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Audiology 1


Pathologies of the outer ear generally result in conductive loss charactized by flat or semi flat across all tested frequencies
Outer ear problems may be a result of blockage, foreign bodies, impacted cerumen, congential atresia
Impacted ceremen against the typmpaic membrane will result in 40 dB loss at all frequencies
Otoacoustic emissions (OAEs) preseence requires acoustic signal, efferent response from CNS,Normal OHCs, Hearling loss less than/greater to 35dBHL
ABR latency-intenisty fx will help identify high/low frequency loss; severe to profound loss
ABR latency-intensity fx will not id conductive loss of less than 35 dBHL.
ABR reflects activity in the auditory nerve & brainstem pathways
What is retrocochlear? pertaining to the disorders of the 8th CN or beyond the cochlea
In the Hood method of masking, adequate/effective masking is what portion of the graph Plateau
Optokinetic test nystagmus; is a test of the oculomotor/ocular system & its CNS connections; involve a visual target
Optokinetic nystagus test patient follws a series of vertical bands moving left to right; normal is mirror image
Optokinetic nystagmus test abnormal is grossly asymetric
Nystagmus induced by a given position postional nystagmus
Nystagmus in a neutral position spontaneous nystagmus
Measurement of nystagmus ENG - electronystagmongraphy
Electronystagmongraphy (ENG) monitors eye movement with electrodes around the eyes; picks up corneoretinal potential
Corneoretinal potential electical difference between the front & back of th eye
two types of testing for auditory fx Behavioral Testing requiring a behaviroal response; Physiological test requiring a nonbehavorial response
examples of phsiological tests Auditory Evoked Response (AER); Otoacoustic Emissions (OAE); Elecronystagmongraphy (ENG)
Example of auditory evoked response tests ABR (auditory brainstem reponse)
OAE by product ofauditory styem activity in outer hair cells of the cochlea
OAE soft sounds generated by movment of the outer hair cless in the cochlea
pathway of stimulation of outer hair cells stimulation is sent in through the middle ear, emission occurs within the cochlea, sound then must travel back out through tht middle ear, external ear & be recorded by themicrophone of the deveice
Structures of the inner ear cochlea, footplate of the stapes; set deep in temptoral bone of skull
basel end of cochlea (base) high frequency sounds
apical end of cochlea (apex) low frequency sounds
smooth pursuit test tests central dysfx; follows a visual target; oculomotor testing
gaze testing oculomotor testing; fixed point
saccedes rapid eye movement; ENG is not effective with this testing
diseases of the outer ear acute otitis externapericondritishematomaatresia
hearing loss at birth congential heaing loss due to hereditary links, genetc mutations during evelopment or infections/trauma in prenatal & perinatal periods
acquuired hearing disorder occur later in life from noncongenital factors
Presbiacusis age related hearing loss
Neural Dis-synchrony/Auditory Neuropathy disorder where the neurons do not fire with the normal synchrony thta is necessary to conduct cochlear output to the brain
Types of Otoacoustic emissions Spontaneoustransient evokeddistortion product
OAE routinely used in clinic transient evokeddistortin product
transient evoked present a tone burst or click; the same sound over a number of frequencies; intense
transient evoked activates the cochlea across a wide fx region, if outer hair cells are normal, TEOAs are producted
distortion product otoacoustic emissions - DPOAE stimuli are two closely spaced pure tones, f1 & f2
distortion product the calculated response; the intermodulation distortion product produced by the ear when stimulated; 2f1-f2
DPOAE frequency range 500-10,000 Hz; results difficult to obtain below 1500 Hz
Otoacoustic emissions uses newborn screenings; confirm soundfield testing in toddlers; imp for early id/diagosis of auditory dysfx in pediatric & adult populations; substantiate results of "feigned hearing loss"
OAE does not test hearing but rather outer hair cell integrity
TEOAE response to noise floor differences calculated at individual frequencies 500 Hz to 5000 Hz
TEOAE is depicted by waveform picked up in the ear canal after a click
ABR estimates normal hearing thresholds
ASSR estimates severe to profound hearing loss
ABR cannot estimate profound hearing loss
ABR requires skilled analysis
latency amount of time delay since presentation of stimulus
ABR is not impacted by arousal state
ABR assesses hearing & disagnosis
Factors to consider with ABR age, gender, maturation
Which gender has shorter latency periods & larger amplitude waves for III, IV & V females
Absolute latencies appear slighly longer with advancing age
Conductive losses reduce the amount of signal intensity reaching the cochlea thus, they tned to have the latency-intesity fx that are displaced horiontally to the right (higher click levels)by the amount of the hearing loss
cochlear impairments have V latencies that are elevated at & slightly above threshold
Conductive losses must be at or above 35dBHL to distinguish from sensorineural impairments
Cross hearing for air-conducted sounds occur prmariy through what mechanism? bone conduction
cross hearing sound presented to one ear which is actually heard by the other
cross hearing shadow hearing
Crossover occurs when the signal is physically present in the opposite ear
cross hearing signal presented in opposite ear is audible
the tone by cross-hearing continues to be heard in the masked ear despite the noise since the tone level is below the threshold of the test ear undermasking
clinical masking render a tone inaudible due to the presence of noise
bone conduction masking rule AB gap is more than 10dB in the test ear
air conduction masking rule difference of 40dB or more between AC threshold on test side & the BC thresholds of the non test side
masking level so intense that it crosss to the test ear resulting in continuous shifts in the thresholds of the tone w/increases in the masking noise over masking
when the threshold of the tone for the test ear has been reached, the level of noise can be increased several times w/out affecting the level of tone that vokes a response is called effective masking/plateau
ENG electodes pick up the corneoretinal potential. What is that? an electrcal difference between the front & back of the eyes
bedside vestibular tests stepping fukuda test, Romberg test, past finger pointing test, post head-shaking nystagmus test
condition characterized by an abnormally small or malformed auricle microtia
disorder characterizedby bony outgrowths occring in the externalear canal & are thought to arise from repeatd & prolonged exposure to cold water exostoses
disorder characterized by a benighn mass that invades the middle ear space cholesteatoma
disease characteriazed by episodes of vertigo, fluctuating low fx sensorineural hearing loss, aural fullness & tinnitus Meniere's Disease
fixation suppression (suggesting central pathology)is performed during this test caloric tests
menier's treatment salt restriction, diuretics, steroids, surgery as a last result
diuretics thiazides, neptazane
Variable influencing the presence of OAEs level of physiologic noise, middle ear integrity, debris in external canal, noise in room
OAEs can be measured across a frequency range
OAEs response is caluclated response is calculated above a noise floor
OAE tsts require acoustic stimulus and recording microphone in hermetically sealed probe module
What is the stimulus used for transient evoked OAE? click or tone burst; NOT narow band noise
Proper time sequence of auditory evoked responses occur in what order ECochG, AMR, AMLR, ALR, P300
Difference between Distortion Product & Transient Evoked Disortion is closely spaced pure tones; Transient - abrupt click or tone burst across a wide frequency region
Auditory Evoked Potential Tests used to determine if specific parts of the vestibular system are functioning properly or too see if the roadway is blocked
Blockage may occur due to tumor, infection, nerve damage
A large perforation of the tympanic membrane theoretically results in hearing that is slight to moderately impaired
inflammation of the mastoid mastoiditis
collection of fats & other skin debris in the middle ear, usually caused by infection cholesteatoma
formation of spongy bone that may affect the normal movement of the stapes otosclerosis
general classification of surgical procedures for repairing damage of the middle ear structures tympanoplasty
The ABR latency intensity fx for wave V experected in cochlear hearing losses is increased, primarily at low intensities
Otoschlersosis is most common in women
dots jump from location to location & assess the patients ability to follow the rapidlly moving image saccade test
also called the pendular tracking - patient watches back/forth movment of a light or pendulum testing the CNS ability to make controlled eye movement pursuit test
Patient watches lights on the light bar travel from one end to the other, falling off the end of the bar. Watch or count the dots. If CNS intact, nystagmus will be seen Optokinetic test
examines whethere nystagmus is present without head movement & looks for spontaneous nystagmus gaze test
determine if we can evoke nystagumus by placing the patient in different head and body positions positioning tests
electordes ar eplaced near the eyes to measure involuntary eye moments electronystagmography
recording of eye movments using infrared cameras mounted on goggles to exclude light and disable a patient's visual fixation ability videonysagmography
stimulatin of the horizontal semicircular canals using thermal stiumlation, air wor water, into the ear canal caloric testing
specific positioing test to examine patient for benigh paroxysmal positional vertigo Dix Hallpike test
grommet like tubes inserted into typanic membrane to allow fluid to drain - equalize pressure PE tubes
pain in the ear otalgia
hearing loss occuring after birth caused by diseases, trauma, drugs or aging acquired hearing loss
hearing loss purposely feigned and exaggerated functional hearing loss
when the pars flaccid region of the tympanic membrane becomes sucked in retraction pocket
a condition that is in its initial phase and lasts a relatively short duration acute disorder
refers to something being open patent
accumulation of fluid Effusion
slight elevation in the BC threshold around 2000 Hz seen in cases of otosclerosis from the loss of middle ear resonance due to poor ossicular chain conduction Carhart's notch
a condition that persists over a long period of time chronic
defining which parts of the ear are affectd through evaluation of the case history and audiometric results differential diagnosis
hearing loss of unknown origin idiopathic
fluid that is draining into external auditory canal from the middle ear otorrhea
removal of middle ear fluid using a needle type syringe myringotomy
surgical treament of otosclerosis that involved replacing parts of the stapes with a prosthetic device connecting the incus to the oval window stapendectomy
Created by: cltgrace