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Terms in this set (67)
The prevalence decreases as the severity of the HL ___________________________
The Ear Examination
Otoscopy , video otoscopy
Behavioral subjective tests
1. Pure Tone Audiometry
2. Speech Audiometry; Supra threshold tests
Physiological Objective Tests include
2. Acoustic Reflex
3. Auditory Evoked Potentials AEP, ABRs Optoacoustic Emissions (OAE)
Pure Tone Audiometry
is the measurement of an individual's hearing sensitivity for calibrated pure tones.
Two general methods used for pure tone audiometry
(1) Manual audiometry, also referred to as conventional
(2) discrete frequency or sweep-frequency testing by automatic audiometry, referred to as Bekesy-type audiometry.
Threshold of Audibility is
the minimum effective sound pressure level of an acoustic signal producing an auditory sensation in a fraction of trials.
The threshold of audibility or sensitivity threshold is variable and must be described in terms of a
Liminal /minimal Thresholds are defined as the lowest signal intensity at which multiple presentations (typically odd number3-5) are
detected 50% of the time
(a headset with TDK earmuffs or insert earphones (red color for right ear and blue for the left ear)
is placed over the mastoid region of the temporal bone to deliver sounds through bone conduction ( BC) and bypass the external and middle ear .
Sound level meter SLM
to measure sounds output levels in dB SPL , dB p SPL and peak equivalent SPL and the spectral composition of sounds
a) Equipment Calibration ANSI standards verified in the instrument regularly -sound level meter; b) Listening Check ,earphones right and left are connected properly and functioning c) Environmental conditions : Sound level booth and screening conditions
Ear Canal Examination
Use an otoscope to check that the ears are not occluded with cerumen debris or foreign materials cotton etc.
Examiner needs time to obtain relevant aspects of the case history; establish rapport ; examine/study listener behavior Questions such as which ear seems to be best ?; which ear preferred for telephone ? Id there is tinnitus, physiological noises, intolerance to loud sounds ; psychological confounds etc
When the difference between the values at any two adjacent octave frequencies from 500 Hz to 8000 Hz is 20 dB or more, _________________ measurements should be completed.
False responses may be of two types
1. False Positive : a response when no tone is presented /pulsed
2. False Negative : Failure to respond when a tone that is audible to the listener is present.
A response at any frequency is called
the air conduction response
A bone conduction oscillator
stimulates the inner ear directly and is placed by the audiologist on the mastoid bone.
2.Subjective considerations such as motivation intelligence attention familiarity with the task
3.Internal physiological noise masking floor due to vascular digestive respiratory noises etc.
(can be reasonably controlled under laboratory testing conditions)
1. Physical environment (noise levels , temperature, light, humidity)
2. Measuring calibration instruments need to be used to control these extrinsic factors and operate reliably
The ability to understand and recognize speech sounds must be considered the most important measurable aspect of human auditory function
Speech Detection Thresholds (SDT) also known as Speech Awareness Thresholds (SAT)
measures the lowest intensity at which speech can be detected (which is usually lower that the intensity require for understanding speech)
Speech Recognition Thresholds (SRT)
measures minimal intensity levels for speech recognition /understanding. This thresholds usually occurs about 8-9 dB above SAT/SRT-
Suprathreshold word-recognition testing
The primary purpose is to estimate ability to understand and repeat single-syllable words presented at conversational or another suprathreshold level
Uncomfortable Loudness level (UCL)
determines the upper hearing limit for speech; provides the maximum level at which word-recognition tests can be administered.
UCL is useful to determine ______________ range
the dynamic speech
The test that determines the intensity level of speech that is most comfortably loud is called
most comfortable loudness level (MCL) test
is a fast non behavioral (objective) method to evaluate middle ear function.
Immittance testing measures
Tympanogram ,Static Compliance and Acoustic stapedius Reflex
Is based on the principle that sound conduction through middle ear is most efficient when the air pressure at both sides of the eardrum is equalized
The results of a Tympanometry are recorded on a two dimensional graph called _______
Tympanogram graph shows what?
how sound is reflected as a function of the variations in pressure from positive pressure to negative (within +/-200 daPA)
Normal Tympanogram, indicates normal middle ear function
flaccid tympanic membrane (hyper mobility) resulting from scar tissue or a disarticulation in the ossicles
non mobile and compliant system Possibly middle ear effusion , OME or obstruction/inflammation in the external auditory canal
stiffness in the middle ear (reduced mobility); fixation of ossicular chain Suggests Otosclerosis
Negative pressure in the middle ear dysfunction of the Eustachian tube
When does the acoustic reflex occur?
when a small muscle in the middle ear , the stapedius muscle, contracts as a result of acoustic stimulation at high intensities (70, 90 and 100 dB HL)
Acoustic Reflex provide valuable info on
1. The middle ear function (absent in case of middle ear dysfunction)
2. Neurological functioning (retro-cochlear pathology)
3. Gross Index of auditory sensitivity
Disorders of the External Ear
1. Congenital : Aural Atresia/Microtia, associated syndromes
2. Acquired: External Otitis, Obstructive and Traumatic disorders
Disorders of the Middle Ear
Otitis Media Acute and Chronic Clinical complications; tympanic membrane perforations.
Disorders of the Inner Ear
1. Congenital and Hereditary Hearing loss
2. Types of hearing loss Sensorineural Conductive and Mixed Hearing Loss , Audiometric characterization
3. Acquired Sensorineural Hearing loss; Presbycusis , Noise Induced hearing loss
Assessing Pathology of The Ear
1. Patient History
2. Otologic Examination
3. Audiometric/Audiology Evaluation
4. Imaging Techniques
5. Genetic Testing
1. Ear Atresia (absence or structure/stenosis of the auditory canal )
2. Microtia: Malformation of the Pinna
1. External Ear infection : Otitis Externa
2. Obstructed/blocked EAC--> Foreign Body cerumen or wax
3. Traumatic lesions of the Auricle /ear
1. Acute Otitis Media OME
2. Chronic Otitis Media
-Incus necrosis; Malleus head fixation; perforation of the tympanic membrane
We categorize a hearing loss by
type , degree and configuration
Basic types of HL
Sensorineural , Conductive and Mixed hearing losses.
Other descriptors associated with hearing loss
1. Bilateral vs. Unilateral ;
2. Symmetrical vs. Asymmetrical;
3. Progressive vs. Sudden
4. Fluctuating vs. stable
Acquired Hearing loss Audiometry and Hearing Loss Examples
1. Noise-Induced Hearing loss
3. Sudden Hearing loss
Hereditary HL defined as
those cases in which the causative factors are present in the genetic composition or makeup of the fertilized ovum (genome)
Congenital HL means
that the hearing impairment is present at birth and includes both hereditary as well as acquired (acquired while the fetus was in- utero but not contained in the germ cells genes)
Degree of hearing loss
normal: -10 to 15
slight: 16 to 25
Mild: 26 to 40
Moderate: 41 to 55
Moderately severe 56 to 70
Severe: 71 to 90
Types of Hearing loss
1. sensorineural, 2. conductive, 3. mixed
1. damage in the inner ear hearing receptor (inner hair cells) also tuning curves are affected.
2. the most common type of hearing loss in adults
Problems in the conduction of sound to the inner ear (external and or middle ear structures /functions) with a preserved inner ear receptor (No damage in the Cochlea)
1. When both Sensorineural and conductive components are present
2. problems in the outer and/or middle ear function as well as permanent damage in inner ear hair cells (cochlea) or auditory nerve
Masking is used to find what?
the thresholds for the other ear (worse ear) we use a continuous making noise/sound delivered to the non test ear (the better ear).
Symmetrical versus asymmetrical
Symmetrical means the degree and configuration of hearing loss are the same in each ear. Asymmetrical means the degree and configuration are different in each ear.
Progressive versus sudden hearing loss
Progressive means that hearing loss becomes worse over time. Sudden means that the loss happens quickly. Such a hearing loss requires immediate medical attention to determine its cause and treatment.
Fluctuating versus stable hearing loss.
Fluctuating means hearing loss that changes over time—sometimes getting better, sometimes getting worse. Stable hearing loss does not change over time and remains the same.
Hereditary HL- Waardenburg's Syndrome
1. Characterized by three signs hypo pigmentation, craniofacial anomalies and muscle deformities.
2. Causes: Affectation of the PAX gene is the most common explains the involvement of symptoms we commonly see
Hereditary Disorders of the Ear Treacher Collins
1. Autosomal dominant hereditary disease,
2. facial nerve abnormalities
3. Craniofacial malformations
4. Atresia, ear tags or pits
5. Abnormal middle and inner ear structures
6. Hearing loss is conductive or Mixed
Otosclerosis: Hereditary, Genetic Hearing Loss
is a disease process in which vascular spongy bone replaces the normal hard bone
1. an age related hearing loss.
2. It usually affects the high frequencies more than the low frequencies.
3. Presbycusis hearing losses. A right hand sloping hearing loss with the left and right ear usually deteriorating at equal rates.
Noise induced hearing loss
1. Noise induced hearing loss is where loud noise has caused damage to the hearing organ, the cochlea.
2. This most commonly occurs at 4KHz.
3. Therefore if a hearing loss is noise induced you would expect that the sounds have to be made louder before they are heard at 4KHz than at any other frequency.
4. This leads to a dip (notch) in the graph as seen in the figure.
5. The frequencies around 4KHz will also be affected.
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