Audiology Exam Notes PDF

Chapter 1: The Profession of Audiology I. Audiology a. discipline that studies hearing, balance and related disorders b. Audiologist: professional who practices audiology i. Provide services to people with auditory or vestibular impairments including:...

Chapter 1: The Profession of Audiology I. Audiology a. discipline that studies hearing, balance and related disorders b. Audiologist: professional who practices audiology i. Provide services to people with auditory or vestibular impairments including: 1. Identification 2. Assessment 3. Diagnosis- what is the disorder 4. Treatment 5. Prevention- to vast majority of population c. Evolution: ii. Prior to WWII: Primary physicians and instrument specialists iii. After WWII: New advancements in technology louder weaponry severe hearing impairments; Audiologists needed and otology (diagnose ear disease) iv. Raymond Carhart: 6. Created aural rehab center\'s 7. Father of audiology 8. US first academic program at Northwestern University II. Doctor of Audiology d. Entry level degree is a professional doctorate e. AuD: doctor of audiology f. 4 year graduate degree g. Comprehensive curriculum and 2500+ hours of clinical experience h. 4^th^ year of AuD program -- externship i. AuD vs PhD v. AuD: clinical doctorate; practitioners vi. PhD: academic doctorate; researchers j. History: vii. Move from clinical master's degree to a professional doctorate began in the late 1980's viii. 1978 ASHA discussed need for professional doctorate so that Ph.D. programs could focus on research instead of clinical training ix. 1995 ASHA endorsed a plan to transition from master's to doctorate x. Final implementation by 2007 xi. Today more than 70 professional doctorate programs k. Licensure and certification- Louisiana xii. Licensure: need one to practice 9. Completion of doctoral degree 10. Clinical assignments 11. Pass a national exam (Praxis) 12. Apply for licensure through state board a. LBESPA 13. Mandatory CEUs b. Take courses (10hr/ year)- ASHA (30/ 3 years) xiii. Certification- optional 14. Not a legal requirement 15. Membership in ASHA -- grants certification (CCC) 16. American Board of Audiology (ABA) 17. Get certified that tell community that you have certain knowledge, skills, etc. that show you can do the job -- ASHA CCC c. need if you want to supervise students 18. ABA- specialization certification III. Specialties l. Medical Audiology xiv. Largest number of audiologists xv. hospitals; Hearing tests, newborn hearing screening oversight, ototoxic monitoring (ex. Chemo), prescreening, hearing aids, cochlear implants, bone anchor devices m. Educational Audiology xvi. schools: Identify hearing impairments/ infections, screening, acoustic environment accommodations for children hard of hearing, educate faculty and parents, prevent hearing loss n. Pediatric Audiology: children's hospitals, speech and hearing centers; Guide parents as well as do typically audiology treatments o. Hearing Aid Dispensing Audiologist: provide aids p. Industrial Audiology: OSHA; make sure companies are up to standards that do not cause hearing loss (noise induced occupational hearing loss 2^nd^ most prevalent hearing damage); screening and testing on employees; educate employees, monitor q. Tele-Audiology: remote aids, counseling r. Academic Audiologist: university level; training and teaching s. Research Audiologist: PhD t. Forensic Audiologist: expert witness to court; occupational and environmental noise with crime u. Intraoperative Monitoring Specialist: auditory response when kids/ adults are sedated (ABR- auditory brainstem testing) IV. Audiologists and Other Professionals v. Employment settings: xvii. Otoscopic examination: looking in ear xviii. Comprehensive audiological evaluations**:** aka hearing test xix. Identification of high-risk factors: noise exposure, age, ear infections, medicines, illnesses (especially with babies), family history xx. Perform tests of vestibular function: hearing and balance xxi. Treatment of vestibular disorders: benign proximal vertigo disorder xxii. Cochlear implant mapping: program device for deafness xxiii. Noise measurements: industrial monitoring of levels of loudness xxiv. Cerumen management (ear wax) xxv. Perform & interpret tests of evoked potentials: hearing tests while asleep xxvi. Tinnitus evaluation and treatment: sensitivity to loud sounds/ ringing xxvii. Hearing Conservation: education xxviii. Audiology research w. Professional organizations xxix. Professional organizations provide advocacy (public awareness), publish scholar journals, education opportunities, political action committees 19. ASHA (American Speech, Language, Hearing Association) 20. AAA (American Academy of Audiology) 21. LSHA -- state association 22. Louisiana Academy of Audiology 23. ADA (Academy of Doctors of Audiology) 24. Educational Audiology Association 25. Academy of Rehabilitation Audiology 26. American Auditory Society 27. Association for Research in Otolaryngology 28. American Tinnitus Association x. Salary expectations: xxx. Median income: \$80,000 xxxi. Median salary for Au.D. with 1-3 years of experience: \$72,000 xxxii. Median Salary for Ph.D.:\$112,705 Chapter 2: Sound and Its Measurement I. Acoustics: branch of physics that deals with sound and sound waves a. Sound: is an auditory experience, the "act of hearing something" i. Travels through any elastic medium ii. A solid is more elastic than a liquid, and a liquid is more elastic than a gas. iii. Psychoacoustics 1. How people perceive the acoustic properties of sound 2. Loudness: Perceptual correlate of intensity (dB) 3. Pitch: Perceptual correlate of frequency (Hz) 4. Measurement techniques: a. Method of constant stimuli: fixed set of tones, differing in intensity -- subject responds yes or no b. Method of limits: present audible tone, descending until subject cannot hear, then increasing until audibility iv. Acoustics v. 3 aspects of sound: 5. Production: vibrations c. Given proper amount of energy, a mass can be set into vibration d. Impedance: forces that oppose vibration e. Free vibrations: no outside force is added f. Forced vibration: outside force is added g. Simple vibration: Can be described by frequency, amplitude, and starting phase i. **Pure tones:** A sine wave characterized by frequency, wavelength, or amplitude. 1. Graphic way to represent sound waves 2. Each cycle of compression and rarefaction, as a function of time 3. Described in terms of: wavelength, frequency, amplitude, phase h. Complex vibration: Combinations of simple vibrations 6. Transmission i. The source will send vibrations that travel: propagation j. Propagation occurs through some medium (air, water, etc) k. Propagation is a result of the back and forth movement of air molecules l. Longitudinal wave: Process of localized back and forth propagation m. Condensation ii. Happens due to increase in sound pressure iii. More molecules per volume n. Rarefaction iv. Happens due to decrease in sound pressure v. Less molecules per volume o. Waves are successive compressions and rarefactions p. Sound travels faster in water and most solids than air q. Rapid and random movement of air particles is called Brownian motion r. If object is distorted it will return to its original shape -- determined by elasticity s. Wave motion: vi. Diffraction: wave is partially obstructed and changes shape around obstruction vii. Constructive interference: when reflected wave and next incident wave add together viii. Destructive interference: when reflected wave and next incident wave cancel each other 7. Analysis t. Wavelength ix. *Distance* from any point on a sinusoid to the same point on the next cycle of the wave x. This maximum pressure to minimum, and back to maximum is also called a cycle u. Frequency xi. How often or how frequently an event occurs xii. In acoustics, we use second (s) as the unit of time \*number of cycles per second (cps) xiii. Hertz (Hz): the unit of one cycle per second 4. E.g., 1000Hz: a pressure wave that repeats itself 1000 times in one second (pure tone) xiv. Frequency range of audibility for humans is between 20-20,000Hz  v. Period: xv. amount of time required for the completion of one cycle xvi. Period = seconds per cycle (seconds/cycle) xvii. Frequency = cycles per second (cycles/second) w. Amplitude: xviii. The magnitude of a sound xix. The range of displacement from its point of equilibrium xx. Peak amplitude: point at which displacement is greatest xxi. force per unit area, is called the Pascal x. Decibel xxii. The dB is a relative measure of intensities or pressures xxiii. Based on a ratio y. Complex sounds xxiv. Characterized through analysis of their simple wave components -- Fourier Analysis xxv. Fundamental frequency: lowest frequency component xxvi. Higher wave components -- harmonics xxvii. White noise: sound containing all frequencies simultaneously II. Sound Measurement b. Hearing vi. Threshold of audibility vii. Stimuli -- single frequency/pure tone viii. Intensity dimension of sound -- measured using dB ix. Measurement scale -- sound pressure level (SPL) c. References for the dB x. Sound Pressure Level (dBSPL) xi. Sound Level Meter xii. Minimum Audibility Curve (reference equivalent threshold SPL) d. Minimal ability curve20090213153707089.jpg e. Hearing level scale xiii. Ear not equally sensitive xiv. HL -- scale that references the average normal hearing thresholds xv. Audiometric zero xvi. 0dB is equal to the minimal audibility curve xvii. Hearing Level (HL) xviii. American National Standards Institute (ANSI) xix. Sensation Level (dBSL) f. Pure tone audiometer xx. AC transducers xxi. BC transducers xxii. 125Hz to 8000Hz -- AC xxiii. 250Hz to 4000Hz - BC  III. Pathways of Sound A diagram of the ear Description automatically generated g. Conductive mechanism: travel through entire system xxiv. Tested via air conduction h. Sensory/neural mechanism: xxv. Bypass the outer and middle ear -- only test beyond xxvi. Inner ear xxvii. Auditory nerve xxviii. Tested via bone conduction: Vibrates skull directly -- stimulates fluids in cochlea directly 8. Bone conduction can never be poorer than air conduction z. Travels through the whole passage i. Types of hearing loss xxix. Conductive 9. Attenuation: loss of volume 10. Barrier in outer or middle ear a. Ear wax- outer b. Middle- ear infections 11. Impaired air conduction 12. Normal bone conduction xxx. Sensorineural 13. Sensory- cochlea 14. Neural- auditory nerve 15. Impaired air conduction 16. Impaired bone conduction 17. Equal AC and BC xxxi. Mixed 18. Conductive and sensorineural loss c. Outer/middle + inner/auditory nerve 19. Impaired air conduction 20. Impaired bone conduction 21. AC loss greater than BC loss j. Non-organic hearing loss xxxii. Hearing loss on audiogram but normal hearing k. Tuning fork tests xxxiii. Pure tone test IV. Chapter 3 and 4: Clinical Audiology l. Patient case history xxxiv. Why: 22. Rapport d. Building relationship and gaining trust 23. Preliminary hypothesis e. What is wrong 24. presenting problem by patient 25. observe f. Observe: xxviii. Gender/age xxix. hearing aids xxx. craniofacial anomalies 5. disruption in embryotic development xxxi. ability to attend to speech xxxv. Info needed from client 26. Identifying g. Demographics, name, DOB 27. presenting complaint 28. accompanying symptoms 29. communication history 30. family history 31. noise exposure history 32. general medical history/birth history 33. Social history 34. previous assessments 35. \_where to send report xxxvi. Do's 36. Keep it at a simple reading level 37. Keep it as concise as possible 38. Translate it into other languages common to your region 39. Translate it into languages common to your region 40. Fill out the form while waiting to see you 41. Mail the form to them before their visit 42. Post the form on your website xxxvii. Don't 43. Hand out form ns fail to review it 44. Only conduct it at the initial evaluation m. Otoscopic examination xxxviii. Examine good ear first 45. Cross contamination xxxix. Examine pinna 46. Outer part of the ear 47. Embryotic development abnormalities xl. Straighten EAC 48. External auditory canal xli. Insert speculum xlii. What to look for? 49. Examine ear canal 50. Light reflex (cone of light) h. Eardrum is cone shape 51. Long process of malleus (manubrium) i. Long bone of malleus 52. Umbo j. Greatest point of retraction of TM k. Where malleus and manubrium attach 53. Lateral process of malleus l. Triangular shape 54. Pars flaccida m. Superior portion of TM n. Flaccid o. Less layer of tissues p. Moves more 55. Pars tensa q. Tense 56. Long process of incus r. Crew s. Lose TM xliii. Characteristics of the TM: 57. Cone shaped 58. Pearl grey 59. semitransparent 60. Rich in blood supply 61. TM Quadrants: t. Anterior superior xxxii. Infront of above u. Anterior inf. v. Posterior sup. w. Posteriori inf. n. Pure Tone Audiometry xliv. Why use? 62. Easy to produce 63. Easy to calibrate 64. Look for pattern of hearing loss as a function of frequency xlv. Allow us to: 65. Describe the amount of hearing loss 66. Determine which parts of auditory system are involved 67. Determine if medical referral is needed 68. Predict how loss may relate to ability to communicate xlvi. Audiometer 69. Diagnostic/clinical audiometer 70. Screening audiometer xlvii. Transducers (calibrated yearly) 71. Supra-aural Earphones (AC) x. headphones 72. Insert Earphones (AC) 73. Bone oscillator (BC) y. Oscillator placed on mastoid bone z. Vibrates entire skull xxxiii. Stimulates both cochlea 74. Speakers (AC) xlviii. Air conduction vs. Bone conduction 75. AC-BC= how much hearing loss is sensorineural and how much is conductive xlix. Audiological testing rooms 76. Soundproof??? 77. Sound-treated 78. Isolated from external noise 79. double walled suites l. Pure tone testing 80. Most basic diagnostic measure 81. Concept of Threshold a. Softest sound you can hear 82. Orientation of patient b. Ideal for patient to be sitting sideways 83. Patient responses (false -- and + ) c. False positive: saying there is a sound when there is not d. False negative: hears sound but doesn't respond 84. Procedure: e. Clear Instructions f. Red= right; blue=left g. 1-2 seconds for presentation h. Continuous or pulsed xxxiv. Pulse is ideal 85. Air conduction i. AC: 250Hz-8000Hz how we test pure tones xxxv. Dotted-line: interoctave 6. Tested as needed xxxvi. Solid line: octave j. When to test ½ octave -- difference of 20 dB or more k. Frequency order l. Re-test 1000Hz xxxvii. You get better at a test the more you practice 7. Could have improved results xxxviii. After testing all the freq. for good ear, move on to other ear before increasing dB m. 5 dB increments xxxix. dB HL- intensity 86. Audiogram n. A graphic representation of hearing results o. Frequency on x axis: begin with 125Hz -- 8000Hz p. Intensity on y axis: goes from -10 to 120dB 87. Procedure: Hughson-Westlake or Up 5, down 10 q. Begin at 30dB, (70dB if suspect loss) xl. 1000Hz r. If no response, increase by 20dB steps s. Duration of tone is 1-2 seconds t. After 1^st^ response, drop 10dB, until NR xli. If no response, go up 5 dB increments until they respond again u. At inaudibility, ascend in 5dB steps xlii. 2 out of 3 ascending responses at the same level v. Decrease in 10dB steps until NR w. Threshold: lowest intensity level that patient responds to at least 50% of ascending presentations 88. Documentation of thresholds: x. Red = right = O for AC y. Blue = left = X for AC xliii. Symmetric: X and O overlap xliv. Asymmetry: big difference between X and O z. PTA: pure tone averages xlv. Look at freq we test xlvi. Averages at three freq with most speech energy 8. 500, 1000, 2000Hz a. Add threshold avg. up (dB) and divide by 3 b. Should be avg. \#dbHL 89. Bone conduction and threshold markings are the only ways to deceiver what type of hearing loss a patient has o. Degree of hearing loss li. Normal: 0-25dB (slight HL 16-25 dB) lii. Mild: 26-40dB liii. Moderate: 41-55dB liv. Moderately-Severe: 56-70dB lv. Severe: 71-90dB lvi. Profound: 90+ lvii. dB Measurements of Common Sounds: 90. 20dB -- a whisper 91. 45dB -- soft conversation speech 92. 80dB -- loud music from a radio 93. 120dB -- chain saw 94. 140dB -- jet engine at takeoff lviii. Bone conduction 95. distortional Bone conduction a. skull vibration (distortion) vibrates bone around cochlea and stimulates hair cells in cochlea b. stimulates bone around both cochlea 96. inertial Bone conduction c. cochlea vibration causes ossicular chain to vibrate xlvii. lags and causes stapes tube to vibrate (inertia) 97. Osseotympanic bone conduction d. Skull vibrate causes vibration into column of air in ear; air escaping out of outer ear e. Causes tympanic membrane to vibrate 98. Testing f. 250Hz -- 4000Hz g. Unspecified bone conduction xlviii. Do not know which ear hears the sound xlix. Assume better ear l. Represented by a stapple symbol h. Procedure li. 1000Hz; 30dB lii. Air and bone the same its normal or sensorineural loss i. tactile responses j. symbols liii. stapple + \*VT: vibrotactile response 9. louder feeling vibration but not hearing liv. \ = unspecified BC lv. \[ \]- masked BC lix. type of hearing loss: bone relationship k. bone conduction needed to determine the type lvi. air conduction determines the degree and which ear 99. Conductive -- loss by air conduction, normal bone conduction 100. Sensorineural -- equal loss by air and bone conduction 101. Mixed -- loss by bone, with greater loss by air conduction p. Characteristics of hearing impairment lx. Degree lxi. Type lxii. Configuration: clue us in on disorder causing the hearing loss (diagnosis) 102. Flat line 103. Sloping: diagonal line going down 104. Precipitous: steep slope 105. Rising: diagonal line going up 106. Notched: flat line then big drop then back up 107. Corner: arrows at bottom of audiogram (on stapples, circles, and X's); no response 108. Bilateral: Loss in both ears 109. Unilateral: Loss in only one ear 110. Asymmetric: Difference in loss/hearing in both ears 111. Symmetrical: loss/ hearing is the same in both ears 112. No response 113. Tactile responses: feeling vibration but not hearing 114. Cookie bite: half-moon shape V. Normal dynamic range: range of what a person can hear; range of loudness and softness q. Hearing loss: reduced dynamic range lxiii. Uncomfortable loudness does not change: 120dB r. dBSL: sensation level lxiv. vs. dbHL: pure tone avg. lxv. ex. 50dB threshold; 0dBSL