CMD361: MIDTERM
pediatric questions for a case history
- Developmental Issues or Concerns - language development (when did they start talking? Is he/she intelligible) - Status of Siblings - Birth Issues - premature, NICU stay - Information from Pediatrician, Health Professionals, Teachers
conductive questions for a case history
- History of Infection - Drainage/Discharge - Excessive Cerumen - Upper Respiratory Infection - Swimming - Are the symptoms associated with an event or disorder
congenital disorder questions for a case history
- Inherited - other family members having similar problems ? - Acquired - maternal illness/ototoxicity, accident/trauma - Family History
rational for calibration of equipment
- Norms are conceived on the audiometer meeting standards - To apply the norms, the standards must be met - Equipment inaccuracy leads to misdiagnosis
central disorder questions for a case history
- Processing Problems - Hearing vs. listening vs. understanding - Other central manifestations - Multiple sclerosis
sensorineural questions for a case history
- Speech Understanding - Noise Exposure - Onset of Loss - Vascular Disorder - diabetes, high blood pressure - Neural Signs - symptoms suggesting schwannoma - Medication History ototoxicity
adaptation
- follows the on effect - a reduction in responsiveness
method of limits
- hearing test method in which the examiner manipulates the intensity of the signal - Patient identifies when it is just audible
weber test
- test where tuning fork is set to the center of the frontal bone - the patient is asked where he/she hears the sound
sound treated booth
- what's happening on the inside of the booth, surfaces in the booth are meant to absorb and diffuse sounds - helps to make sure there isn't a lot of reflection of sound because it gets distorted if it is reflected a lot
electroacoustic procedure, assessment of all parameters using a known normal for comparison
2 ways to calibrate equipment
supra aural headphones
Air conduction transducer: - Less time to prep patient - Work for most patients - May cause collapsed canals - Best for atresia or draining ears - Less costly
pure tone average
Average of 500Hz, 1000Hz, and 2000Hz
sensorineural loss
If AC and BC is depressed equally
mixed loss
If AC is depressed and BC is depressed but better than AC
conductive loss
If BC is normal and AC is depressed
air conduction, bone conduction
_______ can never be better than _______
it gives a chronology of events and is a legal and official document, the answers guide your testing
a case history is rationalized in that it is a professional record, meaning ___________, and a diagnostic tool, meaning __________
intensity is inversely proportional to distance from the source
according to the inverse square law,
60 dbhl
air bone gap maximum is
vibro-tactile response
air conduction can cause bone conduction stimulation by triggering a
entire auditory system
air conduction represents the
insert earphones
air conduction transducer: - Takes more time to place Avoid collapsing canals - Less masking required (because the sound is coming from inside the ear canal) - More costly - new one every single time
fletcher's average
average of the best of 500Hz, 1000Hz, 2000Hz
cochlear function
bone conduction measures
sound poof booth
booth that keeps outside sounds from coming in
normal or sensorineural hearing loss
during a rinne test, if the individual being testing hears the tone louder or longer by air, it suggests
conductive loss
during a rinne test, if the individual being testing hears the tone louder or longer by bone, it suggests
twice as long
during a rinne test, the tone should be ________ by air conduction
when the sounds no longer audible
during a rinne test, when do you move the tuning form from the mastoid toward the ear?
side with a conductive hearing loss or better bone conduction
during a weber test, the tone will lateralize to the
poorer ear
during a weber test, where will someone with a conductive hearing loss say they heard the tone?
better ear
during a weber test, where will someone with asymmetric sensorineural hearing loss say they heard the tone?
in the middle
during a weber test, where will someone with normal or symmetric sensorineural hearing loss say they heard the tone?
ascend 5db
during air conduction testing, each time the patient does not respond to a signal, you
descend 10dB
during air conduction testing, each time the patient responds to the signal, you
electroacoustic procedure
equipment calibration technique that is performed annually
steeply sloping
fletcher's average is usually used for what type of slope on an audiogram?
not calibrated, not reliable, of limited value
gross tests of hearing are
severe and minimal loss
gross tests of hearing may distinguish between
conversational speech, whisper, or watch ticking
gross tests of hearing may use
method of adjustment
hearing test method in which the patient manipulates the stimulus
with an oscilloscope
how is frequency measured during an electroacoustic procedure for testing calibration?
sound level meter and artificial ear
how is intensity measured during an electroacoustic procedure for testing calibration?
phase and rise are measured with an oscilloscope
how is time measured during an electroacoustic procedure for testing calibration?
4
how many times is threshold presented before determined?
general (why are you here, age, health, employment) to specific questions (symptoms, if one ear is better than the other, type of HL questions)
how you want to question someone for a case history
bone conduction is normal
if air conduction is normal,
inverse square law
intensity is inversely proportional to the distance from the source
125Hz-8000Hz
parameters of frequency on an audiometer
-10dB to 110dB
parameters of intensity on an audiometer
frequency, intensity, interrupter, mode selection
parameters of the audiometer
intensity, frequency, time
parameters tested during the electroacoustic procedure
interrupter
part of an audiometer that delivers the stimulus
mode selection
part of an audiometer that delivers which ear, air/bone, speech, sound field, MLV or CD
check equipment, review patient folder, size up patient, establish a rapport
pre hearing test activity
flat or gradually sloping
pure tone average is usually used for what type of slope on an audiogram?
inspect ear canal and ear drum status
purpose of an otoscope
the on effect
quantum leap in the neural system after sustained tone presentation of 1-2 seconds
the on effect, adaptation
testing protocol
test booth, otoscope, air conduction transducers
testing protocol equipment
threshold
the quietest level of sound that can be heard 50% of the time
severity, slope, site
threshold is measured at several frequencies in each ear and help to determine
rinne test
tuning fork test that compares air conduction to bone conduction by placing it on the mastoid and moving it in front of the ear when it is no longer audible
method of limits, method of adjustment
two main methods for testing hearing
rinne and weber
two types of tuning fork tests
severity of loss
what can a tuning fork test NOT tell us?
lateralization
what kind of test is a weber test?
1000hz at 30dbhl for 1-2 seconds
when testing air conduction, one presents a tone at
mastoid
when testing for bone during a rinne test, the tuning fork should be placed on the
mastoid or forehead
where do you place a bone oscillator?
right ear or better ear
which ear does one begin testing in?
red right, blue left
which ear goes which which color when testing air conduction with headphones
the tone will lateralize (or be longer) to the conductive side
why is the weber test a lateralization test?