Audiology PRAXIS

before administering a test, what must you do? how can you be sure it is an appropriate measure for the intended population?

Perform pilot study

Define functional gain.

Performance of auditory testing using hearing aids versus unaided (the improvement of thresholds using aided responses)

Describe different types of hearing protection and the importance of their fit to effectiveness.

Premolded, custom molded, formable (foam, fiberglass, silicone), semi-insert, earmuffs

How do tactile devices provide speech information to the wearer?

Provides clarity. Does not help with localization

What are the standards for classroom acoustics in terms of noise level and reverberation time?

+15 dB SNR, 35 DBA, .6 sec reverb time

describe the requirements of HIPAA.

-For every payer to represent the items and services you provide, CPT is used for procedures and ICD-10 for diagnoses -NPI for individual provider numbers -EIN national employer identifier for each individual practice -Protected health information (PHI) includes 18 identifiers of the patient, which can include device serial numbers for HAs

What are the key precautions used to achieve infection control?

-appropriate personal barriers (gloves, masks, etc) worn when performing procedures that may expose you to infectious agents -hand hygiene performed before and after patient contact and after glove removal -touch and splash surfaces must be pre cleaned and disinfected -critical instruments sterilized -infectious waste disposed of appropriately

Why does fluid accumulate behind the TM in the middle ear space during otitis media?

-eardrum is normally lined with mucus -bacteria travels to middle ear from E tube from build up, which is why AOM develops during/after flu

Describe the procedures for verifying the functioning of a hearing aid

-ensure correct device was selected for patient -confirm features, connect to software, verify features -real ear verification: converts audiogram measurement (HL) to HA output (SPL) 1. RECD measured- without this measurement, conversion could over or underestimate size of person's ear -target prescription selected (NAL or DSL) -Probe mic measurements, commonly viewed by REAR

Where can you find the guidelines for acceptable noise?

-environment must have 85+ dBA noise to need hearing conservation measures -for every 5 dB increase in noise, exposure must be cut by 50%

Discuss confidentiality or patients' records as prescribed by the ASHA code of ethics

-eval, treatment, discussion, and payment is confidential -prohibited from revealing client info to unauthorized third parties -in case of child, only parent of record or guardian has right (some cases biological/adoptive parents not allowed to know info) -cannot discuss in public places -should not share or store records on personal devices

Language and speech characteristics and development over the lifespan

0-2 years: oral language and native sound system 2-3: produce speech in response to written marks made 3-6: intention, context, social 8: spelling, independence in reading 9: less attention to decoding for meaning

What do the Joint Committee on Infant Hearing recommendations require in terms of timing and screening requirements?

1-3-6 screen, diagnose, intervention

What is the minimum age for which cochlear implantation is approved by the FDA?

12 months

Normal processes of auditory behavior over the lifespan

27wks utero: sound awareness 6 mo: babbling until now not affected

In which frequencies and at what intensities are most speech sounds produced?

30-3000 Hz, 55-65 dB

What are the guidelines for acceptable noise in the classroom?

35 dBA SNR at least +15, reverb time .6 seconds

Frequencies tested for OSHA

5 1 2 3 4 6 workers must be noise free for 14 hrs before test to avoid TTS

How long can an employer expose a worker to a 90 dBA sound level during the course of the workday without violating OSHA standards?

90 = 8 95 = 4 100 = 2 105 = 1 110 = .5 115= .25 or less

what hearing thresholds are associated with different levels of hearing loss?

<20= normal 20-35= mild 35-50 moderate 50-70= moderately severe 70-90= severe >90= profound

What is dBA

A-weighted decibels is an expression of relative loudness of sound in air as perceived by the human ear -LF sounds are reduced because the ear is less sensitive to LF audio sounds

What are the different types of tympanogram and what do they indicate?

A= normal As= shallow peak, WNL Ad= high compliance (disarticulation) B= flat (OME, perf) C= negative pressure

when is ASSR called for as an assessment and how is ASSR testing done?

ASSR= auditory steady state response. used for screening and threshold estimates. uses statistical formula to find absence or presence of true response

What do absent OAEs indicate about hearing? What do normal OAEs indicate about hearing?

Absent OAEs do not necessarily mean the patient can't hear. Could be CHL Present OAEs does not indicate normal; could have retrocochlear pathology

what criteria make a patient a candidate for cochlear implant

Adults: moderate to profound SNHL; <50% open set speech rec in implanted ear and <60% opposite ear or bilaterally 2-7years: severe to profound SNHL, limited benefit from amp; MLNT/LNT scores <30% 12-24mo: profound SNHL, limited benefit of amp trial based on MAIS/ITMAIS

what are the appropriate roles for audiology techs and aides?

Audiology assistants perform tasks supervised by audiologist. may/may not be regulated by state laws, increase patient care by increasing services and productivity.

Make a list of age-appropriate testing methods used for infants to age 6

BOA- 0-6mo VRA- 6mo-2years Play= 2-6 years

What is the major difference between behavior observation audiometry (BOA) and visual reinforcement audiometry (VRA)

BOA: birth-4 mo; reflexive behaviors VRA: 5 mo-2yrs, involves conditioning to stimuli

What different kinds of self-report measures can be used with patients and what patient factors should be taken into account in selection and interpretation?

COSI: open ended, choose listening situations APHAB: disability by HL and reduction of disability with HAs HAPI: assesses effectiveness of amp in everyday listening situations SADL: 4 sub scales of cost, positive effects, negative features, and personal image IOIHA: satisfaction and QOL changes with HA use SSQ: several domains of auditory disability and handicap

describe the process of obtaining desired sensation levels or DSL. With what population is this used?

DSL is used in pediatrics as a science based approach to fitting HAs. You first take real ear measures, which converts HL to SPL and DSL prescribes targets for soft medium and loud sounds. Hearing aids are adjusted to fit this prescription. DSL for children (compared to adults) provides 7 dB gain med levels, more in low level, and less in high

how is the verification of hearing aids different for children than for adults?

DSL rather than NAL (provides more data, can generate targets based on ABR data) -selection of hearing aids: factor in activity level in children, growing ears, educational needs, etc

what impacts can hearing loss cause for learning in children?

Delay in speech and language, reduced academic achievement and vocabulary, social isolation and poor self-concept, vocational choices

What is the role of an audiologist on an IEP team

Determining services, placements and accommodations for child with HL. Can include need for service, language level, comm mode, need for interpreters, need for assistive devices and personal hearing tech, classroom environment and accommodations

what is the most significant limitation in audiological findings when sound field presentation of tones is used?

Ear specific measures

What activities are involved in early intervention?

Early intervention services are to meet five developmental areas: physical, cognitive, communication, social, and adaptive Examples of services include assistive technology, audiology, speech, counseling, medical, nursing, nutrition, occupational therapy, physical therapy, psych services

What is the relationship between fundamental frequencies and harmonics?

F0= lowest freq component of a complex periodic sound; harmonic is a regular and repeating multiple of the f0

What are some assistive listening devices that may help a hearing impaired person around the house, at a movie theater, or a worship service?

FM system: radio broadcast technology, portable, can fit on HA via boot infrared system: uses light-based technology, typically used in court proceedings that require confidentiality and places of entertainment induction loop system: t coil hearing aid users (or wear an induction loop receiver), uses electromagnetic field

What assistive device do children who have hearing loss most often use in a class room?

FM systems/ remote mic. A remote mic provides better sound quality than fm system. useful for both HL and APD

What features of a hearing aid can be adjusted and how can they be used to optimize performance for a patient?

Gain processing= minimizes need for volume control, can specifically change loud/soft sounds # Freq Channels: differs among hearing aids; more sounds better but too many can make it muddy Directional mic: reduces noise Digital Noise reduction: amp is reduced in channels providing little benefit to overall speech understanding. Digital feedback reduction: feedback manager to reduce whistling Multiple programs or memories: available for special use, and more advanced HAs can auto adjust from surroundings Self learning: HAs remember your volume and program preferences in specific listening environments Telephone adaptation: t coil is used for patients who report issues on the phone Frequency shifting: or lowering, improves speech understanding by shifting consonant sounds into more audible range Tinnitus maskers: alleviates tinnitus symptoms

List self-reporting scales of hearing problems, and the populations they are appropriate for

HHIA, SAC PEACH, MAIS/ITMAIS

What is the value of a baseline audiogram?

Having a reference for if the patient experiences a change in hearing sensitivity

What provisions of educational legislation (ex: IDEA) have an impact on audiology practice?

IDEA requires a free and appropriate public education, so for audiology, a part of IEP so child can receive appropriate education

what is the function of hair cells (outer and inner)?

IHC: afferently innervated (95%) OHC: efferently innervated

Who determines whether a task required by a subject in an experiment may be invasive?

IRB

how and why is cold water used during VNG and ENG testing

Ice water is used to confirm a complete loss. Put in affected ear, turn patient prone. In true caloric response, waveform will reverse. if it is spontaneous nystagmus, nystagmus will not be affected

In general, how is the effectiveness of a cochlear implant affected by whether the patient was deafened pre lingually or post lingually?

If patient is implanted post-lingually, better outcomes and speech. If pre-lingual, it depends on age of implantation.

How does a pediatric case history differ from an adult case history?

Includes maternal history and birth history adults include occupation and hobbies

What is calibration and what function does it serve?

It's required by law (OSHA) for instruments to be calibrated, but it's important for professionals to calibrate instruments to ensure safety and accuracy in threshold testing -no calibration standards currently for ABRs or OAEs

Describe a program designed for a person with a moderate HFHL who refuses to consider amplification

LACE

Describe upward spread of masking

Low frequency sounds mask higher frequency sounds. Downward spread of masking is when low freq sounds are masked by intense levels of HF sounds.

At what level is a word recognition test administered?

MCL 40 dB SL re: SRT

As an audiologist, can you diagnose otitis media after completing otoscopy

No you cannot diagnose anything

What are the most common screening tools in newborn screenings? List pros and cons

OAEs and ABRs. TEOAEs used in NBHS because more sensitive to mild, 1-3kHz hearing losses DPOAEs: used for monitoring change in hearing, wider dynamic range (ototoxicity)

Describe the differences in results from OAEs versus ABRs in newborn screenings.

OAEs are quicker to perform. ABR gives information on neural function represention ASSR: useful for NBHS because sensitive to lower freqs (mod freq tonotopically processed)

What is the relationship between sound pressure level (SPL) and hearing level (HL)?

SPL= used as output in transducers during audiometric testing (calibrated in SPL) HL= used on audiometer dial, normalized SPL scale to zero --closest relationship in med freq and largest in low and high

What are the types of presbycusis? What parts of the hearing system are implicated in the different types and what are the effects on hearing?

Schuknecht's four types of presbycusis: 1. Sensory 2. Neural 3. Metabolic (atrophy of stria vascularis) 4. Mechanical (stiffening BM)

what behavioral phenomena are associated with CAPD

Sound localization and lateralization, auditory discrim, auditory pattern recognition, temporal aspects (resolution, masking, integration, ordering), auditory performance decrements with competing/degraded acoustic signals

In audiometric screening of workplaces, what is a standard threshold shift? how is it measured and how is it used?

Standard threshold shift is a change in thresholds +10dB at 2,3,4 in either ear. Relative to baseline audio

define standard threshold shift and time-weighted average

Standard threshold shift: a change in baseline audio of average 10 dB in 2, 3, 4 kHz Time weighted average: the average dBA level in an environment, used for assessing noise exposure (ex: 8 hour time weighted average of 85 dBA)

What factors of a case put it outside the scope of audiologic practice?

Surgical intervention, medical intervention

Nongenetically caused congenital HL

TORCH: toxoplasmosis, rubella, CMV, herpes CMV: intrauterine infection viral exposure (syphilis, herpes simplex)

What is the meaning of statistical significance

The probability of rejecting the null hypothesis;

Describe the mapping process for cochlear implants.

Using beeps, find T and C levels. Thresholds are the softest sounds that are detectable and C levels are the most comfortable loudness levels. The audiologist may adjust stimulation rate or programming strategy for MAP

For what suspected condition would you obtain reflex decay?

VIIIn pathologies. Present 1kHz or below 10 dB above ART threshold.

How would you obtain speech awareness thresholds with a very young child who does not talk?

VRA, identify objects, point to body parts

what are the means of hearing aid verification and validation?

Verification is knowing the hearing aid is working for the patient (objective measure), validation is in regards to patient satisfaction and improvement of quality of life after HA use, handicap reduction

what is a warble tone? Why is a warble tone used when testing in a sound field?

Warble tone is useful in sound field testing to eliminate standing waves.

In what circumstance is advocacy for a patient by an audiologist required and appropriate

When patient is in need of assistive devices in work environment (OVR); legally in the courts, can serve as an expert; schools for accommodation

in what circumstances is it crucial to communicate with individuals other than the patient

When the patient is unable to care for themselves, if family members are crucial to the patient's care, language barrier

Are CICs better than BTE for retaining the natural resonating properties of the outer ear?

Yes because the microphone is in the ear, as opposed to on top of the ear like the BTE

on ABR tracings, how can you tell if waves are delayed?

absolute and inter peak/interaural latencies are not WNL

What pathologies are associated with reports of dizziness?

acoustic neuroma, cholesteatoma, AIED, BPPV, concussion, PLF, SCD, meniere's, otosclerosis

Describe the pure tone air and bone conduction results associated with different kind of hearing loss

air normal, bone elevated= conductive both elevated and equal = sensorineural bone elevated and air even more elevated =mixed

What is a human subjects board?

also known as IRB (international review board), is a committee in research community assigned to monitor, review, and approve biomedical and behavioral research involving humans

Which commonly used pharmaceuticals can affect balance? Which are ototoxic?

antidepressants, antihistamines, blood pressure, pain relievers, dizziness ototoxic: cisplatin, aminoglycosides (antibiotic), high blood pressure, aspirin/ibuprofen

Describe testing instrumentation that can be taken into the workplace

area readings, short term personal monitoring, noise dosimetry. Measures made near workers ears

Inverse Square Law

as the distance from a sound source doubles, the sound's intensity reduces by half the SPL when no obstruction is present (drop of 6 dB)

how long is it necessary to keep patients records?

billing records for 7 years according to IRS

Describe the technique for viewing via otoscopy the ear canal and TM

brace head with fingers. pull up and back ear to straighten canal

Why is etiology a critical factor in developing a plan for rehabilitation?

can be remediated with surgical intervention, can fluctuate symptoms, realistic expectations. Appropriate action plan

Identify treatments audiologists can provide for balance issues.

can perform tests but cannot diagnose. Can perform carnality repositioning; adaptation, habituation, and substitution protocol; gaze stabilization exercises; static and dynamic balance exercises

describe the screening protocols recommended for screening adults and children. how do they differ?

children: 20 dB 5,1,2,4

What are the etiologies of hearing loss present at birth?

congenital (can be syndromic or nonsyndromic)

Genetically caused non syndromic HL

connexin 26, connexin 30

What are the advantages of getting the hearing aid closer to the TM?

decreased occlusion effect

what kinds of results in gap detection and dichotic listening are suggestive of CAPD

difficulty in SIN attributed to poor temporal or freq resolution or inability to binaurally separate signals

What is the difference between disinfection and sterilization? When is sterilization required?

disinfection= eliminating/reducing harmful microorganisms (decontaminate surface and air) sterilization= eliminating all microorganisms (food, medicine, surgical instruments)

what is dynamic range and why is it necessary in the fitting of the hearing aid?

dynamic range is threshold to UCL/MPO. It is necessary in the fitting of the hearing aid so that soft sounds are appropriately soft and loud sounds are appropriately loud. a small DR is more difficult to fit

Discuss headphone options. list pros and cons of each.

earphones- easily calibrated, atresia, Inserts- higher IA, reduces risk of masking dilemma, lower variability in HF, eliminates collapsed ear canals, easily used with toddlers. Cons: replacement tips, max output is lower circumaural earphones- approximates canal volume with coupler, can be erroneous for surgical/small ears

What are the effects of hearing loss on language and speech?

effect of perception (distortion, recruitment, temporal resolution), phonetic features (voicing duration frication place)

List the kinds of intervention that can alleviate benign paroxysmal positional vertigo?

employ or sermont maneuvers (typically posterior canal) Lateral canal- log roll Surgical option

What are the effects of hearing loss on educational, vocational, social, and psychological functioning?

employer resistance to hiring person with HL (more likely to be unemployed), educational deficits with HL due to inability to understand lecturer, social isolation and depression, lower education level, loneliness, stress, reduced physical health

how often would you recommend an audiologist see a young child who has just been identified with a sensorineural loss?

every 6 months

What is auditory/verbal therapy?

facilitates optimal acquisition of spoken language through listening by children who are deaf/HOH; guides parents to create supportive envt, monitor language, integrate, and listen.

What impacts can hearing loss cause for adults (ex: social isolation)?

fatigue, depression, social withdraw, impaired memory, reduced quality of life, headaches, increased stress and blood pressure

what are the phonetically balanced word lists used for?

finding speech recognition/awareness thresholds

What features of an assessment will affect its reliability?

homogeneity of subjects, test retest interval, item difficulty, test length

Explain the terms dependent variable and independent variable as they relate to experimental design

independent variable is changed or controlled, and dependent is being tested or measured

what conditions of the ear might cause an audiologist to refer a patient for medical eval

infections, neuromas, drainage, sudden onset HL, dizziness, unilateral loss, ABG, pain/discomfort, child under 18, patient with positive case history of diagnoses associated with HL

what do rotational tests indicate about patients

inner ear vs brain; whether or not both ears are impaired at the same time

What is the difference between reliability and validity for an assessment?

internal validity: did study answer question and control variances well external validity: degree to which generalizations can be made (can't have without internal) reliability: consistency of performance

What results would you get if PE tubes are present?

large volumes

Describe the functions of each of the major components of a hearing aid.

microphone, processor, receiver, power supply (batteries), ear hook/mold, gain/volume controls, telecom, amplifier

Elevated acoustic reflex levels in the presence of normal hearing might lead you to think what?

middle ear disorder, cerumen, etc

What middle ear condition would present with a tymp that is flat and acoustic reflex absent?

middle ear effusion

Candidacy for osseointegrated cochlear stimulator

non-functional poor ear (profound HL) Good ear: 20 dB at 500, 1000, 2000, 3000 Hz -For mixed and con

what types of modifications can be made by changing tubing, venting?

occlusion: lengthen ear mold, add vent, use open fit Decreased tubing diameter decreases mid and HF gain

Describe embryology and the development of the hearing and balance mechanisms

otic vesicle forms week 3, auditory placode turns into otic pit. week 4 brachial arches form (tensor tympani, stapedius). Week 6 auricle forms from hillock, TM forms; ossification of stapes occurs after birth

describe different conditions of the ear canal that can be observed through an otoscope

otitis externa, exostoses, atresia, blood/drainage, cerumen impaction, foreign bodies

Name the condition associated with bony growth surrounding the bones of the middle ear and describe the type of hearing loss that accompanies it.

otosclerosis

Describe the function of each of the three major parts of the hearing mechanism

outer ear: collects HF, increases sound pressure to EC, binaural summation, localization middle: ratio of malleus to incus, size difference of TM to oval window, impedance matching inner: tonotopicity of BM and VIIIn; SOC localization and freq analysis; tectorial membrane displacement, HC innervation

What are the fluids found in the labyrinths of the inner ear?

perilymph is in scala vestibili and tympani. endolymph in media. Endolymph in semicircular canals.

What is informed consent?

permission granted in the knowledge of possible consequences, full knowledge of risks and benefits

how are pitch matching, loudness matching, and self reports used to assess tinnitus?

pitch, loudness, and amount of noise necessary to mask tinnitus. self report measures are useful in determining candidacy for treatment approaches, as well as pre post measures. pitch and loudness can be used in pre post, treatment options

What results from behavioral audiometry call for physiologic assessment to establish patient's condition?

poor word rec malingering= SRT doesn't agree with PTA, if flat moderate loss but fine in normal conversation, exaggeration, half spondee words

Describe the differences in speech and language development between pre- and post lingually deafened children.

pre lingual- deafened before they learn speech post lingua- deafened after they learn speech (about age 6) -effects are not as severe for post lingually deafened children; need to implant/amplify immediately for prelingual

List assistive devices that may be appropriate for a hearing impaired individual with a high degree of communicative needs (ex: someone in workforce with active social life)

remote mic, amplified phone, FM system, captioning

Describe follow-up procedure for a person who has not passed a hearing screening?

should be re-screened with tympanometry in 2-3 weeks; referral for comprehensive testing

What equipment is needed to measure noise in a classroom?

sound level meter, measure SNR and dBA

What factors call for referral to a speech pathologist, to an otolaryngologist, another audiologist?

speech pathologist- language therapy ENT- medical referral Other AuD- specialties (APD, tinnitus, vestib, etc)

Describe different conditions of the TM that can be observed through an otoscope.

stenosis, OME, perforation

Define threshold

the faintest sound where hearing is audible

what is the purpose of real ear measurement?

to convert dB HL of test to SPL targets. To then appropriately fit patient with audible levels

how to find UCLs

typically 100-110 dB HL for normal hearing listeners -cold running speech, or specific frequencies (ex: 500 and 4000 Hz) -level of speech is raised from below UCL by audiologist -patient indicates when speech becomes uncomfortable or intolerable

Having obtained a reliable SRT, how would you estimate MCL?

typically 50-55 dB above SRT -cold running speech, level is varied by audiologist -patient indicated when speech is most comfortable

genetically caused syndromic HL

waardenburg (white forelock, upturned nose, facial anomalies, congenital SNHL) Usher (vision loss, HL); pended (thyroid goiter, EVA) jervell and lange-nielsen (profound HL, irregular heartbeat, fainting, sudden death)