audiology final exam !
tensor tympani muscle
-is connect to the malleus and is innervated by the fifth or trigeminal cranial nerve -The muscle contracts during self-generated sounds such as chewing and reduces the interference of self-generated sounds with hearing of external sounds -Inserts into Manubrium of Malleus -Contraction=tensing of TM -Innervated by Trigeminal (5th CN) -Bilateral Contraction
ear canal volume
-is estimated for the space enclosed between the medial edge of the probe tip and the tympanic membrane -At high ear canal pressures such as +200 daPa or low pressures in the range of -200 to -400 daPA, the middle ear is essentially eliminated from immittance measurement
the phrase word recognition
-is used rather than word understanding because the patient repeats words without understanding or comprehending their meaning -Repetition or identification of words presented in a list during hearing testing
ASHA
-large organization with over 150,000 members. -The majority of these members are speech pathologists, with audiologists accounting for less than 5% of total membership.
Amygdala
-limbic system structure -important in a persons emotional response to sounds
For many types of hearing tests, the patient's task is to
-listen closely for sounds, including very faint ones and to respond with some kind of motor activity whenever they hear a sound -typical responses given by adult patients during hearing testing include pressing a response button or raising a finger, hand, or arm
longer wavelength = _______ shorter wavelength = _______
-low frequencies -high frequencies
the middle ear system serves the important function of matching the
-low resistance (impedance) of the air in the external ear canal to the high resistance or impedance of the fluid within the inner ear
hearing level (HL)
-lowest level an individual can hear/detect a sound -HL used on Audiograms -Audiometer Dial = 0 dB HL (Audiometric Zero) -Because hearing sensitivity is not equal at different frequencies, 0 dB HL can only be achieved by applying different amounts of pressures at the different frequencies -Sound is described in terms of dB HL (hearing level) for most hearing test procedures performed in an audiology clinic -Hearing test results and hearing losses are not reported in dB SPL -The reference point for dB HL is 0 dB HL, also known as audiometric zero
inferior colliculus
-major nucleus in the auditory system -Distinct tonotopic organization. -Ribbon-like regions known as iso-frequency sheets are dedicated to processing sound frequencies within specific ranges. -Plays an important role in the coordination of auditory information from both ears and in localizing the sources of sound in space. -Includes neurons specialized in detecting differences in the intensity, timing, and phase of sounds arriving from each ear
Sound isolated booth
-means we are isolating the test room acoustically from the rest of the building -used in clinical/medical/private practice settings
tympanometry
-measure of integrity of eardrum, ear canal volume and middle ear pressure -measure of middle ear function
type C tympanogram
-most often indicates Eustachian tube dysfunction -A type C tympanogram consists of a peak when negative pressure is created in the ear canal -The tympanogram peak occurs beyond -100 or -150 daPa
lateral lemniscus
-nerve fibers form this major pathways -carries information through the brainstem to the inferior colliculus -A large auditory fiber tract coursing upward through the brainstem from more caudal centers like the cochlear nucleus and superior olivary complex to the inferior colliculus -Tonotopic organization is maintained throughout the lateral lemniscus and the other auditory centers in the brainstem. -All fibers within the lateral lemniscus terminate in the inferior colliculus.
automated auditory brainstem response (AABR)
-neural (cochlea, nerve and brainstem) -frequency range of 2000-4000 Hz
Type A: Type B: Type C: Type Ad: Type As:
-normal -flat -negative -deep -shallow/stiff
auditory neurons form what
-pathways which travel from one region of the brain to the next -Pathways are duplicated on both sides of the brain and communicate by means of bundles of nerve fibers that cross from one side of the brain to the other -crossing fibers are called decussations
CI candidacy: evolving
-patient used to have to have severe-profound hearing loss in both ears -then changed to only severe hearing loss in both ears -now it is moderate sensory neural loss in low frequencies and then severe to profound in mid-high frequencies -z looking pic: shows hybrid technology which is when a patient has near normal or mild-moderate low frequency hearing loss then we can amplify that with an acoustical component thats part of the CI then you see it drop off so they would have acoustical and electrical in that ear
Quantifiable measurement
-performed via pure tone audiometer-compares individual threshold (ϴ) with an established norm -Hearing range=20-20,000 Hz -Decibel=Intensity (-10 to 120 dB HL) (Threshold of pain = 140 dB SPL) -Frequency=Hertz (125-8000 Hz)
WRS
-person repeats monosyllabic words at specified dB SL level to determine how many words they can identify (reported as a percent correct)
SRT
-person repeats two syllable (spondee) words to determine softest level of speech (reported as a dB HL)
AC/BC
-person responds when they hear the tone- determines the softest level the tone is detected
pediatric management of hearing loss: mainstream
-placing child with handicap in "least restrictive environment" -HL impacts child's development and life in a variety of ways to include: "receptive/expressive skills, academic performance (creative learning), social skills, low-self esteem, restricting future potential" -Children with HL in mainstream classrooms make up largest group of those receiving special education services -Classroom teachers admit not having the knowledge/skills for proper management of children in their class with hearing loss (i.e., equipment, classroom acoustics, FMs) -Private schools -Residential schools
region 2: middle ear
-plays a critical role -Stimulus energy must travel through the middle ear to the cochlea -OAE energy from the cochlea is propagated outward to the ear canal via the middle ear -OAEs are reduced in amplitude and often cannot be detected in the external ear canal in patients with middle ear abnormalities
Tonotopical organization of the cochlea describes
-processing of sound of different frequencies at different locations along the membrane -higher frequency sounds occurs toward the tight and stiff basal end of the basilar membrane. -Lower frequencies are represented toward the loose and less stiff apical end
Wave III
-produced by combined activity from two or three pathways in the pons portion of the brain stem
Auditory Brainstem Response (ABR)
-reflects activity of many auditory nerve fibers and of pathways within the auditory brainstem -The summed electrical activity from a sizable group of nerve fibers firing together is picked up with detectors (electrodes) located as far away as the scalp on the forehead and near the ear -Electrical responses to sound in the auditory nerve fibers and in the brain stem must pass through brain tissue and the skull to each the electrodes on the skin
type A tympanogram
-reflects normal outcome for tympanometry -Peak compliance is between 0.30 and 1.50 ml. -The tympanogram peak pressure falls somewhere between the pressure region of +50 daPa to -150 daPa. -As air pressure in the ear canal decreases into the negative region, there is a reduction of middle ear compliance.
supra-aural earphones
-rest on the pinna of the ear -The earphone itself fits within a soft rubber donut-shaped cushion
cupula
-rests on top of the crista -gelatinous structure that enhances movement of the hair cells in the crista with movement of the head
innerportion is ____ and responsible for
-sensory -conversion of sound into chemical and electrical energy -balance
speech reading (watching speakers face/using vision to help them hear)
-slow down rate of speech -articulate words -don't over exaggerate speech
Acoustic Reflex
-sonomotor response consisting of a contraction of middle ear muscles upon sound stimulation -Stapedius muscle normally contracts in response to a high intensity sound exceeding about 70 dB HL -When one normal ear is stimulated with sound, the stapedius muscles in both ears contract -Contraction of the muscles stiffens the middle ear systems and decreases compliance of both middle ear systems
Otoacoustic Emissions (OAEs)
-sounds measured in the external ear canal that are associated with activity of the outer hair cells -The OAE measurement process begins with insertion of a probe into the external ear canal -OAEs represent energy associated with outer hair cell motility that makes its way from the cochlea through the middle ear and finally outward into the external ear canal. -Amplitude of OAEs recorded in the ear canal is normally in the range of 0 to 15 dB SPL
What is an audiometer?
-specifically designed for hearing testing -The operator of the audiometer selects different types of sounds and presents them to the person being tested at precise volume levels -Sounds are presented using earphones or loudspeakers
Behavioral Hearing Testing is
-subjective -Behavioral audiometry techniques are sometimes categorized as subjective measures because the response is dependent on the perception and experiences of the person being tested as well as the tester's perception and experience
Afferent neural pathways
-system carry information from the ear to the brain and in a rostral direction through the brain -Up to 95% of the afferent auditory nerve fibers leading from the ear to the brain communicate directly with inner hair cells -Only about 5% of afferent fibers make a connection with outer hair cells.
Inner versus Outer Hair Cell differences in a nutshell
-the energy supplied by outer hair cell motility helps overcome the loss of energy that occurs as the basilar membrane moves within the thick cochlear fluids -Outer hair cell motility improves our hearing sensitivity by about 40 to 50 dB and contributes to our ability to precisely distinguish among frequencies -Additional energy in the cochlea associated with outer hair cell motility adds to vibration of the basilar membrane and increases activation of the inner hair cells. -However, we cannot hear with our outer hair cells alone; inner hair cell function is essential for hearing -To sum it up in one sentence: We hear with our inner hair cells, but we hear much better because of our outer hair cells
motility
-the lengthening and shortening of the outer hair cells -Some energy from outer hair cell motility returns to the external ear canal
tympanometry
-the most commonly recorded acoustic immittance test -a fundamental and essential procedure for detection of middle ear dysfunction -yields a graph called a tympanogram -Measurement of tympanic membrane mobility as a function of air pressure changes within the ear canal
Wave V
-the most prominent wave -is generated in the rostral midbrain portion of the auditory brainstem
sensation level (SL)
-the number of dB above a person's threshold (relative to speech) -Requires a reference level=speech reception threshold (SRT) -Most often used in speech testing
prevalence
-the number of existing cases of a disorder within the population -increases with age -more adults than children
vertigo
-the sensation that the environment is spinning around a patient. -Persistent or even occasional vertigo can seriously disrupt daily activities and quality of life
tympanic membrane/ ear drum
-the tympanic membrane consists of three different layers of tissue. -The outer epidermal layer is distinguished from the other two layers because it renews itself, -Old cells in the epidermal layer migrate outward through the ear canal and new cells form in their place -located at the end of the ear canal -cone shaped -opaque color (transparent) -separates outer ear from middle ear
behavioral audiometry
-traditional hearing assessment -This term is used because the person being tested responds to sound with some type of behavior that can be observed by the tester
"disability"
"activity limitation" = "effective communication" difficulties
Sound is attenuated:
"decrease in strength of sound"
Mastiod
(Pneumatic-bone filled with air)-behind the Pinna
A hearing impaired person requires for speech understanding a more favorable ratio of ___ dB between the level of speech and background noise
+12
stapes
- 3rd bone in the chain (2.5 mg) -Head, Neck, two Crura, Footplate (Sits in Oval Window)
4 Concepts of the Decibel
- Logarithmic Unit - ratio of sound power/pressure to specified reference sound power/pressure - Relative measure used to express intensity - Unit for sound power and sound pressure
Evidence-Based Practice is a five-part process:
-"Definition of the problem" -"Research for evidence to support the treatment" -"Critically appraise the evidence" -"Detailing the recommendations" -"Outcome assessment following treatment"
Contralateral Routing of the Signal (CROS) and Bilateral Contralateral Routing of the Signal (BICROS)
-"Unaidable"/Unilateral Hearing Loss -one ear has no hearing and one ear has normal
anechoic chamber
-"no hard surface areas to create reverberation in the environment- "free field" -Used in research
childhood communication checklist: developmental
-0-3 Months: startle/wakes up when loud sounds occur; soothed by speech -4-6 Months: Looks for sound location/source; babbling begins -7-1yr: imitates diff speech sounds, 1-2 word vocabulary -2-3 yr: Uses 2-3 word sentences; follows requests -3-4 yr: Answer "W" questions, producing most speech sounds correctly, sentences with 4+words
justification for universal newborn hearing screening (UNHS)
-1 to 6/1000 babies born with HL -HL can be unilateral or bilateral -32/1000 (HL) if NICU stay -In the US, HL is 6th most chronic condition -50-60% genetics; 40-50% environmental causes -$$$$ - if early identification=earlier treatment...early the better re: outcomes for speech/language function -Sufficient Prevalence of Disorder -Evidence the Disorder would be detected early (re: to screening) -Availability of IMMEDIATE diagnostic follow-up for screening refers -Accessibility to treatment IMMEDIATELY following diagnosis -Documentation that Early Intervention is advantageous
pediatric candidates
-12 months through 17.11 years old (Earlier the better) -cochlear americas now have technology for 9 months of age -Prelingual, Perilingual, Postlingual -Bilateral Severe-to-profound SNHL -No medical contraindications -Limited Benefit from appropriately fit HAs -Lack of Auditory Progress -Support system to include: 1. Realistic Expectations 2. Commitment to follow-up/AR 3. Educational: CI support & Auditory-Oral Language
Adult Candidates
-18+ (no upper age limit) -Postlingual -Moderate-to-Profound SNHL -No medical contraindications -Limited/No benefit from appropriately fit Has -Support system to include: 1. Realistic Expectations 2. Desire to be part of hearing world 3. Commitment to follow-up/AR
academic preparation for an audiologist and admission requirements
-Initial minimum degree-B.S./B.A. -Transitioned to Master's degree as minimum-prior to 2006 -As of 2006, entry level degree into the profession = Au.D (Doctor of Audiology) (enter program with BS/BA) -4 year program (3 years academic; 1 year externship) -Require approx. 2000 clinical clock hours (previous ASHA standard). -In addition to a bachelor's degree, admission requires the submission of an official transcript for undergraduate work and letters of recommendation -Most Doctor of Audiology programs also require applicants to take the Graduate Record Examination (GRE). -Application submission deadline is usually in January or February of the year the student will begin graduate studies.
four types of transducers
-Insert earphones -Conventional earphones -A bone vibrator -A loudspeaker
There are considerable differences among adult patients related to the test process including
-Intelligence -Educational level -Processing speed -Stamina -Energy -Motivation -Enthusiasm
universal newborn hearing screening (UNHS) according to ASHA
-Involve parent/caregiver (consent, documentation and educational material) -Follow-up procedure for infants that refer-standard of care -Means to track (data) for those who don't get screened, refer and progress to diagnostic evaluation and early intervention programs -UNHS- "favored approach for identifying high risk children"
Vestibular-Oculomotor Reflex (VOR)
-Involved in the coordination of eye movements that compensate for the almost constant movement of the head during waking hours. -Audiologists measure the VOR with tests during assessment of vestibular function
filtered word test
-It was first administered to a group of normal hearing subjects who had no hearing complaints and who were recruited specifically for the study -Medical diagnostic tests confirmed that each of the patients had a tumor or lesion in the auditory region of the brain
Adult patients must
-Listen closely for sounds, including very faint ones -Respond with some kind of motor activity (e.g., pressing a button) whenever they hear a sound -Understand the task and what is expected of him or her -Remember the task until testing is completed -Attend to and listen carefully for the sounds throughout testing
superior olivary complex
-Located in the pons region of the brainstem. -Consists of groups of nuclei with the appearance of an olive when viewed from the surface of the brainstem. -Plays an important role in localization and lateralization of sound -Also plays a role in the fusion of two sounds heard separately in the right ear and the left ear into an image of sound in the middle of the head -First center in the auditory system that receives binaural input, from fibers entering the central nervous system from both ears. -Involved in the ability to precisely determine where a sound is coming from using binaural hearing. -Helps us to perceive speech and other sounds in noisy listening environments
four concepts for understanding the decibel are:
-Logarithmic unit -Ratio of one sound power to another specified reference sound power or one sound pressure to another specified reference sound pressure -Relative measure, not an absolute measure -Unit for sound power and also for sound pressure
speech-in-noise tests
-Many speech-in-noise tests are available to assess speech recognition with some type of background sound or acoustic competition -Tests involving speech perception in noise evaluate "auditory performance in the presence of competing acoustic signals."
masking
-Masking involves presentation of sound to the non-test ear -The reason for masking is to assure that the patient's response is due to sound stimulation of the test ear -Masking is a very important element of hearing testing. -Masking in hearing testing serves the same purpose as covering an eye in vision testing. -The goal of masking in clinical audiology is to isolate the test ear and to eliminate any contribution of the non-test ear to the hearing test results -adding "noise" to the contralateral ear is the only way to determine which cochlea is responding -Stimuli presented by Bone Conduction (forehead or mastoid) results in BOTH cochlea's receiving the signal -Unless masking is applied; responses will be from "better hearing ear/cochlea"
early hearing and detection intervention (EHDI) program goals
-Maximize linguistic competence and literacy development for children who are deaf and hard of hearing -Optimize language, social, and literacy development for children who are Deaf or Hard of Hearing D/HH -Provide children with HL the greatest chances...educational success and mainstream into society
ABR
-Measure of the integrity of the Auditory Nerve and Brainstem
communication/listening strategies
-Minimize background noise -Once your child/loved one receives a hearing aid or cochlear implant, make sure he or she wears it every waking hour -Check the hearing aid or cochlear implant regularly -Check batteries, too. -AR/Speech Therapy -Be informed -Adhere to recommendations
preventing medical errors
-Minimizing errors is a high priority in healthcare. -Errors in healthcare result in patient injury and even death -Drug-related medical errors account for a high proportion of adverse healthcare outcomes -Certain drugs can damage structures within the inner ear(Ototoxicity: Ex. Gentamycin) -Audiologists are sometimes asked to test patients who are at risk for drug induced hearing loss (Ototoxic Monitoring) -Some medical error incidents occur in the operating room during surgical procedures -Regular continuing education on the prevention of medical errors in audiology is required for renewal of professional licenses in some states and by some healthcare institutions
midbrain
-More rostral in the central nervous system than the pons and cerebellum -Contains the largest collection of neurons within the brainstem
diagnostic audiometer
-Most audiometers have two channels. -A channel on an audiometer allows an audiologist to: -Select a signal like a pure tone or speech -Change the intensity level of the signal -Direct the signal to either or both ears of a patient with earphones, a bone vibrator, or a loudspeaker -With a two-channel audiometer it's possible to independently select, control, and deliver to the patient at the same time two different types of signals
Following activation of neurons in nuclei within the pons, auditory pathways
-travel upward on the same side (ipsilateral) to higher centers -Other pathways cross over from one side to the other before traveling to higher centers. -there are also crossing or decussating fibers that connect identical structures located on the right and left halves of the brainstem.
different type of work settings for an audiologist
-universities and research labs -industry and manufacturers (see next cards for more details)
Otoscope/otoscopy
-used to visually inspect the outer ear, ear canal and ear drum -Hand held -Pneumatic -Video -Operating
type B tympanogram
-usually indicates severely restricted mobility of the middle ear system -A type B tympanogram sometimes appears rounded or as a flat line -This pattern may be associated fluid in the middle ear space immediately behind the tympanic membrane or other disorders requiring immediate medical attention -two potential pathologies: one is that there is fluid in the middle ear and the eardrum cant move. second is that there is a hole in the eardrum. we need to know the ear canal volume (>2.5= hole in eardrum. <2.5= fluid in the eardrum)
speech materials
-various stimuli used in speech audiometry -include: consonant-vowel (CV) syllables like "da", single-syllable (monosyllabic words such as "jar", two-syllable (spondee) like "baseball"
calibration
-verification that the equipment is performing properly and that the stimuli produced by the audiometer and the sound levels produced by the transducers are accurate -accuracy of hearing test results depends on precise calibration of equipment, including the audiometer and the transducers -Hearing test equipment is calibrated with a sound-level meter using a physical reference for decibels (dB) sound pressure level (SPL) even though hearing testing is conducted using the dB HL unit of intensity
middle ear implants (Moderate-to-Severe SNHL; Mixed HL)
-vibrant soundbridge -maxum -esteem -FDA Approval= 18+ -Fully Implanted Middle Ear Prosthetic Device -rare
VOR= Maintain what
-visual stability/fixation during head movement -Hair cells depolarized in right HSC -Hair cells hyperpolarized left HSC -neural activity on right side -neural activity on left side -Eye movement to the left
autonomic nervous system controls what
-vital bodily functions such as homeostasis which is maintenance of bodily stability
free field
-where no hard surfaces to cause reverberation -"Mountaintops" -"Anechoic Chambers"
type of white noise in hearing test
-white noise or broadband noise -narrowband noise (NBN) -speech spectrum noise -octave band noise
length
-↓ Length, ↑ Frequency (Short Strings (High Frequency=HF); Basal End of Cochlea) -↑ Length, ↓ Frequency (Long Strings (Low Frequency=LF); Apical End of Cochlea)
joint committee on infant hearing (JCIH) guidelines strongly recommend reliance on three objective techniques for hearing assessment of infants and young children from birth to 6 months:
1. Acoustic immittance measurements 2. Otoacoustic emissions 3. ABR
CochG consists of three components
1. Cochlear microphonic (CM) 2. Summating potential (SP) 3. Action potential (AP)
3 general steps of using an audiometer
1. Decides how the sounds will be delivered to the patient. Usual options are: earphones, bone vibrator, loudspeaker 2. selects a particular sound, such as: a pure tone, speech signals, some type of noise 3. Presents sounds to the patient at specific intensity levels
Hearing by bone conduction is a combination of the following:
1. Distortional Bone Conduction 2. Inertial Bone Conduction 3. Osseotympanic Bone Conduction
four things sound needs
1. Energy Source 2. Energy source applied to a source of vibration 3. Vibration moved through a medium 4. Medium extended to receptor capable of receiving/interpreting sound -Medium = Air -Receptor= Ear
partially implanted components for middle ear implants
1. External Audio Processor 2. Implanted Receiver-transmits converted electrical signal 3. Ossicle Transducer
Three major changes in the waveforms as stimulus intensity level is decreased:
1. Latency of the waves increases as stimulus intensity level decreases 2. Amplitude of the waves decreases as stimulus intensity level decreases 3. Only wave V remains at the lowest intensity level at which an ABR is still present
two placement sites of BC testing
1. Mastoid Process (preferred placement site) 2. Forehead: Disadvantage=10 dB increase in intensity needed relative to stimulating normal thresholds
ECochG responses arise from:
1. Outer hair cells (CM) 2. Inner hair cells (SP) 3. Auditory nerve fibers (AP)
3 factors that contribute to increased energy of sound pressure as it passes from the ear canal to the inner ear
1. TM is larger than the oval window which causes fluid in the cochlea to match the vibration of the TM 2. the ossicles are positioned so that the stapes will vibrate strongest 3. the cone shape of the TM increases sound pressure
3 distinct features of speech in noise tests
1. Type of speech used in the test 2. Type of sound or noise in the background 3. Intensity difference or ratio between the speech signal and the other sound, commonly called the signal to noise ratio (SNR)
bony labyrinth consist of
1. anterior portion (cochlea) 2. central portion known as the vestibule 3. posterior portion containing the three SSC -filled with perilymph fluid -network of supportive tissues and blood vessels
4 quadrants of the tympanic membrane
1. anterior-superior 2. anterior-inferior 3. posterior-superior 4. posterior-inferior
Hearing threshold assesses by behavioral testing is about ___ dB ____ than the minimum intensity level producing an ABR wave V
10 db lower
Electrocochleography (ECochG) discovered in ____ and is a technique similar to ____
1930, ABR
Example of Phases of Sine Wave using Tuning Fork Condensation/Rarefaction Motion and degrees in a circle
1=0 degree phase (no movement-start of cycle) 2=90 degree phase (maximum rarefaction) 3=180 degree phase 4=(-)270 degree phase (maximum condensation) 5=360 degree phase (no movement-end of cycle)
ADA updated 2010:
21st Century Communication and Video Accessibility Act-equal access to a variety of technologies
Mechanical properties of the basilar membrane change along the what
25- to 35-mm length from its base to the apical end
two membrane separate the cochlea into what
3 portions or scala
regularly scheduled physical calibration of hearing test equipment with a sound-level meter is typically performed only
3-4 times a year
Inter-aural Attenuation (IA) Values for supra aural headphones
40 dB HL
how many ligaments in middle ear
5
___ dB difference between the intensity of speech and the level of background sound is generally needed for a normal hearing person to understand speech
6
average level for conversational speech
65 dB SPL
what percentage of people with hearing loss live in countries with little or no access to audiologist
90%
The three SCCs lay at approximately ___ ____ to each other
90º angles
"handicap"
= "participation restriction" = "social, vocational, educational" difficulties
Inter-aural Attenuation (IA) Values for bone conduction
= 0 dB HL -Important because: 1. Want ear specific information. Hearing thresholds may be obtained at lower thresholds in cases of asymmetrical hearing loss if masking not performed 2. Need to determine how much of a conductive component may be involved 3. Can misdiagnose hearing loss (type and degree) in test ear as non-test ear may be responding if masking not used
type of masking used for air conduction and/or bone conduction
= Narrow-band noise always presented via the non-test ear (NTE) air conduction pathway (headphone or insert)
type of masking used for speech testing
= speech noise which is filtered white noise
Energy + Vibration
=sound
loudness levels: most comfortable levels
-Most comfortable level (MCL) is the intensity level that a person perceives as comfortable to listen to -MCL is not too soft and not too loud -MCL can be measured for pure tone signals and for speech signals -Decibel level in which speech is most comfortable -Usually 40-55 dB above (SRT) threshold -Cold running speech is recommended to adjust for fluctuations in speech -Technique: present speech just above SRT and gradually increase sound until patient indicates sound is "most comfortable"
Marion Downs
-Mother of Pediatric Audiology -said that pediatric audiology is a speciality
Cortical Auditory Evoked Responses
-Multiple auditory evoked responses arise from regions of the central nervous system above the level of brainstem -Cortical auditory evoked responses were discovered in the late 1930s -Audiologists sometimes apply them in the assessment of central auditory nervous system function and auditory processing disorders -Audiologists sometimes record three cortical auditory evoked responses
what are the different pediatric audiology services
-Newborn hearing screening -Diagnosis of hearing loss in infants -Treatment and management of children after hearing loss is confirmed with hearing aids and other devices -Educational settings where audiologists work closely with speech pathologists in a public school setting to provide various services to children aged 5 to 18 years.
Nonorganic/Functional Hearing Loss
-No functional cause associated to hearing loss/auditory dysfunction-but test results indicating some degree of hearing loss -Malingering=purposely "faking" a hearing loss for attention or financial gain -Psychogenic Hearing Loss=psychological disorder (emotional, traumatic, mental) Examples: -Workers Comp Claim -person seeking attention
med-EL ADHEAR
-Non surgical bone conduction -CI -adheres onto mastoid
what do OAEs tell us about auditory function?
-Normal OAE amplitudes provide evidence that outer hair cells for that portion of the cochlea are intact. (responses present 6 dB above noise (Dr. Cosby)) -Normal OAEs also indirectly indicate that a patient's middle ear is functioning normally -Decreased OAE amplitudes or absence of detectable DPs for test frequencies are evidence of cochlear dysfunction involving outer hair cells -If patient has more than a mild (i.e. 35-40 dB HL) hearing loss, OAEs will NOT be present (Dr. Cosby)
clinical uses of electroacoustic test
-Objective test permitting assessment of auditory function in patients who cannot participate in behavioral hearing testing. -useful for assessment of auditory function of infants and young children -can perform hearing screening of newborn babies using electroacoustic procedures, thus permitting early identification of hearing loss -Audiologists occasionally encounter older children who are difficult or impossible to test for whom electroacoustic test procedures may be ideal. -offer a highly sensitive tool for documenting abnormal function of the auditory system.
Speech Awareness Threshold (SAT)/Speech Detection Threshold (SDT) for children birth- two years old
-Obtained using animal sounds, singing, different inflection in voice -When comparing to responses obtained from VRA, the results are considered to be in good agreement if SAT/SDT is within +/- 10 dB HL relative to threshold responses in the speech frequency range of 250-4000 Hz.
sensorineural hearing loss
-Occurs as a result of inner ear (cochlear and/or neural) deficits -Sound attenuation occurs in both AC and BC pathways -Hearing loss is permanent (i.e., can't be restored back to normal function with medication or surgery)
central auditory processing
-Refers to our ability to discriminate and identify sounds, words, directions, conversation, and classroom instruction and comprehend what we hear -Any problem in one or more of these abilities results in a person misperceiving what they hear -Deficits in auditory processing can negatively impact learning and day-to-day communication
condensation
-Region of a sound wave characterized by increased density of molecules -Opposite of rarefaction -Acoustic stimulus produced by a positive electrical pulse activating a transducer like an earphone to produce condensation stimulus polarity -Particles close -increase in air pressure and density of air molecules on one side of the vibrating object"
Rarefaction
-Region of a sound wave characterized by less dense molecules -Opposite of condensation -Acoustic stimulus produced by a negative electrical pulse activating a transducer like an earphone -Particles apart: -reduced air pressure directly behind (or after the condensation"
quality of life for a patient with hearing loss
-Relationship; poor health; decreased physical activity; depression; cognitive decline -Progressive HL--> Progressive Physical and Psychosocial Dysfunction -Depression = 4 times more likely -Cognitive decline/Comorbid conditions = 1/3 risk of developing Dementia
sensation level (SL)
-Requires a reference level -Most often used in speech testing -Sound is described in terms of dB SL (sensation level) as an indicator of a specific patient's hearing level. -The sounds are presented at an intensity level that is a certain number of decibels above the faintest level of sound that the person can detect. -The term threshold is used to describe the faintest level of sound a person can detect.
Word Recognition Testing in Young Children
-Researches developed phonetically balanced kindergarten word lists (PBK lists). -The lists are useful for word recognition assessment of children who have a developmental age of 4 to 5 years, and for older children
SOAP formant for report writing
-S (subjective): Relevant complaints/reason for visit; subjective observations and family, medical, and otologic history -O (objective): Tests or procedures completed; findings and test conditions. -A (assessment: A summary of the "S" and "O" to provide a diagnostic statement and the implications of the findings. -P (plan): Appropriate recommendations; follow-up
Common psychosocial responses to hearing loss and other communicative disorders include
-Sadness -Anxiety -Frustration -Irritability -A sense of loss -Depression
tips for audiogram interpretation
-Scan the audiogram immediately for information on: the patient's age, earphones used during air conduction testing, reliability of the patient's responses -Immediately inspect the audiogram to determine whether findings are entirely normal for either ear or both ears •In analyzing findings, begin with: -The right ear, unless there is a good reason to begin with the left ear -The lowest test frequency -Air conduction and then bone conduction findings for the same ear -Focus on the analysis of one ear at a time -Examine each symbol with a critical eye
amplification considerations
-Select style and technology necessary to fit hearing loss and patient needs -Select style and mold material -Select accessories e.g. Bluetooth device or FM to fit audiological needs and patient life style
function of middle ear
-Separates ME from Inner Ear -Sound Transmission (increased through system) -Acoustical to mechanical energy -Pressure Equalization
adult audiology services
-Some audiologists provide services mostly or entirely to adult patient populations, e.g. -Hundreds of audiologists work in VA Hospitals and Medical Centers and only see adult patients
variables in word recognition performance: configuration of hearing loss
-Some variability in word recognition performance for persons with hearing loss is explained by the configuration or shape of the hearing loss -An audiogram of speech sounds is one way to graphically display the distribution of speech sound energy across the range of audiometric test frequencies
sound reverberation
-Sound reverberation is produced when sound waves reflect off of the walls of a room. -Reverberation of sound can interfere with a person's ability to perceive and understand speech.
longitudinal sound waves
-Sound waves in Air (i.e., like wheat in a field) -Audiology focuses on longitudinal waves -parallel movement
stimulation for ABR measurement
-Sounds are usually presented with insert earphones for ABR measurement in infants and young children -Stimuli used most commonly in clinical ABR measurement are very brief or transient •Common stimuli for eliciting the ABR are: 1. Clicking sounds 2. Very brief tones called tone bursts
air conduction (AC)
-Sounds directed into ear through outer ear canal -Insert earphones (fit in the ears=more comfortable; infection control) -Headphones (diaphragm movement generates sound): supra-aural (conventional) = over the ear and circumaural= around the ear (used in high frequency testing and tinnitus assessment)
bone conduction (BC)
-Sounds directed into inner ear via mastoid process or forehead -bone conduction vibrator (small plastic box attached to headband)
special testing includes
-Speech audiometry procedures -Objective measures of ear and brain function
speech formants
-Speech formants are peaks of energy above the fundamental frequency in vowel sounds. -Formants are regions of energy in speech that are related to resonance of the vocal tract. A speech spectrogram is an image of the frequency information in speech plotted over a time period of one or two seconds. The energy in speech extends up to frequencies of 4000 Hz and higher. As a general rule, vowels are dominated by lower-frequency energy whereas consonants consist of higher frequencies
CI Test Battery for adults
-Speech-Language Assessment -Acoustic Immittance (Tympanometry/ART) -Comprehensive Hearing Evaluation -Aided Testing with appropriate amplification: Word and Sentence Material, In quiet (60 dB A), In noise (+5 or +10) signal to noise ratio (SNR)
different terms for threshold for speech
-Spondee words are a common form of speech material used for measuring the threshold for speech recognition -The term spondee refers to a meter in poetry consisting of two long or stressed syllables -have equal stress on each syllable -Spondee threshold, preferably called speech threshold (ST), is also a term for threshold for speech -Two other terms for describing measurement of speech (both abbreviated SRT) are: -Speech reception threshold -Speech recognition threshold (preferred)
what are the three main types of OAEs that can be recorded with clinical equipment
-Spontaneous OAEs (SOAEs) -Transient evoked OAEs (TEOAEs) -Distortion product OAEs (DPOAEs)
DPOAE stimulus characteristics when recording otoacoustic emissions
-Stimuli in DPOAE recordings are comprised of simultaneous presentation of two different pure tone stimuli -The ratio of the higher frequency tone to the lower frequency tone is slightly higher than 1.0, usually about 1.22. -Activity in the cochlea produced by the two closely spaced stimulus frequencies is called distortion products -DPOAEs travel from the cochlea back through the middle ear and to the external ear canal
cross hearing
-Stimulus sound presented to the test ear at a level exceeding the inter‐aural attention (insulation) provided by the head for air or bone conduction crosses over to and is detected in the non‐test ear -is often used to describe detection of a stimulus sound in the non-test ear
gold standard for behavioral testing of hearing sensitivity-Pure Tone Audiometry
-Subjective test-meaning response is based on "perception and experiences of patient being tested" -Human Range of Hearing =20-20,000 Hz
Semicircular canals (SCC)
-Superior (Anterior) -Posterior (Inferior) -Horizontal (Lateral) -Detect angular/ rotational accelerations of the head -EACH SCC has a base=AMPULLA, sits on the UTRICLE -Sensory portion ("CRISTA") contained in the ampullae -Hair cells project into CUPULA (Gelatinous)
education of audiologist
-The Doctor of Audiology (AuD) Degree -A bachelor's degree is necessary for entry into Doctor of Audiology programs -Students applying to Doctor of Audiology programs have a variety of undergraduate backgrounds including communicative disorders, psychology, biology, English, or music -Some undergraduate coursework in mathematics and the sciences is strongly recommended, particularly courses in biology, chemistry, and physics
current pediatric word recognition tests include
-The Word Intelligibility by Picture Identification (WIPI) -The Northwestern University Children's Perception of Speech (NU-CHIPS) -Pediatric Speech Intelligibility (PSI) Test
loudness
-The psychological correlate to sound intensity. Increases in sound intensity are perceived as increased loudness. The relationship between intensity and loudness is not one‐to‐one but, rather, logarithmic -subjective perception of intensity -duration and frequency of sound also contribute to loudness perception
pitch
-The psychological sensation related to the frequency of sound -High pitches correspond to high‐frequency sounds and low pitches to low‐frequency sounds -subjective perception of frequency -frequency of vibrations increase = perception of higher pitch
relation of SRT to pure tone thresholds
-The pure tone average (PTA) provides a handy way to quantify hearing sensitivity for a central portion of the speech frequency region -The PTA predicts the SRT within about +/- 7 dB -For a variety of reasons, substantial discrepancies between the PTA and SRT are sometimes found in certain auditory disorders. -Speech recognition performance may be markedly decreased in persons with with neural auditory dysfunction even though hearing sensitivity for pure tones is normal.
signal-to-noise ratio (SNR)
-The relation between the intensity level of the words and the intensity level of the background sound -With some speech-in-noise tests, SNR is varied to make the test easier with a larger SNR or more difficult with a smaller SNR -Multi-talker babble -The cocktail party effect
Inertia
-The resistance of any object to change its shape or its state of motion -is the tendency of the object to remain at rest or inactive unless disturbed by an external force
pure tone audiometry
-The results of pure tone audiometry help to define a person's hearing abilities for sounds in the frequency region that is important for understanding speech -The results of pure tone hearing testing contribute importantly to the diagnosis of hearing impairment and to decisions regarding patient management
region 1: external ear canal
-The stimulus is presented via the external ear canal and OAEs are recorded in the external ear canal -The effectiveness of stimulation may be reduced by debris or cerumen in the external ear canal -Normal resonance and acoustics in the external ear canal may also influence stimulation during OAE measurement
how are otoacoustic emissions recorded by using stimulus calibration?
-The stimulus problem is calibrated each day before clinical testing begins with any patients -For each patient ear, the OAE device automatically calibrates stimulus intensity immediately after the probe is inserted and just before OAE recording starts -The audiologist verifies that stimulus intensity levels are close to the "target" (intended) intensity levels
dimensions of duration
-The term spectrum refers to the frequency content of a sound. -Very brief tonal sounds with a spectrum between 500 and 1,500 Hz, centered around 1000 Hz are referred to as tone-burst sounds. -Sound durations of only 100 microseconds or one-tenth of a millisecond (0.1 ms) which cover a very broad spectrum are referred to as click sounds.
Discovery of the Auditory Brainstem Response
-The tiny electrical response from the brain is less than one millionth of a volt -The response is detected with tiny metal discs connected to wires attached to the scalp on the top of the head or on the forehead and also near the ear -The response was first referred to as "Jewett bumps." -Since 1979, it has been called the auditory brainstem response (ABR)
tympanic membrane layers
-The tympanic membrane consists of three different layers of tissue. -The outer epidermal layer is distinguished from the other two layers because it renews itself, -Old cells in the epidermal layer migrate outward through the ear canal and new cells form in their place. -tri-layered -Outer - "cutaneous layer"; epidermal layer-regenerates new skin cells -Middle - "fibrous layer" -Inner - "mucous membrane" -extremely vascular
static acoustic compliance
-The value measured at maximum compliance -For a normal middle ear system, maximum compliance or stiffness is found near 0 daPa, corresponding to atmospheric pressure -At 0 daPa, there is little or no difference in air pressure from one side of the tympanic membrane to the other -The middle ear system is most flexible or least stiff at this neutral pressure.
phase
-The zero voltage point at the beginning of the waveform of a stimulus or of a frequency component of a response waveform expressed in degrees or radians, such as 0 or 90 degrees -Phase of a response is related to latency -point on sine wave compared to a standard
duration
-Time plays an important role in sound production and sound perception. -The phrase "temporal properties of sound" describes the various features of sound that involve time. -One temporal property of sound is its duration. -Duration is the length of time from the beginning to the end of a sound.
oscillate
-To vibrate and move back and forth -"to swing"
estimated economic impact of hearing loss
-Treated throughout childhood: $5 Billion -Untreated: $100 Billion lost revenue -Lifetime:$1 Million -2.1 Billion (417,000/person)
Clinical Applications of Tympanometry
-Tympanometry is a sensitive indicator of middle ear functioning. -Tympanometry is highly sensitive to middle ear dysfunction and is a quick and objective test which is feasible for patients of any age. -However, tympanometry alone does NOT permit the diagnosis of ear pathology. -Additionally, tympanometry is NOT a valid measure of hearing
uncomfortable loudness level (UCL)/ loudness discomfort level (LDL)
-UCL/LDL for normal hearing-usually between 100-110 dB HL -Patients with hearing loss (primarily SNHL) will have reduced (lower) UCL/LDL -Used in assessing patients for hearing aid candidacy, HOWEVER frequency specific UCLs/LDLs are preferred. -Speech UCL measures loudness perception of speech which is based on hearing levels in lower frequencies -Used in soundfield aided condition although more precise methods are available clinically (ex: speech mapping)
pediatric evaluations
-UNHS-Automated Auditory Brainstem Response (AABR) or Distortion Product Otoacoustic Emission (DPOAE) -Flow chart procedures relative to pass/refer -Otoscopy -Tympanometry -Acoustic Reflex Threshold Testing (whenever possible) -Otoacoustic Emissions Testing (DPOAEs or TEOAEs) -Auditory Brainstem Response Testing (ABR); natural sleep and/or sedated -Behavioral Threshold Testing (Unaided) -Auditory Processing Testing (age 7+): Auditory Clinical Picture is not complete without some attempt of behavioral testing (whenever possible and if feasible)
Patient Characteristics for amplification
-Unilateral/Binaural -Anatomical/Structural -Cognition -Physical Abilities
Hertz
-Unit of frequency -formula: 1/period
Management of tinnitus
-Use of hearing aids with and/or without tinnitus masker program -Use of noise maskers (white-noise generators; fans, radios, tinnitus apps, musical/tonal generators (Neuromonics) -Pharmacological: Prescribed Medications and/or vitamins-results vary -therapy based
patient rights and consent
-All patients have a right to know what procedures will be performed and what is expected of them during an assessment -Institutional policies and regulations usually require adult patients to give written consent for treatment -Patients sign a form indicating agreement to the test procedures that will be administered to them -An informed consent form is a special type of consent document that is read and signed by patients who are serving as subjects in a research study -For certain common noninvasive procedures, such as a patient history, an assumed consent may apply
resonance
-All vibrating objects have a natural or resonance frequency -With the application of force an object vibrates or oscillates more readily and more efficiently and with less loss of energy at one frequency than any other frequency -Resonance frequency is also known as the natural vibration frequency of the object
Audiometric Calibration Standards Set By:
-American National Standards (ANSI) -Association of the Advancement of Medical Instrumentation (AAMI) -International Organization for Standards (ISO): -Calibration on all equipment performed at a minimum annually, Hearing test equipment is calibrated with a sound-level meter using a physical reference for decibels (dB) sound pressure level (SPL) even though hearing testing is conducted using the dB HL unit of intensity
Audiometric Calibration Standards Set By:
-American National Standards (ANSI) -International Organization for Standards (ISO)
ABR amplitude analysis
-Amplitude of ABR waves is remarkable small, even in normal hearing persons -An audiologist compares a patient's amplitude values to normal values to determine whether the response is normal or abnormal
cochlear implant
-An electronic medical device, surgically implanted into the cochlea, electrically stimulates the auditory nerve. -Not a device that restores hearing to normal (no reversing sensory neural hearing loss) -Not an "acoustic-signal amplifier" -Bypasses damaged hair cells -Allows for access to sounds and speech perception
Speech Awareness Threshold (SAT)/Speech Detection Threshold (SDT) for children 2 years old- 5 years old
-Animal sounds, Singing, Pointing to body parts, Pointing to Pictures (Speech/sounds that have meaning) -LING Six Sounds =verify speech sounds across the frequency range ( phonetic: /a/, /i/, /u/,/S/, /s/, /m/) -10 dB HL-in good agreement relative to 250-4000 Hz threshold -7 dB HL-in good agreement with pure tone average (PTA) of air conduction thresholds at 500, 1000 and 2000 Hz
ear infections and education impact
-Articulation/Phonological; Expressive and Receptive; Grammar/Syntax -Vocabulary; Auditory Memory; Auditory Perception; Social Maturation -Initial lager's "catch-up" with peers by 2nd grade -Correlation between early infections and speech understanding -Severe hearing loss greater effect -Psychosocial dynamics
Air conduction audiometry procedure
-Assess hearing sensitivity in each ear across frequency range: 125-8000 Hz -Determines DEGREE and CONFIGURATION of hearing loss only -Does not determine TYPE of Hearing Loss (i.e., Conductive, Sensorineural, Mixed) -Use of Headphones vs. Insert Earphones -Color coded: RED=RIGHT; BLUE=LEFT -Advantages/ Disadvantages -Placement of Headphones or Inserts conducted by Audiologist
DPOAE
-Assessing the integrity of Outer Hair Cell function -If more than a mild hearing loss Present (35-40 dB HL) DPOAE will be absent
goals for amplification: restore audibility
-Audibility: Soft Input -Comfort: Average Input -Tolerance: Loud Input -Habilitation -Rehabilitation
Audiogram Interpretation
-Audiogram analysis and interpretation is the process of distinguishing different patterns of hearing loss from the information plotted on an audiogram. -The patterns of findings are related to specific auditory disorders. -Accurate audiogram interpretation requires practice and clinical experience. -With repeated exposure to a variety of audiograms, one begins to recognize patterns and relationships among findings for air and bone conduction threshold measurements for each ear.
are audiologist physicians
-Audiologists are NOT physicians. -Audiologists provide nonmedical treatment to persons with hearing impairment. -Audiologists employed in medical settings like hospitals often provide a wide range of clinical services independently, without direct collaboration with physicians. -There are now many different types of clinical services and career specialties available to audiologists.
decibel (dB)=
-Audiologists regularly apply the concept of the decibel (dB) in manipulating sound and using sound meaningfully in a clinical setting-ratio used to express intensity -unit of measurement used in audiology to express intensity
special testing
-Audiologists sometimes encounter patients who complain of difficulty in hearing, yet the complaints are not confirmed by pure tone audiometry or even by performance on tests of word recognition. -Not all hearing problems result from abnormalities with the ear -Special testing evaluates how the brain processes auditory information
major developments in the new profession
-Audiology scope of practice continued to expand throughout the 1980s and 1990s. -The advent of computer technology and scientific advances like digital signal processing led to more sophisticated hearing tests and more effective options for treating patients with hearing loss -Audiologists took on a variety of new clinical duties.
outer hair cells
-Very small and highly metabolic cells arranged in three to four rows in the cochlea with more than 100 stereocilia ("hairs") on the top. Outer hair cells are capability of motility or changes in shape with activation by sound. There are about 12,000 outer hair cells in a human cochlea -Change shape when activated -Outer hair cell movement produces energy in the inner ear that enhances hearing
CI Test Battery for Pediatrics
-Auditory Brainstem Response (ABR)/Auditory Steady State Response (ASSR) -Otoacoustic Emissions (OAEs) -Acoustic Immittance (Tympanometry/Acoustic Reflex Threshold Testing) -Behavioral Audiometric Threshold Testing -Hearing Aid Verification -Aided Testing (age appropriate material): Auditory Perception, Word and/or Sentence Material, Parental Questionnaires -Speech-Language (communication skills, receptive/expressive language)
objective auditory procedures
-Auditory tests that do not require a behavioral response from a patient -examples: otoacoustic emissions, acoustic immittance measures, and auditory evoked responses
Insertion of the Probe in acoustic immittance measurement
-Before beginning acoustic immittance measurement, an audiologist must carefully inspect the patient's ear canals to rule out abnormalities or other unusual findings -After assuring that the ear canal is clear, an audiologist inserts an appropriately sized probe onto the probe assembly -The probe is inserted firmly into the external ear canal in order to create an airtight (hermetic) seal
technical problems in tympanometry
-Before linking a Type B tympanogram to middle ear abnormalities, an audiologist must first rule out technical problems and external ear canal explanations. -Possible problems include: 1. Debris occluding the probe assembly 2. Cerumen occluding the probe assembly 3. Excessive cerumen in the external ear canal.
is the SRT ever better than the PTA
-Better SRT than PTA is one of the characteristic findings for patients with false or exaggerated hearing loss -A substantial discrepancy between thresholds for speech and pure tone signals warrants: 1. A critical examination of potential technical problems 2. Consideration of patient related factors 3. Perhaps performance of an objective hearing test
vestibular
-Body position/mvmt/balance=bioelectrical code (control-cerebellum)
bone conduction audiometry
-Bone Conduction Hearing Testing Step-by-Step •The steps reviewed for air conduction also apply to bone conduction testing •The range of test frequencies is more limited for bone conduction stimulation than for air conduction hearing testing •Bone conduction hearing thresholds are regularly measured for frequencies of 500,1000,2000, and 4000 Hz; measurement of 250 Hz is also feasible
AABR and OAES
-Both detect sensory (cochlear hearing loss) -Both can be impacted by outer or middle ear pathologies-resulting in a "refer" (i.e., False Positive) -Collectively, ABRs and OAEs can detect 80-90% of hearing losses in the degree of moderate or greater
founders of audiology
-C.C. Bunch -Norton Canfield (Army Otologist) -Raymond Carhart (trained under C.C. Bunch)
ABR latency analysis
-Calculations made most often during ABR analysis are determination of the latency and amplitude of the waves -An audiologist compares a patient's latency values to normal values to determine whether the response is normal or abnormal
inner hair cells
-Very small cells arranged in a single row in the cochlea with stereocilia ("hairs") on the top that communicate with auditory nerve fibers at the bottom. There are about 3500 inner hair cells in a human cochlea -Communicate with auditory nerve fibers -Release a chemical that produces a response in auditory nerve fibers when they are activated by vibrations -The electrical activity within auditory nerve fibers is transmitted quickly to the brain
Outer Hair Cell Motility
-Vibration of the basilar membrane produced sound activates outer hair cells -Movement of the outer hair cells with basilar membrane vibration is enhanced because the tops of the tallest stereocilia on the cells are imbedded with the tectorial membrane -Differences in movement of the basilar membrane below the outer hair cells and the tectorial membrane above the hair cells increase the bending motion of the stereocilia
Outer Ear and its function
-Cartilaginous -Skin continuous w/ skin on face -Level with middle 3rd of the face -Sits at a 30° angle -Helps with sound localization -Passive amplifier -Concave shape helps to collect and amplify sound and to funnel the sound into the external ear canal. -The bowl-shaped concha increases sound levels by up to 10 to 15 dB in the frequency region of 4500 Hz. -Outer ear enhances the detection of sounds coming from the direction a listener is facing. -It enhances localization which is the process of determining where a sound is coming from
what is sound
-Vibrations propagated through a medium (air) in the form of pressure waves -vibration of air particles produced by the vibration of an object or objects -"act of hearing" -Pitch -Loudness -Quality (Timbre) -Directional -mass -elasticity
displacment
-When an object is displaced from one point to another point -is constantly changing over time -Displacement in a waveform is referred to as amplitude
when to mask for air conduction
-Whenever cross hearing ("cross over") is suspected to determine: 1. If original response was from non-test ear (NTE). AND 2. If response is from the non test ear, then masking needed to obtain true threshold for the test ear (TE).
Supra-Threshold Measures
-Words or sentences presented at supra-threshold levels, that is, intensity levels considerably higher than the patient's hearing thresholds -A modest amount of ambient background noise may not affect the test outcomes for normal or near-normal hearing individuals -A level above a person's hearing threshold -Word recognition testing is conducted at a supra‐threshold level -A level above a person's hearing threshold -For example, word recognition testing is conducted at a supra‐threshold level
audiogram
-a graphic representation of hearing sensitivity as a function of frequency ("behavioral-subjective testing") -Pure Tone Air and Bone Conduction Audiometry: (Air Conduction and Bone Conduction) -Speech Audiometry: Speech Reception Threshold (SRT) and Word Recognition Score (WRS) -Pure Tone Average (PTA)
What is the Hippocratic Oath?
-a traditional promise given by healthcare providers to be ethical in their practice and dealings with patients -encourages healthcare professionals to share knowledge with those who follow them, such as less-experienced persons and students -According to the Oath, healthcare providers should use their knowledge and skills for the benefit of those who are not well while avoiding harm to the patient
Flow of Audiology Test Procedures
-Case History -Otoscopy -Tympanometry -Ipsilateral and/or Contralateral Acoustic Reflex Thresholds -Acoustic Reflex Decay -Otoacoustic Emissions (Distortion Product Otoacoustic Emissions (DPOAEs) -Speech Audiometry (Speech Reception Threshold (SRT) and/or Speech Awareness Threshold (SAT)); Word Recognition Score (WRS); Uncomfortable Loudness Level (UCL), Most Comfortable Level (UCL) -Pure Tone Air and Bone Conduction Audiometry -Auditory Brainstem Response Testing (when necessary) -Central Auditory Processing (CAP) testing (when appropriate)
examples of conductive hearing loss
-Cerumen impaction -Tympanic membrane perforation -Otosclerosis - bony growth on stapes footplate -Middle ear infection-Effusion: fluid in middle ear cavity
masking
-Change in threshold as a function of two coexisting sounds -two sounds heard simultaneously, intensity of one sound is louder, thus the other sound signal is not heard -Masker=interfering noise
factors influencing behavior test results
-Chronological age -Cognitive factors (e.g., memory) -Motivation -Attention
Diagnostic Value of Acoustic Reflex Patterns
-Close analysis of the patterns of acoustic reflex findings in the four measurements conditions (ipsilateral and contralateral for right and left ears) is useful for distinguishing persons with normal auditory function from those with various types of hearing loss -The diagnostic information from acoustic reflexes is greatly increased when the findings of pure tone audiometry and tympanometry are also included in the analysis
structures of the auditory brainstem
-Cochlear nuclei -Superior olivary complex -Lateral lemniscus -Inferior colliculus
therapy based management of tinnitus
-Cognitive Behavioral Therapy-Form of psychotherapy -Tinnitus Retraining Therapy (TRT) (Limbic system contribution): -Educational Component -Sound Therapy to facilitate with habituating the sound of the tinnitus by focusing brain on low-level broad band signal (success rate reported as being as high as 80%)
In clinical settings, the phrase patient history is used to describe information about the patient's past and present health status, including:
-Complaints -Symptoms -Diagnosed diseases -Family history of diseases and causes of death -Medical test results -Previous medical treatments
four types of hearing loss
-Conductive -Sensorineural -Mixed -Non-Organic /Functional
Eustachian tube
-Connects to Nasopharynx -Horizontal Orientation in Peds; Vertical in Adults -Maintains air pressure b/w outer and middle ear --"Plugged-up" feeling=unequal pressures --"Popping" sound=air rushing into ME -Closed tube-opens by four muscles/nerve: •Levator Veli Palatine (Vagus X) •Salpingophayngeus (Vagus X) •Tensor Tympani (Trigeminal V) •Tensor Veli Palatine (Trigeminal V) -A passageway that permits communication between the middle ear space on each side and the posterior region of the mouth (the nasopharynx)
the difference of audiologist in US compared to other countries
-Considerable differences in the education and training of audiologists from one country to the next. -Doctor of Audiology approach is rather unique to the United States. -In Sweden and Italy, for example, audiologists are physicians who have elected to specialize in providing services to persons with hearing loss, including nonsurgical management.
recorded speech
-Consists of carefully selected words clearly spoken by a single person without any distinct dialect -Speech is professionally recorded in a sound studio with high quality equipment -Speech materials are available for male and for female speakers -Recorded speech materials are consistent each time they are used -Recorded materials are the same from one clinic to the next
cerebral cortex
-Consists of multiple centers. -Several pathways lead from the thalamus to the cerebral cortex. -The cerebral cortex is very important for speech perception and communication
acoustic reflex
-Contraction of one or both middle ear muscles in response to an intense sound -Contraction of the stapedius muscle is typically measured in clinical audiology
Estimating Auditory Thresholds with ABR
-Currently, evidence based test protocols permit accurate estimating hearing thresholds for different audiometric test frequencies even in infants within days after birth -To objectively estimate auditory thresholds in infants and young children, the ABR is repeatedly recorded at progressively lower stimulus intensity levels for click stimuli and for tone burst stimuli at different frequencies
threshold for speech
-Defined simply as the faintest or lowest intensity level in dB HL at which a person can correctly recognize or identify about 50% of words that are presented -In some patient populations, such as infants, persons with reduced cognitive functioning and persons with profound hearing loss, only SDT measurement may be possible -At the least, SDT provides information on the minimum intensity level the patient requires for detection of speech -Recognition of identification of speech, such as specific words, is a more complex response than simple speech detection or awareness
prescription targets (different types of prescriptions for hearing aids)
-Desired Sensation Level (DSL 5.0) (99% of the time is used for Pediatric) -National Acoustic Laboratories (NAL-NL 2) (99% of the time for Adult/Geriatric) -Proprietary (Manufacturer specific)
what are the types of services an audiologist might focus on
-Diagnosis of hearing loss -Fitting of hearing aids and other devices -Assessment and treatment of persons with vestibular or balance disorders -Assessment and treatment of tinnitus
what is an audiologist's or an SLPs primary professional responsibilities
-Diagnosis of speech, language, hearing, and related disorders -Implementation of appropriate intervention -Referral to other professionals when appropriate
consonant-vowel dichotic tests
-Dichotic test with consonant-vowel (CV) syllables are rarely applied in clinical audiology -Peripheral hearing loss influences performance on CV tests more than for other dichotic procedures -The precise intensity level of words presented to each ear seems to be more critical for CV test materials than for other types of dichotic tests
HA Circuitry-digital technology
-Digital: Current Technology (90-100% of hearing aid fittings) -Mini computer that converts input signal (i.e., frequency, intensity and temporal pattern) into an enhanced speech/acoustic signal -Wireless -Binaural Synchronization -Sound transposition: Audibility in High freq. -Multi-Channel: High Fidelity processing -Automatic: Optimal program for every environment -Multiple Memories: Flexibility in hearing aid function based on environment -Feedback control: Automatic cancellation of sound loops (Trouble shooting) -Wind suppression: Automatic adjust microphone input when detect wind -Signal-to-noise (SNR) -Compression: Hearing aid quickly reduces input of loud sounds to avoid discomfort -Telecoil/Bluetooth
the phrase speech discrimination
-Distinguishing between two speech items that differ in only one speech sound like "cat" versus "bat." -is sometimes used, although inaccurately, when referring to word recognition. -Speech recognition materials for hearing assessment date back to the late 1940s and early 1950s.
period
-Duration in seconds of one complete cycle of a vibration or a pure tone. The period is the reciprocal of frequency. For example, the period of a 1000 Hz tone is 1/1000 second -time required per cycle -formula: 1/frequency
examples of mixed hearing loss
-Ear infection and noise induced hearing loss -Otosclerosis -Malformations of outer ear
stiffness
-Ease (compliance) or difficulty (stiffness) of the flow of energy
possible explanations for discrepancies between pure tone audiometry and OAE findings:
-Effect of middle ear dysfunction -Hearing loss that doesn't involve outer hair cell dysfunction
tinnitus can negatively impact life by:
-Emotionally, Socially, Strain personal relationships, Impact functionality at work, Disturb sleep, Disrupt concentration -Typically described as "ringing, buzzing, roaring, crickets, whooshing, hissing, tonal" sounds. -Tinnitus frequency can be "matched" at any frequency between 125-20,000 Hz. •Perceived loudness of tinnitus can be measured at any decibel level from -10 through 120 Hz. Impact on quality of life can be assessed via self-report questionnaires (One example: Tinnitus Handicap Inventory (THI)
Test Results Outcomes Dependent on Many Factors
-Equipment/ Environment -Examiner -Patient
sentence tests
-Everyday conversational speech generally consists of sentences that are often heard in the presence of background sound -Traditional monosyllabic word tests are not very realistic -Listeners can take advantage of a variety of auditory and non-auditory clues in perception of conversational speech
evidence-based tests
-Evidence or findings from research should guide clinical practice -Research findings for evidence-based tests are published in the peer-reviewed literature
carrier phrase
-Examples of carrier phrases preceding the test word are: "Say the word ____" or "You will say ____", where the blank is the word that the patient is expected to repeat. -Although the use of a carrier phrase is a common procedure in word recognition assessment, the strategy does not consistently improve test scores
Tele-Audiology
-Falls under Tele-Medicine/tele-health Umbrella -Principle is to provide service via a trained "facilitator" to those living in rural areas who are not able to travel long distances for treatment -Audiologist interprets/disseminates results; Testing performed only conducted under licensed practitioners scope of practice -Must be licensed/certified in state where service is being provided -World Health Organization (who): hearing loss #1 disability -Nemes (2010) estimates that as many as 90% of those needing audiological intervention live away from urban centers
high-risk peds for hearing loss
-Family history of Congenital hearing loss -Hearing Loss due to TORCH infections -Craniofacial anomalies -Non-syndromic and syndromic hearing loss -Neurodegenerative disorders -Bacterial/viral infections -Neonatal Intensive Unit-NICU > 5 days -TBI -Chemotherapy -Low APGAR score
Psychoacoustics
-Field focuses on study of the relation between the physical properties of sound (e.g., intensity and frequency) and the psychological or perceptual aspects of hearing (ex: loudness and pitch) -describes human perception of the physical properties of sound. -the study of the psychological or sensory response to the acoustical features of sound -Studying the relationship between physical aspects of sound (acoustics) and psychological responses
speech threshold measures relation to audiograms
-For children and adults, the intensity level at which speech is detected (the SDT/SAT) generally agrees with the lowest pure tone hearing threshold in the test ear within the frequency region from 250 to 4000 Hz -SDT/SAT can be up to 10 dB better than the speech recognition threshold (SRT) in the same person
BAHA: amplification for specific patient needs
-For patients who cannot use Air-Conduction Hearing Aids: Bone-Conduction Hearing Aids and Bone-Anchored Hearing Aids (BCHA and BAHA) -Alternative to a traditional bone conduction hearing aid -Suitable for children or adults with conductive or mixed hearing losses or single-sided hearing loss -Oticon Medical (PONTO 4) -Cochlear Americas (Osia) -Med-El Bonebridge
music is described in terms of
-Frequency and pitch -Intensity and loudness -Temporal properties such as the duration and sequence of sounds
region 3: inner ear
-Functional integrity of outer hair cells is essential for generation of OAEs -Increased basilar membrane movement associated with outer hair cell motility contributes importantly to hearing -The stria vascularis plays an critical role in generating energy needed for outer hair cell movement
Speech fundamental frequency
-Fundamental frequency is determined by the rate at which the vocal folds vibrate. -For any given person, the fundamental voice frequency depends on a variety of factors, such as age, gender, and the size of the vocal folds. -The male voice fundamental frequency ranges from 85 to 180 Hz. -The female voice fundamental frequency ranges from 170 to 250 Hz. -The fundamental frequency for young children is above 300 Hz.
good clinical etiquette
-Good clinical manners and habits contribute importantly to the ongoing maintenance of an environment of care and to an appropriate environment for hearing services -Clinical etiquette includes good habits in the direct provision of services, such as hearing testing -Development and consistent practice of good clinical habits will result in fewer mistakes in hearing testing, more efficient use of test time, and, perhaps most importantly, improved quality of care to patients
Sine Wave or Sinusoidal
-Graphic display of sound wave -Represents a single frequency -AKA=pure tones
patient response
-Hand raise -Push Button -Verbal Response -Non-verbal Response
Audiologist measure
-Hearing Sensitivity re: Hearing Disorder (C.C. Bunch) -Sound Level of Environment
audiologist measure
-Hearing Sensitivity re: Hearing Disorder - "C.C. Bunch" -Sound Level of Environment
mixed hearing loss
-Hearing loss as a result of outer or middle ear impairment/pathology AND inner ear deficit -Conductive and Sensory Mechanisms involved -Conductive component to hearing loss may be medically treated; however, medical intervention may not always resolve conductive component
Common Chief Complaints
-Hearing loss in one or both ears -Ear pain -Dizziness -Bothersome ringing sound in the ears
examples of clinical applications of otoacoustic emissions
-Hearing screening of infants, pre-school children, and school age children -Diagnosis of auditory dysfunction in children and adults -Monitoring cochlear (outer hair cell) auditory function in patients receiving drugs that potentially damage the ear -Early detection of false or exaggerated hearing loss -Early detection of ear damage due to exposure to excessive levels of noise or music
transcranial hearing
-Hearing sounds that travel across or around the head from one ear to the other -Most transcranial hearing occurs via bone conduction from one ear to the cochlea on the other side
universities and research labs
-High-quality state-of-the-art clinical services for patients with hearing loss and hearing related problems rest on a foundation of basic and clinical research. -Basic hearing research, often carried out in laboratories with animals as subjects, usually focuses on the anatomy and physiology of the auditory system and on the principles and mechanisms underlying hearing.
mass
-How fast or slow system oscillates -Adding mass ("thicker harp string") slows system down=low frequency produced
Birth of Audiology
-Important component of military rehabilitation effort for hearing loss was amplification (hearing aids). -Hearing aids were used to amplify volume of sound in attempting to facilitate communication in hearing-impaired soldiers. -Amplification (hearing aids) remains the most common approach to rehabilitation of persons with hearing loss.
Interference-interactions between sound waves (1+ tones)
-In phase -Out of phase (opposite phase) = sine wave flipped 180° -Different Waves can create new waves that sound like: 1. Beats 2. Pulsing 3. Difference Tones
industry and manufacturers
-In recent years an increasing number of audiologists have elected to take positions with hearing-related companies. -Some of these companies manufacture equipment used to test hearing. -Other companies manufacture devices used in the management of persons with hearing loss. -These companies design and build hearing aids and also complex electrical devices like cochlear implants.
dichotic listening tests
-In the dichotic listening condition, information that enters each ear travels up the auditory nerve -Then the information takes pathways that cross over to the other side of the brain -The dichotic listening mode puts great demands on the auditory system -information from each ear reaches the auditory cortex only via the contralateral or crossing pathways -Activity is suppressed in ipsilateral pathways during dichotic listening •Auditory information (e.g., words or sentences) entering the right ear reach only the left side of the brain and vice versa
The acoustic reflex is activated and recorded with four combinations of measurement conditions
-In the ipsilateral condition a sound stimulus is presented to one ear and the change in middle compliance is recorded in the same ear -In the contralateral condition, the activating sound stimulus is presented to the ear opposite the ear with the probe assembly recording changes in middle ear compliance -There are four measurement conditions since each ear can be used for stimulus presentation and for recording middle ear compliance
condition play audiometry
-Incorporating the use of games into Audiology Test Procedure: Dropping blocks in bucket, Connect 4, Puzzles, Blowing/ Popping Bubbles (Last Resort) -At a minimum want Speech Threshold and Threshold in each ear at 500, 1000 and/or 2000 and 4000 Hz
false negative
-Incorrect Elimination of Disorder (Type II Error) -Not responding when tone is presented -Re-instruct -Change stimuli
false positive
-Incorrect diagnosis (Type I Error) -Responding when no tone presented -Re-instruct -Change stimulus -Change response manner (hand raise to push button or say "yes")
joint committee for infant hearing position statement-audiology highlights
-Infant screenings should be performed prior to 1 month of age -Infants that refer should receive "comprehensive audiological" evaluation prior to 3 months of age -Infants with confirmed hearing loss (including ANSD) should receive appropriate intervention prior to 6 months of age -JCIH, 2019 new position statement with 12 specific goals (expanded from 8 goals (2013)
protected health information includes
-Information typically recorded in a medical or health history -Physical examination and diagnostic test results -Details about the patient's injury, illness, diagnosis, or surgery -Other displays of health findings, such as photographs, radiographs, and hearing test results
key factors in amplification success
-Initial Needs Assessment: Case history, diagnosis, address parents or patients concerns -Electroacoustic and Physiologic compatibility -Hearing Aid Verification -Comprehensive Habilitative/Re-habilitative follow up. -Parents advised that child should wear device(s): ALL WAKING HOURS of the DAY -Sound therapy at home-Auditory Training -BTE with FM system -Aural rehabilitation -Lipreading classes -Not a CI candidate
performance intensity functions for phonetically balanced words
-abbreviated as PI-PB function -a graph showing word recognitions scores for word lists as the testing is conducted at different intensity levels -Word recognition scores typically increase as the intensity level increases -Word recognition performance for some patients atypically and paradoxically worsens for the highest presentation levels -Jerger and Jerger coined the term rollover to describe the decrease in word recognition scores as the intensity level increases
Localization
-ability to detect the direction a sound is coming from -Possible due to: interaural phase difference (below 1500 Hz) and Intensity difference (High Frequencies) -Interaction of both ears
License requirements
-academic degree -passing score on national exam (praxis) -state licensure (legally mandated) -American Speech-Language Hearing Association (ASHA); Certification of Clinical Competency (CCC-A) required; CEUs regulated (30 in 3 YEARS) -American Academy of Audiology (Volunteer Membership); American Board of Audiology (ABA); Life-long CEU commitment
Audiogram for sensorineural hearing loss
-air conduction and bone conduction responses are within 10 dB HL -bone conduction masked thresholds required when one ear is the better hearing ear (250-4000 Hz)
Audiogram for mixed hearing loss
-air conduction and bone conduction responses have some frequencies with a 0-10 dB HL air bone gap difference, while other frequencies have a 15 dB HL or greater air bone gap difference AND all bone conduction thresholds are in the hearing loss range (250-4000 Hz)
transducers
-all devices that deliver sound during hearing testing -An electroacoustic device for convert- ing energy from one form to another. An earphone is a transducer that converts electrical energy to acoustic energy (sound).
manual dial
-allows for intensity changes of tone and/or speech -Typically set for 5 dB HL increments; however, can also be changed in 1 or 2 dB HL increments
Speech Detection Threshold (SDT)
-also called speech awareness threshold (SAT), is the lowest intensity level in dB HL at which a person is aware of or can detect the presence of a speech signal -Measurement of the SDT does not require the patient to repeat or understand speech. -Only awareness is needed for a correct SDT response
private rules apply to what
-any general information that could possibly reveal the identity of the patient, such as the patient's: -Name -Birth date -Hospital or medical record number -Social security number -Telephone number street mailing address or e-mail address
Distortion product OAEs (DPOAEs)
-are elicited with pairs of two pure tones rather than a single transient stimulus -The two stimulus tones are labeled f2 and f1 which are closely spaced together -The ratio the higher frequency to the lower frequency (the f2/f1 ratio) is about 1.20. -Stimulus tones are presented simultaneously at moderate intensity levels usually in the range of 55 to 65 dB SPL -DPOAEs are usually recorded across a frequency region of 500 to 8000 Hz
Transient evoked OAEs (TEOAEs)
-are elicited with very transient or brief sounds like clicks or tone bursts -Stimuli are usually presented at an intensity level of 80 dB SPL -TEOAE energy is recorded within a frequency range of 0 Hz up to about 4000 Hz
screenings using physiological/objective test equipment
-automated auditory brainstem response (AABR) -otoacoustic emissions (transient evoked and/or distortion product)
the cerebellum plays an important roll in what
-balance and the coordination of movement -may also be involved in auditory function
Health Insurance Portability and Accountability Act (HIPAA)
-because of this, Federal and state laws pertaining to privacy and security of PHI were strengthened considerably between 2003 and 2005 -designed to maintain patient privacy and security -Healthcare professionals and all other persons who fail to maintain patient information confidentiality can face very serious penalties, among them civil or criminal sanctions such as substantial fines and prison time -Penalties may be imposed whether the disclosure of PHI was incidental, accidental, or unintentional -Most audiologists and speech pathologists are required by their employers to regularly review HIPAA rules and regulations and to complete training modules
techniques used when behavioral testing with peds birth- two years old
-behavioral observation audiometry (BOA) -visual reinforcement audiometry (VRA)
Audiogram for conductive hearing loss
-bone conduction responses are all within normal limits -air bone gaps of 15 dB HL or greater -some or all of the air conduction thresholds are in the hearing loss range
SCAN test battery
-brief test battery consisting of four separate subtests. -Well-known audiologist Bob Keith developed the SCAN -The original SCAN consists of four speech procedures: 1. Filtered Words subtest 2. Auditory Figure Ground subtest 3. Competing Words subtest 4. Competing Sentences subtest
collapsing ear canals
-can interfere with presentation of sounds during hearing tests and can lead to an erroneous finding of hearing loss (High Frequency Conductive Hearing Loss) -The relatively soft cartilaginous portion of an external ear canal sometimes collapses under the pressure of conventional earphones that fit over the external ears -The likelihood of ear canal collapse is increased in certain populations, such as infants and elderly adults
afferent auditory pathway
-cochlea -CN VIII -brainstem (cochlear nucleus, superior olivary complex, lateral lemniscus, inferior colliculus (crossover), medial geniculate body) -brain (auditory cortext/temporal lobe)
Otoacoustic Emissions (Transient Evoked and/or Distortion Product Otoacoustic Emissions)
-cochlea only (peripheral system-specifically outer hair cells) -Freq. 500-4000 Hz -DPOAEs more common than TEOAEs
Surgical options
-cochlear implants (CI) -bone anchored hearing aid (BAHA) -Middle ear implants (Moderate-to-Severe SNHL; Mixed HL) -auditory brainstem implants
outer and middle ear are ____ and responsible for
-conductive -collecting acoustic sound -converting acoustic sound to mechanical energy -transmitting the sound to inner ear
evidence-based practice
-conscious, explicit, and judicious use of the best and current evidence available, when making decisions about patient care -Uses clinical experience and research based principles when providing intervention services
different references for decibels
-dB SPL (sound pressure level) -dB HL (hearing level) -dB SL (sensation level)
distorted speech tests
-distorted speech tests are sometimes included in test batteries for the evaluation of specific types of auditory dysfunction -Distorted speech tests are used to assess auditory processing disorders (APD)
the limbic system serves the functions of
-emotion, long-term memory, and other aspects of behavior
Why is ABR important in Hearing Assessment of Children?
-essential for describing both the degree and type of hearing loss in infants and young children -findings lead directly to early intervention for hearing loss -Early intervention of hearing loss in children (before 6 months after birth) is critical to increase the chances of normal development of speech, language, and effective communication
A turn of the head to the right will generate an _____ _____ in the right ear and a corresponding ____ ____ in the left ear
-excitatory response -inhibitory response
power
-exertion of physical force/energy -expressed as rate in which energy is expended -Measure for the magnitude of sound -As distance from source ↑'s; sound energy ↓'s
transient sounds
-extremely brief sounds with durations of milliseconds or even a brief portion of just one millisecond. -Examples of transient sounds are click sounds and tone bursts.
whats the preferred method
A long‐standing approach for conducting pure tone hearing testing in which sounds are decreased in intensity by 10 dB and then increased in intensity by 5 dB
impedance
A measure of total opposition to energy (current) flow in an electrical, mechanical, or acoustical system. Inter‐electrode impedance in evoked response measurement is the opposition to current flow between a pair of electrodes, reported as electrical resistance in ohms
tuning fork
A metal device with a stem and two tines that produces a specific frequency like 500 Hz with vibration after it is struck on the hand
ascending technique
A technique for estimation of pure tone hearing thresholds that begins at a level below a person's likely hearing threshold with presentation of stimulus sounds at progressively higher levels
conditioned play audiometry
A technique for hearing testing in young children that trains the patient to perform a game‐type activity like dropping blocks into a bucket or putting pegs into holes in a board every time a sound is heard
ear specific
A term used to describe test results that result from stimulation of only the right or the left ear without involvement of the non‐test ear
weber test
A test performed with a tuning fork or an audiometer to measure the lateralization of forehead presented bone conducted sound to the right ear, the left ear, or the middle of the head. The Weber test is usually performed with low-frequency pure tones like 250 and 500 Hz
bing test
A test to measure the occlusion effect that can be performed with a tuning fork or audiometer. The Bing test is useful in trying to determine whether a hearing loss is conductive.
endolymph
A thick fluid in the auditory and vestibular portions of inner ear and specifically within the scala media
closed-set response test
A type of speech audiometry procedure that includes a relatively small and fixed number of items like words or sentences that the patient responds to
decaPascals (daPa)
A unit of pressure used in acoustic immittance measurements, such as tympanometry
temporal bone
A very hard skull bone enclosing the external ear canal, the middle and inner ear, and within the internal auditory canal, the eighth (auditory) cranial nerve
cochlear implants
Complex electrical devices that are used in the management of persons with severe or profound hearing loss consisting of external components for picking up sound and converting the sound to electrical signals and internal components for delivering the electrical signals to the auditory nerve
damping
Decrease in the amplitude of a vibrating body over time
instantaneous displacement
Displacement of a point on a waveform at a specific time
auditory neuropathy
Disruption in the transmission of information from inner hair cells to and along nerve fibers results neural auditory dysfunction
Wavelength
Distance between the same point on two successive cycles of a pure tone
pediatric audiology
Evaluation of hearing and management of hearing loss in children
initial effective masking
Initial starting level in dB HL where narrow-band noise (NBN) masking is presented to the non testing ear
over masking
Level of narrow band noise (NBN) is so loud that it crosses over to the TE (testing ear) and causes interference with detecting the pure tone signal
loudspeakers
Loudspeakers located a few feet away from the ears are sometimes used to deliver sounds to a patient
plateau method
Masking technique that progressively increases the loudness of the narrow-band noise (NBN) to ensure masking threshold in the non testing ear (NTE)
true positive
Sensitivity (correct diagnosis of disorder)
warble tones
Slight and rapid change or modulation the frequency of pure tones used in hearing testing with loudspeakers in a sound‐treated room to minimize the likelihood of constructive or destructive interference
Greater Impedance= _________ Amplitude
Smaller
concha
The bowl‐shaped region of the outer ear that helps to collect sound before it passes into the external auditory canal
Elasticity
The capacity of an object that has been deformed to return to its natural shape
Spiral Ganglion
The collection of auditory nerve cell bodies
labyrinth
The complex fluid‐filled passageways within the auditory and vestibular portions of the ear that are enclosed within the temporal bone including the bony labyrinth and the membranous labyrinth
degree of hearing loss
The extent or severity of a deficit in hearing thresholds. Degree of hearing loss on an audiogram is often described with terms like mild, moderate, and severe
audiometric frequencies
The frequencies typically included in hearing testing including 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz, and 8000 Hz.
maximum masking
The highest intensity level of masking noise that can be presented to the non‐test ear before the noise level exceeds inter‐aural attention for the earphone and cross masking occurs and the test ear is affected by over‐masking
cochlea
The inner ear located within the temporal bone of the skull. The cochlea consists of important structures for hearing, including the inner and outer hair cells, the basilar membrane, the stria vascularis, and many other structures
initial masking
The lowest level of noise presented to the non‐test ear during masking. The level of initial masking is equivalent to the hearing threshold in the non‐test ear
minimum masking
The lowest level of noise presented to the non‐test ear that masks hearing and prevents detection of stimulus sound crossing over from the test to the non‐test ear
Speech Reception Threshold (SRT)
The lowest speech level at which a listener can correctly repeat or recognize approximately 50% of a small series of words. See Speech recognition threshold
apex
The low‐frequency region of the cochlea at the opposite end from the base near the stapes
bony labyrinth
The peripheral vestibular organs are housed in the petrous portion of the temporal bone within a series of hollow channels, known as the bony labyrinth
transcranial transmission loss
The reduction in the intensity of a sound stimulus as it travels from the test ear to the nontest ear. See Interaural attenuation
organ of corti
The sensory organ of hearing is located on the basilar membrane of the cochlea (inner ear). It contains inner and outer hair cells as well as supporting cells. Mechanical energy is transduced to bioelectrical energy at the organ of Corti
configuration of hearing loss
The shape of an audiogram determined by how the degree of hearing loss changes as a function of the test frequency. Common configurations are flat, rising, and sloping hearing losses
video otoscopy
Visualization of the external ear canal and tympanic membrane with a computer or video monitor during inspection of the ear.
when did the profession of audiology begin
WWII (mid 1940's)
medial
a location towards the middle or inside
health information should not go beyond what
a patient and her/his healthcare provider, unless the patient gives written consent for a release of information to other persons or parties or the information is required for treatment purposes
audiologist use sound as
a signal or stimulus to assess hearing
Otoscopic inspection may reveal
a variety of unexpected objects such as pebbles, small parts of toys, bits of food, pieces of cotton swabs, and even insects
Board Certification
In audiology the highest credential for clinical practice offered by the American Board of Audiology (ABA)
what are the areas of study within hearing science
anatomy, physiology, psychoacoustics, and auditory neuroscience.
Each canal is stimulated primarily by
angular acceleration (head rotation) in the plane in which it is oriented
The vestibular system is responsible for
angular, rotational motion, linear acceleration of the head/body and gravitational forces and functions as one component of a complex sensory and motor output network (VOR, balance)
each cochlear nucleus is located
anterior to the cerebellum in the brainstem
Helicotrema
apical most portion of cochlea where fluid can pass between Scala Tympani and Scala Vestibuli
Wave I
arises from activity in auditory nerve fibers, particularly fibers in the distal end of the auditory nerve near the cochlea
why is hearing aid verification a critical component of the hearing aid fitting
as it ensures the appropriateness of hearing aid settings and features (adults and pediatrics) and provides the best possible starting point to enhance communication development (pediatric population)
The normal human ear responds to frequencies
as low as 20 Hz to frequencies as high as 20,000 Hz
speech testing
assesses speech sensitivity and word recognition abilities (frequency range 250-4000 Hz)
the basilar membrane is more narrow where
at the base than at the apical end
The eighth cranial nerve transmits
auditory and vestibular information from the ear to the brain
what is at the highest level of the central nervous system
auditory cortex (within the cerebrum)
Efferent auditory system function may also be related to what
auditory disorders like tinnitus in persons who have been exposed to excessive levels of noise
Acoustic reflex decay is a sign of what
auditory dysfunction involving the auditory nerve or the auditory brainstem, rather than the inner ear
the eighth (or 8th) nerve is sometimes known as the
auditory, acoustic, or audiovestibular nerve
outer ear
auricle/pinna
amplitude
calculated as the size of the wave in microVolts (mV) from its peak to the valley that occurs before or after the peak
bone vibrator or oscillator
can be used to deliver stimulus sounds to the inner ear by vibrating the bones in the skull
advanced bionics
can have hearing aid on one ear and CI on other
umbo
center point of TM pulled inward by ~ 2 mm
Aural Rehabilitation
centers for soldiers after ww11
Modiolus
central portion around which the cochlea turns. Central portion is hollow and houses auditory portion of CN VIII
Tracts from the vestibular nucleus on each side of the brainstem travel to the
cerebellum, to visual and motor centers in the brainstem, to eye muscles, and to large muscles of the neck and trunk
what is the most complex region of the brainstem and the highest level of the auditory system
cerebral cortex
Perilymph is very similar in composition to the ______ that surrounds the spinal cord the brain.
cerebrospinal fluid
ECochG is important in the diagnosis of
certain auditory disorders in children and adults
earwax
cerumen
membranous labyrinth is housed within the ____ and is filled with ____
channels of the bondy labyrith and is filled with endolympth
are there discrepancies between the pure tone audiogram and OAE findings
clinical experience has repeatedly revealed the possibility of discrepancies
auditory and vestibular neural pathways travel _____ ____ within the ____ _____ _____ from the ear to the brain
closely together internal auditory pathway
Auditory nerve fibers make their initial synapse with neurons in the where?
cochlear nuclei in the brainsteam
Quantifiable measurement performed via pure tone audiometry compares _____ with an _____
compares individual threshold (ϴ) with an "established norm at various frequencies"
crista
complex sense organ containing hair cells within the ampulla
Most middle ear abnormalities obscure
confident detection of acoustic reflexes
even the highest level of acceptable noise for sound-treated rooms is
considerably less than noise levels encountered in everyday settings
Currently, the best strategies for preventing permanent hearing loss due to noise exposure are
consistent use of hearing protection and avoidance of exposure to high intensity whenever possible
white noise or broadband noise
consists of sound at about the same intensity level over a wide range of frequencies.
Perilymph within the scala vestibuli and scala tympani contains
contains a high concentration of sodium (Na+) ions and a low concentration of potassium (K+) ions
efferent auditory system plays a role in
controlling function of the ascending afferent auditory system
communication modes
cued speech, manually coded english, american sign language, auditory verbal (AV) approach, aural/oral method, total communication
Measurement of acoustic impedance
defines the total amount of opposition to the flow of energy through the middle ear system from the eardrum to the inner ear
Pyschosocial
describes a patient's conscious and unconscious psychological adjustment and adaptation to the social environment
Head tilt (Utricle: Horizontal Plane)
detected due to the density and weight of otoconia under the force of gravity (Horizontal Mvmt=Head upright relative to gravity-head/body bending forward)
Linear acceleration (Saccule: Vertical Plane)
detected in the same manner when translational (body mvmt) forces applied ( Vertical mvmt=Elevator; Car Forward/Backward)
vestibular system specializes in
detection, coding, and processing of movement
aural habilitation examples:
diagnosis of communication/hearing related difficulties, speech perception training, & speech and language therapy
Aural Rehabilitation examples
diagnosis of hearing loss and communication handicap, amplification, ALDs, CIs, auditory training, communication strategy training & speech and language therapy
Because hearing sensitivity is not equal at different frequencies, 0 dB HL can only be achieved by applying different
different amounts of pressures at the different frequencies, re: large number of normal hearing individuals
Auditory Processing Disorders (APD)
difficulties some patients experience in processing auditory information even when the audiogram is normal
hearing disability
difficulty performing biological/socially useful functions
Results of acoustic immittance measurement are distinctly different for a patient with a ____ than for a patient with ____
disorder that increases stiffness of the middle ear system THAN for a patient with a disorder producing excessive flexibility within the ossicular chain
Movement of the heavier otoconia located above the stereocilia increases what
displacement of the stereocilia on the hair cells and enhances vestibular function
Disorders of the vestibular system result in what most people call
dizziness, imbalance, lightheadedness, or vertigo
pathways that lead from one ear to the central auditory system on the opposite side are ___________ than pathways carrying information from the ear to higher structures on the same side
dominant and more plentiful
hearing loss can occur
due to diseases or conditions that affect any portion or a combination of portions of the ear
most hearing loss is due to what
dysfunction of hair cells within the inner ear
tympanic membrane is your what
eardrum
The scala media is filled with a fluid called
endolymph
fluid inside the three semi circular canals
endolymph
audiologists and speech pathologists receive inoculations
for diseases that can be transmitted from one person to another, such as tuberculosis and hepatitis B
infection control and prevention are always
foremost in a healthcare facility
speech sounds are highly important for humans as they
form the basis for oral communication
Audibility of sound varies greatly, depending on the properties of sound including
frequency, phase, duration, and intensity (dad found insulin pens)
resonance is determined by what
frictional characteristics: mass, elasticity, impedance
ventral
front side of the brain
in phase waves together=
greater amplitude
The saccule and utricle detect
movement in a straight line and also the force of gravity
Shearing of hair cells occur as a result of
movement of endolymph causing Otoconia to depress on otolithic membrane
The temporal bone is one of the _______ bones in the body
hardest
Auditory brain-stem response measurement is one method for screening ____ _____
neonatal hearing
is there a one-to-one relation between a single auditory structure and a single ABR wave
no besides wave I
is the ABR a test of hearing
no but it is a valuable clinical tool
octave band noise
noise that falls within a single octave range of frequencies, such as between 1000 and 2000 Hz or between 500 and 1000 Hz
masking noise delivered to the
nontest ear during bone-conduction audiometry performed from the mastoid, using a supra-aural earphone and the forehead, using an insert earphone
the impedance matching middle ear system is important for
normal hearing
The presence of acoustic reflexes usually indicates
normal middle ear function
electroacoustical auditory responses are ___ ____ on the patient's attention to the stimulation
not dependent
example of spondee words- SRT
oatmeal, mushroom, northwest, toothbrush, inkwell, hotdog, armchair, headlight, horseshoe, sidewalk
Acoustic immittance measurements allow audiologists to
objectively describe and quantify how well the middle ear is working
conductive hearing loss occurs as a result
of outer or middle ear pathology
Between formally scheduled calibration sessions, the output of audiometers should be monitored
on a daily basis with a listening check
Otoconia (Calcium Carbonate Crystals) lies where
on top of otolith membrane
hearing is entirely dependent on
on transmission of electrical activity from the inner hair cells to auditory nerve fibers
who do audiologist work closest with
otolaryngologists (ear, nose, and throat or ENT specialists) and otologists (ear subspecialists in otolaryngology)
The saccule and utricle are referred to as what and because they contain
otolith organs because they contain tiny rock-like crystals called otoconia
what plays an important role in the production of OAEs
outer hair cell motility
what separates the middle ear from the inner ear
oval window
Tectorial Membrane
overlays organ of Corti and is coupled to stereocilia of outer hair cells
Before beginning the assessment process, an audiologist generally acquires and/or reviews the relevant ______ _____
patient history
The scala tympani is filled with
perilymph
The scala vestibuli is filled with a fluid called
perilymph
fluid inside the vestibule
perilymph
two subsystems of the ear
peripheral system and central system
In developing materials, word lists were strategized to be
phonemically balanced and called PB word lists
rising
poorer hearing thresholds for lower frequencies and better hearing at higher frequencies
Endolymph has a significant
positive ion (+80 mV) in comparison to the essentially neutral ionic charge of the perilymph
otoscopy provides clues about the
possibility of ear canal collapse and may reveal evidence of external or middle ear pathology
pediatric management considerations
prelingual, perilingual, postlingual
Recent research on structure and function of the outer hair cells has revealed the
presence of a specialized motor protein known as prestin
probe device in OAEs is used to what
present stimulus sounds to the ear and to detect very faint sounds produced by the ear
the test booth needs
proper ventilation, patient viewing, and lighting is necessary
Audiologists, physicians, and other healthcare professionals have an obligation to assure that ____ ____ ____of patients remains strictly confidential
protected health information (PHI)
humanistic caregiver
provides services with empathy and compassion, making every effort to understand the effect of the patient's hearing loss on psychosocial functioning and quality of life
Acoustic reflex measurement in combination with other tests of auditory function, provides a
readily available, quick, and objective method for ear specific identification of hearing loss in infants and young children
precipitous sloping
reasonably good hearing thresholds at lower frequencies, then, hearing thresholds decrease sharply as test frequency increases
A clear understanding of how OAEs are generated within the cochlea is essential for
recording OAEs and analyzing findings in varied patient populations
right earphones are distinguished by
red markings
patients with acoustic reflex decay outcome are promptly
referred to a medical specialist like an otolaryngologist for further evaluation
auditory temporal resolution
refers to the ability to detect rapid changes in a set of sounds and that is important given that speech itself is a rapidly changing set of sounds
auditory closure
refers to the ability to identify words when sounds in those words are distorted or masked by noise.
auditory temporal patterning
refers to the ability to recognize stress and intonation changes that add to the meaning of speech.
audiotory binaural interaction
refers to the ability to use differences in timing, intensity, and/or frequency of sounds between the two ears that help us hear better in noise
binaural separation
refers to the ability, when presented with a different message at each ear, to identify one message while ignoring the other message
binaural integration
refers to the ability, when presented with a different message at each ear, to identify those different messages.
acoustic admittance
refers to the ease with which energy flows through the middle ear
what are the four general regions of auditory system anatomy that are involved in OAE measurement
region 1: external ear canal region 2: middle ear region 3: inner ear region 4: efferent auditory system
lesion
region of damaged or diseased tissue
3 categories of sound wave interactions or interference
reinforcement, cancellation and sound reverberation
Auditory nerve fibers from the right ear lead directly to the
right cochlear nucleus
what form the organ of cortis main supporting framework and enclose the tunnel of corti
rods and pillars
Two of the major structures of the peripheral vestibular system are the
saccule and the utricle
The basilar membrane separates the
scala media from the scala tympani
reissner's membrane separate the
scala vestibuli from another wedge-shaped portion of the tube, named the scala media
Angular or rotational movement of the head is detected by
sense organs at the base of the three semicircular canals
The acoustic reflex for noise stimulation increases directly as
sensory hearing loss increases
macula is the
sensory receptor organs
Materials used in speech audiometry also consist of more complex units of speech, such as _____
sentences
Hair cells are arranged
shortest (Stereocila) to tallest (Kinocilium) extend into the) otolith membrane (Gelatinous)
where is the temporal bone located
side of skull
what is the simplest form of vibratory motion
simple harmonic motion aka oscillation
the inner ear is surrounded by what
skull bones
hearing threshold (ϴ)
softest intensity level in which a sound is heard (50% of the time)
audiologist work with various types of what
sound
true negative
specificity (Rejecting incorrect diagnosis)
Audiologists can select from a variety of test procedures designed especially for assessing ____ _____ and _____ ____ in young children, including tests incorporating words that are within the vocabulary of pre-school and young school-age children
speech thresholds and speech recognition
Sound energy reaches the inner ear when the
stapes footplate at the end of the ossicular chain moves in and out
The presence of acoustic reflexes is highly dependent on
status of the ear
Forces of gravity and inertia bend the
stereocilia on vestibular hair cells
anatomy
structure
tinnitus
subjective report of "sensation of ringing or other sounds in the head, without an external cause: etiology
where are the important auditory centers in the cerebrum found
temporal lobes
conductive hearing loss by be
temporary hearing loss
reliability
test repeatability
Family Educational Rights and Privacy Act (FERPA) was passed to ensure what
that student personal information is properly safeguarded and used only for legitimate purposed and only when necessary
famous hearing science research centers in the early years included
the Psychoacoustic Laboratory (PAL) at Harvard University in Cambridge, MA and the Bell Labs in New York and New Jersey
in contrast to pure tone stimulation, there is a more direct relation between hearing loss and
the acoustic reflex thresholds elicited with noise stimulation
dorsal
the back side of the nervous system
The efferent auditory system may help to improve what
the detection, localization, and perception of speech in a setting of background noise
what did hearing science research lead to
the development of the audiometer which was first used by several prominent otolaryngologist in clinical hearing assessment
audibility of a sound occurs at
the faintest intensity level of the sound that can be detected.
acceptable noise levels in the test room also depend on
the frequencies of sound used to assess hearing
audiology
the health profession responsible for caring for persons with hearing loss and related problems
Behind the oval window is a space called the vestibule which leads to
the hearing part of the ear, the cochlea, and also to the vestibular part of the ear
A patient's auditory threshold corresponds to
the intensity level where ABR wave V disappears
where are the outer hair cells located
the lateral portion of the cochlea
Type I and Type II cells are located within
the macula
in the inner ear, thousands of tiny and delicate hair cells are activated as what?
the membrane moves up and down rapidly in response to sound
manubrium of malleus is attached to what
the middle, fibrous layer
pars flaccida
the most flexible region of the tympanic membrane, is near the edge in the anterior-superior quadrant.
stapedius muscle is connected to ____ and is innervated by the ____
the neck of the stapes and innervated by the seventh (facial) cranial nerve
techniques and strategies used during speech audiometry with children are very much dependent on what?
the patients developmental age
the cerebellum is found at the same level as what
the pons
reinforcment
the pressure of two or more waves add to each other
insert headphones
the stimulus is delivered into the ear canal by means of a soft compressible foam plug inserted well within the external ear canal
validity
the test accurately measures what it was designed to measure
latency of a wave
the time interval from the presentation of the stimulus to the occurrence of a wave
phonemically balanced means
the word lists are composed of speech sounds or phonemes which occur with about the same frequency as they do in everyday conversation
inferior
there is a structure above it
Superior
there is a structure below it
hearing loss is the ____ most chronic health condition within the elderly population
third
are there more outer or inner hair cells
three to four times more outer hair cells
how do hair cells communicate with nerve fibers
through a synapse which is defined as a "point of contact"
goal of the hearing aid selection process
to define the appropriate physical and electroacoustic characteristics of the desired hearing aids for a particular individual using methods that will facilitate ordering, verification, and validation of the devices
Tensor tympani muscle is connected to the ____ and is innervated by the _____
to the malleus and innervated by the fifth (trigeminal) cranial nerve
ABR threshold is measured for ___ ____ ____ at different frequencies such as ___, ___, ____, and/or ____ Hz.
tone burst stimulation 500, 1000, 2000, 4000
rostral
toward the head
lateral
toward the side or outside
Caudal
toward the tail
true or false: ABR provides no information on auditory structures above the level of the brainstem
true
The superior and posterior canals are oriented in
two different vertical planes
epitympanic recess
tympanic cavity houses ossicles and muscles
eardrum
tympanic membrane
sound levels in restaurants
typically range from 59 to 80 dBA with an average of 71 dBA
Ohm (Ω)
unit of measurement for impedance
bone conduction
used to describe hearing tests conducted via vibrations transmitted through the temporal bone which generate movement of fluids within the inner ear and activate outer and inner hair cells
air conduction
used to describe hearing tests conducted with insert earphones (or Supra Aural Headphones) since the ear is stimulated by sound waves traveling through the air
total communication
uses a variety of modes to communicate (i.e., hearing/listening, signing, speech reading)
Damage to hair cells caused by diseases or by exposure to very high intensity sounds is
usually irreversible and results in permanent hearing loss
____ is a main feature of a vestibular disorder
vertigo
assessment of the ____ ____ and ____ _____ is within the scope of practice of audiologist
vestibular system and vestibular function
point of entry for the cochlea
vestibule
Almost all auditory nerve fibers connect via what
via a synapse with the inner hair cells
inertia + elasticity =
vibrate
cosine wave
vibration begins at 90°
Each movement of the stapes footplate produces
vibration of the basilar membrane that travels away from the footplate
Initial Evaluations-Case History/Diagnostics for pediatrics
•Pregnancy/Birth History: •Normal/complications •Pass UNHS •Medical History: •Major Illnesses/Surgeries •Ear Infections •Early Development: •Meet Milestones •Communication Mode •Educational History: •Concerns •Hearing History: •Family History of HL •Parent Concerns about Child's Hearing •Hearing Aid/CI History: •Technology •Consistent use/function/satisfaction
manually coded english
•Signed English (SE) •Signing Essential English (SEE) •Signing Exact English (SEE 2) •Pidgin Sign English (PSE) •English is Linguistics of Visual English (LOVE) •Rochester Method (speech and fingerspelling; "writing in the air")
inner hair cells characteristics
•Single Row with approx. 3000 IHCs per cochlea •Responsible for Sensory Transduction •Receive primarily afferent innervation (ascending to brain) • Stereocilia are not imbedded in the tectorial membrane •Shaped like a flask
outer hair cells characteristics
•Three to Five Rows with approx. 12,000-15,000 OHCs per cochlea •Responsible for amplification and fine tuning of the traveling wave •Receive primarily efferent innervation (descending from brain) •Contain Prestin, a motor protein, and are motile (they are able to move and generate force) •Stereocilia are imbedded in the tectorial membrane •Shaped like a tube
professional liability dictates what
healthcare professionals, including audiologists, by virtue of their advanced knowledge, training, and skill, have a responsibility to adhere to certain standards of conduct and protect patients from unreasonable risks and intentional or unintentional injury
the organ of corit plays a critical role in
hearing
Perilingual
hearing loss occurring during timeframe of acquiring speech/language
prelingual
hearing loss prior to acquisition of speech/language
automated audiometry
hearing testing under computer control
what does the mastiod bone play a role in
hearing tests that involve bone conduction stimulation
flat
hearing thresholds are approximately at the same hearing loss dB level across the frequency range
corner
hearing thresholds are recorded only for a few of the lowest test frequencies and only at very high intensity levels; for higher test frequencies, there is no response to pure tone stimulation at the outputs of the audiometer
sloping
hearing thresholds are relatively better at lower frequencies and progressively decrease at higher frequencies
notching
hearing thresholds are relatively good for lower test frequencies; thresholds then slope downward, usually reaching maximum hearing loss at one of more test frequencies within the region of 3000 to 6000 Hz; then, hearing thresholds improve for the highest test frequencies with a notching pattern
Endolymph consists of a
high concentration of potassium (K+) ions and a low concentration of sodium ions
what types of sounds activate hair cells in the base of the inner ear towards the stapes footplate
high pitch sounds
lateral semi circular canal is in a
horizontal plane
In providing clinical services, audiologists and speech pathologists strive to follow a
humanistic approach focused and centered on the patient and family (family centered)
what do audiologist do when accurately evaluating hearing function
identify, quantify, describe, precisely define, and manipulate sound
Lateralization
identifying whether sound is coming from the right or left side
in phase
if vibration begins at 0° or 360°; adding two
The phrase acoustic immittance is a combination of the terms
impedance and admittance
what is an audiologist or SLPs ultimate objective
improvement of a patient's communication and quality of life
Each of the 3 semi circular canals are oriented
in a different position and at right angles to the others.
hermetic seal
in audiology, an airtight seal or connection between a rubber probe tip and the walls of the external ear canal.
reverberation occurs in what type of environments
in environments with hard surfaces
peripheral vestibular apparatus is located
in the temporal bone near the cochlea
where are the 3 semi circular canalas
in the vestibular apparatus
speech spectrum noise
includes energy approximately within the frequency region that encompasses the energy found in speech
narrowband noise (NBN)
includes frequencies in a limited region, such as from 900 to 1100 Hz
peer-reviewed literature
includes scientific articles published only after close review by multliple experts to verify that proper research methods have been followed and that analysis of the results is appropriate
reliability
indicates that the results of a test are repeatable from one test session to the next
universal precautions are followed in health care to prevent _____ and enhance ____ _____
infection and patient safety
two types of hair cells within the cochlea are called
inner and outer hair cells
greater attenuation of ambient sound is achieved with ___ ____ than with ____ ____ ____
insert earphones than with supra-aural earphones
nerve fibers originating in the lowest region of the brain that travel downward through the _______ to the cochlea
internal auditory canal
Aural Rehabilitation
intervention aimed at minimizing and alleviating the communication difficulties associated with hearing loss
aural habilitation
intervention for persons who have not developed listening speech and language skills
Communication from each inner ear to the cochlear nucleus is always along
ipsilateral pathways
Organ of Corti
is a complex of structures located on the basilar membrane of the cochlea
What is 0 dB SPL mean?
it doesn't mean no sound, it means the pressure output is 0 dB above the pressure reference
what is hearing science
it is the branch of scientific study that investigates the auditory system and how it responds to sound
American Sign Language
its own structured language
goal in clinical setting of the test booth is to
keep the noise level below the level of masking (noise) that would cause a threshold shift or worsening in a normal hearing person's thresholds
inner ear is also referred to as
labyrinth
pars tensa
largest and tightest portion of the tympanic membrane and contributes mostly to hearing.
what will help someone appreciate the relation between signal-to-noise ratio (SNR) and listening difficulty
learning about the magnitude of noise levels in common communication settings like restaurants
Auditory nerve fibers from the left ear lead directly to the
left cochlear nucleus
the vibrations of an object and the sounds produced by the vibrations are affected by what
length, stiffness, and mass
how are the ossicle bones attached to the middle ear
ligaments
The auditory nerve shares what
limited space in the internal auditory canal with the facial nerve (7th) and the superior and inferior divisions of the vestibular nerve
auditory training examples
lip reading ("Lindamood-Lips Program", speech reading ("Seeing and Hearing Speech CD", speech perception, and auditory listening training ("Earobics", "FastForward")
There is no attenuation of ambient sound when stimulation is presented via
loudspeaker with the ears uncovered
Abnormal middle ear function characterized by high impedance or resistance, like fluid within the middle ear cavity, is associated with
low admittance
Ambient noise is primarily ____ sound while speech includes information in ______ regions.
low- frequency sound high frequency
what type of sounds progressively activate hair cells toward the other end of the inner ear which is called the apex
lower-pitch sounds
acoustic reflex threshold
lowest level muscles contract in response to a loud sound
Chief Complaint (CC)
main reason the patient presents (comes in) for hearing testing
vestibular system contributes importantly to our ability to
maintain a stable position in space
The two vestibular nerves are involved in
maintaining balance and posture
tympanometry
measures mobility of the eardrum, ear canal volume and middle ear pressure
Within the inner ear, _____ activity related to sound vibrations is converted into ____ activity.
mechanical, electrical
where are the inner hair cells located
medial portion of the cochlea
where will most audiologist be employed at
medical settings. these include different types of hospitals and practices that also include such health professionals as physicians, psychologists, speech pathologists, and therapists
Conductive losses may be treated
medically or surgically and may restore hearing to normal or near normal after treatment
Tympanogram Classifications
Type A = Normal Type B = Flat Type C = Negative Type As = Stiff/Shallow Type Ad = Deep/Disarticulated
visual reinforcement
Use of light, picture, or mechanical play activity to maintain a child's attention during behavioral hearing testing and to reinforce responses to sound.
cued speech
Uses 8 handshapes to supplement speech reading skills. Formed shapes represent speech sounds that are difficult to "lip read" (i.e., /m/, /b/, /p/)
inner ear
•Ménière's disease •Labyrinthitis •Cochlear Otosclerosis •Presbycusis •Acoustic trauma •Ototoxicity •Circulatory Failure •Head trauma
cross hearing
Stimulus sound presented to the test ear at a level exceeding the inter‐aural attention (insulation) provided by the head for air or bone conduction crosses over to and is detected in the non‐test ear
outcomes vary depending on
-Age of onset -Age at implantation -Etiology of hearing loss -Neural Survival -Duration of hearing loss -Amount of residual hearing -Auditory memory of speech/sound -Motivation/expectations for (re)habilitation -Equipment/Technology -Efficacy based: Should be documented objectively (test battery) and subjectively (self-report measures) and compared with pre-post treatment
thalamus
-A sub‐cortical oval shaped structure on each side of the central nervous system that serves as a major relay station for sensory pathways (auditory, visual, somatosensory) between the brainstem and cor- tex. The medial geniculate body, an important auditory structure, is located on the posterior portion of thalamus -Found between the brainstem and the cerebral cortex. -Where information from the auditory, visual, and touch senses is coordinated. -Diffuse pathways which contain many neurons and synapses that result in slow transmission of auditory information. -Polysensory pathways that convey visual, tactile, and auditory information -Medial geniculate body (MGB) is a region of the thalamus specialized for processing auditory information
sensorineural acuity level (SAL) technique
-A test for estimating bone conduction hearing levels based on a comparison of pure tone air conduction hearing thresholds in quiet versus with at least 50 dB of narrowband noise presented via bone conduction -Bone conduction hearing is calculated with an analysis of the shift or increase in hearing thresholds with noise
waves in ABR
-ABR consists of a series of peaks and valleys which are referred to as waves -Waves represent activity in one or more regions of the auditory system -Major ABR waves are waves I, III, and V -Electrical responses to sound in the nerve fibers and brain stem pass through brain tissue and the skull to reach electrodes on the skin
Jewett's discovery in the early 1970s was particularly noteworthy for at least four reasons
-ABR recordings were highly consistent and almost identical from one person to the next -The response could be activated by sounds that were presented very rapidly -The ABR was clearly visible when elicited with different types of stimulation, including clicking sounds and short bursts of tones -Sleep, sedation, or anesthesia had no effect on the ABR, so babies did not need to be awake during testing
code of ethics
-According to the American Academy of Audiology (AAA), the code of ethics "specifies professional standards that allow for the proper discharge of audiologists' responsibilities to those served, and that protect the integrity of the profession; alleged violations of ethical conduct are taken very seriously." -A document developed by a professional organization for guiding the professional behavior of its members
Impedance (Z) Matcher:
-Air-to-fluid mismatch=~30 dB reduction of sound intensity 1: Larger to smaller surface (TM 17 x's larger than OW)=pressure amplifier 2: Lever Action (Malleus Larger re: Stapes)=1.3 ratio diff in force at footplate- stapes vibrates faster than malleus so pressure is equal 3: Buckling Effect (TM shape re: umbo)= 2 x's greater force applied
patient selection- CI process
-Referral for Audiological Evaluation -Medical Evaluation -Speech-Language Evaluation -Psychology/Social Work Counseling -Team Meeting -Device Selection -Pre-surgical Assessment -Surgery -Initial Device Activation -Mapping/ (Re)habilitation
cocktail party effect
-The phenomenon of hearing multiple voices at the same time and with concentration perceiving the speech of a single speaker -occurs when background noise is present in a small group of speakers but, with some effort, a normal-hearing listener can understand what each speaker is saying
why is masking needed
-Accurate assessment of hearing depends on verifying that test results only reflect stimulation of the test ear -Ear specific test findings are always very important for pure tone audiometry with air conduction and also for bone conduction hearing testing -Correct analysis and meaningful interpretation of hearing test results is entirely dependent on an accurate description of the hearing status for each ear -Errors in hearing testing resulting from inadequate masking of the non-test ear can lead to inappropriate treatment for hearing loss or no treatment for patient's who really need it. -Masking is necessary in any hearing test procedure if there is a chance that the stimulus might cross over from the test ear to the non-test ear -The amount of inter-aural attenuation varies depending on what type of earphone is used in hearing testing and also for earphones versus bone vibrators
Noise Requirements for Hearing Testing
-Accurate measurement of hearing requires a sufficiently quiet test setting -There are internationally recognized standards for maximum acceptable levels of ambient noise in rooms used for hearing assessment -In the United States, audiometric sound-treated booths, rooms, or suites are designed to be in compliance with standards such as those of the American National Standards Institute (ANSI, 1999)
Objective testing can rule out nonorganic hearing loss
-Acoustic Reflex Threshold Testing -Otoacoustic Emissions Testing -Auditory Brainstem Response Testing
Early Measurement Technique
-Acoustic immittance recording with clinical instrumentation produces at least four different measurements. 1. Equivalent volume of the ear canal 2. Static acoustic compliance of the middle ear 3. Tympanometry 4. Acoustic Reflexes
Acoustic Reflex Measures: Recording Technique
-Acoustic reflex measurement with the probe in one ear is recorded immediately after tympanometry has been completed with the probe assembly still sealed in the ear -Acoustic reflexes are recorded at the external ear canal air pressure where there is a tympanogram peak and where compliance reaches its maximum value -Acoustic immittance devices include a range of stimuli that can be used to activate the acoustic reflex -Acoustic immittance devices include a range of stimuli that can be used to activate the acoustic reflex. -Stimulus options include: -Pure tones (e.g., 500, 1000, 2000, and 4000 Hz) -Noise signals like broadband noise (BBN)
The acoustic reflex decay test is performed in the following manner:
-Acoustic reflex threshold is determined for one ear with a stimulus, like a 1000 Hz tone -Next, the same stimulus is presented continually for 10 seconds at an intensity level 10 dB higher than the threshold -Results are analyzed and usually printed out
Patient Placement in Booth for Testing
-Adult facing the audiologist (my clinic) -Adult facing away from the audiologist (left or right) -Child on parent lap facing audiologist window -Child in high chair facing audiologist window
CI companies
-Advanced Bionics -Cochlear americas -Med-El -oticon medical: neurelec
afferent pathways for acoustic reflex measures
-Afferent structures consist of the cochlea and the auditory portion of the eighth cranial nerve -Afferent pathways carry information from the ear to the brain -The cochlear nucleus (nuclei) in the brainstem contribute (s) to the acoustic reflex arc in the both ipsilateral and contralateral measurement conditions -Additional neurons in the trapezoid body and medial superior olivary complex contribute to the acoustic reflex pathways in the contralateral measurement condition
patient factors affecting speech in noise tests
-Age -Cognitive factors like attention -Degree of hearing loss affecting audibility of the signal -Auditory processing abilities -Whether the patient is a native speaker of the test language
AC audiometry procedure
-1ST STEP: Case History and Consent Documentation -2ND STEP : Patient Instructions -FREQUENCIES AND TEST ORDER: Start at 1000 Hz, then 2000-8000 Hz, then 250-500 Hz -STARTING LEVEL: 30 dB HL -TECHNIQUE: Bracketing (Descending/Ascending Method): start at 30 dB HL, -if patient responds then move dial down (descending) in 10 dB HL steps until the patient does not respond, then move the dial up (ascending) by 5 dB HL steps until the patient responds again, then move the dial back down by 10 dB HL until the patient does not respond, then move dial up by 5 dB HL until they respond again. Threshold obtained when 2 out of 3 (ASCENDING) responses obtained. -if no response when presented at 30 dB HL, move dial up to 50 dB HL and up in 20 dB HL steps until an initial response is obtained. At that level, then begin bracketing technique as described above. -STIMULI: Continuous Steady Pure Tone, Pulsed Tone, FM Warbled Tone, Narrowband Noise, Speech (live voice or recorded) -RECORDING OF RESULTS: " O" red=Right Ear; "X" blue=Left ear ; bone responses masked versus unmasked -INTERPRETING RESULTS: -DEGREE=TRADITIONALY USED BY AUDIOLOGISTS TO DESCRIBE RESULTS TO PATIENTS -PERCENTAGE=FORMULA DEVELOPED BY THE AMERICAN ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY (AAOOO, 1979) ; PHYSICIAN DESCRIBES AMOUNT OF HEARING LOSS BASED ON A CALCULATED PERCENTAGE (OUTDATED MEANS OF HEAIRNG LOSS DESCRIPTION)
speech audiometry procedure
-1ST STEP: Case History and Documentation -2ND STEP: Patient Instructions -STARTING LEVEL: 30 dB HL -TECHNIQUE: Bracketing (Descending/Ascending Method): start at 30 dB HL -STIMULI: Speech (live voice or recorded) -RECORDING OF RESULTS: Speech Reception Threshold (SRT) in dB HL (each ear) -INTERPRETING RESULTS: Softest intensity level (in dB HL) that a person can repeat two-syllable (Spondee) words
malleus
-1st bone in the chain (25 mg) -Embedded in TM-middle layer (fibrous tissue) manubrium=handle; umbo=center
incus
-2nd bone in the chain (25 mg) •Head of malleus connects to incus body •Long Process=Crus •Lenticular Process=Short Crus (Sits on Head of Stapes)-incudostapedial joint
the ossicles of the middle ear
-3 smallest bones in the human body -malleus -incus -stapes
childhood communication checklist: motor
-4-6 Months: Turns toward/response to sounds -Developmental in general-ASHA
auditory brainstem implants
-4th surgical option -have acoustic neuromas -tumors grow on CN 8 and basically kill the nerve
tinnitus statistics
-50 million people-estimated number reporting experiencing tinnitus -25 million people (10% of US population) experienced tinnitus lasting longer than 5 minutes during the 2014-2015 year -2.5 million classify tinnitus as "debilitating" -12-15% of those 65 years or older report experiencing tinnitus -60% of children with hearing loss report experiencing tinnitus -60% experience bilateral tinnitus -Affects men and women equally
Inter-aural Attenuation (IA) Values for insert earphones
-70 dB HL (Martin and clark) -Inserts=60 dB HL (J. Hall 2013; Sanders and Hall, 1999) -Inserts=65 (Yacullo, 1996)
the ear is going to continue to grow and change shape until age what?
-9 -up until age 9, they have a smaller ear canal volume
bone vibrator placement
-A bone vibrator is used in bone conduction hearing testing -An audiologist positions the bone vibrator on the mastoid process located just behind and toward the lower portion of the pinna -A bone vibrator can also be located on the forehead during hearing testing
cycle
-A complete 360‐degree course of a single sine wave from beginning to end -One complete condensation and rarefaction cycle -0 to 360 degrees -Specified amount of time
efferent pathways for acoustic reflex measures
-A descending efferent pathway passes from the brainstem back to the ear -The descending (efferent) pathway includes motor fibers within the 7th (facial) cranial nerve, particularly a small branch that innervates the stapedius muscle -Ipsilateral acoustic reflex pathways remain on one side of the body and are sometimes described as an uncrossed acoustic reflex -Contralateral pathways are often described as crossed acoustic reflexes
sound level meter
-A device for measuring and quantifying sound intensity level in decibels (dB) sound pressure level (SPL) -Sound level is measured and quantified with a sound level meter -A microphone for detecting sound and converting acoustic energy to an electrical signal than can then be quantified in decibels. -A meter, like a needle or a digital display, representing the measured sound levels.
temporal integration
-A measure of processing of brief durations of sound -hearing thresholds are progressively elevated for sounds as duration decreases below 200 ms
how are otoacoustic emissions recorded by using detection of OAEs
-A miniature microphone within the probe assembly detects OAE related sound as well as any other sound in the ear canal during the recording -OAE activity must be distinguished from other noise in the external ear canal -There are two general types of noise: 1. Physiological noise is from the patient 2. Ambient noise is from the environment -Audiologists minimize noise levels in the external ear canal are minimized controlling ambient noise and counseling the patient to remain quiet during testing
rollover is demonstrated to:
-A modest extent in patients who have a sensory hearing loss -A greater extent in patients with a neural hearing loss
air-bone gap
-A person with normal hearing is expected to yield very similar air and bone conduction hearing thresholds at each test frequency -An air-bone gap that is clinically important: defined as a difference (of more than 10 dB) between air and bone conduction pure tone thresholds -Dr. Cosby: Air-Bone Gap=15 dB HL
measurement process of acoustic immittance measurement
-A portion of the sound impinging on the tympanic membrane returns back through the ear canal to the microphone -The sound pressure level that is measured at the end of the probe tip is directly proportional to acoustic immittance -It is important to keep in mind that each measure of acoustic immittance is made at the tip of the probe and not at the tympanic membrane
coupler
-A specially designed device for connecting an earphone with a microphone of a sound‐level meter -used to describe a small device that connects the acoustic tube of an insert earphones with a foam or rubber tip
Instrument for acoustic immittance measurement
-One important part of the device is a miniature loudspeaker that produces a pure tone of 226 Hz -Some devices also include the option of presenting a 1000 Hz pure tone which is needed for measurements in infants -The pure tone is referred to as a probe tone since it is delivered to the ear canal via a tube in a probe assembly -Another important component of acoustic immittance instrumentation is a small microphone located within a second tube in the probe assembly. -Sound in the ear canal from the probe tone that has returned from the tympanic membrane is picked up by the microphone and converted to an electrical signal. -The signal is amplified, processed, and sent to an analysis system to be measured -The final part of the instrumentation is an air pump for changing air pressure within the sealed external ear canal. -A device called a manometer quantifies air pressure within the ear canal. -Air pressure is described in either millimeters of water pressure (mm H20) or decaPascals (daPa).
temporal lobes
-One of the four major lobes of the brain. -Auditory regions are located in the temporal lobe
environmental sounds
-One of the most common causes of hearing loss results when a person is exposed to very high-intensity levels of sound -The damaging sound may be recreational noise like noisy motorcycles, rifle fire during shooting and hunting, or high levels of music -Excessive sound exposure may also occur during work-related and vocational activities -Audiologists and other professionals are very interested in limiting and preventing permanent hearing loss caused by exposure to high-intensity levels of sound
techniques used when behavioral testing with peds 2 years old- 5 years old
-Operant Conditioning Audiometry (OCA) and Tangible Reinforcement Operant Conditioning -Visual Reinforcement Audiometry (VRA) -Condition Play Audiometry
impedance
-Opposition to the flow/transfer of acoustic energy -↑ density = greater impedance; ↑ impedance = smaller amplitude -Example: Closed Door=more impedance for sound to get through door
ossicle function
-Orientation-suspended in ME -Chain not in a straight line rather: -"points posteriorly" (backwards) -"medially" (inward) -Vibrations from TM- Malleus/Incus Rotate -Transfers force of vibration to Stapes •Pushes Oval Window in/Out (Rocks)
Bone Anchored Hearing Aid (BAHA)
-Osseointegrated -Conductive HL (large ABG; i.e., 30 dB HL) -FDA approval=Ages 5+ -Single Sided Deafness -Congenital Deafness -Sudden Unilateral Deafness -Acoustic Trauma -surgically screw in a screw to the skull and then 3 months later the BAHA can be attached -snaps on and off on a daily bases
anatomy of middle ear
-Oval- -~2 cm3 (½ inch high; ½ inch wide; ¼ inch deep) -Air-Filled -Mucous Membrane -Walls-6 -Bones-3 -Muscles-2 -Ligaments/Nerves /Arteries/Veins -Eustachian Tube: Connects to Nasopharynx; Aerates ME
Pediatric Audiology
-Pediatric audiology specialty certification is available through the American Board of Audiology (ABA) -Pediatric audiologists work in a variety of settings including private practice clinics, public schools, and children's hospitals
music
-Persons with hearing impairment who have difficulties understanding speech also may express concerns about problems hearing music. -Range most important for hearing speech: 250-4000 Hz
earphone placement
-Placement of earphones (or a bone vibrator) on the patient is the final step before testing begins -Audiologists usually delay earphone placement until after the patient is given instructions about the test procedure
Hearing Screenings Throughout Childhood
-Pre-school -Kindergarten -Grades: 1, 3, 5 7 and/or 9 -Thresholds screened (1000, 2000 and 4000 Hz) -Screening level: 20 dB HL -Tympanometry screening (audiologist involved) included (pre-school through grade 1) -OAE screening (audiologist involved) and included for pre-school children and special needs -Rescreen immediately upon refer at any frequency and w/in 6-8 weeks (by Audiologist) when refer by all screening measures
Examples of sensorineural hearing loss
-Presbycusis (Age-related HL) -Noise exposure -Ototoxic medications -Viral or bacterial infection (Meningitis) -Acoustic neuroma - tumor growing in internal auditory meatus -Auditory Neuropathy Spectrum Disorder (ANSD)- dyssynchrony in firing of 8th CN neurons
occlusion effect
-Present in the frequencies of 1000 Hz and below when the ear is occluded while measuring bone conduction thresholds. -Will cause increase in the intensity of bone conduction signal for patients with either normal hearing or sensorineural hearing loss. -Happens because of changes in osseotympanic bone conduction that cause increase (better thresholds) for bone conduction. -Can result in air bone gaps (difference of 15 dB or more between air conduction response and bone conduction response for the same ear). -Perception of increased loudness of a bone conducted tone stimulus when an ear is covered with an earphone or when the external auditory canal is occluded with an insert ear tip -The occlusion effect also occurs for patients with middle ear disorder and conductive hearing loss
fall prevention
-Preventing falls is another important duty of modern-day healthcare providers, including audiologists. -Healthcare costs associated with patients who fall are enormous, exceeding $2 billion annually in the United States alone. -At least 70 percent of hospital patient accidents are due to falls
pediatric management of hearing loss: educational options
-Public Law 94-142 (1975; Amendment 1986-inclusion of birth to 3 for children with hearing loss and other disabilities) -Individual Education Plan (IEP) (Public-Law 99-142) -Individual Family Service Plan (IFSP) (Public-Law 99-457) -No Child Left Behind (2001) -Individuals with Disabilities Education Act (Public-Law 101-476) Individuals with Disabilities Education Act Amendments of 1997 (Public-Law 105-117)
sound field
-Pure tone and/or speech testing via one or more loudspeakers in the test booth -Limitation of Sound Field testing: does not provide Ear Specific results
types of sounds that an audiometer can include
-Pure tones -Noise -Words -Other speech materials
variety of stimuli used when behavioral testing 2 years old- 5 years old
-Pure-tones -FM Warbled Tones -Narrowband Noise
variety of stimuli used when behavioral testing birth- two years old
-Pure-tones -FM Warbled Tones -Narrowband Noise
Count-the-Dots Method
-The ability to detect speech or audibility of speech sounds is directly related to pure tone thresholds -Information in speech that contributes most importantly to its detection and perception is in a frequency range from 300 Hz up to about 4000 Hz -The term Articulation Index is used to describe the percentage of speech that is audible -Articulation Index values range from 1.0 to 0 -An Articulation Index of 1.0 indicates that 100 percent of speech is audible -An Articulation Index of 0 indicates that speech is not audible. -Audibility Index/Articulation Index -Used to estimate speech recognition abilities relative to audibility of speech intensity of 45-50 dB HL -Count the dots below threshold=percentage of "conversational speech energy audible at a distance of 3 - 6 feet" -Useful in hearing aid counseling
dB SPL (sound pressure level)
-The amount or intensity of a sound, such as an acoustic stimulus for evoked responses, expressed in decibels (dB) -an intensity level of 0 dB SPL is the smallest amount of displacement of air molecules caused by a sound that can be just be detected by the human ear at a given frequency -a physical scale for intensity level -The normal hearing SPL decibel (dB) reference is 20 micropascals, i.e., dB SPL = 20 log (Po/Pref) -where Po is observed instantaneous pressure and Pref = 20 pascals -Calibrating with a sound level meter -Documenting sound level to verify the function of hearing aids and other devices designed for people with hearing loss -dB SPL is sometimes in special hearing test procedures
Expansion of the scope of practice of audiology included what?
-The assessment and management of persons with vestibular disorders -Monitoring hearing function of patients undergoing surgery that could damage auditory system -Hearing screening of newborn infants in the intensive care nursery (ICN) setting -Evaluation and rehabilitation of patients with severe hearing loss considered to be candidates for surgical implantation of electrical hearing devices
efferent auditory system
-The descending auditory pathways in the central nervous system that serve an inhibitory function. The efferent system ends with efferent fibers that connect with the hair cells in the inner ear -descending pathways (from the brain to the ear) -plays a role in controlling function of the ascending afferent auditory system -may help to improve the detection, localization, and perception of speech in a setting of background noise -may also be related auditory disorders like tinnitus in persons who have been exposed to excessive levels of noise
region 4: efferent auditory system
-The efferent system is not essential for the generation or clinical application of OAEs -OAEs are influenced by efferent auditory activity -Stimulation of the efferent pathways that course from the lower brainstem to the outer hair cell, suppresses outer hair cell activity and reduces OAE amplitude
outer ear: external ear canal
-The external ear canal is essentially a tube with effective acoustic characteristics. -The adult ear canal amplifies sound at a resonance frequency within the region of 2500 to 3000 Hz, depending on the diameter and length of the canal. -This frequency region is very important in the perception of consonants and speech sounds. -Resonance frequencies are considerably higher for the smaller ear canals of infants and young children -Lateral (outer) 2/3: cartilaginous -Cerumen producing region----ceruminous and sebaceous glands (Hairs, Skin ~ 0.5-1.0 mm thick) -Medial (inner) 1/3: bony (Skin very thin ~ 0.2 mm thick)
Early Identification and Diagnosis of Hearing Loss in Infants
-The importance of detecting and defining hearing loss in early childhood was recognized in the earliest years of audiology -Research clearly confirms that early intervention means the initiation of appropriate management within the first six months after a child with hearing impairment is born
variables in word recognition performance: intensity level
-The intensity level for presentation of words must exceed a patient's SRT -The relationship between the intensity level and how well a patient performs on a word recognition test is often plotted on a graph called a performance intensity (PI) function -Presentation level is typically at an intensity level of 30 or 40 dB above the patient's SRT or at the patient's MCL -The abbreviation PBmin is used to describe the poorest or minimum word recognition score at the highest intensity level -Rollover is a decrease in word recognition performance at high intensity levels -Rollover can be specified and quantified by calculating the difference between PBmax and PBmin. -The rollover index takes into account the amount of rollover relative to the maximum PB score: Rollover index = (PBmax- PBmin)/PB max)
Inverse sqaure law
-The intensity of any sound is inversely proportional to the squared distance that the sound has traveled. -Sound power decreases 6 dB and sound pressure also decreases 6 dB as the distance from the source is doubled -The principle of physics that defines the decrease in sound intensity as a function of the square of the distance from the source of the sound
Interaural Attenuation (IA)
-The isolation or attenuation produced by the head when sound is presented to one ear before it crosses over to the other (non‐test ear) -is the phrase used to describe reduction of sound as it crosses the head from one ear to the other
intensity
-The magnitude of sound energy per unit area. The term is commonly used in describing sound levels used in hearing testing -Intensity of a sound is related to the maximum displacement or the amplitude of a waveform -Audiologists repeatedly manipulate the intensity of sounds in hearing testing -Unit of measurement: watt/m2
retrocochlear auditory dysfunction
-The major focus of diagnostic audiology in the 1960s and early 1970s was the detection of retrocochlear auditory dysfunction in patients with unilateral hearing loss -The term retrocochlear at that time referred to patients with a tumor involving the auditory nerve -Measurement of word recognition performance was also a regular part of the traditional diagnostic test battery
resonance frequency
-The natural frequency for vibration of an object where vibrations occur with the least external force -§=(fnat) frequency that particles vibrate most naturally and with great magnitude
critical band
-The part of a band of noise in a region above and below the frequency of a pure tone -A tone is barely detectable when the level of the critical band is the same as the level of the tone -Further increases in the frequency width beyond the critical band do not result in more effective interference with detection of the pure tone
four subdivisions of the peripheral ear
-for the peripheral: outer ear, middle ear, inner ear and the nerve -outer and inner ear are responsible for the conductive mechanisms of sound -the inner ear is responsible for the sensory component (cochlear and vestibular system) -outer ear: general anatomy -aka the auricle -The C-shaped portion of the outer ear that projects outward is the pinna -Main anatomic structures of the auricle are the: -Pinna -Helix -Lobe -Tragus -Concha -The auricle consists of cartilage covered by skin
audio oscillator frequencies
-frequencies 125-8000 Hz (up to 20,000 Hz with Circumaural phones) -Intensity output range from -10 to 120 dB HL
bone conductor/oscillator frequencies
-frequencies 250-4000 Hz -Output range of about 50 dB HL at 250 Hz and between 70-80 dB HL at 500-4000 Hz -High intensity output in the low frequency testing can lead to "Vibrotactile" repsonses
test battery
-group of speech audiometry tests to evaluate auditory function -the typical test battery includes procedures that are sensitive to different auditory processes and to abnormalities in the auditory system
earmolds and pediatric technology
-have to change ear molds often: -0 to 6 months every 4-6 weeks -6 to 12 months every 2 months -12 months to 3 years (3 to 4 times per year) -A child's ears grow approximately until 9 years of age -Hot of the presses: Pediatric population (4-21 years old) now being fit with open-fit receiver in the canal (RIC) technology ~ 12% (4-10) ~53% (11-21) -Rechargeable technology purchases also on the rise increased from 14% in 2018 and up by 48% between April and June of 2020.
postlingual
-hearing loss occurring after developing speech/language -Auditory Memory: assimilation, storage and retrieval of previously experienced sounds
PTA
-hearing threshold averages at 500, 1000 and 2000 Hz; provides an "impression for the degree of communication impact" as a result of the hearing loss. -Verifies SRT scores are "in good agreement" with pure tone thresholds. If SRT and PTA are within 7 dB HL of each other than considered "in good agreement"
hearing aid styles
-in the canal -in the ear -cross and bicross -open fit -invisible CIC -RIC device is most common
type Ad tympanogram
-indicates a highly compliant middle ear system or tympanic membrane. -The type Ad pattern may be associated with a tympanic membrance that has healed following a perforation or, less frequently, a discontinuity or break in the ossicular chain.
type As tympanogram
-indicates a restriction in the flexibility (compliance) or an increase in the stiffness of the middle ear system -this pattern may be associated with a fixation of the ossicles connecting the tympanic membrane to the inner ear.
In the real-world acoustic environment there are
-infinite combinations of frequencies within complex sounds -there are also myriad combinations of frequency, phase, amplitudes, and temporal characteristics
stapedius muscle
-inserts into the neck of the stapes and is innervated by a branch of the seventh or facial cranial nerve -stabilizes the stapes bone in quiet conditions -Arises from posterior wall -Attaches to head of Stapes -Innervated by branch of Facial (7th CN) -Contracts bilaterally to sound The smallest muscle in the human body, attached to the posterior portion of the neck of the stapes and innervated by a branch of the seventh (facial) cranial nerve. The stapedius muscle contracts in response to high‐intensity sounds
Auditory Training
-instruction designed to maximize an individuals use of residual hearing by means of both formal and informal listening practice -formal: structure program/ SLP -informal: books on tape, at home activities/homework -targets: sound awareness, discrimination, identification, comprehension
dichotic listening tasks
-involve binaural hearing with different sounds are presented to each ear at the same time -different speech signals such as words, numbers, or sentences are presented simultaneously to each ear.
electroacoustic procedures
-involve the measurement of sounds within the external ear canal. -some provide information about how well the middle ear system transmits energy from the outer ear to the inner ear -Others detect sounds in the ear canal that actually reflect energy associated with movement of outer hair cells within the cochlea -examples: acoustic immittance measurements and otoacoustic emissions
central masking
A change in hearing threshold in one ear associated with the presentation of masking noise to the opposite ear at a relatively low level that is not adequate to crossover to mask the test ear
speech-in-noise test
A common type of test of auditory processing that requires recognition of a speech signal like a word or sentence in the presence of some type of background noise or speech
artificial mastoid
A device for calibrating bone conduction vibrators that is connected to a sound level meter that documents the intensity level in either decibels or units of force
artificial ear
A device for calibrating the sound produced by earphones used in air conduction hearing testing. It consists of a 6 cm3 coupler to connect an earphone to a microphone
performance intensity (PI) function
A graph displaying word recognition performance in percent correct on the y‐axis as a function of the intensity level of the words on the x‐axis
tympanogram
A graph showing measurement of tympanic membrane mobility as a function of air pressure changes within the ear canal
DPgram
A graph showing the amplitude of distortion product otoacoustic emissions plotted as a function of the stimulus frequency (usually the f2 stimulus). See Distortion product otoacoustic emissions
descending-ascending method
A procedure for estimating hearing threshold that involves repeating the process of decreasing sound levels in 10 dB steps until the patient doesn't hear the stimulus and then increasing the level in 5 dB level steps until the patient responds again
Clinical Scholar
A professional who has expertise in providing patient services combined with research education and experience
Frequency
A property of sound defined as the number of complete cycles or oscillations of a vibrating body -Cycles per second (cps) -1 second=1000 milliseconds (ms) -hertz and period
vibrotactile response
A sensation of feeling with the presentation of high-intensity and low-frequency bone conduction sounds
pure tones
A single-frequency tonal sound, e.g.. 1000 Hz; a sinusoid
rollover index
A somewhat paradoxical decrease in performance (percent correct) scores for a speech audiometry procedure at highest stimulus intensity level versus maximum scores at a lower intensity level. Rollover of greater than 20% is often considered a sign of retrocochlear auditory dysfunction
Public Law 101-336:
American with Disabilities Act (1991)-prohibits discrimination against individuals with disabilities
effective masking
Amount of narrow band noise (NBN) that is needed to eliminate (or "mask out") the perception of the pure tone signal being presented (and heard in the NTE)
what does an audiologist do before performing any test procedures
An audiologist almost always inspects the patient's pinna and external ear canal
Educational Audiologist
An audiologist working usually in a school setting who has responsibility for hearing care of students there
talk back
An electronic connection for communication between an audiologist outside of a sound room and the patient inside the sound room. A TalkBack system consists of a microphone and earphones or a loudspeaker for the tester and for the patient
three semi circular canals
Anterior, Inferior, Lateral
scope of practice
Audiologists must practice within a scope of activities defined according to professional organizations
dB HL is reference used for
Audiometer and on Audiograms
0 dB HL=
Audiometric Zero
cerebellopontine angle (CPA)
Auditory nerve fibers from the right ear and the left ear enter into the brainstem at the junction of the medulla and the pons on each side of the brainstem
vibration
Back and forth movements of an object that give rise to sound energy
etiology
Believed to arise from autonomic nervous system (limbic-emotional impact) and secondary involvement from peripheral auditory system (cochlea-hearing loss); central auditory system (cochlea nucleus) and perhaps cortical regions (cerebral blood flow)
inertial bone conduction
Bone conduction stimulation that is produced by the lag in movement between the vibrations of the bone surrounding the ear and the movement of the stapes in and out of the oval window
masking dilemma
Briefly, when the level of masking noise that is adequate to mask the non‐test ear crosses over to the mask the test ear (cross masking occurs)
transducer: inserts, headphones or sound field (SF) for children 2 years old- 5 years old
Caveat with SF-responses DO NOT provide ear specific information
transducer: inserts, headphones or sound field (SF) for children birth- 2 years old
Caveat with SF-responses DO NOT provide ear specific information
behavioral observation audiometry (BOA)
Changes such as startling, quieting, eyes widening, turning toward sounds, cessation of movement/sucking on pacifier or bottle
when to mask for bone conduction
Cross hearing (cross over) suspected whenever an Air-Bone Gap (ABG) of greater than 10 dB HL is present -ABG=15 dB HL (Dr. Cosby) -BC Rule: Air-Bone Gap in the test ear greater than or equal to 15 dB
middle ear cleft
E-tube + ME + TM
purpose of early hearing and detection intervention (EHDI) programs
Early Intervention services represent the purpose and goal of the entire EHDI process
hearing aids
Electrical devices that amplify sound to improve hearing and communication
Spontaneous Otoacoustic Emissions (SOAEs)
Energy produced by outer hair cells and detected in the external ear canal in the absence of any outside acoustic stimulus
Operant Conditioning Audiometry (OCA) and Tangible Reinforcement Operant Conditioning
Food/prize based reward system for responding to stimuli
speech frequency region
Frequencies within the 500 to 2000 or 3000 Hz region that are important for the perception of speech
what led to the discovery that hair cells can regenerate
Hearing research involving chickens in the 1980s
What are the 2 units of time components associated with a sine wave?
Hertz and Period
other organizations
In 1988, the American Academy of Audiology (AAA) was formed under the leadership of Dr. James Jerger. -The Student Academy of Audiology (SAA) is an organization designed for students in Doctor of Audiology programs.
OAE assessment
Measurement of the integrity of the Outer Hair Cells in the Cochlea
otolaryngology
Medical specialty dealing with medical and surgical treatment of diseases and disorders affecting the ears, nose, and throat (ENT)
simple harmonic motion
Movement of an object back and forth to produce multiple vibrations
noise
Noise is sometimes appropriately defined in a negative way as undesirable acoustical energy that disturbs or interrupts an activity or causes displeasure, discomfort, or even potential danger.
speech noise
Noise with energy within the spectrum or frequency region of speech
under masking
Not enough narrow band noise (NBN) being presented to the non testing ear (NTE) to prevent pure tone signal from crossing over and being heard in the NTE
distortional bone conduction
One of the three forms of bone conduction stimulation in which vibrations of the bones surrounding the cochlea are transmitted through cochlear fluids to hair cells
osseotympanic bone conduction
One of the three mechanisms of bone conduction hearing. With osseotympanic bone conduction, sound energy from vibrations of the skull produced in the external ear canal reaches the tympanic membrane and then activates the cochlea
round window
One of two openings in the bony wall of the inner ear connecting the inner ear to the middle ear. The round window, which is covered with a thin membrane, acts as a pressure release valve permitting movement of inner ear fluids with movement of the stapes footplate
oval window
One of two openings into the inner ear (cochlea) from the middle ear space. Vibrations transmitted through the middle ear are send via the stapes footplate through the oval window into the inner ear
Brainstem
Part of the central nervous system above the spinal cord that contains important auditory centers as well as centers that control vital life functions like breathing and heart activity
contralateral pathways
Pathways that cross over from one side to the other
ipsilateral pathways
Pathways that remain on one side
"People first"
Person not the disability should be emphasized, so use of "handicap" instead of "disabled" and "person with hearing loss" instead of "hearing-impaired person"
vestibular system
Portion of the nervous system that is responsible for maintaining a person's equilibrium and position in space -consists of structures in the ear, vestibular nerves, and collections of vestibular nerves in the brainstem with connections also to eye muscles and large muscle groups in the trunk of the body
Visual Reinforcement Audiometry (VRA)
Present speech/sound; child turns to see animated toy light up or dance
visual reinforcement audiometry (VRA)
Present speech/sound; child turns to see animated toy light up or dance
monitored live voice
Presentation mode for speech audiometry using speech spoken into a microphone with visual monitoring of the voice level on a meter or digital display
what is the mechanism underlying the motility of the outer hair cells
Rapid elongation and shortening of prestin molecules within the walls of the outer hair cells
Who is the father of audiology?
Raymond Carhart
what do we do when we have false positive/false negative responses
Re-instruct, change stimuli, change response, re-instruct
Contralateral Routing of the Signal CROS
Receiver in hearing aid for ear with normal hearing or hearing loss and Microphone in ear with no hearing
Bilateral Contralateral Routing of the Signal BICROS
Receiver/microphone in "better ear" that also has some hearing loss and microphone in unaidable ear for routing of signal to "better ear"
multi-talker babble
Recording of ongoing speech of two or more speakers that is unintelligible -is a recording of actual environmental noise from, for example, a restaurant or a cafeteria; in these test conditions, many people are talking in the background but it is not possible to follow any of the conversations
reference equivalent threshold sound pressure levels (RETSPLs)
Sound level values that are determined from calibrating sounds with a sound level meter connected to a specific type of coupler
otology
Specialty within otolaryngology specializing in diagnosis and treatment of ear and related problems like vestibular or balance disorders
traveling waves
Systematic movements of the basilar membrane progressing from the base near the stapes foot- plate toward the apex. Deformations of the basilar membrane activate the outer and inner hair cells in the cochlea
validity
Test Measuring what it is suppose to measure
test-retest reliability
The agreement between results from one test to the next for the same patient under the same test conditions. Also called test repeatability
Amplitude
The amount of vibration movement of a mass from the position of rest to the farthest point from the position of rest. Also, a measure of the size or magnitude of an auditory evoked response wave usually made from either a peak to a preceding or following trough or from the peak of a wave to some index of baseline. Amplitude of an evoked response is expressed in microvolts
Industrial Audiology
The area of audiology that focuses on prevention and documentation of noise related hearing loss in work settings
the internal auditory canal (IAC)
The auditory nerve is enclosed within a narrow passageway in the temporal bone called the internal auditory canal (IAC)
central auditory nervous system (CANS)
The auditory system beginning with the cochlear nucleus in the brainstem and including also pathways and auditory regions in the thalamus and the cerebrum
cortilymph
The thick fluid located within the organ of Corti in the cochlea
cerebral cortex
The thin outermost layer of the cerebrum. The auditory cortex is located on the superior surface of the temporal lobe in the cerebrum
perilymph
Thick fluid within the scala vestibuli and the scala tympani in the cochlea and also within the vestibular portion of the ear
attenuate
To reduce the intensity level of a sound. Ear plugs attenuate noise levels that reach the inner ear
forced vibration
Vibration of an object that is maintained by the application of ongoing external energy
Picture-Pointing SRT Testing
With young children, effective SRT measurement often involves a picture pointing task rather than a verbal (repetition) response
membranous labyrinth
Within the bony walls of the cochlea is a complex network of delicate membranes
Abnormal acoustic reflex decay is defined as
a decrease of 50 percent or more in the amplitude of middle ear compliance during the 10 second time period
hearing impairment
abnormality that is psychological, physiological or anatomical
in the acoustic reflex threshold, the 7th and 8th cranial nerves are part of
acoustic reflex arc in brainstem
how we hear
acoustical (outer ear) --> mechanical (middle ear) --> hydraulic (oval window) --> chemcial (cochlea) --> electrical (cochlea nerve) --> neural (nerve/ CANS/brain) ALYSSA MAKES HAM & CHEESE EVERY NIGHT
ABR does not reflect
activity of all types of neurons in the auditory system
ABR primary reflects
activity of the nerve fibers, not the many collections of nerve cell bodies within the auditory system
ear canal volumes are directly related to what
age, body size, and gender
OAEs findings sometimes ____ ____ with the audiogram
agree closely
types of masking
air conduction or bone conduction masking and speech testing masking
ambient noise
background sound during audiometric testing
promontory
basal turn of the cochlea that protrudes into ME spca-medial wall
anterior
before or in front of
where does the s-shape tube begin and end at
begins at concha and ends at TM
posterior
behind or toward the rear
in the acoustic reflex threshold, the stapedius muscle is
bilaterally contracted
the listening check is also referred to as
biological or psychoacoustic calibration
Stria Vascularis
blood & oxygen supply to Organ of Corti , K+ recycling to maintain endolymphatic potential
left earphones are distinguished by
blue markings
vestibular system structures are mostly located in the
brainstem (cerebellum)
what is the lowest portion of the brain
brainstem-located just above the spinal cord within the cns
middle ear
•Otitis media •Middle ear fluid •Otosclerosis •Ossicular chain disruption •Barotrauma •Patulous eustation tube •Vascular abnormalities •Neuromuscular tics •Middle ear tumors
SRT is used to
eliminate influence in the non testing ear and obtain true speech threshold for the testing ear
What do audiologists do?
evaluate, diagnose, treat, and manage hearing loss and balance disorders in adults and children
ear canal
external auditory canal (EAC)/ meatus/auditory canal
stimulation in the 3 SCCs results in an
excitatory or inhibitory response
Endolymph within the scala media shares
features of fluids within most cells in the body
annulus
fibrocartilaginous ring surrounded outer edge of TM
Basilar Membrane
floor of the organ of Corti and moves up and down in a hinge like motion as the traveling wave moves through the cochlea
Physiology
function
Hair cell regeneration in humans may be possible with
genetic manipulations and therapy in the future
Utricle and Saccule (Otolith Organs) responds to
gravity (head tilt) and motion (linear acceleration) in a straight line-in any direction (head and body positions)
external ear
•Impacted cerumen •Foreign object •Otitis externa •Perforation •Myringitis bullous
AR options
•Individual face-to-face •Group •Home-based: DVD: Listening and Communication Enhancement •CPU: The Listening Room ,Hope, Med-El, Angel Sound
referrals
•Medical Evaluation (Primary Care) •Medical Specialty (Otolaryngology/ENT) •Psychology/Social Work Counseling •Neurologist •Genetic Counselors •Speech-Language Pathologists •Teacher of DHH •Classroom Educators/School Administration
transverse sound waves
water (perpendicular movement)
cancellation
waveform shape changes or wave amplitude decreases
hearing handicap
way in which individuals are disadvantage in fulfilling their role
when is the autonomic nervous system activated
when we hear potentially dangerous sounds ("fight or flight")
When to mask Speech Reception Threshold (SRT) and Word Recognition (WRS):
whenever cross hearing is suspected
ampulla
wider portion of each semicircular canal
Where is the inner ear located?
within the triangular-shaped petrous portion of the temporal bone
key to testing children 2 years-5 years old
work quickly but efficiently
central nervous system
•Acoustic neuroma •Cerebellopontine tumors •Vascular malformations •CNS Syphilis •Epilepsy •Migraine •Concussion •Tumors
other
•Anemia •Carotid arteriosclerosis •Cardiac Murmurs •Allergy •Psychogenic ("Posttraumatic Stress Disorder, PTSD")
Other technologies/styles
•Body Worn •Eyeglass •CROS •BiCROS •Bone Conduction Hearing Aid •Implantable Bone •Middle Ear Implants •Cochlear Implants
emotion response for audiological counseling
•Confusion/Disturbed (Terminology) •Non-receptive of detailed information following diagnosis •Reaction can vary: takes time to accept and could cycle through "stages" more than once): •Sorrow/Grief •Shock •Denial ("Self-defense") •Fear •Anger •Helplessness •Blame •Guilt
Multicultural Considerations
•Ethnicity •Religion •Sexual orientation •Geographic region •Socioeconomic levels •Educational background •Mental/physical disability •Age-base peer groups •Linguistic diversity-English as a second language learners •Asha knowledge and skills-multicultural diversity (1997-2015) •Remember: We all have a culture/traditions that make us who we are -respect all individuals/families and their cultural diversity
Initial Evaluations-Case History/Diagnostics for adults
•Hearing History •Family History •Perceived HL •Noise Exposure/Tinnitus •Changes in hearing/pathologies (previous 90 days) •Medical History •Major Illnesses/Surgeries •Cold/FLU/Ear Infections •Dizziness •Hearing Aid/CI History •Technology •Consistent use/function/satisfaction •Medications •Updated list of medications
personal adjustment for audiological counseling
•Helping the patient/family reach a point of ownership/advocacy for the hearing loss and management •Informing patient/family when professional counseling may be necessary •Audiologist/SLP must remember: role is to provide information in such a way to allow patient/family to make informed decision •Cognizant of words/deeds and the impact they may have on the patient/family •Make patient/family feel comfortable to ask any question and express their feelings; supportive Counseling •Support Groups
