✓Audiology Praxis 5343 Study Set #1
What test is the only indicator of cochlear function?
Otoacoustic emissions (OAE's).
What the three (3) parts of IDEA ?
Part B: special education for school age children (3-21) Part H: handicapped children age birth to 2 years. Part C: Early intervention.
Of the two fluids in the inner ear, which is closer in composition to the fluid of the cerebral spinal fluid (CSF)?
Perilymph.
Describe Developmental theory.
Predicts that a child with developmental delays will progress through the same maturation sequence as the normal child, only slower.
Describe difference theory.
Predicts that auditory responsiveness displayed by developmentally delayed children will be varied and unpredictable.
What is audiology training?
Process designed to enhance the ability to interpret auditory experiences by maximally utilizing residual hearing.
What is RASTI?
Rapid Speech Transmission Index
Define REAR.
Real Ear Aided Response.
Define RECD.
Real Ear Coupler DIfference: - difference b/t the output of a signal in the real ear vs. output of the same signal in a 2-cc coupler. (RECD value usually positive b/c real ear usu. smaller than coupler)
Define REIG.
Real Ear Insertion Gain
Define RESR.
Real Ear Saturation Response.
Define distortion.
Refers to the presence of frequency components in the output that were not present in the aids input.
TEOAE's are stronger in which ear?
Right ear.
The SOT (sensory organization test) is actually an expansion of what well known test?
Romberg test.
Which test is more sensitive ? Calorics or rotary chair?
Rotary chair.
Which medications are mainly cochleotoxic in nature?
(iVANKa) Vancomycin, amikacin, neomycin, kanamycin, (aminoglycoside antibiotics), furosemide, bumetadine, ethacrynic acid (diuretics) quinine (or derivatives), ASA: aspirin & salicylates, cisplatin.
What is the COSI?
*Client Oriented Scale of Improvement* An open-ended scale in which the client identifies up to 5 areas of listening difficulty (from a list of 16) upon which to focus for improvement
Individuals with hearing loss, particularly children, require a S/N ratio of what level?
+ 15 dB
Hard of Hearing (HOH) children need what SNR to understand intelligible speech?
+15 dB SNR
What SNR must be reached by a teacher so that all children in the classroom can hear the spoken message well enough to understand the meaning?
+15 to +20 dB SNR (signal-to-noise ratio)
What is the average signal-to-noise ratio (SNR) of the average classroom?
+5 dB SNR
What signal-to-noise (SNR) is needed for satisfactory communication?
+6 SNR
Adults (with normal hearing) require a S/N ratio of what?
+6 dB (approx. twice as loud as background noise)
What signal-to-noise (SNR) ratio is needed for a normal hearing person to receive intelligible speech?
+6 dB SNR
What is a normal tympanic peak pressure in an adult?
-200 to +100 daPa
Ling sounds & corresponding frequencies.
/m/ @ 250 Hz. /u/ @ 500 Hz. /i/ @ 500 Hz. (F1) and 2 KHz. (F2) /a/ @ 1 KHz. /sh/ @ 2 KHz. /s/ @ 4 KHz. silence
What are the three AFG subtests?
0 dB SNR, 8 dB SNR and 12 dB SNR.
If patient has an acoustic reflex at 90 dB, what is their estimated acoustic threshold?
0-30 dB HL. (estimated thresholds are 60-90 dB below the patient's reflex threshold).
What is the detection criteria for acoustic reflexes?
0.03 (at 500, 1000, and 2000 Hertz)
What the RT (reverberation time) for a typical classroom?
0.4 to 0.6 seconds
What questions need to be asked to determine if ABR is normal?
1) Does it look like an ABR? 2) Is it repeatable? 3) What is relationship between signal & noise?
What three (3) basic questions does audiometric testing answer?
1) Does pt. have HL, what type and degree? 2) Is HL correctable by medicine, surgery or amplification? 3) Is HL interfering with communication?
List some of the pathologies that can cause a type B tympanogram.
1) Low ECV: cerumen impaction, 2) Normal volume: ME effusion or stapes fixation, 3) Large ECV: PE tubes or TM perforation
What companies produce cochlear implants?
1) Med-El 2) Cochlear America 3) Advanced Bionics
Cues of malingering.
1) PTA is 12 dB or greater than SRT, 2) half-word responses (like hot for hotdog) 3) associated words during WRS (dog for cat)
What is Waardenburg syndrome?
1) Partial albinism: w/ 'White Forelock' of hair 2) Deafness 3) Unibrow
Questions to ask during assessment?
1) Reason for visit? 2) Onset of symptoms? 3) Better ear? or worse ear? 4) Constant or intermittent? (time course) 5) Illness or trauma? (complicating factors) 6) Family Hx? 7) Noise exposure? 8) Ear infections? Surgeries? 9) Medical conditions? medications?
What are the two primary concerns/considerations when fitting any hearing aid?
1) acoustic feedback, 2) occlusion effect
What classes of drugs are generally considered ototoxic?
1) aminoglycoside antibiotics, 2) loop diuretics, 3) salicylates & NSAIDS, 4) quinine (& derivatives), 5) cytotoxic (chemo) drugs, 6) solvents, 7) anti-malarials
What are the three sources of noise in a classroom?
1) classroom: talking, HVAC, pencil sharpener, etc., 2) internal: hallway noise, gym, other classes, cafeteria, 3) external: road noise, wind, aircraft, playground, etc.
What are symptoms of Waardenburg Syndrome?
1) cleft lip, 2) deafness, 3) constipation, 4) pale blue eyes (or eyes that don't match), 5) joint problems, 6) intellectual deficit, 7) white patch of hair (or early graying), 8) wide space b/t eyes
CHARGE syndrome symptoms?
1) coloboma of eye 2) heart defects 3) atresia of nasal cavity 4) retardation of development 5) genital abnormalities 6) ear abnormalities/deafness
What are some advantages of open canal fittings?
1) cosmetic, 2) relief from occlusion effect, 3) comfort, 4) preservation of natural ear canal resonance, 5) sound quality, 6) strong client preference for open-fit mini-BTE style HA's
What are a few advantages of CIC hearing aids?
1) cosmetics, 2) preservation of sound localization, 3) reduce wind noise, 4) natural pinna effects, 5) some high frequency benefit >2000 Hz.
What are some advantages of doing a binaural fitting versus a unilateral hearing aid fitting?
1) decreases head shadow effect, 2) loudness summation (2 - 8 dB, depends on many factors), 3) improved sound localization, 4) binaural redundancy, 5) binaural squelch
What are some potential contraindications to binaural fitting of HA's?
1) degree of hearing loss, 2) cost, 3) convenience, 4) binaural interference, 5) perceived benefit
What are some drawbacks to CIC hearing aids?
1) dexterity/vision concerns, 2) size 10 battery (life/size), 3) no directional mics, telecoils
What is the most common first treatment(s) for Meniere's disease?
1) diuretics 2) low Na+ diet 3) oral steroids
What are potential benefits of bilateral hearing aid fittings?
1) elimination of head shadow effect, 2) loud summation, 3) sound localization, 4) improved speech in noise perception
What are the symptoms of Meniere's disease?
1) episodic rotary vertigo, 2) roaring tinnitus, 3) rising (reverse) SNHL, 4) sometimes aural fullness also. [generally starts unilaterally then can become bilateral in @ 2 yrs.]
What speech information is available at 250 Hz.?
1) first formant of vowels /u/ and /l/ 2) fundamental freq. of children & female voices 3) nasal murmurs assoc. with /m/, /n/, and /ng/ 4) male voice harmonics 5) suprasegmental patterns (stress, rate, inflection, intonation)
What are strategies for treating the occlusion effect?
1) go to an open style dome, 2) add venting to ear mold (both of these strategies allow the escape of low frequency sounds)
What is the basic etiology of otosclerosis?
1) growth around stapes footplate, 2) hereditary (autosomal dominant), 3) more in caucasians, 4) ages 15-45, 5) during puberty & pregnancy, 6) female: male ratio 2:1
What are some of the factors that affect style selection of HA's?
1) hearing loss, 2) cosmetics, 3) ear canal shape/size, 4) presence of cerumen, 5) dexterity/vision, 6) comfort, 7) communication needs, 8)environment used in
What are symptoms of Superior Canal Dehiscence?
1) imbalance, 2) sound-induced vertigo, 3) pulsatile tinnitus, 4) autophony, 5) aural fullness, 6) oscillopsia
Symptoms of Pendred Syndrome.
1) inner ear changes 2) enlargement of thyroid gland 3) SNHL present at birth 4) balance problems due to altered function of auditory system.
Describe some treatments for Meniere's disease.
1) low salt diet, 2) oral steroids, 3) endolymphatic shunt, 4) gentamicin injections into scala tympani, 5) vestibular neurectomy or labyrinthectomy.
What are the three (3) main types of vents in a hearing aid shell or earmold?
1) parallel, 2) diagonal, 3) trench
To learn a new word, a child must do four things. What are they?
1) perceive speech, 2) detect that a word is new, 3) learn the word's meaning, 4) remember the word.
Advantages of using inserts over headphones.
1) prevent collapsing of ear canals, 2) increase interaural attenuation, 3) more reliable, 4) more sanitary.
What are the basic three-lead electrode array in AEP tests?
1) primary electrode (non-inverting) 2) secondary electrode (inverting) 3) common ground
Alport syndrome symptoms?
1) progressive kidney disease 2) mild-profound SNHL 3) hematuria 4) proteinuria 5) obnormal ocular lense 6) dialysis, transplant, vision/hearing
What the symptoms of Meniere's disease?
1) rotary vertigo, 2) roaring tinnitus, 3) Rising SNHL 4) (aural fullness - sometimes seen)
What three test sets are involved in CDP testing?
1) sensory organization tests, 2) motor control test, 3) adaptation test
What are the 6 types of prebycusis?
1) sensory, 2) neural, 3) strial, 4) cochlear conductive, 5) mixed presbycusis, 5) intermediate presbycusis
What are the three (3) types of otoacoustic emissions?
1) spontaneous, 2) stimulus frequency, 3) transient evoked, 4) distorsion product
Cochlear Implants: For each electrode, what two levels are assigned?
1) threshold level, 2) comfort level
What are the hypothesized causes of endolymphatic hydrops?
1) too much fluid secretion from stria vascularis, 2) too little endolymphatic sac absorption, 3) autoimmune disorder
What theories are there about the causes of Meniere's disease?
1) too much secretion of endolymph in the scala media, 2) not enough endolymph absorption by the endolymphatic sac, 3) autoimmune disorder
Which three (3) balance senses are tested with CDP testing?
1) visual, 2) somatosensory, 3) vestibular
What are some secondary effects of venting?
1)Reliefs pressure (occlusion), 2)allow some air flow (dissipate humidity), 3) more nature sound, 4) relieve hollow sound b/c of occlusion
When are CI post op evaluations scheduled?
1, 3, 6 and 12 months
How much attenuation occurs from the head shadow effect and in what frequency range?
10 - 15 dB attenuation of sound, mainly in high frequencies
During acoustic reflex decay, how long is the tone presented?
10 seconds
What is the prevalence of Meniere's disease in the US?
100-200 per 100,000 (or 0.2%)
The SRT should be within ______ dB of the PTA.
12 dB
Children do not hear and process oral language at adult-like levels until what age?
13 years old
When using an ear mold with slim tubing, insertion gain is increased across the frequency spectrum. However, there is significant drop at what frequency?
1500 Hertz.
What dB of benefit comes from loudness summation?
2 - 8 dB depending on various factors
At what age does the ABR look like that of an adult?
2 years old.
Approximate size of ear canal.
2.5 cm length by 8 mm diameter.
When is inner ear formation mature where functional hearing begins?
20th week
The acoustic reflex is tested using what probe tone?
226 Hz.
When performing immitance measures, what frequencies are used for adults and children?
226 Hz. for adults; 1,000 Hz. for pediatrics (under 6 months)
When a pediatric patient is set up with their cochlear implant, how many units does the audiologist usually start the child with?
25 units.
What are the primary frequencies testing during an audiological evaluation?
250, 500, 1000, 2000, 4000, & 8000 Hertz.
Number of births with Hearing Loss per 100,000.
260 per 100,000 (approx. 3%)
Distortion product formula?
2f1 - f2
How large of an asymmetry is needed before you can administer the Stenger test?
30 dB
What is the dynamic range of the LTASS in dB?
30 dB
When is the cochlea complete with regard to size, structure and development?
34th week
ANSI (2002) recommends that classroom noise levels not exceed ______ dB and reverberation times not to exceed ______ seconds.
35 dBA, 0.6 to 0.7 seconds
What is the main amplification benefit of deep canal CIC (or IIC)?
4 dB greater output in lows & 8 - 10 dB greater output at 4 KHz.
Acoustic reflexes should be measurable to what audiometric threshold?
40 dB HL
When is fetal development considered full term?Z
40 weeks
What percent of glomus tumors are familial?
50%
What is the normal tympanic width for an adult?
51 - 114 daPa
Reverberation is the time it takes for reflected sounds to die down by how many dB from cessation of the source sound?
60 dB
# of words for a child at 18 months of age?
8 - 10 expressive words.
What frequencies should be tested when monitoring ototoxic medication administration changes?
8,000 to 20,000 Hertz.
What is the normal tympanic gradient for children?
80 - 15o daPa
How many sweeps should you take when performing an ABR?
800 (minimum) - 2,000
How much language do children learn incidentally?
90%.
What is the CPT code for basic canalith repositioning procedure (such as Epley maneuver, Semont Maneuver, etc.)?
95992
What are adult norms for adult acoustic reflexes?
< 95 dB HL (for 250-2000 Hz. pure tone) < 100-105 dB HL (for 4000 Hz.) < 90-95 dB HL (for BBN)
A hearing loss at what level will show an absence of DPOAE's?
> 60 dB HL
How much acoustic reflex decay indicates a retrocochlear pathology?
>50% (comparison is made b/t the initial reflex and at the end of the 10 sec. window)
What is criteria for Sudden SNHL?
>= 30 dB HL for three (3) adjacent frequencies.
On the ABR tracing, what can occur at 12 - 16 msec and what does it signify?
A Pam tracing can appear (a large wave) that results from neck tension and is only present if the patient is hearing the clicks. (This unwanted wave can act as a cross check that the patient is hearing the stimuli. If the PAM wave is present you know the patient is hearing the stimuli.)
Describe otosclerosis.
A conductive HL that typically occurs with a notch at around 2 KHz. on the audiogram (the air-bone gap is smallest at 2 KHz.)
How is the "Competing Words: Free Recall" test performed?
A different monosyllabic word is presented to each ear simultaneously (dichotic listening). The tester is to repeat each word in any order.
Describe an ipsilateral acoustic reflex pathway.
A loud sound travels from cochlea (to) cochlear nucleus (to) superior olivary complex (to) facial nerve nucleus (to) stapedius muscle causing contraction.
What is Schwartz sign in otosclerosis?
A pink color noted through the TM.
What is palatal myoclonus?
A rapid spasm of the palatal (roof of the mouth) muscles, which results in clicking or popping in the ear.
What is an APGAR score?
A scale used to assess newborn health.
Describe a type Ad tympanogram.
A tympanogram with a high peak. Compliance > 2.0 ml.
What is Goldenhar syndrome?
AKA oculo-auriculo-vertebral dysplasia (OAV). Associated with anomalous development of the 1st and 2nd branchial arches.
What is the ANSI standard that has been the defining document for hearing performance since 1977?
ANSI S3.22
Define APHAB.
Abbreviated Profile of Hearing Aid Benefit.
What is the APHAB?
Abbreviated Profile of Hearing Aid Benefit. The APHAB is a more clinical friendly measure of outcome.
Which medications are mainly mixed cochleo- and vestibulo- toxic?
Actinomycin, bleomycin, nitrogen mustard.
What are the ABCDs started in the 1990's that are part of the Universal Newborn Hearing Screening's high risk register?
Affected family; Bilirubin level; Congenital rubella syndrome; Defects of the ear, nose and throat; Small birth weight.
What does ANSI stand for?
American National Standards Institute.
What drug classes of medications are ototoxic?
Aminoglycoside antibiotics, Loop diuretics, NSAID's Antimalarial drugs Antineoplastic drugs Miscellaneous
What is the main cause of endolymphatic hydrops in Meniere's disease?
An overabundance of endolymph in the scala media (cochlear duct).
What is the primary disadvantage when testing children in soundfield?
Any results can only be for the better of the two ears.
During the Fukada step test, how much of a turn by the patient is considered abnormal?
Any turn greater than 30 degrees is considered abnormal. (Many clinicians use the 50 step method.)
At about what point do acoustic reflexes become absent?
Around 70 dB HL.
What is the purpose of the "Competing Words: Free Recall" test?
Assesses ability to process competing speech signals.
What is the purpose of the "Auditory Figure Ground" test?
Assesses the ability to process speech presented with background noise.
When are APGAR scores taken on a newborn?
At 1 minute of life and at 5 minutes of life.
When do children with hearing loss start to differentiate themselves from normal hearing children?
At around 6 - 8 months, when hearing children develop variegated babbling.
What is AIED?
Auto-immune inner ear disease.
What is the 6 dB rule?
Average speech level falls by 6 dB for every doubling of distance from the speaker. (This also works the other way. Cutting the distance in half will increase level by +6 dB)
Mondini's Aplasia?
Basal turn of the cochlea develops with abnormally wide or absent vestibular structures.
Why does endolymphatic hydrops affect the low frequency portion of the hearing first?
Because the wider apex end is less stiff and will start bulging (and rupture) first before the stiffer basal (high freq.) end of the cochlea.
What is BOA?
Behavioral Observation Audiometry (BOA)
At what age is Conditioned Play Audiometry appropriate?
Best for 3 yrs. to early school age.
When is traditional audiometry appropriate for children?
Best for 4-5 years forward.
At what age is Visual Reinforcement Audiometry appropriate?
Best for 6 to 24 months.
Between what audiometric levels would you expect elevated acoustic reflexes?
Between 40 dB HL and 70 dB HL.
How does a binaural fitting affect sound perception in noise?
Binaural fittings improve the SNR by 2 to 3 dB better. This improvement is due to binaural squelch & redundancy.
With regard to equipment calibration, what should be performed on a regular basis, if not almost daily?
Biologic check.
What obliterates the acoustic reflex?
CHL.
What test is the gold standard for identifying vestibular pathology?
Caloric irrigation.
Symptoms of otosclerosis.
Carhart's notch type As tymp in affected ear Schwartz sign
Perilymph is sodium rich and very similar to what other body fluid?
Cerebral spinal fluid (CSF).
When doing cerumen management prior to air calorics, which method should not be used or used with caution and why?
Cerumen management with warm water. Afterwards, when air calorics are performed if the canal is still damp the water will evaporate during the air caloric causing a COOLING effect during the caloric.
What is a normal equivalent ear volume of a child or adult?
Children: 0.3 - 0.9 cm^3 Adults: 0.9 - 2.0 cm^3
What stimuli are used for TEOAE's?
Clicks or tone pips.
ABR: Wave I originates in what part of the auditory pathway?
Cochlea
Function of LENA.
Collect, process and analyze language from environment for children 2 - 48 months; records up to 16 hours of continuous speech data.
Michel's Aplasia ?
Complete failure of development of inner ear.
Define dichotic.
Completely different signals presented to each ear. (ex: dichotic digits, words or CV's)
What is CDP?
Computerized Dynamic Posturography
Cochlear implant signal strategy where pulses are presented to electrodes in a non-overlapping sequence.
Continuous interleaved sampling.
Define CROS.
Contralateral Routing of Signal. Used on a patient with a single-sided deafness (SSD) to route signal from one side to the other side to give a 360 degrees reception of sound.
Plane that divides the body into anterior & posterior portions?
Coronal plane.
Who was the first person to record OAE's in 1978?
David Kemp
What is speech reading?
Deciphering speech by looking at the face of the speaker.
Why don't we use pure tones for soundfield testing?
Development of standing waves.
Definition of asymmetrical hearing loss.
Difference of 10+ dB in two adjacent frequencies, or 20+ dB at one frequency.
What is the only hearing aid option proven to improve signal-to-noise (SNR) ratio?
Directional microphones.
What is the tympanic width (gradient)?
Distance from the peak to the positive tail. The gradient is measured at 50% of the peak.
What type of pathologies can cause a type As tympanogram?
ET dysfunction; ME effusion, otosclerosis; stapes fixation; TM malformation (thickened)
What act did Congress pass in 1975 regarding education?
Education for All Handicapped Children's Act (EAHCA).
When testing children in soundfield, what methods of stimuli must be used and why?
Either FM, warbled or NBN must be used. This decreases reverberation (from standing waves).
Newborn hearing screening should be include which tests and interpretation by whom?
Either OAE's or ABR (or both depending on hospital policy). Interpretation must be by an audiologist or physician.
Potential advantage of binaural hearing aid fitting.
Elimination of the head shadow effect (10 to 15 dB attenuation of sound, mostly high frequency, by the head when sound arrives from contralateral side.
What is EVA?
Enlarged vestibular aqueduct: Common congenital inner ear malformation; may exhibit mixed or SNHL as well as vestibular disorders.
What is the goal of classroom acoustics?
Ensure 100% of speech signal is audible 100% of the day.
What is the ratio used for DPOAE's ?
F2/F1 ratio is most commonly 1.2
What type of presentation do we use to test aided ears in soundfield?
FM tone, warbled tone and NBN (make sure audiometer is calibrated for NBN) 0 degree azimuth
When attempting to decrease the occlusion effect with vents or open style domes, what other problem can arise?
Feedback (with enough amplification open style domes, vents or slits can allow feedback to occur)
Describe a type B tympanogram.
Flat tracing: Compliance: abnormal, no peak Gradient: abnormally wide Peak Pressure: abnormal, no peak
What are some advantages of soft silicone earmolds?
Flex to accommodate TMJ movement. Better seal for profound losses. Good choice for kids & sports.
What is the mathematical formula related to fmp in ABR testing?
Fmp ~ (S/N)^2 (signal-to-noise ratio squared)
Define Bi-CROS.
For use with SSD (single-sided deafness) by using a CROS on the deaf ear and an aid on the functioning ear.
A graphical representation of the hearing aid output as a function of frequency is referred to as ?
Frequency response curve
What population is generally affected by Meniere's disease?
Generally occurs in adulthood, but numbers increase rapidly around 60 yrs. of age.
What is Pendred syndrome?
Genetic disorder leading to congenital bilateral SNHL and goiter with euthyroid or mild hypothyroidism. (also known as Goiter-deafness syndrome)
Who theorized the traveling wave theory (passive function) in 1940's?
Georg von Bekesy.
What is the most important action when a patient presents with sudden SNHL?
Get them treatment immediately (within 2 days).
Prior to caloric testing, what questionnaire can help the clinician assess how the patient will respond to the caloric testing?
HADS (Hospital Anxiety and Depression Scale)
What the the two types of distortion?
Harmonic and intermodulation.
What is the HAPI?
Hearing Aid Performance Inventory
What is the HHIA or HHIE?
Hearing Handicap Inventory for Adults (or Elderly). It is a 25 item questionnaire with 2 subscales (emotional consequences & social and situational effects) to measure the perceived effects of hearing loss. There is a 10 question screener as well.
Define HHIE/A.
Hearing Handicap Inventory for Elderly/Adult.
Reverberant sounds mask what kind of sounds?
High frequency sounds
What are the four (4) possible results from a test in regard to sensitivity and specificity?
Hit, Miss, Correct rejection, false alarm.
Caloric irrigations test what two parts of the balance system anatomy?
Horizontal (lateral) canal, Superior vestibular nerve
Plane that divides the body into superior & inferior portions?
Horizontal plane.
Define diotic.
Identical signals presented to both ears.
Purpose of a Libby horn.
Increase high frequency response.
What is the popular documented cause of Meniere's disease?
Increase in endolymph or endolymphatic hydrops.
What is an IFSP?
Individualized Family Service Plan.
What is IDEA?
Individuals with Disabilities Education Act
What are the two types of hair cells in the cochlea and their function?
Inner & outer hair cells. IHC's (1 row) of mainly afferent hair cells and OHC's (3 rows) of mainly efferent hair cells.
Describe ipsilateral acoustic reflex testing.
Involves stimulating and measuring in the same ear.
Describe contralateral acoustic reflex.
Involves stimulating one ear and measuring in the opposite ear.
What is the Directivity Index (DI)?
It compares sounds that originate in front of the HA to other sounds around the hearing aid. Omni directional hearing aids have a DI of 0. A really good directional hearing aid can have a score of 5 or 6 (maximum in theory).
What is the MarkeTrak Satisfaction Survey?
It is a 48 item questionnaire with several subscales used to obtain the patient's satisfaction as it relates to specific hearing aid features and listening environments. It is published every four years.
Describe the occlusion effect.
It is an increase in low frequencies (generally <500 Hz.) that occurs when the ear canal is occluded that causes a "hallow" or "booming" sound in the ear when the client talks or chews.
When did Kansas enact legislation for UNHS?
July 1, 1990.
What is LENA?
Language Environment Analysis System.
What is LACE?
Listening and Communication Enhancement
What is LACE and how often are sessions?
Listening and Communication Enhancement. 25 minute sessions for 10-20 days. Practice is performed in difficult situations; ex. speech in noise, rapid speakers, competing speakers, filling in mission words.
What is the LTASS?
Long-term average speech spectrum.
What is the site of lesion for an abnormal Romberg test?
Lower limb proprioceptive spinal reflex arc.
A wider tympanic gradient (or width) is indicative of what pathology?
ME dysfunction, likely fluid or effusion
Ipsilateral acoustic reflexes are more sensitive to what type of pathology?
MES pathology. MES pathology typically wipes out all AR's.
What audiological testing method is recommended by ASHA?
MHW, Modified Hughson Westlake method.
What are the Ling sounds?
MM, AH, EE, OO, SH, SS Allow all of the different frequencies to be tested.
Main electrolytes in endolymph.
Mainly composed of high quantities of potassium (K+) and low quantities of sodium (Na+).
Define MPO.
Maximum Peak Output - is the highest possible signal that a hearing aid is capable of delivering.
What two divisions occur in the ear canal in 1/3's?
Medial bony portion covers 2/3's of canal and lateral cartilaginous portion covers the outer 1/3 of canal.
What is common mode rejection?
Method that processes the input signals by which any identical voltages from two divergent sources are eliminated while any dissimilar voltages are recorded. This is used with the inverting and non-inverting electrodes in ABR's to eliminate noise and leave the remaining signal which is the resulting ABR waveforms.
Scheibe aplasia?
Most common; membranous portion of the cochlea and saccule are involved.
Define a type C tympanogram.
Negative pressure: > -200 daPa Compliance: normal Gradient: normal Peak Pressure: greater than -200 daPa ECV: normal
Who is more likely to have spontaneous OAE's?
Newborns and females.
Is a bilateral hearing aid fitting always better for the patient than a unilateral fitting?
No, some patients do not perform well with a bilateral fitting.
Do most pre-term newborns have recordable ABR's?
No, the AEP is not fully mature. (It is recordable at 27 weeks, but latency & interwave latency will be prolonged and weaker amplitude will be present.
Does the acoustic reflex attenuate sounds at all frequencies equally?
No. It attenuates low sounds and a few high frequencies. Actually, at some frequencies the sounds are actually amplified (esp. at 1 KHz.)
Describe normal or abnormal Romberg test.
Normal - patient should not fall or increase sway for 30 seconds. Abnormal - patient has an increase in sway, stagger.
During tympanometry, what is the norms for adults.
Normal compliance: Adults: 0.30 - 1.70 ml Children: 0.25 - 1.05 ml
Hearing levels in dB?
Normal hearing: 0 - 20 dB (20) Mild hearing loss: 21 - 40 dB (20) Moderate HL: 41 - 55 dB (15) Mod. Severe HL: 56 - 70 dB (15) Severe HL: 71 - 90 dB (20) Profound HL: 91 + dB (20+)
When one takes measures to decrease feedback, what other problem can then arise?
Occlusion effect (sometimes you have to balance b/t feedback & occlusion effect)
Define intermodulation distortion.
Occurs when two frequencies are presented together and the output of the signal contains frequencies that are mathematically related to the sum or/and difference of the two input frequencies. This type of distortion can be either greater or less than the original frequencies unlike harmonic distortion. (Principle used in DPOAE's.)
What are some symptoms of Pendred's syndrome?
SNHL Thyroid problems Kidney issues
cVEMP focuses on what two (2) vestibular structures?
Saccule & inferior vestibular nerve function.
What is innervated by the inferior vestibular nerve?
Saccule & posterior SCC. (Just think of the anatomy; inferior nerve innervates inferior parts. The posterior SCC is the most inferior of the canals & the saccule is inferior to the utricle.)
What plane divides the body into left & right planes?
Sagittal plane.
What is the SADL?
Satisfaction with Amplification in Daily Life
What is the 1-3-6 goal of EHDI?
Screen within the first day of life. Confirm HL by three (3) months of age. Intervention no later than six (6) months of age.
Children who do not qualify for an IEP might qualify for what other assistance?
Section 504.
Define binaural.
Similar, but not identical signal presented to two ears.
Which medications are mainly vestibulotoxic?
Sisimycin, Tobramycin, Gentimicin, Streptomycin. (STaGS - do ya think he has balance problems?)
What are some advantages of silicone earmolds?
Softer & more comfortable for longer periods. May expand to fill leaks. (slit leaks, odd shapes, etc.) Good for mild to severe losses. Also, good for sports involvement.
What type of materials are best suited for earmolds when the patient has a hearing loss of >75dB?
Softer materials; silicon or vinyl
What happens to the sound output when peak clipping occurs?
Sounds are distorted, often described as sounding "scratchy."
Define monaural or monotic.
Speech presented to only one ear.
A narrower tympanic width is indicative of what pathology?
Stapes fixation.
What is Goldenhar syndrome? triad?
TRIAD: 1. ocular dermoid 2. preauricular skin tags 3. vertebral dysplasia
OAE's test the outer hair cells of the cochlea. What else do they tell us about hearing in a roundabout way?
That the outer and middle ear are functioning normally. Pathology of the outer and especially MES will obliterate OAE's.
What four subscales does the APHAB focus on?
The APHAB uses 24 items that focus on 4 subscales: ease of communication reverberation background noise aversiveness of sounds
What hearing aid can be placed in the ear for extended periods and how long is the time it can stay in the canal?
The Lyric IIC is an extended wear aid that must be inserted by a professional and can remain in the canal for three to four (3-4) months.
Define sensitivity.
The ability of the test to correctly identify those WITH the condition.
Define specificity.
The ability of the test to correctly identify those WITHOUT the condition.
What is gap detection?
The ability to detect brief silent gaps of variable durations b/t tone pairs. *** Two tones are played and patient tells you if they heard one or two tones. ***
Contrast mass and stiffness in relation to the basilar membrane.
The base is more stiff (less mass) and the apex has more mass (less stiff).
Audiological testing should begin in which ear?
The better ear.
Describe the basilar membrane in reference to its' width at the base and apex.
The high frequency base is narrow (stiff) and the low frequency apex is wider (more mass).
In regard to fmp quality, is a lower or higher number better?
The higher the number, the better the quality and the higher the S/N ratio.
What would be a normal result to a Fukada stepping test?
The patient has no deviation > 45 degrees from starting point.
What happens when T levels on a CI are set too low?
The patient will miss out on soft sounds that should be heard.
The LTASS is also known as what other well known audiology tool?
The speech banana. (It is just replotted in dB HL on the audiogram.)
Define reverberation.
The time it takes in seconds from the moment a sound is stopped until the sound level has diminished 60 dB.
Why is speech in noise perception improved with a bilateral fitting?
There is a 2 to 3 dB better SNR with bilateral fitting due to binaural redundancy and binaural squelch
How do latency and amplitudes of ABR's change as infants grow?
They start to look more like an adults. Latency becomes shorter & amplitudes are more defined.
Who theorized that cochlear function was more of an active process in 1948?
Thomas Gold.
What population of people will likely exhibit abnormal acoustic reflexes?
Those with otitis media; negative middle ear pressure.
What is the purpose of the "Filtered Words" test?
To assess ability to process distorted speech.
What is the purpose of the acoustic reflex?
To block the upward spread of masking of your own voice at low frequencies.
What is the main purpose of venting in an earmold?
To provide reduction of low frequency sounds.
What is the number one complaint of hearing aid wearers? (Think real world situations.)
Trouble hearing in noise.
Define trochee.
Two syllable word, unstressed second syllable (most English words).
ANSI classroom standards?
Unoccupied classroom: <35 dBA SNR at child's ear: +15 dB Unoccupied reverberation: 0.6 sec. (for larger classes: 0.7 sec.)
What is another name for the Fukada stepping test?
Unterberger test.
oVEMP focuses on what two (2) vestibular structures?
Utricle & superior vestibular nerve function.
What are some advantages of acrylic earmolds?
Very durable Easily modified in office. Easily inserted. Good for mild to severe losses.
What is the VOR?
Vestibular ocular reflex.
What is peak clipping?
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.
Define harmonic distortion.
When a certain frequency of input (ex. 500 Hz.) results in harmonics of that frequency being in the output of the signal such as 1 KHz, 2 KHz, and so on. The distortion frequencies will always be greater than the original and a multiple of that frequency.
When do patients generally notice tinnitus the most?
When in quiet environments or under stress.
When are TEOAE's usually not present?
When the patient has a hearing loss of 25 dB or greater.
What would be considered an abnormal Fukada stepping test?
When the patient has a rotation of 30 degrees (for 50 steps) in either direction. (direction of rotation generally accepted as being side of weaker labrinth)
When should interoctave frequencies be tested?
When there is a 20+ dB difference b/t two adjacent frequencies.
What is vasovagal syncope?
When you have a sudden drop in heart rate and blood pressure leading to fainting. This is often the reaction to stressful trigger such as the sight of blood, fear or anxiety.
Even with all of the advantages of digital hearing aids, what would be a distinct advantage of a libby horn?
When your digital hearing aid is at its maximum, the addition of a libby horn can still give a boost in the high frequencies what may be greatly beneficial. Great example would be a patient that needs a stronger hearing aid, but can't afford it at the time.
What is the WIPI test?
Word Intelligibility by Picture Identification (WIPI)
Define aspects of an IEP?
a) current educational status, b) goals and objectives for one year, c) instructional setting or placement (LRE) d) special considerations
OSHA standard threshold shift?
average of 10 dB or more at 2, 3, & 4 KHz.
What is the MCL.
most comfortable loudness level.
What term is used to express when a hearing aids input level and gain exceed the MPO?
saturation
How many tests are performed during CDP?
six (6)
What is the most robust DPOAE stimuli?
Cubic difference tone (2F1-F2)
