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Audiology Exam 2

Terms in this set (94)

Ear canal volume for infant-8 years old
0.2-0.9 cm
Ear canal volume for children 9 and older (female)
0.9-2.1 cm
Ear canal volume for children 9 and older (male)
0.9-2.3 cm
The stapedius muscle contacts
bilaterally
What is the starting level for acoustic reflex threshold
80 dB HL
What is the cutoff for mild hearing loss
40 dB
The superior olivary complex is also known as
CSLIMA
Noise we use for hearing testing with masking
narrowband noise (pure tone air and bone conduction testing)
Noise we use for speech testing
speech noise (filtered white noise)
Other noises
cocktail noise, multi talker babble noise, broadband noise
Speech reception threshold acronym
SRT
Reference for decibel sensation level
dB SL
Appropriate starting level is
40 dB SL
Air bone difference that is allowed for sensory neural hearing loss is
0-10 dB
Decibel value for air bone gap that we are concerned about and then need to apply masking is
15 dB HL
Conductive hearing loss is if every result is
in the normal hearing range
Relationship between SRT and SAT
The decibel value that is allowed between the SRT and pure tone average +/-7 decibel hearing level
To calculate PTA you have to look at the
air conduction threshold response for each ear at 500, 1,000, and 2,000 Hz(added and divided by 3)
Speech detection threshold or speech awareness threshold is when
the patient cannot repeat back the word or verbally respond but they can raise their hand or give a thumbs up to acknowledge they hear the audiologist
Any threshold within the speech range that is within 10 dB is
in good agreement
Testing procedure
-Written consent
-Build repour
-Ask about previous symptoms and illnesses
-Otoscopy
-conduct full acoustic emittance test battery (starting with tympanometry, then acoustic reflex threshold testing (both ears), then acoustic reflex decay)
-Otoacoustic emissions (both ears) ipsilaterally
-Speech audiometry starting with the SRT, UCL, MCL, WRS, at 40 dB sensation level for both ears
-Test air conduction
-Pure tone air conduction for each ear
-Bone conduction for each ear
- If patient comes in with specific concerns, then we could do auditory brainstem response testing and/or central auditory processing disorder testing
If we suspect rollover the acoustic emittance test we will see an abnormal response on is
acoustic reflex decay (decays before 5 seconds)
Speech banana is where all of the sounds in the English language are produced such as
frequency and decibel intensity level
Range of decibel intensity level for speech banana is
30-35 decibels (range), softest is at 4,000 Hz at 20 dB, loudest is at 250 Hz at 55 dB
Speech reception/recognition threshold (SRT) def
Person repeats two syllable words to determine the softest level of speech they can hear
Speech awareness threshold (SAT)/speech detection threshold (SDT) def
The point at which a person can understand that you are speaking but will not be able to repeat the word
Word recognition score (WRS) def
Person repeats monosyllablic words at certain dB SL levels to determine how many words they can identify (reported as a percentage)
Pure-tone average (PTA) def
Hearing threshold averages at 500, 1,000, and 2,000 Hz. Verifies if SRT scores are "in good agreement" with pure tone thresholds
If SRT and PTA are within 7 dB HL of each other then
they are considered in good agreement
Most comfortable loudness level (MCL) def
Intensity level that a person perceives as comfortable to listen to
Uncomfortable loudness level (UCL) def
-Intensity level that a person perceives as uncomfortable to listen to
-measures loudness perception of speech which is based on hearing levels in lower frequencies
Types of hearing loss
-conductive
-sensorineural
-mixed
-non-organic/functional
Conductive hearing loss
-occurs as a result of outer or middle ear pathology
-strength of sound is decreased
-may be temporary
Sensorineural hearing loss
-occurs as a result of inner ear issues (cochlear and/or neural)
- occurs in both air and bone conduction
- hearing loss is permanent
Mixed hearing loss
- hearing loss as a result of outer or middle ear impairment/pathology and inner ear deficit
- conductive part of the hearing loss may be treated but may not resolve it
Nonorganic/functional hearing loss
- no exact cause of the hearing loss but test results indicate some kind of hearing loss
- could be purposely faking a hearing loss or could have a psychological disorder
Air bone gap (ABG)
A difference of more than 10 dB between air and bone conduction pure tone thresholds (Dr. Cosby 15 dB HL)
Configurations of hearing loss
-rising
-sloping
-precipitous sloping
-notching
-corner
-flat
Rising configuration
worse hearing for lower frequencies and better hearing at higher frequencies
Sloping configuration
Hearing thresholds are better at lower frequencies and gradually decrease at higher frequencies
Precipitous Sloping configuration
Good hearing thresholds at lower frequencies but hearing thresholds decrease as the test frequency increases
Notching configuration
Hearing thresholds are relatively good for lower test frequencies but the threshold slopes downward around 3,000 to 6,000 Hz then hearing thresholds improve for the highest test frequencies
Corner configuration
Hearing thresholds are recorded only for a few of the lowest test frequencies and only at very high intensity levels
Flat configuration
Hearing thresholds are about at the same hearing loss dB level across the frequency range
acoustic immittance measurements allow
audiologists to describe and quantify how well the middle ear is working
Tympanometry
procedure for detection of middle ear dysfunction
Type A tympanogram
-Normal
-Reflects normal outcome for tympanometry
Type As tympanogram
-Shallow/stiff
-Indicates a restriction in the flexibility or an increase in the stiffness of the middle ear system
Type Ad tympanogram
-Deep
-Indicates a highly compliant middle ear system or tympanic membrane
Type B tympanogram
-Flat
-Indicates severely restricted mobility of the middle ear system
Type C tympanogram
-Negative
-indicates Eustachian tube dysfunction
Masking
-involves sound in the non-test ear
-reason is to make sure the patients response is due to the sound being presented in the test ear
-goal is to isolate the test ear and eliminate any sounds the non-test ear may hear that will affect the ear being tested
Interaural Attenuation
The reduction of sound as it crosses the head from one ear to the other
Effective Masking
Amount of narrowband noise that is needed to mask the pure tone signal being heard
Masking plateau
Gradually increases the loudness of the narrowband noise to ensure masking in the non test ear
Occlusion effect
-increase in the amount of bone conduction sound entering the ear when it is masked
-causes increase in the intensity of bone conduction signal for patients with normal or sensorineural hearing loss
Speech frequency range
250-4,000 Hz
Validity
Test measuring what it is supposed to measure
Test battery
A group of speech audiometry tests to evaluate auditory function
Rollover
-The decrease in word recognition scores as the intensity level increases
- aka: the louder the sound gets the worse a patients WRS score gets
Performance intensity function
graph showing word recognition scores for word lists as the testing is done at different intensity levels
Auditory brainstem response (ABR)
-shows how the inner ear and brain pathways for hearing are working
-reflects activity of auditory nerve fibers and pathways within the auditory brainstem
-electrical responses to sound in the nerve fibers and brain stem pass through brain tissue and the skull
test/re test reliability
measures the reliability of a test over time by giving the same test to the same group of people at different times and seeing if they score the same results as last time
Signal to noise ratio (SNR)
the relationship between the intensity level of the words and the intensity level of the background sound
Types of noise used in different testing for SNR
Multi talker babble
Cocktail party
Count the dots/articulation audiogram
-used to estimate speech recognition abilities relative to audibility of speech intensity of 45-50 dB HL
-count the dots below the threshold = percentage of conversational speech energy audible at a distance of 3-6 feet
- the more dots that occur above the hearing threshold line the more speech energy that the individual will perceive
what is being assessed with the acoustic reflex threshold
change in compliance in the middle ear, with response coming from the ear drum
what is being assessed with acoustic reflex decay
-the auditory dysfunction involving the auditory nerve or auditory brainstem rather than the inner ear
-response comes from the contraction of the staples muscle
Speech signal testing to differentiate between cochlear, neural or central auditory system pathologies
cochlear: EcochG, auditory reflex decay
neural: cortica, AER
Central: ABR
Auditory evoked responses/potentials what is being assessed
the brainstem and the different parts of it
what parameters are needed/used for interesting results for auditory evoked responses/potentials
amplitude over latency
Frequency range for air conduction is
250-8,000 Hz
Frequency range for bone conduction is
250-4,000 Hz
Decibel range is
-10 dB HL to 120 dB HL
Audiogram symbols
-red circle: right unmasked
-red triangle: right masked
-red greater than sign: right unmasked
-red greater than bracket: right masked
-blue x: left unmasked
-blue square: left masked
-blue less than sign: left unmasked
-blue less than bracket: left masked
-arrow down to the right: left ear no response
-arrow down to the left: right ear no response
Red is
right
Blue is
left
Masking clarification
the symbol always goes with the ear being tested. So the right ear during air conduction has masking noise being presented then that means the left ear is the test ear and the masked symbol should be plotted for the left ear (the triangle would be plotted if the right ear was the test ear)
Range of human hearing
-20-20,000 HZ
-frequencies between 500 and 4,000 Hz are most important for speech processing
Ranges for degrees of hearing loss
- < 25 dB HL: normal hearing sensitivity
- 26 to 40 dB HL: mild hearing loss
- 41 to 70 dB HL: moderate hearing loss
- 71 to 90 dB HL: severe hearing loss
- > 91 dB HL: profound hearing loss

(0-25)
Otoacoustic emissions (OAEs) def
sounds measured in the external ear canal that are associated with activity of the outer hair cells
How to determine whether SAT/SDT are in good agreement with pure tone test results?
plus or minus 10
What is the importance of objective vs subjective measures used in hearing assessment in the pediatric and/or special needs populations
-early intervention and to determine if the patient is lying or not
- subjective tests rely on a patients response which means a patient can lie on the test by indicating they heard a sounds when they really didn't and objective test doesn't rely on a patient response because the body will naturally show you a response
Example of a subjective tests
WRS, pure tone air and bone, and MCL and UCL (with speakers for pediatrics)
Example of a objective tests
Otoacoustic emissions, electro acoustic test, ABR, and tympanomatry (and acoustic immittance for pediatrics)
Stimuli used for OAE
tone bursts and clicks
Speech banana lowest to highest sound
250-4,000 Hz
ECochG is testing the
cochlea
ABR image waves
-wave 1: arises from activity in the auditory nerve fibers
-wave 3: produced by combined activity from 2 or 3 pathways in the pons portion of the brain stem
- wave 5: the most prominent wave
Testing list
-written concsent
-otoscopy
-tympanometry
-ocustic reflex threshold
-otoacoustic reflex decay
- otoacousic emissions
-speech audiometry
-pure tone air and bone conduction
Optional: auditory brainstem response testing and central auditory processing
Nerves involved in acoustic reflex ARC
7th and 8th
Start air conduction at
39 dB and frequency of 1,000 Hz
Speech banana is
average range the speech is produced in
Central auditory processing disorder
Difficulty some patient experience in processing auditory information even when the audio gram is normal
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