May cause an invalid high-frequency air-bone gap

Known Threshold

Performed by obtaining air-conduction thresholds for each transducer on a listener and comparing them to previous thresholds. Thresholds need to be within +- 5 dB of the previous thresholds

Why are listening checks important

To make sure equipment is working properly before testing patients

Impedance

The total opposition to the flow of energy in a system such as the outer and middle ear.

Admittance

Refers to the ease with which acoustic energy is transmitted through the outer and middle ear; used synonymously with compliance.

Immittance

Measurements electronically or electroacoustically based on impedance or admittance, representing the relative height of a tympanogram at its peak.

Compliance

The inverse of stiffness as it relates to the ease of acoustic energy transmission.

How are stiffness and compliance related

Stiffness and compliance are inversely related

As one increases the other one decreases

What is the primary application of immittance measures

• evaluates middle ear function 

  • Otitis media

  • Confirm the diagnosis of auditory neuropathy

  •  Provide diagnostic information regarding facial nerve lesions

  •  Diagnose perforations of the tympanic membrane

  •  Detect the presence of ostoscerosis 

Type A Tympanogram

A tympanogram type that suggests normal tympanic mobility and normal middle ear function.

Type Ad Tympanogram

A tympanogram type representing abnormally high static admittance.

Type As Tympanogram

A tympanogram type representing abnormally low static admittance.

Type B Tympanogram

A tympanogram type representing little or no static admittance in the conductive system; the most abnormal tympanogram pattern.

Type C Tympanogram

A tympanogram type representing normal compliance and static admittance but abnormal negative pressure in the middle ear.

What is the clinical standard probe tone frequency used for tymps

226 Hz

What is the probe tone frequency used to test infants tymps?

660 to 1000 Hz

What frequencies are assessed in acoustic reflex?

500, 1000, 2000, and 4000 Hz

Ipsilateral stimulus

• An ipsilateral acoustic reflex stimulus is delivered to the probe ear

• For ipsilateral acoustic reflexes you can go up to 100 dB HL

• uncrossed = ipsi

Contralateral stimulus

• a contralateral acoustic stimulus is delivered to the ear opposite the probe ear

• For Contralateral acoustic reflexes you can go up to 105 dB HL

• Crossed = contralateral

Name three conditions that affect the ability to record reflexes

Middle ear disorder

Hearing loss in the stimulated ear

Interruption of the neural innervation of the stapedius muscle

Name the mechanical abnormalities/conditions that can obliterate the recording of an acoustic reflex 

• Otosclerosis: cause the footplate of the stapes to adhere to the bone surrounding the oval window, increasing the stiffness of the ossicular chain

• Middle ear fluid: cause the tympanic membrane and middle ear structures to lose all compliance, and stapedius muscle contraction cannot influence the immobility of the middle ear system

• Disarticulation: result in loss of energy transfer across the ossicular chain to the tympanic membrane

• Perforation: cause the probe tone to be presented directly to the middle ear space, giving a large equivalent volume reading

Acoustic Reflex Threshold (ART)

The lowest intensity at which an acoustic reflex contraction occurs.

Partial reflexes

a reflex is present at some frequencies tested and absent at others

Elevated reflexes

• reflex thresholds exceeding 100 HL

Absent reflexes

Absent reflexes in individuals with normal or near-normal hearing may indicate middle ear disease or neurological involvement of CN VIII

Acoustic Reflex Decay

A test assessed with low frequencies ($500\,\text{Hz}$ and $1000\,\text{Hz}$) presented contralaterally at $10\,\text{dB SL}$ or between $90\,\text{dB HL}$ and $105\,\text{dB HL}$ for $10\,\text{seconds}$ to measure muscle contraction endurance.

What is the purpose of doing reflex decay on a patient?

To help identify retrocochlear pathologies, which are problems located beyond the cochlea

Pure-Tone Threshold

The lowest intensity at which the patient is able to respond to a stimulus $50\%$ of the time.

What frequencies does the human ear respond to? 

Human ear responds to frequencies between 20-20,000 Hz

What frequencies are critical for the perception of speech

Only those frequencies between 300-3,000 Hz are actually critical for the perception of speech

False-Negative Response

A response error occurring when a patient fails to respond when an audible stimulus is presented.

False-Positive Response

A response error occurring when a patient responds in the absence of a stimulus.

Modified Hughson-Westlake Method

A threshold estimation procedure using an ascending technique in $5\,\text{dB}$ steps preceded by a descending familiarization trial in $10\,\text{dB}$ to $20\,\text{dB}$ steps.

Hearing test normal findings

pure tone air and bone conduction thresholds will be at 0 dB HL at all frequencies

Conductive HL

• Pure-tone bone conduction thresholds are normal and pure tone-air

• conduction thresholds are abnormal

• Measures of middle ear functions will be abnormal

• The maximum amount of hearing loss due to conductive pathology is 60 to 70 dB

• No difficulty discriminating speech for a sufficiently loud signal

• May have softly spoken speech because their own voice is perceived louder than normal due to an occlusion effect

Sensorineural HL

• The air and bone-conduction thresholds are both elevated and within 10 dB of each other

• Symptoms characteristics include: 

• Shouting or talking in a loud voice: does not have normal hearing by bone conduction so their own voice or other voices may not be heard

• Difficulty discriminating speech sounds: better hearing in low frequencies than in the high frequencies resulting in consonant  sounds not heard or easily confused

• Recruitment: rapid growth in loudness once threshold has been crossed

• Individuals dynamic range (range of intensities between an individual’s threshold and uncomfortable listening level) is limited

• Frequent decrease in word discrimination ability: due to distortion of the speech signal caused by auditory nerve fiber loss

• Experience greater difficulty in noisy environments

Mixed HL

• Both air and bone-conduction thresholds are elevated but bone- conduction thresholds are better than air conduction thresholds by 10 dB or more

• Difference between the two thresholds is referred to as the air-bone gap and represents the amount of conductive loss present

Air-Bone Gap

The difference between air-conduction and bone-conduction thresholds of $10\,\text{dB}$ or more, representing the amount of conductive loss present.

describe the classification system for children degrees of hearing loss

• 0 to 15 dB HL: within normal limits

• 16 to 25 dB HL: slight

• 26 to 30 dB HL: mild

• 31 to 50 dB HL: moderate

• 51 to 70 dB HL: severe

• 71+: profound

describe the classification system for adult degrees of hearing loss

• 0 to 25 dB HL: within normal limits

• 26 to 40 dB HL: mild

• 41 to 55 dB HL: moderate

• 56 to 70 dB HL: moderate to severe loss

• 71 to 90 dB HL: severe

• 91+: profound

Hearing Disability

The limitation on function imposed by a hearing loss.

Hearing Handicap

A measure of the effect that a hearing loss has on psychosocial function.

Deaf

Term reserved for individuals whose auditory sensitivity is so severely impaired that only a few or none of the prosodic and phonetic elements of speech can be recognized.

Hard of Hearing

Term describing individuals with hearing loss who can identify enough distinguishing features of speech through hearing alone to permit at least partial recognition of spoken language.

Types of Pure Tone findings