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