audiology final exam !

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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


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