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Otologic versus Audiologic Otologic = physical symptoms Audiologic = hearing symtoms
Otologic pain discharge bleeding feeling of fullness or blockage
Audiologic Conductive hearing loss and/or air-bone gap Elevated SRT Normal Word Recognition absence or elevated acoustic reflexes abnormal tympanogram and negative response to special tests for sensory and neural lesions
Atresia A.K.A. STENOSIS acquired or congenital absence or malformation of the opening to the ear could be the affect of a pathology rather than a pathology unto itself
Acquired Atresia Etiology? surgical procedures such as a mastoidectomy or removal of skin in canal from a myringoplasty burns or other injuries.
Congenital Atresia Etiology? Teacher Collins (hereditary) or Drugs (Thalidomide)
How can you diagnose Atresia from an Otologic perspective? Observation, history of hereditary syndrome accident or from surgery.
How can you diagnose Atresia from an audiologic perspective? Might not be able to test via air conduction, may need to determine hearing via bone conduction and can only be done for the better ear in this case.
How can Atresia be remediated? Surgery. Can return hearing to withing 20 - 25dB of Normal There might be OTHER malformations if embryologic such as the TM or ossicles.
Basal Cell Carcinoma 5 - 8% of all skin cancers mostly geriatrics heavy exposure to sun more often males more often blondes
How do you diagnose a Basal Cell Carcinoma? 50% start on upper helix small painless growth chronically ulcering and crusting slowly increasing in size.
How do you treat a Basal Cell Carcinoma? Proper referral for surgical excision and check histology for malignancy!
What is the difference between Exostosis and Osteoma? Exostosis have a broad base and occur on both sides in MULTIPLES found incidentally... Osteomas are PENDUNCATED STALKLIKE THINGS AND ARE SINGLE ON ONE SIDE AND ARE RARE.
How does a person get Exostosis or Osteomas? Swimming in cold water.
How does a person get diagnosed with Exostosis or Osteomas? Found randomly during a otoscopic exam bony growths hard smooth round white they narrow the canal and can cause a mild conductive hearing loss depending on the degree of STENOSIS/ATRESIA.
How do you treat Exostosis or Osteomas? Surgical removal when STENOSIS or ATRESIA factors are sufficiently a problem.
Foreign Bodies in a person's ear can cause hearing loss... remove my instrumentation or syringing with warm water or refer for surgical removal.
Polyps are: the general term to describe any mass of tissue that bulges.
Polpys in the EAM usually originate from the middle ear and go through a perforation in the tympanic membrane
POLYPS MAY BE THE FIRST SIGN OF a carcinoma or a Glomus Jugular Tumor REFER IMMEDIATELY!!!
How could you diagnose someone as having polyps?? Otoscopic Exam - you might SEE them or possibly investigating a conductive hearing loss...
How are polyps treated? Refer, surgical excision, histological exam so that you don't miss a malignancy!
Otitis Externa very common may occur with a lot of other diseases 3 TYPES: Acute Diffuse Otitis Externa Otomycosis Chronic Diffuse
Of the types of Otitis Externa, which is from a bacilla? Acute Diffuse Otitis Externa associate with swimming
Which type of Otitis Externa comes from a FUNGUS? Otomycosis is a type of Otitis Externa that comes from fungus and can thus occur in tropical climates over 53 DIFFERENT TYPES OF FUNGUS CAN CAUSE OTOMYCOSIS.
Which type of Otitis Externa has pruritis/itching red scalling and inflamation and weeps Cause Unknown Chronic Diffuse Otitis Media
All types of Otitis Externa are characterized by Itching Redness and Weeping of the ear
How do you treat Otitis Externa? Avoid Water in the Ear Rinse with Otic Solution possible need for surgery if stenosis occurs.
Tympanic Membrane Perforation size matters (may affect magnitude of loss - effective area distance btw TM and Stapes Footplate Location matters too (pars tensa has greatest loss) and if the TM is punctured sound reaches round window directly cancels stapes footplate movement
Disruption of the Ossicles: if there is disruption of the ossicles sound reaches both windows simultaneously and causes a sound cancelation could be a blow to skull or resorption of ossicles from infection
Occlusion of the Eustacian Tube Occlusion of the Eustacian Tube produces the absorption of oxygen and then nitrogen from dead air, then negative intratympanic pressure, then stiffness, then fluid, then conductive hearing loss.
Myringitis Myringitis is inflammation of the tympanic membrane.
Myringitis: could be Acute, Chronic or Bullosa
Acute Myringitis: infection of middle ear? infection of TM? thickening of TM due to hypervascularity which affects impedance audiometry lots of white blood cells blisters and bulging TM
Acute Myringitis can result in going away by itself or progression to the point of FOCAL NECROSIS which is really bad. Perforatio & pussing (suppurative otorrhea)
Chronic Myringitis is really rare... thick TM, flat granules on the drum, but NORMAL HEARING AND NO PERFORMATION...??!??
Myringitis Bullosa Usually results from The Flu. Inflamed TM enflamed EAM, blood and serous fluid on TM, minimal hearing loss SEVERE PAIN and all you can do is puncture the blebs...
Tympanic Membrane Perforations Could happen as a result of trauma or infection.
Types of TM Perforations? Central(rim remains at all borders because it is in the pars tensa) Marginal(some part stretches to annulus/bony ring TM is attached to) Perforation at Pars Tensa or Umbo (greatest affect on hearing and size matters too.)
How is a TM Perforation Treated? patch test (to see if a permanent patch would help at all) Most perforations heal spontaneously... Myringoplasty: surgical repair and Myringotomy: putting a hole in the TM and put PE tubes in.
What is the difference between a myringoplasty and a myringotomy? A myringoplasty is surgery to repair hole but a myringotomy is making a hole and putting in PE tubes (pressure equalization tubes made of polyethylene)
What do PE tubes do? They act as eustachian tubes and equalize pressure.
Cholesteatoma: normal skin in an abnormal place like endometriosis. Ingrowth of epithelial tissue and the debris adheres to wall in M.E. and then gets covered over by tissue.
Cholesteatoma could be Congenital or acquired (attic retraction)
Congenital Cholesteatoma: congenital rests / fetal tissue embedded in other tissue incomplete canalization during embryological development could be signaled by pain in a child with atresia.
Acquired Cholesteatomas: Attic Retraction type. Common in Chronic Suppurative Otitis Media where there was a perforation of pars flaccida
Treatment of Cholesteotomas: could be surgical to remove the tissue and leave the canal clean and dry.
Secondary acquired cholesteatomas most common occurs from otitis media. Necrotic tissue sloughs off and lands and epithelial tissue grows over it. Results in an acid reaction from bacteria that can cause a necrosis of surrounding bone which can be very serious or life threatening.
Mastoidectomy: done when an infection is not responding to therapy bone absorption high fever severe pain cut out mastoid cortex and air cells. Only done to be life saving. Can cause moderate to severe hearing loss.
Tympanoplasty reconstructive procedure incorporates antibiotics and Wullstein microscope. Type of surgery depends on ossicular chain - surgery is to repair TM can go anywhere from skin grafting to removal of stapes footplate.
Tympanotomy elevate a portion of the TM and surgically explore middle ear...
Carcinomas / tumors of the middle ear mostly aurical then EAM and lastly ME mostly basal and only sometimes squamous: otorrhea HL pain bleeding facial paralysis mastoid swelling vertigo in advanced cases facial nerve and inner ear are destroyed...
Carcinomas: what do they do to treat them? Biopsy through EAM and surgery plus radiation sometimes cryosurgery. Prognosis: Poor.
Glomus Jugular Tumor is usually NOT a carcinoma Rather, it is a small globular body beneath the ME cavity rich blood supply so it bleeds like crazy when cut (located at the jugular bulb...) occurs most frequently in middle age. Usually white females.
How do you know when someone might have a Glomus Jugular Tumor? Middle aged white female with a hearing loss that might be Conductive, SN or Mixed. Do they have PULSING tinitis??? Pain? Vertigo? Vertigo happens if it invades the middle ear in advanced cases. Could have PALSY of one cranial nerve...
Glomus Jugular Tumor: What does it look like? A blue pulsating mass behind the inferior portion of the TM or may be seen on the floor of the EAM in more advanced cases. Biopsy = profuse bleeding. Excise or radical mastoidectomy with radiation.
Paget's Disease Osteitis Deformans: changes in the skull and large bones... Men, middle age, enlarged skull, shortening of stature, kyphosis (curvature of spine.)
What is the audiologic impact of Paget's Disease? Mixed hearing loss, poorer in high frequencies, positive SISI, Pagetic bone enroaching upon ossicles resulting in stiffness of Immitance Audiometry.
How do they treat Paget's Disease? Cortisone and florides (nothing else they can do.)
Acute Secretory Otitis Media due to obstructed eustachian tube. Upper respiratory infection, cold, dental malocclusion, etc.Mucus, stopped up, numbness, fluid feeling in ear, voice sounds funny to self, pain if TM is inflamed. Originally TM retraction...
How do they diagnose Acute Secretory Otitis Media? diagnostic puncture of TM; conductive hearing loss particularly in the low frequencies, see fluid behind TM.
How do they treat Acute Secretory Otitis Media? Myringotomy (small incision in the ear drum and the fluid removed via catheterization or suction; harder to remove mucus over serous type.)
Chronic Secretory Otitis Media a lot like Acute, but without fever - comes from a series of acute episodes... Might have history of allergies, hypothyroidism or endoccrine disturbances.
Chronic Secretory Otitis Media Deafness. Tinitus. Fullness in ears. Vertigo sometimes and from time to time. If ossicles or round window is involved deafness is more pronounced. Autophony (echo-like production of one's own voice.) TM retracted. TM adhered to wall of tympanic cavity.
How to cure CSOM? How chronic? How many pathological changes? If slight, excellent prognosis, otherwise restoration of hearing prognosis = poor.
Adhesive Otitis Media inflamations of ME result in adhesive process affecting membrane around oval window. Stapes may get fixed to window resulting in chronic partial deafness, tinitus, vertigo if eustachian tube gets blocked. TM appears lusterlous thickened and opaque.
How do you treat Adhesive Otitis Media? Like CSOM: catheterization and pneumomassage but they don't change the adhesive process...
Acute Suppurative Otitis Media redness from excessive blood supply, pain, may have TM perforation, pus, pathogenic material in ME caused this... bacteria of various types Streptococcus most dangerous to bony tissue. Can turn to staph.
Scarlet Fever Measles Diptheria Mastoid Surgery colds infected adenoids or tonsils syphillis tuberculosis bathing or diving in rhinitis all can cause otitis media and acute infectious fevers.
Acute Suppurative Otitis Media Symptoms pain fever microorganisms cilia gets destroyed and can't propel secretions down eustachian tube, pain earache fullness headache temp until drainage occurs, bulging TM tinitis pulse HL Treat: incise TM b4 rupture.
Glue Ear is the result of: unresolved acute suppurative otitis media
How do you treat glue ear? Large incision in TM when bulging takes place simple puncture is usually not sufficient and then sulfanomides and antibiotics to control purulent process...
Chronic Suppurative Otitis Media (person having for years.) Mucoid discharge through perforation in TM. Polyps, odorous, granulations, hearing loss, cholesteotoma, polyps, intracranial implications.
How could someone get Chronic Suppurative Otitis Media: Not treating acute form, lowered resistance enlarged or infected adenoids, scarlet fever, measles, diphtheria, TB. Always a partial hearing loss. Can become acute mastoiditis.
A central perforation indicates a simple infectious process.
Mastoiditis: discontinuity of cell walls from chronic infection sclerosis to obliteration of pneumatic spaces.
Otosclerosis: hereditary, young adults, abnormal bone growth around stapes footplate and can fix it against bony cochlear capsule. If it invades the cochlea then SN or may be paired with a conductive component. May begin at age 10 not noticable till 20 or 30
Otosclerosis is the number one cause of conductive hearing loss in adults with no history of infection or trauma and with normal TM.
Otosclerosis: more women in 20's to 30's more whites and with positive family history. Replacement of compact bone with cancellated/lattice bone.
Otosclerosis Replace compact bone with lattice bone increase in Haversian cells (vascular canal cells) and increase in osteoplasts (bone forming cells.)_
Otosclerosis: Primary Pathology?? irregular ossification usually around the stapedius footplate and oval and round windows. (may occur in cochlea, styloid process and semicircular canals too though.)
How do they treat Otosclerosis? Remove footplate from oval window, remove, chip, chisel, drill etc.
Otosclerosis. People often think it is unilateral But Otosclerosis is BILATERAL, just may not present bilaterally at FIRST.
How does Otosclerosis present? minor in audiological. SLIGHT low frequency loss by air conduction, stiffness, bilateral progressive hearing loss, conductive loss with ENT exam, 11 - 30 years of age, gradual, increased by pregnancy, tinitus, some vertigo, may be followed or start SN.
Otosclerosis> air bone gap (notch) normal speech discrimination when there is no SN.
How to treat Otosclerosis? Stapes mobilization Stapedectomy Stepedotomy
What are some signs of an Inner Ear Hearing Loss? Tinitis or other head noises often, Recruitment, SN HL (high frequency) reduced word recognition.
Presbycusis: a hearing loss affecting seniors; some conductive hearing loss by the 80s, reduced mechanical functioning in the inner ear, vascular changes, loss of neurons in CNS. No treatment.
Ototoxicity HL caused by meds particularly mycins and cancer drugs. Destroys hair cells in inner ear. The cells are destroyed via endolymph. HL is bilateral, mild to total sometimes vestibular effects too. No treatment, monitor audiograms, make pro/con decisions.
Sudden Hearing Loss Sudden! Could be vascular so refer to a physician IMMEDIATELY!!!! Stress, bloodsludging or viral immune disorder fistula. Symptoms: tinitis vertigo unilateral hearing loss mild to severe REFER IMMEDIATELY!
Meniere's Disease Etiology? What causes Meniere's Disease? Cause unknown. Cold be related to allergies, stress, psychological?
Meniere's Disease Symptoms: Unilateral, Roaring Low Pitch Tinitus, Severe Vertigo, LOW FREQUENCY SENSORINEURAL HEARING LOSS (WEIRD.), HL may fluctuate... Physiology relates to excessive intrococchlear pressure due to excessive endolymph fluid.
What kind of Audiogram for Menieres? Flat or Low Frequency Slope.
Noise is a very common and very serious etiology for hearing loss: Noise related HL comes from insult to the basal part of the cochlea after hair cells are destroyed. Symptoms? High frequency hearing loss both TTS and PTS and tinnitus. What is the treatment? Hearing conservation! Use protective earwear.
What are some disorders of hearing that can occur in childhood? Bacterial infection (strep, staph meningitis, etc.) Pus, HL, permanent inner ear damage. No treatment.
Viral infections can result in HL in children: virus can reach the inner ear through the bloodstream, bacteria through the cerebrospinal fluid of the cranial cavity; virus does not cause pus to form but can damage the inner ear structures.
Maternal Rubella: There was a severe outbreak of Maternal Rubella from 1963 - 1965, an epidemic, and it caused big problems for babies in the first trimester. Developmental abnormalities of the cochlea.
Influenza, mumps and cytomeglavirus can cause HL
Rh factor and incompatibility between mother and unborn baby cause of prenatal HL high incidence 31%
Prematurity can cause HL greater susceptibility to viral and bacterial infections intracranial hemorrhage, cyanosis(failure to breathe) all of which can cause CN damage.
Hereditary Disorders can cause HL do relatives have HL? Hereditary deafness may be syndromic or not; could be a mutant or recessive gene refer to genetic counselor.
Disorders of the 8th Nerve Multiple Sclerosis - demyelinating disease myelin sheath covers the nerve the sheath deteriorates HL is usually unilateral unless damage at brainstem level then bilateral HL.
Acoustic Tumor 8th nerve tumor, cerebella-pontine angle tumor or neurinoma or neuroma
Acoustic Tumors Are asymetrical usually HL is unilateral tinitus vertigo headaches food tastes different visual problems gait problems other neural problems. Almost always nonmalignant. Commonly in 40s. Surgery = base of brain (implications.)
Central Disorders Infections: encephalitis meningitis syphilis CVA (cardiovascular accident) death of neurons accidents and birth injury
Central Disorders diagnosis difficult as it becomes higher order symptoms: audiological limited to extensive word deafness.
Functional Hearing Loss: usually a trigger event Intact Auditory Psychogenic or for Monetary Gain
Things to ask when developing case history: which ear, how long, what other problems existed at the time, what did you do about it, family members, general health, major complaints, employment, what are your reasons for coming today, what are the symptoms (pain fever tinnitus, HL) ? etiology ?
What are some good questions to help identify a conductive hearing loss problem? Do you have a history of ear infections, discharge? cerumen? is cerumen excessive? upper respiratory infections, allergies, swimming, frequency of any symptom, associate symptoms with events or disorder?
How to identify Sensorineural: Don't understand 'speech' well, hard to understand in noisy environment, sudden loss or gradual? time of onset? viral vascular headaches food taste facial numbness other neural signs?
How to determine if something is congenital? Other family member have any defects in hearing? Positive family history? Other inherited anomalies
How to tell if something is acquired? Maternal illness or accident? Birth trauma? Drugs during pregnancy?
With children ask: Other siblings have HL? Developmental questions, birth history, what does physician or school say? recognize high conductive incidence.
For pure tone audiometry, first you: Pretest Activity: check equip and other materials review folder size up the patient establish rapport.
We do hearing tests: to see what is wrong with the auditory system where is the lesion and how severe is it, fitness for certain duties, need for SPED, claim for compensation, need for hearing aid, recognize hazardous exposure and needs related to it.
Gross Tests of Hearing are used for distinguishing between total deafness and the existence of some hearing: not calibrated not reliable as to signal and presentation, appropriate only when no equipment and trained personnel are available.
What are examples of Gross Tests for Hearing? Conversational Speech (voice) Whisper (normals hear a whisper at 20dB) coin click watch tick
Earliest device for gross test for hearing Galton Whistle (high frequency) and tuning forks
Tuning forks each has a unique frequency in octaves, vibrate, used for BC measurement by placing on mastoid tip
Rinne Test when tuning fork is applied to mastoid and no longer hear it place in front of ear it should be audible for 2x by AC = Postive Rinne
Rinne Test If can't hear it suggests a conductive disorder
Weber: Bone Conduction Lateralization to conductive side... Fork is placed at center of the frontal bone above eyebrows... where do you hear it? tone will lateralize to side with the better BC.
Pure Tone Audiometry Are you measuring for screening diagnosis or research? Pure Tone Audiometer Speech Audiometer Manual Audiometer Automatic Audiometer often in one unit.
Frequency dial gives parameters for frequency, range, octaves, half octaves
Intensity dial gives parameters for range in dB increments
Tone Presentation gives parameters for Continuous versus Interrupted
Mode Selection gives parameters for Ear Choice AC or BC speech masking special test procedures sound field
Pre-Test Activities: check equipment and materials: power on any obvious problems psycho-acoustic calibration check do you have earphones immittance inserts tapes CD otoscope forms audiograms speech lists immittance forms red and blue pencils scrap paper?
Reason for Referral? Reason for referral? Referral by whom? has the patient been seen before? (review results and report.)
Sizing up the Patient What is his/her personality like? Attstaitude toward coming?
Establishing rapport rapport is important to facilitate expedious and accurate test
Hearing Test Procedure Objective to measure the "On-Effect" Relates to "Rise Time."
What is the "On-Effect?" The On-Effect is based on the theory that the initial response by the auditory system at the onset of stimulation is the most vigorous response - a quantum leap in the neural system. Most robust response. Too long or too short = error potential.
When the 'On-Effect' is sustained, what happens? When the 'On-Effect' is sustained, it is followed by a reduction in responsiveness known as adaptation.
What is Adaptation? The reduction in reponsiveness following the 'On-Effect' if the stimulus is sustained.
How long should a signal be sustained to maximize the 'On-Effect?' 1 - 2 seconds
Measuring an individuals hearing thresholds at each of several frequencies What is threshold for each frequency.
From determining the thresholds for each of several frequencies we can determine the severity of the lesion, what frequencies the individuals hears best or most poorly at and some information regarding the location of the lesion
Thresholds must be determined for both ears = get data on thresholds for best ear first, or right ear.
Method of Limits the examiner manipulates the intensity of the signal while the patient tries to identify when it is just audible (different from method of adjustment where the patient controls the intensity of the signal.)
With a hearing test for pure tone audiometry, what intensity do you start with for a presumed normal hearing patient? 30 dB with a normed expectation. Present a 30dB tone for 1 - 2 seconds. If patient responds, down 10 up 5 until you get first crossing. then down ten and then up 5 to get 2nd crossing and affirmation
If you present the tone at 30dB and the person doesn't hear it (perhaps older or perceived HL) then go up 15dB until the person DOES HEAR IT (RESPONSE) and then go down 10 up 5 for two crossings to determine threshold. Threshold is where 2 affirmations occur. + or - 5db; may get diff result; can't be perfectly but can be RELIABLY replicated!
To complete an audiogram you present these pure tones in this order 1K, 2K 4K 8K 250, 500 and then retest 1K (sometimes you also do half octaves and sometimes you test at 125Hz too) if a 20dB shift occurs between octaves, test half octaves also there is an intensity shift at 3K so for hearing aids you often test at 3K.
How do you know which ear to start with? Better (judging by patient history) or Right Ear.
Patient Instructions: We are going to test your ability to hear some tones. When you hear the tone or even THINK you hear it, raise you hand. Put your hand down when you don't hear it anymore."
Headphones Put then on patient Right on Red squarely over ears without hair between the phones and ears and adjust the headband
When you sit down to the audiometer, select Select ear to be tested, set frequency to 1K Hz set intensity to 30dB begin the Carhart and Jerger technique (down 10 up 5) 1 - 2 second presentation Threshold is where 2nd crossing occurs.
After you determine the threshold make the appropriate symbol in the appropriate color on the audiogram Red Pencil for Right Blue Pencil for Left O = Right X = Left
After you put marks on audiogram for 1K Hz, continue to 2K 4K 8K 250Hz and 500Hz and then VERY IMPORTANTLY... RETEST AT 1K! mark all in, then test other ear.
Acceptable disagreement for reliability check? + or - 5dB
Some possible exceptions to the general rules may be made for age and intelligence factors also keep in mind motivational factors
Setting the attenuator at 30dB for initial signal presentation may be an exception for those with perceived hearing loss or impression of the patient's hearing
Presentation duration may be an exception in the elderly you may want to present it slightly longer in spite of the physiological contraindication
Sometimes an exception is made regarding frequencies to be tested as it relates to 125Hz or half octaves. (If there is a 20dB or more difference between octave thresholds, test the half octaves! You may also do this for a hearing aid test.)
Two modes of conduction as it relates to Bone Conduction? Compression (means compression of inner eaar fluids) and Inertia (relates to ossicles.) Inertia is more of a low frequency.
With Bone Conduction there is Simultaneous Bilateral Stimulation Bone Conduction is a cochlear function = stimulation of bones in the skull, but it stimulates the ossicles TOO and they have a small role in bone conduction.
What is the maximum loss by Bone Conduction? 60dB - this would imply NO AIR BONE GAP
Air Conduction if presented loudly enough can cause a Bone Conduction stimulation
If a signal is presented loudly enough to a person who cannot hear they may respond due to vibrotactile response - they are FEELING the signal, rather than hearing it.
Pure Tone Audiometry for Bone Conduction involves a direct assessment of what? The function of the cochlea. Stimulation via oscillator right is NOT a test of right cochlea functioning without masking the non participating ear.
How does Pure Tone Audiometry for Bone Conduction directly measure the function of the cochlea? It causes an oscillation of the bones of the skull.
When a signal is presented through air conduction what happens? The signal is conducted throughout the entire auditory system.
We are interested in the relationship between Air Conduction and Bone Conduction because If there is a GAP between Air Conduction and Bone Conduction then there is a CONDUCTIVE LOSS!!! If there is NO GAP AND THERE IS INTERWEAVING then it is a SENSORINEURAL LOSS.
What is proper placement for Bone Conduction Hearing Assessment? You place the oscillator on the Mastoid Tip you must locate the MOST PROMINENT MASTOID TIP.
Why must masking be done with bone conduction? Because the signal stimulates both cochleas but if there is a problem with one cochlea, without masking the results will provide data for the better hearing cochlea. Must mask the contralateral ear to remove it from the testing scenario.
If hearing is normal by air, do you need to test by bone? NO IF HEARING IS NORMAL BY AIR THEN IT IS NECESSARILY NORMAL BY BONE.
If an ear is depressed by Air Conduction, then Bone MUST be tested - Why? Because you need to determine if the loss is conductive or sensorineural in nature.
How do you choose which ear to test by bone first? You pick the ear that has the better Air Conduction that still has a loss by air conduction... Must use masking on contralateral side.
For Bone Conduction, which frequencies are tested? For Bone, you only need to test the octave frequencies between 500 and 4000 Hz. (some people test at 250 Hz but it is less reliable.)
What frequencies are tested when you test for Bone Conduction? 1K 2K 4K and 500Hz then 1K again; then switch ears and use masking to isolate the new test ear and do 1K 2K 4K 500Hz and 1K again.
A complete pure tone audiogram has thresholds for Air Conduction and Bone Conduction for both ears (unless of course the Air Conduction was normal in which case you wouldn't have tested for Bone.)
Must use masking for bone conduction to remove participation of non-test ear
Masking may also be needed for Air Conduction because at a certain dB there may be participation of the contralateral ear for air conduction too
Some things that matter as it relates to Masking Some? None? Oscillator placement (location and accuracy) Interposition of hair mastoid air cells
What is meant by reduced audiometer output by Bone Conduction?
Calibration Rationales Norms are conceived on the audiometer meeting certain standards - to apply the norms the standards must be met. Equipment inaccuracy is common and that can cause a diagnostic error.
What are the general parameters for a hearing assessment? Intensity Frequency Time (phase and rise-decay time.)
Electroacoustic Method versus Psychoacoustic or Biologic Method Psychoacoustic or Biologic Method (using a human)must be done every day - any person who gets a bizarre result ask first if something is wrong with equipment.
What are some things that can be determined from audiograms??? Comparison between Air Conduction and Bone Conduction Slope Severity Concept of Unilateral versus Bilateral Remember - the disorders may be entirely different between the two ears both with regard to severity and location in the auditory system.......
Potential problems with patients? uncooperative, anxious, hostile, drugs/drunk responds unreliably out for gain didn't understand directions fatigue - reschedule in a politically correct manner.If you have had anything to drink in last 24 hours invalidates the results.
Potential problems with equipment? What to do when there is a potential equipment failure (keeping in mind that you JUST DID a psychoacoustic check prior to the days testing...) are all switches appropriate set? listen to signal yourself under headphones check all jacks jiggle wires
Potential problems with tester? Do you understand the procedure? Were your instructions clear?
WHAT IS PURE TONE AVERAGE? Find the average of thresholds between 500, 1000 and 2000 for Air Conduction.
WHAT IS FLETCHER AVERAGE? Find the average of the BEST TWO FREQUENCIES btw 500, 1000 and 2000
What is the difference between Sensory and Neural when pulled apart from the combined term Sensorineural? Sensory = Inner Ear Neural = 8th Nerve
Vibrotactile Responses when something is felt and a person responds to a signal they can't actually 'hear.' Can cause an 'artifact' - a bone conduction response when there actually wasn't one.
Interstimulus Interval The time between stimulus presentations; do not present rhythmically or the person will predict the stimulus. Vary the presentation 1 second, 6 seconds 7 seconds later, etc.
Visual Cues during auditory testing Bad idea - you are testing hearing and not supposed to be providing any visual cues (ie: cover your mouth when testing SRT)
Canal Collapse some people have very narrow ear canals and when you put head phones on them their ear canals collapse and you get strange results - use ear buds for these people. You would get an air bone gap that shouldn't be there. ENT exam and other tests normal.
Speech Recognition Threshold SRT What is the purpose??? SRT is a reliability check - you are setting the level of dB for word recognition
What is the DEFINITION OF SRT Speech Recognition Threshold is the minimum level at which 50% of 'spondees' are repeated.
What are 'spondaic words?' Spondaic Words are high redundancy words with high energy vowels.
There is a relationship between what three things? PTA Fletcher Average and SRT
How do you administer the SRT? Familiarize pt. with words: "I am going to have you read this list, take a look at it. Now just repeat the last word that I say to you - take a guess if you are not sure." Test Better Ear First. Decide carrier phrase or just word; check to peak at Zero 0
How do you administer the SRT after instructions are provided? Say word, carrier phrase or hit play on CD, should peak at 0.
During the SRT when the bar goes to Zero it means that the intensity of the word you are delivering is the intensity you are TRYING to deliver... Needs to peak at zero. If it DOESN'T you are on the wrong level for attenuator.
How do you know what to set attenuator at when determining SRT? You start at 15dB above the anticipated threshold based upon pure tone audiometry thresholds. Put on 1dB steps! Test is delivered in 4 word SETS.
How do you know when you have discovered an SRT threshold? You start at 15dB and put it on 1dB steps. Pt. already has instructions. Say a word, pt. repeats word. You have a list of 4 words. They have to get 2 right! As soon as they GET 2 right you descend by 4db.
In the determination of an SRT threshold, suppose the person gets word 1 and 2 right? Then they already are at 50% - don't bother testing for words 3 and 4, just go down 4dB and start a new list of 4 words. Could also get 1 and 3 right and then you would move to a new list and go down 4 dB.
When testing SRT when the person is unable to get 50% on their four word list what do you do? You go up by 2dB and give them another four word set. If they get 50% that is their SRT. If they DON'T then the prior success point is the SRT.
If the Fletcher Average is ZERO, where do you start the SRT? At 16dB.
The last place the person got 50% correct on the SRT assessment is the SRT.
When you are doing the SRT be sure to cover your face so that they don't get visual cues for the words and you are really assessing the minimal level of intensity that the person can identify and repeat bisyllabic spondaic words correctly 50% of the time.
The minimal level that a tone is audible 50% of the time = Pure Tone Threshold
Pure Tone Average should be the same as SRT + or - 5dB
Reliability is a comparison between PTA and SRT + or - 5dB
When an audiogram is FLAT or GRADUALLY SLOPING Flat or gradually sloping is when PTA and SRT are the same + or - 5 dB
If there is a precipitous DROP though, then the SRT would be equal to the Fletcher Average. SRT = FA with precipitous drop.
SRT should be equal to Fletcher Average + or - 5dB. This equals reliability.
SRT is one way to determine malingerers If SRT is much better than pure tone audiometry there is a malingerer potentiality.
SRT is not a diagnostic test - it is only a test of reliability. The purpose of the SRT is that the test should agree with pure tone data. If it DOES than we can say that Pure Tone Data is reliable. SRT should produce a threshold for speech that should be very similar to certain pieces of data from pure tone data.
Speech has a variety of frequencies and pure tone is only one frequency, but if you can hear pure tones normally than you should be able to hear speech normally, too. If one is abnormal, the other is similarly abnormal, too.
Is the pure tone audiometry data reliable? The answer to this question comes from the SRT.
Most MAJOR SOURCE OF UNRELIABILITY IS THE PATIENT. Patient profiles that can cause unreliable data: emotional or mental problems motive for gain intoxicated sleep deprived not feeling well, etc. reschedule reschedule reschedule and advise why in a polite manner.
Can always discharge someone from therapy from service if they are not discharge if they are not able to benefit enibriated often, chronically absent, etc. Behavioral therapy cannot work without continuity. Our therapy is not a pill...
How do you REPORT??? When you provide a narrative report, you have to report on TYPE DEGREE and SLOPE OF LOSS. "Pure tone audiological test results indicate..." ie: a Mild High Frequency Sensoryneural Loss on the Right and a Moderate Low Frequency Loss on the Left.
With a sensorineural loss louder doesn't help Louder for people with sensorineural loss just results in LOUD DISTORTION.
At least four idiosyncratic audiograms worth knowing by sight Noise induced hearing loss; meniere's disease, presbycusis, and otosclerosis
Know the four conditions between Bone and Air
Air Bone Relationship tells you something about the site of the disorder
What does low frequency slope tell you? If SN could be Menieres, if just air could be conductive - kid could be hearing sound at a language developmental time like they have ear plugs in which will damage their language capacities and mess them up in diagnostic and rehab settings.
What does high frequency slope tell you? Possible presbycusis at least unable to understand certain parts of speech (sibilants fricatives consonants)
What does flat audiogram tell you? Uncertain
Need to know how to use these together: Pure Tone Audiometry Speech Audiometry and Emittance Audiometry
If Interweaving slope could be Sensorineural if there is interweaving after the conductive loss part is remediated.
When you see a high frequency loss and it is gradual, it is likely presbycusis but if it is a marked or precipitous drop if the high frequency loss is precipitous or marked 20 - 25dB it is NOT presbycusis...
Conventions: something not scientific, but rather agreed upon (like not testing below zero in most cases.) These things are supposed to be debatable... There may be no diagnostic value, but we are supposed to be accurate.
Best instructions are BRIEF Wordy directions tend to confuse people. Too much info leads to mistakes.
Ear Phones Red on right, blue on left. Color coded.
Method of Limits Descending 3 - 4 dB lower thresholds.
Headband with Chinese finger trap front finger trap part is adjustable front.
Test this this way 1000 Hz at 30dB for 1 - 2 seconds. Then down 10 up 5.
Symbols? Colors? Check the KEY. ASHA has a different KEY!!!
When you recheck at 1,000 it should be the same as the first time plus or minus 5dB reliability check. You only recheck at 1,000 Hz.
How do you KNOW the test is reliable as in the actual TEST? Can retest six months later do informal probes general observations deliver a different test use a duplicative test. Can't just go by the manual saying so.
Age Motivation and Intelligence may affect testing protocol may shift from 'raise your hand when you hear the tone' to 'raise your hand when you are SURE you hear the tone.'
Always use the prior person's data unless you always use the prior person's data unless you question it's validity.
With a 100dB hearing loss, only 60dB of that can be attributed to conductive. You can only have a 60dB air bone gap. You could have an 80dB hearing loss, but the amount that can be attributed to conductive is only 60dB.
100 dB hearing loss = 60dB conductive and 40 dB bone. You are measuring the attenuating property of the conductive component by comparing air versus bone.
Air conduction can cause a bone conduction stimulation if it is low frequency and high intensity.
Conductive Hearing Loss but Bone is fine... Means normal bone; problem is NOT in cochlea - it is only AIR that is abnormal.
If the loss by bone is the same as the total loss then there is no conductive component.
If the loss by bone is x and the loss by air is x then there is no conductive component because the loss is actually in the cochlea!
If Air is Abnormal and Bone is Abnormal but Air is Worse than Bone You have a sensorineural and other loss so that is called MIXED LOSS What you do is try to fix the conductive part and then you likely get interweaving and the HL remains as SN but no longer SN and Conductive so hearing improves.
If Air is x and Bone is x and the pt. asks what can be done, you fix the conductive part and the hearing remains at the level of Bone because you cannot fix SN.
Once you have an audiogram for Air on both sides and Bone for the side where there is a hearing loss you have a completed audiogram.
Biologic psychoacoustic calibration the known normal goes through the equipment each day for a biologic calibration
How do you calibrate for intensity? Sound Level Meter and an Arificial Ear.
How do you calibrate for Frequency? With an oscilloscope and a frequency counter.
How do you calibrate for time? An oscilloscope.
Interpreting and Audiogram Comparison between Air and Bone tells the type of hearing loss. Normal, Conductive, Sensorineural or Mixed.
Shape Contour Configuration has some limited diagnostic information
How do we quantify severity via the audiogram? see chart
Air Conduction Symbols solid line
Bone Conduction Symbols dotted line
Look at the symbols and mentally remove the ones that we are not talking about and use the key
Slope is discussed as a function of air conduction
Conductive Hearing Loss Normal Bone, Loss by Air, Low Frequency Slope/sometimes can be Flat, but usually a low frequency slope.
No Air-Bone Gap with HL Sensorineural
High Frequency Slope is overwhelmingly common in Sensorineural hearing loss - lose the ability to hear high frequencies.
If there is a Bone Conduction loss it is at least in part sensorineural, but if there is an air-bone gap of at least 15dB, then it is a Mixed Hearing Loss. Mixed Hearing Loss = 15dB Air Bone Gap
15 dB Air-Bone Gap Mixed Hearing Loss
15 dB Air-Bone Gap what do you do to treat? Make the Conductive part go away; stuck with the sensorineural part. When the interweaving starts the person will begin to believe they are then hearing normally.
Slopes and Mixed Losses Slope does not have much meaningfulness in mixed losses. High Frequency, Low Frequency and Flat. Can't determine mixed from that... If it is mainly sensorineural then it is most likely a high frequency slope. Low Frequency then mostly always conductive.
Flat Slope? Mixed Losses? Hard to know what the problem is without more information.
Severity? 0 - 15dB is normal for a child (though not agreed upon)
Characterizations and labels are not as important as the realities that are attached to them... More important is the impact on daily function, speech and language development.
Severity is calculated using Pure Tone Average (average by air conduction for 500 1000 and 2000
If the pure tone average is 20dB or under = normal
25 - 40 mild HL
40 - 60 moderate
60 - 80 severe
Above 80 Profound HL
Average the pure tone audiometry thresholds for 500 1000 and 2000 and you have the Pure Tone Average and the number you need to determine severity.
Narrative Description: must talk about type, slope, and degree of loss.
Must talk about all of these: type slope and degree of loss for a narrative description
A good fitting ear plus is about 20 dB of attenuation - takes away the subtleties of speech and requires medical intervention. Could result in auditory deprivation and speech and language problems.
20dB attenuation is like a good fitting ear plug could result in auditory deprivation and mess up speech and language development.
What is a Noise Notch??? Frequency Slope = High Frequency Slope. A drop in ability to hear between 3K and 6K and a potential recovery at 8K. Narrative Description: Normal Hearing up to 2,000 Hz with a sensorineural hearing loss after 2K.
High Frequency Hearing Loss: If you don't know what this is it could be sensorineural hearing loss, probably is, but if you get anything other than an interweaving audiogram it would be very abnormal...
SRT a measure of reliability to demonstrate an AGREEMENT between the SRT and the Puretone Thresholds - SRT and Fletcher Average should be about the same + or - 5dB
Near audiometer is a list of words to be used for SRT and for Word Recognition SRT is in sets of 4
What is the general difference between central versus peripheral understanding? Peripheral is hearing everywhere except in the brain; Central is the level of the brain (brainstem to cortex.)
How do you measure peripheral understanding versus central understanding? Use simple stimuli - simple stimuli such as monosyllabic word presented at a comfortable level - you are measuring via WRT the ability to recognize a monosyllabic word presented at a comfortable level. (definition)
What is the definition of WRT? the ability to recognize a monosyllabic word presented at a comfortable level
What are PB words? PB Words are Phonetically Balanced Words - it isn't that the WORDS are phonetically balanced, rather it is the LIST that is phonetically balanced.
What does phonetically balanced mean? the list takes into account the frequency of sounds as they are presented in speech.
When would you use a picture test for WRT? Person may not be able to give an oral answer - it is not a test of articulation, it is a test of hearing; unable to voice, unable to speak, use picture test. ???
What intensity do you present a stimulus at for WRT? For WRT you present the stimulus 40dB above the SRT. This would equate with a comfortable hearing level but if recruitment is evident, may lower the dB.
Make sure that you don't corrupt the testing environment by giving visual cues. Need to cover your mouth as you give the words for SRT and WRT so that you are actually testing hearing and not hearing + vision. Also, if the environment is noisy, you are no longer testing peripheral but rather central too as you have complicated test.
Anything that degrades the signal makes the test not peripheral but rather central auditory processing because the person needs to work harder mentally.
What are two hearing disorders that can result in Recruitment and a need to lower the dB for a WRT test? Cochlear Disorder and Meniere's Disease may both result in recruitment.
How to you test WRT? Tell the pt after you have set to mic and set to 40dB over SRT that you are going to say some words and they need to repeat the word back to you. Take a guess if you are not sure. Choose preferred ear. Carrier phrase not required. 50 words with exception
What is the exception for testing all 50 words on the WRT? If they get 2 or fewer wrong on the first 25 words, you can stop the test.
2 wrong at the end of 25 on WRT what is score 92%
3 wrong at the end of 50 on WRT 94%
If any part of the word is stated incorrectly on the WRT the word is then wrong.
Normals and Conductives get what kind of score on the WRT? Normals and Conductives get a score IN THE 90% - 100% RANGE. This relates to the fact that when you make the signal louder for normals and conductives they hear it BETTER, unlike those with cochlear damage (because loud distortion is still distortion.)
Sensori or Neural problems score how on WRT? If someone has either a sensory, neural or sensorineural disorder, they will do poorly on WRT cannot predict how poorly, but CAN SAY UNDER 90%. SOMETHING UNDER 90%.
Catch phrase for when puretones are backed up by SRTS The SRT's were in agreement with the Puretones. Basically, it lets the reader of the report know that they can trust the audiogram that you provided.
What do you write right after you write "The SRTs were in agreement with the puretones..." "The SRTs were in agreement with the puretones. Word Recognition Testing using NU6 materials scored at 86% right and 26% left at 50dB left and 60db right." (you don't have to state the presentation levels in words but MUST DO SO IN NUMBERS.)
With regard to reporting scores for the WRT you must list the name of the test materials and the score both right and left and the presentation level must also be provided.
Decibel is the measure of the amplitude of a signal used most commonly when referring to amplitude in terms of pressure or power.
There is no such thing as absence of sound, this is why even with no sound there is sound pressure and thus a measurement is used to represent "zero."
minimal pressure variation .0002 dyne/cm2
Frequency is the number of cycles completed in 1 second
Hz is Hertz is a measure used to describe Frequency (psychological correlate = pitch.)
Frequency is the amount of time it takes for a sinusoid to complete 1 cycle of vibratory motion
T - 1/f and F = 1/t
Sinusoid the simplest pattern of vibratory motion (sinusoid or sine wave.)
dBHL is an arbitrary system made up by someone but not a physical measurement
HL is a scale (hearing level) used when testing hearing
HL is a scale that represents normal human hearing. The zero point is at different levels for frequencies because human hearing is not the same at each frequency
1K Hz sound = 0 dBHL = 7.5 dBHL meaning that at this frequency the normal listener would begin to hear this sound at 7.5dBSPL
You need lots more pressure with low frequency sounds. Ear hears 1K the best. It is also hard to hear high frequency sounds. Low number for threshold = lower = better hearing.
Zero is the lowest limit of normal hearing and is called audiometric zero.
Best Hearing for humans is between 500 Hz to 4000 Hz
Audiometric zero = 0dBHL at 7.5 dBSPL 125Hz audiometric zero = 45 dBSPL and 8K Hz at audiometric zero = 15.5dBSPL
Human Ear can detect sounds in a 20 to 20,000 frequency range But sound intensity must be raised at either end for the frequencies to be detectable.
Human Hearing is most sensitive to sounds in what frequency range? 500 to 5,000 Hz (some say 300 - 4,000) (others say 3,00 to 3,000)
Most of the frequencies contained in speech are in the range where hearing is most sensitive.
Where do hearing disorders most commonly occur?
Where are certain disorders most commonly located?
Major structures of the ear with regard to physiology
Know about the middle ear as it relates to transformance or impedence matching mechanism.
Understand the physiology of the parts where disorders are most likely to occur so you have an idea of where to start.
Impedance matching has to do with amplification that acts in a compensatory fashion. If you dump fluid in the middle ear and you don't hear very well, then you end up in the speech and language clinic.
Fluid in middle ear can lead to a loss of sound intensity as sound moves from a low impedance medium (air) to a higher impedance medium (liquid) Air = low impedance Liquid = higher impedance
How much sound intensity is lost in an impedance mismatch from air to liquid? about 35 dBSPL is lost in the transition.
With regard to impedance mismatch the unique properties of the ossicular chain offset this intensity loss Ossicle leverage action give back about 2dB and the ratio of TM to oval window 17:1 gives back about 25dB.
Impedance is by definition the opposition to the flow of energy.
Vibrating air molecules cause the TM to start moving which then moves the ossicular chain and then the stapes footplate moves in the oval window causing a pressure change in the cochlea
What is the medium of propagation in the middle ear? air
Stapes footplate is seated in the oval window in the scale vestibuli
When the stapes footplate moves in the oval window what starts to move? When the stapes footplate moves in the oval window it causes the perilympth in the scale vestibuli to move TOO.
Once the stapes footplate moves in the oval window and the perilympth starts moving what is the propogation change? air to liquid - sound is moving through liquid now. Energy travels more easily through air because it is less dense. In liquid there is more density. Air has less resistance/impedance.
Water has more density, more resistance and more impedance. As a result, we lose a bunch of sound and sound is decreased in dB.
As sound goes from air to liquid we lose about this much in dB 30dB is lost right off the bat.
Eusatacian tubes
Eustachain tube disorder as it relates to hearing problems and children versus adults changing at age 12?
Know these terms: impacted cerumen, atresia, otitis externa and know that these are OUTER EAR CAUSES
What is a middle ear cause? Otitis media - fluid in middle ear due to Eustachian tube.
Otitis Media is the #1 childhood illness in the United States causes conductive hearing loss and potential language issues
4 causes of Conductive Hearing Loss Impacted Cerumen, Atresia Otitis Externa and Otitis Media
Any problem in outer or middle ear causes what kind of hearing loss? Conductive Hearing Loss - that is the only type possible
AIR BONE GAP AIR BONE GAP = 15dB of hearing loss
Degree of Loss for either air or bone are the same labels 0 - 15 WNL kids 0 - 25 WNL adults 15-25 slight HL 26-40 mild 41-55 moderate 56-70 mod severe 71-90 severe greater than 91-profound
Normal by air and bone 0 - 25 normal 26 - 40 = mild hearing loss
Puncture in Tympanic Membrane - what kind of loss? Conductive
TM perforation does not always cause a loss of hearing could just be a pin hole size depends also on portion of TM
Anything that happens to INNER EAR is a SENSORINEURAL LOSS SN loss is a loss by bone AND a loss by air.
In a Sensori Neural Loss there IS NO AIR BONE GAP because both air and bone are impacted and the loss has to be EQUAL to be SN A Mixed Loss is both conductive and sensorineural but when you cure the conductive part you get just SN
SN loss is a loss where? In the cochlea or in the 8th nerve or both
Mixed Hearing Loss is ALWAYS worse by air bone can never be worse than air
What could cause a sensorineural loss? Concert, loud noise, industry noise, factory noise, military, landscaper, could be noise exposure one time or over time. Can't fix it.
Sensorineural Loss cannot be fixed, why? Because it relates to cochlear or 8th nerve damage - there is no pill for this - it is due to the death of inner ear hair cells. SN loss is permanent.
Inner ear / cochlea has a hearing part and a vestibular balance branch part
Must know about transmission and transduction in the cochlea Transmission is the course a sound wave follows - the stapes presses on the oval window and starts the coursing around of perilympth in the scala vestibuli. TRANDUCTION is Electrochemical!
Transduction is ELECTROCHEMICAL - starts with the mechanical hydraulic wave but the issue is to pass energy to the 8th nerve... The brain can't recognize mechanical energy so the energy has to go from mechanical energy to electrochemical energy. If you have messed up hearing, this energy change happens in an imperfect way.
Test validity has to do with measuring what is purported. If not possible, you must state this is not purely valid test data due to a) b) and c) and be specific.
Otology deals with ears
Audiology deals with hearing
What are some things that should point out a conductive disorder? blocked ear feeling, sound stuffed up, AIR BONE GAP,
In an air-bone gap, bone can be normal meaning that the persons hearing might be normal by bone but messed up by conduction. Bone conduction bypasses everything and goes directly to the cochlea = it bypasses the conductive part.
If you see an audiogram and bone and air are different for an ear you have a conductive hearing loss at a minimum.
Most conductive hearing losses are ammendable medically but you should refer out for medical attention
What does NORMAL WORD RECOGNITION tell you??? Normal Word Recognition means that the person can repeat a monosyllabic word correctly if they hear it at a comfortable level (WRT) iF THE PERSON CAN DO THIS IT IS A CONDUCTIVE DISORDER
People with SN (bone) (cochlea)damage have difficulty with WRT Normal Word Recognition because if you make the signal louder, all they get is loud distortion.
If someone has a conductive disorder and you use an amplifying device to test it is fine - it doesn't take away from testing validity.
Why might a person have atresia/stenosis accident, congenital, surgical procedure, usually happens at birth, can be related to congenital or inherited, or drugs. Could be a bony or membraneous plug in ear canal - ask if a physician has seen that other malformations might be visible or not...
On it's own, atresia may not cause a hearing problem but may come with other malformations that could... some other malformations may not be visible, refer to physician for follow up unless the physician is already aware.
If you see a Basal Cell Carcinoma, you have a responsibility to refer to a physician - likely to occur on the pinna - just say "I am not exactly sure what that is but a doctor needs to see that."
Exostosis and Osteoma: Exostosis have a broad base and occur on both sides in MULTIPLES found incidentally... Osteomas are PENDUNCATED STALKLIKE THINGS AND ARE SINGLE ON ONE SIDE AND ARE RARE.
Osteomas: Stalklike, Single Side...
Surfer's Ear from swimming in cold water might be Exostosis or Osteomas an incidental finding that doesn't cause a problem until it becomes affects hearing - Canalplasty (brush in ear canal to remove growths.) Non malignant.
What might indicate a foreign body? No's to all kinds of things like no medical history of hearing problem, no illness, no injury and kid is crying and pulling on their ear...
Polyps refer to Dr - alerting topic, any bulging mass does not belong - could be precancerous - need to refer for histology. RECOGNIZE AND REFER GROUP...
Otitis Externa also known as swimmer's ear COMMON, SO PROBABLY WORTH KNOWING ABOUT. Most are bacterial but may be fungal and meds for each and other are NOT interchangeable...
Otitis Externa probably a discharge - well, is it coming from canal or tympanic membrane? This tells you if it is Otitis Externa or Otitis Media - can tell from physical exam.
Otitis Externa no swimming till clears up and treat with appropriate meds - little or none for hearing loss mainly a treatable medical condition
Cerumen versus impacted cerumen depends on how impacted - if there is even a tiny space for sound to get through, there could be no hearing impact. 20 - 30dB of sound loss (like a good fitting ear plug) with cerumen (even when fully occluded.)
With a Tympanic Membrane perforation what is impacted? TM perforations result in problems with impedance matching and performance matching.
Hole in pars tensa is a hearing problem because of magnitude of loss pars tensa has greater impact than pars flaccida
Disruption of the ossicles lever action of ossicles, law of lever, mechanical efficiency rigidity connected to conduct sound properly... blow to the skull can disrupt them or there could be resorption due to caustic material or infection can get dissolved (big time hearing loss)
Middle ear disorder/infection is an occlusion of the Eustachian tube - source of inflammatory disorder in the middle ear
The purpose of the eustachian tube equalizes pressure in middle ear, drainage, maintenance of PATM - pressure of middle ear should be same as in room -
Eustachian tube is like a window to outside from a room goes to nasopharynx and out nose briefly it opens every couple of minutes but is usually in a collapsed state. If it closes though for too long, gases are absorbed and ear drum retracts then fluid fills middle ear. Can see fluid line behind TM and TM pushes back out bulges & may rupture.
What you feel popping on an airplace is actually your eustachian tube - you can actually have normal hearing out of the ear it can feel full, dull, and can last for days and weeks.
TM usually looks grey translucent pearly
Red ear drum = TM Myringitis more of a symptom than a disease
If TM is red and swollen conductive hearing loss possible now ask if the person gets it often, is it on both sides, a one time thing or a pattern? The likelihood of a problem can range from 0% to 100% before you jump into therapy, you need to know if you should modify what you do
Ear Drum Perforations have more than one etiology: Infection is Primary One, but Trauma is a 2ndary possibility; could have been a loud blast, an impaling object - a hole in the eardrum doesn't always mean infection MUST DIFFERTIATE THE SOURCE BY HISTORY. Ask the questions, look for the cause and effect!
A hard blow to the ear with a cupped hand can rupture someone's ear drum Yikes.
If perforation to TM is not central it is less impact, but harder to heal
How to determine what you need to know or remember? High? Med? Low? Trivia? Common? Happens often? Unique? High Magnitude? ie: cholesteatoma doesn't happen a lot, but has a huge impact...
What is cholesteotoma? Normal skin growing in an abnormal place. In-growth of epithelial tissue. Injury in middle ear, healing process, a denuded area and a healing process. Tiny space hurt by caustic material and tissue forms on top of debris.
Cholesteatoma can look like a tiny pearled onion some people can be congenitally born with it but really rare. Often cholesteatomas lie dormant for a long time and be asymtomatic but when recognized immediate surgery as can cause necrosis in surrounding bone.
If a person has a lot of middle ear infections, like, a LOT they might get cholesteatomas so they should have their hearing assessed and a TM inspection annually or ever other year.
Secondary acquired cholesteatomas can become aggressive and there can be an infection process person can get sick like with an upper respiratory infection and can get bone infection where the cochlea is involved. Infection can reach meninges and become meningitis or a lethal cranial infection.
Infancy to age 12 eustachian tube is on an angle instead of horizontal 2 and 6 instances of middle ear infections could be one and the same never cured could impact hearing and language development if recurrent and constant.
Serous fluid is sterile till you pop it and then you let bacteria in if someone comes in and has a bacterial infection you use antibiotics but if they have serous fluid it is better to do nothing.
If you have sterile fluid in ear it could just be a closed eustachian tube one case pt could be sick another could just be allergies...
Mastoidectomy remove infectious condition scrap away infection when antibiotics have failed years ago people died from middle ear infections and they would remove the mastoid bone to save them widened ear canal - like looking down a garden hose or a dent behind ear
Tympanoplasty reconstructive procedure to approximate normal function can connect the stapes to the ear drum, or lift ear drum to do other surgeries; goal is to repair TM can go anywhere from skin grafting to removal of stapes footplate.
Myringotomy puncture of TM or PE tubes in ears. Paracentesis, intentional puncture, a surgical nick in TM to allow for suction of fluid out of middle ear
PE tubes Pressure Equalization Tubes equalizes pressure in Eustachian tube and allows them to air out and dry out very tiny come out on their own but after surgery the tubes can get blocked...
Otitis Media Most Common Inflammatory Disease Has to be looked at in terms of infectious or non-infectious.
Otitis Media Need to be on alert as this may impact our work amenable to compensation via amplification should have no impact on work if you compensate for it!!!!
High absentee rate could mean more upper respiratory illnesses more ear infections if they sound congested get out amplification equip.
Serous and secretory Otitis Media NOT INFECTIOUS NOT SICK, or at least, not bacterial... Bad if secretion is COLORED. Clear is sterile...Absence of pain? Not infectious, No temp? Not infectious. Still conductive disorder though!
Fluid in middle ear is inflammatory regardless and is therefore conductive disorder if impacting hearing. Otitis Media is a continuum could have closed ET, bulging, infection, fluid disappating, could get infected, could go away by itself, could need medical intervention, etc.
Artic disorders and delayed language usually caused from hearing deprivation during a critical time of language development - relates to hearing loss.
There is no normal speech and language development without normal auditory development Whatever can be done to moderate or reduce underlying etiological issue ie: antihistamines allergy management that is what they will do.
Acute Suppurative Otitis Media the infectious form Suppurative and Purulent mean about the same thing red and painful TM is infectious
Non infectious type is hard to diagnose kid turns up TV loud but eats, sleeps, plays OK no symptoms for long time but auditory deprivation for a long time - speech and language issues develop because of auditory deprivation
Otosclerosis: abnormal bone growth compact bone replaced by spongy cancelous bone 10 - 20 females more likely bone grows abnormally around stapes MOST COMMON NON-INFLAMATORY CAUSE OF CONDUCTIVE HEARING LOSS
In Otosclerosis the stapes which is supposed to articulate with the oval window but instead bony plaque fixates the stapes to the oval window and doesn't allow for normal articulation with the oval window.
Otosclerosis can start subtley and begin to present at 20 -30 years of age but has been developing all along, can exacerbate during pregnancy and is bilateral eventually can relate to positive family history, not often in Black or Asian populations 90% have no symptoms but get CONDUCTIVE HEARING LOSS WITHOUT INFLAMMATION!!
Conductive Hearing Loss and absence of any inflammatory disorder this becomes more suspect unless there was an injury, accident, start poking around... any family members with hearing loss while they were young? were the women? any of them had surgery?
Otosclerosis gets worse ends up being bilateral but can present as unilateral originally. Negative ENT exam - LOOKS NORMAL because the problem is by the stapes... If the abnormal bone growth enters the inner ear surgery won't work anymore.
Treatment for Otosclerosis: stapedectomy or stapedotomy stapes has to be removed from being affixed to oval window. Better to use a prosthetic device. NON INFLAMMATORY DISORDER.
Most conductives are inflammatory - if you see conductive but normal ENT write a referral.
Per Dr. Singer 0-20 normal 20-40 = mild loss 40 - 60 moderate 60 - 80 = severe greater than 80 is profound
Identify errors betw data and history full case examples audiometric data you supply the results short essay regarding public school hearing screening and any issues relating to reliability; reliability measures: 1000 Hz recheck, relationship btw tests
Exogenous Non genetic (drugs, illnesses, accidents)
Endogenous genetic...... syndromic and nonsyndromic (syndrome = a collection of symptoms that occur together; known for one MAJOR THING and 1, 2, 3 subordinate things/ideas. If syndromic, ask about other family members...
Masking involves the isolation of the non-test ear from the testing scenario - what you think you are testing should actually be what you ARE testing.
Shadow Curve every time you elevate the intensity on the test side, it is being MIRRORED by the other side; even if you deliver sound to a dead ear, eventually sound will be heard by the good ear via bone conduction.
When a signal is delivered loud enough by air, it can be heard via BONE Must mask to remove participation of the non-test ear.
Interaural attenuation Interaural attenuation between the ears for AIR conduction is 40-50dB; LESS THAN 40-50dB won't be perceived.
By bone there is simultaneous bilateral stimulation both cochleas hear the signal unless masking is present.
Admittance and Impedance are reciprocal terms Impedance is resistance and admittance is the flow of energy. Can talk about sound in both terms.
Admittance on a tympanogram = horizontal is pressure measured in daPa or mmH20.
Zero is what kind of pressure? Ambient pressure.
Middle ear is open to the environment by virtue of the eustachian tube periodically opening and ventilating the middle ear. PATM = appropriately ventilated.
Positive pressure is like blowing up a balloon Negative pressure is like a vacuum.
Retracted ear drum = what kind of pressure? negative pressure in the middle ear.
Admittance is the ease of flow of energy. Meaasured in mmhos or ml or cm3 (pronounced millimoze) (opposite of Ohmz which relates to the resistance from electrical terminology)
As energy goes higher, what happens to admittance? Admittance goes up with energy going up - the more ease of flow...
Around zero, the flow of energy is at what? Zero pressure.
Tympanometry tells us about what? Tympanometry tells us about normal conductive health at the time the test is given. volume changes as a result of ear drum moving in response to pressure change. Pressure sweeps from -200 to +200 and we use the pressure change to measure mobility of TM.
The mobility of the TM in response to pressure changes is measured via tympanometry and is a measure of admittance as a function of pressure change. Pressure Compliance Function 3 measures to evaluate a tympanogram.
What are the three measures used to evaluate a tympanogram? Static Admittance, Canal Volume and Pressure Peak
Static Admittance (same thing as static immitance by the way...) is: the difference between the PEAK in a tympanogram and the value at +200. Peak, to the right side of the typanogram.
If Peak Pressure is 2.2 and the value at +200 is .8, what is static admittance? 2.2 - .8 = 1.4 SA
Is 1.4 a normal SA? Yes, because NORMAL for SA is .3 - 2.0 maybe even 2.5...
Canal Volume is what? Canal volume is simply the volume of the ear canal = from the tip of the plug to the TM.
Where do you find the value for Canal Volume??? At +200. Whatever the value is at +200, that is canal volume.
What is NORMAL for Canal Volume???? .3 - 2.0 measured at stiffest point (+200)
How can canal volume help detect a perforated or punctured ear drum??? Can't always SEE a perforated ear drum, but you can tell by canal volume which would be greater than normal. Can use CV to detect a tiny, tiny hole.
Pressure Peak is what???? Pressure Peak is where the ear drum moves the most EASILY.
What is NORMAL for Pressure Peak???? Normal for Pressure Peak could be anywhere from +100 - -250...
Most everybody has a Pressure Peak at what value? Near Zero... but SOME people have peaks varying from +100 - -250 and that is still normal for them. Basically, if an eardrum has mobility, then it responds to pressure and as long as there thus is no decreased function, nothing needs to be addressed.
Do retracted ear drums cause hearing loss? No, retracted ear drums do NOT cause hearing loss, at least not unless they cause such negative pressure that they start filling up with fluid.
In a negative pressure tympanogram is there hearing loss? In a negative pressure tympanogram there is no hearing loss; the ear drum is still moving. If it goes extremely negative, it still may self-correct, but once it is like -400 then it causes a vacuum, fills with fluid and then TM doesn't move anymore.
Does a negative pressure peak cause an abnormal canal volume? A negative pressure peak even at -400 can lengthen canal volume, but not enough to put it out of normal range.
Flat Tympanogram: describe. Flat tympanogram means there is no Pressure Peak because there is no peak. That means there is also no Static Admittance because there is no difference btw Peak and the value at +200. Canal Volume should be normal though.
Low Peak = what???? Low peak is Reduced Mobility of the TM. Because the peak is low, that makes the SA low.
What is a medical etiology for hearing loss that could cause a low Static Admittance? Otitis Media is #1 for cause; fluid in the middle ear whether it is infectious or non-infectious causes a flat tymp... however, Otosclerosis could also cause a low normal SA.
What does the tympanogram look like for Sensorineural hearing loss??? SN Tymp is NORMAL. The reason for this is Sensorineural hearing loss is not a problem in the middle ear, but rather one of the inner ear.
Why would they do tympanograms at schools for the deaf? Because a kid could still have otitis media and need medical attention.
If a kid had otitis media but had very clear serous fluid behind the TM what kind of tymp? Might equate with a non-completely flat tymp because there still might be some mobility of the TM.
Can cerumen impact a tympanogram Yes, cerumen can impact a tympanogram if the pressure cannot pass the cerumen to reach the TM.
How can scar tissue impact a tympanogram? Scar tissue could result in the TM being LESS mobile or MORE mobile (sometimes scar tissue is hyperelastic.) A healed TM could be thickened or hypersensitive and hypermobile.
Excessive ear drum mobility could result in a peak being where? Excessive ear drum mobility could result in a pressure peak being off the chart...
What could cause excessive ear drum mobility? Scar tissue could result in hypersensitive and hypermobile TM or it could be OSSICULAR DISCONTINUITY from the ossicals being damaged (like a loose jump rope) OR resorption of the ossicles.
What could cause the ossicular chain to be loose resulting in excessive ear drum mobility? Ossicular discontinuity could be caused by a blow to the skull.
Excessive ear drum mobility affects tympanogram in what way? Pressure peak may be off the chart high and SA would be thus Excessive.
What could cause excessive ear drum mobility besides scar tissue on TM and ossicular discontinuity? Resorption of the ossicles from sitting in caustic bacterial material - makes them no longer rigid (think loose jump rope again) and could cause excessive TM mobility, excessive SA and high PP (bad otitis media)
Every sensorineural loss creates this kind of tympanogram: normal.
More important than characterizations and labels are the realities that are attached to the categorizations and labels, such as the impact on daily life, daily function, speech and language development, etc. These things don't necessarily link to 'severity' in hearing loss.
Off of what numbers do you determine severity of hearing loss? Off of the pure tone average; average of 500, 1K and 2K via AIR conduction
PTA of 20 or under normal
PTA 25 - 40 mild
PTA 40 - 60 moderate
PTA 60-80 severe
PTA 90 and above profound
A good "Narrative Description" contains what three things? Type Slope Degree
A good fitting ear plug takes away what? 20dB of sound = takes away subtleties of speech and required medical intervention - could result in auditory deprivation and with speech and language issues.
Noise Notch - what is it? High Frequency Hearing Loss - normal hearing with a drop between 3K and 6K with a possible recovery at 8K Narrative Description = normal hearing up to 2K with a sensorineural hearing loss after 2K.
What is acoustic reflex? the least intensity level that generates a DEFLECTION of .02
How do you assess acoustic reflex? Set intensity to 90dB (possibly higher up to 100dB) and then step it down 10 until you get no response, then go up by 5s until you get up to the point of response, either new or original. Do this for 500Hz, 1K Hz and 2K Hz.
You need to get the LOWEST POSSIBLE THRESHOLDS FOR 500 1K AND 2K and a deflection of .02 for acoustic reflex (auditory deflection reflex)
A threshold of 55dB or 60dB can have this impact on acoustic reflex 80dB may not be enough intensity to evoke the reflex and reflexes may be elevated.
If the person has a SENSORINEURAL LOSS Below 55dB, what does it mean if they DON'T have a reflex? 8th nerve problem is possible...
If sensorineural threshold is greater than 55dB you might have this happen with acoustic reflex there might not be a reflex even with an increased intensity signal - with very elevated thresholds there may be no response and then you have a sensorineural origin but can't tell which - just something cochlear...
Mild Cochlear = 50dB or below = what are reflexes? Normal
Conductive Loss = reflexes are... CONDUCTIVE REFLEXES? ABSENT!
Normal Hearing: reflex at .02 REFLEX AT 95 DB OR LESS (.02 simply defines a real reflex) Normal Hearing: reflex at .02 REFLEX AT 95 DB OR LESS (.02 simply defines a real reflex)
Sensorineural: below 50dB = normal reflexes above 50dB may need to raise intensity of signal which may result in normal reflexes or absence of reflexes Sensorineural: below 50dB = normal reflexes above 50dB may need to raise intensity of signal which may result in normal reflexes or absence of reflexes
Has to go back to zero line, approximately, after a deflection of .02 to be a acoustic reflex
When hearing loss is severe or worse 60dB and higher the acoustic reflex can first be elevated and then absent - just assume cochlear (the only time you can say that it might be neural is if the loss is BELOW 50dB with an absent response and then it might be 8th nerve/neural.)
Very elevated thresholds, sensory or neural? Can't distinguish over elevated reflexes; can only say neural if under 50dB and no response. Then you can say 8th nerve/neural.
Do not refer to a tympanogram as 'flat' rather, call it ABNORMAL
How and when can you get a normal tymp in a conductive disorder? Otosclerosis: the affect on the tymp depends on the amount of sclerotic material and how much it is creating a conductive loss..
Normal tymp and normal reflex - what could it be? Could be normal hearing, or could be mild cochlear loss (as long as thresholds are below 50dB.)
Bilateral conductive loss: what kind of reflexes, what kind of tymps? Bilateral conductive loss: absent reflexes, abnormal tymps.
When you see a conductive hearing loss, best guess for reflexes is absent.
Two definitions of hearing conservation? Hearing screenings in the public schools and screening and conservation of hearing in noisy settings and industries.(management of noise and hearing problems related to industrial noise exposure.)
If a child fails a hearing screen what happens? Medical remediation and educational remediation.
There are group tests and individual tests for hearing Individual usually done in schools - more reliable but slower process.
Military and industry are group tests which are less reliable but more rapid.
If you buy audiology equipment, buy only those things that fit the procedures you need to do Know the goals of the program before you go and buy equipment. Also, if you have 2-3 year old children, you need more than just equipment, you need additional staff to help do hearing screenings...
Testing environment is critical for screenings: see what the site is like on the days and times you are planning to use it: no visual and auditory distractions cover all windows, check for outlets for equipment or have ext cords, carpets, draperies good.
Equipment should match goals of the screening process. Is it adequate or what equip do you wish to buy? If you only need puretones and tymp $5,000. Require backup equipment as you need a spare piece of equipment if you can get it. With regard to equip, bilogical calibration has to be done daily. Get golden earred person and check 5,1,2,4.
Can have parent volunteers do screenings but the SLP has to do the rescreenings and screening failures.
Train your volunteers Screening is NOT threshold finding. Do NOT TOUCH the attenuator during a screening, watch the volunteers and make sure they do this right. Black and white test!
In a screening you set the attenuator and deliver the signal they either raise their hand or they don't. If they raise their hand = pass. Don't = fail. TESST ON 500 1K 2K AND 4K We don't test 250 because we are not in a sound booth. Can deliver first signal at 40dB, but then set to screening level and leave it there for rest of screening.
Too much ambient noise during a screening, need to find another room. Cannot fix it by elevating the level of the cutoff. You are going to hear some little sounds. Raise your hand even if you hear it only a tiny bit.
During a screening, you might have the initial presentation be at a higher intensity for mental representation of the sound, but then drop it down for the actual screening pass/fail part. After mental representation level, bring it down to screening intensity and do not touch attenuator.
When doing tympanometry advise the pt. to not talk or move their mouth could break tymp seal
What constitutes a failure on a hearing screen? Well, if a kid has a normal SA and a peak at -200, this has no treatable disorder so shouldn't send to Dr, even though a -200 peak is abnormal.
If SA is -3 or -4 or less, going to a physician is justified. Reduced SA can be referred. Some kids who don't get follow up will suffer so need to decide how many you will refer.
We do not test 250 in a screening because it is not done in a a sound booth.
When writing Fail letter to parents for a screening, be careful and selective in your language.
Program Implementation for Hearing Screenings: inform everyone that this event is going to take place: parents, teachers, principal, etc. Please get kids to me in an orderly fashion. May contact pediatricians to let them know they may be getting more referrals.
Before a screening, double check to ensure you have all your materials: personnel, physical space, equipment, forms, paperwork, tools.
Screenings are done typically every other year and all these children are seen: all new children, all children with referrals, all children with known hearing losses - these children may receive hearing screenings during the off years, too.
When someone fails a creening, the SLP does the re-screen. A failure equals a medical referral. May refer to ENT, to an audiologist, to a doctor, to a pediatrician, to a GP if an adult.
For a child that is unreliable that fails a screening (ie: doesn't raise his hand at all, raises his hand when he feels like it... Screening is not a labeling service; need to refer kid to ENT = may still need help.
Compensatory strategies for kids who fail screenings: referral, devise compensatory strategies, writing plus oral, verify kid understands, preferential seating...
What is the mechanism for eliciting a response? As in when a kid fails, you write a referral, and then how do you follow up? Have a folder on child, a tracking system, sent a note to parent and pediatrician, and request that they keep you advised on follow up, then verify if you did or did not get feedback.
You should always monitor your own screening program - Ask yourself, what have we learned that we could do better next time? Did we write just the right amount of referrals? Did the room work? Did we get adequate support from principal, teachers, parents, kids, etc.?
Referral and action on referral may be 10 days apart and some conductive cases might self heal. Sometimes we make errors in referrals to help the kids who really need it - better to not not miss kids who need help.
On page 43 and 44 you used the terms simple and narrow before discussing OAE and ABR. What is meant by simple and narrow????
Otoacoustic Emissions are known as OAE
What is OAE (Otoacoustic Emissions) and what are they used for? OAE / Otoacoustic Emissions are used for newborn hearing screenings. Clicks or pips (several hundred of them) are introduced to the ear canal to evoke a response. Individuals with normal conductive and inner ears and even mild hearing loss have OAEs.
Auditory Brainstem Response is known as ABR
What is ABR (Auditory Brainstem Response)? Auditory Brainstem Response (ABR) is the measure of electrical responses by the lower brainstem and 8th nerve using electrodes on scalp. People who get an ABR? People who fail the AOE. If the fail the AOE, they get an ABR.
Core Conditioned Operative Response: Behavioral technique with kids - based on mental age of child 6months to 24months. Sound = monkey sound = monkey sound=child looks for monkey means child hears sound.
What is TROCA? TROCA stands for Tangible Reinforcement Operant Conditioning Audiometry It takes into account an older age child age1 to age3 where the kid expects a tangible reward (M&Ms)
Describe the TROCA procedure Kid hears sound and is encouraged to push a button on a box and an M&M comes out. Sound, push, M&M Kid pushes when hears sound (clinician actually makes M&M come out, not the button.)
What is Play Audiometry? At this older age of 2 1/2 to age 5, play is the reinforcer... Bucket of blocks. Put block up to kids ear, kid hears tone, puts block in bucket. Pick up block, up to kids ear, sound, put in bucket. If reinforcement goes away, you need to recondition.
Public school hearing screening what does that have to do with issues relating to reliability in that process?
What are some of the measures in general that allow for reliability of hearing assessments? Recheck at 1K, SRT in agreement with puretones, WRT using NU6 was %/%. Tympanometry indicated normal middle ear function bilaterally. Ipsilateral acoustic reflex results were normal. Take into account if history matches results and so forth?
Post Evaluative Counseling: MEET THEIR INDIVIDUAL NEEDS. Find out what the pts agenda is and be informative and leave them feeling positive about what took place and about themselves. Info delivered depends on patients curiousity and sophistication. Only productive and helpful data.
Red Flag List for Referrals: Anything medically treatable, any sudden or noticeable changes in hearing, any sign of conductive as it is medically treatable, anything possibly neural (persistent severe headaches, tinnitus, vertigo if sudden & simultaneous.) Asymmetry of symptoms.
Psych referrals might relate to: Depression over hearing loss, problems obtaining or keeping a job = voc rehab counselors do exist and may help with obtaining a hearing aid.
Counseling can be 30 seconds to five minutes if you do it succinctly. State the Results, the Implications of the Results, and then What Do We Do About It?
Counseling: You have a little bit of hearing loss in both ears that relates to the aging process; you may have more difficulty understanding women and children because of their high pitched voices; some things you can do is (list behavioral aural rehab solutions.)
Counseling: You have a little bit of hearing loss in your right ear due to fluid in your ear behind your ear drum that is making it harder for it to move. I am going to write a referral to your dr so you can obtain meds & then I want you to come back for follow up.
What could be an example of follow up for a geriatric as part of counseling dialogue? If presbycusis and age related, they might want to come back to be fitted for a hearing aid or for aural rehabilitation.
What could be an example of follow up for a child as part of a counseling dialogue? for Otitis Media, the child should get a referral to their pediatrician that you should TRACK and then they should come back to you to be re-evaluated to ensure their hearing is now normal. Might need multidisciplinary follow up for continued hearingloss.
Report Writing: 3 parts: Problem and History Narrative Description Impressions and Recommendations
Statement of Problem and History Identify who the patient is, where they are being seen, and why they are being seen, and when they are being seen. Hillevi was seen at the URI Speech and Hearing Center on July 20th for an audiological evaluation as part of a class assignment, then data
What is the data that you provide as part of Problem and History in an Audiological Report? You provide the pts history chronologically. Pick the positive things (noteworthy) and provide sufficient explanation and detail (since when, what did you do about it, last time treated?) make it meaningful.
What do you do with the No's - the NON significant medical history part on the Problem and History section of an audiological report??? You simply state "The remainder of medical and familial histories were negative." This means that you did your job and asked all the pertinent questions but that the 'no-s' were unrevealing.
What is the 2nd part of an audiological report? The Narrative Description Part.
When you write the narrative description part of an audiological report, what goes in it? Slope Degree and Type Then, SRTs were in agreement with the puretones. WRT using NU6 materials were %/%. Tympanometry indicated normal middle ear function bilaterally (if each of 3 results was normal), Ipsilateral Acoustic Reflex results were normal.
Brevity!!! Results were either NORMAL, AT EXPECTED LEVELS, ELEVATED OR ABSENT. Just say so.
Last part of an audiological diagnostic report? Impressions and Recommendations.
What goes in the Impressions and Recommendations (last part) of an audiological evaluation report??? This is the counsel part: State the Results, the Implications of the Results, and What Should Happen Next. Provide a clear sense of direction.
Example of Impressions and Recommendations on an audiological evaluative report: Mr. John Smith has a mild conductive blilateral hearing loss (don't give slope, type and degree here) this may account for his not being able to hear his wife in noisy situations or when he cannot hear the speaker. Rec seen by GP; follow up for re-eval
Example of Impressions and Recommendations on an audiological evaluative report for a child with hearing loss: A.B. has a conductive hearing loss in her right ear which may be impacting her ability to understand directions in the classroom setting; referral to pedi follow up in 2 wks, consult with SLP and teacher to improve classroom function.
Normals should return in 3 - 5 years unless hearing changes. If something changes, they should come in for a re-eval.



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