Final Exam Review - Audiology PDF
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Brock University
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This document is a review of audiology topics. It covers areas like audiometry, different types of earphones, masking, and various tests like BOA, VRA, and CPA.
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Final Exam Review - Audiology ASSESSMENT Describe the audiometry test environment Separate from building to reduce sounds from building getting in Quiet Soft surfaces for no echo Patient sits away from audiologist Window to see each other Explain pure tone...
Final Exam Review - Audiology ASSESSMENT Describe the audiometry test environment Separate from building to reduce sounds from building getting in Quiet Soft surfaces for no echo Patient sits away from audiologist Window to see each other Explain pure tone audiometry test procedures Start at 1000Hz at 30dB HL Raise 10dB HL until they respond Go down 5dB HL When they can't hear it again, raise 10dB HL Repeat until threshold is detected 2/3 times Done at 500, 1000, 2000, and 4000 Hz Describe the difference between supra-aural earphones, insert earphones, and an oscillator Supra-aural ○ Over pinna ○ Left and right side ○ Air conduction Insert (Better) ○ Cleaner ○ Easier to block out background sound ○ More comfy ○ Left and right side ○ Air conduction Oscillator ○ Measures bone conduction signal ○ Oscillates skull Explain when masking is necessary When testing bone conduction ○ Can hear through skull in both ears ○ Need to block one ear to test one side When testing for single-sided hearing loss/asymmetrical hearing loss For conductive hearing loss Distinguish between BOA, VRA, and CPA Behaviour observation audiometry (BOA) ○ Infants under 6 months ○ Play sound and watch infant for behaviour change Blinking, still, high-amplitude sucking test ○ Change notifies sound recognition ○ Masking on parent so they don't give any cues to hearing sound Visual reinforcement audiometry (VRA) ○ Children 6 months to 3 years ○ Toy pops out and child is trained to look at the toy when the sound is heard ○ Doesn't test individual ears ○ *just because they didn't turn their head doesn't mean they didn't hear the sound necessarily Conditioned play audiometry (CPA) ○ 3-5 years ○ Teach child to play with toy in a certain way when they hear the sound ○ Will do whatever they were taught to do with the toy when they hear the sound SPEECH AND IMMITTANCE TESTING Determine the meaning of different peaks on a tympanogram Changes ear pressure in outer ear to figure out what's happening in the middle ear ○ Raise air pressure in outer ear to measure the volume of middle ear 0.3-3mL is normal (compliance) ○ Shoot air into ear (+200dpa), play tone (220hz), measure sound that bounces back from tympanic membrane (impedance) Compliance is how much the tympanic membrane moves ○ High compliance = floppy tympanic membrane ○ Low compliance = stiff tympanic membrane Type Ad ○ Peak at 0 for air pressure ○ High compliance ○ Sign of discontinuous ossicles Type A (Normal) ○ Peak at 0 for air pressure ○ What we want to see Type As ○ Peak at 0 for air pressure ○ Low compliance ○ Sign of stapes problem such as otosclerosis Type B ○ Aka flat tips ○ No peak ○ Sign of fluid in middle ear ○ Otitis media ○ Bad ear infection Type C ○ Peak at negative air pressure (so, not at 0) ○ Regular compliance ○ Sign of otitis media before fluid buildup or eustachian tube dysfunction ○ Not crazy emergency, but something is happening Interpret results of an acoustic reflex test Normal range = 85-100dB SL (this is what we need to know, probably the only thing for this subject on the exam) Explain how to test for the speech recognition threshold Speech recognition threshold (SRT) = lowest threshold at which speech is understood Uses spondees ○ Two syllable words with equal stress (usually compound words - hotdog, baseball, toothbrush, etc.) Start at 30dBHL Increase by 10dB until they hear it and repeat correctly Decrease by 10dB until they are correct again Increase by 5dB until they repeat correctly Continue decreasing by 10dB and increasing by 5dB ○ If you decrease and they don't respond, increase by 10dB again Repeat until they are at least 50% accurate (or 3 times) Calculate signal-to-noise ratio Signal-to-noise ratio = the difference in intensity between the signal and background noise Signal noise - background noise = signal-to-noise ratio Ex: Signal is 60dB and the background noise is 40dB the SNR will be 20dB. List the characteristics of speech testing that an audiologist must report Percent of sounds heard correctly Test name and list number Intensity level If masking was used SNR and type of sound used ○ Signal to noise ratio ○ Was sound one voice, multitalker babble, or white noise NEWBORN HEARING SCREENINGS Describe the components of an EHDI program Aka early hearing, detection, and intervention program Identify hearing loss by 1 month Diagnose hearing loss by 3 months Provide intervention by 6 months List three reasons UNHS programs are important Aka universal newborn hearing screening Unaddressed hearing loss can cause (cascading effect) ○ Language delays ○ Speech delays ○ Academic difficulties ○ Employment difficulties Explain how an OAE test is conducted Aka otoacoustic emissions testing Screening tool usually done at birth Put probe in ear that emits sounds Measures whether there is a sound produced by the movement of the hair cells If the sound that it makes, comes back out and makes a sound on the way out Provides a pass or refer Distinguish between an ABR and ASSR test Auditory brainstem response (ABR) ○ Used primarily in audiology ○ Measures auditory evoked potential from CN8 ○ Electrode on skull ○ Plays signal into ears ○ Measures brain waves Is the signal passing through the CN8 correctly? ○ Wave V indicates signal has gotten to the brainstem Absence of wave V would indicate problem Auditory Steady State Response (ASSR) ○ Depends on amplitudes and phases ○ High repetition stimuli ○ Results based on algorithm, not audiologist interpretation ○ Faster than ABR ○ Can estimate more specific thresholds/frequencies than ABR HEARING TECHNOLOGY Differentiate different styles of hearing aids Body worn Behind the ear (BTE) ○ Most powerful ○ Cheaper ○ Bigger ○ Almost all children use these ○ Mold in pinna keeps device on ○ Carries signal directly into ear ○ Can benefit different frequencies ○ Ear mold can be closed or open Open if there's a little hearing left ○ Microphone picks up external sounds and carries down tubing to ear mold where sound is amplified into ear Receiver in canal (RIC) ○ Smaller than BTE ○ Wire used instead of tubing ○ Amplifier goes into the canal ○ Popular with adults because you can't see it as well ○ Doesn't block pinna so can still pick up sounds naturally ○ Only works for mild-moderate hearing loss ○ Still part that goes behind the ear In the ear (ITE) ○ Molded to ear ○ Microphone and receiver go into canal ○ Used for moderate-severe hearing loss Not powerful enough for profound ○ Has nothing to hook an FM system to In the canal (ITC) ○ Smaller version of ITE ○ Appealing to adults Smaller so need good dexterity to change the battery Not great for the elderly ○ Moderate severe to severe hearing loss ○ Smaller mode that goes deeper into canal than ITE Completely in the canal (CIC) ○ Sits in the canal ○ Has thread to pull them out of the canal ○ Mild-moderate hearing loss ○ Close to eardrum so signal gets there easily ○ Easy to get distortion because the microphone and receiver are too close Invisible in the canal (IIC) ○ Similar to completely in the canal Same advantages and disadvantages ○ Cannot be seen Light driven ○ Transducer on top of tympanic membrane ○ Wear external device over ear Shines light onto transducer ○ Transducer translate light into vibrations ○ Has huge range of frequencies Cros/Bicros Hearing Aids ○ For single-sided deafness ○ Signal from bad ear is transmitted to the device on the good ear ○ Hard to have localization with these Bone Conduction Hearing Aids ○ More typical for single-sided deafness ○ Bone conduction sends signal to both ears ○ For people with air conduction hearing loss - conductive hearing loss (only have bone conduction hearing - sensorineural hearing is good) ○ Device on mastoid bone takes signal and amplifies it through the bone to the cochlea by vibration ○ Can be uncomfortable if the band is too tight ○ For children 5 and up Skull is still growing Ossiointegrated Hearing Aids (BAHA) ○ Titanium implant behind ear (abutment) Must be able to take care of properly Can get infected easily ○ Sound processor screwed onto abutment ○ For conductive hearing loss or single-sided hearing loss ○ BAHA system detects sounds ○ Sound vibrations pass through bone and into the inner ear Describe how a cochlear implant works Sound input from the environment is collected by microphone The microphone sends the signal to the processor where it is converted to an electric signal (both sit behind ear) Processor sends electric signal down coil to transmitter (on skull), which transmits signal to the receiver under the skin The implant sends electrical signals to the cochlea and the electrodes matching up with the electric signal are activated The activation of the electrodes sends the information down the auditory nerve to the brain Identify 4 different implantable hearing devices It will be described and then we have to name it. 1. Cochlear implant 2. Auditory Brainstem Implant ○ Like cochlear but sends signal directly to the brainstem ○ Bypasses the cochlea ○ Cannot normally achieve speech and language from this Has detection of sound but not discrimination or identification 3. Middle Ear Implant (Osia) ○ For conductive hearing loss ○ Magnet on the outside hold the audio processor/receiver ○ Implants vibrating ossicular prosthesis under skin (VORP) ○ The conductor link attached to the VORP sends signal to the floating mass transducer which helps to vibrate the ossicles 4. BAHA - Titanium pisces that stickers out of the skin from the mastoid List 3 goals for fitting hearing aids Restores access to speech and environmental sounds Restores and retains clarity of sound in quiet and noise High intensity sounds remain tolerable List 3 reasons children might reject hearing technology Uncomfortable Acoustically unpleasant Ugly BALANCE, TINNITUS, AND HYPERACUSIS List four causes of vestibular disorders Disease Toxins Trauma Syndromes Name five tests for vestibular dysfunction VNG - Videonystagmography ○ Measures eye movements vHIT - Video head impulse ○ Measures reaction to motion by watching eyes ○ Measures all 3 planes of vestibular system Rotary Chair Test ○ Moving chair CDP - Computerized Dynamic Posturography ○ Balancing test (standing) VEMP - Vestibular-Evoked Myogenic Potentials ○ Measures electrical signal Describe three elements of a tinnitus evaluation Medical evaluation - Could be associated with something else that needs to be treated Case history - Environments, trauma, disease Self-assessment We need to see how it affects their daily life Describe what they're hearing Use masking - Play opposite tone to try to cancel it out Explain the effect of tinnitus on the daily life of those who have it Frustration ○ Can't find cure ○ Annoying to have Emotional Stress Can be intermittent, fluctuating Define and identify two disorders of sound tolerance Hyperacusis: Sound become overwhelming ○ Sensory processing issue ○ Common in autism Misophonia: Negative reaction to soft sounds ○ Can learn to express emotions ○ Learn to handle situation Describe the audiometry test environment Explain pure tone audiometry test procedures Describe the difference between supra-aural earphones, insert earphones, and an oscillator Explain when masking is necessary Distinguish between BOA, VRA, and CPA Determine the meaning of different peaks on a tympanogram Interpret results of an acoustic reflex test Explain how to test for the speech recognition threshold Calculate signal-to-noise ratio List the characteristics of speech testing that an audiologist must report Describe the components of an EDHI program List three reasons UNHS programs are important Explain how an OAE test is conducted Distinguish between an ABR and ASSR test Differentiate different styles of hearing aids Describe how a cochlear implant works Identify 4 different implantable hearing devices List 3 goals for fitting hearing aids List 3 reasons children might reject hearing technology List four causes of vestibular disorders Name five tests for vestibular dysfunction Describe three elements of a tinnitus evaluation Explain the effect of tinnitus on the daily life of those who have it Define and identify two disorders of sound tolerance