Lec # 1 Hearing Disorders: Part 1 PDF

Created with Coconote - https://coconote.app Lec # 1 Hearing Disorders: Part 1 I grew up in Montreal, Quebec, and I did my undergrad in psych and neuroatnego. Okay. Yeah. I'm Bren. I did my undergrad or I grew up in Vancouver, and I did my undergrad in BC in psych. I'm Kirsten. I grew up in Calga...

Created with Coconote - https://coconote.app Lec # 1 Hearing Disorders: Part 1 I grew up in Montreal, Quebec, and I did my undergrad in psych and neuroatnego. Okay. Yeah. I'm Bren. I did my undergrad or I grew up in Vancouver, and I did my undergrad in BC in psych. I'm Kirsten. I grew up in Calgary, Alberta, and I did my undergrad here at Gal, and I double majored in psychology and theater as well. Beautiful. Okay. My name is Sally. I'm from Montreal, New Brunswick, and I do my undergrad at Saint Mary's in psychology. Jackie, I'm from BC, and I did an arts degree and an education degree. Where? In BC? Oh, sorry. My arts degree was at Dowling. My education is at Mount Samuelsa. So you can be a teacher? Yeah. Is that okay? Okay. Excellent. It's, it's interesting to always see bit of the background because it's very diverse. You know, so that tells you what kind of profession and program you're in. Right? It's not like, well, it's very different than medicine even now. But when I went through, you were had to be very science driven, organic chemistry and stuff. But, you know, health professions is very different, and it doesn't matter what background you have. You know, as long as you have some base of knowledge and you know how to deal with people. Right? So that's the important thing. And hopefully that the message comes across in this course. So, lecture times, this is really prime nap time for me. So I won't take offense if, you know, some of you guys start dozing off because that's what I would be doing too. This is a pretty good classroom, so I think we got lucky there last year. We were stuck in the link, which is not the best setup. So again, I'm at the IWK. My information is there. If you need to contact me, email is the best, but please use my IWK email because I don't always remember to check my dial one. Right? I mean, readings, the you don't really have to have buying any textbooks. I'm sure nobody wants to spend 100 of dollars in stuff that you may read just the just for a few months Because, again, you'll see the degree of different disciplines we cover when we talk about some of these disorders. So there's no one good textbook, that you we need or you you need to buy. Articles, I'll I'll probably give you 1 or 2 article that you should read. I will tell you if that article information in that article will be on your exam. Right? But that will be later on. So the course outline, if you look at the back of the syllabus, you can see all the topics outlined there, and it's sort of organized into first and second half. So the first half of the class is based on pediatric or congenital disorders. The latter half is more acquired or adult on set disorders. And you'll see there's also a bit of an anatomical or systems related division in terms of, the lecturer organization. So, again, it's sort of in a format where things go back and forth a little bit, but overall, it's sort of very well organized in terms of learning and studying like most sort of, students have told me before. There's one assignment, and I'll tell you more about that when the time comes closer, but that's worth worth 15%. There's a midterm and a final exam. Final exam used to be worth more, more, so don't complain. And remember, this is this is a very, I have a full time job across the street. This, I'm sort of doing a side, so it's not like I have a lot of time to mark bunch of different assignments or quizzes. So it is heavily based on the final exam, but the good news is that midterm is based on the first five lectures, and the final exam is based on lecture number 6 to 11. So it's not like for the final, you don't have to study and memorize try to memorize everything we learn throughout the year. Okay. So, again, no textbooks. You have the outline. Usually, what will happen is I will post the lecture over the weekend before the Monday's lecture. Right? Next Monday, there's no lecture because I'm away. But it's, makeup there have been 2 makeup classes that have already been scheduled. Like, you should have that in your calendar, but I'll remind you. But next Monday, there's no class. So here's the outline for today. K? Is this lighting okay? Yeah. You don't need it darker. Can you guys hear me back there? Do you want me to use this? Yeah. Is this is this on? Can you guys hear me? Can you guys hear me? Yeah. Can you hear me back there? Yeah. Okay. Alright. I don't wanna walk around with this, so I'll just leave it because I'll try to figure this out during the first. Okay? Okay. So here's the here's the outline today, and it's a bit of an introductory lecture, but it's actually pretty important because we'll learn about things that we're gonna use throughout the entire course. K? Some of the terms we'll learn, some of the, definitions that we'll learn about, We're gonna use that all throughout the course. Okay. So we're building a sort of a base of knowledge today. So first thing you should realize is that communication disorders are very, very common. Right? That's why you guys are here, to learn more about them and to help individuals with communication disorders. So this is very outdated. Probably, the number is getting higher and higher, but up to 15, 20% of the general population will have some type of communication disorder. And, again, the prevalence of these disorders are increasing. There are lots of different reasons why we think, but, again, your need in the community becomes higher and higher as time progresses. Now we also live in a culture where we want things loud. You guys are probably a little bit well, actually, a lot of you live undergrads here, so apparently, this is what Pacifico looked like looked like when it was, in the maritime center at the end of, spring Gardens. Right? It used to be there. Right? Yes. So lots of places you go, gyms, nightclubs, even shops like Lululemon. You can hear the music pumping in the background. Right? It's a very, very loud sort of culture we live in. So there are some hazards or potential hazards that we need to learn about as well. Okay. So we're gonna talk about some terms. K? Gonna be medical terms, anatomical terms, and audiological terms. So, again, these are terms that we're gonna use out throughout the entire course. And, again, it's important to know the precise definition because this is how we communicate with each other. Right? So you're gonna do a hearing test, and you're gonna write up a report and then send it to me or send it to your speech colleagues. And we use terms like conductive hearing loss. Right? So we have to know what all of those terms mean. So first thing is knowing anatomy and physiology. Okay? So that's probably one of the most important things you the themes throughout this course is knowing the normal anatomy and physiology, meaning how things work, gives you the baseline for understanding abnormal conditions. Right? So first thing is learning how normal things work to learn about how abnormal things can occur. Right? So in terms of anatomy, this is the anatomical position. Right? You have already had some anatomies, so you know this. Right? The person sort of with their palms out towards, like so so using that picture in your mind, we have these terms. Right? These are relative terms in terms of describing where things are. Right? So superior, inferior. Right? Unilateral, bilateral. Right? So is it a unilateral ear disease, or is it bilateral? Again, the other terms are all sort of, relative as well. Ipsilateral, contralateral. Again, we're talking about hearing disorders. So are we talking about are we right this right here in this order, or is it something contralateral? Things like anterior posterior, there are other terms like ventral and dorsal. So that anatomical position actually doesn't show the tongue for US SLPs, but the anatomical position is like this. So the tongue is actually flipped up. Okay? So the bottom of the tongue, right, is actually the, belly or the so the under surface of the tongue is the ventral surface, because the vein is lifting up. Right? So the surface of the tongue, the tongue you actually see, is actually the dorsal tongue, for instance. Right? So you see the importance of knowing the anatomical position. Because if you don't know that, then you don't know how we describe things. So, again, if you have a client with who had tongue cancer, which was cut out on the ventral surface of the tongue, then you know what it means. Right? And that person may not have perfect, speech articulation, for instance. Right? So, again, this this why this is why we have to know some of these terms because this is how pathology is described. Now when we talk about a lot of this this a lot of these disorders, especially the congenital ones, we do have to know what incidence and prevalence means. And you guys have research methods this term? Okay. So you'll learn more about it there as well. But so incidents describes the number of new cases for for a certain time period. Prevalence is little bit different in that it describes number of cases present at a certain time. So the key difference is sort of the new cases that's coming on during a certain time versus prevalence describing whatever time period you're counting all the disease diseases. Right? So typically speaking, we use incidence when we talk about something new, like, our something new with a baby, for instance. The prevalence is more commonly used to describe acquired or laid onset disorders. Now the other terms to note in in epidemiology is sensitivity and specificity. The reason why we have to know these terms is we're gonna be talking about different tests to consider some diagnosis. So we have to know how good those tests are. Right? How accurate are they? How reliable are they? And the way we tend to describe it is since using sensitivity and specificity. So sensitivity means it's a test's ability to identify what you wanna identify, positive results. Specificity is sort of the opposite. The test's ability to identify negative results. And the way they're calculated is pretty simple. You just have to sort of memorize this table here. So what this table is describing is a condition, let's say, a genetic hearing disorder on the column here, the first column. And this is when you have the disease, the genetic urine disorder, and this is when you don't. These two columns describe the test work we're considering or interested in. So positive test means, again, you get the positive result back. Negative test means you get the negative test back. So true positive is what you want. Right? True positive means it actually the test is detecting the disease when it's really there. True negative is good too because it's saying there's no diseases test when that individual doesn't have the disease. But there are false negatives and false positives, which are not good because that means the test is wrong. Right? Again, I apologize. I mean, some of you know this very well, but, again, this is a review, and this may be something relatively new for some of, classmates here. So just bear with me for if it's something you already know about. So, again, if you're given this sort of graph, given this table, and you can plug in the numbers, you can figure out sensitivity and specificity. K? I'll show it here. So this is a genetic test, let's say, to this detect this hearing disorder, and the numbers are given there. So 95 true positives, 800 and true negatives, and so forth. K? And, again, using that formula, you can generate sensitivity and specificity. So sensitivity is 95% using this hypothetical test, and specificity is 90%. So is this a good test or bad test? If you just look at those numbers, if you have to guess. Thumbs up. Yeah. Anyone else? Yeah. It's a great test. Right? Those numbers are good. So what you should realize is a lot of the tests we have, even even though you may think they're really good, their sensitivity and specificity is typically lower, a lot lower than what you see here. Right? So things like let's talk let's think of what about mammography for breast cancer screening? What's the sensitivity of picking up a small early breast cancer using mammography? It's not 95%. Right? It's much lower than that, for instance. So, again, when you consider these disorders and you get these test results, you have to think, well, is that a really sensitive text or specific text? Right? Right? Now it's good to know to how to calculate those, but it's really memorizing the table. But better to know how to interpret the findings. So sensitivity of 95% really means this. Right? There's a 95% probability. It's not 100%. You can still be wrong with the positive test, but 95% chance that the person who tested positive will have that disorder. Right? So that's what it means. And, again, ideally, that's the way you should think about it in your mind because that's how you understand things the best. In terms of specificity, there's a 90% chance that a person who tested negative will not have that specific hearing disorder. So, again, you'll see we're gonna talk about some tests, like newborn hearing screening, where we have to consider the specificity and sensitivity. Okay. So now we're gonna talk about some terms, very important terms, medical terms that we're gonna, again, use every lecture. So when you hear the prefix of oto, o t o, that means it's something related to the ear. K? So otellgia, for instance, means ear pain because alga means pain, the suffix alga. Right? So I my specialty is called oral laryngology. So the oto is the ear part. Anything that ends with -itis means infection or inflammation. K? So if you have an appendicitis, your appendix is infected or inflamed. K? If you have arthritis, that means your joints are inflamed. Again, alga means pain. Myalgia means you have muscle aches after having a back, cold, or working out a lot in the gym. When you hear the term or the suffix, rhea, means it's some type of fluid. And, really, we only have to know otorhea. It means there's some fluid coming from the ears, whether it's again pus or something else. Right? So we don't say ear fluid, we say, ourea now. Right? That's how we communicate. When you hear the term ectomy, that means something has been removed. So, appendectomy means you have your appendix removed. So ectomy means something was excised or removed. Automy means something was cut into. You're making an incision into it. So, you will hear the term myringotomy, for instance. Mierangs is the Latin term for the eardrum. So when you hear the term, myringotomy, it means we're making an incision in the eardrum, probably to drain out some fluid. When you hear the term plasty, that means something was altered. So rhinoplasty means you had a nose job, right, for instance. Abdominoplasty, maybe you had a tummy tuck for instance. But you'll see why we talk about plasty later on when we talk about outer ear disorders. Hypo means too little, so, like, hypothyroidism. Hyper means too much. Right? Hyperthyroidism, for instance. When you hear the term tumor so when you, in the general public, what what do you think of when you hear the term tumor? Cancer. Cancer. Right? If I tell my mom, I saw a kid with tumor, She's gonna think, oh my god. That kid kid's gonna die with a cancer. Right? But tumor actually means tumor doesn't mean it's a malignant, like, growth, for instance, like cancer. Right? Tumor could mean it's a benign thing. It could be a cyst. It may not be it could be a something very safe. So it's a very general term to describe sort of any sort of growth or mass. Could be an enlarged lymph node, which y'all we all have had throughout our lives. Lesion is somewhat similar, but it's more general When you hear the term lesion, it could be a rash. It could be a tumor. So lesion means, again, just something abnormal, basically. So if you have any questions, just raise your hand. Okay. So now we have some terms how we're gonna communicate with each other. Right? And, again, we do have to sort of know anatomy, and this will be a brief review. We're gonna focus on each part of the year and other parts. We even have a lecture on cleft palate, k, where we consider relevant anatomy. But this will be a very high overview of anatomy. So the ear for us doesn't mean just this. Right? We have to be a bit more definitive when we talk about the ear. So the ear has 3 different parts for us, external, middle, and inner ear. So the external ear is actually composed of the the pinna or the oracle and the ear canal or the external auditory canal. Don't worry too much about the pressure stuff. So the external ear is this along with this. K? So don't forget this part, the ear canal. K? The middle ear so the so the external ear, the pinna or the oracle, If you look at your ears carefully, it's a very intricate structure. Right? Look at all those sort of folds and curves and hollows. And all of those things have names, and, unfortunately, you do have to know some of the names. Okay? And we'll cover that, in the next lecture. But, again, the prominent features of the year are very consistent throughout homosapiens, and some of those features have names. Now there's also positioning of the pen. K? Not only do your ears have to have those structures, the label structures in the previous slide, but the positioning, including how it's angulated on the side of your head, we need to know about it. K? Because there are some abnormal conditions where the ears may be really low set, for instance. So, again, you have to know normal anatomy. Right? Anatomy. Right? The easiest sort of way to, assess positioning of ears, if you draw a straight straight line from your lateral or the lateral and you know what that means, lateral eyebrow, you think if you draw a straight line, parallel to the parallel to the floor, you should hit the top you should hit the top of the heels. Yeah. Everyone's gonna do it later or now, but if it's a bit low set, that's okay. That doesn't mean you have some disorder. Right? There are variabilities. Right? So the bottom of the ear usually coincides with the middle or the the middle part of the nose. That's called the columella. But if you draw a straight line, you should hit the lobule. But, again, there's a different angle tilt to the ear as well, as well different degree of ear prominence, which we'll cover. The middle ear, it's a very interesting anatomical space. It is an airs aerated space, and it's composed of the eardrum, the tympanic membrane, and the 3 ossicles. Right? And the term we'll use is malleus, incus, and stapes. Right? Obviously, there are other names like the hammer, anvil, and stuff like that, but we'll use the terms malleus, incus, and stapes. Now this space, there's a little tube here, and that's the eustachian tube, which becomes very important in terms of otitis media, cleft palate, speech delays as well. But this is a game for explaining why the middle ear space needs to be aerated and why the ossicles look like the way they are. Right? They have really bizarre looking shapes. Right? But there's gotta be a reason. Right? There is usually this. Now the inner ear, as we go sort of more inwards or medial, the inner ear is also known as the labyrinth, and you know why it's called the labyrinth. Right? Labyrinth is like a maze, and it looks like a maze. So the inner ear is composed of the 3 semicircular canals, the cochlea, the hearing organ, as well as the vestibule and the sacrum. Right? So there's a balance organ as well as a hearing organ. Now the inner ear has an outer bony covering, which is shown in this sort of white grayish there, and then an inner membranous covering, which is shown in pink. So inner ear is, again, composed of bone. So when we do surgery, we can see the bone covering the outside. But if you drill into it, you can see the membranous part, meaning it's formed of sort of, like, a sheet of soft tissue. Right? That's important to know because if you take a cross section of the inner ear, the outer layer, again, is the bone. It's called the bony labyrinth. Inside the circle is called the membranous labyrinth. Right? So who cares? Like, why are we talking going into this much detail? Well, we care because there are disorders that affect the bony labyrinth versus membranous labyrinth separately. In between those, there's the perilymphatic fluid, endolymphatic fluid. Again, we're gonna cover all these details later on. So, obviously, the cochlea is very important for us. Right? Because it is the hearing organ and the inner ear. Right? So cochlea means snail in Latin and looks like a snail. It's composed of 2.5 turns. The basal turn is the base, the wide part. The top part is called the apical term. And, again, if you take a cross section of the cochlea, then you see something like this. This is a classic sort of cartoon figure. So the green part is a scalar media. The top part is a scalar vestibuli. The bottom part is the scalar tympan. The scalar media houses the the hair cells, the inner hair cells, outer hair cells, and all these other important structures such as textural membranes, striovascularis, all the important structures there. So, again, my god. That's a lot of detail. This is a lot to it. Though already, but we do have to know some of these because some disorders will affect, for instance, the stria vascularis of the cochlea. Some may affect tear cells. So, again, the importance of normal anatomy and physiology will will be realized very soon. Now if you go further in, the inner ear is innervated by the cochlear vestibular nerve, the cranial nerve number 8. Right? So, again, the cochlear cochlear part, and then there's the vestibular part of the cranial nerve number 8, and you can see them here. So if something happens to these nerves, obviously, even if the inner ear is normal, you may not have nor you may not have normal auditory function. Now going further inwards, there's the auditory central pathway. Right? So you have these nerve fibers that pull up the brain stem and into your brain. Right? So, again, if anything happens along this pathway, so if you get a stroke or a bleed or some type of concussive injury, which affects this pathway, then you may not have normal auditory function. Now for you speech people, I mean, won't be looking at the ears, but you'll be looking at mouths. You'll be doing oral MAC exams. Some of you will be doing laryngeal exams if you're doing voice stuff or dealing with patients with laryngeal cancer, for instance. So in terms of knowing the anatomy, again, we do have to know about the oral cavity, palate, tongue, which we'll cover later on as well, especially when we talk about cleft palate. K. So we'll cover cranial nerves, and then we'll take a break. Now cranial nerves, you've already learned about them. Right? So don't have to go over them in detail. But there are some very important ones that we do need to know well in our in this course. So, again, you know about these nerves. The important one is the facial, the cranial nerve number 7 and 8. Obviously, cranial nerve number 8 makes sense, but why do we have to know about the facial nerve? do we have to know about the facial nerve? Well, they're very close in terms of their positioning in the brainstem. K? So it's very common to have a cochlea vestibular nerve problem, a tumor there, which can affect the facial nerve, for instance. So you should know what the cranial nerves do. And what I mean by that is, obviously, you do need to know what they do, but it's sort of better to understand what they do. K? What do I mean by that? Well, I mean, yeah, you can memorize what they do, but can you tell me what's going on here? So you ask this person first at the top, you say, can you look to your right? And that happens. And then you ask the same person, can you look to your life? And that happens. So what's going on here? Can anybody tell me? Yes? Can you can you be a bit more specific? Yes. I mean, there's something wrong with the eye movement. Yes. But when you say ocular motor, technically, that means cranial nerve number 3. Right? It's actually anybody anybody else? You're on the right track. The eye's moving. Right? It's making some movement. It's not stationary. Yeah? Maybe the adductors? Yeah. Adducens nerve. Abducens. Abducens. Sorry. I forgot what's pronounced it. Right. So you're on the right track, but specifically look at the movements. Right? So the abducens nerve turns I laterally. So if I'm this person, someone so you guys tell me to turn and look to the right. So I should I should look to the right on both sides. Yeah? Yeah. I'm not exactly sure what NERVA would be, but it seems like there's some sort of, like, not paralysis, but something affecting it. Because if you look, like, one is moving and one is still, but it reverses. So they're capable of movement, but it's just like it's not quite something isn't quite right. Yeah. So it's yeah. It's the abducens nerve. So Mhmm. Again, abducens nerve moves eyes laterally. K? What's lateral? It's this. Right? So medial movement should be fine, but the lateral movement isn't. Right? So look at Look to your right. Well, this eye can't look right. This eye can't look laterally. Left eye looks medially fine. Right? Conversely, you say look to the left. Well, this eye, left eye, can't look laterally, but the right eye can look medially. Right? So this person cannot move their eyes laterally. Medially is fine. Yeah? Could you also argue that there may be an issue with the top earner? So stat 1 Listen, don't get too fancy. No. Yeah. I mean, you can. The trochlear nerve, the way it sort of courses, it's got a bit of a bend to it and stuff, but we're we're not gonna we're not gonna what's the program? Orthoptics or something? Yeah. That's where you may need to have that discussion, but, yeah, this is just sort of simply the eyes can't move laterally. Trochlear move actually sort of rotates the eye or the, yeah, cranial nerve force. So, that's a that's a pretty complicated nerve to explain. Right? So again, the way there are 2 ways to learn cranial nerves. You can just memorize it. Right? Anybody can do that. Well, actually, no. Not not anyone can do it. Better way to learn is to try to understand what the nerve is doing. So this is easier, and this is something you SLPs may see. Let's say you see an 80 year old gentleman who has stroke, and he does not sound very clear anymore. He's no longer very intelligible, and you get them to stick out their tongue. And then you see this, what cranial nerve is affected here? Did someone say 7? Right? Would it be nerve number 12? Yeah. A little bit more specific, please. Right or left? Left. Right. Right. Left. Well, it looks like it's So if you write that on the exam, you're not gonna get that right. Okay? So you get the so you get the person to stick out your tongue, and it's deviating towards the left. Right? Yeah? Yeah. I think because the muscle is not pulling it in the right direction, which is what it would need to be balanced, that it would be the left hypoglossal nerve. No? Well, it's Well, you're saying it right, but you send it off the cystophagus. Yeah. Oh, okay. Yeah. It's not a problem. So the nerve is pulling up the tongue. Yeah. But if one side is weak, for instance, the right side, then it's gonna be pulled towards the stronger side. Right. So This is not gonna focus, but I think that's the picture. Right? So this gentleman has a right hypoglossal nerve or cranial nerve number 12, palsy. Right? Okay. You said you did learn cranial nerves. Right? Mhmm. Who taught it to you? No. What? What? I'm gonna see a little refresher. Oh, just Okay. And I mean, you know, I'm not gonna well, yeah. I the importance is, again, knowing how things work. So that can now if you know normal physiology or how things work, then you can gather how. When things go wrong, you can you can sort of determine in your mind how it could have gone. Okay. So we'll take, if it's okay with you guys, we'll take 2 breaks. We will very unlikely go the full 3 hours ever because, nobody in the world can pay attention for that long. So the lectures have been, again, sort of streamlined and truncated to really cover the important stuff. But we'll still take 2 breaks because, you know, we can use our lobster and sort of fresh refresh our minds. So it's 324. We'll come back at 334, and then cover the next bit.