Advanced Assessment Midterm
how does phonemic balancing it relate to the HINT?
68% of HINT lists were within +/- 1 phoneme from each other
According to the Martin survey, what percentage of audiologists still use tone decay?
61%
What signal-to-noise ratio would a person with normal or near normal hearing sensitivity require to obtain approximately 50% of key words correct on the QuickSIN?
+2dB
What is the critical different value needed to detect a significant difference between two testing sessions of two lists each with speech and noise presented from the same speaker?
1.2 dB
Does the QuickSIN include any special lists on the CD? If so, describe them.
12 standard lists 3 pairs of standard lists (for research) 3 practice lists 12 lists w/ speech on channel 1 and noise on 2 12 lists w/ 30 dB HFE 2 pairs of HFE lists (for research) 12 lists w/ 30 dB HFE and low pass filtering 2 pairs of HFE low pass filtering lists (for research)
According to the normative data for the HINT-C, at what age are scores similar to adults?
12 years old
How many lists of the QuickSIN are recommended to obtain reliable results? (I may not have given you an exact #, but what do you think)
2 lists
If you want to determine if there is a significant difference between a condition with a directional microphone and a condition without a directional microphone, what 95% critical-difference value will you need to obtain for two QuickSIN lists?
2.7
Normal ARTs are measured between what and what level in dB HL?
250-4000 Hz at 85-100 dB HL
What criteria suggest an abnormal ear for AR decay?
50% decrease in amplitude within 5 seconds.
What frequencies and intensity levels are recommended for acoustic reflex decay testing?
500 and 1000 Hz at 10 dB SL relative to ART
What is a PI function?
A PI function shows a person's speech rec performance as a function of intensity
Know all acronyms for tests we covered in detail.
ABLB: Alternate Binaural Loudness Balancing SISI: Short Increment Sensitivity Index STAT: Suprathreshold Adaptation Test BCL: Bekesy Comfortable Loudness PI Function: Performance Intensity Function PIPB: Performance intensity function for phonetically balanced words
Name four types of AEP testing that may be used in today's site-of-lesion testing?
ABR: within 10 ms of click - Brainstem disorders. ECochG: Meniere's disease, Endolymphatic hydrops, maybe SSCD MLR: Primary auditory cortex: difficult to pin down. Late Cognitive Potentials: processing of sense info
The acoustic reflex is the basis for what measurements?
Acoustic-reflex thresholds Acoustic-reflex decay
Describe the adult and pediatric versions of the AzBio, and how is it different from other tests we discussed?
Adult: 15 lists uses 10 talker babble, has 4 talkers: 2 male and 2 female Children: 16 lists of 20 sentences, single female speaker in 20 talker babble These tests are different from others because they are mostly used for pt.s with Cis.
What is the mean SNR-50 for adults with normal-hearing sensitivity on the BKB-SIN? Children ages 5-6?
Adults: -2.5 5-6 yrs: 3.5
How does the test-retest reliability change as a function of age for the BKB-SIN?
As the pt. gets older the test-retest reliability gets better
What is the SPIN (describe it)?
Assesses a listener's ability to use of (1) acoustic and (2) linguistic information. Appropriate for ages 12+ years. Sentences in speech babble can be presented at various SNRS
Name three ways the BKB-SIN is different from the QuickSIN?
BKB has simple sentences BKB takes about 3 minutes per list vs 1 BKB you subtract total correct from 23.5 but QuickSin total correct is subtracted from 25.5
How is the interpretation chart different for the BKB-SIN different from the interpretation chart for the QuickSIN?
BKB=SNR-50 QuickSIN=SNR loss
Do these listeners perform better or worse when the speech and noise are spatially separated (presented from different speakers)?
Better
ART pattern with bilateral OM? Right OM? Left OM?
Bilateral OM=Absent ALL conditions Right OM= RI: absent RC: absent IL: present LI: absent Left OM= RI: present RC: absent IL: absent LI: absent
What should we do before we confront the person with our suspicions?
Check yourself Check your equipment Check your environment Reinstruct Consider the presence of tinnitus (use pulsed tones)
Why is ANL useful and what is the main purpose of ANL testing?
Clinical measure for predicting HA outcome Found to correlate with HA success better than speech rec in noise Can use any passage w/ background noise
Describe values constitute a mild, moderate, and severe SNR losses.
Mild: 3-7 dB Moderate: 7-15 dB Severe: greater than 15 dB
Name indicators of faking during audiological testing.
Difference between PTA and SRT Poor reliability during testing (greater than 15 dB differences in responses with pure-tone testing) Good word rec but poor pure-tones Reflex threshold less than 10 dB above pure-tone threshold Strange responses during SRT (repeats half of spondee) Deliberate errors during word rec (words that rhyme) Respond with 3 or 4 syllable words during word rec Responding "I can't hear that" Lack of cross hearing (for unilateral) Bone worse than air Pulsed threshold worse than continuous Fail to false alarm during silent periods
Name behavioral indicators of faking.
Exaggerated attempts to lipread, constant fixation on face Exaggerated attempts to hear, tilting head so ear in line with speech signal Complaint of inability to hear followed by request to communicate in writing Unfamiliarity with the operation of a hearing aid supposed to belong to them Use of a HA with a dead battery Apparent nervousness and anxiety
Describe how late potentials may be used clinically.
For documenting cortical maturation
Name other terms used for pseudohypacusis.
Functional hearing impairment Non-organic hearing impairment Malingering "goldbrick" Psychogenic hearing loss
Describe the LiSN-S purpose and test conditions.
General procedures: You open the program on the computer and input all the patient's information, you click add, and then pick an instructor from the drop down and press next, you do not apply prescribed gain and then click next. You tell the patient that they will hear some noise in the background and a sentence and to repeat the sentence as best as they can, even if they only know a few words that's okay because they get points for every word correct. Then you press start and record the number of words correctly repeated. You go through all 4 conditions to obtain your results. Purpose: This test assesses a patient's ability to understand speech when there is noise coming from different directions and is especially helpful with individuals with APD. Test Conditions: Different voices +/- 90 degrees, Same voices +/- 90 degrees, Different voices 0 degrees, Same voices 0 degrees
Pure Tone Stenger
General procedures: You present a tone in the good ear at +10 dB SL and a tone in the poorer ear at -10 dB SL simultaneously. If the patient fails to respond the test is positive for functional hearing loss but if they do respond it is a negative Stenger. Purpose: This test is used to determine if a unilateral hearing loss is organic or non-organic.
Lombard Test
General procedures: You present noise in the good ear and observe the volume of the patient's voice and then you put noise in both ears and observe their voice. The patient's voice should increase in intensity when noise is in both ears if they have a functional loss. Purpose: This test is done to determine if the hearing loss is organic or due to pseudohypacusis.
What are possible findings on the SISI and how do you interpret them?
Greater than or equal to 70%: positive for cochlear pathology Less than or equal to 30%: negative for cochlear pathology (retrocochlear, conductive, or normal) 30-70%: not strongly diagnostic
What is one change in the traditional ABR parameters that may be used to examine site-of-lestion?
High repetition (stim) rate can be used and 1-5 IPL needs to be assessed along with wave 5 interaural latency. Stacked ABR can also be used and a tumor will result in decreased amplitude.
what setting is the highest incidence of pseudohypacusis found?
Industrial
How many ART measurements are clinically recommended? Describe them.
Ipsi and contra @ 500, 1k, and 2k Hz.
What are the listeners asked to do on the SIR?
Listen to a passage of connected speech in the presence of background noise and rate their perceived intelligibility.
Describe the values needed to compute an ANL
MCL BNL MCL-BNL=ANL
What recommendations do the QuickSIN creators recommend when someone has a severe SNR loss?
Maximum SNR improvement is needed. Consider FM.
What do we know about using the NU-6, W-22, NU-CHIPS, and WIPI word lists in noise?
NU-6: Significant difference between lists in noise W-22: no list equivalence in noise NU-CHUPS: Not designed for testing in noise, reduced reliability in noise, effects of gender, no list equivalence in noise WIPI: no list equivalence in noise
What are the four response patterns and what do they suggest?
No Recruitment: Stimuli are judged as equally loud at equal SLs, can be normal HL, conductive, and retrocochlear. Complete recruitment: Stimuli are judged equally loud at equal dB HL, rapid loudness growth, cochlear losses. Partial recruitment: Equal loudness falls between those with no and complete recruitment, cochlear losses. Derecruitment: slower than normal loudness growth, poorer ear needs a much greater intensity to sound equally loud to good ear, SL difference is 15 dB or more, retrocochlear.
What is important to consider when using the SPIN in clinical practice?
No list equivalence so it should not be used clinically
According to the normative data for people with normal-hearing sensitivity, what is the approximate average score with speech and noise presented from the same speaker?
Noise 0: -2.82 dB S/N
Counting method:
Okay we are done testing your hearing now we are going to play a counting game. Tell me how many beeps you hear (play some below "threshold")
When including reflex decay in your test battery, when should it be conducted? Why??
Only do when necessary and it should be done after threshold testing as it can cause a temporary threshold shift.
What are the two criteria we can examine to determine whether or not rollover is present?
PB Max (best performance intensity)- PB Min (poorest performance occurring at intensity higher than where max occurred) If PB Max-PB Min is greater than 20% it is rollover Rollover index= (PB Max- PB Min)/ PB Max and compare to normative data
What is the CST (describe it)?
Passage of 9 or 10 sentences presented by a female speaker w/ multi-talker babble Listener informed about the topic of the passage Scored based on the number of scoring words repeated correctly
What does positive and negative decay mean?
Positive: the pt. perceives that the tone has gone away even when it is still present. Negative: the pt. hears the tone for its duration
How do you conduct the Olsen-Noffsinger tone decay method?
Present a continuous pure-tone @ 20 dBSL for 60 seconds at a given frequency (500, 1k, 2k, or 4k). The pt. raises their hand and keeps it raised fir as long as they hear the tone.
What are the primary mechanisms thought to associate with MLR?
Primary auditory cortex and the thalamo-cortical pathway
What is the approximate test-retest reliability for two, 10-sentence HINT lists?
Quiet: 1.48 dB Noise @ 0 degrees: 1.2 dB Noise @ 90 degrees: 1.39 dB Noise @ 270 degrees: 1.51 dB
Left SOC pathology with normal right??
RI: Present RC: Absent LI: Present LC: Present
What type ART pattern would you expect with eighth nerve tumor on the right side with a normal left side?
RI= absent RC=absent IL= Present IC= present
What pathology is suggested when abnormal reflex decay is detected?
Retrocochlear/8th nerve pathologies Cochlear losses don't normally show decay but it does show faster decay than NH
What does the acronym SIR stand for and what is the main purpose of this test?
Speech intelligibility rating Created for HA setting and HA comparisons, can be used to differentiate among listening programs for HAs
What does the acronym RSIN stand for and what is one advantage and disadvantage of this test?
Revised Speech in Noise Test Now there is list equivalence, good test-retest reliability Takes a long time, you need to have big differences between the conditions to show significance
Describe the relationship (correlation) between CST scores and the signal-to-noise ratio of the stimuli.
SNR can be adjusted There is a linear correlation between scores and SNR (scores increase as SNR decreases)
Describe the difference between SNR-50 and SNR loss for QuickSIN.
SNR loss is the dB increase in the SNR needed by a hearing impaired person to understand speech in noise compared to NH SNR 50= SNR for 50% correct score
How do you interpret an ECochG?
SP/AP ratio A large SP/AP ratio is positive for endolymphatic hydrops Those with Meniere's have larger summating potentials
Yes-No Method
Say yes when you hear it and no when you don't
Name two reasons you might want to use the split tracks on the BKB-SIN CD?
So, you can assess FM benefit You can vary the SNR starting and therefore ending point, this is needed with FM because they may do better than an SNR of -6 and you can make is harder.
What is the purpose of the ABLB and how do you conduct it?
Tests for loudness recruitment in patients with unilateral hearing loss. Performed by alternating a fixed frequency between ears. You start at 10 dB HL or at the patient's threshold in the better ear and on channel 2 you begin at 20 dB SL (in reference to the better) in the poorer ear. You present the tones and ask the patient if the 2 tones are equal or if one is louder or softer. Then you adjust the varied tone until the patient perceives the 2 tones as equal loudness. Once you complete this, you increase the intensity in the reference ear by 20 dB and repeat all the steps until you reach the patient's uncomfortable loudness level.
What are the basic principles behind the SISI and how is it conducted?
That normal ears are NOT sensitive to changes in intensity when listening to low intensity signals but are very sensitive to intensity changes at high levels. Ears with cochlear pathology are able to detect small changes in intensity at low sensation levels. A continuous tone is presented at 20 dBSL and every 5 seconds a short increment is superimposed in 1 dB steps, 20 separate presentations of the 1 dB increments are presented and the pt. indicates when a change in intensity has occurred.
Why is the HINT more sensitive than tests using fixed-intensity levels?
The SNR is changing (Adaptive)
How does the STAT method differ?
The STAT is presented at a HIGH intensity (110 dB SPL) and the non-test ear is masked with 90 dB SPL of white noise
What is the primary purpose of site of lesion testing and why is much of it no longer used clinically?
The primary purpose is to separate sensory (cochlear) and neural (retrocochlear) losses. Not used clinically anymore due to the invention of electrophysiology testing.
How is AR decay conducted?
The stimulus is present for 10 seconds at 10 dB SL relative to ART
How do we know that the sentence lists are equivalent for the QuickSIN (how did the developers ensure this)?
They had 25 NH listeners take each list of the test
What is the QuickSIN (describe it)?
This is used to determine an individual's SNR loss which is important because pure tone audiometry cannot reliably predict speech understanding in noise
Name reasons for speech-in-noise testing.
To determine the need for amp To compare listening performance with aid and without To demonstrate to the pt. that their ability to recognize speech in noise is diminished To determine if expected benefit has been achieved To obtain specific areas of listening difficulty
What type of Bekesy pattern would we expect if someone has retrocochlear pathology? Why does this happen?
Type 3 (dramatic drop of C below I w/ 40-50 dB separation) or Type 4 (c drops below I at frequencies lower than 1k Hz) Because nerve can't sustain the response
What is the range of 95% critical-difference values necessary to determine a significant difference between two list pairs for children, adults and users of cochlear implants?
a. Adults: 1.6 b. Adults w/ CI: 3.1 c. 5-6 years: 3.3 d. 7-10 years: 2.5 e. 11-14 years: 2.3
How is the acoustic reflex measured (don't say with an immittance bridge)?
We record the change in admittance into ME as result of stapedius-muscle contraction
Name reasons someone may exhibit pseudohypacusis.
Workers Compensation Lawsuits for loss of hearing related accidents Pt.s may be incapable of more reliable behavior Children may want: Peer acceptance, Parental affection and attention, Decreased academic pressure, Emotional problems, Or may not understand the directions
Is the SIR a reliable and valid test?
Yes, the test retest is very high and you should use 3 passages to determine critical differences for HI
What four aspects may lead to varied results when determining PI functions?
a. Intensity b. Talker c. Pt. d. Speaker e. Type of pathology f. Speech stimuli
Name 3 characteristics important for interpreting ABR results.
a. Latency b. Interpeak latency c. Morphology
What is the HINT (describe it)?
an adaptive measure of SRT in noise that uses gated speech shaped noise. It consists of 25 lists of 10 phonemically balanced sentences. The pt. must repeat the WHOLE sentence correctly.
In Bekesy audiometry, what type of stimuli are used for site-of-lesion testing?
either continuous or pulsed/interrupted