1 in ___ Australians have a hearing impairment
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Effects of hearing impairment include: impaired ability to hear the difference between your choice of signal and _____________ signalscompetingDecibel is a unit that measures the __________ of soundintensitySound pressure level (SPL) uses _____________ as a measure of intensitypressuredB reference for measuring threshold (softest sound that the ear can detect) is dB _____________ (dB HL)hearing levelIn the average normal hearing threshold level (HTL) graph, low frequencies need much ________ pressurehigher3 dimensions of sound include pitch ( __________ ), loudness (amplitude) & length (duration)frequencyBone conduction hearing aid is ___lateral treatmentbiReconstructive surgery for anotia include: Unilateral surgical treatment which is delayed till ___ years of age, bilateral surgery begins around ____ years of age, or prosthesis (implant) which can be built onto BAHA6, 4Complications of otitis media: __________________ (white patches beneath lining of epithelium of ME), adhesive otitis media (fibrous adhesions develop in ME, can affect function of ____________ )tympanosclerosis, ossiclesComplications of otitis media effusion: _______________ (cyst like collection of keratin debris within middle ear), mastoiditis ( ________ infection of bone of mastoid and air cell system), meningitischolesteatoma, acuteTreatment options for otitis media: antibiotics (treatment for 10-14 days, reduce symptoms in 2-3 days, complete in _____ weeks), ______________ _____________ (long term low dose treatment with antibiotics, for children with recurring infection), ______________ (surgical incision to drain fluid from ME)6, antimicrobial prophylaxis, myringotomyTreatment options for otitis media with effusion: grommets, myringotomy and ________ , vaccinetubesSensorineural hearing loss results from disorders of cochlea, VIII nerve or cochlea _________nucleiMeniere's disease is characterised by _________________ hydrops (watery swelling of the cochlear duct and vestibular organs) (abnormal build-up of ______ rich fluid / endolymph)endolymphatic, K+Sudden idiopathic sensorineural hearing loss = larger than _____dB deterioration in hearing over less than 3 days. Causes is usually a _________ infection or interruption to _________ supply. Treatment with steroid drug (prednisone)30, viral, bloodPresbycusis is hearing loss due to ___________agingGenetic reason for hearing loss includes mutation in the ___________ 26 geneconnexinInner ear structural abnormalities include Michel, Mondini, Scheibe, Alexander Aplasia. Mondini involves a developmentally deformed _________ where only the basal coil can be identified - middle & external ear may also be involved, fluctuating hearing losscochleaPerilymphatic fistula is ___________ or _______________ induced vertigoexercise, hyperventilationOver ______% childhood deafness is genetic in origin50Semicircular canals detect __________ acceleration eg. shaking headangular__________________ reflex is when rotation of the head is detected, and excitatory signal is sent to the extra-ocular muscles on the other side (opposite motion of eyes)Vestibulo-ocularOtolithic organs sense __________ acceleration eg. elevator, when head doesn't moves in relation to your body but your body moveslinearKey cause of tinnitus is _______________exposure to soundPotential causes of pulsatile tinnitus include: aneurysms, hydrocephalus (increased ________________ pressure eg. skull not formed properly), arteriosclerosisintercranialTreatment for tinnitus includes: TRT (tinnitus reduction therapy) - exposing people to different sounds that _______ tinnitus), therapeutic noise generators, neuromonics device, CBT (aim is to limit attention paid to it)maskAdvantages of pure tone screening is that it is calibrated to deliver frequency ____________ sounds, equipment is readily available, relatively quickspecificWhen screening the elderly, the pure tone criteria is _____dB hearing level (HL) at 1K and 2KHz40When testing children, types of tests include behavioural observation audiometry (BOA) Behavioural tests are much more variable and subjective. It involves observing changes in behaviour in response to ____________soundsBehavioural Observation Audiometry is for very young babies (eg. under ___ months). Responses are usually very subtle eg. change in suck rate, change in eye gaze, _________ reflex for loud sounds6, startleLimitations of Behaviour Observation Audiometry (BOA) include high ______ positive and negative rate, responses dependent on infant state, time consuming, babies are unreliable. Overall, it's ______ ____________ for screening (limited information)false, not effectiveFor infants that are 7 months to ___ years, Visual Reinforcement Orientation Audiometry or ________ Audiometry is used (behavioural techniques)3, PlayIn Visual Reinforcement Orientation Audiometry (VROA), _____________ conditioning and _________ reinforcement is used eg. lighted puppet theatre. Its advantages include: can provide frequency- specific threshold information, can systematically _______ the sound, it's a parent observing test so parents can obtain a good idea of child's hearingoperant, visual, varyPlay Audiometry (3 to ___ years) is where children have to do a _______. The child puts on headphones and tones are presented with varying loudness.9, taskFor adult populations, they should be screened at 40, _____ and _____ dBHL at 1KHz, 2 KHz. There is much more comprehensive screening for adults - range of intensities, localisation of sound etc.60, 80_________________ processing involves sounds coming into the ear, going to the auditory cortex eg. pure tone audiometry / Acoustic-perceptual processingBottom-up_________________ processing involves listeners using their knowledge related to phonological, syntactic context eg. gesturing, tone of voiceTop-downPure tone audiometry is a poor predictor of speech ___________________ and speech understandingdiscriminationSpeech Detection Threshold (SDT) is the level that speech can be _____________ (lowest speech sound a person can hear)detectedSpeech Reception Threshold (SRT) is approximately ____dB louder than SDT. Not only does a person need to detect sound, but they need to identify sound ( _________ reception threshold than detection threshold), listener needs to be able to repeat 50% of stimuli presented9, higherSDT should correlate with pure tone average. Usually no more than ___dB different to pure tone average based on 500, 1000, 2000Hz5Types of speech audiometry include sound field audiometry and non-sound field audiometry ie. using _______________headphonesClinical application of Performance Intensity (PI) Function shows the anticipated discrimination with __________________ (presenting a person with a sound/ word at different intensities). Adults are tested with AB word list (scored phonemically) and children use picture pointing responseamplificationSignal to noise ratio (ratio greater than 0dB indicated more _________ than _________ )signal, noiseNoise effects on hearing loss: May require SNR to be improved by 5 to ____dB relative to normal hearing, another ___dB if reverberation is present10, 3Speech perception in noise test makes speech test more sensitive, a valid ________________ of everyday listeningreflectionOtoscopy middle ear testing is checking for the bulging, retraction, redness etc. of the __________ ____________tympanic membraneTympanogram measures the _____________ of the eardrum. Middle ear problems can include ossicles disruption ( _____________ ), perforated tympanic membrane, OME because of fluid buildup. It is quick, non ______________ and objectivestiffness, otosclerosis, invasiveType A tympanogram has a _______ near atmospheric pressure (0)peakType B tympanogram is ______ due to immobile tympanic membrane (pressure from obstruction in middle ear)flatThe peak in Type C tympanogram is displaced to negative pressure, due to ____________ ________ __________________. Air pressure is greater in the ear canal than middle ear.Eustachian tube dysfunctionTympanometry tells you about ________________ lossconductiveOtoacoustic emissions (OAEs) are used to differentiate between sensory and _________ hearing lossneuralThere are two types of OAEs: spontaneous and _________ (stimulus provided)evokedThere are two types of Evoked OAEs: click (transient) - absent for sensorineural losses greater than 20 to ____dB HL and distortion product OAE (absent in sensorineural losses greater than 45 to ____dB HL, absent DPOAE means large HL)30, 55Limitations of OAEs include: absent in _______________ loss / can't be detected if tympanic membrane is immobile, not sensitive for _________ within 24 hours of birth, noise and electrical interference can affect results, not a test of hearing (limited application)conductive, neonatesStiffness and _______ of basilar membrane differs along its lengthmassAt the base of the basilar membrane near the oval window are _______ frequencieshighAt the apex of the cochlea / wide flexible area of basilar membrane near the helicotrema are ______ frequencieslowThere is a ________________ organisation of sound frequencies along the basilar membranetonotopicOnly _________________ are exposed to endolymph due to tight junctions. They contain mechanically-gated cation channels and open on movementstereociliaEndolymph is at +_____mV. When the basilar membrane deflect the inner hair cells (bend towards the tallest member), tip links stretch and open channels. K+ enters and the hair cell _________________, and a graded potential is generated. Depolarisation opens voltage-gated ____ ion channels, which enter, allow vesicles to bind and cause a greater increase of ________________ neurotransmitter. More neurotransmitters lead to higher rate of action potentials (rate of APs in VIII nerve afferent increases)80, depolarises, Ca2+, glutamate10-20 type 1 (large, myelinated, glutamatergic) neurons innervate each ________ hair cell. These neurons are spontaneously active and has different thresholdsinnerEach type _____ neuron (small, unmyelinated, glutamatergic) innervates 15-20 different ________ hair cellsII, outerPitch (tone) discrimination - determined by the ______________ of vibrations. Up to approx. 5kHz, there is also phase-locking where neurons respond to a specific period of stimulation elicited by a stimulusfrequencyTimbre discrimination is the characteristic ___________ of a sound. It's determined by the relative STRENGTHS of components of different frequenciesqualityIntensity (loudness) discrimination is dependent on _______________ of vibrationamplitude_______________ superior olive responsible for interaural phase (time) differenceMedial_______________ superior olive is responsible for interaural intensity differenceLateralVertical source of sound is detected in the ____________ cochlear nucleidorsalSound localisation in the ______________ plane happens in the superior olivary complexhorizontalIn the primary auditory pathway, the FIRST BILATERAL projection (used for location detection) happens in the ______________ _________ ______________ in the ponssuperior olivary complexHigh frequency sounds are at the ___________ aspect of the primary auditory cortexmedialLow frequency sounds are at the ___________ aspect of the primary auditory cortexlateralInjury to semicircular canals can result in poor balance, nausea and blurred __________visionMeniere's disease: recurrent attacks of ____________ with tinnitus, aural fullness and loss of hearing 'endolymphatic hydrops'vertigoMost vestibular processing is _______________. Information relayed to red nucleus is responsible for _________ coordination, superior ________________ is responsible for eye movement, motor cortex is responsible for conscious awareness, hypothalamus responsible for perception of _______________unconscious, motor, colliculus, discomfortVestibular processing signals project via VIII nerve to the vestibular __________ at the pons / medulla junction.nucleiVestibular nuclei mediate _______________ movements of the eyes (via CN III, IV, VI), head and neckreflexive____________________ is the sense of body orientation and motionEquilibriumSaccule is functionally similar to utricle but hairs are _____________. Responds selectively to tilting of head away from a _______________ position ie. getting out of bed, vertically directed ____________ acceleration / deceleration ie. in a lift or jumping up and downhorizontal, horizontal, linearOtolith organs tell you which way is up and what _____________ you're headeddirectionReceptor hair cells in the utricle are contained in the ______________maculaeOther auditory responsive cortices: The anterior ________ cortex (medial to primary auditory cortex) is implicated in _____________, possible role in music appreciation. Corticofugal (cortex to deeper brain) projections: modulatory and ____________ effects, modulation of _______ responsesinsula, empathy, learning, motorRostral superior temporal gyrus may contain __________ identity areavoiceNuclei of the lateral lemniscus in the pons / midbrain in the primary auditory pathway is primarily ___________________. Inferior colliculus in the midbrain is responsible for auditory ___________.contralateral, reflexesOuter hair cells are not sensory receptors but increase frequency tuning and s________________ of hearingsensitivityPrevalence of vomiting is highest in ______ (7%) Prevalence of motion sickness symptoms is highest in _________ (41%)sea, road1. Stimulation of hair cells at a specific location along the basilar membrane activates sensory neurons 2. Sensory neurons carry the sound information in the cochlear branch of the vestibulocochlear nerve (VIII) to the cochlear nucleus on that side 3. Information ascends from each cochlear nucleus to the inferior colliculi of the midbrain 4. The inferior colliculi direct a variety of unconscious motor responses to sounds 5. Ascending acoustic information goes to the medial geniculate nucleus 6. Projection fibres then deliver the information to specific locations within the auditory cortex of the temporal lobeHair cells of vestibular apparatus consists of 1 cilium --> the k______________. There are 20-50 m___________ --> the stereocilia, arranged in order of heightkinocilium, microvilliVIII nerves are t_____________ active. The brain detects a change in r______ of action potentials in vestibular nerve fibres innervating a pair of semicircular canals on either side of the head. Following ie. a head turn, the vestibular fibres on the side of the head to which the head is turning i____________ firing, the fibres on the o_____________ side decrease their rate of firing. Amount of head movement is coded by r_____ and d_____________ of action potentials.tonically, rate, increase, opposite, rate, duration