Comprehensive Audiology Praxis

Hair cells resting

-70 mV

Option (B) is correct. 0 dB0 decibels HL on an audiometer represents the minimum audible pressure needed at each frequency for an individual with normal hearing to detect a pure tone. This value varies with frequency due to the anatomic and physiologic properties of the auditory system.

0 dBHL is best described by which of the following? A. The intensity at which the audiometer produces no sound at any frequency B. The different sound pressure levels that occur at different frequencies C. The minimum level at which speech is understood 50 percent of the time D. The intensity of 10 dB SPL at 1000 Hz

Reverberation time

0.05V/A 0.4-0.6 = acceptable

ABR artifact rejection

0.1 - 1.0

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

1-3-6 screen, diagnose, intervention

Maryland CNC

"say the ____ again" VA uses it

What steps need to be taken to verify the different kinds of assessment equipment?

#1: Annual electroacoustic calibration (does not exist for OAE & ABR) #2: Biological checks... self-listening check & hearing threshold check (audiogram on someone with "known and stable" thresholds.

period =

1/freq

yellow battery

10

ototoxic drugs

1. nonsteroidal anti-inflammatory drugs (NSAIDS) - ibuprofin 2. Platins (antineoplastic agents) 3. Diuretics 4. Mycins (Antibiotics - aminoglycosides)

words at 24 mo

100

Neurodiagnostic ABR

100 - 3000 hz click

red battery

5

vestib migraine

5 episodes lasting 5 min - 72 hours oVEMP - reduced/absent - central processing dirupted mixed results

How long is it necessary to keep patient records?

5 years (7?)

What value shows positive acoustic reflex decay?

50%

What are the etiologies of hearing loss present at birth?

50% Genetic (30%syndromic - 70% Non-syndromic) 25% Environmental 25% Idiopathic

2k method WRS

50-55 + 20-25 60-65 + 15 70-75 +10

likilihood a child has normal hearing after a referral to AuD

50-68%

Acoustic reflex stimuli

500, 1k, 2k, (not 4000Hz). Broadband noise. Should be 70-90 dB above threshold.

good electrode impedance

500-10,000 ohms

chronic / persistent tinnitus

6 mo +

normal sensation level

60-100

blue battery

675

big to small battery sizes

675 13 312 10 5

What coupler is used to calibrate supra-aural earphones?

6cc

What APGAR score is good within one minute?

7-10

at 1000 Hz 0dB SPL =

7dB HL

Good APGAR score at 5 minutes?

8+

words at 36 mo

800-900

NIOSH

85 db 8 hours 3 dB exchange rate

Musicians earplugs filter options

9, 15, or 25 dB atttenuation

OSHA

90 db 8 hours 5 dB exchange rate

What is the code for immittance testing?

92550

Code for tympanometry

92567

Code for ART

92568

Code for Comprehensive OAE

92588

Speech testing for ages

<2 years: Early speech perception test 2-5 years: NU CHIPS 4-6: WIPI 6+: PBK-50

reduced sensation level

<60 cochlear HL

ABR residual noise

<= 0.05

specificity

= TN / (TN + FP) accurately identifying who doesn't have it

sensitivity

= TP / (TP + FN) accurately identifying who has it

elevated sensation level

>100 retrocochlear or CHL

oVEMP abnormal

>40% asymmetry absent response low threshold below 70 Latency >13msec (retrocochlear)

ABR cross correlation value

>= 0.70

Med EL

12 pairs = 24 electrodes find M level IDR = 75 dB

# of OHCs

12,000

Pediatric cochlear implant candidacy

12-24 months Profound SNHL AU

In what freq and what intensities are most speech sounds produced

125 Hz - 8k or 250 - 4000 (speech banana) intensity: 55-65dB

orange battery

13

Medical asymmetry

15 dB @ 2 consecutive freq or >20 dB @ 1 freq

About how much is sound amplified at the resonant frequency?

15-25dB

Advanced bionics

16 electrodes Find M level Hires p = 120 IDR = up to 80

after a loud sound exposure that causes a TTS - how long does it take for the ears to recover

16-18 hrs

Wide dynamic range compression (WDRC)

1:5 and 3:1 are common compresison ratios low compression threshold, low compression ratio

12-18 mo

1st words

What number refers to the left ear in coding?

2

ABR thresholds are generally most closely correlated with behavioral thresholds for freq of

2 - 4k Hz

At what stage is the cochlea adult size?

20 wks

School screening

20dB HL @ 1000, 2000, 4000 Hz

Cochlear

22 electrodes Find C levels & T levels IDR: 30-45dB

Performance intensity functions

Articulation/Recognition/Discrimination function Change in intelligibility with change in intensity PB Max: the best score on the function WRS scores as a function of loudness of the presentation level

What does the APHB questionnaire consist of?

24 questions with 4 subscales Ease of communication Reverberation Background noise Aversiveness

EAC

25 mm long 8-9 mm diameter 1/3 cartilagneous outside 2/3 bony medial

When does phase locking occur until?

4-5kHz

Vestibulotoxicity

Constant Calorics: no response or low response o&cVEMPS: reduced of absent bilaterally vHIT: corrective saccades in all planes VST&SHA: LF affected before HF - good monitoring tool

What is current steering?

Current steering involves the simultaneous delivery of current to adjacent electrodes, where stimulation can be steered to sites between the contacts by varying the proportion of current delivered to each electrode in an electrode pair. Current steering may increase the number of spectral channels beyond the number of fixed electrode contacts.

A patient reports that hearing loss in both ears has slowly worsened and that hearing is better under noisy conditions than under quiet conditions. The patient's hearing loss is most likely to be...

CHL

ABR all waves delayed but interpeark latencies WNL

CHL

Longitudinal fracture

CHL

What type of hearing loss is associated with Fetal Alcohol Syndrome syndrome?

CHL, SNHL, or mixed

Advanced combination encoder ACE

CI Programming where a channel is generated by one implanted electrode, and the original spectrum is reproduced by 8-10 fixed channels

HiRes 120

CI programming strategy where the original spectrum is reproduced by 15 virtual channels, and all electrode pairs are turned on in a predefined sequence within 15 consecutive clock cycles

What cranial nerve innervates the tensor tympani muscle?

CN V

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

COSI APHAB HAsHAPI SADL IOIHA SSQ

What should caloric responses be?

COWS (Cool stimulation should beat eyes in the opposite direction of stimulated ear. Warm---same direction)

appropriate testing methods: 2.5 - 5 years:

CPA

determine appropriate assessment for...Use of different kinds of behavioral assessment?

CPA, VRA, BOA. Children or adults with developmental disabilities

What microphone has the delay ratio of 1 and has the least sensitivity to sounds from behind?

Cardioid

How and why is cold water used during videonystagmographic (VNG) and electronystagmographic (ENG) testing?

Cold water is used to gather a response. Cold water will stimulate a response for caloric testing if the warm and cold air does not provide a sufficient response.

CHARGE syndrome

Coloboma - missing segment of eye; Cranial Nerves Heart defects Atresia Choanae - bone blocking nasal passage Retardation of growth/development Genital/Urinary Abnormalities Ear abnormalities/hearing loss - normal (15%); mild-mod (38%); severe-profound(47%) 4/6 characteristics must be present for diagnosis Autosomal Dominant

Tinnitus Masker

Just a masking device

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

LACE

TEOAEs are better for ____________

LFs

Vestibulo-spinal reflex (VSR)

LVST + MVST keeps us upright

●Top: Anterior Semicircular Canal (Superior Semicircular Canal) [Bottom part of diagram, from left to right...] ●Posterior Semicircular Canal ●Lateral Semicircular Canal (Horizontal Semicircular Canal) ●Utricle ●Saccule

Label the 5 vestibular end organs.

[Going clockwise after the Trochlea...] 1. Superior Oblique 2. Medial Rectus 3. Inferior Rectus 4. Inferior Oblique 5. Lateral Rectus 6. Superior Rectus

Label the 6 eye muscles (this is a right eye, staring at you).

Oculomotor muscles (6)

Lateral rectus

perilymph fistula

Leaks of perilymph around the oval or round window. Caused by trauma or congenital conditions. Allows pressure changes to affect the inner ear

Typically, Meniere's affects _____ frequencies first

Low

Interaural Timing Difference (ITD)

Low Freq MSO

Complaints of Autoimmune inner ear disease

Low roaring tinnitus, dizziness, episodic hearing loss

Menieres treatment

Low salt, diuretics if that does not work, oral steroids during flare ups, meniett device: provides pressure to improve symptoms

Noonan syndrome

Low-set ears. SNHL in up to 50% of patients. Short stature, heart defects

Threshold

Lowest level at which responses occur in at least 1/2 of a series of ascending trials

Oculomotor muscles (3)

M (medial rectus) I (inferior rectus) S (Superior Rectus) O (inferior Oblique)

At what level is a word recognition test administered?

MCL/ 50-60 dB for normal hearing patients, for patient with hearing loss-- 20-30 dB SL the poorest air conduction threshold in the test ear from 1000-4000 Hz OR 20-30 dB SL the SRT

Discuss the pros and cons of MLV vs. recorded

MLV can be personalized. Recorded is more consistent and more standardized. MLV can be paced however is needed. Accents are a barrier (could be different than local dialect with either presentation). Recorded voice presents normative data (helpful when fitting).

TM layers

Cutaneous (outer) - EAM Fibrous Serous (inner) - ME

Right ASCC affected: down-beating right torsion Left ASCC affected: down-beating left torsion

Describe the type of elicited nystagmus in BPPV when the Anterior Semicircular Canal is affected?

describe the requirements of HIPAA.

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

Inferior Vestibular Nerve

Identify the site of lesion for the following test results: Lateral vHIT: WNL Vertical vHIT (RALP/LARP): Abnormal for upward impulses for side of lesion cVEMP: Abnormal recordings from the neck muscle toward side of lesion oVEMP: WNL

Posterior Canal

Identify the site of lesion for the following test results: Lateral vHIT: WNL Vertical vHIT (RALP/LARP): Abnormal for upward impulses for side of lesion cVEMP: WNL oVEMP: WNL

Saccule

Identify the site of lesion for the following test results: Lateral vHIT: WNL Vertical vHIT (RALP/LARP): WNL cVEMP: Abnormal recordings from the neck muscle toward side of lesion oVEMP: WNL

Utricle

Identify the site of lesion for the following test results: Lateral vHIT: WNL Vertical vHIT (RALP/LARP): WNL cVEMP: WNL oVEMP: Abnormal recordings from the eye muscle away from side of lesion

What is Tympanometric peak pressure?

Middle ear air pressure. TPP is negative when middle ear pressure is below ambient. TPP is associated with eustachian tube malfunction. TPP varies widely in children's ears that are normal

medical conditions associated with pediatric balance disorders

Migraine Benign paroxysmal vertigo of childhood (BPVC) otitis media viral infection head trauma

MAP

Minimum audible pressure monaural threshold w/ headphones

Meniere's disease: active state

Minutes - hours Gaze, positional, HFHS - opposite of alexanders law - beats towards affected ear EchochG: abnormal oVEMP: low amp, high Threshold, altered freq tuning, asymmetry cVEMP: low amp, high theshold, lower rates VST: low gaun & asymmetry, reduced time constant SHA(VOR): inc phase lead in LF, gain is WNL or reduced @ all freq

Option (D) is correct. A false-negative response is a response that occurs when a stimulus is presented, but the patient does not respond.

In audiometric testing, a false-negative response means that the signal was A. Not presented and the patient did not respond B. Not presented and the patient responded C. Presented and the patient responded D. Presented and the patient did not respond

4 habits model

Invest in the beginning, elicit the patients perspective, demonstrate empathy, invest in the end

Optokinetic:

Moving left and right at the same speed. OPK reflex response. Measures gain and symmetry. Really should be whole visual field-more than a light bar.

___________ typically has a much bigger modulation depth - aka greater variability in intensity and larger dynamic range than industrial noise

Music

ICD codes

international classification of diseases

Peds expectations: 4-6 mo

marginal babbling

Real Ear Saturation Response (RESR)/REAR 90/MPO

maximize DR

reporting cerumen management

methods/procedures outcome reccomendations

input dynamic range

mic sensitivity affects this

MAF

minimum audible field bianural threshold w/ loudspeakers

Marfan Syndrome

ong arms, legs, fingers & toes. Heart defects. CHL & recurrent ear infections. Hypertention can also cause SNHL.

COSI

open ended choosing listening siuations

Synthetic Sentence Identification (SSI)

open set sentences; 10 synthetic sentences that have typical sentence structure but without meaning

Speech recognition materials that may be helpful in ruling out a lesion affecting CN8

open set, monosyllabic, phonetically balanced word lists, administered at several intensity levels

A primarily hereditary, progressive disorder where the stapes footplate becomes partially fixed to the oval window.

otosclerosis carhart's notch stapendectomy

IDEA part A

outlines IDEA's purpose and defines terms used within the document.

disability

participation restriction/limitation

What the output level would exceed the MPO and the hearing aid stops the output at the MPO causing the sound to be clipped. This is one method of controlling the output so that the aid does not exceed safe out levels.

peak clipping

subjective tinnitus

perception of sound in the absence of an external acoustic stim

objective tinnitus

perception of sound that is generated by sources somewhere in the body

most valid method of monitoring a childs progress in aural rehab

periodically administering probes of treatment targets in naturalistic contexts

Unilateral weakness

peripheral finding WNL <22%

Temporal / volley theory

phase locking - responses summed Better for LF

elder abuse

physical, emotional, financial, sexual, neglect, abandonment

APD

poor neural encoding of auditory input within the central auditory pathway

What features of research supports generalizability of findings?

population, the age of the population, and the different variable each study has. If the variables are more wide-spread and cover a greater possibility of the population the results can be more generalized to cover the findings found

PAM

post auricular tension in neck or jaw 10-14 ms

What is the success with which the test predicts what is it supposed to predict?

predictive validity

Grades for hearing screening (minimum)

preschool, kindergarten, and grades 1, 3, 5, and either 7 or 9

3PD - persistent postural-perceptual dizziness

present most days 3+ months psychological dizziness testign essential WNL, subjectivly abnormal

Probe tube not deep enough in ear

reduced HF

Probe tube against canal wall

reduced LF

What are critical features of the documentation of intervention and the results of intervention?

referral procedures diagnosis Plan Telecoil awareness 30 day trial HAs will not restore hearing completely No need for medical evaluation prior to HA purchase Cost of HAs

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

remote mic, amplified phone, FM system, captioning

VBRT: habituation

repeating exposures "avoid avoidance"

What are the guidelines for acceptable noise levels OSHA?

requires employers to implement a hearing conservation program when noise exposure is at or above 85 decibels averaged over 8 working hours, or an 8-hour time-weighted average (TWA), which is a combination of all the sound intensities throughout the work shift. At 90 dB for 8 hours, the noise has reached the PEL (permissible exposure level), and hearing protection is warranted. Hearing protection required at 90 dB TWA & 85dB TWA with previous STS

Loudness matching minimizes the effect of ____________

residual inhibition

right anterior canal BPPV

rightward torsional and down-beating vertical nystagmus

If you do a blow by on an earmold impression

risk for malpractice

promontory

rounded elevation from the basal turn of the cochlea

diotic

same sound presented to both ears

IOIHA

satisfaction and QOL changes with HA use

Superior Canal Dehiscence (SCD)

seconds - minutes LF CHL oVEMP huge dizziness triggered by loud sounds or straining

BPPV

seconds - minutes rotary nystagmus in dix hallpike 70-80% in PSCC

Physical safeguard options outlined by the Health Insurance Portability and Accountability Act?

security cameras locked doors

How is verification of hearing aids different for children than for adults?

select DSL and targets change (louder) for children NAL-NL2 for adults

n400

semantics

Ototoxic moitoring

serial hearing assessments with ultra HF thresholds conducted up to 20k Hz or the highest frequency with at threshold at or below 100 dB SPL

SSQ

several domain of auditory disability and handicap

stages of grief

shock denial questioning (snger) bargaining mourning guilt acceptance

identification

show me the cat

Which provides the best hearing protection silicone vs foam vs silicone w/ filters vs passive circumaural earmuffs

solid silicone

peripheral nervous system (PNS)

somatic & autonomic gangion & nerves

parietal lobe

somatosensory association cortex

Real Ear Aided Response (REAR)

speech mapping HA on an in ear

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

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

Which muscle do we measure in acoustic reflexes?

stapedius

immittance

stiffness mass resistance/conductance

hit

stim presented and pt responds

monotic

stimulus presented to only one ear

Cerumen

subdermal sebacious glands subdermal apogcrine glands desquamated epithelial cells

validation

subjective pt satisfaction

corrected gestational age

subtract number of weks preterm

secondary objective tinnitus

suggestive of an underlying medical condition

p600

syntax

Chorda Tympani

taste

Human Subjects Board

the administrative and decision-making body having responsibility for review and approval of research involving human subjects.

pragmatics

the appropriate use of language in different contexts the social aspect

Weber

tuning fork test that evaluates bone conduction of sound in both ears at the same time forehead = lateralization midline = normal

Usher syndrome

type 1: (90%) retinitis pigmentosa by 10, profound congenital HL, Absent vestib Type 2: (10%) retinitis pigmentosa by 20's, Mod progressive HL,nrom or dec vestib Type 3: (<1%) retinitis pigmentosa by puberty, progressive HL, variable vestib

SHA: inc phase lead in LF, returning to norm

typical unilateral peripheral lesion

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

typically 50-55 dB above SR

PICO

Pop Intervention Comparison Outcome

VST symmetry

R gain vs L gain >30% = unilateral peripheral loss

When performing REUG which is most appropriate for verifying accurate probe tube placement in the EAC

REUG and monitoring gain at 6kHz

Which polarity is most effective?

Rarefaction It's depolarizing More effective activation of OHC due to upward deflect of BM

OAEs

Response above -10 Noise below 10 SNR >6 above NF

If an ABR wave I is normal, but latencies between waves I-III and I-IV are abnormally prolonged indicate

Retrocochlear pathology

Option (B) is correct. FM systems use an FM radio signal to deliver a louder and clearer signal from the teacher to the student, thus improving the signal-to-noise ratio. FM systems help overcome the effects of distance and can greatly reduce the effects of background noise and reverberation.

The primary benefit of using FM systems in the classroom is that they A. Enhance the effects of classroom noise on the student's speech understanding B. Reduce the speaker-to-listener distance, thus improving the signal-to-noise ratio C. Improve speech understanding by extension of the frequency response of the amplification system D. Convert analog signals into digital signals, which do not often face distortion

Vestibulospinal tract

VCN Occulomotor nuclei Abducens nuclei Trochlear Nuclei Vestib Cortex Cerebellum Spine to balance posture

What do you expect to see if there is a unilateral finding of delayed I-III interwave latency?

Tumor in the cerebellopontine angle

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

Tumor/other retrocochlear pathology

Sinusoidal Harmonic Acceleration (SHA)

VOR VFx VVOR phase gain symmetry spectral purity

VBRT: adaptation

VOR improvement - watching a tennis match

appropriate testing methods: 6 months-2.5 years:

VRA

How would you achieve SAT with a very young child who does not talk?

VRA, identify objects, point to body parts

Describe the mapping process for cochlear implants.

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

Pediatric Closed set WRS

WIPI NU-CHIPS

VST gain

WNL = 0.4 - 1.0 Low; <0.4 - uncompensated unilateral or bilateral loss Excessive; >1.0 = cerebellar - strap in head

SHA: gain

WNL= 0.8 - 1.0 dec? - acute unilateral vestib lesion or bilat vestib loss excessive? - head slip or cerebellar

In an ECochG, what does the AP represent?

Wave I on the ABR abnormal = ratio of 0.5 of greater

Waves of an ABR and their origin

Wave I: 1.5msec- distal portion of VIIIth CN Wave II: 2.5msec- proximal portion of VIIIth CN Wave III: 3.5msec- second order nruon activity near cochlear nucleus Wave IV: 4.5msec- third order neurons in SOC/lateral lemniscus Wave V: 5.5 msec- termination of lateral lemniscus and inferior colliculus

Interwave latencies

Waves I-III- 2msec Waves I-V- 4msec Waves III-V- 2msec

Holds the image of a stationary object on the fovea when the head is still

What is the main function of the Visual Fixation class of eye movement?

Calorics: normal Horizontal vHIT: normal Vertical vHIT: abnormal ipsi downward impulse cVEMP: abnormal ipsi upward impulse oVEMP: normal

What is the pattern of test results and impaired structures for a Inferior Vestibular Nerve impairment? Calorics: Horizontal vHIT: Vertical vHIT: cVEMP: oVEMP:

Calorics: normal Horizontal vHIT: normal Vertical vHIT: normal cVEMP: abnormal ipsi oVEMP: normal

What is the pattern of test results and impaired structures for a Saccule impairment? Calorics: Horizontal vHIT: Vertical vHIT: cVEMP: oVEMP:

Calorics: abnormal ipsi Horizontal vHIT: abnormal ipsi Vertical vHIT: abnormal contra downward impulse cVEMP: normal oVEMP: abnormal ipsi ear stimulated

What is the pattern of test results and impaired structures for a Superior Vestibular Nerve impairment? Calorics: Horizontal vHIT: Vertical vHIT: cVEMP: oVEMP:

Calorics: abnormal ipsi Horizontal vHIT: abnormal ipsi Vertical vHIT: abnormal ipsi cVEMP: abnormal ipsi oVEMP: abnormal ipsi ear stimulated

What is the pattern of test results and impaired structures for a Total Unilateral impairment? Calorics: Horizontal vHIT: Vertical vHIT: cVEMP: oVEMP:

Calorics: normal Horizontal vHIT: normal Vertical vHIT: abnormal contra downward impulse cVEMP: normal oVEMP: normal

What is the pattern of test results and impaired structures for a aSCC impairment? Calorics: Horizontal vHIT: Vertical vHIT: cVEMP: oVEMP:

Calorics: abnormal ipsi Horizontal vHIT: abnormal ipsi Vertical vHIT: normal cVEMP: normal oVEMP: normal

What is the pattern of test results and impaired structures for a hSCC impairment? Calorics: Horizontal vHIT: Vertical vHIT: cVEMP: oVEMP:

Calorics: normal Horizontal vHIT: normal Vertical vHIT: abnormal ipsi upward impulse cVEMP: normal oVEMP: normal

What is the pattern of test results and impaired structures for a pSCC impairment? Calorics: Horizontal vHIT: Vertical vHIT: cVEMP: oVEMP:

Calorics: normal Horizontal vHIT: normal Vertical vHIT: normal cVEMP: normal oVEMP: abnormal ipsi ear stimulated

What is the pattern of test results and impaired structures for a utricule impairment? Calorics: Horizontal vHIT: Vertical vHIT: cVEMP: oVEMP:

Extorsion; Elevation; Abduction

What is the primary, secondary, and tertiary action of the Inferior Oblique when the eye is in Central Position?

Depression; Extorsion; Adduction

What is the primary, secondary, and tertiary action of the Inferior Rectus when the eye is in Central Position?

Abduction

What is the primary, secondary, and tertiary action of the Lateral Rectus when the eye is in Central Position?

Adduction; N/A; N/A

What is the primary, secondary, and tertiary action of the Medial Rectus when the eye is in Central Position?

Intorsion; Depression; Abduction

What is the primary, secondary, and tertiary action of the Superior Oblique when the eye is in Central Position?

Elevation; Intorsion; Adduction

What is the primary, secondary, and tertiary action of the Superior Rectus?

Nystagmus defined by the eye rotating around the anterior-posterior axis

What is torsional nystagmus?

The false sensation that the individual or environment is moving. This is commonly described as a "room spinning" sensation.

What is vertigo?

Visual input and proprioceptive/somatosensory input

What other kinds of input, besides vestibular, do the vestibular nuclei receive?

● Superior: anterior SCC, horizontal/lateral SCC, utricle Inferior: posterior SCC, saccule

What structures do the superior vestibular nerve and inferior vestibular nerve innervate, respectively?

(C) vHIT (high acceleration, natural head movement VOR)

What test is used to assess the function of the Anterior Semicircular Canal/Superior Vestibular Nerve? (A) oVEMP (B) cVEMP (C) vHIT (D) Calorics

(C) vHIT (high acceleration, natural head movement VOR)

What test is used to assess the function of the Posterior Semicircular Canal/Inferior Vestibular Nerve? (A) oVEMP (B) cVEMP (C) vHIT (D) Calorics

(B) cVEMP (Vestibulo-[Sacculo])-collic Reflex

What test is used to assess the function of the Saccule/Inferior Vestibular Nerve? (A) oVEMP (B) cVEMP (C) vHIT (D) Calorics

(A) oVEMP (Vestibulo-[Utriculo])-ocular Reflex

What test is used to assess the function of the Utricle/Superior Vestibular Nerve? (A) Ocular VEMP (B) cVEMP (C) vHIT (D) Calorics

Dix-Hallpike test

What test would you conduct when you suspect BPPV?

(C) vHIT, (D) Calorics, and (E) Rotary Chair vHIT (natural head movement and high-frequency VOR) Caloric testing (very-low frequency VOR function) Rotary Chair (low-mid frequency VOR function)

What tests are used to assess the function of the Horizontal Semicircular Canal/Superior Vestibular Nerve? (A) oVEMP (B) cVEMP (C) vHIT (D) Calorics (E) Rotary Chair

What type of hearing loss is associated with Stickler snydrome?

What type of hearing loss is associated with Stickler snydrome?

Time course: seconds Associated symptoms in addition to vertigo: N/A Exacerbating factors: movement

What would the history break down of BPPV (a peripheral vertigo disorder) look like?

Time course: hours to days Associated symptoms in addition to vertigo: hearing loss; tinnitus Exacerbating factors: N/A

What would the history break down of Labyrinthitis (a peripheral vertigo disorder) look like?

Time course: minutes to hours Associated symptoms in addition to vertigo: hearing loss; ear pressure; drop attacks; tinnitus Exacerbating factors: atmospheric and weather changes; diet

What would the history break down of Meniere's Disease (a peripheral vertigo disorder) look like?

Time course: minutes to hours Associated symptoms in addition to vertigo: hearing loss; drop attacks; amplification of sound Exacerbating factors: loud noises

What would the history break down of Superior Semicircular Canal Dehiscence (a peripheral vertigo disorder) look like?

Time course: hours to days Associated symptoms in addition to vertigo: N/A Exacerbating factors: N/A

What would the history break down of Vestibular Neuritis (a peripheral vertigo disorder) look like?

Daily biological/listening checks.... when should you do this? why should you?

When? Before using new equipments, daily or some other regular interval Why? To detect problems prior to obtaining clinical data & monitor the status of your equipment

504 plan

a plan developed to ensure that a child who has a disability identified under the law and is attending an elementary or secondary educational institution receives accommodations that will ensure their academic success and access to the learning environment

Residual inhibition

a temporary decrease of tinnitus after a prolonged acoustic stimulation.

Dysacusis

altered perception of tonal quality or distortion of sound

how to try and eliminate CM from a electrocochleographic response

alternating polarity clicks

Real Ear Insertion Gain (REIG)

amount of gain provided by the HA alone REAR-REUR

cone of light quadrant

anterior inferior

impairment

any loss of abnormality of psychological, physiological, or anatomical structure or function (HL on audio)

expansion

applying less gain for soft sounds

hyperpolarize

inhibitory (-)

Before administering a test, what must you do? How can you be sure it is an appropriate measure for the intended chart?

instruct your patient on what they need to do and what is expected of them. You can make sure it is an appropriate measure for the intended target by making sure that the individual is able to perform the tasks if there is no suggested age limit.

pulse width/duration CI

intensity 25micros/phase

independent variable

The experimental factor that is manipulated; the variable whose effect is being studied.

IDEA part B

covers children and young adults with disabilities ages 3-21

Peds expectations: birht - 1 mo

cry & vegitative sounds

insertion loss

decrease in natural amplification when the external auditory canal is closed off. When the ear canal is closed off with an earmold or a hearing aid, there is a loss of natural resonance in the ear canal

negative reinforcement

decrease undesirable behavior

Steps of auditory

detection or awareness discrimination identification comprehension

dichotic

dfferent sound presented to the two ears

real ear to coupler difference (RECD)

difference in dB across freq btwn a pts real eat and a 2cc coupler

APHAB

disability by HL and reduction of disability with

handicap

disadvantage for an individual that limits or prevents the fulfillment of a role that is normal (no promotion of job b/c HL)

MVST

doesnt extend past he thoracic region (head neck upper limbs)

left hemiphere

dominant for speech & language

Medicare part D

drug benefit

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

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

IDEA part C

early intervention

Individualized family service plan (IFSP)

early intervention services and planning for an infant/toddler to three years old and their family

supraaural headphones

easy to calibrate, could cause collapsing ear canals. lower inter-aural attenuation (easier for sound to travel from one ear to the other). Worse for high frequencies. Better for lows.

Peds expectations: 8-12 mo

echolalia

What provisions of educational legislation (e.g., IDEA) have an impact on audiologic practice?

educational legislation (e.g., IDEA) have an impact on audiologic practice? IDEA, IEP, FM systems, the cost and need the children need, hearing aids, parts for broken hearing aids etc

Childrens Auditory processing performance scale (CHAPPS)

efficiency measure for HATs

Describe cases that call for the inclusion of individuals besides the patient in communication about intervention.

elderlychildcognitive impairmentdisability/syndromeinterdisciplinary involvement- other doctors- specific diag

Disenfection

eliminating / reducing harmful microorganisms (decontaminate surface & air

Sterilization

eliminating all microorganisms (food medicine surgical instruments) - done with bodily fluids

gap junction beta 2 (GJB2)

encodes co cx26 protiens

P2 N2

endogenous

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

every 6 months

WRS classifications

excellent: 90-100 Good: 80-89 Fair: 70-79 Poor: 40-69 Very Poor: 0-39

Deoplarization

excitatory (+)

frontal lobe

executive function motor

P1 N1 P2

exogenous

36 - 40 mo

expressive vocab why singing compond & complex sentences

Ewalds law

eye and head movements always occur in the plane of the canal being stimulated eye measurements are in the direction of endolymph flow

What is auditory/verbal therapy?

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

Impacts of Adult HL

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

Medicare

federal 65+. diabetes, end stage renal disease

early intervention

five developmental areas: - physical - cognitive - communication - social - adaptive Examples of services include assistive technology, audiology, speech, counseling, medical, nursing, nutrition, occupational therapy, physical therapy, psych services

Connexin 26

found in the cochlea, support cells, and stria vascularis mutation: varies from mild - profound HL

otomycosis

fungal outer ear infection

stacked ABR

good for finding small tumors

Sensory Presbycusis

hair cells. Initially affects the outer row of OHC in the basal turn. Secondary degeneration of auditory nerve fibers occurs.Lipofuscin (age pigment) accumulates in cochlea cells.

informed consent

he permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits

apgar scores

health after birth at 1 & 5 minutes

High frequencies are _______ dominated, while low frequencies are ______ dominated.

high frequencies are stiffness dominated low frequencies are mass dominated.

Is infrared higher or lower frequency than bluetooth?

higher

Medicare part A

hospital insurance

Vestibular neuritis

hours - days NO HL cVEMP: WNL oVEMP: reduced Calorics: UW Gaze, HFHS, Positional: nystagmus beats to better ear VST: low gain and time constant, asymmetry SHA: high phase lead, low gain, asymmetry posturography: increased sway in 5&6

Labrynthitis

hours - days SNHL cVEMP: reduced oVEMP: reduced Calorics: UW Gaze, HFHS, Positional: nystagmus beats to better ear VST: low gain and time constant, asymmetry SHA: high phase lead, low gain, asymmetry posturography: increased sway in 5&6

What is gradient /tympanometric width (TW) is a measure of?

how "sharply peaked" vs. "flattened" the tympanogram is. Flattened tympanograms are associated with effusion. Gradient / TW are mainly an attempt to quantify this qualitative observation

Real Ear Unaided Response (REUR)

how sound behaves in the ear alone (un-occluded)

analytic auditory training

breaking speech into smaller components

Presbycusis by stria vascularis

trouble with K= reentering the endolymph

Artherosclerosis

Hardening and narrowing of the arteries due to buildup of cholesterol plaques Fail VAST

cVEMP

Ipsi saccule Inf vestib nerve inhibitory P1 (13) N1 (23)

Posterior SCC

Ipsi: Superior Oblique Contra: Inf rectus

Horizonal SCC

Ipsi: medial rectus Contra: LAteral rectus

Outer Hair Cells (OHC)

Cochlear Amplifier - efferent signal embedded on TM 3 rows

What are the 3 primary sections of the CN VIII?

CochlearSuperior VestibularInferior Vestibular

SADL

4 subscales of cost, positive effect, negative features, and personal image

Autoimmune disorders related to autoimmune inner ear disease (AIED)

Cogans syndrome, rheumatoid arthritis, hashimotos, wegeners granulomatosis

SL =

(SPL - RETSPL) - HL

HL =

(SPL - RETSPL) - SL

Metabolic Presbycusis

(atrophy of stria vascularis): Stria generates energy and nutrients for the cochlea; stria loss reduces cochlear function. Flat audiometric configuration

Mechanical Presbycusis

(stiffening BM): cochlear conductive HL. The assumption is that structural changes in the basilar membrane and/or spiral ligament occur with age. Hearing loss has a shallow slope and no histologic evidence of cochlear or neural damage

double a sound source

+ 3 dB

What is the acceptable error that an audiometer may differ from the RETSPL or RETFL?

+/- 2.5dB

Minimum Classroom SNR

+15 dB

Example of psychophysical (behavioral) tests

+Dichotic listening tests--corpus collosum +Temporal processing (gap detection, pattern perception) +Low-redundancy speech (distorted speech)+Binaural interaction\ +Auditory discrimination tests

double distance of sound source (inverse square law)

- 6 dB

Speechreading tests

- difficult to administer and assess because of intertalker differences and lack of naturalness - the most realistic measure of speechreading ability are administered in a combined auditory visual mode

Alexanders law

- fast phase (beat) towards healthy ear - greatest when gaze is directed towards healthy ear, reduced at center, and eliminated when gaze is toward affected ear - nystagmus improves w/ visual target

APD prosodic dysfunction *R hemi*

- missing prosodic cues of speech - monotone speech - visual spatial relations - poor sight word readin & math -Dichotic - contra - LE deficit - bilateral temporal patterning deficit

Central findings that dont follow alexanders law

- nystagmus changes direction - L or R beat nystagmus present in all conditions - nystagmus doesnt go away with fixation - vertical

APD interhemispheric dysfunction

- speech in noise issues - maybe loclization issues - dichotic tests : L ear deficit - temporal pattern: labelling issues

APD auditory decoding deficit *L Hemi"

- speech in noise issues - mishear info - better w/ visuals All R ear or bilat deficits - monaural low redundancy - auditory closure - temporal pattern resolution - dichotic listening

Jervell & Lange-Nielsen Syndrome

-Autosomal Recessive (i.e., both copies of the gene in each cell have mutations) -most often the parents of a child with an autosomal recessive disorder are not affected but are carriers of one copy of the mutated gene. -condition that causes [bilateral] profound hearing loss from birth and a disruption of the heart's normal rhythm (arrhythmia). This disorder is a form of long QT syndrome, which is a heart condition that causes the hear (cardiac) muscle to take longer than usual to recharge between beats. Beginning in early childhood, the irregular heartbeats increase the risk of fainting (syncope) and sudden death. congenital bilateral (profound usually) HL family history of sudden death

CI objective measures

-Electrically evoked stapedial reflexs (ESRT) - Electronically evoked compound action potentials (ECAP) -eABR -AEV

What are different conditions of the ear canal that can be observed through the otoscope?

-Exostoses - bony growth-Osteoma - bony growth -External otitis - infection of ear canal and pinna

List self-report scales of hearing problems.

-Scale of Self-Assessment of Hearing Handicap - Client Oriented Scale of Improvement (COSI) Glasgow Hearing Aid Benefit Profile (GPHABP) -Denver Scale of Communication Function - Modified (DSCF-M) -Profile of Hearing Aid Performance (PHAP)

self-report scales of hearing problems.

-Scale of Self-Assessment of Hearing Handicap -Client Oriented Scale of Improvement (COSI) -Glasgow Hearing Aid Benefit Profile (GPHABP) -Denver Scale of Communication Function - Modified (DSCF-M) -Profile of Hearing Aid Performance (PHAP)

What are the key precautions used to achieve infection control?

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

conditions that require multiple audiometric assessments to diagnose

-otoxicitiy -temporal bone trauma -autoimmune inner ear disease (AIED) -SCDS -Meniere's -Sudden idiopathic SNHL -perilymph fistulas -acoustic neuroma -ANSD

CI FDA ages

1 yr Bilat 6 yrs SSD

Steps for biological check

1) Phone check... play a continuous pure tone, reduce and increase (check for noise). 2) Bone oscillator check... across frequencies at 30 dB and 50 dB for distortion 3) Audiometer check (are dials loose? Listen for background noise in between signals) 4) Threshold check (on chair in booth) 5) Tymp: 2cc on volume measures on tymp. should easily obtain a sea

Digital HAs

1. Mic 2. A/D converter 3. amplifier/compressor 4. Signal processor/tone controls/filters 5. D/A converter 6. Reciever

Inner Hair Cells (IHC)

Signal detection - sensory Afferent Signal Not embedded on TM 1 row

Peds HA Verification

1. RECD w/ test box verification 2. RECD w/ on ear verification 3. avg RECD by age w/ test box on ear verification (only in rare circumstances

4 main vestib questions

1. When did it start 2. what does it feel like 3. how long does it last 4. is it getting better

effects of HL

1. decreased audibility 2. decreased dynamic range 3. decreased freq resolution 4. decreased temporal resolution

FDA Red Flags

1. visible congenital or traumatic deformity of the ear 2. Hx of active drainage in past 90 days 3. Hx of sudden or rapidly progressive loss in past 90 days 4. acute of chronic dizziness 5. unilateral Sudden HL 6. 15 dB ABG @ 500, 1000, & 2000 7. signifignat cerumen accumulation or foreign body 8. pain or discomfort in ears

NIOSH (National Institute for Occupational Safety and Health)

3 dB exchange 85 8 hrs 88 4 hrs etc

Recurrent Acute OM

3 or more bouts within 6 months

IEP (Individualized Education Plan)

3+ legal document that is specifically tailored for the disabled student

What estimation of children in the US are deaf or hard of hearing?

3-4 million

Threshold ABR

30 - 3000 Hz Tone burst

sudden SNHL

30 dB within 72 hours of 3 continuous freq - must see them in 14 days

When should you retest if you see a STS

30 days

brown battery

312

classroom reccomendations

35 dB +15 SNR 0.6 RT

# of IHCs

3500

Option (D) is correct. The middle-ear system of an infant is mass dominated with a lower resonant frequency; thus, a 1000 Hz probe frequency would be more appropriate for detecting changes in middle-ear function than a 226 Hz 226 probe tone.

A 1000 Hz tympanogram is obtained on a 1-month-old infant by an audiologist, who reports a flat tympanogram. The parents seek a second opinion from another audiologist, who performs a low-frequency 226 Hz tympanogram and reports a normal tympanogram. The discrepancy in the tympanograms is most likely the result of A. Differences in training between the two audiologists B. A misinterpretation of the tympanogram by one of the audiologists C. Increased cooperation by the infant during one of the measurements D. The decreased reliability of low-frequency tympanograms on infants

Option (B) is correct. Given that the child is 13 months of age, the fitting of amplification needs to happen as soon as possible. However, it is necessary to obtain medical clearance before fitting the child with amplification.

A 13-month-old child has been diagnosed with a severe-to-profound hearing loss. An audiologist has met with the child's parents to discuss the functional impact of this hearing loss, as well as treatment options, which the parents have read about online. Which of the following is the audiologist most likely to recommend as the next best step for the parents to take? A. Obtaining bilateral cochlear implants for the child B. Consulting with a pediatric otolaryngologist to obtain medical clearance for amplification C. Scheduling a future appointment with the audiologist to review information about their child's hearing loss D. Joining a support group for parents of infants with hearing loss to gain insight into the issues they may face

Option (D) is correct. There is poor agreement between the pure-tone average and the speech-recognition threshold, accompanied by discrepancy between word-recognition scores and pure-tone average, suggesting a nonorganic hearing loss. Using an ascending-threshold measurement technique will disrupt the child's loudness yardstick and provide a better estimate of true organic hearing sensitivity.

A 13-year-old child presents the following audiometric results: normal acoustic immittance battery, pure-tone average of 50 dBHL bilaterally, bilateral speech-recognition thresholds of 20 dBHL, and word-recognition scores of 100 percent bilaterally at 50 dBHL. Which of the following is the most appropriate next step for the audiologist to take? A. Administering pure-tone Stenger tests B. Obtaining typanograms C. Administering a central auditory processing test battery D. Reinstructing the child and using an ascending-threshold measurement technique

Option (C) is correct. The child had already begun to learn oral speech and language before experiencing the hearing loss, and the family has no known ties to Deaf culture. Because the child is responding well to amplification and the family appears to be willing to be very involved in rehabilitation, auditory-verbal therapy is the best choice for a communication mode.

A 2-year-old child was recently identified as having a severe-to-profound sensorineural hearing loss bilaterally after a bout with meningitis. Before contracting meningitis, the child had developed some speech and language but now uses very few words expressively. The child's receptive language is at the level of an 18 month old. Initial responses to binaural amplification have been very positive. Parents and siblings, who have normal hearing, are highly motivated to do what is necessary for the child's development. Based on the preceding information, what communication methodology would be the best option for the family to pursue? A. Signed Exact English B. Total communication C. Oral/aural communication D. Simultaneous communication

Option (B) is correct. Since the child is cooperative for otoscopy and tympanometry, she will likely be cooperative for otoacoustic emission (OAE) testing, which will provide important information to the parents.

A 23-month-old child was seen in an audiology clinic. The child presented with a chronic history of upper respiratory infections, middle ear infections, diminished vocabulary, and delayed speech-sound development. She had pressure-equalization (PE) tubes placed when she was 19 months old, and audiologic testing was attempted but was unsuccessful in the ENT office post-surgery. She is the daughter of bilingual parents who divide their conversational speech between English and Spanish in the home environment. The child was cooperative for otoscopy, and PE tubes were observed bilaterally, with subsequent large volumes confirmed by tympanometry. Which of the following tests is most likely to be performed next? A.Air- and bone-conducted picture-pointing speech recognition thresholds B.Otoacoustic emissions C.Sound field visual-reinforcement audiometry D.Audiometry played through headphones

Option (C) is correct. While all the vestibular tests shown could provide beneficial information, rotary chair, vHIT, and oculomotor testing are the only tests that can be performed on someone with a surgically closed canal.

A 35-year-old male is scheduled for vestibular testing. In reviewing his case history, an audiologist finds that he is status post mastoid obliteration with surgical ear canal closure following cholesteatoma removal on his right ear two years ago. He did have residual dizziness following his surgery, requiring him to attend vestibular rehabilitation for twelve weeks postoperatively. Which of the following test batteries is the audiologist most likely to recommend for the patient (assuming the audiologist does not have the ability to do bone-conducted VEMPs) ? A. Rotary chair, full VNG, bilateral VEMPs B. Posturography, calorics, bilateral VEMPs C. Rotary chair, vHIT, oculomotor testing D. Oculomotor testing only

(C) Inability to process spatial cues The correct answer is (C). Localization in the horizontal plane (which is the task required to locate voices in a group) is based on the spatial cues of interaural time and intensity. (A) is incorrect because pinna filtering is not distorted with in-the canal hearing aids, and pinna cues are primarily used for vertical localization. (B) is incorrect because ear-canal resonance is not eliminated by hearing aids; ear-canal resonance is altered by hearing aids. (D) is incorrect because frequency selectivity is not important for locating a sound source in the horizontal plane.

A 38-year-old patient with a moderate midfrequency hearing loss was fit with bilateral in-the-canal hearing aids. The patient complains of difficulty finding the person speaking when in a social or work situation where there are more than three or four people. Which of the following is most likely to be responsible for the patient's reported problem? (A) Distorted pinna filtering (B) Absent ear-canal resonance (C) Inability to process spatial cues (D) Decreased frequency selectivity

Option (B) is correct. The ocular VEMP afferent pathway consists of the utricle and superior vestibular nerve branch and is recorded contralateral to the ear of stimulation. In this example, when the stimulus (125125 decibels dB SPL) is applied to the left ear, there is no recordable response from the right inferior oblique. The ear in question is the left ear as no repeatable waveforms were obtained.

A 42-year-old male is being seen for vestibular testing. He reports that his primary symptoms are feeling off balance and some triggered symptoms of slight dizziness with head movements. Vestibular evoked myogenic potentials (VEMPs) were performed as part of a comprehensive vestibular evaluation. The results of the cervical (cVEMP) and ocular (oVEMP) responses for each ear are summarized in the following table. Testing was performed at 125 dB SPL at 500 Hz for air conduction stimuli. Otoscopy and tympanometry were performed prior to VEMP testing and verified normal outer and middle ear status. Appropriate electromyography (EMG) levels were maintained throughout testing. Which of the following statements best describes the VEMP test results? Amplitude cVEMP right ear: Present response at appropriate amplitude cVEMP left ear: Present response at appropriate amplitude oVEMP right ear: Present response at appropriate amplitude oVEMP left ear: No repeatable waveforms A. Possible dysfunction of the left utricle/inferior vestibular nerve B. Possible dysfunction of the left utricle/superior vestibular nerve C. Possible dysfunction of the left saccule/inferior vestibular nerve D. Possible dysfunction of the left saccule/superior vestibular nerve

Option (A) is correct. Knowledge and application of repair and facilitative strategies would assist interprofessional practice.

A 5-year-old child was recently diagnosed with a bilateral, moderately severe sensorineural hearing loss after a bout of meningitis. She had typically developing speech and language before her illness but now has significant difficulty communicating because of her hearing loss. She also has other comorbidities as a result of the meningitis. Knowledge of which of the following would assist other professionals who are working with this child? A. Use of communication strategies B. Vestibular rehabilitation exercises C. Cochlear implant evaluation D. The etiology of the meningitis

Option (C) is correct. Cisplatin can be ototoxic, and tinnitus and hearing loss are common side effects.

A 54-year-old computer sales representative was treated with cisplatin for an infection. Now the patient has trouble understanding speech, especially in noisy situations, and complains of tinnitus in both ears. Which of the following is the most likely cause of the patient's hearing problems? A.Bilateral otosclerosis B.Ménière's disease C.Ototoxicity D.Presbycusis

Option (B) is correct. Cisplatin treatment is ototoxic, impacting ultrahigh frequencies.

A 54-year-old patient who will start cisplatin treatment in two days has been referred to audiology. Which of the following is consistent with guidelines for audiological management of the patient? A. Baseline testing should be conducted one week after the first dose is administered and should include pure-tone air conduction testing and speech recognition screening. B. If the patient is able, serial hearing assessment using ultrahigh frequency thresholds should be conducted up to 20 kHz or the highest frequency with a threshold at or below 100 dB SPL. C. A 5 dB5 decibels shift in pure-tone thresholds at one or more frequencies should be considered a significant change in hearing if middle-ear dysfunction has been ruled out. D. If the patient is not able to complete full behavioral testing, transient OAE monitoring should be implemented.

Option (D) is correct. The audiologist needs to address the patient's chief complaint of difficulty understanding speech in noisy situations, such as large-group meetings and busy cafeterias.

A 55-year-old patient is having trouble understanding others speaking in group situations at work and in the cafeteria at lunchtime. The patient's audiometric results indicate normal hearing in both ears and that word recognition in quiet is at 96% bilaterally. Which of the following tests should also be conducted? A. Otoacoustic emissions B. Loudness discomfort levels C. Acoustic reflex decay D. Speech-in-noise

Option (D) is correct. Low-level environmental noise or internal noise generated by the hearing instrument should be less audible when expansion is activated.

A 55-year-old sound engineer who works at a local television news company visits an audiologist. He recently obtained receivers in the ears (RITEs) from another audiologist, but he still experiences listening difficulty. His recent audiogram is within normal limits, from 250 Hz to 750 Hz, progressively sloping to severe impairment at 8 kHz in both ears. To address his reported listening difficulties, the audiologist reviews his hearing-aid settings and creates a new multichannel expansion program. Also completed was on-ear speech mapping at increasing input levels (50 dBSPL to 80 dBSPL). Which of the following responses to this adjustment would the patient be most likely to report? A. Reporting that the internal noise from his hearing aids has increased B. Reporting that high-frequency speech sounds are much clearer C. Reporting that there is no difference between soft and loud speech sounds D. Reporting increased difficulty hearing low-level, high-frequency speech sounds

that the middle ear and the cochlea are probably intact and that a surgeon has only to open the occluded canals for hearing to be made functional. However, to perform surgery on a 6-month-old child without having more information about hearing competence would be unwarranted. Because bilateral atresia often can be handled through a bone-conduction hearing aid, such a device should be tried first and the child's growth and development monitored to determine when surgery should take place. (A), (B), and (C) are incorrect because they are not appropriate courses of action based on the evaluation of the child.

A 6-month-old child born with bilateral bony atresia is seen for an audiological evaluation and treatment recommendation. Radiological evidence indicates the probable presence of an intact middle ear and cochlea. A B R responses have been obtained at near-normal levels to bone-conducted signals. Of the following, the most (A) defer treatment until growth of the external and middle ear is complete at about age 6 (B) suggest that surgery be initiated on at least one ear to permit a normal air-conducted pathway (C) recommend an implanted bone-anchored hearing aid (D) investigate the use of a bone-conduction hearing aid until audiological test results can be confirmed and surgery initiated when the child is older

Option (B) is correct. The best option is to deactivate frequency lowering in the hearing-aid settings and perform Real-Ear Aided Response (REAR). This process will allow the audiologist to rapidly identify maximum audible output across the frequency range and determine whether high-frequency sounds are inaudible or appropriate per the prescription targets.

A 60-year-old man has bilateral, moderate-to-severe, precipitously sloping sensorineural hearing impairment. During the hearing-aid trial period, he is extremely dissatisfied because he constantly reports that /s/, /f/, and /sh/, sounds are not clear. Which of the following is the best method of addressing his concern? A.Creating hearing-aid program settings with microphone arrays in split-directional mode B.Deactivating frequency lowering and performing probe microphone verification by measuring REAR C.Reprogramming the hearing aids to reduce low and mid-frequency gain at all input levels D.Activating frequency lowering and performing probe microphone verification by measuring REOR

Option (B) is correct. Directional microphones are designed to reduce sounds from behind the listener. If the listener perceives that sounds are loud from behind, it is likely that the front microphone is functioning like the back microphone and undesirable sounds are not being canceled from behind. Measuring the front-to-back ratio will determine which microphone has greater output and help to resolve the problem.

A 60-year-old patient has bilateral, mild-to-moderate sensorineural hearing loss. Dissatisfaction is reported by the patient during a behind-the-ear (BTE) hearing aid trial period because sounds heard from behind are louder than sounds heard from the front. The patient wants the issue resolved. Which of the following is the best first option for determining hearing aid directionality? A. Performing real-ear target assessments at different input levels B. Performing real-ear front-to-back ratio measurements C. Returning the hearing aids to the manufacturer to rewire the microphones D. Measuring the patient's aided signal-to-noise ratio loss

Option (D) is correct. The patient reported symptoms, and audiometric findings strongly suggest superior semicircular canal dehiscence (SSCD). Vestibular evoked myogenic potentials (VEMPs) are used to screen for this condition: large VEMP amplitudes, low thresholds, or present responses at high frequency testing (e.g., 4000 Hz ocular VEMPs) are found in patients with SSCD.

A 61-year-old female patient is referred to the vestibular clinic with symptoms of imbalance and dizziness associated with loud sounds, including her own voice and chewing. She is more sensitive to loud sounds in the right ear. A recent audiogram revealed normal hearing sensitivity with no air-bone gaps in the left ear. A mild low-frequency conductive hearing loss was observed for the right ear with normal tympanometry. The patient denies any additional symptoms. Which of the following vestibular tests is the most clinically appropriate first step to evaluate the patient's symptoms? A. Computerized dynamic posturography B. Video head impulse test C. Videonystagmography/electronystagmography D. Vestibular evoked myogenic potentials

Option (C) is correct. She should use a message-tailoring strategy that teaches her communication partner to use simple syntax and multiple shorter phrases rather than one longer one.

A 65-year-old woman is fitted with her first pair of hearing aids. She and her husband are attending their first audiologic rehabilitation session about communication strategies. She states that she struggles to understand what her husband says "because he uses too many words." Which of the following facilitative strategies would be the most appropriate to improve the situation? A. She should ask him to write down key words and topics. B. She should make sure the lighting is appropriate for speechreading. C. She should ask him to use shorter phrases and pause often. D. She should encourage him to speak very slowly and exaggerate his enunciation.

Option (D) is correct. Further information is needed to determine if a referral or assessment is needed.

A 76-year-old patient with a primary complaint of hearing loss reports experiencing an unsteady gait and needs assistance walking and climbing stairs. Which of the following would be the most appropriate course of action to take with this patient? A. Include a VNG in your evaluation. B. Refer the patient to a physical therapist for a risk of falls assessment. C. Inform the patient's primary care provider that the patient is a fall risk. D. Screen the patient for risk of falls.

Option (A) is correct. The geotropic nystagmus pattern (right-beating with head right and left-beating with head left). The geotropic pattern of nystagmus suggests canalithiasis type horizontal canal BPPV. The supine head roll side with the stronger nystagmus response represents the side involved with the horizontal canal BPPV, which is on the right side in this example.

A 78-year-old male presents to a clinic with significant symptoms of imbalance and a recent fall with injury. Upon further questioning, the patient reports a "swirling" feeling when he rolls over in bed to the right and left side. He is now avoiding movements in bed. Supine head-roll testing reveals the following findings. -Head roll to the right: 52 degrees/second right-beating nystagmus, which had a crescendo-decrescendo pattern and strong symptom response -Head roll to the left: 34 degrees/second left-beating nystagmus, which had a crescendo-decrescendo pattern and less intense symptom response The audiologist concludes that the patient has horizontal canal benign paroxysmal positional vertigo. Which of the following treatment maneuvers is most likely to be recommended? A. Geotropic Gufoni maneuver for right horizontal canal BPPV of canalithiasis type B. Geotropic Gufoni maneuver for left horizontal canal BPPV of canalithiasis type C. Apogeotropic Gufoni maneuver for right horizontal canal BPPV of cupulolithiasis type D. Apogeotropic Gufoni maneuver for left horizontal canal BPPV of cupulolithiasis type

Option (D) is correct. The patient's self-assessment of hearing difficulties will provide an audiologist with information about areas where improvement is needed, and the questionnaire will allow the patient to see how much benefit the hearing aids are providing.

A 79-year-old patient who lives alone has returned to the audiologist following a two-week trial use of new hearing aids. The patient reports trying the hearing aids for the first couple of days, becoming frustrated, and deciding to return them. Which of the following is the best way for the audiologist to help the patient deal with frustration and dissatisfaction? A. Spending time going over the instruction booklet to be sure the patient understands how to use the hearing aids properly B. Counseling the patient on how to use the directionality and noise reduction features of the hearing aids C. Reassuring the patient that the adjustment to hearing aids is an extended process and will take more time before seeing any benefit D. Having the patient complete a self-assessment of hearing difficulties and a questionnaire that asks questions about hearing aid benefits

Option (B) is correct. Patients who are residents of care facilities and do not benefit as expected from binaural hearing aids can benefit from FM systems, which improve the signal-to-noise ratio in noisy environments, such as common activity rooms.

A 92-year-old resident of a skilled nursing facility reports that binaural hearing aids are not improving the resident's ability to understand what coresidents and caregivers are saying, particularly in the common activity room. Which of the following is the best way to address the resident's concern? A. A personal sound amplification product (PSAP) B. An FM system C. A softband bone-anchored hearing device D. A BiCROS hearing aid

Define standard threshold shift.

A change in hearing threshold, relative to the baseline audiogram for that employee, of an average of 10 decibels (dB) or more at 2000, 3000, and 4000 hertz (Hz) in one or both ears.

(C) Utilize a personal frequency modulation (FM) system with the hearing aids. The correct answer is (C). Using an FM system provides the most benefit in improving signal-to noise ratio, so (C) would be the most appropriate recommendation for a child who has difficulty understanding speech in noise. As such, (A) and (B) would not be the most appropriate answer. (D) is incorrect because a low-gain FM system would not be appropriate considering the moderate hearing loss and the use of hearing aids.

A child comes to the clinic due to problems understanding the teacher at school. The child has a moderate hearing loss and wears bilateral hearing aids. Aided speech-recognition scores at 55 dB HL in quiet were 88% correct, with scores being 60% correct with a +5 SNR. Which of the following would be the best recommendation for the child? (A) Increase the gain of the hearing aid. (B) Utilize directional microphones with the hearing aids. (C) Utilize a personal frequency modulation (FM) system with the hearing aids. (D) Utilize a low-gain frequency modulation (FM) system with headphones.

(D) Usher syndrome The correct answer is (D). Approximately 40% of patients with Usher syndrome show a profound hearing loss with vestibular dysfunction and an early onset of retinitis pigmentosa (RP), a progressive degeneration of the retina that leads to loss of night vision, restriction of visual field, and, ultimately, blindness. (A), (B), and (C) are incorrect because the etiologies are not associated with progressive visual deterioration.

A client with a history of bilateral profound sensorineural hearing loss, lack of vestibular function, and progressive retinal deterioration is scheduled for an audiological assessment. Which etiology is consistent with the client's history? (A) Auditory neuropathy (B) Vestibular schwannoma (C) Neurofibromatosis (D) Usher syndrome

Anti-Kickback Statute

A criminal law that prohibits the exchange of anything of value to reward the referral of a patient sponsored by a government insurance plan.

What is peak admittance?

A measure of the of ability of the middle ear system to accept acoustic energy. The tympanic membrane is in its position of rest; it is not forced medially or laterally. The pressure in the canal is equal to the pressure in the middle ear. The peak tends to be large with "loosening" pathologies: ossicular discontinuities, atrophic TMs. Admittance is small with stiffening pathologies: middle ear effusion, otosclerosis

Option (B) is correct. Given that the audiologist does not speak Spanish, securing the services of a Spanish-speaking interpreter would be the most effective solution to assist the audiologist with speech-recognition testing.

A native Spanish speaker who speaks very little English is seen for a hearing evaluation by an audiologist who does not speak Spanish. The audiologist does not have any Spanish materials for speech-recognition testing. Which of the following is the most appropriate course of action for the audiologist? A. Referring the patient to a Spanish-speaking otolaryngologist B. Rescheduling the patient for a time when a Spanish-speaking interpreter is available C. Administering an English word-recognition test and scoring it as accurately as possible based on the patient's responses in English D. Administering an English word-recognition test, having the patient write down the responses in Spanish, and asking a Spanish-speaking interpreter to score the responses

Option (B) is correct. Increasing the stimulus repetition rate results in decreased amplitudes, longer absolute latencies, and prolonged interpeak latencies.

A neurodiagnostic auditory brainstem response (ABR) evaluation using different stimulus (click) repetition rates is performed on an adult with a suspected vestibular schwannoma. Which of the following is the most likely outcome if the patient has a vestibular schwannoma when the ABR stimulus (click) repetition rate is increased from 21.121.1 per second to 89.189.1 per second? A.Increased waveform amplitudes, increased wave V latencies, and prolonged, shortened wave I-V interpeak latencies B.Decreased waveform amplitudes, increased wave V latencies, and shortened, prolonged wave I-V interpeak latencies C.Increased waveform amplitudes, decreased wave V latencies, and prolonged wave I-V interpeak latencies D.Decreased waveform amplitudes, decreased wave V latencies, and shortened wave I-V interpeak latencies

Option (C) is correct. Even though the child is 1 month of age, the cochlear implant evaluation and process can start right away, because the child does not need to be 12 months of age to receive a cochlear implant.

A newborn did not pass the hearing screening while in the hospital, and a test for cytomegalovirus (CMV) was ordered. The baby was found to have congenital CMV and at 4 weeks was diagnosed by auditory brainstem response (ABR) with a severe to profound sensorineural hearing loss bilaterally. The parents want to pursue bilateral cochlear implants. Which of the following is the most appropriate recommendation from the audiologist at this point? A. Advising the parents to wait until their child is at least 12 months of age before pursuing implantation B. Purchasing an adjustable hearing aid headband to evaluate how their child responds to sound C. Having the parents make an appointment as soon as possible for a cochlear implant evaluation D. Retesting their child in four months to confirm the presence of a permanent hearing loss

Functional gain

Aided vs unaided soundfield thresholds

Dix-Hallpike test Option (C) is correct. The test used to diagnose BPPV is the Dix-Hallpike, which is a positioning test that assesses the presence of otoconia in the semicircular canal.

A patient comes to a clinic complaining of short, intense dizzy spells. An audiologist suspects that the patient may have benign paroxysmal positional vertigo (BPPV). Which of the following tests is most appropriate to confirm the diagnosis? A. Headshaking test B. Ocular VEMP test C. Dix-Hallpike test D. Fistula test

(A) The maximum power output (MPO) is set too high. The correct answer is (A). The patient is complaining that loud sounds are too loud, which suggests that the MPO is set higher than the patient's loudness discomfort level. When the MPO is set too high, loud input levels continue to receive additional gain, which makes loud inputs too loud. (B) is incorrect because a narrow dynamic range means the MPO is likely set lower than it should be, reducing the usable range of audibility available to the patient. A narrow dynamic range and low MPO setting typically negatively affect speech understanding and would not make loud sounds such as door slams sound uncomfortably loud. If the problem was the occlusion effect, the patient would be complaining that his or her own voice was too loud, not external sounds. In fact, if the patient was experiencing the occlusion effect, sounds such as doors slamming may actually sound more comfortable. Therefore, (C) is incorrect. The directivity index is a measurement that quantifies the amount of directionality provided by the polar plot of the hearing aid. Fast attack and release times would actually help the patient's tolerance of loud sounds such as doors slamming because a fast attack time would quickly reduce the gain in the hearing aid after a loud transient signal was present. Therefore, (D) is incorrect.

A patient fitted with hearing aids for the first time returns for a two-week follow-up appointment. The patient reports feeling uncomfortable when doors slam. Which of the following is the most likely cause for the patient's complaint? (A) The maximum power output (MPO) is set too high. (B) The dynamic range of the hearing aid is too narrow. (C) The patient is experiencing the occlusion effect. (D) The attack and release times are too fast.

(B) Decreasing the output compression threshold The correct answer is (B). Decreasing the output compression threshold effectively lowers the MPO of the hearing aid so that loud sounds do not receive any additional gain above the output compression threshold. Setting the output compression threshold below the patient's loudness discomfort level ensures that loud sounds are not too loud. (A) is incorrect because using expansion adjusts gain for soft sounds, not loud sounds. (C) is incorrect because decreasing the input compression ratio results in decreasing gain for soft sounds rather than loud sounds. (D) is incorrect because increasing the input compression ratio results in increasing gain for soft sounds rather than loud sounds.

A patient fitted with hearing aids for the first time returns for a two-week follow-up appointment. The patient reports feeling uncomfortable when doors slam. Which of the following strategies is most appropriate for addressing the patient's complaint? (A) Using expansion (B) Decreasing the output compression threshold (C) Decreasing the input compression ratio (D) Increasing the input compression threshold

Option (C) is correct. The chorda tympani, which is a branch of the facial nerve (cranial nerve VII), is responsible for the sensation of taste in the anterior two-thirds of the tongue. Therefore, when it is damaged or nicked, taste is affected.

A patient had recent surgery for otosclerosis in the right ear. The ENT indicated that the procedure was successful. However, the surgeon nicked the chorda tympani. Which of the following is the patient most likely to report? A. Decreased hearing in the low frequencies B. Difficulty swallowing C. Decreased sensation of taste D. Numbness on one side of the face

Option (A) is correct. The increase in the amount of endolymph in the inner ear expands the apical end of the cochlea because of a decreasing stiffness gradient of the basilar membrane. Since it is the low frequencies that are sensed in this location, it is the low frequencies that are diminished when there is too much endolymph.

A patient in the early stages of Ménière's disease will have an increase in the amount of endolymph in the inner ear. Audiometric assessment is likely to show sensorineural hearing loss that primarily affects which of the following frequency ranges? A. 250-2000 Hz B. 2000-4000 Hz C. 4000-8000 Hz D. 8000-10,000 Hz

Option (D) is correct. Counseling patients about where to sit in noisy environments will maximize the capability of the directionality feature of the hearing aids. Cardioid microphones in hearing aids pick up sounds with sensitivity from the front and sides but poorly from the rear. It is therefore best to sit or stand with the back to the noise that is interfering with hearing and let the sound come from the front or sides.

A patient with new hearing aids complains of difficulty understanding speech in noisy environments such as restaurants. The audiologist verifies that the cardioid polar plots with fixed directionality are working appropriately. Which of the following is the most appropriate action for the audiologist to take when counseling the patient? A. Encouraging the patient to consider purchasing hearing aids with omnidirectional polar plots B. Recommending that the patient avoid reverberant environments when first wearing the new hearing aids C. Advising the patient to face the noise in certain environments to maximize the directional function of the hearing aids D. Counseling the patient to sit with the back toward the noise to maximize the directional function of the hearing aids

Option (D) is correct. Videonystagmography (VNG) results normally provide site-of-lesion specific information to determine the probable side of weakness. In this example, the patient had a 50 percent right peripheral vestibular weakness, suggesting a peripheral pathology affecting the right side. The post-headshake left-beating nystagmus suggests that the lesion is dynamically uncompensated.

A patient is seen for a vestibular evaluation with the primary complaint of persistent imbalance for the past six months. The patient reports one severe attack of true rotary vertigo six months ago and since then fears that another will occur. The patient has limited many activities because quick head movements increase symptoms. Videonystagmography (VNG) results indicate normal saccade, optokinetic, and smooth pursuit testing. A left-beating nystagmus is observed during gaze testing without fixation. Post-headshake nystagmus reveals a left-beating nystagmus. No positioning or positional nystagmus is observed. Bilateral bithermal caloric test results indicate a 50 percent right weakness with no significant directional preponderance. Based on the preceding information, the patient most likely has which of the following? A. A central vestibular pathology B. A statically uncompensated peripheral pathology affecting the right ear C. A dynamically uncompensated peripheral pathology affecting the left ear D. A dynamically uncompensated peripheral pathology affecting the right ear

Option (C) is correct. The follow-up medical evaluation that occurred would normally focus on physical healing and would not include an audiometric evaluation. The audiologist should conduct a routine audiometric examination to determine the precise level of postsurgical hearing loss and compare the new results to previous results.

A patient presents to an audiologist eight weeks after surgery to repair a fistula in the round window in the left ear. The patient reports that the surgeon had, at the time of the patient's release, pronounced the procedure successful. The patient has not noticed any change in hearing since the operation. Which of the following actions should the audiologist take after reviewing the patient's previous test results? A.Referring the patient for another medical evaluation B.Conducting auditory brainstem response (ABR) testing C.Conducting a follow-up audiometric evaluation D.Evaluating the patient for a CROS hearing aid

Option (D) is correct. The cVEMP, which assesses the inferior vestibular nerve, was abnormal for the left ear, and there was a pattern of rightward torsional and slight down-beating nystagmus, indicating involvement of the left inferior vestibular nerve.

A patient reports a three-day history of true vertigo, ongoing imbalance, and blurred vision with head movements. Videonystagmography (VNG) oculomotor results indicate normal saccade, optokinetic, and smooth pursuit testing. Rightward torsional and slight down-beating nystagmus is noted in the majority of positions and in postvertical headshaking. No spontaneous, positioning, or gaze nystagmus is noted. Bilateral bithermal caloric results are robust and symmetrical bilaterally. The following results are from ocular and cervical vestibular evoked myogenic potentials (oVEMP and cVEMP) testing. Test Right Ear Left Ear oVEMP -- Present -- Present cVEMP -- Present -- Absent The preceding scenario and the results in the table suggest involvement of which of the following? A. The right superior vestibular nerve B. The left superior vestibular nerve C. The right inferior vestibular nerve D. The left inferior vestibular nerve

Option (A) is correct. People speak more loudly in noisy conditions and doing so provides a higher-amplitude speech signal. This improves the signal-to-noise ratio and the sensorineural input for individuals with conductive hearing loss.

A patient reports that hearing loss in both ears has slowly worsened and that hearing is better under noisy conditions than under quiet conditions. The patient's hearing loss is most likely to be A. Conductive B. Sensorineural C. Caused by a cortical lesion D. Caused by presbycusis

Option (B) is correct. A hollow sound indicates that low frequencies are being overemphasized; a vent would help low-frequency sound to escape before being amplified.

A patient wearing a behind-the-ear hearing aid returns to an audiologist with a complaint that sound is hollow and the patient's voice sounds as if it were in a barrel. Which of the following actions by the audiologist would likely be most helpful in this situation? A.Lowering the OSPL 90 B.Adding a vent or enlarging the present vent C.Adding a 680-ohm or 1500-ohm damper to the earhook D.Widening the earmold bore

Option (B) is correct. A tinnitus instrument is a device that combines a tinnitus masker, which will help relieve the patient from tinnitus, and a hearing aid, which will help with the hearing loss.

A patient who has a moderate sensorineural hearing loss also complains of bothersome tinnitus. Which of the following is the most appropriate recommendation for treatment for the patient? A.Fitting the patient with a tinnitus masker B.Fitting the patient with a tinnitus instrument C.Creating CDs that contain noise that can mask the patient's tinnitus D.Recommending that the patient purchase a sound machine

Option (C) is correct. It is most likely that a person with a severe hearing loss will most accurately recognize voicing.

A patient who has a severe hearing loss takes a consonant recognition test. An analysis of the consonant-confusion error patterns is performed. Results will most likely indicate that the feature recognized most accurately was A. Manner B. Nasality C. Voicing D. Place

Option (D) is correct. The hearing-loss symptoms described—significant decay of the acoustic reflex, poor word recognition, and no measurable ABR—are consistent with an VIII nerve disorder.

A patient who has a unilateral, progressive sensorineural hearing loss accompanied by significant decay of the acoustic reflex and no identifiable waves on auditory brainstem response shows a disproportionately poor word-recognition score. The result is suggestive of A. A cochlear disorder B. A temporal lobe lesion C. A middle-ear dysfunction D. An VIII nerve disorder

Syndromic:

Alport syndrome Branchio-oto-rental syndrome CHARGE Jervel and Lange-Nielson Syndrome Pendred syndrome Treacher Collins syndrome Stickler syndrome Ushers syndrome Waardenburg syndrome Down syndrome Neurofibromatosis type 2

(C) 10 dB The correct answer is (C). SNR loss is defined as the increase in signal-to-noise ratio required by a listener to obtain a 50 percent correct score as compared to normal performance. Listeners with normal hearing achieve a 50 percent correct score at a 2 dB SNR. Therefore, if the person with a hearing loss requires the signal to be at 12 dB, the SNR loss is calculated by subtracting 2 dB (normal performance) from 12 dB (impaired performance), which gives 10 dB. (A), (B), and (D) are incorrect because they do not give the correct levels.

A person with a hearing loss who requires speech to be 12 dB higher than noise to achieve a 50 percent correct sentence-recognition score most likely has an SNR loss of (A) 6 dB (B) 8 dB (C) 10 dB (D) 12 dB

(D) Refer the patient to a colleague at another location The correct answer is (D). Since the practitioner is concerned about her unborn child, the best alternative is to refer the patient to another practitioner. (A) and (C) are incorrect because the practitioner should not refuse to see the patient, and performing only noninvasive procedures would not result in a complete audiological evaluation. (B) is incorrect because it does not address the practitioner concerns about her unborn child.

A solo practitioner audiologist who is in the first trimester of her pregnancy reads the case history information provided by a patient who has CMV. To avoid ethical issues with patient abandonment, the practitioner should do which of the following? (A) Refuse to see the patient for three months (B) Wear a mask and gloves and proceed with seeing the patient (C) Perform only noninvasive audiological procedures using earphones (D) Refer the patient to a colleague at another location

Option (C) is correct. Experts in childhood hearing screenings found that frequent and thorough screener training, control of instrument calibration, and rigid ambient-noise control reduced false‐positive rates from a range of 40%-90% down to a more acceptable level of 20%-30%.

A stimulus-response table is being maintained to record results of a hearing screening. The trials in which a listener reports hearing a stimulus when a stimulus is not present are recorded in the table as A. Hits B. Misses C. False alarms D. Correct rejections

What is the warble tone? Why is the warble tone used when testing in the sound field?

A tone whose frequency varies periodically several times per second over a small range; used to prevent standing-wave patterns from forming in reverberation chambers: when the vibrational frequency of the source causes reflected waves from one end of the medium to interfere with incident waves from the source.

Which THREE of the following must be included in the written report of an audiologic assessment for a patient with Medicare?

A.Referral source key B.Reason for referral key C.Relevant medical history key

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

ABR babies get re-screened once only. Never OAE screen after ABR because you'd miss ANSD. OAE babies get one re-screen in hospital and one outpatient re-screen

Cochlear n of m stratigies

ACE (12 of 22) SPEAK (6-10 of 20)

Goldenhar syndrome

Abnormal development of the eye, ear and spine. Usually ONE SIDED atresia (missing ear canal) and MISFORMED OSSICLES! Usually normal inner ear.

(B) Individualized Education Program The correct answer is (B). The progress of all children with documented hearing loss must be followed by the school, and the specific recommendations for each child must be described in an Individualized Education Program. (A) is incorrect because an individualized Family Service Plan is required for children 0 to 3 years of age. (C) is incorrect because the case study does not indicate that Kim has behavioral problems, so a behavioral intervention plan is not correct. (D) is incorrect because a child's cumulative record does not reflect any related service recommendation.

According to IDEA, the audiologist's recommendations for this child should be addressed in which of the following documents? (A) Individualized Family Service Plan (B) Individualized Education Program (C) Behavioral intervention plan (D) Cumulative academic record

(A) Conducting hearing and tympanometry screening tests on older children and adults The correct answer is (A). Audiology assistants can conduct hearing and tympanometric screening on older children and adults without interpretation. (B), (C), and (D) are incorrect because audiology assistants cannot contribute to and participate in Individualized Education Programs (IEPs), disclose test results and protected health information to the patient, nor instruct patients and make referrals for additional services without a supervisory audiologist.

According to professional practice guidelines, services that audiology assistants can perform include which of the following? (A) Conducting hearing and tympanometry screening tests on older children and adults (B) Contributing to and participating in Individualized Education Programs (IEPs) (C) Disclosing test results and protected health information to patients (D) Instructing patients and making referrals for additional services

Option (C) is correct. Part C of IDEA, PL 99-45, specifies that an Individualized Family Service Plan (IFSP) be developed that lists in detail the early-intervention services that the child through age 2 and the family will receive.

According to the Program for Infants and Toddlers with Disabilities (Part C of IDEA), an infant or toddler with a hearing loss is entitled to which of the following? A. Receiving financial assistance for binaural hearing aids B. Enrollment in a center-based habilitation program C. Documentation in writing of an Individualized Family Service Plan D. Training in total communication following cochlear implant surgery

Therapy based Vestib rehab

Adaptation Sensory sub Habituation

what criteria make a patient a candidate for cochlear implant

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

Option (B) is correct. An auditory brainstem response would rule out auditory neuropathy and is the only reliable measure for estimating hearing sensitivity in infants less than 6 months of age.

An 8-week-old infant born at home is brought to an audiology clinic by the parents, who report that the child appears to respond inconsistently only to very loud sounds. Both the birth and medical history are unremarkable, and there is no family history of hearing loss. Tympanograms are normal, and acoustic reflexes are present bilaterally at 1000 Hz at 90 dBHL. Which of the following additional steps should be taken to rule out a significant hearing loss? A. Testing the child using visual reinforcement audiometry B. Performing an auditory brainstem response evaluation C. Scheduling the child to return at 6 months of age for visual reinforcement audiometry D. Advising the parents to return in a year for more reliable testing of hearing sensitivity

(C) IDEA Part C The correct answer is (C). IDEA Part C provides guidelines for services to children from birth to 3 years of age. (A) is incorrect because IDEA Part A lays out the basic foundation for the rest of the IDEA legislation. (B) is incorrect because IDEA Part B lays out guidelines for school-age children (ages 3-21). (D) is incorrect because IDEA Part D describes national activities to be undertaken to improve the education of children with disabilities.

An Individualized Family Service Plan (IFSP) is mandated under which of the following provisions of the Individuals with Disabilities Education Act (IDEA) ? (A) IDEA Part A (B) IDEA Part B (C) IDEA Part C (D) IDEA Part D

Option (D) is correct. Absent reflexes have been observed in individuals with facial nerve paralysis.

An absent stapedial acoustic reflex can result from which of the following? A. A patent eustachian tube B. A space-occupying lesion of the midbrain C. A 35 dBHL noise-induced hearing loss D. Bell's palsy

Option (B) is correct. The audiologist should counsel the patient about reasonable accommodations in the workplace mandated by the Americans with Disabilities Act.

An adult with a progressive sensorineural hearing loss is no longer able to use a telephone at work. An audiologist should assist the patient with A.learning a manual communication system B.obtaining reasonable accommodations for appropriate communication at work C.working with vocational rehabilitation to be considered for a cochlear implant D.using an assistive listening device that alerts the client that the phone is ringing

Option (D) is correct. The recurrent otitis media suggests a medical problem; the child should be referred to a physician for diagnosis of possible middle-ear dysfunction. In addition, speech-language consultation is indicated because of the child's limited vocabulary knowledge.

An audiologist evaluates a 2-year-old child with a history of recurrent serous otitis media and limited expressive speech production. Pure-tone audiometry reveals a mild conductive hearing loss from 500 to 2000 Hz. Based on these findings, the audiologist should first recommend which of the following? A. An audiometric follow-up in one year B. An evaluation for a mild-gain hearing aid C. A home language-enrichment program D. A medical referral and speech-language consultation

Option (D) is correct. Expansion reduces the gain of low-level ambient sounds.

An audiologist fit a patient with binaural, digital, behind-the-ear hearing aids three weeks ago. The patient reports that the devices have provided suitable amplification in most environments but also complains that soft background noise is distracting. To reduce the adverse noise effect, which of the following is the best adjustment for the audiologist to make to the hearing aids? A. Increasing the threshold kneepoint B. Decreasing the compression ratio C. Enabling wide dynamic range compression D. Enabling expansion

Option (D) is correct. The test will not be valid if the background noise is too high, because the noise will mask signals at hearing levels needed for accurate hearing-threshold measures. OSHA provides a table of maximum allowable octave-band sound-pressure levels for audiometric test rooms.

An audiologist is asked to establish a hearing-conservation program for an industrial firm. To ensure validity in monitoring the hearing of workers in conformance with the requirements of Occupational Safety and Health Administration (OSHA) regulations, the audiologist must do which of the following? A. Administer tests at the end of the work shift in order to record the observed temporary threshold shift (TTS). B. Administer tests at all frequencies in octaves between 250 and 8000 Hz and also at 3000 Hz and 6000 Hz. C. Administer tests only to those employees whose daily noise dose exceeds maximum permissible noise levels. D. Administer threshold tests in areas where ambient noise levels conform to the regulations published in the Federal Register.

Option (D) is correct. Digital noise reduction reduces the level of amplification provided by the hearing aids in noisy environments, which provides the patient with more comfort in dealing with noise and with ease of listening.

An audiologist is selecting hearing aids for a new hearing-aid user who works full time in a loud environment, according to the case history, and finds listening in this environment to be very tiring. Which of the following features would be most appropriate to include in the new hearing aids to specifically address the user's concern? A. Directional microphones B. Binaural synchronization C. Speech enhancement D. Digital noise reduction

(D) Referring the patient to a physician The correct answer is (D). Recent onset of hearing loss unilaterally and with poor speech recognition could suggest a retrocochlear lesion. The patient should be referred to a physician for diagnosis. (A) is incorrect because discussion of a hearing aid evaluation should take place only after a physician has ruled out medical and/or surgical intervention. (B) is incorrect because relevant audiometric tests have been completed and cannot rule out the possibility of a retrocochlear lesion. (C) is incorrect because ASSR testing would not provide any neurodiagnostic information.

An audiologist is the first professional to see a patient who has experienced difficulty hearing in one ear for about two months. The audiologist finds the hearing impairment to be a mild-to-moderate unilateral sensorineural hearing loss. The word recognition score for recorded, full-list NU-6 monosyllabic words in quiet at 40 d B above the speech recognition threshold is 24 percent in that ear. Which of the following is the audiologist's most appropriate next step? (A) Discussing the potential of CROS hearing aids and making an appointment for a hearing aid evaluation (B) Scheduling another session for further audiometric tests (C) Referring the patient for auditory steady state response (ASSR) testing (D) Referring the patient to a physician

Option (B) is correct. Tracking involves having the client repeat phrases read by the audiologist from different sources. Because each author has a different style, there will be considerable variation in how familiar the vocabulary is to the patient and in the number and degree of redundancy of syntactic clues, which are all factors that affect word-per-minute scores.

An audiologist is using a tracking procedure to assess a patient's progress in communicating under audition-plus-vision conditions. The materials used are articles from popular magazines. Data are collected for fifteen minutes every working day for a week. Word-per-minute scores of 23.4, 43.6, 13.6, 54.2, and 27.3 are obtained. Which of the following is the most likely explanation for the variation in the patient's scores? A.A gradual negative learning effect B.Authorial vocabulary or syntax C.Normal response variation D.Decreased cognitive ability

Option (B) is correct. The Stark law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient, to an entity providing designated health services (DHS) if the physician (or an immediate family member) has a financial relationship with that entity.

An audiologist owns a private practice and is in partnership with a sibling, who is an ear, nose, and throat (ENT) specialist. The audiologist receives direct referrals from the ENT specialist for hearing-aid dispensing. Which of the following laws are the professionals violating? A. Anti-kickback law B. Stark law C. False Claims Act D. Medicare Part B

Option (C) is correct. Use of a clean speculum will prevent spreading any infection from one ear to the other.

An audiologist performing otoscopy on an adult noted that the first ear examined had obvious evidence of redness, swelling, and moisture. Based on that finding, what is the best next step for the audiologist to take? A.Conducting a test to detect hearing loss in the ear B.Removing any discharge from the outer part of the ear C.Changing the speculum and examining the other ear D.Discontinuing the otoscopy and moving to tympanometry

Option (C) is correct. Individuals with traumatic brain injuries may be more likely to respond to speech than they are to respond to pure tones. Speech-awareness tests have a high correlation with pure-tone thresholds at certain frequencies.

An audiologist suspects that a patient who has had a traumatic brain injury may not have understood the directions given for a pure-tone threshold test. Which of the following is the best test that the audiologist could appropriately use to confirm that the patient's responses represent true thresholds? A. Speech Stenger test B. Word recognition test C. Speech recognition or awareness test D. Most-comfortable loudness level test

Option (B) is correct. The audiologist's actions leave the patients with no other audiologist present to perform follow-up procedures, which could lead to charges of patient abandonment.

An audiologist who works at a rural speech-language-hearing center is scheduled to conduct several follow-up assessments for patients who have been fitted with hearing aids. The audiologist objects to the charges imposed by the owner of the center for follow-up evaluations and quits on the day several patients are scheduled to be seen for follow-up. There are no other audiologists in the practice. The audiologist's action could most likely result in which of the following? A. The audiologist being found in violation of self-referral guidelines B. The audiologist being charged with patient abandonment C. The owner of the center being reported to the state licensure board D. The patients being reassigned to a center in a neighboring community

Option (B) is correct. The sound pressure level necessary to achieve 0 dB is greatest at low frequencies, lessens in the middle frequencies, and then increases at high frequencies.

An audiometer attenuator is set to 0 dBHL. Which of the following is true about the sound pressure level output at the earphone? A. It is constant across all frequencies. B. It is lowest at midfrequencies. C. It increases as a function of frequency. D. It decreases 6 dB per octave.

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

An ear infection is caused by a bacterium or virus in the middle ear. This infection often results from another illness — cold, flu or allergy — that causes congestion and swelling of the nasal passages, throat and eustachian tubes. Swollen eustachian tubes can become blocked (eustachian tube dysfunction), causing fluids to build up in the middle ear (effusion). This fluid can become infected and cause the symptoms of an ear infection

Option (B) is correct. The child needs a diagnostic evaluation before being referred out and before meaningful counseling can take place.

An infant who was referred on a first screening for automated auditory brainstem response testing (AABR) passes on a second screening with DPOAEs before discharge from the hospital. The parents bring the infant to the clinic because the infant is still not responding consistently to sound. Which of the following is the audiologist's best next step? A.Rescreening the child with TEOAEs B.Rescreening the child with ABR C.Counseling the parents that the child will respond better with age D.Counseling the parents that they should wait until the child can be tested with VRA

What does ECochG measure?

Analysis of the cochlear microphonic and summating and action potentials stim = clicks

Vestibular suppression meds

Antihistamines, benzos, antidepressents

AI-DI

Articulation Index/Directivity Index 0 the ratio of the microphone output for signals from the front to those sounds originating from all other directions larger = better

Malignant skin lesions

Basal cell carcinoma Squamous cell carcinoma Malignant melanoma Metastatic malignant melanoma

Purpose of caloric testing

Assessment of horizontal SCC. The only test to assess right and left individual peripheral systems. When endolymph is heated, it will rise. When it's cooler, it will sink.

Where is TTS the greatest?

At a half octave above the frequency of the sound producing fatigue

(A) Pronounced acoustic reflex decay The correct answer is (A). Pronounced acoustic reflex decay is associated with pathologies located between the cochlea and the cochlear nucleus (that is, at the first-order afferent nerve fibers). (B) is incorrect because compliance is a measure of middle-ear function and provides no indications of retrocochlear function. (C) is incorrect because loudness recruitment is associated with cochlear, not retrocochlear, pathologies. (D) is incorrect because individuals with retrocochlear pathologies typically have poor speech recognition in noise.

Auditory manifestations of a retrocochlear pathology at the first-order afferent nerve fibers typically include which of the following? (A) Pronounced acoustic reflex decay (B) Reduced compliance (C) Loudness recruitment (D) Normal speech recognition in noise

Teacher Collins syndrome

Autosomal Dominant All types of HL Auricular deformities Ossicular malformations Facial Bone abnormalities

Neurofibromatosis

Autosomal Dominant Type 1 - cafe au lait spots - tumors occur in the small nerves of the skin and the large nerves inside your body Type 2 - tumors primarily affect the auditory nerves (i.e., typically bilateral acoustic neuromas) (accounts for 5% of acoustic neuromas)

Apert Synddrome

Autosomal Dominant flat cHL - often bilateral maybe SNHL - malformed cochlear aqueduct

Pendred syndrome

Autosomal Recessive deficit in ion transportation in endolymph reabsorption U-shaped audio, high freq SNHL HL noted by age 2 progressive

Waardenburg Syndrome

Autosomal dominant, color irises, white forelock, defective or absent organ of corti, reduced AN fibers

appropriate testing methods: 0-6 mo

BOA or ABR

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

BOA: birth-4 mo; reflexive behaviors VRA: 5 mo-2yrs, involves conditioning to stimuli (reinforce with video/items)

(B) Otitis media The correct answer is (B). According to the case history provided, the patient is a 6-year-old child who has experienced recurrent sinus infections and likely has allergies. Together with the audiometric data that reveal a bilateral hearing loss with air-bone gaps, flat tympanograms and absent acoustic reflexes suggest a conductive hearing loss. (A) is incorrect because the flat tympanograms rule out the possibility of otosclerosis. (C) is incorrect because the degree of hearing loss cannot be accounted for by impacted cerumen. (D) is incorrect because the equivalent ear canal volume is too small to be associated with eardrum perforation. Thus, the only answer that fits with all of the audiometric results and the history is otitis media (B).

Based on the audiometric and case history information provided, which of the following is the most likely etiology for Kim's hearing loss? (A) Otosclerosis (B) Otitis media (C) Impacted cerumen (D) Perforated tympanic membrane

A devastating form of a stroke with high morbidity and mortality. Symptoms: dizziness, headache, difficulty with speech, nausea and vomiting, changes in vision, abnormal consciousness Signs: acute neurologic signs including motor deficits, hemiparesis or quadriparesis and facial palsies, dysarthria and articulation difficulties Oculomotor Disturbances: Horizontal gaze paresis, Gaze-induced nystagmus, Oculocephalic reflex loss, Vestibular nystagmus, Vertical gaze palsy, Downbeat nystagmus, Internuclear ophthalmoplegia, Ocular bobbing, 1½ syndrome. Effects on Vestibular Function: BA supplies neural components of the vestibulo-cerebellar complex through cerebellar branches. Vestibular function may be compromised and result in vertigo VESTIB: Oculomotor Disturbances Tests of VOR function: Acute Vestibular Syndrome can result from vertebrobasilar stroke AVS: Rapid onset of vertigo, nausea, vomiting, gait unsteadiness, and nystagmus H-HIT of VOR function; normal results indicate centralized location Vertical or torsional nystagmus also indicate central pathology Skew deviation Pt complained of vertical diplopia, nausea, HL, ventilation problems -CT normal upbeating jerk nystagmus and skew deviation. MRI ordered and basilar artery occlusion found Vestibular nystagmus; rotary chair b/c probably bilateral involvement AUDITORY: Hearing Loss 5 patients reported hearing loss; ABR revealed 28 patients had cochlear hearing loss. Patient complaint: fluctuating hearing loss

Basilar Thrombosis

In an ABR, why is wave V dominated by energy in the 2-4kHz range?

Because the click stimulus only has energy at 2-4kHz

When to use a 1000 Hz tymp

Below 9 mo - but if you see a dip in the peak move to 226 (this usually occurs 6-9 months)

What microphone has a delay ratio of 0 and is least sensitive to sounds on the sides?

Bi-Directional

Down Syndrome

Bilateral CHL or Mixed lateral ET Shortened ABR interwaved laterncies

What should be different for music program vs. speech programs?

Broader flatter frequency response a little more gain in lows than what we would typically worry about with speech

(B) The pathology is distal to the stapedial branch of the VIIth nerve. The correct answer is (B). The acoustic reflex measurement helps to determine the site of lesion of facial nerve disorder as either distal or proximal to the stapedial branch of the VIIth nerve. If the acoustic reflex is present at normal HTLs, the localization of pathology is likely distal to the stapedius branch of the nerve. (A), (C), and (D) are incorrect as the reflexes do not indicate the descriptions put forth in each option.

Carol is a 34-year-old woman with a sudden-onset, left-sided facial paralysis that has been diagnosed as Bell's palsy. Acoustic reflexes are present at normal levels bilaterally for both ipsilateral and contralateral stimulation. Which of the following statements accurately applies to this situation? (A) The pathology is proximal to the stapedial branch of the VIIth nerve. (B) The pathology is distal to the stapedial branch of the VIIth nerve. (C) The facial paralysis is probably nonorganic in nature. (D) No reliable statement can be made about VIIth nerve function, since the responses could be due to Vth nerve activity.

Fixation Index

Central Finding WNL <50%

Own voice sounds distorted

Change to compression limiting Increase MPO Decrease gain for intense low freq. sounds

List the key components of a case history

Chief complaint/reason for coming Concerns with hearing: degree, onset, cause, length of time with HL, which ear, fluctuations/progression? Dizziness & ringing? Previous hearing tests? Noise exposure Family history of HL Medical history: surgery on ears, pain, drainage, fullness, visual disturbances HA history

What behavioral phenomena are associated with Central Auditory Processing Disorder (CAPD)?

Children behave as if they have a peripheral hearing loss even though hearing sensitivity in the classroom is normal, where they are likely to perform more poorly in subjects requiring use of verbal language skills and have difficulty with multistep directions. Children also may be distractible and refuse to participate in class discussion.

determine appropriate assessment for...Physiologic measures rather than behavioral assessment?

Children who can not give reliable behavioral results

COSI for kids

Children's outcome worksheets (COW)

A cystic mass that may occur within the middle ear and other pneumatized area of the temporal bone. They develop as a complication of recurrent or chronic middle ear infection. Retraction or perforation of the TM usually accompanies the formation of this mass. On rare occasions, they may occur with no apparent predisposing middle ear abnormality. A possible danger of this cystic mass involves erosion of important otologic or cranial structures (i.e., destruction of the ossicular chain, fistulation or invasion of the bony labyrinth, erosion of the fallopian canal, etc.)

Cholesteatoma

What are the different conditions of the tympanic membrane that can be observed through the otoscope?

Cholesteatoma, glomus tumor, ossicular disarticulation, TM perforation, tympanosclerosis, and ET dysfunction

Option (C) is correct. The correlation between ABR and behavioral thresholds is greatest at frequencies between 2000 and 4000 Hz

Click-evoked auditory brainstem response (ABR) thresholds are generally most closely correlated with behavioral thresholds for frequencies of A. 250-500 Hz B. 500-1000 Hz C. 2000-4000 Hz D. 6000-8000 Hz

Top (Primary Processor): Vestibular Nuclear Complex Bottom (Adaption Processor): Cerebellum

Complete the diagram

Top: Superior Vestibular Nerve (SVN) Left: Lateral Vestibular Nerve (LVN) Right: Medial Vestibular Nerve (MVN) Bottom: Inferior Vestibular Nerve (IVN)

Complete the diagram

What type of hearing loss is associated with Apert syndrome

Conductive- craniofacial abnormalities

What type of hearing loss is associated with Pierre Robin Syndrome

Conductive- lower jaw abnormalities

What type of hearing loss is associated with Nager Syndrome

Conductive-underdeveloped cheek (malar hypoplasia), jaw (micrognathia), and external ear malformations

Non-syndromic:

Connexin mutation related BFN B4 Mitochondrial

The opening of the eustachian tube is assisted by what?

Contraction of the tensor veli palatini and the levator veli palatini

IDEA Part B

Covers assistance for education of all children with disabilities HAs functioning properly

Describe the criteria for selecting appropriate assistive devices for patients. Describe how different assistive devices work.

Criteria: High SNR, Children in class need FM system, Perceptual difficulties in noise, TV, and phone listening Increase SNR Difficulty hearing in background noise Difficulty hearing the TV\ Difficulty hearing the phone

programmed longevity theory

DNA / genes determine aging

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

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

technical safeguard options outlined by the Health Insurance Portability and Accountability Act?

De-identification of data firewalls mobile device management data encryption multifactor or two factor identification remote wipe capability

A 60-year-old man has bilateral, moderate-to-severe, precipitously sloping sensorineural hearing impairment. During the hearing-aid trial period, he is extremely dissatisfied because he constantly reports that /s/forward slash, s, forward slash, /f/forward slash, f, forward slash, and /sh/forward slash, sh, forward slash sounds are not clear. Which of the following is the best method of addressing his concern?

Deactivating frequency lowering and performing probe microphone verification by measuring REAR. The best option is to deactivate frequency lowering in the hearing-aid settings and perform Real-Ear Aided Response (REAR). This process will allow the audiologist to rapidly identify maximum audible output across the frequency range and determine whether high-frequency sounds are inaudible or appropriate per the prescription targets.

What happens when you decrease the diameter of tubing?

Decrease the low frequencies

Ad Tymp

Deep (high peak). Ossicular disarticulation; monomeric TM

Impacts of hearing loss for children

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

● Descriptors for muscles involved in the push-pull of the eyes → these muscles work simultaneously ● Agonist = muscles that contract and pull the eye in direction of movement ● Antagonist = muscles that relax

Describe agonist versus antagonist muscles.

● Feedback: postural control that occurs in response to sensory feedback from external perturbation ● Feedforward: postural control that occurs in anticipation of a voluntary movement that is potentially destabilizing

Describe the difference between feedback control and feedforward control.

None. Indicates a peripheral vestibular lesion in either ear or a central vestibular lesion (low clinical value)

Describe the localization of Directional Preponderance in a caloric test?

indicates a central lesion (moderate clinical value)

Describe the localization of Failure of Fixation suppression in a caloric test?

None. Indicates a peripheral vestibular lesion in either ear or a central vestibular lesion (unknown clinical value)

Describe the localization of Gain Asymmetry in a caloric test?

indicates a central lesion most likely involving the cerebellum (moderate clinical value)

Describe the localization of Hyperactivity in a caloric test?

None. Indicates a peripheral vestibular lesion in either ear or a central vestibular lesion (moderate clinical value)

Describe the localization of a Baseline Shift in a caloric test?

indicates a peripheral vestibular lesion in both ears or a central vestibular lesion (moderate clinical value)

Describe the localization of a Bilateral Weakness in a caloric test?

Indicates a lesion involving the lateral semicircular canal or its afferent neural pathways in the weaker ear (high clinical value)

Describe the localization of a Unilateral caloric weakness in a caloric test?

Canalithiasis: Right ASCC affected: Geotropic* Left ASCC affected: Geotropic* Cupulothiasis and anterior arm canalithiasis: Right ASCC affected: Ageotropic* Left ASCC affected: Ageotropic* *Indicates that BPPV on one side will produce nystagmus with provocative test to both sides.

Describe the type of elicited nystagmus in BPPV when the Horizontal Semicircular Canal is affected? Differentiate between Canalithiasis & Cupulothiasis and anterior arm canalithiasis.

Right PSCC affected: up-beating right torsion Left PSCC affected: up-beating left torsion

Describe the type of elicited nystagmus in BPPV when the Posterior Semicircular Canal is affected?

What is the goal of tinnitus counseling and management?

Develop sound plan Strategies for managing tinnitus Support Residual inhibition

Option (A) is correct. Narrow bands of masking noise on audiometers should be wider than a critical band because they provide more effective masking for the frequency being tested without requiring higher overall intensity.

Diagnostic audiometers generally provide one-third-octave noise bands for use in masking pure tones. Which of the following best explains why one-third-octave noise bands are used? A. They are wider than critical bands. B. They produce more masking than pink noise. C. They produce more masking than do half-octave bands. D. They have less width than do critical bands.

HIPAA

Disclosures to or requests by a health care provider for treatment purposes; disclosure to the individual who is the subject of the information, uses or disclosures made pursuant to an individual's authorization; uses or disclosures required compliance with HIPAA; disclosures to the Department of Health and Human Services (HHS) when disclosure of information is required under the Privacy Rule for enforcement purposes; and uses or disclosures that are required by other law.

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

Disposable foam earplug: provides the most attenuation, but attenuation depends highly on fit. Premolded, disposable earplug: attenuation depends on fit, correct size, can fall out when chewing/talking.Banded earplugs: lower attenuation than most earplugs. Convenient to put around neck. Custom earplug: lower attenuation. Can attach to radio.Passive earmuff: Good for intermittent noise Earmuffs with radio or amplification: Better compliance, allow communication, better for low levels of noise, manage impulse noise level dependent devices: Communication and situational awareness in certain situations Combined hearing protection and communication systems: allows for communication in loud environments

Option (B) is correct. DPOAEs arise from two sources of generation, and TEOAEs arise from a single source of generation.

Distortion-product otoacoustic emissions (DPOAEs) and transient-evoked otoacoustic emissions (TEOAEs) provide similar information, but they differ in which of the following ways? A. DPOAEs provide more frequency-specific information than TEOAEs. B. DPOAEs and TEOAEs have different sites of generation. C. DPOAEs provide better low-frequency information. D. TEOAEs provide better high-frequency information.

(A) Monocular movements of each eye

Duction refers to: (A) Monocular movements of each eye (B) Conjugate eye movements, rotating both eyes in the same direction by the same amount (C) Disjunctive eye movements, rotating the two eyes in opposite directions

Option (B) is correct. Cochlear implants (CI) are typically programmed for each patient based on auditory perceptions in response to electrical stimuli. When a patient's device is initially activated, stimulation levels can change frequently while the patient is learning to listen with the cochlear implant. Stimulation levels can increase during the beginning of a patient's CI experience, but eventually a plateau is reached and stimulation levels hover in a certain clinical unit range.

During mapping sessions (programming of the device) for cochlear implant recipients, audiologists may adjust several parameters. What is the most important aspect of the programming to adjust? A. Input dynamic range B. Stimulus levels C. Gain settings D. Pulse width

Pt comes in saying they hear sounds louder behind them than in fromt of them

EAA - directionality on HA's to check to see if mics are swapped

Definitive test for menieres in active state

Electrochcleography

What kind of results in gap detection and dichotic listening are suggestive of CAPD?

Exhibit poor performance on gap detection testing. Perform poorly on dichotic listening tests with the right-ear performance often worse than left-ear performance. Integration-deficit is characterized by left-ear suppression on dichotic listening.

What type of study is controlled so that the researcher manipulates one variable to determine it's effect on other variables?

Experimental Study

Anterior Canal

Identify the site of lesion for the following test results: Lateral vHIT: WNL Vertical vHIT (RALP/LARP): Abnormal for downward impulses for side of lesion cVEMP: WNL oVEMP: WNL

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

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

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

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

hearing a stimulus when a stimulus is not present

False alarms

Endolymph

Fills the Scala Media and SSC's K+

B tymp

Flat (no peak). Large ECV= TM perf or patent PE tube.Normal ECV= ME effusion, blocked PE tube, cerumen occlusion.Small ECV= Blocked probe, cerumen occlusion.

Option (D) is correct. According to the inverse square law, the sound intensity decreases by 6 dB when the distance from a sound source doubles. Conversely, the sound intensity increases by 6 dB when the distance to the sound source is halved.

For someone sitting 20 meters from a concert stage, the average intensity is 65 dB SPL. Which of the following best indicates the average sound-pressure level at a seat 10 meters from the stage? A. 59 dB B. 62 dB C. 68 dB D. 71 dB

Describe the screening protocols recommended for screening adults and children. How do they differ?

For those children who can be conditioned for visual reinforcement audiometry (VRA), screen using earphones (conventional or insert), with 1000, 2000, and 4000 Hz tones at 30 dB HL. For those children who can be conditioned for play audiometry (CPA)--up to age 18--, screen using earphones (conventional or insert), with 1000, 2000, and 4000 Hz tones at 20 dB HL. Adults: Position conventional earphones (or insert earphones) and present pure tones at 25 dB HL at the frequencies of 1000, 2000, and 4000 Hz.

What is the function of the Inner Ear?

Frequency selectivity - tonotopic Balance maintenance Electrical

Option (C) is correct. Functional gain is the amount of improvement that the hearing aid brings to the wearer's hearing levels—more precisely, the difference in decibels between aided and unaided sound-field thresholds.

Functional gain of a hearing aid is best defined as the difference between which of the following? A. Input at the hearing-aid microphone and output into an HA-2 coupler B. Input at the hearing-aid microphone and output into the ear canal C. Aided and unaided sound-field thresholds D. Aided and unaided ear canal resonance

Elicitation of an acoustic reflex at a hearing level better than obtained with voluntary behavioral responses suggests the presence of

Functional or nonorganic hearing loss

What is the relationship between fundamental frequency and harmonics?

Fundamental Freq = the lowest frequency of a periodic waveform (F0) Harmonic = the regular and repeating multiple of F0

What is the function of the Outer Ear

Funnels sound and localization ITD & ILD cues Acoustic

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

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

Meniere's disease: btwn episodes state

Gaze, positional, HFHS - follows alexanders law - beats to healthy ear Calorics UW EchocG: WNL oVEMP: low amp, high Threshold, altered freq tuning, asymmetry cVEMP: low amp, high theshold, lower rates VST: low gaun & asymmetry, reduced time constant SHA(VOR): inc phase lead in LF, gain is WNL or reduced @ all freq

_________ is in a class of antibiotics (aminoglycosides) that are known to cause bilateral vestibular loss due to ototoxicity. A sign of bilateral vestibular loss is unsteadiness (ataxia) when standing and walking.

Gentamicin

Tinnitus instrument

HA + Masker

Real Ear Occluded Response (REOR)

HA in ear and off

DPOAEs are better for ____________

HFs

SPL =

HL + RETSPL + SL

What is the relationship between SPL and HL

HL normalizes SPL scale to 0 SPL necessary tp achieve 0dB HL is greatest a LF, lessens in the middle freq, and increases at HF

Superior Vestib nerve

HSCC ASCC Utricle

Vestib Blood supply: anterior artery

HSCC ASCC Utricle

Rotary chair tests

HSCC & utricle VST & SHA

Benefits of a baseline audio

Having a reference for future audiograms and can determine if the patient experiences a change in hearing sensitivity. Should be obtained within 30 days of starting work in a noisy area. Test after 14 hours after a noise-free-period.

What are appropriate roles for audiology techs and aides?

Hearing tests, cleaning and repairing broken hearing aids, and immittance testing. Techs and aides are unable to diagnose or counsel with a patient on what their hearing loss shows and where to go from there.

interaural Level/inensity difference (ILD)

High Freq LSO

Amplullopedal

Horiz SCCs towards ampulla

What microphone is most efficient directionally and has max reduction in the back corners?

Hypercardioid

Type 1 afferent fibers

IHC

Total Unilateral Vestibular Loss

Identify the site of lesion for the following test results: Lateral vHIT: Abnormal for impulses toward side of lesion Vertical vHIT (RALP/LARP): Abnormal for downward impulses for side of lesion cVEMP: Abnormal recordings from the neck muscle toward side of lesion oVEMP: Abnormal recordings from the eye muscle away from side of lesion

Superior Vestibular Nerve

Identify the site of lesion for the following test results: Lateral vHIT: Abnormal for impulses toward side of lesion Vertical vHIT (RALP/LARP): Abnormal for downward impulses for side of lesion cVEMP: WNL oVEMP: Abnormal recordings from the eye muscle away from side of lesion

Lateral Canal

Identify the site of lesion for the following test results: Lateral vHIT: Abnormal for impulses toward side of lesion Vertical vHIT (RALP/LARP): WNL cVEMP: WNL oVEMP: WNL

Option (A) is correct. The output SPL in a 6 month old's ear is typically higher than it is in a coupler because of the small ear canal volume of an infant's ear.

If an audiologist does not account for the real-ear-to-coupler difference (RECD) during a hearing-aid fitting for a 6 month old, the fitting will most likely provide A. Overamplification B. Underamplification C. Adequate amplification D. Inadequate amounts of noise suppression

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

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

(B) 35 dBA or less and 0.6 second or less The correct answer is (B). The level of 35 dBA or less and the time of 0.6 second or less capture the recommendations for any core learning space with an enclosed volume below 10,000 cubic feet. (A) and (C) are incorrect because the noise levels indicated are stricter than the recommendations, which were designed for practical application in school settings. (D) is incorrect because by the ANSI guidelines, the classroom acoustics indicated would exceed the recommended noise levels for an unoccupied classroom. Also, the acoustics indicated by (A) and (C) would allow reverberation times that exceed the recommendations for classrooms.

In 2002, the American National Standards Institute (ANSI) adopted guidelines for classroom acoustics, intended for use in the design of new classrooms and in the renovation of existing classrooms. The ANSI-recommended average noise levels and reverberation times for unoccupied classrooms (<10,000 cubic feet) are (A) 25 dBA or less and 2.0 seconds or less (B) 35 dBA or less and 0.6 second or less (C) 45 dBA or less and 2.0 seconds or less (D) 55 dBA or less and 0.2 second or less

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

In situations where the patient is unable to understand what is going on and is in the care of another individual, for example, a child. If the patient is in need of help from other healthcare professionals, you could be the one getting them in contact with other healthcare professionals.

(B) decrease the high-frequency response The correct answer is (B). Probe tubes for measuring real-ear sound-pressure levels (SPLs) should be inserted as close to the tympanic membrane as possible, since it is the SPL at the tympanic membrane that is being measured. If the probe tube is too far from the tympanic membrane, high-frequency sound waves bounced off the eardrum will dissipate before reaching the probe, but low-frequency sound waves, which do not dissipate as easily, will be essentially unaffected. The overall effect will thus be a decrease only in the high-frequency response. (A), (C), and (D) are incorrect because they describe incorrect frequency results.

In the measurement of real-ear sound-pressure levels with a probe-tube microphone system, insufficient probe-tube depth will tend to (A) increase the high-frequency response (B) decrease the high-frequency response (C) decrease the low-frequency response (D) increase the low-frequency response

Increase ABR repetition rate

Inc latencies Dec Amp prolonged interpeak latencies

What does section 504 of Rehabilition Act and Americans with Disabilites act state?

Includes school aged children with hearing loss or APD that do not require special education services

Voice Sounds muffled

Increase gain for intense low frequency sounds or increase max output at low frequencies

confidentiality of patients' records as prescribed by the ASHA Code of Ethics

Individuals shall protect the confidentiality and security of records of professional services provided, research and scholarly activities conducted, and products dispensed

Option (A) is correct. For individuals with unilateral hearing loss, speech intelligibility improves when the ear with better hearing is closer to the noise source. When this occurs, the signal-to-noise ratio improves in the better ear.

Individuals with normal hearing sensitivity in one ear and a severe hearing loss in the other ear experience which of the following? A. An improvement in speech understanding when the noise source is closer to the ear that has normal hearing B. Improved ability to localize when the noise source is closer to the ear that has hearing loss C. Better speech understanding and localization as the reverberation time increases D. Improved localization when the noise is at 0 degrees azimuth and the source is closer to the ear that has hearing loss

Option (B) is correct. The primary cues used for localization of sounds below 1500 Hz are interaural time differences. The other cues, interaural intensity differences and spectral cues, occur at high frequencies. Therefore, a signal with energy centered at 700 Hz would be localized using interaural time differences.

Individuals with normal hearing use multiple cues to localize sounds. Which of the following are primarily involved in localizing a siren with a frequency of 700 Hz? A. Interaural time and intensity differences B. Interaural time differences only C. Spectral cues and interaural intensity differences D. Interaural intensity differences only

Oculomotor: up and in

Inf oblique

Describe different approaches to counseling and what they are intended to achieve.

Informational: simply providing information without commentary; explanation of hearing loss and its effects and function of hearing aid Personal adjustment- adapting to HL, emotive counseling Person-centered: involves listening to clients rather than volunteering information (aka client-centered) Rational-emotive: involves confronting clients about the reasons for their behavior Psychoanalytical: explores unconscious feelings and memories Behavioral: sets up goals and incentives to meet them

"I hear people better at a distance than those at my table"

Insufficient gain for high input levels Increase gain for intense sounds and increase MPO

Anterior SCC

Ipsi Superior rectus Contra: Inf Oblique

Flaccid ME system

Less energy than normal reflected, back and recorded at the mic (discontinuity of ME ossicles, monomeric TM)

semantics

Meaning of words and sentences

Posturography

Measurement of the ability to maintain normal balance/control and recognize the orientation in space mvst & lvst

What are the four regions of the vestibular nuclei?

Medial Lateral Superior Descending/Inferior

Medicare part c

Medicare Advantage (extra benefits)

Brachio-oto-retnal syndrome

Melnick-Fraser syndrome Sensorineural, conductive, or mixed & can be progressive or permanent at birth. Can cause ossicular fixation or cochear hypoplasia. Kidney abnormalities!

Adult CI Candidacy

Moderate to profound SNHL AUSentence recognition scores of 50% or less in ear to be implanted and 60% or less in opposite ear

Illness

More gradual - long term noisy job

Stiff ME system

More than normal energy reflected back and recorded at the mic,(ossicular fixation, OM, cholesteatoma)

What is burnout phenomenon associated with menieres?

No more dizziness attacks but still have aura fullness, tinnitus, and hearing loss

Overmasking

NTE masking >= IA + BC NTE + 5

● Effect of stimulus varies patient to patient. ● Frequency of caloric response is well below the optimal range for vestibular receptors.

Name one disadvantage of caloric testing.

● CN III (oculomotor): superior rectus (contralateral), inferior rectus, medial rectus, and inferior obliques ● CN IV (trochlear): superior obliques ● CN VI (abducens): lateral rectus

Name the cranial nerves and the eye muscles they innervate.

● Horizontal/lateral SCC: transverse plane ● Anterior/superior SCC: sagittal plane (EX: nodding) ● Posterior SCC: frontal/coronal plane

Name the planes in which the semicircular canals detect movement.

IDEA part D

National Activities to Improve Education of Children with Disabilities

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

Natural resonance of EC Increased gain Diminished occlusion Reduced feedback Secure retention Ear's natural directionality Use of phones Decreased wind noise

C tymp

Negative (normal peak, negative pressure).Fluid, ET dysfunction, beginning or resolution of ear infection.

What should you expect in RECD with a patient with tubes?

Negative values in low frequencies

Why is it difficult to obtain quality recordings at 500Hz toneburst on an ABR?

Neural firing is less synchronous at lower regions of the cochlea

Directional Perponderance

Non localizing WNL <28%

Degree of HL classifications

Normal: -10 to 15 Slight: 16 - 25 Mild: 26 - 40 Moderate: 41 - 55 Moderately severe: 56 - 70 Severe: 71 - 90 Profound: 91+

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

OAE: Quick, Placement of probe prone to be failed compare to ABR. ABR: Testing retrocochlear area. Neural function and more informations on hearing loss. Not recommended for NICU bc ANSD risk factor.

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

OAE: frequency specific >1k. ABR: stimulus= clicks or chirps. click is 1-4k. Level is 35 dB (would not detect LF hearing loss.)

Type 2 efferent fibers

OHC

What do OAE's indicate about hearing

OHC function (cochlear amplifier) If present can rule out all but a mild loss

secondary Auditory tinnitus

OM, cerumen impaction otosclerosis, menieres, AN etc

What United States federal regulations defines the minimum hearing conservation standards for a noise-exposed worker?

OSHA 29 CFR 1910.95

Option (C) is correct. A low-pitched, pulsating tinnitus synchronous with the heartbeat and acoustic immittance fluctuations are symptoms of glomus jugulare tumors, vascular growths originating from the glomus bodies. These tumors sometimes expand into the middle ear, causing hearing loss by putting the pressure of a pulsating jugular vein on the ossicles.

On a case history form, a patient reports having low-pitched tinnitus and a hearing loss. While conducting acoustic immittance measures, the audiologist notes periodic fluctuations in admittance that are synchronous with the patient's pulse. Which of the following medical conditions is the most likely cause of the audiologist's findings? A.An acoustic neuroma B.Cholesteatoma C.Glomus jugulare tumor D.Otosclerosis

What is mondini deformity?

Osseous cochlea- 1.5 turns

Option (B) is correct. Upper brainstem lesions do not always interfere with otoacoustic emissions, so otoacoustic emissions can be recorded from the ears of patients with upper brainstem lesions.

Otoacoustic emissions can often be recorded from the ears of a patient with A. severe presbycusis B. upper brainstem lesions C. otitis media D. aminoglycosides in the body

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

Otosclerosis. CHL. Can be congenital or acquired (through perf or constant negative pressure) NO CONSISTENT TYMP PATTERNS, DEPENDS ON DEGREE OF OSSICULAR CHAIN INVOLVEMENT Bacteria often associated with the mass!

Statistically signifignat

P-value less than 0.05.

Option (C) is correct. According to the plateau method of determining true threshold, the true threshold is reached when the threshold of a test ear remains stable over a range of at least 20 dB increase in masking intensity. In the figure, the test-ear threshold plateaus at 75 dB

PIC: According to the contralateral masked-threshold function shown in the preceding figure, which of the following values represents the true threshold for the test ear? A.50 dB B.65 dB C.75 dB D.95 dB

Option (A) is correct. With a decrease in false negatives, the sensitivity will be higher. Applying the formula for sensitivity (TP/TP +FN) x100, the fraction T P over T P, end fraction, plus F N, times 100 and specificity (TN/TN+FP) x 100, the fraction T N over T N, end fraction, plus F P, close parenthesis, times 100 also reveals that sensitivity is higher and specificity is lower.

PIC: Hearing screening outcomes are displayed in the tables using a 40 dB nHL and 30 dB nHL screening criteria. Compared to the 40 dB nHL criterion, the outcomes for the 30 dB nHL criterion reveal that A.sensitivity is higher B.specificity is higher C.sensitivity and specificity are higher D.sensitivity and specificity are lower

Option (A) is correct. The statistical findings show only one P-value less than 0.05. Therefore, the only statistically significant findings were seen at the 0 dB SNR.

PIC: Researchers performed a study on interlist equivalency of four word lists used for word-recognition testing. Each list was presented at five different signal-to-noise ratios (SNR). The word-recognition scores for each SNR for each list were obtained for a group of subjects. Word-recognition performance was evaluated, and the following statistical findings were obtained. There is a significant difference in the mean word-recognition scores among the four word lists at which SNR? A. 0 B. -15 C. -20 D. -25

Option (C) is correct. The data reveal VII nerve and VIII nerve lesions in the right ear.

PIC: Test results shown in the audiogram were obtained for a 48-year-old patient. The acoustic reflex pattern, immittance results, and pure-tone audiometry are most indicative of which of the following? A.VII nerve lesion, right ear B.VIII nerve lesion, right ear C.VII nerve and VIII nerve lesions, right ear D. Cochlear hearing loss, right ear; subtle conductive hearing loss, left ear

Option (B) is correct. Specificity refers to the accuracy of the ABR test to correctly identify those patients who do not have the disorder of interest, where specificity equals true negatives (307) divided by true negatives plus false positives (307 + 11) times 100.

PIC: The clinical-decision matrix shown displays data for screening auditory brainstem response (ABR) test outcomes compared to conventional ABR test outcomes (serving as the gold standard) with the same population of 336 ears. What is the calculated specificity of screening ABR? A.100% B. 97% C. 93% D. 90%

Option (C) is correct. The student is most likely to benefit from a hearing aid that deploys directional microphone systems that boost sounds coming from the front of the wearer and reduce sounds coming from other directions. Directional hearing aids are designed to improve signal-to-noise-ratio (SNR) based on the spatial location of the signal of interest relative to unwanted signals. Even though the magnitude of the improvement in SNR provided by directional hearing aids is much smaller than that reported for FM systems, they can still provide improved speech recognition across a range of noisy environments when compared to omnidirectional amplification.

PIC: The following audiogram, admittance test battery, speech audiometry, and otoacoustic emission (OAE) test results were obtained from a 22-year-old college student who is complaining of having trouble understanding speech, specifically in noisy classrooms. The patient communicates having no tinnitus, dizziness, ear drainage, or family history of hearing loss. Which of the following hearing-aid technologies would most benefit the student who needs to understand speech in a noisy listening environment? A. Digital noise reduction B. Slow-acting compression C. Directional microphone systems D. Direct audio input

Option (B) is correct. Aging and exposure to loud noise may cause wear and tear on the hair cells in the cochlea that send sound signals to the brain. When these hairs or nerve cells are damaged or missing, electrical signals are not transmitted as efficiently, and hearing loss occurs.

PIC: The following audiogram, admittance test battery, speech audiometry, and otoacoustic emission (OAE) test results were obtained from a 22-year-old college student who is complaining of having trouble understanding speech, specifically in noisy classrooms. The patient communicates having no tinnitus, dizziness, ear drainage, or family history of hearing loss. The patient's history and audiometric test battery results are consistent with hearing problems caused by A. Vestibular schwannoma B. Damage to the hair cells in the cochlea C. Otosclerosis or Usher's syndrome D. Tympanic membrane (eardrum) perforation

Option (D) is correct. A biological calibration or verification is performed to confirm that the system is free of any defects that might erroneously impact test results.

PIC: What is the most appropriate course of action for an audiologist to take when presented with a patient with test results such as those shown in the accompanying image? A. Refer the patient for medical evaluation. B. Administer a battery of speech audiometric tests. C. Check for acoustic reflex decay. D. Perform a biological calibration.

Option (D) is correct. The acoustic reflex relies on the VII nerve to carry the stimulus to the stapedial muscle. The absence of any reflex in the left ear suggests that there is a VII nerve pathology preventing measurable reflex contraction on the left side.

PIC: What is the most likely cause of the following acoustic reflex results? A. VIII nerve pathology on the right side B. VIII nerve pathology on the left side C. VII nerve pathology on the right side D. VII nerve pathology on the left side

Option (B) is correct. The compression ratio is the change in input over the change in output. From 50 to 110 dB SPL, for every 10 dB change in input, there is a 5 dB change in output, resulting in a 2 to 1 compression input.

PIC: Which of the following best indicates the compression ratio for the input-output function from 50 to 110 dB SPL? A.1 to 1 B.2 to 1 C.3 to 1 D.4 to 1

Option (D) The solid line lags the broken line by 90° is correct. The starting phase of the solid line is 0°, and the starting phase of the broken line is 90°. Therefore, the solid line lags the broken line by 90°.

PIC: Which of the following describes the relationship between the solid wave and the broken wave in the figure? A. They are in phase with one another. B. The broken line leads the solid line by 180° C. The solid line leads the broken line by 90° D. The solid line lags the broken line by 90°

Inferior vestib nerve

PSCC Saccule

Vestib Blood supply: Posterior Artery

PSCC Saccule

Option (B) is correct. A 7-month-old child can be expected to be able to track objects laterally with their eyes. This skill is essential if a visual reinforcement audiometry (VRA) test is to be used to measure the child's hearing sensitivity.

Parents bring their 7-month-old child to the clinic. They report that the child has had two bouts of otitis media and want to be sure the child's hearing is okay. The audiologist would like to test using VRA. Before beginning testing, the audiologist should be certain that the child is able to A. Cross the midline with an object B. Visually track objects laterally C. Localize sounds and objects from above D. Make eye contact when interacting

Syndromes with enlarged vestibular Aqueduct

Pendred Branchio-oto-renal CHARGE Waardenburg

Best to worst for Therapy based Vestib rehab

Peripheral stable loss Central Stable loss Fluctuating peripheral Fluctuating central

Chronic Suppurative OM

Persistent inflammation and disease of the middle ear

Vestib rehab types

Pharmacological Surgical Therapy based

Surgery may be warranted for...

Posterior BPPV, SSCD, perilymph fistula

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

Posterior BPPV: hall pike, dix hall pike, epley Horizontal BPPV: side roll/BBQ roll Anterior BPPV: Can treat as contralateral BPPV

pediatric case history

Pre-natal history, birth history (born full term? complications?) and NICU stay, passed HBHS?, general health/ear infections, family history of childhood hearing loss, S/L development, global development, educational concerns, hearing concerns??

Chronic OM

Presence of fluid for more than 30 days

When considering the ARTs of a person with a mild cochlear hearing loss in the right ear and normal hearing in the left ear, you would typically expect to find:

Present ARTs at a normal or reduced SL when the stimulus is in the right ear (right ipsilateral and right contralateral conditions) and present ARTs at a normal SL when the stimulus is in the left ear (left ipsilateral and left contralateral conditions).

For what suspected condition would you obtain reflex decay?

Present activator continuously for 10 seconds and if the reflex rapidly decreases in strength, this is "fatigue" and it is often associated with retrocochlear pathology (e.g., 8th-nerve tumor)

Stark Law

Prohibits physicians from making referrals to Medicare

How do tactile devices provide speech information to the wearer?

Provides clarity. Does not help with localization

Hallmark of glomus tumor?

Pulsitile tinnitus, affects cranial nerves. Browns sign: when ear canal pressure is raised, tumor will pulsate vigorously and then turn white.

Own Voice sounds boomy?

Reduce gain for intense low frequency sounds Check for OE

Option (D) is correct. Diabetes is a major cause of acquired visual impairment; the audiologist should take this fact into consideration when planning rehabilitation for patients with diabetes.

Reduced visual function, which can complicate planning for aural rehabilitation, is most likely to be found in patients with hearing loss who present with A. Ménière's disease B. Treacher-Collins syndrome C. Erythroblastosis fetalis D. Diabetes

What is the function of the Middle Ear?

Reduces impedance mismatch & protects from loud sound Ossicles, ET, pressure equalization Mechanical

Option (B) is correct. The consequences of untreated hearing loss include lower signal quality in the brain (leading to a higher cognitive load), a change in the structure of the brain, social disengagement, behavior changes, and health issues like dementia, depression, fatigue, and anxiety.

Research shows that people wait as long as seven years before they seek hearing health care services due to the negative stigma associated with hearing loss. Which of the following is most likely to occur with untreated hearing loss? A. Vision decline B. Cognitive decline C. Chronic fatigue D. Debilitating tinnitus

What communication method uses fingerspelling and oral language only

Rochester method

Tests of monaural low redundancy

SCAN 3 Filtered words AFG Time compressed Sentences

Describe testing instrumentation that can be taken into the workplace.

SLM: used for particularly noisy areas, near a machine. Type 2 (Class 2) can be used for most HCPs. Can be used to make a "noise map." Do not necessarily measure an individual's noise exposure. Noise dosimeter: SLM that is worn on the body; log an employee's noise exposure.

Transverse fracture

SNHL

What type of hearing loss is associated with Alport Syndrome

SNHL

What type of hearing loss is associated with CHARGE syndrome?

SNHL

What type of hearing loss is associated with Neimann-Pick Type C syndrome?

SNHL

What type of hearing loss is associated with Ramsey Hunt Syndrome?

SNHL

What type of hearing loss is associated with Williams Syndrome

SNHL

What type of hearing loss is associated with Charcot-Marie-tooth syndrome

SNHL *The incidence of CMT-related hearing loss varies by CMT subtype. This is a group of inherited genetic disorders that cause damage to the peripheral nerves. It's sometimes also called hereditary motor and sensory neuropathy. It results in weaker muscles. You may also experience loss of sensation and muscle contractions, and difficulty walking. Foot deformities such as hammertoes and high arches also are common. Symptoms usually begin in the feet and legs, but they may eventually affect your hands and arms. Symptoms typically appear in adolescence or early adulthood, but may also develop in midlife.

What type of hearing loss is associated with Edwards Syndrome?

SNHL (can have conductive component)

Where does the auditory information cross over?

SOC

Oculomotor: in and down

SUP OBLIQUE

Perilymph

Scala Vestibuli Scala Tympani Na+

Otoscopy characteristic of otosclerosis

Schwartze's sign: reddish hue observed from the promontory

A 76-year-old patient with a primary complaint of hearing loss reports experiencing an unsteady gait and needs assistance walking and climbing stairs. Which of the following would be the most appropriate course of action to take with this patient?

Screen the patient for risk of falls. Further information is needed to determine if a referral or assessment is needed.

Benign Skin Lesions

Seborrheic keratosis Seborrheic dermatitis Chondrodermatitis modularis helicus (wrinklers) Psoriasis

What is a standard procedure to ensure that all members of the office staff are conforming to HIPAA?

Signing a HIPAA form saying that you are going to conform to the information and keep patient information confidential Yearly training

Types of Presbycusis

Sensory Neural Metabolic Mechanial

25-18 year CI candidacy

Severe to profound SNHL AU Monosyllabic word scores of 30% of less in best aided

As tymp

Shallow (small peak). Thick, scarred TM; otosclerosis; cholesteatoma; fluid.

Tinnitus pitch matching is most useful when the tinnitus assessed is described as...

Single or overlapping tones. Tinnitus pitch matching is useful with tonal tinnitus.

What equipment is used to measure noise in a classroom

Sound level meter (type 2/class 2)

auditory verbal

Speech + audition

Auditory Oral

Speech + audition + gesures + speech reading

Cued speech

Speech + speechreading + audition + cued speech

total communication

Speech + speechreading + cued speech + sign + audition + gestures

Musicians Audiologic test battery

Speech in noise testing OAEs Extended HFs All interoctaves

Oculomotor muscles (4)

Superior Oblique

Undermasking

Test ear theshold - NTE masking level > IA

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

Surgical intervention, medical intervention

True: Lots of redundancy here.

T/F: Each vestibular nuclei is receiving coincident information from all 5 end organs.

False: Whatever we are born with is what we get.

T/F: Humans make otoconia as we get older.

False: They are considered motor.

T/F: The lateral (pyramidal) tracts and the medial (extrapyramidal) tracts are considered sensory.

True

T/F: The primary purpose of VNG/ENG is separating central from peripheral pathologies.

True: It's in the name.

T/F: Vestibulo-spinal reflexes depend on the connection between the vestibular periphery and the spinal cord.

False: It's the opposite.

T/F: vHIT is a low-frequency test and calorics are a high-frequency test.

Option (D) is correct. Variability depends on the number of test items or words that are used, as well as on the patient's true recognition ability, since scores in the middle of the distribution are more variable.

Test-retest variability in a client's suprathreshold and word-recognition score is influenced by both the number of test items or words and the initial suprathreshold word-recognition score. The largest test-retest variability can be expected to occur with which of the following combinations of number of test items or words and initial suprathreshold word-recognition score? Number of Words and Word-Recognition Score A. 50 words and 10% B. 50 words and 50% C. 25 words and 10% D. 25 words and 50%

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

The Institutional Review Board

(D) sensitivity The correct answer is (D). The question gives a definition of test sensitivity. (A) is incorrect because not all sensitive tests have reliability (the ability of the test to show consistent results for the same subject under different conditions). Validity is the ability of a test to measure what it is designed to measure; a test can be sensitive without being valid if there are too many false-positives, so (B) is incorrect. Specificity refers to how accurately the test identifies those individuals who do not have a hearing loss, so (C) is incorrect.

The accuracy of a hearing screening test in correctly identifying those individuals who actually have a hearing disorder is referred to as the screening test's (A) reliability (B) validity (C) specificity (D) sensitivity

(D) the outer third of the canal The correct answer is (D). Cerumen is created by a combination of secretions from sweat glands and sebum glands, which are located in the cartilaginous outer third of the ear canal. (A), (B), and (C) are incorrect because they do not describe the correct location.

The area of the ear canal where most cerumen is generated is (A) at the isthmus (B) the bony portion (C) the middle third of the canal (D) the outer third of the canal

(A) 34 dBA The correct answer is (A). Starting at 34 dB, intensity will increase by 3 dB each time the number of sources is halved. So going from one to two sources/fans will increase the intensity from 34 dB to 37 dBA. Doubling the number of sources again, from two to four sources/fans, will increase the intensity another 3 dB to 40 dBA. (B) is incorrect because mathematically starting at 28 dBA and increasing twice by 3 dB will bring the total to 34 dBA, which is below the allowable maximum of 40 dBA. (C) is incorrect because mathematically starting at 20 dBA and increasing twice by 3 dB will bring the total to 26 dBA, which is below the allowable maximum of 40 dBA. (D) is incorrect because mathematically starting at 10 dBA and increasing twice by 3 dB will bring the total to 16 dBA, which is below the allowable maximum of 40 dBA.

The audiometry room used for an occupational hearing conservation program is scheduled for renovation. The renovated room will have four ducts for ventilation. Each duct will have one fan, and all fans must be identical for effective ventilation. In order to obtain valid thresholds, the total noise of the fans must remain below 40 dBA. Assume that the noise from the duct fans radiates equally throughout the room. Which of the following represents the maximum noise level that can be emitted by each individual fan? (A) 34 dBA (B) 28 dBA (C) 20 dBA (D) 10 dBA

Option (D) is correct. Continuous interleaved sampling (CIS) is a cochlear implant signal-processing strategy that minimizes channel interaction by presenting pulses in a nonoverlapping sequence.

The cochlear implant signal-processing strategy in which brief pulses are presented to each electrode in a nonoverlapping sequence is known as A.a filter bank B.fine structure C.current steering D.continuous interleaved sampling

Option (B) is correct. An exposure to a maximum sound level of 94 dBLAeq would reach a 100 percent noise dose in an hour using NIOSH criteria. As described in the scenario, the patient will have been exposed to the sound for only 24 minutes during the day, which makes option (B), or 40 percent, the best answer.

The hearing of a 47-year-old patient who has worked in an office in a large factory for the last twenty years has been declining for the last five years. The noise measurements on the factory floor were 94 dB LAeq (94 decibels equivalent sound level.) The patient walked around the factory floor four times a day, and each walk took six minutes. Which of the following is closest to the NIOSH noise dose associated with the worker's exposure to the factory noise? A. 24% B. 40% C. 100% D. 160%

Option (B) is correct. According to the HIPAA, medical records cannot be released to anyone without written permission.

The husband of a patient contacts the audiologist and asks for the results of his wife's hearing test. Before this information can be provided, which of the following must occur? A. The wife must give verbal permission to release the results of her testing over the phone. B. The wife must sign a HIPAA form listing individuals who may have access to her records. C. The husband must request that the referring physician certify the results of testing. D. The husband and wife must make an appointment for a data security IT consultation.

Compression Threshold

The input level above which the gain of the hearing aid starts reducing as the input level increases

What is the area of the ear canal that is most narrow?

The isthmus

SAT

The lowest level at which the listener can just detect speech (but not understand it). To compare with the best pure tone threshold (i.e., cross-check with audiogram). Use with young children or developmentally delayed patients who cannot point to pictures or repeat words for the SRT.

SRT

The lowest level at which the listener can just detect speech (but not understand it). To compare with the best pure tone threshold (i.e., cross-check with audiogram). Use with young children or developmentally delayed patients who cannot point to pictures or repeat words for the SRT.

(A) Cubic difference tone The correct answer is (A). As noted in the question, a pair of tones is presented via an earphone in the measurement of DPOAEs. Because the normal auditory system is nonlinear, when two primary tones are introduced into the ear, distortion products are produced. The largest distortion product, and the one recorded in the evaluation of DPOAEs, is the cubic difference tone. (B) is incorrect because a summation tone may occur and harmonics may occur, but they will be very small, definitely not large enough to be measured. (C) and (D) are incorrect because hair cells do not resonate.

The measurement of distortion product otoacoustic emission (DPOAE) involves the presentation of pairs of pure tones to the patient's ear. Which auditory response does this test measure? (A) Cubic difference tone (B) Summation tone (C) Resonance in outer hair cells (D) Resonance in inner hair cells

dependent variable

The outcome factor; the variable that may change in response to manipulations of the independent variable.

(A) Obtaining another waveform under identical conditions The correct answer is (A). Repeatability is crucial for the reliability of test results. Obtaining a second waveform under identical stimulation and recording conditions provides a check of reliability by determining repeatability. (B), (C), and (D) are incorrect because changing any of the conditions will essentially result in a different test being performed, so the original results will not be shown to have been repeated.

The reliability of an obtained waveform on the auditory brainstem response is best checked by doing which of the following? (A) Obtaining another waveform under identical conditions (B) Increasing the stimulation rate (C) Opening the filters (D) Using digital filters after completing the test

How does coding for diagnosis and for billing work in audiology?

There is a different code based on what is being done in audiology. There are different systems of codes, ICD and CPT for example, that are used to code for either a diagnosis, the testing that was done, equipment, etc.

Narrow bands of noise are used for masking because...?

They are usually 1/3 octact in width which encomasses a critcal band

Diagnostic audiometers generally provide one-third-octave noise bands for use in masking pure tones. Which of the following best explains why one-third-octave noise bands are used?

They are wider than critical bands. Narrow bands of masking noise on audiometers should be wider than a critical band because they provide more effective masking for the frequency being tested without requiring higher overall intensity.

superior semi-circular Canal dehiscence?

Thinning of bone over SCC Tulio's phenomenon: vertigo elicited by loud noise. Auditory sensitivity to their own voice, heartbeat. Unstable visual field, vertigo. Dehiscence acting as a third window causing inner ear conductive loss!!

Holds images steady on the retina during brief head rotations or translations.

What is the main function of the Vestibular class of eye movement?

Option (A) is correct. Tinnitus pitch matching is useful with tonal tinnitus.

Tinnitus pitch matching is most useful when the tinnitus assessed is described as A. Single or overlapping tones B. Pulsing C. Musical D. Crackling

What different interventions can be used to alleviate the impact of tinnitus?

Tinnitus retraining therapy Maskers HAs

determine appropriate assessment for...Use of different kinds of stimuli?

Tinnitus, bored children, people with CI need broadband noise

What is the role of the audiologist in nursing homes/assisted living care?

To check hearing, help with hearing aids, and if needed get the patients access to hearing aids.

Option (C) is correct. This patient reports symptoms that could suggest either an otolith or semicircular canal dysfunction.

To which of the following patients would it be most appropriate to recommend a full vestibular evaluation? A. A 70-year-old male who states he has occasional dizziness when he stands up quickly B. A 43-year-old female who states she had an episode of dizziness about 10 years ago following a severe head cold C. A 62-year-old female who denies vertigo but states she often veers when she walks and loses her balance when she turns her head quickly D. A 53-year-old male who reports brief vertigo when turning over in bed or bending over

Smooth pursuit

Track image on the fovea with smooth continuous eye movements. Different frequencies. Tests velocity gain, asymmetry, and phase. CENTRAL lesion if abnormal.

Option (B) is correct. The agreement was verbal, and it is not illegal to modify prices for audiological services. It is doubtful that a lawsuit would result in damages beyond a refund of the non-discounted hearing aid price. The practice is not illegal but does raise ethical issues in terms of holding the welfare of the patient paramount and also in terms of maintaining harmonious relationships with other professionals.

Two audiologists in private practice together discuss hearing aid pricing and verbally agree on fee-for-service prices. During the second quarter, business slows down, so Audiologist B decides to discount hearing aids by 20 percent. Two patients who are friends are fitted with identical hearing aids, one by Audiologist A and one by Audiologist B. Through conversation, the friends discover that the one who bought from Audiologist B paid 20 percent less. The individuals complain to their respective audiologists and threaten to report them to the licensure board and to ASHA. Which of the following best describes this situation? A. Both audiologists are professionals and can set their own fee-for-service prices. B. Although the practice is not illegal, it can be construed as unethical. C. The situation is both illegal and unethical. D. The situation provides grounds for a lawsuit.

What type of sound level meter should be used to calibrate audiometers?

Type 1 (Class 1)

What is the difference between a Type 1/Class 1 and a Type 2/Class 2 sound level meter?

Type 1/Class 1: -precision grade for laboratory and field use - Tolerance: ± 0.7 dB -environmental, building acoustics, road vehicles Type 2/Class 2: -general purpose grade for field use - Tolerance: ± 1.0 dB -noise at work, basic environmental, motor sport

When should unethical (or suspected unethical) conduct be reported to appropriate licensing or regulatory boards?

Unethical conduct should first be mentioned either to the source or the boss of the company to first see if any problems can be fixed prior to going to stronger lengths to be fixed. However, all forms of unethical conduct are based on the contract at each location and might be handled differently. Also, the different types of misdemeanors are handled differently as well. Depends on situation being concerned and discussed about.

At what age is myelinazation of Wave V nerve complete?

Up to 18 months of age

(C) Disjunctive eye movements, rotating the two eyes in opposite directions

Vergence refers to: (A) Monocular movements of each eye (B) Conjugate eye movements, rotating both eyes in the same direction by the same amount (C) Disjunctive eye movements, rotating the two eyes in opposite directions

(B) Conjugate eye movements, rotating both eyes in the same direction by the same amount

Version refers to: (A) Monocular movements of each eye (B) Conjugate eye movements, rotating both eyes in the same direction by the same amount (C) Disjunctive eye movements, rotating the two eyes in opposite directions

Ampullofugal

Vertical SCCs Away from ampulla

What is Hennebert's sign?

Vertigo induced by pressure changes

Tumors that arise from the neurilemmal sheath, the sheath of Schwann, of the VIIIth CN. Characteristically, the arises within the internal auditory canal from the vestibular portion of the VIIIth nerve. Clinical Presentation -progressive, unilateral or asymmetric sensorineural hearing loss with a sloping contour (worse in HFs) -The loss is preceded or accompanied by tinnitus in more than 80% of individuals. -Dizziness or unsteadiness -A sensation of ear pressure/fullness When you'll suspect it: -tymps: normal -reflexes: elevated or absent with sound to the affected ear and normal with sound to the unaffected ear; abnormal reflex decay in the affected ear if they have normal hearing thresholds in both ears -unilateral or asymmetric sloping HF SNHL -WRS: normal or disproportionately reduced relative to the degree of pure tone sensitivity -Rollover: the shape of the PI function for speech materials is usually abnormal ***IMMEDIATELY REFER TO ENT*** Prevalence: Onset of symptoms is usually between 30-50 years of age. Approximately 55%-65% of patients are female. The tumor is unilateral in about 95% of patients. Symptoms are due to compression, atrophy, and invasion of the auditory and vestibular nerve trunks, interference with the blood supply to the cochlea, biochemical disturbances of the cochlear fluids, pressure on adjacent cranial nerves, and/or compression or displacement of adjacent brain stem structures.

Vestibular Schwannoma

● The max distance a person can move without taking a step ● the max angle that the center of gravity can move from the vertical position without a loss of balance

What are limits of stability?

Spinal cord, brainstem, and cerebral cortex

What are the 3 levels in the hierarchy of motor control?

1. Characteristic of the sensation (vertigo; light-headedness; presyncope/syncope; disequilibrium) 2. Time course of attacks (seconds; minutes-hours; hours-days) 3. Associated events and symptoms (hearing loss; ear pressure; drop attacks; tinnitus; amplification of sound; headaches) 4. Exacerbating factors (movement; loud noises; atmospheric and weather changes; diet; medication)

What are the 4 key components of the history for a vestib appointment (and the possible answers to each component)?

● Sensory redundancy: If one SCC becomes non-functional, brain can still take in information from the other ● Brain can dismiss "noise" (changes in neural firing that occur simultaneously in both, possibly in relation to temperature or chemistry) ● Compensate for sensory overload

What are the advantages to having coplanar pairs in the peripheral vestibular system?

Moves both eyes in opposite directions so that images of a single object are simultaneously placed on the fovea of each eye

What is the main function of Vergence?

Latency: 1-15 Duration: 5-60 seconds (longer in horizontal canal and in cupulothiasis) Direction of nystagmus: in the plane of the stimulated canal. Most commonly mixed up-beating and torsion., may be down-beating and torsion, or horizontal Symptoms Vertigo: Fatigability: Typical Nausea and vomiting: Unusual with a single test; may develop with repeat testing Associated neurological signs and symptoms: None

What are the common features of BPPV?

Latency: 0 Duration: Persistent as long as the head is in the provoking position Direction of nystagmus: Typically pure down beat, may be pure up-beat or horizontal Symptoms: No vertigo Fatigability: No Nausea and vomiting: No Associated neurological signs and symptoms: None, spontaneous nystagmus or oculomotor abnormalities

What are the common features of Central Positional Nystagmus?

Latency: 0-5 Duration: 5-60 seconds Direction of nystagmus: Pure vertical, pure torsional, or horizontal Symptoms: Vertigo Fatigability: Possible Nausea and vomiting: More frequently seen with a single test Associated neurological signs and symptoms: None, cerebellar signs, or oculomotor signs

What are the common features of Central Positional Vertigo?

Option (A) is correct. Once a baby is born, the sounds of the outside world come in loud and clear unless there is a hearing loss. The baby learns to attend and respond to the human voice, the barking of a dog, and other sounds.

What auditory skill involves becoming aware of and learning to attend to sounds? A. Detection B. Comprehension C. Identification D. Discrimination

Horizontal movement about the craniocaudal axis away from the median plane

What is Abduction?

Horizontal movement about the craniocaudal axis toward the median plane

What is Adduction?

Both eyes rotating horizontally about the craniocaudal axis toward the median plane

What is Convergence?

Downward rotation about the interaural axis

What is Depression (for a duction eye movement)?

Both eyes rotating downward about the interaural axis

What is Depression (for a version eye movement)?

Both eyes rotating about the naso-occipital axis so that the top pole of the eyes rotate toward the subject's right

What is Dextrocycloversion?

Both eyes rotating to the right about the craniocaudal axis

What is Dextroversion?

Both eyes rotating horizontally about the craniocaudal axis away from the median plane

What is Divergence?

Upward rotation about the interaural axis

What is Elevation (for a duction eye movement)?

Both eyes rotating upward about the interaural axis

What is Elevation (for a version eye movement)?

Both eyes rotating about the naso-occipital axis so that the top pole of both eyes rotates toward the median plane

What is Excyclovergence?

Rotation about the naso-occipital axis so that the top pole of the eye rotates away from the median plane

What is Extorsion?

Both eyes rotating about the naso-occipital axis so that the top pole of both eyes rotates toward the median plane

What is Incyclovergence?

Rotation about the naso-occipital axis so that the top pole of the eye rotates toward the median plane

What is Intorsion?

Both eyes rotating about the naso-occipital axis so that the top pole of the eyes rotate toward the subject's left

What is Levocycloversion?

Both eyes rotating to the left about the craniocaudal axis

What is Levoversion?

● Calcium carbonate crystals in the utricle and saccule ● Embedded in gelatinous material into which the hair cells project ● Provide the otolith organs with inertial mass

What is otoconia?

A central region that appears in both the utricle and saccule ● Divides the utricle and saccule into two parts ● Sets up the morphologic polarization of the organs ● Utricle: kinocilia of HCs oriented toward striola ● Saccule: kinocilia of HCs oriented away from striola

What is striola?

● Endolymph: high potassium, low sodium ● Perilymph: high sodium, low potassium

What is the chemical makeup of endolymph and perilymph?

The COM is the point at the center of the total body mass and the COG is the vertical projection of the COG.

What is the difference between a person's center of mass and center of gravity?

Reset the eyes during prolonged rotation and direct gaze toward the oncoming visual scene

What is the main function of Nystagmus quick phases?

Bring images of objects of interest rapidly onto the fovea

What is the main function of Saccades?

Holds the image of a small moving target on the fovea; aids optokinetic responses to stabilize gaze during sustained head rotation

What is the main function of Smooth Pursuit?

Holds images steady on the retina during sustained head rotation

What is the main function of the Optokinetic class of eye movement?

Option (A) is correct. Proper probe-tube placement is crucial to appropriate amplification settings. Measuring unaided gain at 6 kHz will determine if the probe tube is close enough to the eardrum.

When conducting real-ear measurements, which of the following is most appropriate for verifying accurate probe-tube placement in the ear canal? A.Performing REUG and monitoring gain at 6 kHz B.Using the intertragal notch for probe-tube insertion depth at 10-15 mm C.Performing REAG and monitoring gain at 6 kHz D.Arranging the probe module on the ear with the reference microphone facing inward

Whenever the head is in movement, which is essentially all the time.

When is the VOR engaged?

What is crisis of tumarkin? Associated with menieres

When lifting someone up from dix hallpike they are dizzy and disoriented

In what situation would it be necessary to obtain permission from an audiology patient or parent?

When wanting to access their information and give to a doctor, teacher, or other professional. If want to use their information for research purposes.

(A) Degeneration of sensory hair cells, (B) Degeneration of auditory neurons, and (C) Degeneration of the stria vascularis The correct answers are (A), (B), and (C) because they are the causes of three identified types of presbycusis: (A) causes sensory presbycusis, (B) causes neural presbycusis, and (C) causes strial presbycusis. (D) and (E) are incorrect because the ossicular joint and tectorial membrane are not involved in presbycusis.

Which THREE of the following can known types of presbycusis be attributed to? (A) Degeneration of sensory hair cells (B) Degeneration of auditory neurons (C) Degeneration of the stria vascularis (D) Degeneration of the ossicular joint (E) Degeneration of the tectorial membrane

Options (A), (B), and (C) are correct. Medicare does not require diagnostic and procedure codes in the report and will not allow a recommendation for annual recheck.

Which THREE of the following must be included in the written report of an audiologic assessment for a patient with Medicare? A. Referral source key B. Reason for referral key C. Relevant medical history key D. Diagnosis and abbreviated codes E. Recommendation for annual recheck

Options (A), (C), and (E) are correct. CPT code 92557 includes the following tests: (A) air conduction, (C) bone conduction, and (E) speech audiometry.

Which THREE of the following tests are included in CPT code 92557, which is a comprehensive audiological evaluation? A. Air conduction B. Immittance C. Bone conduction D. Otoacoustic emissions E. Speech audiometry F. Pure-tone screening

Options (B) and (D) are correct. Option (B) is correct because intertalker differences are difficult to control for consistency in speechreading assessments. Option (D) is correct because speechreading in actual use depends on both auditory and visual input for most clients. The measure of speechreading ability that best reflects a client's real ability is one that is administered in a combined auditory-visual mode. Creating a video assessment is often unnatural and lacks validity in assessing speechreading skills.

Which TWO of the following are accurate statements concerning assessment measures of speechreading ability? A. Speechreading test results are likely to have a high correlation with measures of visual intelligence. B. Speechreading tests are difficult to administer and assess because of intertalker differences and lack of naturalness. C. The most realistic measures of speechreading ability are administered in a visual mode only. D. The most realistic measures of speechreading ability are administered in a combined auditory-visual mode. E. Intertalker differences are eliminated as a test variable when speechreading test results are scored based on viseme recognition.

Options (A) and (B) are correct. Patients diagnosed with hyperacusis should avoid wearing hearing protection and need to be exposed to average environmental sounds in order to desensitize them.

Which TWO of the following are inappropriate treatments for a patient diagnosed with hyperacusis? A.Recommending that the patient wear earplugs B.Avoiding exposure to average-level sounds C.Desensitizing the patient to listening to average-level sounds D.Desensitizing the patient to listening to loud sounds

Options (A) and (C) are correct. Although speech-in-noise testing and otoacoustic emissions are important when determining the patient's hearing acuity and proceeding with or programming amplification, it is not considered part of the standard test battery for a psychoacoustic evaluation for tinnitus. This evaluation is an important tool to help guide patient counseling, patient education, and baseline information. The psychoacoustic evaluation may include, but is not limited to, a full case history, audiological evaluation, tinnitus pitch matching, tinnitus loudness masking, minimum masking level evaluation, residual inhibition assessment, and subjective patient questionnaires.

Which TWO of the following measurements are included in a psychoacoustic evaluation of tinnitus? A. Pitch matching B. Speech-in-noise testing C. Residual Inhibition Assessment D. Otoacoustic Emissions

Options (A) and (D) are correct. Diuretics and cancer medications have been shown to cause ototoxicity.

Which TWO of the following types of medications are considered to be in the family of ototoxic medications? A.Diuretics (furosemide) B.Lipid-lowering medications (statins) C.Anti-inflammatory medications (ibuprofen) D.Cancer medications (cisplatin)

Left: Type II Cylindrical with multiple nerve terminals at the base) Right: Type I (globular, flask shaped with single large chalice-like terminal surrounding base)

Which is a Type I hair cell? Which is a Type II hair cell?

Option (A) is correct. Anterior canal BPPV corresponds with a torsional nystagmus that beats toward the involved ear (in this case, the right ear) and a vertical down-beating nystagmus.

Which of the following abnormal eye movements (fast-phase of the nystagmus) corresponds with right anterior canal benign paroxysmal positional vertigo (BPPV) ? A. Right torsional and down-beating vertical nystagmus B. Left torsional and down-beating vertical nystagmus C. Right torsional and up-beating vertical nystagmus D. Left torsional and up-beating vertical nystagmus

Option (D) is correct. Visual fixation always suppresses nystagmus caused by a peripheral lesion, such as a labyrinthine lesion.

Which of the following always applies to nystagmus caused by a labyrinthine lesion? A.It is right-beating on right gaze and left-beating on left gaze. B.It is enhanced with eyes open. C.It is up-beating on up gaze and down-beating on down gaze. D.It is suppressed by visual fixation.

Option (C) is correct. Migraine and benign paroxysmal vertigo of childhood (BPVC) are the most common medical conditions associated with pediatric balance disorders and may require further vestibular assessment and medical referral for treatment.

Which of the following are the most common medical conditions associated with pediatric balance disorders that may require further vestibular assessment and medical referral for treatment? A. Skull-base fracture and congenital atresia B. Diabetes and thyroid disease C. Migraine and benign paroxysmal vertigo of childhood (BPVC) D. Respiratory allergies and benign paroxysmal positional vertigo (BPPV)

Option (B) is correct. Ultrahigh-frequency thresholds are recommended as ototoxicity may initially be observed in the higher frequencies (10K Hz, 12K Hz, 14K Hz). Moreover, since ototoxicity affects outer hair cells initially, otoacoustic emissions are a sensitive measure of outer hair cell function.

Which of the following are the tests recommended for monitoring hearing when there is concern about ototoxicity? A.PI-PB functions and reflex decay B.Ultrahigh-frequency thresholds and otoacoustic emissions C.Acoustic-reflex thresholds and word recognition with ipsilateral masking D.Speech-recognition thresholds and tympanometry with a high-frequency probe tone

(C) Cervical vestibular evoked myogenic potential (cVEMP) testing The correct answer is (C). The cVEMPs are myogenic responses elicited by acoustic stimulation of the otolithic organs, specifically, the saccule. The saccule is innervated by the inferior branch of the vestibular nerve, which has been shown to project to the lateral vestibular nucleus, the origin of fibers that descend by way of the lateral vestibular tract to anterior horn cells, which affect the contraction of the sternocleidomastoid muscle, the source of cVEMPs. (A) is incorrect because the bithermal caloric test activates the horizontal semicircular canal, which is innervated by the superior branch of the vestibular nerve. (B) is incorrect because the head shake test activates the horizontal semicircular canals, which are innervated by the superior branch of the vestibular nerve. (D) is incorrect because oVEMPs are thought to be generated by acoustic activation of the utricle, which is innervated by the superior branch of the vestibular nerve.

Which of the following assessments best determines the integrity of the inferior branch of the vestibular nerve? (A) Bithermal caloric test (B) Horizontal head shake test (C) Cervical vestibular evoked myogenic potential (cVEMP) testing (D) Ocular vestibular evoked myogenic potential (oVEMP) testing

Option (B) is correct. When the ear canal is closed off with an earmold or a hearing aid, there is a loss of natural resonance in the ear canal.

Which of the following best describes insertion loss? A. The difference between coupler gain and real-ear gain B. The decrease in natural amplification when the external auditory canal is closed off C. Real-ear aided response minus real-ear unaided response D. Real-ear saturation response minus real-ear unaided response

(C) OAE and ABR; ABR The correct answer is (C). The guidelines clearly indicate that ABR is the screening tool to be used in the neonatal intensive care unit (NICU). For an infant in the well-baby nursery, OAE can be used for screening, but ABR could also be used. (A) and (B) are incorrect because OAE is not recommended for use in the NICU. (D) is incorrect because ASSR is not a recommended screening tool.

Which of the following best identifies the appropriate tools to screen for newborn hearing loss in accordance with the Joint Committee on Infant Hearing Guidelines in these settings?: In the Well Baby Nursery; In the Neonatal Nursery Intensive Care Unit (A) ABR; OAE (B) OAE; OAE or ABR (C) OAE and ABR; ABR (D) ABR; ABR and ASSR

Option (B) is correct. An 18-month-old child should have a spoken or expressive vocabulary of about 50 words.

Which of the following children should be referred to a speech-language pathologist? A. A 2 month old with no expressive vocabulary B. An 18 month old with no expressive vocabulary C. A 24 month old who can form short sentences D. A 42 month old who can retell stories

Option (A) is correct. At 9 months old, a typically developing child can provide reliable responses to all octave band frequencies, and VRA is the most valid and reliable method.

Which of the following evaluation measures is most likely to provide valid and reliable information about a typically developing 9-month-old child's hearing sensitivity at 500 to 4000 Hz? A.Visual reinforcement audiometry (VRA) B.Otoacoustic emissions C.Auditory brainstem response (ABR) audiometry D.Behavioral observation audiometry (BOA)

Option (B) is correct. Exostoses are generally bilateral asymptomatic growths found in individuals with a history of cold-water swimming activity.

Which of the following is a bilateral benign bony growth of the external ear commonly found in persons with a history of cold-water swimming? A. Cholesteatoma B. Exostosis C. Otitis externa D. Polychondritis

Option (D) is correct. Alternating the polarity of the stimulus cancels out the cochlear microphonic, making it easier to visualize the electrocochleography response.

Which of the following is an effective way to eliminate the cochlear microphonic from the electrocochleography response? A. Increasing the distance between the transducer and the electrode sites B. Using insert earphones to eliminate artifact C. Lowering the intensity of the stimulus D. Using alternating polarity clicks

Option (D) is correct. The COSI is a self-reported assessment questionnaire. One of the greatest advantages of the COSI has been to promote a greater focus on the patient's individual needs when designing a rehabilitation program. The other self-report inventories are too lengthy or may have questions that do not apply to the patient's specific lifestyle.

Which of the following is most appropriate to use to determine information about a patient's individual situation and communicative needs? A. Hearing Aid Selection Profile (HASP) B. Communication Profile for the Hearing Impaired (CPHI) C. Hearing Handicap Inventory for Adults (HHIA) D. Client Oriented Scale of Improvement (COSI)

Option (D) is correct. Presbycusis typically causes a high-frequency hearing loss, which is the most important frequency range for the recognition of consonant letters such as /f/, /h/and /s/

Which of the following is most likely to be detrimental to the recognition of consonants? A. Mild low-frequency hearing loss B. Moderate conductive hearing across all frequencies C. Ménière's disease D. Presbycusis

Option (C) is correct. A head injury that involves a fracture through the cochlea causes fluid drainage and hair cell damage, which creates irreversible sensorineural hearing loss.

Which of the following is most likely to result from a head injury that involves a transverse fracture of the temporal bone through the otic capsule? A. No hearing loss B. Transient sensorineural hearing loss C. Permanent sensorineural hearing loss D. Conductive hearing loss

Option (B) is correct. Gentamicin is in a class of antibiotics (aminoglycosides) that are known to cause bilateral vestibular loss due to ototoxicity. A sign of bilateral vestibular loss is unsteadiness (ataxia) when standing and walking.

Which of the following is the most appropriate reason for an audiologist to monitor and evaluate the vestibular function of a patient who has undergone intravenous gentamicin treatment? A.The patient experiences light-headedness upon standing abruptly. B.The patient exhibits ataxia of gait or stance. C.The patient has type B tympanograms. D.The patient reports having experienced hearing loss.

Option (C) is correct. Background noise in schools is likely to be of consistently high amplitude at low frequencies; a 250 Hz tone is more difficult to distinguish from such background noise than are higher frequencies.

Which of the following is the most commonly accepted reason for not using 250 Hz in screening audiometry in a school environment? A. School-age children rarely can respond to the 250 Hz tone reliably. B. Sound at 250 Hz contributes virtually nothing toward the understanding of speech. C. Noise in the test environment is likely to interfere with detection of the 250 Hz tone. D. The responses school-age children give at 250 Hz are most likely to be vibrotactile rather than auditory.

Option (B) is correct. The ABR test is objective and sensitive, and it can determine whether the VIII nerve is functioning properly.

Which of the following is the most sensitive measure of VIII nerve dysfunction? A. Otoacoustic emissions test B. Auditory brainstem response test C. Speech-recognition testing D. Performance intensity-phonetically balanced function

Option (B) is correct. The sound pressure level (SPL) at the eardrum is a function of the volume of the external auditory meatus: the smaller the volume, the greater the sound pressure. An OSPL 90 set to a level appropriate for adults may produce an undesirably high maximum SPL in a child.

Which of the following is the primary reason for limiting a hearing aid's OSPL 90 to a lower level when it is worn by a child than when it is worn by an adult? A. Loud amplified sounds may frighten a young child and result in rejection of the hearing aid. B. The volume of the external auditory meatus in children is less than that represented by a 2-cc coupler, and consequently the SPL at the eardrum is greater. C. Parents and teachers of children with hearing impairments typically talk louder than do people who interact with adults with hearing impairments. D. The primary speech signal will be masked because room noise and reverberation will be amplified.

(C) A bone-conduction hearing aid The correct answer is (C). A bone-conduction hearing aid can boost the bone-conduction signal and provide enough amplification to be helpful to clients with moderate hearing loss, and the hearing aid will not interfere with the drainage of the ear. (A) is incorrect because hearing aids with earmolds are unsuitable for clients with chronic drainage because the drainage would damage the earmold, and the additional blockage of the external canal would exacerbate the drainage problem and increase the likelihood of infection. (B) is incorrect because body-worn hearing aids are coupled to earmolds and may provide more power than is necessary for people with only moderate hearing loss. (D) is incorrect because vibrotactile aids and cochlear implants are useful only for clients with profound hearing loss who cannot benefit from amplification.

Which of the following is typically the best choice of amplification for a person with bilateral moderate conductive hearing loss and chronic drainage from both ears? (A) Behind-the-ear aids with vented earmolds (B) A body-worn hearing aid (C) A bone-conduction hearing aid (D) A multichannel cochlear implant

Option (A) is correct. Under HIPAA guidelines common technical safeguard options can include but are not limited to antivirus software, multifactor or two-factor authentication, data encryption, de-identification of data, firewalls, mobile device management (MDM), and remote wipe capability. Surveillance cameras and locked doors are considered physical safeguards.

Which of the following lists examples of technical safeguard options outlined by the Health Insurance Portability and Accountability Act? A.De-identification of data, firewalls, mobile device management B.Data encryption, multifactor authentication, malware C.Remote wipe capability, surveillance cameras, password renewal cycles D.Locked doors, de-identification of data, two-factor authentication

Option (D) is correct. Acoustic modification should emphasize high-frequency amplification and de-emphasize low-frequency amplification. A flared horn (Libby), a short sound bore, and a wide vent is the best combination to achieve that goal.

Which of the following lists the most appropriate set of acoustic modifications for an earmold when fitting a patient with a precipitously sloping high-frequency sensorineural hearing loss? A. Standard tubing, 2 mm sound bore, no vent B. Libby horn, 3 mm sound bore, narrow vent C. Libby horn, 4 mm sound bore, no vent D. Libby horn, 2 mm sound bore, wide vent

(D) 88% right ear, 90% left ear The correct answer is (D). The pure-tone air and bone conduction thresholds together with the immittance results indicate that this 6-year-old child has a purely conductive, bilateral hearing loss. Thus, it is expected that once speech is clearly audible to the child, word recognition ability will be good to excellent bilaterally. The only reasonable choice of word recognition scores is therefore 88% right ear, 90% left ear, which is (D).

Which of the following lists the scores that are most likely to be obtained if word recognition is assessed using an age-appropriate test at 40 dB SL? (A) 70% right ear, 66% left ear (B) 60% right ear, 80% left ear (C) 80% right ear, 72% left ear (D) 88% right ear, 90% left ear

Option (A) is correct. Caloric irrigation stimulates the horizontal semicircular canal in one ear at a time.

Which of the following provides information about the left horizontal semicircular canal independent of the right horizontal semicircular canal? A. Caloric irrigation B. Sinusoidal harmonic acceleration C. Dynamic posturography D. Fistula test

Option (C) is correct. Performance level rises most steeply with small increases in intensity when the speech sample is large and provides some context; this is true of synthetic sentences, even though they do not provide as much context as natural sentences. In addition, the SSI allows the subject to pick out a word from a list, which provides additional clues.

Which of the following speech-recognition materials should the audiologist use to obtain the steepest possible performance-intensity function? A. Nonsense Syllable Test (NST) B. Central Institute for the Deaf, Test W-22 (CID W-22) C. Synthetic Sentence Identification (SSI) Test D. Northwestern University Auditory Test No. 6 (NU-6)

(C) It suggests a left peripheral vestibular disorder of either the labyrinthine or the VIIIth nerve. The correct answer is (C). A unilateral weakness indicates a disorder of the labyrinthine or the VIIIth nerve on the same side as the weakness. Thus, in this case the disorder is indicated on the left side, not the right side, so (C) is the correct answer and (A) is incorrect. (B) is incorrect because the disorder is localized to the periphery. (D) is incorrect because a central vestibular disorder is ruled out by these results.

Which of the following statements about a caloric response yielding a left unilateral weakness in the interpretation of videonystagmography results is most accurate? (A) It suggests a right peripheral vestibular disorder of the labyrinth. (B) It suggests a nonspecific (nonlocalizing) vestibular disorder. (C) It suggests a left peripheral vestibular disorder of either the labyrinthine or the VIIIth nerve. (D) It suggests a central vestibular disorder.

(A) Dizziness associated with loud sounds The correct answer is (A). The thin or absent bony covering of the superior semicircular canal (SSC) allows pressure from the external auditory canal to be transferred to and stimulate the SSC, resulting in dizziness. (B) is incorrect because a persistent feeling of spinning is not associated with superior semicircular canal dehiscence (SSCD). Dizziness with SSCD is intermittent and associated with loud sounds or pressure changes. (C) is incorrect because difficulty walking is not associated with SSCD. (D) is incorrect because hearing loss is not associated with SSCD.

Which of the following symptoms is most indicative of superior semicircular canal dehiscence? (A) Dizziness associated with loud sounds (B) Persistent feeling of spinning (C) Inability to walk in a straight line (D) Fluctuating low-frequency hearing loss

Option (C) is correct. A large difference in sensitivity in the ears of an adult is easily verified by the Stenger test.

Which of the following tests would yield the most important information in the audiological evaluation of an adult with an average unmasked air-conduction threshold of 90 dBHL in one ear and normal sensitivity in the other ear? A. Tympanometry B. Reflex decay test C. The Stenger test D. Acoustic reflex testing

Option (D) is correct. Speech understanding may be affected in a patient with a suspected retrocochlear lesion. Administering a performance-intensity function and then calculating rollover would be an appropriate step before referring the patient for more objective tests to rule out a retrocochlear lesion.

Which of the following types of speech recognition materials is most useful to rule out a lesion affecting the VIIIth nerve? A. Closed-set monosyllabic and bisyllabic words that vary in stress pattern B. Closed-set sentences approximating natural syntax, administered in varying intensity levels as in an ongoing message C. Open-set, monosyllabic, phonetically balanced word lists that are representative of the patient's language D. Open-set, monosyllabic, phonetically balanced word lists, administered at several intensity levels

Option (D) is correct. The WIPI is the only test listed that is both appropriate for a young child and requires no verbal participation by the child.

Which of the following word-recognition materials is most appropriate to use with a 5-year-old child who has otitis media and a severe articulation disorder? A. Central Institute for the Deaf, Test W-22 (CID W-22) B. Phonetically Balanced Kindergarten (PBK) test C. Northwestern University Test No. 6 (NU-6) D. Word Intelligibility by Picture Identification (WIPI)

(D) Preferential classroom seating and regular monitoring of middle-ear status The correct answer is (D). Providing Kim with preferential seating and monitoring her middle-ear status is clearly the most appropriate remediation strategy for the educational audiologist to recommend. (A) is incorrect because the history and audiometric results indicate bilateral otitis media, which can be treated medically; a bone-anchored hearing aid is not a reasonable choice for remediation. (B) is incorrect because a mild gain hearing aid for classroom use is not warranted unless it is determined that medical treatment does not improve auditory acuity. (C) is incorrect because while tutoring may be beneficial if the child is having a problem with a specific subject, Kim should remain in the classroom for as much of the school day as possible. Thus, taking her out of class for three hours a day is not feasible.

Which of the following would be most appropriate for the audiologist to recommend to accommodate Kim's needs? (A) Binaural, bone-anchored hearing aids (B) A mild-gain hearing aid for use in the classroom (C) Individual tutoring outside the classroom for three hours per day (D) Preferential classroom seating and regular monitoring of middle-ear status

Rotary chair testing

Which test is the gold standard for assessing bilateral vestibular loss?

Option (D) is correct. Solid custom plugs provide the greatest attenuation since adding a filter reduces the maximum attenuation.

Which type of hearing protection device provides the greatest amount of noise reduction (attenuation) ? A. A foam earplug B. Passive circumaural earmuffs C. A custom full-shell silicone earplug with musician filters D. A custom solid full-shell silicone earplug

Superior vestibular nuclei (SVN)

Which vestibular nuclei is known for being the major relay center for the ocular reflexes mediated by the semicircular canals?

Option (B) is correct. The audiologist should have received appropriate training for the procedure so that it is always performed correctly. The mistake could be construed as malpractice.

While making an earmold impression for a patient, an audiologist allowed the impression material to go beyond the cotton block, resulting in trauma to the tympanic membrane of the patient. The audiologist explained the situation to the patient and made an appropriate referral for follow-up medical care. Which of the following statements about the situation is most accurate? A.The audiologist may be guilty of an ethical violation. B.The audiologist may be subject to litigation for malpractice. C.The audiologist should refer the patient elsewhere for another earmold impression. D.The audiologist should use a different type of earmold impression material.

Option (D) is correct. The volume of the external canal is large; the scenario suggests the possibility of a perforated membrane, which is even more likely because of the ear's failure to maintain the seal.

While performing tympanometry on a patient, an audiologist obtains a seal on the patient's test ear, which has a large external canal, but the seal is lost intermittently whenever the patient swallows. Which of the following is the most likely cause of the problem? A. Eustachian tube dysfunction B. A collapsed canal C. Otitis media D. A perforated tympanic membrane

We have no access to the labyrinth or nerve, so we have to use secondary motor responses.

Why do use eye movement to assess the functioning of the vestibular labyrinth and vestibular nerve?

What are the phonetically balanced word lists used for?

Word recognition testing. Single-syllable words (CVC) that are phonetically balanced, meaning the beginning and ending phonemes are chosen according to their frequency of use in conversational speech

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

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

The psychoacoustic evaluation may include, but is not limited to...

a full case history, audiological evaluation, tinnitus pitch matching, tinnitus loudness masking, minimum masking level evaluation, residual inhibition assessment, and subjective patient questionnaires.

Wideband power reflectance or absorbance

a method to assess middle ear status yellow tells us whats normal

to develop normally

all children need full and complete acess to language - type of language does not matter as lond as it is complete and acessible full time

Your patient is complaining that their hearing aid has an echo. What is a solution(s) you are thinking about?

a.) increasing the vent size b.) decreasing low frequency gain c.) counseling to adapt

Saccades

ability to refixate on a moving target. Measures velocity, accuracy, latency. Abnormalities indicate CENTRAL lesion.

recruitment

abnormal loudness growth resulting from loos of OHCs and reduced dynamic range

Dipalcusis

abnormal perception of sound such that a single sound is heard as two, often resulting in pitch perception problems

Hyperacusis

abnormally acute sensitivity to normal or moderately loud sounds

18 month old child vocab

about 50 words

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

acess like using the phone at work pt not getting proper care pt can advocate for themselves

Describe an auditory training program for a child implanted with an artificial cochlea at age 3.

activation 1 month after implant return 1 and 2 weeks post activation return 1 month post activation return regularly until consistent or good map speech therapy weekly auditory verbal therapist in school, least restrictive environment in school if possible with aid

Red & Bulging TM

acute OM

Output limiting compression

adjusted w/ MPO automatic gain control rapidly and agressively limits output w/o distortion

LLR & 40 hz

affected by pt attention must be awake

Post-Lingual

after language was acquired - about age 6

free radical theory

aging due to oxidative damage wear and tear are the root cause of aging

Stochastic

aging events occur randomly as genetic mutations & accumulate randomly over time (chance)

programmed senescence

aging is predetermines and is a function of structured genetic expression

progressive lenses

are the WORST for balance

Functional auditory performance Indicators (FAPI)

assess broad and detailed sequence of development of functional aud skills

Screening Instrument for Targeting Educational Risk (SIFTER)

assess impact of HL on childs school performance in 5 areas

HAsHAPI

assesses effectiveness of Amp in everyday listening siuations

secondary tinnitus

associated w/ a specific underlying cause (other than SNHL) or an identifiable organic condition

Neural Presbycusis

auditory nerve. Histology shows loss of >50% of cochlear nerve fibers, with greatest loss in the basal turn.Speech recognition performance is lower than expected from audiogram. 90% of fibers must be lost before threshold decreases

6-12 mo

babbles non-verbal comm understands no

apogeotropic

beats away from head position head right - beat left otoconia stuck to walls cupulolothiasis

geotropic nystagmus

beats to head position head right - beat right otoconia are floating around canalithiasis

Pre-lingual

before language was acquired - start CI eval process ASAP

Short sound bore Wide Vent

better to let LF come in naturally

CPT codes

billing codes for medical, surgical and diagnostic services

CI stim

biphasic pulse train

IDEA (Individuals with Disabilities Education Act)

birth - 21 Provides a free appropriate public education for students with disabilities

oscillopsia

blurred vision when in motion

central nervous system (CNS)

brain and spinal cord

apraxia

brain issues motor planning

cABR

brainstem response that reflects neural encoding of speech sounds /da/

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

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

Positional testing

can help diagnose cervical vertigo

Identify treatments audiologists can provide for balance issues.

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

18-24 mo

carries out verbal commands body parts asks simple ?

What type of study looks at a single subject or case

case study

hematoma auris

cauliflower ear

pragmatic auditory training

child learns to control comm variables

Honey colored TM

chronic OM with effusion

auditory pathway

cochlea AN CN SOC IC MGB AC

40 Hz response

coincides w/ behavioral thresholds 8+ intensity doesn't impact latnecy

Eclectic Auditory training

combo of most or all strategies (pragmatic, synthetic, analytic)

Schwabach Test

compares pt and practitioner BC

Rinne

conductive vs SNHL HL

Does the test measure what it is supposed to measure?

content validity

The cochlear implant signal-processing strategy in which brief pulses are presented to each electrode in a nonoverlapping sequence is known as...

continuous interleaved sampling (CIS)

right ear advantage

contralateral pathway is strongest to L hemi for speech

oVEMP

contralteral utricle Superior Vestib nerve excitatory N1 (10) P2 (15)

Peds expectations: 1-4 mo

cooing - more vowel like

primary tinnitus

idiopathic and may or may not be associated w/ SNHL

stenger test

if 20dB gap in threshold 10dB above better ear 10dB below worse ear (+) no response = faker (-) response = truther

Immittance

impedance + admittance

Where is the CI implanted?

implanted into the scala tympani 22-30mm inside of the cochlea

positive reinforcement

increase a behavior you want to see

libby horn

increases HF response

Higher P/I function

increases with large speech sample & context

Peds expectations: 9-12 mo

jargon

Vestibulocolic reflex (VCR)

keeps head upright

ABR intensity inc

latencies shorten, peaks inc

SHA: high phase lead across all freq

likely central (brainstem)

comprehension

listen to a story and answer ?

Theory of Natural Selection

longevity will be selected if its beneficial to ones fitness to survive

Longer pulse width/duration

louder but lower rate

Hidden HL

low spont rate fibers are gone threshold doesn't change but supra threshold coding does

Class I Medical Device

low/moderate to health/safety (non-wireless)

eABR

lowest current levels that elicit a response from the auditory pathway in CI and ABI pts

Audiologist role in interoperative monitoring

monitor 8th nerve during surgery

Inserting a conventional foam earplug into the ear canal typically results in which pattern of attenuation?

more HF attenuation than LF

Class II Medical Devices

more complex higher risk (wireless)

synthetic auditory training

more global approach - stresses meaning / syntax cues to derive understanding

SHA: spectral purity

morphology of sine wave of eye movement compared to the sine wave of the head (chair) abnormal; central or deconjugate eye movements nonpathological reasons: head slip, camera, blinking

Dysarthria

motor speech disorder impared muscles

Automatic volume control

moving sounds to be within IDR

eligibility for special education services

need specially designed instruction

ASSR

neural potential that follows the envelope of complex sounds FFR objective measure - pt threshold

contralateral AC ABR recording

no wave 1

contralateral AC ABR resording

no wave 1

Candidacy for osseointegrated cochlear stimulator

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

carhart's notch

normal bone... air is worse at lower frequencies, rises to meet bone at 2k, and then get's worse again. Unilateral.

false negative

not perceiving a stimulus that is present

HSCC BPPV

nystagmus changes direction with position

verification

objective Test box etc

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

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

Injury

occurs suddenly - acoustic trauma

awareness

of sounds peekaboo

SHA: symmetry

of the slow phase component velocity (no beats) L<R = R hypofunction R<L = L hypofunction

SHA: high phase lead low time constant

problems w/ velocity storage, CN8, or labrynthe

PSSC BPPV

proximal and transient rotary nystagmus upbeating towards affected ear

You create a multichannel expansion program on a pts HA and recomplete speechmapping increasing input levels 50 dB SPL - 80dB SPL)

pt reports increased difficulty hearing low level HF speech sounds

false positive

pt responds w/ no stim

VBRT: sensory Sub

pull from vision, proprioception brain - use a night light - common w/ bilat vestib hypofunction

What features of a CI can be modified, and how can they be used to optimize performance for the patient?

pulse width → increase width, decreases threshold, comfortable levels should drop stimulation rate → ANR DR increases as pulse rate increases dynamic range → larger the DR, larger amount of sounds can be heard T levels → threshold C/M levels → comfortable level

What tone do you never use in sound field

pure tone

Equivalent Continuous Sound Pressure Level LAeq

the constant noise level that would result in the same total sound energy being produced over a given period. A fundamental measurement parameter designed to represent a varying sound source over a given time as a single number. in 1 hour you reach 100% noise dose at whatever LAeq is

Discrimination

the cow says moo

0dB HL is best decribed by

the different sound pressure levels that occur at different freq

immunological theory

the immune system is preset to decline by an internal biological clock

tensor tympani

the muscle attached to the malleus; tensing decreases vibration

standard threshold shift

threshold change of 10 dB + at 2, 3, and 4kHz in one or both ears

Velocity Step Test (VST)

time constant Gain Symmetry

VST time constant

time for nystagmus to reduce by 63% (WNL: 14-16 sec) Abnormal: - UW; 5-10 sec - constants for rotations ipsi to pathology - BW; <5 sec

reverberation

time required for the signal to decay by 60 dB following offset of the signal

Attack time

time to dec gain

release time

time to release gain back to target value

what is the purpose of real ear measurement?

to convert dB HL of test to SPL targets. To then appropriately fit patient with audible levels taking into account ear canal acoustics

place theory

tonotopic better for HF

reverse telemetry

used in CI software to check CI impedance

Tinnitus Retraining Therapy (TRT)

utilizes both sound therapy and counseling to achieve habituation of tinnitus. Intent is to remove the negative association attached to tinnitus and to help the patient habituate so that it becomes less adverse. Takes 12-18 months where you present a low level broadband noise to help the patient habituate to their own tinnitus.

______ suppresses nystagmus caused by a peripheral lesion

visual fixation

Peds expectations: 6-8 mo

vocal play reduplicated & nonbabbling

Pt w/ severe hearing loss can most likley best indicate ___________ in a consonant recognition test

voicing

tidal volume

volume of air from 1 inhale & exhale

Medicare part B

voluntary supplemental

Medicaid

welfare program where individuals qualify based on need & poverty lvl - state

LVST

whole spinal chord

extrinsic redundancy

within spoken language (distorted speech)

intrinsic redundancy

within the auditory system (CANS)

Sources of Noise in Oral Communication

within the speaker within the listener within the comm env

factors influencing redundancy in speech

within the speaker within the listener within the comm env within the message

connexin 32

x - linked

if you increase a high pass filter

you decrease low freq energy therefore decreasing amp and latency