Audiometry Test Procedures and Equipment

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Questions and Answers

What is one characteristic of speech testing that must be reported by an audiologist?

  • Patient's previous hearing history
  • Patient's age
  • Intensity level (correct)
  • Duration of the test

What is a key component of an early hearing, detection, and intervention (EHDI) program?

  • Diagnose hearing loss by 3 months (correct)
  • Identify hearing loss at birth
  • Provide intervention by 12 months
  • Monitor speech development annually

What is a result of unaddressed hearing loss in newborns?

  • Improved employment opportunities
  • Language delays (correct)
  • Earlier detection of hearing loss
  • Enhanced cognitive skills

How does an otoacoustic emissions (OAE) test evaluate hearing?

<p>By emitting sounds into the ear and measuring the response (C)</p> Signup and view all the answers

What differentiates the auditory brainstem response (ABR) test from the auditory steady state response (ASSR) test?

<p>ABR primarily measures auditory evoked potentials, while ASSR evaluates brain activity over time (D)</p> Signup and view all the answers

What is one characteristic of an Auditory Brainstem Implant?

<p>It typically does not allow for sound discrimination. (D)</p> Signup and view all the answers

Which of the following is a goal for fitting hearing aids?

<p>To restore access to speech and environmental sounds. (A)</p> Signup and view all the answers

What might be a common reason for children to reject hearing technology?

<p>Perception of discomfort. (D)</p> Signup and view all the answers

Which of the following is NOT a cause of vestibular disorders?

<p>Environmental noise exposure. (C)</p> Signup and view all the answers

Which test is commonly used to measure eye movements for vestibular dysfunction?

<p>VNG - Videonystagmography. (C)</p> Signup and view all the answers

What does hyperacusis refer to?

<p>An overwhelming sensation to normal sound levels. (D)</p> Signup and view all the answers

What is one element of a tinnitus evaluation?

<p>Medical evaluation for associated conditions. (C)</p> Signup and view all the answers

In relation to vestibular dysfunction tests, what does VEMP stand for?

<p>Vestibular-Evoked Myogenic Potentials. (D)</p> Signup and view all the answers

Which type of sound tolerance disorder is characterized by a negative reaction to specific soft sounds?

<p>Misophonia. (A)</p> Signup and view all the answers

What is an important characteristic to report in speech testing?

<p>The level of background noise during testing. (C)</p> Signup and view all the answers

What is the primary purpose of conducting a pure tone audiometry test?

<p>To determine hearing thresholds at various frequencies (A)</p> Signup and view all the answers

Which statement correctly describes the use of insert earphones in audiometry?

<p>They provide a cleaner signal and block out background noise effectively. (B)</p> Signup and view all the answers

What does a Type B tympanogram indicate?

<p>Fluid in the middle ear. (C)</p> Signup and view all the answers

When is masking required during audiometry?

<p>When assessing for single-sided or conductive hearing loss. (A)</p> Signup and view all the answers

What does the term 'compliance' refer to in the context of tympanometry?

<p>The movement of the tympanic membrane. (B)</p> Signup and view all the answers

What type of audiology test is appropriate for infants under 6 months?

<p>Behavior observation audiometry (BOA). (B)</p> Signup and view all the answers

Which combination of frequencies is typically used in pure tone audiometry testing?

<p>500, 1000, 2000, 4000 Hz (B)</p> Signup and view all the answers

When calculating signal-to-noise ratio (SNR), which mathematical operation is used?

<p>Subtraction of background noise from the signal level. (C)</p> Signup and view all the answers

Which type of tympanogram is characterized by high compliance?

<p>Type Ad (D)</p> Signup and view all the answers

In speech recognition threshold testing, what type of words are primarily used?

<p>Spondees with equal stress. (C)</p> Signup and view all the answers

What is the normal range for an acoustic reflex test?

<p>85-100 dB SL (D)</p> Signup and view all the answers

What happens during Conditioned Play Audiometry (CPA)?

<p>Children play with toys upon hearing specific sounds. (A)</p> Signup and view all the answers

What does the absence of Wave V indicate in an auditory response?

<p>A problem has occurred (A)</p> Signup and view all the answers

Which hearing aid style is most commonly used by children?

<p>Behind the ear (BTE) (B)</p> Signup and view all the answers

What is a limitation of the in-the-canal (ITC) hearing aid?

<p>Cannot connect to FM systems (A)</p> Signup and view all the answers

Which hearing aid style sits in the ear canal and can be difficult to handle for the elderly?

<p>Completely in the canal (CIC) (B)</p> Signup and view all the answers

How does a bone conduction hearing aid work?

<p>Transmits sound via vibration to the cochlea (B)</p> Signup and view all the answers

What type of hearing aid is specifically designed for single-sided deafness?

<p>Cros/Bicros hearing aids (A)</p> Signup and view all the answers

Which feature differentiates the 'invisible in the canal' (IIC) hearing aids from other styles?

<p>It cannot be seen at all (D)</p> Signup and view all the answers

How does a cochlear implant transmit signals to the brain?

<p>Using electrical signals sent to the cochlea (B)</p> Signup and view all the answers

What disadvantage do completely in the canal (CIC) hearing aids face?

<p>Can easily distort sound quality (C)</p> Signup and view all the answers

Which type of implantable hearing device includes a titanium implant secured to the skull?

<p>Ossiointegrated hearing aids (BAHA) (D)</p> Signup and view all the answers

What is a key characteristic of the receiver in canal (RIC) hearing aid?

<p>It uses a wire instead of tubing (D)</p> Signup and view all the answers

What limits the functionality of light-driven hearing devices?

<p>Restricted frequency range (A)</p> Signup and view all the answers

Which hearing aid type is best suited for individuals with conductive hearing loss?

<p>Bone conduction hearing aids (B)</p> Signup and view all the answers

What is one major advantage of Auditory Steady State Response (ASSR) over Auditory Brainstem Response (ABR)?

<p>ASSR can estimate more specific thresholds (C)</p> Signup and view all the answers

Flashcards

Speech Reception Threshold

The percentage of sounds a person can hear correctly during a speech test.

Intensity Level

The level of sound intensity used during a speech test.

Early Hearing Detection and Intervention (EHDI)

A program designed to identify hearing loss in newborns and provide early intervention services.

Otoacoustic Emissions (OAE)

A test used to screen for hearing loss in newborns that measures the sound produced by the hair cells in the inner ear.

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Auditory Brainstem Response (ABR)

A test that measures the brain's response to sound, specifically from the auditory nerve.

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Distance

The distance between the listener and the speaker, usually measured in feet.

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Intensity

The level of loudness or softness of a sound.

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Tympanometric Peak

The ability of the middle ear to change pressure to match the air pressure in the ear canal.

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Frequency

The number of times a sound wave vibrates per second, measured in Hertz.

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Signal-to-Noise Ratio (SNR)

The difference in loudness between the signal and background noise.

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Visual Reinforcement Audiometry (VRA)

A type of audiometry test used for children ages 6 months to 3 years, where a toy appears when a sound is heard to encourage the child to respond.

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Behavior Observation Audiometry (BOA)

A type of audiometry test used for infants under 6 months, where the infant's behavior is observed for changes when a sound is presented.

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Tympanometry

This test measures how much the eardrum moves in response to changes in air pressure in the ear canal. It provides information about the functioning of the middle ear.

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Middle Ear Compliance

This test measures the volume of the middle ear, looking for blockage or fluid buildup. It provides information about the functioning of the middle ear.

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Acoustic Reflex Testing

This test assesses the middle ear's response to loud sounds, helping identify problems with the middle ear muscles.

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Speech Recognition Threshold (SRT)

This test identifies the softest level at which a person can understand speech, typically using two-syllable words. It provides information about how well a person can hear and understand spoken words.

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Spondees

These are two-syllable words with equal stress on both syllables, commonly used to assess speech recognition.

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Bone Conduction

This is the ability to hear sounds through the bones of the skull.

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Air Conduction

This is the ability to hear sounds through the air, using air conduction.

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Acoustic Reflex

This test measures the loudness level needed to elicit a reflex in the middle ear, typically between 85-100dB.

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Auditory Brainstem Implant

A device that bypasses the cochlea and sends signals directly to the brainstem, helping individuals with severe hearing loss perceive sound but not necessarily understand speech.

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Bone Anchored Hearing Aid (BAHA)

A titanium implant that protrudes from the skin behind the ear, used for conductive hearing loss. It conducts sound vibrations directly to the inner ear.

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Misophonia

A condition where soft sounds cause extreme negative reactions, potentially leading to anger, anxiety, or physical discomfort.

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Videonystagmography (VNG)

A test that measures eye movements in response to head movements, used to assess vestibular function.

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Hyperacusis

A condition in which sounds become overwhelming and unbearable, leading to discomfort or pain.

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Computerized Dynamic Posturography (CDP)

A test used to assess balance by having the patient stand on a platform that moves and adjust their balance in response to varying conditions.

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Vestibular-Evoked Myogenic Potentials (VEMP)

A test that uses clicks or tone bursts to measure the response of the vestibular system, specifically the saccule and utricle.

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Tinnitus Masking

The act of playing a different sound to counteract tinnitus, often a tone opposite to the tinnitus frequency.

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What is Auditory Steady State Response (ASSR)?

Auditory Steady State Response (ASSR) is a hearing test that utilizes high repetition stimuli to measure the brain's response to sound, using algorithms to analyze the results. It can assess hearing thresholds and frequencies more accurately than the Auditory Brainstem Response (ABR).

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What does Wave V in an ABR test indicate?

Wave V in an auditory brainstem response (ABR) test indicates that the sound signal has reached the brainstem. Absence of Wave V suggests a potential problem with the auditory pathway.

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What are body-worn hearing aids?

Body-worn hearing aids are the most powerful and affordable option. They are often used by children and can accommodate different hearing frequencies. They feature an ear mold that fits the pinna and directs amplified sound into the ear.

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What are behind-the-ear (BTE) hearing aids?

Behind-the-ear (BTE) hearing aids are another popular type, known for being powerful and affordable. They offer versatility in frequency adjustment and can be customized with open or closed ear molds.

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What are receiver-in-canal (RIC) hearing aids?

Receiver-in-canal (RIC) hearing aids are smaller than BTEs, using a thin wire instead of tubing to direct sound to the ear. They are popular among adults due to their discreet nature and natural sound pickup.

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What are in-the-ear (ITE) hearing aids?

In-the-ear (ITE) hearing aids are molded to fit the ear, with the microphone and receiver located in the ear canal. They are suitable for moderate-to-severe hearing loss but lack the power for profound loss.

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What are in-the-canal (ITC) hearing aids?

In-the-canal (ITC) hearing aids are smaller versions of ITEs, appealing to adults with good dexterity. They are suitable for moderate-to-severe hearing loss.

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What are completely-in-the-canal (CIC) hearing aids?

Completely-in-the-canal (CIC) hearing aids are designed to be discreet and comfortable. They offer a close proximity to the eardrum for direct sound delivery but can be prone to distortion.

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What are invisible-in-the-canal (IIC) hearing aids?

Invisible-in-the-canal (IIC) hearing aids are extremely discreet, almost invisible in the ear. They share advantages and disadvantages with CICs.

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How do light-driven hearing aids work?

Light-driven hearing aids use a transducer on the tympanic membrane to translate light into vibrations, providing a wide range of frequencies..

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What are Cros/Bicros hearing aids used for?

Cros/Bicros hearing aids are designed for single-sided deafness, transmitting sound from the weaker ear to the hearing device on the stronger ear.

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What are bone conduction hearing aids?

Bone conduction hearing aids are an alternative for single-sided deafness or conductive hearing loss (where sound doesn't reach the inner ear through air).

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What are ossiointegrated hearing aids (BAHA)?

Ossiointegrated hearing aids (BAHA) involve a titanium implant placed behind the ear, which is attached to a sound processor that vibrates the bone to deliver sound.

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How does a cochlear implant work?

A cochlear implant converts sound into electrical signals that are sent to the cochlea, stimulating the auditory nerve and transmitting information to the brain.

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Name an implantable hearing device: converts sound to electrical signals for the cochlea.

A cochlear implant - converts sound to electrical signals for the cochlea.

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Name an implantable hearing device: uses a titanium implant to vibrate the bone and deliver sound.

A bone-anchored hearing aid (BAHA) - uses a titanium implant to vibrate the bone and deliver sound.

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Name an implantable hearing device: amplifies sound vibrations directly in the middle ear.

Middle ear implants - amplify sound vibrations directly in the middle ear.

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Name an implantable hearing device: sends electrical signals directly to the brainstem.

Auditory brainstem implant (ABI) - sends electrical signals directly to the brainstem.

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Study Notes

Audiometry Test Environment

  • Separate from building to reduce outside noise
  • Quiet environment
  • Soft surfaces to prevent echoes
  • Patient sits away from audiologist
  • Windows to allow visual contact

Pure Tone Audiometry Procedures

  • Start at 1000 Hz at 30 dB HL
  • Raise 10 dB HL until a response is detected
  • Go down 5dB HL
  • When no response, raise by 10dB HL
  • Repeat until threshold is detected (2/3 times)
  • Test frequencies: 500, 1000, 2000, and 4000 Hz

Earphone Types

  • Supra-aural: Placed over the pinna
    • Left and right sides
    • Air conduction
  • Insert: Better for background noise reduction
    • Cleaner
    • More comfortable
    • Left and right sides
    • Air conduction
  • Oscillator: Measures bone conduction
    • Bone conduction signals
    • Oscillates skull bone

Masking

  • Necessary when testing bone conduction
  • Blocking one ear to test the other
  • Necessary for single-sided hearing loss
  • Necessary for conductive hearing loss

Audiometry Types

  • BOA (Behavior Observation Audiometry): Observation of a patient's reactions to sounds.
  • VRA (Visual Reinforcement Audiometry): Using visual rewards to encourage responses to sounds.
  • CPA (Conditioned Play Audiometry): Training the patient to perform an action in response to sounds.

Tympanometry

  • Measures middle ear pressure and compliance.
  • Normal response is 0.3–3 ml (compliance).
  • Different peak types suggest different issues.

Speech Recognition Threshold (SRT)

  • Lowest level where speech is understood
  • Uses spondee words (two-syllable words with equal stress).
  • Procedure: start at 30dB HL, increase by 10 dB until words are understood, then decrease by 10dB for correct response, then increase by 5dB.

Signal-to-Noise Ratio (SNR)

  • Difference in intensity between signal and background noise.
  • Calculated by subtracting background noise level from the signal level.

Newborn Hearing Screenings (UNHS)

  • Components of an EHDI program: Early hearing, detection, and intervention program
  • Identification by 1 month, diagnosis by 3 months, and intervention by 6 months.
  • Importance of UNHS: Prevent language delays, speech delays, academic difficulties, and employment issues from unaddressed hearing loss.

Otoacoustic Emissions (OAE) Testing

  • Screening tool performed usually at birth
  • Place a probe in the ear canal to emit sound.
  • Measurements take place as the sound bounces off the tympanic membrane.
  • Evaluate if hair cell function is normal.

Auditory Brainstem Response (ABR) and Auditory Steady State Response (ASSR)

  • ABR measures auditory evoked potentials (responses from auditory nerve).
  • ABR electrodes on the patient's skull (CN8); signal into ears, measure the brain waves.
  • Wave V indicates that signal has passed through the brain stem.
  • Absence of wave V indicates a problem.
  • ASSR is similar to ABR but uses repetitive stimuli and can measure frequencies more accurately

Hearing Aids

  • Different types: Body worn, behind-the-ear (BTE), in-the-ear (ITE), in-the-canal (ITC), completely-in-the-canal (CIC), invisible-in-the-canal (IIC)
  • Differences: Placement, size, and power.

Cochlear Implants

  • Converts sound to electric signals relayed to the auditory nerve via electrodes.
  • Helps people with profound hearing loss, conductive hearing loss, sensorineural hearing loss, and single-sided hearing loss.

Implantable Hearing Devices

  • Cochlear Implant: Electrically stimulates the auditory nerve.
  • Auditory Brainstem Implant: Sends signals directly to the brain stem.
  • Middle Ear Implant (Osia): Vibrates ossicular prosthesis to stimulate the inner ear.
  • BAHA (Ossiointegrated Hearing Aids): Titanium implant behind the ear. Sound processor attaches to the implant.

Goals of Hearing Aid Fitting

  • Restore access to speech.
  • Restore and retain clarity.
  • High intensity remains tolerable.

Hearing Technology Rejection by Children

  • Reason(s) for rejection: Discomfort.

Vestibular Disorders

  • Four causes: Disease, toxins, trauma, syndromes.
  • Five tests: VNG, vHIT, Rotary Chair Test, CDP, VEMP.

Tinnitus Evaluation

  • Medical evaluation
  • Case history and environments.
  • Self-assessment: questions about daily life and sounds.
  • Use of masking: use masking techniques.

Sound Tolerance Disorders

  • Hyperacusis: Overwhelming sensitivity to sounds
  • Misophonia: Negative emotional reaction to specific sounds.

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