Praxis Study Guide
no pinna
anotia
the time delay that occurs between the onset of an input signal loud enough to activate compression (i.e., input signal exceeds the TK) and the resulting reduction of gain to its target value. Specifically, ANSI (2014) defines this as the time between the abrupt increase in input level from 55 to 90 dBSPL and the point where the output level has stabilized to within 3dB of the steady value for an input of 90 dBSPL.
attack time
▪ AP: all or none electrical discharge ▪ Dynamic range ● Saturates after ● 60 db range: 25 dB wide for some groups and 40 dB others ▪ responds to wider freq range as stim level raised
aud. nerve
What are treatment options of Meniere's patients?
avoiding caffeine and nicotine and salt restricted diet. Endolymphatic shunt procedures, vestibular nerve sections, and labrinthectomy.
different group of subjects used to test each level of the variable
between subjects
▪ with intact ME and cochlea, BC HA ▪ surgery initiated when child is older (what age???)
bilateral atresia
Ipsilateral right - Present & WNL Contralateral left - Present Ipsilateral left - Present & WNL Contralateral right - Present
bilateral mild-moderate SNHL (30-50 dB HL range)
used in Stenger test ▪ PT lateralizes to side presented at higher SL
binaural fusion
What is the purpose of a voltmeter?
measures the output of an electronic device.
Head trauma and HL - Temporal bone fracture
concussion, inner ear damage, facial paralysis, severe dizziness and hearing loss May also cause ossicular disarticulation, TM perf, EC bleed
what is a period? (parameter of sound)
duration of 1 cycle (amount of time to complete 1 cycle)
"cookie bite" HL configuration- HL greater in MF than LF
metabolic cochlear disorder
small pinna
microtia
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. Otosclerosis E. Polychondritis
exostosis Exostoses are generally bilateral asymptomatic growths found in individuals with a history of cold-water swimming activity.
▪ I- café-au-lait spots ▪ II- bilateral AN/VS + other tumors ● Autosomal dominant
neurofibromatosis
does compression provide linear or non-linear compression?
non-linear
An ear mold made of which of the following materials is a hard acrylic that is most commonly used when constructing ear molds?
lucite Lucite ear molds come in several colors. Some of these include clear, opaque beige, and pastel colors.
what is frequency (cps/Hz)? (parameter of sound)
number of times it repeats itself in 1 second
difference between hearing aid input and output at the coupler
o **Full on gain:
tympanogram types and indications
o A - normal ▪ AD- hyper mobility of eardrum- discontinuity ▪ AS- hypomobility of ear drum- otosclerosis o B-OME- normal ECV o B-perf- large ECV (or tubes) o C- ETD - negative pressure
- What are the most common screening tools used in newborn hearing screening? List the pros and cons of each.
o ABR: ▪ Pros: non behavioral, diagnose ANSD, can do in the presence of conductive hearing loss, more info from abr ▪ Cons: limited by ambient noise, time consuming, more prep, o OAE ▪ Pro: non behavioral, quick, tells us how cochlea/OHC is functioning ▪ Con: limited by ambient noise, more sensitive, limited by fluid in ears, only outer hair cells
o condition with bony growths in middle ear ▪ conductive hearing loss- speech just as difficult to understand in noise as in quiet ▪ Carhart's notch at 2k ▪ Often diagnosed < 40 years
otosclerosis
EFFERENT ● Cochlear amplifier- sensitizes/fine tunes o Enhances signal received by IHC o Soft sounds and Fine freq distinctions o Responsible for sharp peak in TCs ● -70 mV ● 12k ● tube-shape ● contractile proteins ● electromotility ● 5% afferents- type II (unmyelinated, small, pseudomonopolar) ● efferent fibers synapse directly with OHCs
outer hair cells
If an audiologist does not account for the real-ear-to-coupler difference (RECD) during a hearing-aid fitting of a six month old, the fitting will most likely provide A. overamplification B. underamplification C. adequate amplification D. inadequate amounts of noise suppression E. an inadequate T-coil response
overamplification The output SPL in an infant's ear is typically higher than it is in a coupler because of the small ear canal volume in an infant's ear.
occurs when there is a disruption of the barrier between the perilymphatic space of the inner ear and the middle ear (air filled cavity). A loss of perilymph ensues. caused by head trauma, barotrauma, congenital malformations of the inner ear, decreased bone thickness, may occur spontaneously, result of increased cerebrospinal fluid pressure. Symptoms are similar to Meniere's disease; differences include a history of trauma in these patients, variable HL, and no family history of the disease. Treatment options include stable hearing: bedrest, head elevation, avoiding situation that may increase intracranial pressure (sneezing and straining).decreased hearing loss: surgical treatment considered such as oval and round window grafting.
perilymph fistula
cortical disorders will cause all ipsi/contra ARTs to be:
present lesions in these areas are above the acoustic reflex arc.
- IF the ME function is normal, and a mild to moderate SNHL less than 40-60 dBHL is present, with absent or elevated ART then a diagnosis of ________ is implied
retrocochlear pathologyis implied in the stimulus ear.
what type of nystagmus is seen in canalathiasis?
rotary and geotropic
what type of nystagmus is seen in cupulathiasis?
rotary but ageotropic
▪ Spontaneous Nystagmus Test - done bc the presence of nystagmus will influence measures of slow phase symmetry ▪ SHA - patient seated so that two vestib systems are equal, head tiltled down 30 degrees ( maximizes HSCC) ▪ Velocity step - abruptly accelerated or decelerated ro right or left, measures decay rate of nystagmus ▪ VVOR (visual fixation suppression) - rotating in darkness with and without a fixation laser that moves with the chair ▪ Optokinetics - stripes of light on the wall
rotary chair
▪ Can't be too large but may be wasteful of time and resources ▪ Can be too small or unrepresentative (poorly selected) → can lead to failure to demo effectiveness of intervention
sample size
List the common vestibular disorders and their length of nystagmus.
seconds = BPPV minutes = veterbrobasilar insufficiencyhours = Meniere's days/weeks = vestibular neuritis and labrynthitis
what is amplitude? (parameter of sound)
size or magnitude
Head trauma and HL - Traumatic brain injury (TBI)
speech awareness/rec to confirm true pure tone thresholds if unsure if patient understood directions b/c more likely to respond to speech than PTs
- occurs in the absence of input stimulus, so no oscillator or attenuator required to provide stimuli
spontaneous OAEs
○ Normal = no nystagmus & Abnormal = yes nystagmus ○ Peripheral or central nystagmus is dependent on subjective dizziness. ■ Peripheral = report subjective dizzines ● If the fixation suppresses = peripheral ■ Central = if they have significant spontaneous nystagmus (vertical)and no dizziness ● If fixation does not suppress = central ○ Alexander's Law: The amplitude of the nystagmus increases when the eye moves in the direction of the fast phase (saccade). ■ Peripheral = if this happens ■ Central = if this doesn't happen
spontaneous nystagmus test
rotary nystagmus beats stronger towards bad ear ***
BPPV
How long does the otoacoustic emission screening take?
10 seconds The otoacoustic emission screening takes 10 seconds in each ear. A diagnostic test would take 1 minute in each ear.
Fully developed for ABR at ____ months
24
"Uncomfortably loud" is what level of the Cox Contour Test?
7 Of the seven levels of the Cox Contour Test, "uncomfortably loud" is the last. "Loud, but o.k." comes right before it.
The Functional Auditory Performance Inventory addresses functional auditory skills in how many categories?
7 The inventory monitors children's progress throughout intervention. It takes into account: 1. Awareness and meaning of sound. 2. Auditory feedback and integration. 3. Localizing sound source. 4. Auditory discrimination. 5. Auditory comprehension. 6. Short-term auditory memory. 7. Linguistic auditory processing.
___________ is the fourth goal of the National Goals for EHDI Programs.
"All infants and children with late-onset or progressive hearing loss will be identified at the earliest possible time." Hospitals will report all late-onset or progressive hearing loss to the state as soon as possible. The state will then be responsible for ensuring proper follow-up so that the infants/children receive the appropriate care.
According to the National Goals for EHDI Programs, goal number 3 is what?
"All infants identified with hearing loss will receive appropriate early intervention services before 6 months of age."
Which of these is goal 6 of the National Goals for EHDI Programs? "Every state will have an EHDI Tracking and Surveillance System that minimizes loss to follow-up." "Every state will have a system that monitors and evaluates the progress toward the EHDI goals and objectives." "All infants with hearing loss will have a medical home as defined by the American Academy of Pediatrics." "All infants and children with late-onset or progressive hearing loss will be identified at the earliest possible time." "All infants identified with hearing loss will receive appropriate early intervention services before 6 months of age (medical, audiologic, and early intervention).
"Every state will have an EHDI Tracking and Surveillance System that minimizes loss to follow-up." This will be a computerized, statewide system. It will record screening results, as well as risk factors and follow-up for all births.
A SIRS score of 5 means:
"The child's speech is very hard to understand. I typically understand only occasional, isolated words and/or phrases." Speech Intelligibility Rating Scale is a 6-point measurement of a child's intelligibility. The six points are: 1 = "I always or almost always understand the child's speech with little or no effort." 2 = "I always or almost always understand the child's speech; however, I need to listen carefully." 3 = "I typically understand about half of the child's speech." 4 = "I typically understand 25% of the child's speech." 5 = "The child's speech is very hard to understand. I typically understand only occasional, isolated words and/or phrases." 6= "I never or almost never understand the child's speech."
Level ___ of Audiologic tinnitus management is screening.
1 Telephone screening is done to identify those who need intervention. Also, basic concerns are addressed at this time.
o Apgar score- lower is correlated to more HL what is considered a lower score?
(0-4 at 1 minute or 0-6 at 5 min) ▪ Assesses 5 functions at 1 min after birth ▪ Assigns 1 point for each function within normal range ▪ **Apgar score of 5 in 1 minute after birth is normal ▪ Point values at further intervals are different
A research study tested the hypothesis that individuals with symmetrical hearing loss who have been fit with one hearing aid would demonstrate improved speech recognition in background noise with increases in head angle. Fourteen individuals were fit monaurally with a behind-the-ear (BTE) hearing aid with directional and omnidirectional microphone modes. Speech recognition performance in noise was tested using the audiovisual version of the Connected Speech Test (CST v.3). The test was administered in auditory-only conditions as well as with the addition of visual cues for each of three head angles: 0º, 20º, and 40º. Results indicated improvement in speech recognition performance with changes in head angle for the auditory-only presentation mode at the 20º and 40º head angles when compared to 0º. Improvement in speech recognition performance for the auditory + visual mode was noted for the 20º head angle when compared to 0°. Additionally, a decrement in speech recognition performance for the auditory + visual mode was noted for the 40º head angle when compared to 0º. These results support a speech recognition advantage for listeners fit with one BTE hearing aid listening in a close listener-to-speaker distance when they turn their head slightly in order to increase signal intensity. * This study can best be described as an example of which of the following types of research? A. Retrospective B. Normative C. Randomized clinical trial D. Experimental E. Case study ** In this study, speech recognition performance can best be described as which type of variable? A. Independent B. Dependent C. Classification D. Criterion E. Predicted *** Which of the following best describes the type of research design used in this study? A. Between-subjects design B. Within-subjects design C. Mixed (between- and within-subjects) design D. Single-subject design E. Crossover design
* Experimental - This is an experimental study because one variable (head angle) is manipulated under highly controlled conditions to see if changes in head angle causes any changes in another variable (speech recognition). ** Dependent - Speech recognition performance is a dependent variable because it is affected by head angle, which is manipulated in this study under highly controlled conditions. *** Within-subjects design - This is a within-subjects design because the variable of head angle is being manipulated to determine if speech recognition improves within each subject, with each subject serving as his or her own control.
A 40-year-old man has experienced a gradual onset of hearing loss from the age of 35: Normal hearing AD, normal steeply sloping to severe SNHL AS; Normal tymps AU; 96% WRS AD, 20% WRS AS; present 2 kHz ART AD; absent AS. * The absence of an acoustic reflex threshold at 2000 Hz in the left ear is most likely the result of **If this hearing test and audiology exam represent the initial point of entry, the audiologist should *** Based on the results of all the audiological tests, the site of lesion for the left-ear thresholds is most likely
* a possible brainstem lesion - . Brainstem lesions are likely to result in absent reflexes. ** refer the patient for a complete otological evaluation - Based on the audiogram, which shows an asymmetrical audiometric configuration, it is necessary to rule out a brainstem lesion, such *** retrocochlear in origin - The unilateral hearing loss, the poor word recognition score, and the disagreement between the SRT and the PTA in the left ear are all indicative of a retrocochlear pathology.
Ipsilateral Right - Absent Contralateral Left - Absent Ipsilateral Left - Present & WNL Contralateral Right - Present & WNL
** 7th N Lesion - Probe Ear Absent** Normal hearing with a right facial lesion (Bell's Palsy), this ART pattern may occur. · VIIth cranial nerve is on the motor leg of the efferent portion of the acoustic reflex arc that innervates the stapedius muscle. Therefore it will affect the probe ear.
Ipsilateral Right - Absent or elevated Contralateral Left - Present & WNL Ipsilateral left - Present & WNL Contralateral right - Absent or elevated (stimulus ear)
** 8th N Lesion = Stim Ear Absent** VIIIth lesion in RE and normal hearing in LE. Lesion is along auditory nerve, medial to the cochlea, which is along the afferent portion of the arc. ART will be absent or elevated in the stimulus ear. ART may be elevated by 20 to 25 dB HL even though hearing sensitivity is no more than 5 or 10 dBHL. Once the hearing loss exceeds 70-75 dBHL the ART becomes absent. - If the elevated or absent ART isn't attributable to conductive loss, there is risk for CNVIII pathology in stimulus ear.
Ipsilateral Right - Present & WNL Contralateral Left - Absent or elevated Ipsilateral Left - Present & WNL Contralateral Right - Absent or elevated
**Higher up Brainstem = Contra Absent** Lesion within the brainstem, in the pathways going from one side of the arc to the other are affected and the ipsilateral pathways are not effected. This is also known as intra-axial brainstem disorder. This time of ART pattern can also be seen with those with demyelinating and neuromuscular disease.
What is the acceptable error that an audiometer may differ from the RETSPL or RETFL?
+/- 2.5 dB when compared to the reference threshold level.
- Describe the differences in results in OAE vs. ABR newborn screenings.
- ABR is giving you waves 1-5 place of activation in brainstem, generator site integrity, nerve function firing, measures in terms of amplitude and latency of activation of generator sites, can tell a more central pathology - OAE is outer hair cell function - SNR reflected back- outer hair cell function only
what type of lesion usually produces no abnormalities in either contralateral or ipsilateral reflex, because these centers are above the acoustic reflex arc.
- Lesions in the higher areas of the auditory cortex these centers are above the acoustic reflex arc.
Disorders interrupting neural innervations of stapedius muscle (absent AR)
1. Brainstem lesion 2. Auditory Neuropathy spectrum disorder 3. Facial Nerve (CNVII) lesion 4. CNVIII lesion
____ years old is the age at which children should receive their final hearing screening, as per AAP.
10 The first should occur at the age of 4. There should be a total of 5 screenings.
compression may be used to:
1. Limit the output of the hearing aid without distortion, 2. Minimize loudness discomfort, 3. Prevent further damage to the auditory system, 4. Optimize the use of the residual dynamic range, 5. Restore normal loudness perception, 6. Maintain listening comfort, 7. Maximize speech recognition ability, and 8. Reduce the adverse effects of noise.
List the 5 types of audiometer classifications
1. Pure tone audiometer 2. Automatic audiometer 3. Speech audiometer 4. Extended High-frequency audiometer 5. Free field equivalent audiometer
List the 5 types of transducers
1. Supra-Aural earphones 2. Insert earphones 3. Circumaural earphones (for high frequencies) 4. loudspeakers 5. bone oscillators
List the conditions that must occur during a Dix-Halpike test in which BPPV would be positive
1. delayed onset: 10 seconds after reposition, nystagmus occurs. Maximum severity occurs at 20-30 seconds and minimizes after 40-60 seconds 2. burst of activity: a sudden onset of nystagmus occurs 3. subjective vertigo: nausea and vomiting 4. fatigable: once the patient returns to upright position, nsytagmus diminishes
What are the functions of the vestibular system?
1. integrates sensation in the brain stem 2. awareness of one's body position in relation to gravity 3. maintains posture and equilibrium.
what are the 4 types of nystagmus?
1. spontaneous: occurs without vestibular or visual stimulus and does not suppress with visual fixation. 2. positional: occurs with following changes in head position. 3. gaze: occurs following a shift in gaze. 4. congenital: may be seen in young people. A slight nystagmus that doesn't interfere with daily functioning. Might be genetic.
Which of these is the inside diameter measurement of tubing that is size #13 medium?
1.93mm Tubing size #13 medium has an outside diameter of 10 mm. The tubing length can affect the frequency response of the hearing aid.
The Language Environment Analysis can capture how much of the daily auditory environment of the child?
10-16 hours This tool is a digital language processing recorder. Recording this much of the child's auditory activity enables parents to get an actual figure of how many words their child speaks per day. This can help with parents/therapists creating/ modifying the child's spoken language goals.
- Cannot test for ARTs at levels greater than ___ dBHL
105
____ to ____ months is the age at which the third and final vocal production transition, according to The Infant Monitor Of Vocal Production, takes place.
10;12 There are three times these transitions occur. The first is 4 to 6 months, and the second is 6 to 7 months.
Which of the following is the optimal range of stimulation rates for determining threshold for a click ABR?
11.1 to 21.1
As per ASHA, when should the final routine childhood hearing screening take place?
11th grade. ASHA recommends that several hearing screenings take place with regard to children. The first should occur as soon as the child enters school, while the final occurring at 11th grade.
Parents are given the opportunity to observe their children in ____ listening situations, when using the Early Listening Function (ELF).
12 ELF is administered at home, and must be done so in quiet and loud environments. Some are near the child, and others ar farther away.
Children often struggle with noise-induced hearing loss at a very young age. In fact, in children between the ages of 6-19, the percentage of those who are impacted by this form of hearing loss is approximately:
12%. This type of hearing loss occurs as a result of damage to hair cells in the inner ear. Once it occurs, it is permanent.
How long does vertigo last in BPPV patients?
15 to 30 seconds.
Slight degree of hearing loss is within which dB HL range?
16-25 Normal degree of hearing loss is within the range of -10 to 15 dB. Slight degree of hearing loss is within 16 to 25 dB. Mild degree of hearing loss is within 26 to 40 dB. Moderate degree of hearing loss is within 41 to 55 dB. Moderately severe degree of hearing loss is withing 56 to 70 dB. Severe degree of hearing loss is within 71 to 90 dB. Profound degree of hearing loss is within 91+ dB.
Which of the following would be the most appropriate acoustic modifications for an earmold when fitting a precipitously sloping high-frequency sensorineural hearing loss? A. 2 mm sound bore, standard tubing, no vent B. 3 mm sound bore, Libby horn, narrow vent C. 4 mm sound bore, Libby horn, no vent D. 2 mm sound bore, Libby horn, wide vent E. 4 mm sound bore, long tubing, narrow vent
2 mm sound bore, Libby horn, wide vent Acoustic modification should emphasize high-frequency amplification and de-emphasize low-frequency amplification. A short sound bore, a flared horn (Libby), and a wide vent is the best combination to achieve that goal.
What is the average adult resonance primary peak in the REUR?
2,700 Hz The primary peak of the REUR is typically 2,700 Hz at 17 dB. The secondary peak is 4,000 to 5,000 at 12 to 14 dB.
How long is the silent gap in the GIN test?
2-20 msec The Gaps-in-Noise Test (GIN) uses silent gap intervals. These intervals last between 2 -20 msec. within a 6 second segment of broadband noise.
wave V is dominated by energy in what frequency range?
2-4 kHz
The conditioned play audiometry method is BEST for children of what age?
2-5 years
How many mutated alleles are necessary to express a trait, in an autosomal recessive inheritance?
2. This usually means that although they are unaffected, both of the child's parents have a copy of the mutated gene. With autosomal recessive inheritance, many generations can have one copy of the mutated gene, but not be affected.
What is the inside diameter of tubing size #12?
2.16mm There are various ear mold tube sizes to choose from, with size #13 being the most common. The outer diameter of tubing size #12 is 3.18 mm.
Read the options below, and select the outside diameter of ear mold tubing #15.
2.95 mm. 3.30 mm is the outside diameter of tubing size #13 thick. The outside diameter of size #13 medium is 3.10 mm. 1.40 mm is the outside diameter of a thin tube. 3.18 mm is the outside diameter of tubing size #12.
Of the following, what is the outside diameter of tubing size #13 standard?
2.95mm The inside diameter for this tubing is 1.93 mm. Size #13 is the most commonly used size.
A client's pitch matching test indicates that the tinnitus is mid pitch. What would be the frequency of the tone?
2000 Hz Pitch matching frequency may be low, mid or high. Low frequency is below 1 KHz. Mid is between 1 and 2 KHz. A high KHz is 2 KHz or more.
Under Occupational Safety and Health Administration (OSHA) regulations adopted in March 1983, a standard threshold shift on an annual audiogram is defined as a change in hearing threshold relative to the baseline audiogram of an average of 10 dB or more at which of the following frequencies?
2000, 3000, and 4000 Hz (in either ear) Standard threshold shift
Click-evoked auditory brainstem response (ABR) thresholds are generally most closely correlated with behavioral thresholds for frequencies of A. 1000 Hz only B. 250-500 Hz C. 500-1000 Hz D. 2000-4000 Hz E. 6000-8000 Hz
2000-4000 Hz The correlation between ABR and behavioral thresholds is greatest at frequencies between 2000 and 4000 Hz.
In which frequencies and what intensities are most speech sounds produced?
250 Hz at >60 dB - visualize speech banana
A patient in the early stages of Ménière's disease will have an increase in the amount of endolymph in the inner ear. At the same time, audiometric assessment is likely to show sensorineural hearing loss that primarily affects which of the following frequency ranges?
250-2000 Hz 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.
Which of the following reflects the compression ratio for the input-output function at 50 dB SPL? A. 2:1; 50 dB SPL B. 1:1; 50 dB SPL C. 4:1; 90 dB SPL D. 3:1; 50 dB SPL E. 5:1; 90 dB SPL
2:1; 50 dB SPL The compression ratio is the change in input over the change in output. From 50 to 60 dB SPL, there is a 10 dB change in input, with only a 5 dB change in output, resulting in a 2:1 compression input.
what are some ideal HA modifications for a pt. with precipitously sloping HF SNHL?
2mm sound bore, libby horn, wide vent
The Conditioned Assessment of Speech Production has how many levels of assessment?
3 This tool is used to measure the speech production of a child who is deaf/hard of hearing. The three levels assessed are pre-canonical vocalizations, basic canonical syllables, and advanced forms.
"cauliflower" ear- boxers get from bleeding
Hematoma auricularis
While tympanometry is being performed on a patient, a seal is obtained on the test ear. The volume of the external canal is 5 cubic centimeters. During the tympanometric measurement, the seal is lost intermittently whenever the patient swallows. Which of the following is the most likely cause of the problem?
A perforated tympanic membrane
_____ mm is the outside diameter of tubing size #13 thick.
3.30 1.93 mm is the inside diameter for tubing size #13 thick. The inside diameter and length of the tube has an impact on the frequency of the hearing aid.
Pitch matching is one of the foundations for tinnitus evaluation. Tinnitus is generally matched to tones in the______Hz range.
3000-4000 Psychoacoustic effects elicited by acoustic stimuli form the foundation for tinnitus evaluation to include Pitch Matching , Loudness Matching, Masking, and Residual Inhibition. Octave confusion appears when an individual identifies a specific frequency as the pitch match of his tinnitus. It is highly related to the fact that most patients with tinnitus have a high frequency hearing loss. Tinnitus is generally matched to tones in the 3000-4000 Hz range.
o At 1k Hz with headphones, 25 dB HL would be: (SPL/HL conversions and math and research)
32 dB SPL (7 dB difference) 1000 Hz- 0 dB HL = 7 dB SPL (or 7.5) 12.5 dB for SRT o 7.5 + 12.5 = 20 dB SPL (reference level for speech in dB SPL)??
How many questions are included on the LittleEars questionnaire?
35 LittleEars is a questionnaire used for children with severe hearing loss. It is to ensure the child is progressing, since intervention has taken place. The questionnaire's questions are on the following topics: 1. auditory awareness. 2. auditory attention. 3. auditory localization. 4. simple discrimination. 5. recognizing emotion. 6. speech imitation. 7. language comprehension. 8. understanding simple and complex commands. 9. knowing the names of family members.
ANSI classroom acoustics standards
35 dBA or less (noise level in quiet) 0.6s or less (reverb) SNR should be +15 dB
The American National Standards Institute (ANSI) standard for classroom acoustics (ANSI/ASA S12.60) pertains to noise levels in unoccupied classrooms and recommended reverberation times. The ANSI standards are intended for use in the design of new classrooms and in the renovation of existing classrooms.
35 dBA or less and 0.6 seconds or less The ANSI standards for classroom acoustics specifies that ambient noise levels in unoccupied classrooms should not exceed 35 dBA and that reverberation times not exceed 0.6 seconds.
The MCL is usually _____ dB above the patient's SRT.
35-40
"Comfortable" is what category of the Cox Contour Test?
4 Right before the "comfortable" category is "comfortable, but slightly soft". Right after "comfortable" is "comfortable, but slightly loud".
How many auditory levels are included in the Cincinnati Auditory Skills Checklist?
4 There are 35 items on this checklist. They are divided into the four following categories: 1. Detection 2. Discrimination 3. Identification 4. Comprehension. The checklist can help monitor the progress of children with varying degrees of hearing loss.
The reflection of the cone of light corresponds to which position in the right eardrum?
4 o'clock to 5 o'clock position in the right eardrum. The Cone of Light is a light reflex that occurs when the tympanic membrane is examined through an otoscope. Shining light on the eardrum causes a cone-shaped refection of light to appear in the anterior inferior quadrant. This corresponds to the 4 o'clock to 5 o'clock position in the right eardrum and the 7 o'clock to 8 o'clock position in the left eardrum.
Of the following, what is the minimum age at which a child can be fitted with a hearing assistive technology system?
4 weeks A hearing assistive technology system (HATS) can be used in conjunction with a hearing aid or cochlear implant to improve hearing. It can also be used by itself.
embryology: - Most hearing organs develop in ____ weeks
4-12
The first transition assessed in the Infant Monitor of Vocal Production occurs at what age?
4-6 months With The Infant Monitor of Vocal Production, 3 transitions are assessed. The transition from 4 to 6 months is the reflexive vocal production that does not require an auditory feedback loop.
Which of the following is most likely to result from a head injury involving a transverse fracture of the temporal bone through the otic capsule?
A permanent sensorineural hearing loss
The Pure-tone average should approximate the Speech Reception Threshold (SRT) within how many decibels?
5 Frequencies of 250-8000 Hz are used in pure-tone testing because this range represents most of the speech spectrum, although the human ear can detect frequencies from 20-20,000 Hz. The Pure-tone average (PTA) is the average of hearing sensitivity measured at 500, 1000, and 2000 Hz. This average should approximate the speech reception threshold (SRT), within 5 dB, and the speech detection threshold (SDT), within 6-8 dB.
"Comfortable, but slightly loud" is what level of the Cox Contour Test?
5 Right before the "comfortable, but slightly loud" level is "comfortable". Right after "comfortable, but slightly loud" is "loud, but o.k.".
Which of the following is considered to be the best AI-DI for a directional microphone performing in noise?
5 dB The AI-DI is a single number that represents the ratio of the microphone output for signals from the front to those sounds originating from all other directions. It is weighted by the articulation index. The larger the number the better the AI-DI.
During a loudness matching test, in what increments should the tone be increased?
5 dB The loudness matching test begins as a threshold based on the audiogram. The tone increases at a rate of 5dB until the client determines it is the loudness of the tinnitus.
The Early Listening Function allows parents to learn what their children can and cannot hear with/without hearing aids, with regard to distance and noise affecting speech and environmental sounds. This discovery tool is used for children in what age group?
5 months to 3 years Although the Early Listening Function is not technically an assessment, it does give parents the opportunity to truly understand the impact of their children's disability. It also lets them learn conditions where their children consistently have auditory responses.
The age of onset for Y-Linked Nonsyndromic Hearing Loss is which of the following?
5-27 years. The median age of onset is 11 1/2. This type of hearing loss is based on patrilineal inheritance.
- SNHL up to ~____ dBHL will have present ART
50
SNHL up to about ____ dB HL will have present ARTs
50 - ARTs become elevated until ~80-85 dbHL where they become absent
What percentage of the population has spontaneous otoacoustic emissions?
50% Only 70% of the population has spontaneous otoacoustic emissions. Otoacoustic emission testing is evoked in the entire population.
What is the lowest SNR that a listener can recognize in QuickSIN threshold?
50% The SNR is the signal-to-noise ratio, which the QuickSIN measures. The threshold is 50% of what a client can hear with the background noise during the assessment.
A client has difficulty hearing speech in noisy situations. Speech to noise evaluations measure a person with normal hearing to be able to identify___% of key words in sentences.
50%. Managing hearing loss requires not just an audiogram, but a measure of a person's ability to understand speech in noise. Many objective measures of speech-to-noise tests yield a signal-to-noise ratio (SNR) that an individual needs to understand about 50 percent of the speech. A person with normal hearing typically needs the speech to be 2 dB louder than the noise for 50 percent correct recognition. A person with hearing loss might need speech to be 12 dB or more above the noise for 50 percent correct recognition.
At which age would intervention for a child be advised?
6 months Children are assessed for hearing impairment at the age of 3 months. The age for intervention is 6 months.
When performing the Frequency response curve test, as per ANSI S3.22-2003, the input should be:
60 dB SPL The gain setting should be RTS. In addition, tolerance should be ±4 dB from the lesser of 1.25 f1 or 200 Hz to 2 kHz / ±6 dB from 2 kHz to the lesser of 4 kHz or 0.8 f2.
When troubleshooting using the battery current test, the input should be which of these?
65 dB SPL The frequency of this test should be 1,000 Hz. In addition, the tolerance should be +20%.
What is the minimum age at which the patient should be given the dichotic digit test?
7
A person calls to order tickets for a concert and is told that at the rear of the orchestra section, which is 20 meters from the stage, the average intensity is 65 dB SPL. The person decides to purchase tickets for seats that are 10 meters from the stage, where the sound-pressure level will average which of the following? A. 59 dB SPL B. 62 dB SPL C. 65 dB SPL D. 68 dB SPL E. 71 dB SPL
71 dB SPL 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
According to the contralateral masked-threshold function shown in the figure, which of the following values represents the true threshold for the test ear? A. 50 dB HL B. 55 dB HL C. 65 dB HL D. 75 dB HL E. 95 dB HL
75 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.
reflex decay tests for
7th CN abnormality retrocochlear abnormalities
- How long can an employer expose a worker to a 90 dBA sound level during the course of a workday without violating OSHA standards?
8 hours
-How long can an employer expose a worker to a 90 dBA sound level during the course of a workday without violating OSHA standards?
8 hours (must provide hearing protection)
stimulus ear absent or elevated for ARTs
8th Nerve Lesion unilateral CHL - Stimulus ear rule→ conductive loss in stimulus ear causes the acoustic reflex to be elevated by the amount of the conductive impairment. The amount of stimulus that actually reaches the cochlea will be reduced by the A-B gap. If the A-B gap is large enough (at least 30 dB) the ART will be absent.
Describing symptoms accurately can mean the difference in a successful diagnosis and one that is missed. Choose the best description for the symptom of DIZZINESS.
A sensation of light-headedness, faintness, weakness or unsteadiness. Dizziness is a sensation of light-headedness, faintness, or unsteadiness. Vertigo is the perception of rotational movement or whirling of the self or of surrounding objects. Disequilibrium is the loss of equilibrium experienced as feeling off balance or a sensation of spatial disorientation.
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. A trial period of speech-language therapy C. An evaluation for a mild-gain, ear-level hearing aid D. A home language-enrichment program E. A medical referral and speech-language consultation
A medical referral and speech-language consultation 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 limited vocabulary knowledge.
Under which of these speech reading methods is the focus on syllable drills, rhythm practice, and kinesthetic awareness?
Jena This method was developed in Germany. It focuses on imitating movements and perception of movements and position.
Upon examination of the tympanic membrane wth an otoscope, the cone of light appears in which corresponding area of the left ear?
A 7 o'clock to 8 o'clock position in the left ear. The Cone of Light is a light reflex that occurs when the tympanic membrane is examined through an otoscope. Shining light on the eardrum causes a cone-shaped reflection of light to appear in the anterior inferior quadrant. This corresponds to the 4 o'clock to 5 o'clock position in the right eardrum and the 7 o'clock to 8 o'clock position in the left eardrum.
Of the following conditions that can affect children's hearing, which is the most likely cause of acquired sensorineural hearing loss? A. Serous otitis media B. Otosclerosis C. Waardenburg syndrome D. Bacterial meningitis E. Turner syndrome
Bacterial meningitis Bacterial meningitis can cause profound sensorineural hearing loss in children.
When practicing audiology within a school in your community, you will need to ensure that your documentation is complete and accurate. Which of the below listed criteria is not necessary in this situation? A complete client list, cross referencing students with existing clients. Screening results recorded on each student seen by you, including a general health assessment. Documentation of students being referred for medical evaluation and the doctor's results. Documentation of all students with non-medically significant hearing loss, and further follow up. Ensure that all assessment results are recorded in the students' school records, and also health records.
A complete client list, cross referencing students with existing clients. You will need to document all services rendered, including those in regards to the school and the hearing screenings you conduct there. You do not need to cross reference your records, that will be done in the office, or by the software. You do need to record all assessments, results, and referrals in the students' permanent school files or health records.
Which of the following is NOT one of the four major ways which indicate a hearing loss that should be assessed in children? A constant ringing in the ears. Vocational choices are limited. Social isolation ensues and poor self concepts start to develop. Academic achievement is compromised. Speech and language skills are delayed.
A constant ringing in the ears. The earlier a hearing problem is identified and intervention begun, the less serious the impact. There are 4 major ways in which hearing loss affects children: It causes delay in the development of receptive and expressive communication skills (speech and language). The language deficit causes learning problems that result in reduced academic achievement. Communication difficulties often lead to social isolation and poor self-concept. It may have an impact on vocational choices.
The most important information for an audiologist to include in any written report of a pediatric audiologic assessment is which of the following?
A discussion of the implications of the findings for communication development
One component of the adult aural rehabilitation process is listening training. In listening training, the patient is trained to:
Be alert, attentive, and set to receive communication
A patient is seen for a vestibular evaluation with the primary complaint of persistent imbalance for the past six months. She states that she had one severe attack of true rotary vertigo six months ago, and since then fears another will occur. She has limited her activities, as quick head movements increase her symptoms. She reportedly takes meclizine daily. Videonystagmography results indicate normal saccade, optokinetic, and smooth pursuit testing. A second-degree left-beating nystagmus is observed during gaze testing without fixation. Postactive head-shake nystagmus reveals a left-beating nystagmus. No positioning or positional nystagmus is observed. Bilateral bithermal caloric results indicate a 50 percent right weakness with no significant directional preponderance.
A dynamically uncompensated peripheral pathology affecting the right ear Videonystagmography results normally provide site-of-lesion specific information (i.e., caloric irrigations) to determine 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 postactive head-shake left-beating nystagmus suggests that the lesion is dynamically uncompensated.
what is the treatment for BPPV?
A focus on several repositioning maneuvers designed to deposit the posterior SCC debris into the vestibule (Epley maneuver = canalithiasis theory, Semont's maneuver = cupuloithiasis theory).
Which of the following is NOT a reason an individual may not be eligible for an ENG or the results of the test are not helpful? Too many head movements. Taking a sedative. Poor eyesight. A good night's rest. Taking a stimulant.
A good night's rest. Consuming caffeine or medications for vertigo are other reasons an individual may not be able to have an ENG or the results of the test are not helpful. A lot of eye blinking can also negatively impact the test.
A patient reports no major hearing loss but says she experiences tinnitus in both ears. She does not report difficulties understanding others except in noisy surroundings. She reports no difference between the two ears. Which of the following is the audiologist most likely to see when the client is tested with pure-tone audiometry? A. Hearing within normal limits B. A moderate conductive hearing loss below 500 Hz and above 8000 Hz C. A hearing loss at frequencies above 8000 Hz D. A high-frequency sensorineural hearing loss E. A low-frequency sensorineural hearing loss
A high-frequency sensorineural hearing loss Patients with tinnitus often think the tinnitus is the cause of their hearing problems, yet they often have an accompanying high-frequency sensorineural hearing loss. A high-frequency sensorineural hearing loss makes it difficult for the listener to hear soft high-frequency consonant sounds. Thus the hearing problems experienced by the patient are due to the hearing loss, not the tinnitus.
Which of the following best describes American Sign Language? A. A language that uses visual gestures to spell individual words B. A language with its own syntax that relies on visual-gestural symbols C. A language with English syntax that relies on visual-gestural symbols D. A language of visual-gestural symbols easily transferable to written English E. A language of visual-gestural symbols that are comprehensible to anyone who uses a signed language
A language with its own syntax that relies on visual-gestural symbols American Sign Language has its own syntax and relies on visual-gestural symbols.
What would be used to determine hearing at specific frequencies in an ABR?
A tone burst All of the answer choices provide stimulus. An ABR will provide broad and specific frequency information. The click provides broad range data, while the tone burst is used to identify data on specific frequencies.
What is the cause of vestibular neuritis?
A viral infection in the vestibular system. Up to 40% of patients had a preceding viral illness
Which of the following analysis parameters is (are) most affected when auditory brainstem response tests are conducted using supra-aural earphones rather than insert earphones? A. Absolute latencies B. Interpeak latencies C. Interaural latencies D. Amplitude E. Waveform morphology
A. Absolute latencies Insert earphones cause a delay due to sound travel through the tubes; this delay lengthens absolute latencies.
Which of the following is the most sensitive measure of VIIIth-nerve dysfunction?
ABR
▪ I-V = brainstem conduction time ● Prolonged→retrocochlear pathology, e.g. acoustic neuroma ▪ Infants ● Only reliable measure for estimating sensitivity in infants < 6 months of age ● Consider gestational age not chronological age when interpreting Wave V latencies ● Prematurity affects the stage of myelinization of auditory system, which affects latiences of EPs ● Threshold prediction in limited frequency range (not 500-4000 hz) ▪ Fully developed - 24 months ▪ Click evoked- most closely correlate with behavioral thresholds from 2000-4000 Hz ▪ Most sensitive measure of 8thnerve dysfunction (over ART and decay) ▪ Insert vs. headphone ● Changes absolute latencies** o Inserts - earlier latencies (inserts are closer to generator site) - .9msec o Headphones - later latencies (headphones are farther from the generator site) ● Inserts cause delay of 0.9 ms ● Relative latencies the same
ABR
● Only reliable measure for estimating sensitivity in infants < 6 months of age
ABR
head movement in one direction results in eye movement in the opposite direction.
vestibular occular reflex (VOR)?
Where is the cone of light on the right eardrum?
Between 4 and 5. The cone of light should appear on a healthy, visible eardrum. If the eardrum is a clock, it would appear between 4 and 5 on the right eardrum and between 7 and 8 on the left eardrum..
What is the most significant limitation in audiological findings when sound-field presentation is used?
Ear specific information is not obtained. Thresholds achieved are of at least one ear, thus should a patient have normal hearing, than the audiologist may report that normal hearing sensitivity in at least one ear.
Which of the words below is a "hard" word of the Lexical Neighborhood Test? Cake. Snake. More. White. Hold.
Cake "Seat" and "nine" are hard words on this list. Additionally, "sun", "bath", and "wrong" can be used.
Which of the following is a type of test that provides information about the left horizontal semicircular canal independent of the right horizontal semicircular canal? A. Caloric B. Sinusoidal rotary C. Pseudorandom rotary D. Dynamic posturography E. Fistula
Caloric The caloric test affects only one ear at a time.
______ is a scale for children ≤ 3 years.
Early Listening Function The author is Anderson (2002). The respondent of this scale is the parent.
Describe how SCC respond to head movement.
Canals respond maximally to plane stimulation in which they are oriented (LARP RALP HH). Both canals are stimulated. One canal is hypo-polarized (inhibited) and the other is depolarized (facilitated). The brainstem integrates the information from the two sides together. Posterior excited - head down Anterior excited - head up Horizontal excited - either left or right
Loudness recruitment associated with ______ pathologies
cochlear
The "A" in CHARGE syndrome represents which of the following?
Atresia of choanae. Atresia can be the absence of or abnormal narrowing of a body's passage. In this case it is the choanae, which means the back of the nasal passage is blocked.
Which of the following individuals should be referred to a speech-language pathologist? A. A 2-month-old male with no expressive vocabulary B. An 18-month-old female with no expressive vocabulary C. A 24-month-old male who is starting to put words together in sentences D. A 24-month-old female who is starting to put words together in sentences E. A 42-month-old female who is able to tell stories
An 18-month-old female with no expressive vocabulary An 18-month-old child should have a spoken vocabulary of about 50 words.
Of the following scales, which is used for children > 6 years old?
Children's Abbreviated Profile of Hearing Aid Benefit. The authors are Kopun and Stelmachowicz. The parent/child are the respondents for this scale.
Of the following, which is the first standard of the Standards of Practice for Audiology?
Education "Education" includes audiologists being responsible for their own professional development. They are also expected to promote hearing healthcare initiatives to improve public health.
▪ Present OAE and/or cochlear microphonic ▪ absent ABR ▪ Absent acoustic reflexes ▪ Poor speech perception,may be poorer than expected ▪ Varying levels of hearing loss
ANSD
What is the ANSI standard for specification for audiometers?
ANSI S3.6-1996 (revised from 1989 standard).
What is the ANSI standard for specification for audiometers?
ANSI S3.6-1996(revised from 1989 standard).
The nature of sound is determined by all of the following, except: Wave form. Acoustic filter. Amplitude. Frequency. Speed.
Acoustic filter. The nature of sound is primarily determined by waveform, amplitude and frequency, which are also known as the basic parameters of sound. Acoustic filter is just a system that influences the processing of sound by the inner ear.
Of the tests below, in which is the listener given a choice of two noise bursts and must tell which contains the gap?
Adaptive Test of Temporal Resolution. The authors of this test are Lister, Roberts, Shackleford, & Roberts, 2006. The test is considered adaptive because the gap's duration goes up and down until the detection threshold has been located.
A patient wearing a behind-the-ear hearing aid returns to an audiologist with a complaint that sound is hollow and that her own 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 OSPL90 B. Adding a vent or enlarging the present vent C. Ordering a new earmold without a helix portion D. Adding a 680-ohm or 1500-ohm damper to the earhook E. Widening the earmold bore
Adding a vent or enlarging the present vent A hollow sound indicates that low frequencies are being overemphasized; a vent would help low-frequency sound to escape before being amplified.
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?
Administer threshold tests in areas where ambient noise levels conform to the regulations published in the Federal Register
Choose the statement that is NOT correct regarding EustachianTube Dysfunction. Obesity can increase the risk of ETD because fatty deposits may accumulate around the eustachian tubes. Smoking can damage protective hairs in the middle ear (celia) and can increase the chances of mucus getting stuck. People with allergies may experience more mucus and congestion, leading to increased risk of infections. Adults are at a greater risk of ETD because their eustachian tubes are larger, which increases the chance that mucus and germs will become trapped. Allergies, illnesses and changes in altitude are likely causes of ETD.
Adults are at a greater risk of ETD because their eustachian tubes are larger, which increases the chance that mucus and germs will become trapped.
There are certain cultural and physical diversities that make people more prone to Otitis Media. These include all, but which of the following? Indigenous Australians. Children with a cleft palate. Children under the age of 8. Adults living in close quarters. People with Down Syndrome.
Adults living in close quarters. There are certain people that are very prone to infections of the middle ear space, Otitis Media. Children under the age of 8 are more prone to develop otitis media, about 50 percent of infants have at least one ear infection by their first birthday. People with down syndrome develop otitis media due to abnormalities of the immune system. Any malformation such as cleft palate of the upper airway can affect the function of the Eustachian tube and increase the possibility of persistent fluid in the middle ear, which is a primary cause of ear infections. Indigenous Australian Aboriginal and Torres Strait Islander children have one of the highest rates of middle ear disease and hearing loss in the world.
Vestibular Neuritis & BPPV - nystagmus beats toward _____ ear Unilateral Vestibulopathy - nystagmus beats toward ____ ear
Affected/"Bad" Ear Good Ear
Functional gain of a hearing aid is best defined as the difference between which of the following?
Aided and unaided sound-field thresholds 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.
○ : The amplitude of the nystagmus increases when the eye moves in the direction of the fast phase (saccade). Peripheral = if this happens Central= if this doesn't happen
Alexander's Law
When designing, supervising, or providing school audiology screening services, you should focus your attention to certain groups of students. Which of the below groups, is not the main focus of your efforts? All students who failed the previous year's screening and were not cleared by an audiologist since that failed screening. All transfer students should be screened within two months, who are entering into the school without a current screening record. All students who are being assessed or are receiving special education or and/or related services. All students that are enrolled in public funded early childhood programs, such as Headstart. All students enrolled in the school system, from kindergarten through high school school be screened on a yearly basis, preferably at the beginning of the school year
All students enrolled in the school system, from kindergarten through high school school be screened on a yearly basis, preferably at the beginning of the school year. Your focus will be on the pre school and elementary aged students. In the high school level, the students' hearing development has occurred. You need to focus on those in preschool, special education classes, and new transfer students of this age group.
There are several ethics issues related to the reimbursements your office will request in payment for services rendered. Which of the infractions listed below is not an ethics issues that will result in a challenge or charge from the board? Allowing staff to provide less hours of care than provided in a Prospective Payment environment, as in instances when the patient's condition is improving quickly. Supervision of students or other audiology service providers in which the environment can be considered "fee for service". Accepting referrals that are discounted or provided as a professional courtesy at no cost to the patient, with absence of documented need of the patient. Scheduling your services more often or for a longer period of time, than deemed necessary, such as home care or rehabilitation. Provision of your services in cases with no reasonable expectation of assistance or improvement of the patient's condition.
Allowing staff to provide less hours of care than provided in a Prospective Payment environment, as in instances when the patient's condition is improving quickly. There is no problem in providing less hours of care, when the patient's condition is improving. Providing more hours of care than necessary or usual is a problem, and can result in a board related challenge or charge if payment is requested. It is also a problem ethically, if you provide discounted or free services to patients who are referrals from other professionals.
What is vestibular neuritis?
An acute onset of unilateral peripheral vestibular dysfunction with normal hearing. (labrynthitis has the auditory dysfunction)
Individuals with normal hearing sensitivity in one ear and a severe hearing loss in the other ear experience which of the following?
An improvement in speech understanding when the noise is closer to the ear with hearing loss
The prevention of hearing loss is a standard of practice for you as an audiologist. A new factory has relocated near you and the potential for hearing loss in the employees needs to be monitored. Which of the below listed criteria is not your responsibility in regards to employees hearing loss prevention? Assess the ambient noise levels in the factory and determine the approximate exposure levels of the employees, at any given time. Design, supervise, monitor and administer informational programs and materials aimed at preventing hearing loss in the workplace. Investigate and collect data based on the effects of the noise in the factory, outside the factory affecting the neighborhood for medical purpose, maybe even legal use. Appeal to the city council, in regards to limits on the noise levels both inside and outside of the factory, and present your data on the effects on the hearing of the employees and neighbors to the property. Investigate the non-hearing impairment effects that the factory's noise has on it's community, such as the nuisance factor, interference in communication, etc.
Appeal to the city council, in regards to limits on the noise levels both inside and outside of the factory, and present your data on the effects on the hearing of the employees and neighbors to the property. The factory is already in existence, you cannot have the city council change the situation now. You can study, collect data, and design programs to be used within the factory to combat hearing loss. Your educational materials can educate the employees on ways to mitigate hearing loss resulting from work. You may be asked to use your data in a legal case, or use it in your future medical purposes.
Of the words below, which is an easy word on the MLNT? Yellow. Purple. Apple. Hello. Carry.
Apple "Sugar" and "alright" are easy words on the list. Additionally, "about", "because", and "crazy" can be used.
Which of these is a pulmonary condition that accompanies hearing loss in children? Asthma. Obstructive congenital heart defects. Legal blindness. Cerebral palsy. Syndactyly.
Asthma The other options are also physical conditions that can accompany hearing loss in children. Obstructive congenital heart defects are cardiovascular in nature. Legal blindness is an ophthalmic condition. Cerebral palsy is neurologic and syndactyly is orthopedic.
This test measures how well a person can use pitch and spatial cues to distinguish speech among background noise. People with this condition find it hard to cut out background sounds in noisy areas, such as bars, restaurants, or movie theaters.
Audiologists are able to diagnose spatial hearing disorder with a test called the Listen in Spatialized Noise-Sentences, or LiSN-S, test. This test measures how well a person can use pitch and spatial cues to distinguish speech among background noise. The inability to distinguish spatial cues is known as spatial hearing loss. For example, if a person suffers from spatial loss of hearing, they would likely be unable to tell where a sound came from. They would also have a difficult time picking one person's voice out of a crowd. People with this condition find it hard to cut out background sounds in noisy areas, such as bars, restaurants, or movie theaters.
What should audiometers be calibrated to for proper functioning of the pure tone audiometry screening and threshold screening?
Audiometers have test tones ranging from 250 to 8000 Hz and volumes of 0-80/100 decibels. Audiometers have test tones ranging from 250 to 8000 Hz and volumes of 0-80/100 decibels, this allows the screener to perform both pure tone audiometry screening and threshold screening. Headphones are calibrated to a specific audiometer and are not interchangeable with other machines. Specifications vary somewhat between brands but most audiometers have the following frequency dial that rotates from 250 to 8000 Hz. This dial controls the test frequency or the pitch of the tone. The decibel or hearing level dial controls the test intensity or loudness of the tone. This is typically a rotary dial, which allows the screener to vary the tones presented in 5dB steps from approximately 0 to 80/100dB.
The following test results indicate what auditory disorder? ▪ Present OAE and/or cochlear microphonic ▪ absent ABR ▪ Absent acoustic reflexes ▪ Poor speech perception,may be poorer than expected ▪ Varying levels of hearing loss
Auditory neuropathy (ANSD)
DFNB1 A is a mutation in which gene?
GJB2 This results in a large portion of cases of moderate to profound nonsyndromic recessive hearing loss. In fact, there are more than 200 mutations that cause disease.
What is the difference between the B-71 and *B-72 bone vibrator?
B-71 is smaller (20g) then the B-72 (48g) and is more commonly used in clinics.
Which of the following, if present in a 7-year-old patient's medical history, does NOT indicate that the patient is at risk for hearing impairment? A. Treatment with ingestion of cisplatin B. An Apgar score of 7 at one minute after birth C. Family history of neurofibromatosis type II D. Treatment with aminoglycosides E. Treatment with loop diuretics
B. An Apgar score of 7 at one minute after birth An Apgar score of 7 at one minute after birth is normal. The other answers are all associated with a risk for hearing impairment.
Which of the following is a VNG/ENG test designed to determine whether nystagmus will occur with a specific rapid body maneuver? A. Epley B. Dix-Hallpike C. Bárány D. Gaze E. Spontaneous nystagmus
B. Dix-Hallpike In the Dix-Hallpike test, the audiologist has the patient sit on a table then quickly lie back and hang his or her head over the edge of the table to see if nystagmus occurs as a result of the movement.
Which of the following is true about an audiologist who bills a CPT code of 92557 for a routine hearing screening? A`. The audiologist is billing appropriately. B. The audiologist could be charged with fraudulent billing practices. C. The audiologist should use an ICD code to modify the billing. D. The audiologist should be reimbursed for the service by all private insurers. E. The audiologist can bill the code only once per month.
B. The audiologist could be charged with fraudulent billing practices. An audiologist who incorrectly codes a procedure can be charged with billing for services not rendered.
Which of the following is a possible outcome of an audiologist using a physician's NPI for billing rather than using his or her own NPI? A. The reimbursement for services rendered will be enhanced. B. The incorrect validation of the physician as the predominant provider of audiology services. C. The expansion of the scope of practice for audiologists. D. The audiologist will not be liable for malpractice E. The audiologist will no longer be eligible to maintain his or her own NPI.
B. The incorrect validation of the physician as the predominant provider of audiology services.
A 7-year-old child has become inattentive and frequently asks for things to be repeated. The child has a history of recurrent otitis media. Pure-tone air-conduction thresholds are borderline normal bilaterally, and the child exhibits flat type B tympanograms bilaterally and a 15 dB air-bone gap bilaterally. The audiologist's most appropriate action would be to refer the child for A. further audiometric testing B. an otologic examination C. a hearing-aid evaluation D. special audiometric testing E. psychosocial counseling
B. an otologic examination The flat tympanograms call for an otologic examination to determine the exact problem.
An audiologist sees his professor entering a hotel room on a Saturday with a woman who is not his wife. He should A. discuss the matter with the professor B. do nothing since it did not occur with a patient and was not in the work setting C. report the matter to the licensure board as a potential ethics violation D. report the matter to the department head E. report the matter to the dean
B. do nothing since it did not occur with a patient and was not in the work setting The matter does not impact the practice of audiology nor does it impact the academic training of the audiologist.
In a classroom, the primary advantage of using an FM system with the receiver coupled directly to the student's hearing aid(s) is that it A. enhances the effects of classroom noise on the student's speech understanding B. improves the signal-to-noise ratio for the student C. improves speech understanding by extension of the frequency response of the amplification system D. converts analog signals into digital signals E. improves binaural hearing capability
B. improves the signal-to-noise ratio for the student An FM system improves the signal-to-noise ratio by using a remote microphone. This reduces noise that would have been picked up by the student's hearing aid microphone.
In audiometric testing, a false-positive response means that the A. signal was not presented and the patient did not respond B. signal was not presented and the patient responded C. signal was presented and the patient responded D. signal was presented and the patient did not respond E. patient is feigning a hearing loss
B. signal was not presented and the patient responded A false-positive response is one in which a response occurs in the absence of a stimulus, such as when a patient responds even though no signal has been presented.
Of the following, which condition usually has an idiopathic cause? Acoustic Neuroma. Cholesteatoma. Autoimmune Inner Ear Disease. Benign Paroxysmal Positional Vertigo. Bilateral Vestibular Hypofunction.
Bilateral Vestibular Hypofunction Individuals who suffer from this condition have issues with balance, especially when walking in the dark or walking on uneven surfaces. Although it can occur secondarily to conditions such as meningitis, the underlying cause usually cannot be determined.
Part C of the Individuals with Disabilities Education Act is specific to people of what age group?
Birth to age 3. Part C of the act provides early intervention for children with disabilities. Some of the services included are home visits, family training, and counseling, audiology and speech pathology services, and sign language and cued language services.
How are audiometers classified?
By Type 1, 2, 3, 4, 5 and HF and speech A, B, and C. The smaller the number, the more features the audiometer has.
Which of these is defined as the difference between the input level and output level of a hearing aid?
Gain Gain is measured in decibels. This is how much the input is amplified.
There is a concern about the client's ability to hear sounds over time. What assessment would be used?
Gap Test The temporal processing/ sequencing tests assess the ability to recognize timing of sound. The gap test is an example of a temporal processing/ sequencing test.
A new patient, Mr. Harris, reports to an audiologist's clinic and reports that eight weeks ago he had surgery to repair a fistula in the round window in his left ear. The patient tells the audiologist that he was discharged by the surgeon and told that the procedure was successful. The patient indicates that he has not noticed any change in his hearing since the operation. Which of the following actions should the audiologist take first? A. Referral for another medical evaluation B. Auditory brainstem response (ABR) testing C. A routine audiometric evaluation D. Evaluation for a conventional CROS hearing aid E. Evaluation for a transcranial CROS hearing aid
C. A routine audiometric evaluation The surgery has apparently been successful, the client's report that there has been no subjective improvement warrants further investigation. The follow-up medical evaluation that occurred would normally focus on physical healing and would not include an audiometric evaluation, so the audiologist should conduct a routine audiometric examination to determine the precise level of postsurgical hearing loss.
A 13-month-old child has been diagnosed with a severe-profound hearing loss. The audiologist has met with the child's parents to discuss the functional impact of this hearing loss, along with intervention options. In addition, the parents have read information online related to intervention options. Which of the following should the audiologist recommend as the step for the parents to take? A. Continuing to search for information online B. Obtaining bilateral cochlear implants for the child C. Consulting with a pediatric otolaryngologist to obtain medical clearance for amplification D. Scheduling a future appointment with the audiologist to review information about their child's hearing loss E. Joining a support group for parents of infants with hearing loss to gain insight into the issues they may face
C. Consulting with a pediatric otolaryngologist to obtain medical clearance for amplification 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.
Which of the following is the most commonly accepted reason for not using 250 Hz in identification audiometry in a school environment? A. School-age children rarely can respond to the 250 Hz tone reliably. B. Hearing loss at 250 Hz via air conduction is most commonly associated with collapsing ear canals. 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. E. 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. 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.
Jonathon is a 2-year-old male who was recently identified as having a severe-to-profound sensorineural hearing loss bilaterally after a bout with meningitis. Prior to contracting meningitis (which occurred at 18 months of age), Jonathon had begun to develop some speech and language, but since his illness he uses very few words expressively. In terms of receptivity, he is performing at the level of an 18 month old. His initial responses to binaural amplification have been very positive. Jonathon has parents with normal hearing and a 5-year-old sister with normal hearing. Jonathon's parents appear highly motivated to do what is necessary for his development. Based on the information provided, 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. Rochester method E. Simultaneous communication
C. Oral/aural communication Jonathon had already begun to learn oral speech and language prior to experiencing the hearing loss, and the family has no known ties to Deaf culture. The fact that Jonathon is responding well to amplification and that the family appears to be willing to be very involved in his rehabilitation, auditory-verbal therapy is a good choice for a communication mode.
Which of the following best describes insertion loss? A. The difference between coupler gain and real-ear gain B. The variation in signal reaching the hearing aid microphone C. The decrease in natural amplification of the ear when the external auditory canal is closed off D. Real-ear aided response minus real-ear unaided response E. Real-ear saturation response minus real-ear unaided response
C. The decrease in natural amplification of the ear when the external auditory canal is closed off When the ear is closed off with an earmold or hearing aid, there is a loss of natural resonance in the ear canal.
Of the following, the most likely adult candidate for a cochlear implant is one with a A. bilateral hearing loss due to chronic otitis media B. bilateral hearing loss due to noise exposure C. bilateral hearing loss due to adult meningitis D. unilateral hearing loss of sudden onset and unknown etiology E. unilateral hearing loss secondary to surgery for vestibular schwannoma
C. bilateral hearing loss due to adult meningitis Cochlear implants are typically recommended only for individuals with severe-to-profound bilateral sensorineural hearing losses; adult meningitis is likely to cause such hearing loss.
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, it is necessary for the A. husband to accompany his wife to the evaluation. B. wife to give verbal permission over the phone. C. wife to sign a HIPAA form listing individuals who may have access to her records. D. husband to speak to the referring physician for the results. E. wife and husband to make a second appointment for a consultation.
C. wife to sign a HIPAA form listing individuals who may have access to her records. According to the HIPAA, medical records cannot be released to anyone without written permission.
Head trauma and HL - Longitudinal fracture (otic capsule sparing)
CHL
what type of HL is most common in children with cleft lip/cleft palate?
CHL ▪ Abnormality of muscles that open Eustachian tube, resulting in neg ME pressure ▪ Neg ME pressure can lead to OM→ CHL ▪ HL that develops over time, not congenital
o To measure client's ability to use visual cues for sentence perception given minimum of auditory input →
CID everyday speech sentences
What are the most common circumaural earphones used in audiology clinics? When are circumaural earphones used?
CIRCA-Sennheiser HDA 200; high frequency threshold testing above 8000 Hz.
most common congenital HL
CMV
probe ear absent or elevated for ARTs
CNVII lesion unilateral CHL - Probe ear rule→ Presence of conductive pathology in the probe ear causes the acoustic reflex to be absent. The stapedius may be contracting, but the presence of the pathology prevents any change in acoustic admittance to be picked up by the probe An air-bone gap of at least 5 dB HLmay cause the acoustic reflex to be absent
DFNA9 is a mutation of ____.
COCH The expression of COCH takes place in the cochlea and vestibular labyrinth. Auditory and vestibular dysfunction occur.
When the pure-tone average of hearing sensitivity is significantly better than the Speech Reception Threshold (SRT), the possibility of _________ should be considered.
Central Vestibular Dysfunction The speech reception threshold (SRT) is the softest intensity spondee words than an individual can repeat at least 50% of the time. If the pure tone average (PTA) of hearing sensitivity is significantly better than the SRT, the possibility of central involvement should be considered. A central vestibular disorder is a dysfunction of one or more parts of the central nervous system that helps to process balance and spatial information.
Which of these activities should be performed every day?
Check the opening of the hearing aid for earwax build-up. Checking the opening of the hearing aid for earwax build-up should be done everyday in order to avoid damage to the aid. The other options should be done on a weekly or as needed basis.
Which of these is an "easy" word from the Multisyllabic Lexical Neighborhood Test? Butter. Children. Lion. Money. Jelly.
Children "Animal" and "monkey" are words on the easy list. Additionally, "finger" and "pocket" can be used.
The hearing aids that sit directly inside the ear are most commonly used in:
Children 10-12 years and up. Hearing aids that fit directly in the ear are beneficial to the wearer because they are less visible. However, one reason that this type of aid is not typically used in a child under the age of 10 is because the child's ears are still growing at a quick rate, which means the aid could fit today, then be too small a few weeks later.
Symptoms of ear infections usually improve within the first couple of days. Which statement below is NOT TRUE in regards to the wait and see approach? Most ear infections clear up on their own within one to two weeks without any treatment. Children 6 to 23 months with mild inner ear pain in one ear for less than 48 hours and a temperature of less than 102.2. F can wait for improvement without medical intervention. Children 24 months and older with mild inner ear pain in one or both ears for less than 48 hours and a temperature of less than 102.2 F can wait for improvement without medical intervention. Children younger than 6 months of age with confirmed acute otitis media can wait and see for improvement without recommended antibiotics. A child with recurrent otitis media or otitis media with effusion will be recommended a procedure to drain fluid from the middle ear.
Children younger than 6 months of age with confirmed acute otitis media can wait and see for improvement without recommended antibiotics. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait and see approach as an options for children 6 to 23 months with mild inner ear pain in one ear for less than 48 hours and a temperature of less than 102.2. F and for children 24 months and older with mild inner ear pain in one or both ears for less than 48 hours and a temperature of less than 102.2 F. Most ear infections clear up on their own within one to two weeks without any treatment. A child with recurrent otitis media or otitis media with effusion will be recommended a procedure to drain fluid from the middle ear. Children younger than 6 months of age with confirmed acute otitis media should NOT wait and see for improvement but will be recommended to treat with antibiotics.
This explains how an observers detections and behavioral responses vary with stimulus intensity.
Classical Threshold Theory. Classical Threshold Theory forms an important foundation for clinic audiometry. This theory tells us than an observer's behavioral responses vary according to changes in the intensity of a signal. Sounds with an intensity above sensory threshold result in a response. Stimuli with an intensity below sensory threshold result in no response. Signal intensities in the region of sensory threshold produce an inconsistent pattern of responses that reflect moment to moment variations in sensitivity.
40yo female pt with bilateral normal sloping to moderate SNHL since 6yo Which of the following is most likely to provide timely and reliable information about the patient's problem situations and communicative needs?
Client Oriented Scale of Improvement (COSI) The COSI is a self-report 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 his or her rehabilitation program. The other self-report inventories (CPHI, PHAP) are too lengthy, may have questions that do not apply the patient's specific lifestyle (HHIA), or assess the patient's beliefs about a number of basic considerations felt to be critical to the hearing aid selection process (HASP).
The "G" in CHARGE syndrome means:
Genital hypoplasia This can relate to genital and/or urinary defects. Examples are hypogonadism and undescended testicles.
Which test assesses the interrelationship of all parts of the balance system: the inner ear, vision, and muscles and joints to determine if one or more is abnormal?
Computerized Dynamic Posturography. To determine the function of the balance system CPD, Computerized Dynamic Posturography tests the interrelationship of the inner ear, vision, and the muscles and joints. This test will help determine if one or more of these three systems is abnormal. While standing on a platform in a harness, electronic sensors and computer monitors record shifts in the body weight that occur while balance is maintained when the platform moves slightly. Body sway is recorded as responses to changes in movement are monitored.
What is the normal shape of the tympanic membrane when viewed through the otoscope?
Concave Any other shape will indicate a possible problem with the structure.
A patient reports that her hearing loss in both ears has slowly worsened. She reports further that she can often hear better under noisy conditions than under quiet conditions. The hearing loss is most likely to be A. conductive B. sensorineural C. caused by a lesion of the auditory nerve D. caused by a cortical lesion E. due to presbycusis
Conductive People speak more loudly in noisy conditions, which provides a higher-amplitude speech signal and improves the signal-to-noise ratio and the sensorineural input for individuals with conducitve hearing loss.
Among children with nonsyndromic clefts of the lip and palate, which of the following types of hearing loss is most common? A. Sensorineural B. Congenital C. Mixed D. Central auditory E. Conductive
Conductive A cleft lip and palate are often associated with abnormalities of the muscles that open the eustachian tube. Eustachian tube dysfunction results in negative middle-ear pressure, leading to otitis media, which in turn can cause conductive hearing loss.
▪ EC- 3-4kHz- 15-20 dB (is this referring to ec resonance at 3800)??? ▪ ME resonant 800-1100 Hz ▪ Head Related transfer function ▪ head shadow- effects freq >1500 Hz more- ILDs ▪ HFs - ILDs ▪ LFs- ITDs ▪ Pinna effect- helps with localization -15-20 dB boost >4 kHz ▪ Middle ear transformer - Overcomes mismatch - Area ratio: effective area of TM is larger than area of stapes footplate so sound pressure acting on TM is focused to a smaller area → higher pressure at stapes footplate (24 dB) - Curved membrane mechanism: manubrium of malleus vibrates w less amplitude and greater force than surrounding areas on the TM (increases force by factor of 2) 20log2= 6 dB - Ossicular lever mechanism: manubrium of malleus is longer than long process of incus so you get an increase of force (20log1.3=2.3 dB of gain) ▪ bone conduction hearing: - Inertial bone conduction: LF,ossicular chain in loosely attached to skull, so bones lag behind movement of skull, movement of stapes and oval window just as air conduction - Compressional bone conduction: inner ear, operates at higher freq greater than 800 Hz, at high freq vib of temporal bone causes alt compression and expansion of cochlear that generate oscillation in RW and traveling wave in cochlea - Osseotympanic: vib of walls of EAC radiate into canal and conducted through TM and normal air conduction pathway (bone conduction by air conduction) impacted by CHL
Conductive boost SPL at frequencies
degree of HL and disorders for absent ARTs
Conductive hearing loss (on stimulus ear) --> probe ear effect and stimulus ear effect (absent probe/elevated stimulus) Severe to profound sensorineural loss (past 75 dB HL) 1. Brainstem lesion 2. Auditory Neuropathy spectrum disorder 3. Facial Nerve (CNVII) lesion 4. CNVIII lesion
When working with a patient, you state that she is prelingually deaf. What does this mean?
Congenitally deaf / deaf from birth. There are 4 categories that describe hearing loss. They are prelingually deaf, postlingually deaf, deafened, and hard of hearing.
CI signal-processing strategy that minimizes channel interaction by presenting pusles in a non overlapping sequence
Continuous Interleaved Sampling (CIS
Which of these is the third of the four steps in performing an RECD?
Coupler measurement. Directly before the coupler measurement, the ear response should be measured. This can be done via the hearing aid or insert headset.
what communication method uses the phonetic alphabet?
Cued speech
An audiologist suspects that a patient who has had a traumatic brain injury may not have understood the directions for a test given for pure-tone thresholds. Which of the following is a test that the audiologist could appropriately use to confirm that the patient's responses represent true thresholds? A. Tympanometry B. Acoustic-reflex thresholds C. A word-recognition test D. Speech-awareness or speech-recognition thresholds E. Most-comfortable loudness levels
D. Speech-awareness or speech-recognition thresholds Individuals with traumatic brain injuries are 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. If the speech-awareness threshold is lower than the pure-tone threshold, it is probable that the speech threshold is closer to the true threshold and that the pure-tone threshold is not accurate.
A patient who has a unilateral, progressive sensorineural hearing loss accompanied by significant decay of the stapedial 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 VIIIth-nerve disorder E. an external-ear dysfunction
D. an VIIIth-nerve disorder VIIIth-nerve disorders typically produce unilateral hearing impairment that can interfere with word recognition.
According to PL 99-457, a child under 2 years of age who has a hearing loss is entitled to A. be fitted with binaural hearing aids B. have ABR testing C. be enrolled in a center-based habilitation program D. have a written Individualized Family Service Plan E. be provided with total communication training
D. have a written Individualized Family Service Plan PL 99-457 specifies that a plan be developed but does not specify the types of services to be delivered.
A 3-year-old child with chronic ear infections had PE tubes placed six months ago. Although the current audiological battery reveals normal hearing bilaterally, the tympanograms reveal a large volume in the right ear and a flat tracing with a small volume in the left ear. The next step should be A. VRA audiometry to determine the status of hearing in each ear B. retesting with a tympanometer that utilizes a 1000 Hz probe tone C. irrigation of the ear in an attempt to determine whether the tube is blocked D. referral to the ENT physician for further evaluation and treatment E. retesting the child in 3 to 6 months
D. referral to the ENT physician for further evaluation and treatment The tympanometric findings are suggestive of poor middle ear function that could be due to a medical condition requiring treatment.
_____ is a mutation in the EYA4 gene.
DFNA10 Postlingual sensory / neural hearing loss begin during the 20s-40s. It progresses moderate to severe levels.
______ is a mutation in the gene, CDH23.
DFNB12. In this case, nonsyndromic hearing loss is usually congenital or prelingual. This type of hearing loss can be progressive and result in moderate to profound severity.
A type of otoacoustic emission that requires the use of two oscillators and two attenuators is known as A. spontaneous otoacoustic emission B. transient evoked otoacoustic emission C. stimulus-driven otoacoustic emission D. fine-structure otoacoustic emission E. distortion-product otoacoustic emission
DPOAEs Distortion-product otoacoustic emissions occur when the ear is stimulated simultaneously by two different pure tones. Two oscillators and two attenuators are required to generate and control these signals.
How often should biological calibration or listening checks be completed?
Daily The listening checks need to be done on a daily basis to make sure that the assessment material is working properly. Electroacoustic calibration must be done annually as well as when the manufacturer recommends.
In the measurement of real-ear sound pressure levels with a probe microphone system, insufficient probe-tube depth will tend to
Decrease the high-frequency response
A patient tells an audiologist that she recently had surgery for otosclerosis in her right ear. The ENT indicated that the procedure was successful. However, the surgeon nicked the chorda tympani. Which of the following is the patient likely to report?
Decreased sensation of taste The chorda tympani, which is a branch of the facial 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.
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 (CID) W-1 B. Central Institute for the Deaf (CID) W-22 C. Phonetically Balanced Kindergarten Test (PB-K) D. Northwestern University Test No.6 (NU6) E. Word Intelligibility by Picture Identification (WIPI)
E. Word Intelligibility by Picture Identification (WIPI) The WIPI is the only test listed that is both appropriate for young children and requires no verbal participation by the child.
As a professional audiologist, you have a responsibility to promote hearing healthcare programs and initiatives that will improve the public's health. Which of the below listed activities is not included in this standard of practice? Keeping up to date on the current developments in the areas of healthcare and education that pertain to your audiology services. Providing educational information and information of a consultative nature to not only your patients, but to the public and other healthcare professionals. Developing counseling materials on a healthcare literacy level that is appropriate for the collegiate level of study or research. Providing clinical based education activities to physicians, audiology students and other healthcare providers. Providing to audiology students, your observations and research based on your personal clinical experiences.
Developing counseling materials on a healthcare literacy level that is appropriate for the collegiate level of study or research. Developing counseling materials on a healthcare literacy level that is appropriate for the consumers and patients, not for the collegiate level. These materials are not intended for the use of your patients and clients. You should also provide other healthcare providers and audiology students your clinical experiences, educational information, etc. Professional development and continuing education is also required.
Reduced visual function that can complicate planning for aural rehabilitation is most likely to be found in patients with hearing losses who present with:
Diabetes Diabetes is a major cause of acquired visual impairment; the audiologist should take this fact into consideration when planning rehabilitation for patients with diabetes.
Which of the following hearing-aid features would MOST benefit a patient who is having trouble understanding speech in background noise? A. Compression limiting B. Directional microphones C. Feedback cancellation D. Digital noise reduction E. Frequency lowering
Directional Mics Directional microphone technology improves the signal-to-noise ratio by suppressing noise in the environment, allowing the speech signal to be received at a higher input level than the noise.
Of the following, which is the second step in troubleshooting hearing aid issues?
Disinfect hearing aid. Once the aid is inspected in the user's ear, disinfect the hearing aid. Disinfecting the aid should always be done before handling it.
Describe how the vestibular system is characterized (divided).
Divided into the peripheral and central sections. Peripheral is has receptor organs located in the inner ear and are sensitive to head movement and gravity. Central is associated with cerebellar, reticular, and autonomic systems. The functions cannot be isolated.
Checks for posterior bppv ○ Nystagmus is typically rotary and geotropic (canalathiasis) ■ Cupolathiasis is also rotary but ageotropic ○ Will be stronger when head is positioned on 'bad side', beating towards that ear *beats toward the affected ear treated with epley maneuver
Dix hallpike
An electronystagmography evaluation of a patient reveals that the responses to the right-warm and right-cool caloric irrigations are 12 percent weaker than the responses to the left-warm and left-cool caloric irrigations. An audiologist should report this finding as a A. unilateral weakness on the left B. unilateral weakness on the right C. directional preponderance to the right D. directional preponderance to the left E. normal caloric response
E. normal caloric response Interaural differences must be at least 15 percent or even 20 percent to be considered significant, so a difference of 12 percent between the right-ear and left-ear responses indicates a caloric response within the normal range.
With regard to CHARGE syndrome, the "E" stands for which of the following?
Ear anomalies, with or without hearing loss. The ears are bowl shaped and concaved. This is known as lop ears.
If the answer to which question below is YES then a further audiological evaluation may NOT be necessary. Do you have trouble hearing in restaurants? Is speech unclear? Do you have trouble hearing in a noisy background? Do you understand clearly what others are saying and reply appropriately? Do you have difficulty hearing over the telephone?
Do you understand clearly what others are saying and reply appropriately? A self administered test can be an initial screening for anyone to determine if further audiologic evaluation is necessary. Questions that are affirmative when asked if hearing is muffled, unclear, or confusing may require further testing by a medical professional. If you understand clearly what others are saying and can respond appropriately a hearing test may not be needed.
Read the terms below and select the one that would be on the easy words list of the Lexical Neighborhood Test. Ear. Hand. Dry. Zoo. Down.
Down "Truck" and "mouth" are considered easy words. Additionally, "pig", "give", and "school" can be used.
In consideration of the cultural and linguistic diversity of the deaf culture, what is NOT an essential component to present during evaluations? Provide all directions in native languages. Emphasis on the belief that deafness is a disability. Use of oral or sign language interpreters. Who is responsible for the overall wellness of the client? Use of 10-20 common words in their native language for the monitoring live voice techniques.
Emphasis on the belief that deafness is a disability. Some cultures, to include the deaf culture, do NOT believe that hearing loss and deafness are disabilities. Consideration of the impact that culture may have on the selected course of examinations and treatments is essential. Knowing to whom and how to talk to this diverse culture is important to conducting an audiological evaluation.
Advocacy for the audiological health of your community, is an important part of your professional development. Which of the below activities is not an effective form of advocacy? Educate yourself fully, on the topics or subject data necessary to make informed decision concerning the issue, such as the need for more educational requirements for the staff of audiologists. Contact your Congressional representative to set up an appointment to discuss his/her views on your idea or issue. Visit your Senator's or Representative's webpage to post your questions or views, and network with other audiologists concerned with the same issues. Post your concerns, information, or questions concerning the advocacy issues on social media to connect with others sharing the same concerns. Employ the services of a consultation firm to research the issues, possible solutions to the issue at hand, and recommend strategies to advocacy and education.
Employ the services of a consultation firm to research the issues, possible solutions to the issue at hand, and recommend strategies to advocacy and education. Advocacy does not need to cost you any money, you can do it without the assistance of a consultant. You need to research and educate yourself on the facts of the issue. Contacting a Senator or Representative is often helpful, this can be done in person, via the telephone, or a visit to a webpage. You can also network with other advocates through social media sites.
An audiologist fit a young woman 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 she complains that low-level ambient noise has been distracting. In an effort to reduce the adverse noise effect, what adjustment might the audiologist make to the hearing aids?
Enabling expansion
Diagnostic audiometers generally provide one-third-octave noise bands for use in masking pure tones. This bandwidth is used because bands of that width
Encompass the width of a critical band
malformation of temporal bone associated with early onset HL and vestib disorders
Enlarged vestibular acqueduct
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 compliance 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 E. A squamous cell carcinoma
Glomus jugular tumor 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.
What are the most common insert earphones used in audiology clinics?
Etymotic Research (ER) 3A and E-A-RTONE 3A
Standard number 3 of the Standards of Practice for Audiology is:
Evaluation/Diagnosis Audiologists must conduct evaluations of individuals who present with complaints to determine whether or not these issues are caused by auditory and/or vestibular insufficiency. They must make sure the evaluation method used is appropriate for the patient's age, physical, cognitive, and mental state, and culture.
● How often would you recommend an audiologist see a young child who has just been ID'd with a SNHL?
Every 3 months
Which of the following formants is (are) most useful in the recognition of vowels?
F1 and F2
Once the sound field has been calibrated, furniture, instrumentation and other objects should not be moved or placed in the room. If so, the sound field should be recalibrated.
Factors to consider in sound field calibration
○ Procedure: ■ Extend arms at a 90 degree angle in front of the body w/ the eyes closed and march in place for 50 steps. ○ Results: ■ Normal → Rotation of position <45 degreesor forward movementonly ■ Abnormal → backwardmovement. Body rotation will be towards the lesion side
Fakuda Step Test
Look at the words below and determine which is a word form the "hard" list on the MLNT. Cookie. Finish. Again. Window. Another.
Finish "Under" and "naughty" are words from the hard word list. Additionally, "really" and "bottom" can be used.
You are using the Ling test to perform a listening check on a client's hearing aid. Which of these is being assessed by using the sound /ah/?
First and second formants; middle frequencies. This test should be performed at a conversational volume. The word "car" is appropriate in testing these frequencies.
The Ling six sound test is evaluating what frequency(ies) with the sound /ee/?
First formant low frequency; second formant higher frequency. The words in this test should be spoken as they are in a normal conversation. They shouldn't be too drawn out. The word "see" is appropriate in testing these frequencies.
To be classified as deafened means:
Hearing loss occurs after completing education in the teens / twenties.
A child with a moderate sensorineural hearing loss who wears binaural hearing aids is referred to the clinic because of problems understanding the teacher at school. The child's aided speech recognition scores in quiet at 55 dB HL were 88 percent correct and in noise with a +5 SNR were 60 percent correct. Which of the following is the best recommendation for this child? A. Referral for a cochlear implant evaluation B. Use of digital noise reduction features in the hearing aids C. Fitting with a personal FM system coupled to the hearing aids D. Fitting with a personal FM system that uses earbuds E. An increase in the gain of the hearing aids
Fitting with a personal FM system coupled to the hearing aids An FM system coupled to the child's hearing aids will take advantage of the prescribed amplification for the child's specific hearing loss and assist in improving the signal-to-noise ratio.
Elicitation of an acoustic reflex at a hearing level better than that obtained with voluntary behavioral responses suggests the presence of
Functional or nonorganic hearing loss Better hearing levels with acoustic reflexes than with voluntary responses are obtained only in cases of nonorganic hearing loss. If a person has a nonorganic hearing loss, then poor hearing levels on voluntary behavioral response tests will be due to voluntary action. Acoustic reflex elicitation, however, is involuntary.
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 compliance that are synchronous with the patient's pulse. Which of the following medical conditions is the most likely cause of the audiologist's findings?
Glomus jugulare tumor 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.
Of the syndromes listed below, which has an undetermined cause? Goldenhar syndrome. Klippel-Feil syndrome. Hunter syndrome. Hurler syndrome. Jervell Lange-Nielsen syndrome.
Goldenhar syndrome. The hearing loss associated with this syndrome is congenital and conductive. Some of the characteristics of individuals with the syndrome include facial asymmetry, microtia, and atresia.
What coupler is used to calibrate insert earphones
HA-1, HA-2, of occluded ear simulator couplers ● HA-1 - calibrates ITE - ANSI ● HA-2 - calibrates BTEs - ANSI ● Inserts - 0.4cc wideband coupler with tric adapter
Mr. Smith, 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. Mr. Smith has an acrimonious relationship with the owner of the practice and objects to the charges imposed by the owner for follow-up evaluations. He quits work and walks out at noon on the day the patients are scheduled to be seen for follow-up. There are no other audiologists in the practice. Which of the following is true of Mr. Smith?
He can be charged with patient abandonment. 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.
When a child is 18 months or older, which of these demonstrates a conditional response to sound?
He claps when he hears Ling's sounds. The Ling's sounds are oo, ah, ee, sh, s, m. The child conditions to respond to the presence of these sounds.
According to the HIPAA regulations, marketing is specifically defined and regulated. Which of the below examples is not regulated or covered under the marketing specifications and require the patient's authorization? Health insurance carrier contacts the patient in regards to a service included in the purchased health plan. Health insurance carrier contacts the patient through writing in regards to purchasing home or life insurance. Health insurer provides a blood pressure cuff manufacturer with a list of enrollees of the health plan. Drug manufacturer obtains patient information from the health insurer and sends coupons for a new depressions medication. Your use of a patient's information in advertising or marketing of the practice, or the services available to the community.
Health insurance carrier contacts the patient in regards to a service included in the purchased health plan. No one is allowed to sell or give a patient's information to any manufacturer or medical vendor. You also may not use the patient's information in personal marketing of the office. The only time that a patient can be approached in regards to their health plan or condition, is when the communication is in regards to the patient's condition.
Of the below, the fifth standard of the Standards of Practice for Audiology is _____________.
Hearing Loss Prevention. One of the duties of the audiologist is to identify individuals who may be at risk for hearing loss due to exposure of high noise levels. Once the identification of such individuals is made, the audiologist should implement strategies to help mitigate this damage.
Which of the below demonstrates the child having auditory identification or association of different-sounding and familiar words and phrases - SIMPLE DIRECTIONS - closed set?
His clothes are laid out, and when his father asks him to give him his socks, the child does so properly. This would typically be a one-step direction. The ability to follow directions that require more than one step is a skill that comes later, developmentally.
Which of the following demonstrates that a child has mastered awareness to sound?
His eyes get wide when he hears his father speaking. With awareness to sound, the child indicates the presence or absence of sound. This can be done verbally or non-verbally.
When discussing the ethical standards that you must adhere to as a licensed and practicing audiologist, have several requirements, pertaining to many things included the rules for any consulting that you may perform within the industry, such as a contractor or vendor. Which of the below questions is not relevant to this subject? Does this company or vendor, offering me the position, need my particular expertise in the area, or my personal input on a topic? Is this company or vendor expecting me to use their goods or services, or expecting my loyalties to their company because of the position? How many times will I be expected to consult for the company or vendor? Will the company expect my services past the initial consultation? Is the pay that is being offered to me for my consulting services, a reasonable amount of compensation, that is normal for the industry standards? Will my patients perceive my relationship with the company or vendor, as being inappropriate or fraudulent in nature; will they believe that I am representing this company?
How many times will I be expected to consult for the company or vendor? Will the company expect my services past the initial consultation? There are several questions that you can ask yourself, in determining the ethics of a consultation position at a vendor's company. Do they really need me? Is the pay comparable to other consulting positions? Does the company expect my loyalty after the job is complete? However, the possible work afterwards, should not be a concern when considering the ethical ramifications.
Read the options below, and select the syndrome that is an X-linked condition with a mutation in the IDS gene. Goldenhar syndrome. Klippel-Feil syndrome. Hunter syndrome. Hurler syndrome. Jervell and Lange-Nielsen syndrome.
Hunter syndrome Progressive sensorineural, conductive, or mixed hearing loss is a part of this syndrome. Skeletal deformities, coarse facial features, and corneal clouding are also associated with Hunter syndrome.
Of the syndromes below, which is an autosomal recessive genetic condition associated with mutations in the IDUA gene?
Hurler syndrome. Hearing loss with Hurler syndrome is progressive, and can be sensorineural, conductive, or mixed. Some of the characteristics associated with this condition are cardiovascular disorders and intellectual developmental disorder.
Which of these results when abnormal bone growth in the modiolus compresses auditory nerve cells?
Hyperostotic presbycusis. Abnormal bone growth of the internal auditory meatus can also compress auditory nerve cells. This compression causes the auditory nerve cells to degenerate.
List the interpeak latencies for an ABR
I-III 2.2 msec apart III-V 2.2 msec apart I-V 4.4 msec apart Interaural < 0.4ms
Act that IEPs & IFSPs are created under Part A: General provisions Part B: Assistance for Education of All Children with Disabilities (children 3-22); Special Education Services, IEP CHILD FIND/ IEP Part C: Infants & toddlers with disabilities (1-3) Early Intervention services. IFSP NCLB: Requires Statewide, annual standardized testing as a part of progress monitoring. Special education students (IDEA) do not receive special services during this time; D- general (grants for students)
IDEA- Individuals with disabilities education act
AFFERENT ● -40 mV intracellular potential(compared to +100 mV endocochlear potential) ● 3.5k ● flask-shape ● 95% afferents supply- type I(large, myelinated, bipolar- cell body along axon not one end) ● 20 nerve fibers/IHC ● efferent fibers do not connect directly
INNER EARS
Which of the following is a hearing aid that is contained in a small case and partly fits into the ear canal?
ITC ITC stands for In-the-Canal. This aid is the smallest type available that fits partly in the ear canal.
A common medication known to be ototoxic is A. ibuprofen B. Benadryl C. cough syrup D. melatonin E. high dosage vitamin C
Ibuprofen Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to be ototoxic. Ibuprofen is an NSAID.
Which statement is NOT TRUE regarding verification of proper functioning of an audiometer? If static is heard, the audiometer needs repairing. Do not use the audiometer if the sound is not produced when the tone lever is pressed. If the indicator lights on the audiometer do not glow, repairs must be made. If headphones do not remain in the proper position over the ears, they can be propped or clipped on for usage. Audiometers should have yearly calibrations.
If headphones do not remain in the proper position over the ears, they can be propped or clipped on for usage. Audiometers should have yearly calibrations. Extensive calibrations are typically done at a repair facility or factory about every fifth year. The audiometer needs repair if 1. The tone does not sound normal. 2. If static is heard. 3. If the sound is not produced when tone lever/button is pressed. 4. Headphones do not remain in proper position over the ears. 5. A dial or switch does not function. 6. Indicator lights do not glow.
When an audiologist gives an adult with a hearing loss an explanation of hearing impairment and its effects, and explains the function of a hearing aid, the audiologist is providing which of the following types of counseling?
Informational
What will make the frequency responses of a BTE similar to a custom hearing aid?
Insert damper in hook The frequency responses of a BTE can be adjusted to resemble a custom hearing aid. This is done by inserting a damper in the BTE ear hook.
What is the target gain for hearing loss?
Insertion gain The insertion gain is discovered by finding the difference between the sound pressure at the tympanic membrane with the hearing aid and without it. This defines the target amount gained in the hearing loss.
Describe the transducer function of earphones, bone vibrators, and loudspeakers.
Inserts, supra-aural, circumaural earphones and loudspeakers convert electrical output from the audiometer into acoustic energy. The bone vibrator converts electrical output into mechanical energy.
Which of these is the first of the main steps in developing speech reading skills?
Instruction There are 4 main steps to follow in developing speech reading skills. In order, they are: 1. Instruction 2. Consider habits and skills 3. Uncover difficulty in listening, and create solutions 4. Implement formal speech reading exercises.
contralateral responses absent or elevated for ARTs
Intra-Axial Lesion
What does a sound level meter do?
It calibrates audiometers A sound level meter (SLM) analyzes the magnitude of sound. It is used to calibrate audiometers.
An audiometer attenuator is set to 0 dB HL. 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 mid-frequencies. C. It increases as a function of frequency. D. It is highest at 4000 Hz. E. It decreases 6 dB per octave.
It is lowest at mid-frequencies.
Which of the following always applies to nystagmus caused by a labyrinthine lesion?
It is suppressed by visual fixation.
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 pendular when the eyes are closed. C. It is enhanced with eyes open. D. It is up-beating on up gaze and down-beating on down gaze. E. It is suppressed by visual fixation.
It is suppressed by visual fixation. Visual fixation always suppresses nystagmus caused by a peripheral lesion, such as a labyrinthine lesion.
A client with tinnitus has pitch matching. How long should tone be held?
It should be held for 2 seconds. Pitch matching is used to assess tinnitus. Each tone should be held for a total of two seconds at a time. The tone may be repeated as necessary.
A VNG/ENG test shows a caloric response yielding a left unilateral weakness. Which of the following statements about the results is most accurate? A. It suggests a right peripheral vestibular disorder of the labyrinth. B. It is of no real interpretive value C. It suggests a nonspecific (nonlocalizing) vestibular disorder. D. It suggests a left peripheral vestibular disorder of either the labyrinth or the VIIIthnerve. E. It suggests a central vestibular disorder.
It suggests a left peripheral vestibular disorder of either the labyrinth or the VIIIthnerve. A unilateral weakness indicates a disorder of the labyrinth or the VIIIthnerve on the same side as the weakness.
This syndrome is an autosomal recessive genetic condition associated with mutations in the KCNE1 and KCNQ1.
Jervell and Lange-Nielsen syndrome. Sensorineural hearing loss is associated with Jervell and Lange-Nielsen syndrome. Cardiac problems, syncope, and sudden death are also associated with this condition.
what is a glomus tumor?
Jugulare ● Vascular growths originating from glomus bodies ● Low pitched, pulsating tinnitus synchronous with heart beat (pulsatile) ● Fluctuations in compliance synchronous with pulse ● Sometimes expand into the ME, causing HL by putting pressure of pulsating jugular vein on ossicles
DFNA2 is a mutation in which gene(s)?
KCNQ4 and GJB3. Most commonly, a mutation in KCNQ4 results in autosomal dominant nonsyndromic hearing loss. This is typically a progressive form of hearing loss.
Which of the following syndromes is an autosomal dominant genetic condition associated with mutations in the GDF3, GDF6 genes?
Klippel-Feil syndrome. Hearing loss associated with this syndrome is congenital, and can be conductive or sensorineural. Some characteristics of individuals with this condition include fused cervical vertebrae, short neck, and decreased head mobility.
Which of these is an Immunologic condition commonly noted in children with hearing loss?
Leukemia. As stated in its name, infantile renal tubular acidosis is a Renal condition. Adrenal gland disorder is a condition of the Endocrine system. Hip dysplasia is Orthopedic in nature. Pulmonic stenosis is of the Pulmonary system.
"Comfortable, but slightly soft" is what level of the Cox Contour Test?
Level 3 The Cox Contour Test of loudness perception yields data describing the sound level required for each of seven categories of loudness. These levels are: 7. uncomfortably loud 6. loud, but ok 5. comfortable, but slightly loud 4. comfortable 3. comfortable, but slightly soft 2. soft 1. very soft
One of the code of ethics that you must adhere to and practice, as a licensed audiologist, is that you should only provide your patients, with the goods and services that are in his/her best interests. Which of the below statements is not included in this principal? Licensed and ethical audiologists should always provide the patient with reasonable amount of information concerning the procedures and side effects. Licensed and ethical audiologists should never exploit a patient in the use of referrals or the delivery of your services. Licensed and ethical audiologists should never charge for consultations, products, or services that were not rendered or delivered. Licensed and ethical audiologists should not conduct his/herself in a manner that would appear or constitute as a "conflict of interest". Licensed and ethical audiologists should always adhere to the standards required in regards to research and the use of the patients' information as data.
Licensed and ethical audiologists should always provide the patient with reasonable amount of information concerning the procedures and side effects. Information concerning procedures and their side effects falls under a specific principal itself, and does not pertain to this sub topic of the ethics of the goods an services that you will deliver. In this case, it does pertain to the ethical standards of the conflict of interest, research data collection, research data collection, and ethical charging for services rendered only.
Of the following communication approaches, which is made of the merger of the auditory-oral and auditory verbal approaches?
Listening and Spoken Language The auditory-oral approach uses amplification and the child's residual hearing to develop language/speech skills. The auditory-verbal approach is a spoken language concept, but does not allow the child to use lip/speech-reading or other non-verbal cues.
Which of these is the first step in troubleshooting a hearing aid problem?
Look for patterns There are typically 6 steps to troubleshooting problems with users' hearing aids. This starts with looking for patterns and ends with performing American National Standards Institute testing on the aid.
When using the Ling six sound test, the /m/ sound tests what frequency(ies)?
Low and mid frequencies
An audiologist fits a patient with a hearing aid that uses wide dynamic range compression (WDRC). Which of the following reflects the compression parameters used with WDRC?
Low compression threshold, low compression ratio WDRC provides gain adjustment across a wide range of input levels. It provides additional gain for low input levels with a low compression threshold and provides gradual increases in gain as input levels increase using a low compression ratio.
1.) Penniform: (feather-like), attached to ossicles via tendons 2.) Stapedius Muscle ● Contracts to loud sounds (acoustic reflex, automatic response) and pulls stapes posteriorly at right angles stiffens ossicular chain and reduces transmission of low freqs < 1000 Hz o Contracts prior to vocalization to reduce voice intensity o Bilateral response, elicited by sounds of any freq but only reduces low freq transmission ● Innervated by stapedial branch of 7th nerve 3.) Tensor tympani: muscle 4x longer than stapedius, medial and anterior walls of ME, superior to ET, attaches to manubrium of malleus, startle reaction to very intense sounds ● Contracts during swallowing and pulls malleus medially-anteriorly at right angles to plane of ossicular chain vibration ● Innervated by a branch of the 5thnerve (trigeminal)
ME muscles
Of the following, which is generally the unit used to measure clock frequency of a hearing aid?
MHz Clock frequency is the processor speed. Typically, the higher the clock speed, the faster and more efficient the activity.
Regarding a hearing aid, of the below, what is the unit of measurement for millions of instructions per second?
MIPS Millions of instructions per second is computational power. A greater MIPS capacity allows for more algorithms to run at the same time.
A variety of tools exists to assess communication need and function, as well as assisting in evaluating patient expectation of hear aid use. These include all of the following, EXCEPT: Lifestyle questionnaires. Client oriented scale of improvement. Manufacturers' recommendations based on referral programs. Hearing handicap inventory for the elderly. Expected consequences of hearing aid ownership.
Manufacturers' recommendations based on referral programs. To assist in the evaluation or patient expectations of hearing aid, use a variety of tools are used to assess patients' communication needs and the proper function of hearing aids. These include but are not limited to 1. Client oriented scale of improvement. 2. Abbreviated profile of hearing aid benefit. 3. Hearing handicap inventory for the elderly. 4. Expected consequences of hearing aid ownership. 5. Lifestyle questionnaires so goals can be outlined. Hearing aids should not be recommended based upon any referral programs offered by manufacturers.
Of the following, choose the scale used for children 3-6 years old.
Meaningful Use of Speech Scale. The authors are Robbins, Svirsky, Osberger, & Pisoni (1998). The respondent is the parent.
Clients should be encouraged to see an Ear, Nose and Throat Specialist, as certain treatments can help reduce symptoms and the frequency of attacks when this disease is presented, typified by a sudden and fluctuating loss of hearing in one ear, violent vertigo and nausea attacks.
Meniere's Syndrome. ▪ Increase in amount of endolymph in inner ear ▪ 4 fluctuating symptoms 1. episodes of whirling vertigo lasting several minutes to several hours 2. low pitched roaring tinnitus with vertigo. 3. fluctuation low tone sensorineural hearing loss 4. sense of aural fullness Meniere's syndrome, also called Meniere's disease and endolymphatic hydrops, is thought to originate in the labyrinth and is related to the over secretion of endolymph. This condition usually begins with an episode sensation (Meniere's attack) of fullness in one ear, to include vertigo and vomitting. Clients should be encouraged to see and ENT Specialist as certain treatments can help to reduce symptoms and frequency of attacks. Some treatments limit fluid retention and sodium intake, there is no cure but clients can grow out of this condition with attacks becoming less violent and frequent.
This is caused by degeneration of the stria vascularis.
Metabolic presbycusis. This form of hearing impairment typically starts when one hits his/her 30s. The progress of this impairment is slow and gradual.
During subjective verification of hearing-aid directionality, a patient indicates that when noise comes from behind, the noise seems especially loud. Which of the following is most likely the cause?
Mics are wired backward
Which frequency(ies) is/are tested with the /sh/ sound, according to the Ling test?
Middle and high frequencies. When performing this test, and the client has two hearing aids / implants, the test should first be performed on one ear, then on the other ear. It should then be performed on both ears, simultaneously. The word "wish" is appropriate in testing these frequencies.
Which of the following are common medical conditions associated with pediatric balance disorders that may require further vestibular assessment and medical referral for treatment? A. Congenital conductive hearing losses B. Skull base fracture and congenital atresia C. Diabetes and thyroid disease D. Migraine, benign paroxysmal vertigo of childhood (BPVC), otitis media, viral infection, and head trauma E. Pediatric patients usually only experience vestibular disorders that are viral in nature, and they usually exhibit spontaneous recovery.
Migraine, benign paroxysmal vertigo of childhood (BPVC), otitis media, viral infection, and head trauma Migraine, benign paroxysmal vertigo of childhood (BPVC), otitis media, viral infection, and head trauma are all common medical conditions that are associated with pediatric balance disorders and may require further vestibular assessment and medical referral for treatment.
don't raise hand when signal presented
Miss
Which speech reading method focuses on rapidly identifying the position and movement of speech sounds?
Mueller-Walle. "Wilson" is a fictitious speech reading method. Mueller-Walle was developed in Germany. As a part of this method, syllable rhythmic drill are used.
What coupler is used to calibrate supra-aural earphones?
NBS 9-A 6 CC coupler IEC 318 coupler (for circum-aural)
what stimulus is used for AC and BC masking and why?
Narrowband noise (NBN) - 1/3 octave width b/c this encompasses width of critical band
Why is it difficult to obtain quality recordings at 500 Hz toneburst on an ABR?
Neural firingis less synchronous at the lower region of the cochlea.
Of the following, this speech reading method focuses on using monosyllabic words to develop eye training.
Nitchie There are 4 major speech reading methods. "Wilson" is not one of them. The Nitchie method started out as an analytic approach, but was later developed into a synthetic approach.
At what age should a child first be given an audiological evaluation?
No child is too young to test. No child is too young to be given a hearing screening or test. Specialized testing and procedures are used to test children in all stages of development. An audiological evaluation is painless and non-invasive but sometimes testing can take multiple sessions to obtain all the information needed to diagnose and treat hearing problems, or loss of hearing.
An electronystagmography evaluation of a patient reveals that the responses to the right-warm and right-cool caloric irrigations are 12 percent weaker than the responses to the left-warm and left-cool caloric irrigations. An audiologist should report this finding as a
Normal - Interaural differences must be at least 15 percent or even 20 percent to be considered significant, so a difference of 12 percent between the right-ear and left-ear responses indicates a caloric response within the normal range.
- Define standard threshold shift and time-weighted average.
O STS: an average shift of >10 dB at 2, 3, 4 kHz in either ear O TWA: an average exposure over a specified period of time that takes into account peaks and valleys during an 8 hour time period (5 dB trade for time/intensity) o 85 dBA 8 hr TWA- action level, HPDs offered (50% dose) hearing protection devices
▪ Limit _____ to lower level for child than adult b/c volume of EAM less than 2 cc coupler and SPL at eardrum is greater
OSPL90
The mutation, DFNB9, affects what gene?
OTOF It is said that OTOF plays a crucial role in synaptic function. Research shows the strong possibility that those with OTOF mutations also suffer from auditory neuropathy.
An adult with a progressive sensorineural hearing loss is no longer able to use a standard telephone at work. The managing audiologist should assist the patient with A. learning a manual communication system B. obtaining a job that does not require spoken communication C. obtaining reasonable accommodation for telephone communication at work D. working with vocational rehabilitation to be considered for a cochlear implant E. using an assistive listening device that alerts the client that the phone is ringing
Obtaining reasonable accommodation for telephone communication at work The audiologist should counsel the patient about reasonable accommodations in the workplace mandated by the Americans with Disabilities Act.
Of the following, which word would be in the "easy" word category of the LNT? Pink. Orange. Song. Fun. Use.
Orange "Brown" and "home" are easy words on this test. Additionally, "old", "watch", and "need" can be used.
Which of these syndromes is an autosomal dominant genetic condition associated with mutations in the COL1A1, COL1A2 genes?
Osteogenesis imperfecta. The hearing loss is progressive and can be sensorineural, conductive, or mixed. Fragile bones, large skull ,and stapes fixation are also associated with this condition.
Which of these is used to screen newborn babies with hearing issues? Whispered speech test. Pure tone audiometry. Tuning fork test. Otoacoustic emissions testing. Auditory brain stem response testing
Otoacoustic emissions testing. A portable unit is used for early detection of inner ear abnormalities. When the cochlea is stimulated by sound, otoacoustic emissions are given off by the inner ear.
Jon, a 45-year-old computer sales representative, was treated with aminoglycoside antibiotics for an infection years ago. Now he says he has trouble understanding speech, especially in noisy situations, and he complains of tinnitus in both ears. He was treated with aminoglycoside antibiotics for an infection. The problems have existed for several years, but they seem to be getting worse with passing time. Which of the following is the most likely cause of Jon's hearing problems?
Ototoxicity Aminoglycoside antibiotics can be ototoxic, and tinnitus and hearing loss are common side effects
With regard to aural rehabilitation, what does the "O" in CORE assessment stand for?
Overall participation variables. These assist in evaluating the characteristics of hearing impairment. It looks at how the hearing impairment affects the patient, as well as family and friends.
Which of the three major types of vents found in a hearing aid shell or earmold is (are) designed to provide some reduction of amplified low frequency sound, to allow low frequency sounds to leak out of the ear?
Parallel, Diagonal, and Trench There are 3 major types of vents found in a hearing aid shell or earmold: parallel, diagonal, and trench. All 3 vents are designed to accomplish the same thing, which is to provide some reduction of amplified low frequency sound—that is, allow low frequency sounds to leak out of the ear. The most commonly used vent is the parallel type. The only difference is the style of vent.
Of the following, which is used in children of all ages?
Parents' Evaluation of Aural/Oral Performance of Children. The authors are Ching & Hill (2007). The respondent of this scale are parents.
Some individuals no longer go to the movies because their hearing loss makes it difficult for them to enjoy the experience. Which of the following domains of auditory function is being described by this behavior as defined by the International Classification of Functioning, Disability and Health from the World Health Organization?
Participation restriction
Which of the following syndromes is an autosomal dominant genetic condition that involves the SLC26a4 gene in ~50% of individuals?
Pendred Syndrome This syndrome is associated with sensorineural hearing loss. Thyroid enlargement is also associated with this condition.
Which of the following is the most valid method of monitoring a 5-year-old child's progress in aural rehabilitation?
Periodically administering probes of treatment targets in naturalistic contex
Mr. Jones is a 92-year-old man with moderate sensorineural hearing loss, dementia, reduced manual dexterity, and a history of losing personal medical devices. He has limited financial resources but would like an amplification device for everyday use. Which amplification device is the most appropriate recommendation for Mr. Jones?
Personal listening system with headphones Mr. Jones could benefit from amplification and given the factors of dementia and reduced manual dexterity, the best option is a personal listening system that is easy to use and less likely to get lost.
autoimmune disease- severe inflamed cartilage
Polychondritis
An ear mold made of this material is recommended in individuals with extreme allergies.
Polyethylene. This is a semi-hard, waxy material. Ear molds made of this material can float in water.
Flexible ear molds are commonly made out of which of these materials?
Polyvinyl Chloride. Polyvinyl chloride is thermoplastic. Due to its firm nature, the wearer can insert the mold.
The HIPAA regulations are extremely detailed and are changing yearly with each revision. What does the term "preemption" refer to in the HIPAA laws?
Preemption is defined as when a state law made in regards to patient information confidentiality is preempted by any federal regulations being enacted. Preemption refers to the regulations enacted in reference to the patient's information and it's handling. Any state laws made in regards to this, are preempted by the federal laws and regulations. This does not refer to appointments, insurance payments or coding, etc.
Considering the Multisyllabic Lexical Neighborhood Test, which of these is a "hard" word on the list? Monkey. Children. Pocket. Purple. Crazy.
Purple "Corner" and "measles" are hard words on this list. Additionally, "ocean", "heaven", and "money" can be used.
Which of the following is defined as "SPL, as a function of frequency, at a specified measurement point in the ear canal for a specified sound field, with the hearing aid (and its acoustic coupling) in place and turned on"?
REAR REAR stands for Real-Ear Aided Response. In layman's terms, this is the difference between the input to the hearing aid monitored by the microphone, and the output of the hearing aid at the eardrum, monitored by the probe tube. difference between hearing aid input and output into the ear canal
Of the following, which is defined as: "SPL, as a function of frequency, at a specified measurement point in the ear canal, for a specified sound field, with the ear canal unoccluded"?
REUR. REUR stands for Real-Ear Unaided Response. It is the first measurement of the probe tube system.
In which of the following tests is the listener given a series of noise bursts with various gap durations, and then must tell if the gap is heard each time?
Random Gap Detection Test. Gap detection is the briefest silent gap that can be heard between two signals. It is a measure of auditory temporal resolution.
In this test, sentences are switched back and forth between both ears at a quick rate.
Rapidly Alternating Speech Perception Test. With this test, there is speech in one ear, and silence in the other. However, the message is present binaurally.
As a licensed audiologist, you must uphold and maintain a particular code of ethics, standards of practice, etc. These standards have a specific section, dedicated to "conflict of interest". Which of the below listed topics is not included as a conflict of interest for you? Commercial interests, such as ownership or the interest in a product manufacturer, vendor, etc. of a product or service that you use or recommend in your practice. Gifts or the acceptance of items of value from manufacturers of your product, non merit based rewards or valued items from sales representatives or vendors, etc. Profession development conferences, educational opportunities, etc. that are sponsored or hosted by a particular manufacturer of a hearing assistive device used in your office. Performing consultation services to a hearing assistive device manufacturer, systems providers, etc., including the disclosure to your patients. Receiving donations from community businesses to be used in the services provided in lower income areas of the city.
Receiving donations from community businesses to be used in the services provided in lower income areas of the city. The industry guidelines for the definition of "conflict of interest" include any practice that could be perceived as unethical to your colleagues, patients, and community. This includes the acceptance of gifts, the consulting or research that you may be involved in, the acceptance of education or professional development at little or no cost, etc. Accepting donations for the use in low income areas, is not included in these standards.
An 8-week-old child is brought to an audiology clinic by the parents, who report that the child appears to respond 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 dB HL. Which of the following additional steps should be taken to rule out a significant hearing loss? A. Performing threshold testing of the child using behavioral observation audiometry B. Referring the child for an auditory evoked brainstem evaluation C. Scheduling the child to return at 6 months of age so visual reinforcement audiometry can be performed D. Reassuring the parents that since acoustic reflexes are present and there are no known risk factors, the child's hearing is normal and that they should return in a year if they are still concerned E. Testing the child using visual reinforcement audiometry
Referring the child for an auditory evoked brainstem evaluation An auditory evoked brainstem evaluation is the only reliable measure for estimating hearing sensitivity in infants less than 6 months of age.
An otologically normal 13-year-old boy presents the following audiometric results: normal acoustic immittance battery, pure-tone average of 50 dB bilaterally, bilateral speech-recognition thresholds of 20 dB, and word-recognition scores of 100 percent bilaterally at 50 dB HL. Which of the following is the most appropriate next step for the audiologist to take? A. Administer pure-tone Stenger tests B. Obtain reflex thresholds C. Administer a central-auditory-processing test battery D. Reinstruct the boy and use an ascending-threshold measurement technique E. Refer the boy for an educational evaluation
Reinstruct the boy and use an ascending-threshold measurement technique 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 boy's loudness yardstick and provide a better estimate of true organic hearing sensitivity.
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?
Rescheduling the patient for a time when a Spanish-speaking interpreter is available
Which of the following does the "R" in CHARGE syndrome stand for?
Retarded growth and development with or without central nervous system involvement. CHARGE syndrome is caused by a genetic disorder. As a result, ear anomalies and deafness can result.
Auditory brainstem response (ABR) testing indicates a prolonged wave I-V latency. These findings are consistent with which of the following?
Retrocochlear pathology, such as acoustic neuroma
Which of the following tests most directly predicts the presence of a conductive hearing loss?
Rinne The Rinne test is the tuning-fork test that most directly predicts the presence of a conductive hearing loss, because it compares air-conduction to bone-conduction reception of the sound. ▪ *judges if sound is louder for AC (EC) or BC (mastoid)→ determines type of loss ▪ Place tuning fork on mastoid and tell when they can't hear it ▪ Do the same near ear canal ▪ NH- AC greater than BC- should hear longer at pinna than mastoid ▪ CHL- better BC than AC threshold
- What equipment is needed to measure noise in a classroom?
SLM dosimeter
What type of suspected hearing loss would benefit from a speech in noise assessment?
SNHL Speech in noise testing is effective in clients with sensorineural hearing loss but not conductive hearing loss. Sensorineural hearing loss is the most common and is evident when background noise is present.
ARTs o Mediated at the level of the:
SOC
▪ Modified Romberg ▪ Fukuda stepping test
SOP- sensory org performance test
Ipsilateral right - Absent Contralateral left - Present & WNL Ipsilateral left - Present & WNL Contralateral right - Absent
Severe SNHL in RE (75-85 dbHL) and normal hearing in the LE
Which of these shows the child is able to use the auditory recall skill, using two critical elements?
She can give her mom a big spoon as opposed to a little spoon. The child is able to remember groups of words that has two critical elements. An example of this can be spoons vs. forks.
Of the following, which shows the child is able to indicate words with different manner and place of consonants, but the same vowel sound?
She can tell difference between words like hill and still. With this skill, the child is able to discriminate words based on segmental features. The child can tell difference between words such as pill, hill, and still.
Which of the following shows a child has auditory discrimination of nonlinguistic sounds and suprasegmental aspects of speech?
She can tell of the two toys, which made the loud noise. Children are able to tell the difference in sounds and/or sound qualities. This relates to volume, whether long or short, and pitch.
What does the amplifier in the hearing aid amplify in the output?
Signal from the microphone and tele-coil. The amplifier in the hearing aid amplifies the output from the microphone and the tele-coil. The loudspeaker is how the receiver operates.
Type 1 of which of these syndromes is an autosomal dominant genetic condition associated with mutations in the COL2A1 gene?
Stickler/Marshall syndrome. Conductive and mixed sensorineural hearing loss is associated with Stickler/Marshall. Severe eye disorders and a small lower jaw are other characteristics of this condition.
Best practices for pediatric audiological assessments and treatment planning include all but which of the following: Obtaining a comprehensive medical history summary. Selecting and modifying procedures based on client factors like age, developmental level, functional status, behavior, cultural and linguistic diversity, physical, sensory, and cognitive abilities. Integrating assessment results and other evaluations from referrals to support treatments. Cross checking to require that one test agrees with, or confirms, another test's results, providing a reliability check between the two tests. Strict adherence to the 1-3-6 rule, benchmarks for the standard of care for infants identified with hearing loss, initiating hearing aid fittings at the earliest point.
Strict adherence to the 1-3-6 rule, benchmarks for the standard of care for infants identified with hearing loss, initiating hearing aid fittings at the earliest point. The 1-3-6 benchmark timeline does provide a reasonable time frame to initiate audiological diagnosis and follow-up however, there may be times when adherence to the 1-3-6 rule is not possible due to medical complications, finances, mixed feelings, and parental anxiety after the initial diagnosis. Audiologists have a professional responsibility to be vigilant in following these timelines whenever possible, being considerate of the grieving process of families with a newly identified, deaf or hard of hearing infant.
An audiologist fits a patient with a hearing aid. This is the first time the patient has worn a hearing aid. Which of the following is the best indicator that the patient is exhibiting early positive acceptance of the hearing aid? A. Aided versus unaided single-word recognition scores in quiet B. The presence of a high-frequency sensorineural hearing loss C. Self-assessment of listening difficulties D. Strong motivation to wear a hearing aid
Strong motivation to wear a hearing aid The patient will not adjust successfully to wearing a hearing aid unless he or she feels motivated to accept any perceived inconvenience in return for better communication.
_____ is a "hard" word from the lists of the Multisyllabic Lexical Neighborhood Test. Broken. China. Summer. Window. Airplane.
Summer "Puppy" and "couple" are words from the hard list. Additionally, "pickle" and "button" can be used.
lowest point in CANS that receives bilateral representation
Superior olive
Of the scales below, which is appropriate for students of all ages?
Teachers' Evaluation of Aural/Oral Performance of Children. The authors are Ching, Hill, & Dillon (2008). The teacher is the respondent for this scale.
The hearing-aid input transducer that is sensitive to electromagnetic energy is the
Telecoil
Of the following, which device would BEST be used to increase the volume of incoming calls, but block feedback and background noise?
Telephone amplifier. This is a cost-effective alternative to investing in a hearing aid, for someone whose hearing difficulties primarily occur with the telephone. This device typically costs around $50 or less.
What are the most common supra-aural earphones used in audiology clinics? (Make and model)
Telephonics TDH 49 and 50
Which of the following is a counseling strategy in which the goal of the audiologist is to provide the client/family with information on "what to do next"?
Telling This directive strategy is typically used in the case where there is little involvement from the family. It is also helpful when there is a cultural difference, particularly in the case where a family is from a culture that expects the audiologist to tell them what they should do, rather than giving them options of what to do.
After obtaining the SRT, how would you estimate the MCL?
The MCL is usually 35-40 dB above the patient's SRT.
Which of the following tests would yield information of greatest importance in the audiologic evaluation of an adult with an average unmasked air-conduction threshold of 90 dB HL in one ear and normal sensitivity in the other ear?
The Stenger test ▪ Must differ by at least 30 dB (40 is better)
What is compromised when assessment tools are not regularly calibrated?
The validity is compromised. Assessment tools need to be calibrated regularly. When the tools are not calibrated regularly, the validity and accuracy of the results are compromised.
What is the most depressed part of the tympanic membrane called? The apex of the cone of light shines upon this area when examined with an otoscope.
The Umbo - the central, most inverted portion of the ear drum (tympanic membrane). Upon examination of the eardrum with an otoscope, the apex of the cone of light is at this most depressed part of the tympanic membrane. The absence of this light reflex does not necessarily signify an ear disorder, it could be due to the slope of the eardrum, or shape of the ear canal.
Which of the following is true about an audiologist who bills a CPT code of 92557 for a routine hearing screening? A. The audiologist is billing appropriately. B. The audiologist could be charged with fraudulent billing practices. C. The audiologist should use an ICD code to modify the billing. D. The audiologist should be reimbursed for the service by all private insurers. E. The audiologist can bill the code only once per month.
The audiologist could be charged with fraudulent billing practices. An audiologist who incorrectly codes a procedure can be charged with billing for services not rendered.
An audiologist who has extensive training in the making of earmold impressions inadvertently allows the impression material to go beyond the cotton block, resulting in trauma to the tympanic membrane. The audiologist explains the situation to the patient and makes 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. E. The audiologist should receive additional training in the making of earmolds.
The audiologist may be subject to litigation for malpractice. The audiologist received appropriate training for the procedure and is therefore not guilty of unethical practice. However, the mistake can be construed as malpractice
An audiologist who has extensive training in the making of earmold impressions inadvertently allows the impression material to go beyond the cotton block, resulting in trauma to the tympanic membrane. The audiologist explains the situation to the patient and makes an appropriate referral for follow-up medical care. Which of the following statements about the situation is most accurate?
The audiologist may be subject to litigation for malpractice. The audiologist received appropriate training for the procedure and is therefore not guilty of unethical practice. However, the mistake can be construed as malpractice.
Before any disciplinary procedures, suspension, or revocation of your audiology certification, the ABA must first fulfill several criteria. Which of the below steps is not required during the disciplinary actions of the board? The board must supply you with a copy of the charges against you, and all of the supporting information concerning the event/events. The board must inform you that no action will be taken against you without a hearing, unless you do not respond to the board within ten days. The board must conduct a fair and impartial hearing, allowing you to be represented by legal counsel, cross examine the witnesses, and examine any documents in evidence. The ABA panel hearing your case shall determine if your license shall be suspended or revoked or if you shall retain your certification. The board must present you with written notice of the findings of the hearing, and any decisions or consequences that may result.
The board must inform you that no action will be taken against you without a hearing, unless you do not respond to the board within ten days. The criteria that the board must abide by in a disciplinary hearing concerning your certification is as follows: the board will provide you with a written copy of the charges, and all of the supporting information. You must respond within forty five days, and you must be provided a hearing. In this hearing you may have a lawyer or attorney who cross examines the witnesses and examines the evidence. You are then informed in writing of the conclusion of the board and the resulting actions.
An otoacoustic emission test is performed. How is the ear affected?
The cochlea hairs vibrate. The otoacoustic emission stimulates the hairs on the cochlea. This produces sound that is reflected in the inner ear which are the otoacoustic emissions. They are only found in healthy ears.
Which of the following best describes insertion loss?
The decrease in natural amplification of the ear when the external auditory canal is closed off
A 1000 Hz tympanogram is obtained on a month-old infant by an audiologist, who reports a type B tympanogram. The parents seek a second opinion from another audiologist, who performs a low-frequency 226 Hz tympanogram and reports a type A tympanogram. The discrepancy 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 E. the use of tympanometers from different manufacturers for the two tests
The decreased reliability of low-frequency tympanograms on infants The middle-ear system of the 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 probe toned.
Which of the following is a possible outcome of an audiologist using a physician's NPI for billing rather than using his or her own NPI?
The incorrect validation of the physician as the predominant provider of audiology services.
The caloric test is designed to stimulate which of the following structures?
The lateral/horizontal semicircular canal SCC closest to the TM
What does the Random Gap Detection Test determine?
The lowest millisecond interval to detect tone. The Random Gap Detection Test displays the lowest millisecond interval to detect tone. It is the ability to understand two similar tone clicks.
To realize the benefits, the cochlear implant device must be carefully and correctly programmed. Cochlear implants (CIs) are typically programmed for each individual patient, based on their auditory perceptions in response to electrical stimuli. Generally, approximately 4 weeks post-implantation, a program or "map," is created for the cochlear implant patient by setting threshold levels. What is a T-Level?
The minimal amount of electrical stimulation required for the auditory system to perceive sound. Cochlear implants offer significant benefits for children and adults with severe to profound hearing loss; however, to realize these benefits the device must be carefully and correctly programmed. Cochlear implants (CIs) are typically programmed for each individual patient based on their auditory perceptions in response to electrical stimuli. Generally, approximately 4 weeks post-implantation, a program or "map," is created for the CI patient by setting threshold levels (T-levels; the minimal amount of electrical stimulation required for the auditory system to perceive sound) and comfort levels (M or C-levels; the upper limit of electrical stimulation judged to be most comfortable, or loud but comfortable). For maximum benefit, CI recipients are seen for regularly scheduled intervals to reprogram their cochlear implant throughout their lifetime. On rare occasion, the implanted CI patient is unable to participate in the mapping protocol. When patient participation is not possible, objective measurements, rather than subjective preferences, are used to determine map settings. Evoked potentials and related measures can be measured and obtained using the manufacturer's provided software.
Which of the following is an accurate statement concerning measures of speechreading ability?
The most realistic measures of speechreading ability are administered in a combined auditory-visual mode. 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.
What does an oscilloscope measure?
Used for measuring the tone-switching performance characteristics such a rise/fall time, overshoot, and pulse durations.
Which of the following is a reason for an audiologist to monitor and evaluate the vestibular function of a patient who has been diagnosed with cancer and is undergoing a cisplatin-based chemotherapy regime?
The patient exhibits ataxia of gait or stance.
What does a Static Acoustic Impedance Measure assess?
The physical volume of air in the ear canal. An audiologist will take measurements that provide information about how the middle ear is functioning. These measurements include tympanometry, acoustic reflex measures, and static acoustic impedance measures. This type of testing is important for preschool children between the ages of 3 and 5 years whom hearing loss is more often associated with middle ear disease. Static acoustic impedance measures the physical volume of air in the ear canal, useful in identifying a perforated eardrum or openness of ventilation tubes. Acoustic Reflex Measures add information about the possible location and type of hearing problem. Tympanometry detects fluid in the middle ear, tearing of the eardrum, or wax blocking the canal.
most common recessive disorder bilateral HL, lack of vestib fn, progressive retinal deterioration→ night vision loss, restriction visual fields, and eventually blindness (40% show all these symptoms)- most common cause congenital deafness
Usher's syndrome
Which of these is the part of the hearing aid that converts input to audio waves that the user's ears can understand?
The speaker The speaker is also known as the receiver. It is situated in a way that faces the user's ear so he/she can actually hear the information.
Which of the following is the primary reason investigators have given for limiting a hearing aid's OSPL90 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. Measuring the degree of hearing loss in preschoolers is often imprecise and may lead to improper fitting of an aid. D. Parents and teachers of children with hearing impairments typically talk louder than do people who interact with adults with hearing impairments. E. The primary speech signal will be masked because room noise and reverberation will be amplified.
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. The sound-pressure level (SPL) at the eardrum is a function of the volume of the external auditorymeatus: the smaller the volume, the greater the sound pressure. An OSPL90 set to a level appropriate for adults may produce an undesirably high maximum SPL in a child.
What is the average change to LDL in hearing loss of 30 dB?
There is no change The loudness discomfort levels do not change between 20 dB and 60 dB. This LDL increases 5 dB for each time it the hearing loss goes up 10 dB.
What is always true of clients with minimal hearing loss? They do not benefit from hearing aids. They benefit from hearing aids. They benefit from cochlear aids. They benefit from assisted hearing devices. They benefit from BAHA.
They do not benefit from hearing aids. People with minimal hearing loss do not benefit from hearing aids. They are better for people with moderate hearing loss.
what does a cochlear microphonic indicate?
This suggests that the outer hair cells are intact. The cochlear microphonic is the pre-neural electrical potential rising from the cochlea minus the stimulus waveform. The cochlear microphonic response can create noise that makes it difficult to interpret the electrocochleography response waves. The polarity of the cochlear microphonic response varies with the stimulus, so when polarity of the clicks used as stimulus alternates, the cochlear microphonic response is cancelled out, and an electrocochleo graphic response wave can be obtained.
What range is considered Mild Hearing Loss?
Thresholds >25 dBHL to 40 dBHL. Slight Hearing Loss is thresholds >15 dBHL to 25 dBHL. Mild Hearing Loss is thresholds >25 dBHL to 40 dBHL. Moderate Hearing Loss is thresholds of >40 dBHL to 55 dBHL. Moderately Severe Hearing Loss is thresholds >55 dBHL to 70 dBHL. Severe Hearing Loss is thresholds of >70 dBHL to 90 dBHL.
Level 3 of Audiologic tinnitus management is which of the following?
Tinnitus intake assessment. Individual educational counseling takes place at this level. Patients who need additional treatment are also identified at this level.
Why would an audiologist conduct an ultrasonography assessment of the ear?
To determine middle ear effusion. Ultrasound examination of the tympanic membrane and middle ear space is performed on each ear to assess the ability and to detect and characterize middle ear effusion, fluid build up. Ultrasonography is an accurate method of diagnosing middle ear effusion in children. Ultrasound testing can distinguish thin from mucoid fluid.
Which of these is a communication approach that is a spoken language/sign concept?
Total Communication. With this approach, spoken language is used, as well as manual/visual methods. Amplification can also be helpful with this method.
Of the following, which is the first level of progressive audiologic tinnitus management (PATM)?
Triage PATM, progressive audiologic tinnitus management, is a hierarchical approach that minimizes the impact of tinnitus on a patient's life as efficiently as possible while providing cost-effective management. PATM services start at Level 1 with triage. Triage provides guidelines for all clinics where patients with tinnitus are likely to be encountered. Levels 2-5, audiologic evaluation, group education, tinnitus evaluation, and individual management, respectively, are specific to services provided by audiologists.
signal presented and client responded (correctly raise hand)
True-positive/Hit
This non invasive test gives information about inner ear fluid and intercranial spinal fluid pressure. It measures eardrum movement in response to different sounds.
Tympanic Membrane Displacement (TMD). The tympanic membrane displacement (TMD) test is an audiometric technique that is used to evaluate changes in intracranial pressure (ICP). TMD exploits the effect of intracranial pressure on the acoustic reflex, a reflex contraction of the stapedius and tensor tympani muscles in response to a sound. A non-invasive method of assessing intracranial pressure (ICP) a TMD assessment benefit patients with abnormal cerebral pathology that could give rise to changes in ICP.
Of the following audiologic rehabilitation candidacy types, which is considered positive with some complications?
Type II Type II candidates are typically concerned about stigma. They understand they need help, but have hesitations when it comes to using hearing aids.
Type ____ audiologic rehabilitation candidates are mostly negative, but agree to attempt an amplification trial.
Type III This type of candidate is usually referred by a family member. They may seek to limit the use of amplification.
This type of audiologic rehabilitation candidate is usually very negative and rejects the idea of hearing aids and audiologic rehabilitation.
Type IV Of the four audiologic rehabilitation candidacy types, this type is usually forced by a family member to seek treatment. The candidate will usually agree to the hearing test, but not to an audiologic rehabilitation consult.
Nystagmus beats towards good ear
Unilateral Vestibulopathy
How are the receptors in the utricle and saccule oriented?
Urticule are horizontal and sensitive to linear head movements. Saccule are vertical and sensitive to vertical movement and vibration.
When conducting a speech reception threshold with a client who has poor word recognition, how many words would you choose?
Use 6 The speech reception threshold has clients repeat spondaic words at soft intensity. When the client is very sick or has poor word recognition, roughly six words should be used in the assessment.
A client cannot tell the difference between pitch and loudness. What is the best way to address the issue?
Use loudness matching. Clients who experience pitch matching often cannot tell the difference between loudness and pitch. If this occurs, loudness matching is necessary.
What would be used to assess narrow band masking?
Use pure tones Masking evaluation can be wide or narrow band. Wide bands use audiometry, and narrow bands are pure tones.
What do we use RETSPL and RETFL for in audiology?
Used as reference standard of measurement for calibrating audiometers. The standards are equal to normal hearing or 0 dB HL. Measured at 70 dB HL (RETSPL) and 50 dB HL (RETFL).
Of the following, which of these is NOT true regarding an FM system? It can be used indoors and outdoors. Using this system, you cannot hear a talker clearly when sitting behind a wall. You can wear the receiving device in many ways. If you do not wear hearing aids, you can use headphones as a receiving device. You can still hear the talker clearly when you are walking around while wearing the device.
Using this system, you cannot hear a talker clearly when sitting behind a wall. The FM system is relatively portable. If you wear hearing aids, you can wear the device as a neckloop or body receiver, or even a small receiver snapped on to your hearing aid.
An audiometric test produces the following results. With the probe in the right ear, the acoustic reflex is present on both contralateral and ipsilateral stimulation. With the probe in the left ear, the acoustic reflex is absent on both contralateral and ipsilateral stimulation. The most likely cause of the results is
VIIth-nerve pathology on the left side
▪ Gaze- check for presence of spont nystagmus ▪ HFHS ▪ Calorics ● Stimulates lateral/horizontal SCC and superior vest nerve ● Provides info about L and R SCC independently ● UW→ o peripheral vestibular disorder of either the labyrinthine or VIIIth nerve on the same side as weakness o <20% difference is normal and >25% is UW o must be at least 15% different, maybe 20% ● 30% for directional preponderance ▪ *If a patient has a Caloric Weakness ● Dynamically Uncompensated: postactice head-shake left beating nystagmus o Dynamic - nystagmus elicited with motion ● Statically Uncompensated: no nystagmus postactive head-shake o Static - nystagmus elicited with no motion ▪ Dix hallpike- positioning→ posterior/ant SCC ● Designed to determine whether nystagmus will occur with specific rapid body maneuver ▪ Positionals- H SCC
VNG/ENG (videonystagmography/electronystagmography)
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?
VRA
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. Pure-tone play audiometry C. Otoacoustic emissions D. Auditory brainstem response (ABR) audiometry E. Behavioral observation audiometry (BOA)
VRA At 9 months, a typically developing infant can provide reliable responses to all octave band frequencies, and VRA is the most valid and reliable method for doing that: the infant's behavior can be reinforced and will be consistent
An audiologist is using a tracking procedure to assess a cochlear-implant patient's progress in communicating under audition-plus-vision conditions. The materials used are articles from popular magazines. Data are collected for 15 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 performance? A. A learning effect B. Variation in the print size used by the publishers C. Variation in the vocabulary or syntax used by the authors D. Normal response variation E. Malfunction of the cochlear implant
Variation in the vocabulary or syntax used by the authors 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, all factors that affect word-per-minute scores.
Definition: constant pulsation for a vessel lying on the nerve believed to cause chronic irritation of the nerve and destruction of myelin. 2. Symptoms: vertigo and disequilibrium, increased I and III interpeak latency on an ABR, chronic nausea, low frequency hearing loss or 15 dB notch at one octave. 3. Treatment: section of the vestibular nerve or vascular decompression.
Vascular Compression Syndrome
The following test results indicate what auditory disorder? ▪ Significant decaystapedial reflex ▪ No id waves on ABR ▪ Disproportionately poor WR ▪ Prolonged I-V ▪ HF tinnitus
Vestibular Schwannoma/Acoustic Neuroma
A mutation in which of the following gene(s) results in DFNA14?
WFS1 This type of hearing loss has a low-frequency configuration. It also progresses slowly.
▪ Inherited congenital condition ▪ Genetic- ▪ White forelock ▪ Prominence of root of nose ▪ Lateral displacement of medial canthi ▪ Hyperplasia portion of eyebrows
Waardenburg - dominant
_____ is on the easy words list of the MLNT. Summer. Button. Pickle. Puppy. Water.
Water "Banana" and "glasses" are also on the easy list. Additionally, "airplane" and "window" can be used.
What is the benchmark for peripheral auditory function in ABR for neurodiagnostic evaluation?
Wave I An accurate wave I is the goal for the neurodiagnostic evaluation. It is the benchmark for the peripheral auditory function. Ear canal and tympanic membrane electrodes will increase the accuracy of wave I results.
What two measurements are used to determine a present tumor when conducting an ABR?
Wave I -V interpeak latency and interaural Wave V latency difference.
It is important to consider the gestational age of an infant, rather than the chronological age, when interpreting which of the following?
Wave V latencies Prematurity affects the stage of myelinization of the auditory nervous system, which affects the latencies of auditory evoked potentials up to 18 months of age.
When would an ENG be a better choice than a VNG?
When the eyes must remain closed. An electronystagmography (ENG) and videonystagmography (VNG) record eye movements. The VNG is faster, but the ENG is used when patients must keep their eyes closed.
When is digital wireless coupling used with hearing aids?
When there is no tele-coil. Digital wireless coupling is used when there is no tele-coil coupling mode available. Inductive coupling is used in the tele-coil mode.
Which of the following is NOT true of infrared systems? You can use it outdoors during the day time. You can wear the receiver in many different ways. You will not hear unwanted radio signals like you might with an FM system. There is more privacy with this system, as opposed to others. Some places such as movie theaters have infrared receivers that they loan out
You can use it outdoors during the day time. The infrared light waves can be affected by too much light, thus making it a bad idea to wear outdoors during the day time. The infrared system helps reduce background noise so that you typically only hear the speech intended.
Your audiologist certification is important to maintain, and is not a one time award, like a doctorate. Which of the below listed criteria is not required for your audiology recertification? Recertification must be completed after three years; you will be sent a notice six months prior to the expiration date of your current certification. You must complete continuing education courses and training, totaling eighty clock hours, before the end of the three year period. Your continuing education activities must be focused on increasing your knowledge in the field of audiology, such as diagnostics, ethics, hearing science, etc. Your continuing education activities must include fifteen clock hours of Tier 1 courses, and forty two clock hours of approved content areas. Your continuing education activities must be provided by a school or organization that is approved by the ABA, including the AMA, the AAA, and IACET.
You must complete continuing education courses and training, totaling eighty clock hours, before the end of the three year period. Recertification is due within three years, at which time you must have logged sixty clock hours of continuing education courses, including fifteen hours of Tier I courses, and forty two hours of approved content courses, provided by a boards approved school or organization. You must also focus on increasing your knowledge of audiology.
In regards to the screening processes that you design, screen, and administer to your patients, there are several criteria that you must consider. Of the below listed criteria, which one is not a priority to you? You must ensure that all of your screening and other processes are valid, reliable, and necessary. You must ensure that all of your screening and other processes are appropriate for the patient's age, condition, and culture. You must ensure that you train and supervise all employees that work for you, or that you are responsible for, whether audiologists or non-professionals. You must ensure that all procedures you administer, have follow-up procedures to assess for further treatment or referrals. You must ensure that all of your screening and other processes are properly billed, collected, and reconciled as prescribed in the state regulations.
You must ensure that all of your screening and other processes are properly billed, collected, and reconciled as prescribed in the state regulations. You need to design the most up to date procedures and screenings, and then administer these procedures to the proper clients. You also need to do the proper follow up for each client, to assess the need for further treatment. You do not need to consider the billing and collecting of payment for these procedures, this is not of a concern at this point of the practice.
There are ethical and moral standards that you must adhere to in regards to the services that you provide to your clients and customers. You must maintain the highest standards of professionalism and competence within your practice. Which of the below listed statements is not an example of this standard? You should always reasonably charge your patients for services rendered, and referrals received, in compliance with the industry standards and code of ethics of audiologists. You should always use the available resources, including referrals to other professionals who are more capable of treating the patient. You should only provide services and administer the testing and diagnosis that you are properly educated in and thoroughly trained in using. You should never knowingly allow an employee, assistant, or other personnel within your practice to behave outside of the code of standards for the audiology industry. You and all of your employees must ensure that all reasonable precautions are made to ensure the safety of all patients and clients.
You should always reasonably charge your patients for services rendered, and referrals received, in compliance with the industry standards and code of ethics of audiologists. You should never charge a patient for a referral to another professional. This is against the code of ethics of audiologists. You should keep your patients safe, ensure that you and all of your staff are in compliance with state regulations and the code of conduct of your profession.
▪ inflammation of membranes that surround the brain and spine ▪ Causes profound loss ▪ Acquired SNHL ▪ If bilateral loss, CI recommended ▪ ossification may complicate CIs
bacterial meningitis (viral or bacterial)
A language-stimulation program for a 6-month-old infant newly identified as having a hearing impairment should
be integrated with routine activities in the home . Intervention for infants who have hearing impairments must center on family involvement.
another suspected cause of BPPV; claims that debris is free floating in the posterior SCC. When the head is moved into a provoking position, the debris moves to the most dependent position in the canal, causing the endolymph to move away from the ampulla causing the deflection of the cupula and vertigo. free floating in PSCC
canalithiasis
Oculamotor testing checks for _____ deficits
central
abnormal tracking/smooth pursuit =
central pathology
○ Procedure: ■ 1. Look straight ahead while seated ■ 2. Hold head still and turn body (left and right) ■ 3. Since we are testing the vestibulo-spinal reflex (VSR), it is normal to NOT have nystagmus after the testing and abnormal to have nystagmus while body turned (and head straight)
cervical vertigo test (VSR)
For audiologic equipment that comes in contact with patients, disinfection and sterilization reduce the risk of cross contamination. The key consideration that calls for sterilization rather than disinfection is that the equipment A. does not have disposable parts B. is used with multiple patients C. is used with patients with known infections D. can survive the heat of sterilization in an autoclave E. comes into contact with blood or other bodily substances
comes into contact with blood or other bodily substances When audiologic equipment comes into contact with blood or other bodily substances, it requires sterilization rather than disinfection because sterilization is capable of eliminating microbiological organisms.
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 Continuous interleaved sampling (CIS) is a cochlear implant signal-processing strategy that minimizes channel interaction by presenting pulses in a nonoverlapping sequence.
o Strongest correlation coefficient for two variables → highest number closest to 1 (doesn't matter if positive or negative) o 0 indicates no correlation between 2 variables o further from 0 indicates stronger correlation
correlation
suspected cause of BPPV; proposes that debris of the degenerating otoconia from the utricle become adherent to the cupula of the posterior SCC. The canal becomes sensitive to gravity instead of angular rotation. When the canal is in a plane parallel to the force of gravity (lying down) the cupula is inappropriately deflected producing the vertigo. adherent to cupula of PSCC
cupulolithiasis
Reduced visual function that can complicate planning for aural rehabilitation is most likely to be found in patients with hearing losses who present with A. Ménière's disease B. Treacher-Collins syndrome C. erythroblastosis fetalis D. otitis media E. diabetes
diabetes Diabetes is a major cause of acquired visual impairment; the audiologist should take this fact into consideration when planning rehabilitation for patients with diabetes.
what does non-linear amplification mean?
different amounts of gain are applied to soft, moderate and intense sounds
In order to minimize the chances of exacerbating tinnitus, which of the following should be avoided? A. Exposure to high levels of chlorine B. Using hearing protection devices C. Taking high doses of beta carotene D. High stress E. High-intensity exercise
high stress
What is real ear insertion gain (REIG)?
how much extra sound is presented to the eardrum as a result of inserting the hearing aid in the ear.
▪ Stapes at OW and RW on bottom ▪ Scala vestibuli- scala media (endolymph K+ intracellular) - scala tympani ▪ Scala media separate from vestibuli by Reissner's membrane ▪ Base- narrower and stiffer - HF ▪ Apex- wider and not stiff - LF ▪ Organ of corti- sensory organ for hearing, sits on BM; complex arrangement of sensory hair cells ▪ Tectorial membrane- on top of organ of corti ▪ Stria vascularis- maintains chemical environment of scala media - Source of metabolic E for cochlear amplifier
inner ear
compression ratio =
input ------ output
output =
input + gain
o SPL inversely related to distance from sound source: doubling distance from sound source yields ½ sound pressure o 6 dB for doubling pressure distance o 3 dB for doubling intensity distance
inverse square law
Using the Lexical Neighborhood Test, which of the following is an "easy" word? Juice. Thumb. Pie. Wet. Fight.
juice The words "good" and "drive" are easy words of this test. Additionally, "time", "gray", and "foot" can be used.
▪ nystagmus always suppressed by visual fixation ▪ beats toward intact ear ▪ follows Alexander's law ▪ enhanced with eyes closed ▪ uni-directional
labyrinthine lesion
The caloric test is designed to stimulate which of the following structures?
lateral/horizontal SCC
Elicitation of an acoustic reflex at a hearing level better than that obtained with voluntary behavioral responses suggests the presence of
malingering/functional HL/nonorganic HL
How long will patients with vestibular neuronitis experience vertigo?
may experience for weeks to months after the acute event.
▪ Consultation with industry for development of products related to audiology ▪ Electro diagnostic assessment for purposes of intraoperative monitoring ▪ Cerumen management to prevent obstruction of EC ▪ Selection of amp systems for pt with hearing loss ▪ Only includes non-medical tx for balance issues
o ASHA "scope of practice"
- What do absent OAEs indicate about hearing? What do normal OAEs indicate about hearing?
o Absent OAEs = hearing loss o Normal OAEs = OHCs functioning normal
define functional gain
o Amount of improvement hearing aid brings to wearer's hearing levels o difference between aided and unaided sound field thresholds o obtained at octave/half octave frequencies only
● What are the advantages and disadvantages of BTE HAs compared to CIC HAs? Are CIC better than BTE for retaining the natural resonating powers of the outer ear?
o BTE ▪ More power ▪ Don't have to change out whole aid if not enough ▪ RICs are small discrete ▪ Can have open dome- less occlusion ▪ Good for any type of loss o CIC ▪ Yes- natural resonating powers of outer ear ▪ Small, discrete ▪ May be uncomfortable ▪ bad for occlusion
cVEMP vs oVEMP
o C-vemp -- Stimulates saccule and inf vestib nerve→ SCM o 0-vemp -- stimulates the utricle and sup vestib nerve
● What criteria make a patient a candidate for a cochlear implant or an osseointegrated cochlear stimulator?
o CI ▪ Bilateral mod/severe to profound HL ▪ >PTA 70 dB HL in both ears?? ▪ <50% word rec in implant ear and <60% in other ear ▪ 1-2 year old ● HA trial 3 months- profound bilateral ▪ >2 Severe to profound HL o BAHA ▪ At least age 5 ▪ Single sided deafness, mixed or CHL ▪ ABG >30 dB ▪ <65 dB HL BC PTA
● Describe the process of obtaining Desired Sensation Level(or DSL). With what population is it used?
o Children o DSL gives more gain than NAL (children need louder) o DSL for loudness (give them as much as possible) NAL- for intelligibility o Patient variables that can affect gain: experience, gender, bilateral/uni, language, age, loudness discomfort measures use
- Discuss headphones options - list the pros and cons of each.
o Circum-aural is for high frequencies o Supra-aural is for normal ones, 40 dB attenuation, possibly cause collapsed ear canal/ standing waves at high frequencies o Inserts are for all, 60 dB attenuation, no collapsed EAC, more comfortable, cleaner, expensive,deeper insertion helps to avoid standing waves
- What is the major difference between behavior observation audiometry (BOA) and visual reinforcement audiometry (VRA)?
o Conditioning response to sound for VRA whereas BOA looks for natural, unconditioned response to sound
● What results from behavioral audiometry call for physiologic assessment to establish patient's condition?
o Conductive HL o Asymmetry in puretones (BC) o Asymmetry in word rec o Abnormal reflexes o Positive decay o Rollover ▪ During speech perception tasks, present at 50 dB HL and patient gets 80%. When they present at 60 dB HL and patient gets 20%. ▪ Indicative of a Retrocochlear Pathology
● CI Signal-Processing Strategies
o Continuous Interleaved Sampling (CIS) - signal-processing strategy that minimizes channel interaction by presenting pusles in a non overlapping sequence o Feature Extraction o Fine Structure o Current Steering o Filter Bank
not presented and doesn't raise hand Can be catch trial
o Correct rejection
- What steps need to be taken to verify the different kinds of assessment equipment?
o Daily - beginning of each day, check cords/plugs, listen for distortion, cross-talk, and transients, and check thresholds of stable hearing person o Annual - SLM, octave band filter, keep calibration records for 5 years o Exhaustive - resets output of audiometer to meet ANSI standards, REQUIRED EVERY 2 YEARS
● Explain the terms "dependent variable" and "independent variable" as they relate to experimental design.
o Dependent: outcome of the study - the thing you're interested in o Independent: thing that predicts the outcome of a study
- What is the difference between disinfection and sterilization? When is sterilization required?
o Disinfection- gross cleaning- cleaning tables o Sterilization- killing all spores (required for critical items- anything that can transmit disease or infection e.g. blood and mucus)- cleaning tools
- What are the fluids found in the labyrinths of the inner ear?
o Endolymph - Scala Media - Basilar Membrane o Perilymph - Scala Vestibuli (RM) and Scala Tympani (BM)
▪ indirect assessment of leak of inner-ear fluid into ME space, at RW membrane ▪ Recording/observing eye movements while pressurizing each ear canal ▪ Positive test = surgical exploration ▪ Window fistulae or SCCD
o Fistula test
● What is the relationship between fundamental freq and harmonics?
o Fundamental frequency: lowest component of complex periodic wave ▪ Largest whole number common denominator of harmonics ▪ Lowest resonant frequency ▪ First harmonic o Harmonics: whole number or integral multiples of the fundamental frequency ▪ Fundamental is also harmonic ▪ X1 - x 2 - x3 to get first 3 harmonics ▪ Some sound waves have odd harmonics (e.g. square wave) ▪ Occur at each multiple of FF for a tube open at both ends ▪ In tube closed at one end, only odd harmonics of FF
what referral would you make for a baby id. w/ severe-profound HL w/unknown etiology?
o Genetic evaluation to help id etiology of impairment and determine probability of couple's future offspring
▪ Can send records clarifying health care charges to 3rdparty payer (e.g. Medicaid) after valid authorization form ▪ Parent of >18 yo cannot request records ▪ Do not mention patient details in public setting ▪ Do not discard medical records in trash → shred ▪ Do not send patient info to org w/o permission ▪ Client must sign HIPAA compliant release of info form
o HIPAA- Health Insurance Portability and Accountability Act
- What does the Joint Committee on Infant hearing require in terms of screening and timing requirements?
o Hearing screening using physiologic measure by 1 month of age o Diagnosis & confirmation of hearing loss by 3 months of age o Infants with confirmed HL, receive intervention services by 6 months of age
▪ Voicing → duration → frication → place ▪ Voicing involves increase in intensity that HI can distinguish ▪ Duration- distinguish by visual cues Frication and place not easy to distinguish- at HF less intense than LFs
o Hierarchy of phonetic features- easiest to most difficult to distinguish with Hearing impairment
● What kinds of results in gap detection and dichotic listening are suggestive of CAPD?
o Higher threshold for GD o Normal is 2-3 ms o Varies based on frequency, duration, amplitude, BW o Not being able to do a dichotic listening task (diff things to each ear)- poor binaural integration and binaural separation o Worse with increased age (and impaired hearing at same level?) o Difficulty with temp fine structure and SIN
● What do rotational tests indicate about patients?
o Horizontal SCC abnormality o Triggers VOR o Evaluates peripheral vestibular with multifrequency stimulation o Best to evaluate bilateral impairment o May not be able to localize findings (central or peripheral)
what are the standard CPT/ICD9 diagnosis codes used by audiologists?
o ICD:international classification diseases- diagnosis code ▪ 389- HL codes ▪ 389.11- SNHL o CPT: Current procedural terminology PT Air & Bone: 92553 SRT: 92555 Speech Audiometry (SRT & WRS): 92556 Comprehensive audiometry with speech rec-92557
● What provisions of educational legislation (e.g. IDEA) have an impact on audiologic practice?
o IDEA- Individuals with disabilities education act ▪ Individualized family service plan (IFSP) - Required for children 0 to 3 years (or 2?) according to PL 99-457 ▪ Individualized education program (IEP) ▪ "least restrictive" educational environment - varies from child to child - individual eval by teamof professionals to determine most appropriate school placement
- Make a list of the age-appropriate testing methods used for infants to children age 6.
o Infant Tymps - 1000 Hz probe tone (up to 6 mo)- the ME system is mass dominated with a lower resonant frequency ▪ Mass impedes high frequencies→ mass dominated ear "likes" low frequencies, need to the high frequency probe tone to evaluate mass-dominant pathology o BOA- up to 6 months cognitive age o VRA- 6 months - 3 yrs cognitive age (according to ped aud) o CPA- 2.5 years - 3 yrs+ cognitive age (according to ped aud) o 5 years cognitive age- hand raising or button o SRT- spondee pictures or body parts o WR ▪ 0-2: ESP ▪ 2-5: NU-CHIPS (4 alternative forced choice paradigm)- closed set ▪ 4-6: WIPI (doesn't require voiced answer -- good for poor articulation, delayed speech) - closed set ▪ 5-8: PBK ▪ Older than 6 (8?): CNC or NU-6 ▪ % correct ● 90-100% excellent understanding of speech in quiet ● 80-89% good ● 70-79% fair ● <70% poor o SIN- BKB-SIN 5 - 14; QuickSIN after
- On ABR tracings, how can you tell if waves are delayed?
o Latency of wave 5 past 5.5ms o 1-5 latency greater than 4.4ms
● List some conditions that require the integration of multiple audiometric assessments to diagnose.
o Meniere's disease o CAPD o ANSD o CHL o Any vestibular disorder o Retrocochlear Pathology
● What is the advantage of getting the HA closer to the TM?
o Natural resonance of EC o Increased gain o Diminished occlusion o Reduced feedback o Secure retention o Ear's natural directionality o Use of phones o Decreased wind noise
Thresholds and levels of HL
o Normal: Above 15 dB o Slight: 16-25 o Mild: 26-40 o Moderate: 41-55 o Moderately-Severe: 56-70 o Severe: 71-90 o Profound: 91+
- When is ASSR called for as an assessment and how is ASSR testing done?
o Only good for infants with flat moderate profound SNHL o ASSR can test 2 ears, 4 carrier frequencies, and 4 modulation frequencies at the same time - fast and automated o Always overestimates the degree of hearing loss (makes it look worse than actually is)
- When is ASSR called for as an assessment and how is ASSR testing done?
o Only good for infants with flat moderate profound SNHL o ASSR can test 2 ears, 4 carrier frequencies, and 4 modulation frequencies at the same time - fast and automated o Always overestimates the degree of hearing loss (makes it look worse than actually is)
-What are the etiologies of hearing loss present at birth?
o Originating from the Mother ▪ Cytomegalovirus (CMV, time of HL onset varies, most common congenital HL) ▪ Syphilis (late onset) ▪ Herpes Simplex ▪ Toxoplasmosis ▪ Drug Exposure (FAS and Cigarette) ▪ Rubella o Originating from the Baby ▪ Anoxia ▪ Prematurity ● Low birth weight ● APGAR below 6 ▪ Hyperbilirubinemia o Congenital Syndromes ▪ Ushers ▪ Waardenburg ▪ Treacher Collins ▪ Pendred ▪ Wolfram ▪ DFNB1
- What middle-ear condition would present with a tympanogram that is flat and acoustic reflex absent?
o Otitis media
- Name the condition associated with bony growth surrounding the bones of the middle ear and describe the type of hearing loss that accompanies it.
o Otosclerosis- conductive HL -Carharts notch- bone conduction falls at 2k also due to resonance of ossicles
● What are the outcome measures that can be used to eval effectiveness of HAs and other assistive technology?
o Outcome Measure = aka validation o COSI o APHAB o HHIE before and after o IOI-HA - covers domains of usage, benefit, residual activity limitation, satisfaction, residual participation restriction, residual impact on others, and QOL change ( 7 Qs) o International Outcomes Inventory for HAs
- Describe the function of each of the 3 parts of hearing mechanism.
o Outer: funnels sound o Middle: encodes sound waves into mechanical vibrations o Inner: sends encoded stimulus to brain
- What is the function of the hair cells? (outer and inner)
o Outer: the mechanics behind the movements of cells o Inner: encodes speech into brain signals
● Describe the technique for viewing viaotoscopy the EC and TM.
o Pull pinna up and back for adults o Pull pinna down and back for kids o BRACE
● What behavioral phenomena are associated with central aud processing disorder (CAPD)?
o Reading difficulties o Difficulty following multi step directions o Difficulty staying on task and completing a task o Difficulty localizing sound o Difficulty remembering sequence of sounds o Difficulty learning what they hear
- Describe follow-up procedures for a person who has not passed a hearing screening.
o Refer for full hearing eval
- Discuss the pros and cons of live-voice vs. recorded-speech testing
o Reliability, consistency, calibration, binomial distribution (critical differences) o cons of live voice: ▪ different between clinicians ▪ different between same clinician ▪ not consistent level ▪ pronunciation o pros of live voice: ▪ better responded to by children & profound losses ▪ can use familiar phrases and words
- What features of an assessment will affect its reliability?
o Response timing o Language o Age o Calibration of equipment o Ambient noise level o Cognitive function
- Elevated acoustic reflex levels in the presence of normal hearing might lead you to think what?
o Retrocochlear
communication method that makes deaf communication like English print with finger spelling and oral language Developed to integrate deaf people into mainstream society Encourages speech reading
o Rochester communication method
● What is the relationship between sound pressure level (SPL) and hearing level (HL)?
o SPL - pressure reference o HL - hearing reference - average hearing threshold of young, healthy, normal humans o Decibels in hearing level, or dB HL, is commonly used in audiology because it refers to the decibel level on the audiometer. The reference level for dB HL is "0," which is related to the averagethreshold in decibels sound pressure level (dB SPL) for the average,normal-hearing listener.
- Having obtained a reliable SRT, how would you estimate MCL?
o SRT to UCL- dynamic range o 40 dB SL (about 60 dB SPL re: SRT)
- Define SRT, SAT, MCL, UCL. Describe the procedure for obtaining UCL.
o SRT: speech recognition threshold, softest level in which someone can repeat back a word 50% of the time o SAT: sound awareness level: softest level someone can tell speech is being presented at o MCL: most comfortable level: persons prefered level of listening to a tone/speech o UCL: uncomfortable level: loudest level a person can tolerate a tone or speech. done at 500 and 3000 Hz, start at 60 dB present continuous tone and increase by 5 dB until patient indicates it is uncomfortably loud. complete twice per frequency and average
- What pathologies are associated with reports of dizziness?
o SSCD o EVAS o Endolymphatic hydrops o BPPV o Meniere's o Note: Labyrinthitis (involves hearing loss) and Vestibular Neuritis can come with reports of dizziness/vertigo as well
- In audiometric screening of workplaces, what is a standard threshold shift?
o STS = Greater than 10 dB shift at 2,3,4 kHz in either ear ▪ Measured with audiometer, used as a baseline, used to determine if HL is caused by workplace noise
- Describe the screening protocols recommended for screening adults and children. How do they differ?
o School age - 20 dB (pure tones for screening) o Adults - 25 dB o Geriatrics- 25 or 40 dB
communication method that involves signing in morphemes
o Seeing Essential English (SEE)-
Sensitivity vs. Specificity
o Sensitivity: correctly id those individuals who actually have Hearing disorder o Specificity: correctly id how accurately test measures those individuals who do not have a hearing loss
what are the types of prespycusis?
o Sensory- atrophy and degeneration of sensory and supporting cells o Neural- loss of spiral ganglion cells o Metabolic/Strial- atrophy and degeneration of lateral wall, especially the stria vascularis o Mechanical- inner ear thought to change its conductive characteristics o Updates findings - places less importance on HC loss and more on neural loss and strial atrophy
● Describe the functions of each of the major components of a hearing aid.
o Sound Bore - increases HF gain o Venting - affects LFs (more venting, less LF gain) - OE o Tubing - thick for more gain, 13 standard, tube lock o Retention - helix lock, tube lock
● Describe different conditions of EC and ear that can be observed through the otoscope and might cause an audiologist to refer a patient for medical consultation
o Stenosis - narrowing of canal, usually acquired o Atresia - narrow or absent canal o Microtia? o acute external otitis - bacterial infection- canal is red and swollen o otomycosis - external otitis-fungal growth o drainage o bullous myringitis - secondary to viral infection of ™- otalgia,otorrhea o dermatitis - allergies- scaling and oily patches ▪ Eczema - dry skin, red ▪ psoriasis- silvery flakes o bacterial perichondritis - infection of dense fibrous tissue o exostoses - bony growth- usually from cold water car o osteama, carcinoma tag/pit labyrinthitis otosclerosis ossicular discontinuity
▪ Hypoplasia of mandible and facial bones ▪ May have cleft palate ▪ Atresia ▪ Tx: BAHA/ BC HA, surgery for atresia
o Treacher-Collins syndrome- dominant- CHL
▪ Assess horizontal & vertical VOR b/w 2 & 6 Hz ▪ Looking for compensating eye movement in response to head movement ▪ Recorded via EOG electrodes prior to ENG/VNG (if same day) ▪ Move head side to side and up and down while looking at target
o VAT - Vestibular Autorotation test
▪ progressive unilateral HL ▪ Significant decaystapedial reflex ▪ No id waves on ABR ▪ Disproportionately poor WR ▪ Prolonged I-V ▪ HF tinnitus
o Vestibular schwannoma/acoustic neuroma/VIIIth nerve disorder
- Which commonly used pharmaceuticals can affect balance? Which are ototoxic?
o Vestibulotoxic: Mycin family ▪ Gentamycin and streptomycin ▪ Aminoglycosides- most vestibulotoxic o Cochleotoxic: platin family ▪ Cisplatin ▪ carboplatin
- What are phonetically balanced word lists used for?
o Word Recognition o Spondees are used for SRT and have the same stress on each syllable o Phonetically balanced words represent each frequency of speech in the word.
● Describe the aud training program for a child implanted with an artificial cochlea at 3 years. (cochlear implant?)
o activation 1 month after implant o return 1 and 2 weeks post activation o return 1 month post activation o return regularly until consistent or good map o speech therapy weekly o auditory verbal therapist in school, least restrictive environment in school if possible with aid
How would you obtain speech-awareness thresholds with a very young child who does not talk?
o awareness can be done with VRA o body parts for SRT o through MLV
▪ flat tympanograms ▪ Absent acoustic reflexes ▪ near normal word rec >80% ▪ low frequency hearing loss with normal BC → ABG ▪ could cause difficulty in school ▪ associated with colds/sinus infections ▪ preferential Classroom seating and monitor ME status ▪ according to IDEA, recommend IEP (individualized education program) ▪ recurrent→ at risk for academic difficulties ● limited vocabulary range ● medical referral ● speech language consultation ▪ with effusion (fluid) ● can be serous- thin, watery, sterile ● suppurative- pus, purulent ● mucoid- thick ● sanguinous- blood ● acute vs. chronic (> 3 months) ▪ CHL ▪ Pressure equalization (PE) tubes ● Equalizes pressure between middle and outer ear ● take over function of blocked eustachian tube ● myringotomy- surgery done to place tubes ▪ Loss from 10-50 dBbut temporary
o chronic otitis media (inflammation ME and TM)
● Describe the procedure for verifying the functioning of HAs.
o electroacoustic analysis before fitting o calibrate test box o place hearing aid in .4cc coupler over x ▪ 2cc - ANSI (blue) ▪ 4cc - Speech mapping (silver) o place microphone close hearing aid mic o run OSPL 90, average gain at 50, average gain at 60, % of distortion (should be less than 3)
● What features of a HA can be adjusted and how can they be used to optimize performance of a patient?
o frequency response- adjusting based on complaints o dynamic range- audibility of sounds o MPO- louder or softer for preference o Compression ▪ WDRC Compression: Low compression threshold, low compression ratio ● Provides additional gain for low input levels with the low compression threshold ● Provides gradual increases in gain as input levels increase using a low compression ratio
● Describe the mapping process for cochlear implants.
o impedance o turn on/live o set T levels (via counting or behavioral) o set C levels o loudness balancing o Put maps in programs & features o write to processor o save in program o exit
▪ causes tinnitus and symmetrical HL and HL in noise ▪ antimalarial drugs (meds quinine based) ▪ cisplatin ▪ aminoglycoside antibiotics- gentamycin ▪ loop diuretics ▪ ethycrynic acid ▪ affects HFs first ▪ anti-cancer/anti-neoplastic- cisplatin ▪ salicylates- aspirin ▪ NSAIDs - ibuprofen
o ototoxicity/vestibulotoxicity
● In general, how is the effectiveness of a CI affected by whether the pt was deafened prelinguistically or postlinguistically?
o prelingual deafening and implantation early= better speech perception results o postlingual deafening= harder adjustment to speech perception ▪ Auditory-Verbal Therapy - preferred Oral/Aural Communication method for involved parents that don't know sign, no ties to Deaf culture, and child shows HA benefit.
● What features of a CI can be modified and how can they be used to optimize performance of a patient?
o pulse width → increase width, decreases threshold, comfortable levels should drop o stimulation rate → ANR DR increases as pulse rate increases o dynamic range → larger the DR, larger amount of sounds can be heard o T levels → threshold o C levels → comfortable level
● What is DR and how is it necessary in the fitting of a HA?
o soft sounds audible o loud sounds comfortable o the range of amplification of a hearing aid
Localize >1500 Hz(or 2000) vs Localize <1500 hz
o toward ear receiving more intense stimulus (ILD) ▪ Baffle effect- temporal cues unreliable at HFs ▪ ild used for high freq o toward ear receiving earlier arriving stimulus (ITD) ▪ itd used for low freq ▪ headshadow
- How often does the audiologist reinforce the child in VRA?
o until task is learned/conditioned to task
● What types of modifications can be made by changing tubingand by venting the EM?
o venting allows for leakage of low frequencies (less occlusion) o Venting will decrease directionality o Thick tubing keeps sound in so more gain o Old tubing is hard and allows sounds to escape
o Steepest rise in performance-intensity function:
o → sentences over words/syllables/phonemes ▪ Rises most steeply with small increases in intensity when the speech sample is large and provides some context ▪ Synthetic sentences don't provide as much context as natural sentences-→ additional clues ▪ Synthetic sentence test allows pt to pick out words from a list
what is a cycle? (parameter of sound)
one replication of vibratory pattern
▪ Malleus or "hammer" ▪ Incus- "anvil"- malleus and incus originate from 1stpharyngeal arch ▪ stapes- "stirrup" ● Annular ligament holds stapes to OW ● Rests on oval window ● Smallest bone in the body
ossicles of ME
▪ swimmer's ear ▪ Acute bacterial infection that causes inflammation of outer ear and ear canal
otitis externa
Click-evoked otoacoustic emissions are most likely to be recorded from the ears of which of the following individuals?
pt w/upper brainstem lesion Upper brainstem lesions do not always interfere with otoacoustic emissions, so otoacoustic emissions can be recorded from the ears of persons with upper brainstem lesions.
When performing identification audiometry for school-age children, which of the following types of signals should be used?
pure tone signals
what is REIG
real ear insertion gain how much extra sound is presented to the eardrum as a result of inserting the hearing aid in the ear.
A patient has been identified with normal hearing through 1500 Hz with a bilateral sharply-sloping sensorineural loss in the frequency range above 1500 Hz. The most appropriate system of amplification to recommend for this patient is A. binaural completely-in-the canal hearing aids B. receiver-in-the-ear (RITE) aids with an open ear fitting C. binaural behind-the-ear aids with occluding earmolds D. in-the-ear aids with no venting E. an assistive listening device
receiver-in-the-ear (RITE) aids with an open ear fitting Given that this patient does not have a low-frequency hearing loss, a RITE hearing aid with an open ear fitting will allow low-frequency sounds to enter without being amplified. As a result, the emphasis of amplification will be in the high frequencies.
what is the purpose of expansion?
reduces the gain of low-level ambient sounds increases signal DR
What is RETFL and what does it measure?
reference equivalent threshold force levels; the reference standard measurement for bone conduction transducers.
What is RETSPL and what does it measure?
reference equivalent threshold sound pressure level; the reference standard measurement of air conduction transducers.
A 3-year-old child with chronic ear infections had PE tubes placed six months ago. Although the current audiological battery reveals normal hearing bilaterally, the tympanograms reveal a large volume in the right ear and a flat tracing with a small volume in the left ear. The next step should be
referral to the ENT physician for further evaluation and treatment
the time delay that occurs between the offset of an input signal sufficiently loud to activate compression (i.e., input signal falls below the TK) and the resulting increase of gain to its target value. Specifically, ANSI (2014) defines this as the interval between the abrupt drop in input level from 90 to 55 dBSPL and the point where the output level has stabilized to within 4dB of the steady value for an input of 55 dBSPL.
release/recovery time
This counseling strategy is especially suitable for families that are involved, but not quite ready or motivated to make a decision.
selling With this strategy, the audiologist's goal is to motivate the family to pursue a particular plan of action. The audiologist must "sell" a specific idea, and if the family can be convinced that this is the best way to go, they will likely follow suit.
What are the symptoms of VN?
severe rotational vertigo with accompanying nausea. Early in the onset of the disorder, spontaneous nystagmus can be detected beating toward the affected ear.
checking for horizontal bppv ○ Fix with: Barbeque roll
side laying
What is real ear aided response (REAR)?
the SPL near the eardrum minus the SPL at some reference point.
In a clinical-decision analysis, sensitivity of a screening test refers to A. the incidence of false positive results in patients who do not have the disorder B. the accuracy of the test in correctly rejecting patients without the disorder C. the predictive value of negative results D. the accuracy of the test in correctly identifying patients with the disorder E. the incidence of false negative results in patients who have the disorder
the accuracy of the test in correctly identifying patients with the disorder Sensitivity" refers to the accuracy of the test to correctly identify those patients who have the disorder of interest.
what does linear amplification mean?
the same amount of gain is applied to all sounds Ex: 30dB of gain is applied at and below the TK regardless of the input level, resulting in linear amplification. Thus, another way to look at linear amplification is that it has a CR of 1:1; compression is applied only above the TK and when the CR is greater than 1:1.
the point at which the slope of the I/O function changes is referred to as the
threshold knee point (TK)
Read the terms below and choose the one that is on the easy words list of the Multisyllabic Lexical Neighborhood Test. Tiger. Bottom. Finish. Bunny. Belly.
tiger "Cookie" and "again" are on the easy word list. Additionally, "another" and "almost" can be used.
▪ Sound is reverberant and hollow and own voice sounds like in a barrel ● Indicates LFs are overemphasized ● Add vent or enlarge present vent→ help LF sounds escape ▪ Feedback → ● decrease vent size/plug up vent ● feedback reduction ● can change tubing ▪ lower OSPL90- lowers all frequencies ▪ add 680 or 1500 ohm damper → would increase LF input ▪ widening earmold bore → emphasize HFs ▪ Precipitously sloping HF SNHL: 2mm sound bore, libby horn, wide vent
troubleshooting HAs
What is the plateau method?
true threshold is reached when threshold of test ear remains stable over a range of at least 15-20 dB increase in masking intensity
A patient who has a sudden profound sensorineural hearing loss with poor word recognition in the left ear undergoes a complete otological evaluation, including a prescribed course of steroids, an MRI, and serial audiograms. The otologist determines that the loss is irrreversible and refers the patient to an audiologist for follow-up. The most logical next step for the audiologist is to A. fit the patient with a power behind-the-ear hearing aid on a trial basis B. suggest the patient enroll in speechreading classes C. try a transcranial CROS hearing-aid with the patient D. make a referral to another otologist for a second opinion E. make a referral to a speech-language pathologist for information regarding speech conservation
try a transcranial CROS HA with the pt A transcranial CROS hearing aid reroutes signals from the poor ear to the better ear via bone conduction
Which hearing test will measure the mobility of the eardrum, reveal a stiff eardrum, or hole in the membrane?
tympanometry An audiologist will take measurements that provide information about how the middle ear is functioning. These measurements include tympanometry, acoustic reflex measures, and static acoustic impedance measures. Tympanometry is an exam used to test the condition of the middle ear and the mobility of the tympanic membrane (eardrum), also in revealing cerumen blockage or tears in the eardrum. Results are graphed on a chart termed a tympanogram.
▪ Acrylic (lucite)- hard plastic-good for elderly ▪ Silicone- good for allergies- good for children ▪ Soft vinyl or silicone for higher gain aid
types of earmolds
Ipsilateral right-Absent (pathology in probe ear) Contralateral left - Absent (pathology in probe ear) Ipsilateral left - Present & WNL Contralateral Right - Elevated by amount of HL or absent
unilateral CHL AD
Which of the following is an effective way to eliminate the cochlear microphonic from the electrocochleographic response?
using alternating polarity clicks The cochlear microphonic response can create noise that makes it difficult to interpret the electrocochleographic response waves. The polarity of the cochlear microphonic response (but not the polarity of the electrocochleographic response) varies with the stimulus, so when polarity of the clicks used as stimuliis alternates, the cochlear microphonic response is cancelled out, and an electrocochleographic response wave can be obtained.
● Done to avoid a basilar strokeand provides information for differentialdiagnosis ○ Procedure: 1. Lean forward while seated, hands on thighs (so BPPV isn't triggered) 2. Head turn to right & left 3. Hyper-extension of neck (aka lookup with head turned) 4. Count aloud to 20 ● ABNORMAL if there is blurred vision, numbness, tingling, slowed/slurred speech, nystagmus
vertebral artery screening
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?
visual reinforcement audiometry (vra)
A 6-month old is brought to the clinic by her parents. They report that she has had two bouts of otitis media already and they want to be sure her hearing is okay. The audiologist would like to test using VRA. Prior to beginning testing, the audiologist should be certain that the infant is able to
visually track objects laterally Six-month-old infants can be expected to be able to track objects laterally with their eyes, and this skill is essential for visual reinforcement audiometry (VRA).
People with HF HL have more difficulty hearing what sounds?
voiceless fricatives (f,th,s,sh)
main ABR wave in interoperative monitoring
wave V
: each subject is tested at all levels of the variable
within subjects
Which of the following analysis parameters is (are) most affected when auditory brainstem response tests are conducted using supra-aural earphones rather than insert earphones?
· Absolute latencies · supra-aural earphones cause a delay due to sound travel through the tubes; this delay lengthens absolute latencies. o Inserts - earlier latencies (inserts are closer to generator site) o Headphones - later latencies (headphones are farther from the generator site)
○ Results: ■ Normal: Conjugate horizontal eye positionw/ gaze straight ahead and vertical head alignment (idk what this even means ugh) ■ Abnormal: Misalignment of the eyessometimes accompanied by upward deviation of both eyes (utricle) and upward deviation of one eye and elevation of one eye and depression of the other.
● Ocular Tilt (Skew Deviation)
Individuals with normal hearing use different cues to localize sounds. Which of the following are primarily involved in localizing an ambulance siren with a frequency of 700 Hz?
· Interaural time differences only · 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.
Which of the following types of speech recognition materials is most useful to rule out a lesion affecting the VIIIth nerve?
· Open-set, monosyllabic, phonetically balanced word lists, administered at several intensity levels · 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.
40yo female pt with bilateral normal sloping to moderate SNHL since 6yo Which of the following speech-recognition materials should the audiologist use in order to obtain the steepest possible performance-intensity function?
· Synthetic sentences · Performance level rises most steeply with small increases in intensity when the speech sample is large and provides some context ▪ Synthetic sentences don't provide as much context as natural sentences-→ additional clues ▪ Synthetic sentence test allows pt to pick out words from a list
The mutation of gene WFS1 results in which of the following?
DFNA38. Before the age of 10, the hearing loss involves 250 and 500 Hz. As it progresses, it increases to include 1,000 to 2,000 Hz.
Which of these is the result in the mutation of TMPRSS3?
DFNB8. This hearing loss is postlingual. The onset is during childhood.
Of the below, which shows that the child has auditory identification or association of different-sounding and familiar words and phrases - OBJECTS - open set?
When in the grocery store, the mom asks the child to help find the bananas. With this skill, the child can distinguish the difference between and respond differently to various environmental sounds. For example, she would likely respond one way to a dog barking, and a different way to a fountain lightly trickling water.
Probe mic verification for kids vs adults
• Probe microphone verification for children; e.g., -- real ear to coupler difference (RECD) -- aided thresholds • Probe microphone verification for adults; e.g., -- real ear insertion gain (REIG) -- real ear aided response (REAR) -- real ear saturation response (RESR) -- Insufficient probe-tube depth will tend to decrease the HF response
significant change in ototoxic monitoring
■ >/= 20 dB shift at 1 frequency ■ >/= 10 dB shift at 2 frequencies ■ NR at 3 frequencies where they were before
WDRC - wide dynamic range compression
▪ : Low compression threshold, low compression ratio ● Provides additional gain for low input levels with the low compression threshold ● Provides gradual increases in gain as input levels increase using a low compression ratio
CI candidacy * double check this in amp comp notes
▪ Bilateral mod/severe to profound HL ▪ >PTA 70 dB HL in both ears?? ▪ <50% word rec in implant ear and <60% in other ear ▪ 1-2 year old - minimum age 12 months ● HA trial 3 months- profound bilateral ▪ >2 Severe to profound HL no benefit from HAs
CHARGE stands for:
▪ C - coloboma ▪ H - heart defects ▪ A - choanal atresia ▪ R - [retarded] delayed growth & development ▪ G - genital abnormalities ▪ E - ear anomalies
what is a cholesteatoma?
▪ Complication of recurrent OM and TM perfs ▪ Can result in HL and vestibular issues ▪ Squamous epithelium growth in ME and mastoid
what are the different types of OAEs?
▪ DP: cubic distortion product ● Occurs when ear is stimulated by 2 different PTs ● requires use of 2 oscillators and 2 attenuators to control signals ● Presentation of pairs of pure tones to pt ear ● Measures auditory response: cubic difference tone (largest DP) ● Distortion products are produced b/c nonlinear system ● Summation tone and harmonics may occur but very small (not measured) ● (HCs do not resonate) ▪ transient evoked (click) ● not likely to be recorded from person with profound HL, severe presbycusis, otitis media, or taken aminoglycosides ● absent for severe SNHL and poor transmission when impedance of ME abnormal ● may be present in person with upper brainstem lesion ● in response to stimuli generated and controlled by single oscillator and attenuator ▪ spontaneous OAE- occurs in the absence of input stimulus, so no oscillator or attenuator required to provide stimuli ▪ stimulus-driven OAE: in response to stimuli generated and controlled by single oscillator and attenuator ▪ Fine structure OAE- in response to stimuli generated and controlled by single oscillator and attenuator
what are some hearing aid modifications you can make?
▪ Gradually increase tubing diameterfrom earhook to canal tip→ boosts HFgain in BTE ▪ Increase vent- decrease LFs gain ▪ Plug up vent- increase LF gain AND prevent feedback ▪ Damper?? Affects mid frequencies → smooths out peaks ▪ Horn effect: progressively increasing the internal diameter of the sound bore ● Boosts HF response ▪ Boost HF response of HA, as measured in EC ● 4 mm Libby Horn- bore widened at eardrum end ● 3 mm Libby Horn- ""- allows HFs to pass w/o being hampered by too little space for diffusion ● shortened canal- more space at eardrum than outer end (shortened tube?) ● bell bore- bore widened at TM end (gradually increased diameter) ● NOT- bore with narrow diameter ▪ Bore with narrow diameter- enhances LFs ▪ Tube changes- 3-4 months
o NAL-NL2
▪ Increase for experience ▪ Increase for males ▪ Both DSL and NAL2 decrease for bilateral ▪ Now has different for child vs. adult
Types of counseling models
▪ 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
what are the types of IE abnormalities involving the cochlea?
▪ Michel-type aplasia- total bilateral absence of differentiated inner ear structures, abnormal curse of facial nerve and jugular veins ● Genetic origin - dominant- suggested ● Complete labyrinthine aplasia ▪ Michel dysplasia- arrest in embryonic development occurs later ▪ Mondini dysplasia/malformation- most common coch abn ● Incomplete cochlea ● Single turn of cochlea (< normal 2.5) ▪ Scheibe degeneration- cochleosaccular dysplasia (partial) ● Partial orcomplete aplasia cochlea and saccule ● Normal utricle and SCCs ▪ Cochlear aplasia- complete absence cochlea and hearing function ▪ Alexander- cochlear basal turn dysplasia- LF residual hearing only
types of HL due to head trauma:
▪ Temporal bone fracture→ concussion, inner ear damage, facial paralysis, severe dizziness and hearing loss ● May also cause ossicular disarticulation, TM perf, EC bleed ▪ Transverse fracturethrough otic capsule (involving) → fracture through the cochlea→ fluid drains out and HCs damage → permanent SNHL ▪ Longitudinal fracture (otic capsule sparing)→CHL ▪ Traumatic brain injury (TBI)→ speech awareness/rec to confirm true pure tone thresholds if unsure if patient understood directions b/c more likely to respond to speech than PTs
o An audiometer attenuator is set to 0 dB HL. What happens to the SPL across frequencies?
▪ The SPL necessary to achieve 0 dB HL is highest at LF, lessens in the middle frequencies, then increases at high frequencies
TORCHS stands for:
▪ Toxoplasmosis- parasite ▪ Other ▪ Rubella ▪ CMV- 1-2% of live births but only 10% have hearing loss ● Cytomegalovirus ● Most common fetal viral illness ● Herpes related ▪ HIV or HSV encephalitis ▪ Syphilis
ototoxicity
▪ causes tinnitus and symmetrical HL and HL in noise ▪ antimalarial drugs (meds quinine based) ▪ cisplatin ▪ aminoglycoside antibiotics- gentamycin ▪ loop diuretics ▪ ethycrynic acid ▪ affects HFs first ▪ anti-cancer/anti-neoplastic- cisplatin ▪ salicylates- aspirin ▪ NSAIDs - ibuprofen
stenosis - collapsed canal
▪ collapsed canal- smaller ECV ▪ HL- including 3000-4000 Hz
meningitis
▪ inflammation of membranes that surround the brain and spine ▪ can cause profound hearing loss ▪ may be good candidate for CI ▪ bacterial or viral ▪ ossification may complicate CIs
Developmental milestones
○ 6-9 mo: vocalize and localize ○ 1 yr: first word, understand simple words ○ 1-1.5 yr: understand directions, learns words but may be unintelligible most of the time, points to objects/body parts ○ 1.5-2: short phrases ○ 2-3: follow multi-step directions ○ 3-4: retells stories in detail, 5 or more sentences
immittance norms * double check this in notes
○ Ear canal volume ■ Child: 0.30-1.10 ml ■ Adults: 0.65-1.75 ml ○ Static Admittance (compliance) ■ Infants (2-4.5 mos): 0.11-0.92 ml ■ Child (3-5 yrs): 0.22-0.90 ml ■ Adults: 0.40-1.60 ml ○ ME Pressure ■ Child: -150- +50 daPa ■ Adults: -100- +50 daPA o Gradient for children (<11 yo): >275 daPA
excessive charges, claims for not medically necessary services, improper billing
● Abuse
prohibits payments for referrals o Safe harbors
● Anti-kickback
what are the 2 types of IE potentials?
● Cochlear microphonic: AC potential ● Summating potential: DC potential
○ Assess compensation pre-therapy vs. post-therapy ○ Have them shake their head on the vertical and horizontal plane (different fonts) and then compare to the baseline. ○ Results: ■ Lose 50% of horizontal = unilateral vestib ○ Since there is more info coming in at the vertical plane than the horizontal plane, the impairment doesn't impact the vertical plane as much as the horizontal
● Computerized Dynamic Visual Acuity
○ Assess the VOR ○ Procedure (can be done Sneilen chartlike eye test or computerized) ■ Have the patient look at a certain line of letters that is readable ■ Oscillate head back in forth between 2 & 6 Hz while having them read different lines on the chart. ○ Results: ■ Normal = no more than 1from baseline Abnormal =2or more lines from the baseline
● Dynamic Visual Acuity
prohibits submission of false claims
● False Claims act
billing for services not provided or falsifying claims
● Fraud
○ Evaluates the ability to utilize & integrate sensory input for postural control (visual, vestibular & Somatosensory) ○ Done under 7 conditions ■ 1st 6 tests - Romberg ■ 7th test- Fukuda ○ Can be administered post-therapy to demonstrate treatment outcomes
● Gans Sensory Organization Performance (SOP) test
○ Purpose: assesses the VORby utilizing thevelocity storage mechanism ■ Velocity is stored in the vestibular nucleus. This is why if you shake your head for a while and feel dizzy, but if you stop you wouldn't feel vertigo ○ Procedure: ■ 1. Tilt the head 30 degrees ■ 2. Rotate the head from side to side (for 25 cycles @ 2 Hz). ■ 3. Stop the head at midline and observe for nystagmus. ■ 4. Doing this w/ vision deniedis the best condition ○ Results: ■ Normal = no nystagmus ■ Abnormal = nystagmus--> can be monophasic or biphasic. ● Peripheral = horizontal away from affected side ● Central = vertical
● Halmagyi Head Thrust Test - more fluid consistent shake
Assesses the VOR ○ Procedure: Move the head rapidly (by examinier randomly) and watch gaze of eyes ■ Normal = gain maintained& eyesstay forwardas head moves ■ Abnormal = Eyes move with head (catch up saccade)
● Halmagyi Head Thrust Test - sharper more random shake
○ Purpose: assesses the VORby utilizing thevelocity storage mechanism ■ Velocity is stored in the vestibular nucleus. This is why if you shake your head for a while and feel dizzy, but if you stop you wouldn't feel vertigo ○ Procedure: ■ 1. Tilt the head 30 degrees ■ 2. Rotate the head from side to side (for 25 cycles @ 2 Hz). ■ 3. Stop the head at midline and observe for nystagmus. ■ 4. Doing this w/ vision deniedis the best condition ○ Results: ■ Normal = no nystagmus ■ Abnormal = nystagmus--> can be monophasic or biphasic. ● Peripheral = horizontal away from affected side ● Central = vertical
● High frequency Head Shake - more fluid consistent shake
• Treatment for benign paroxysmal positional vertigo (BPPV)
● Pharmacology - drugs suppressants ● Counseling - cognitive behavioral therapy ● Vestibular Rehabilitative Therapy - promotes compensation following impairment of peripheral or central vestibular system ● Positioning via Hallpikes
what is the difference b/t reliability and validity?
● Reliability refers to the extent to which assessments are consistent ● Validity refers to the accuracy of an assessment -- whether or not it measures what it is supposed to measure
types of presbycusis
● Sensory presbycusis: Degeneration of sensory hair cells o Steeply sloping HF HL o Good WR ● Neural: Degeneration of auditory neurons o SGCs o Poor WR ● Strial: Degeneration of stria vascularis o Slowly progressing flat HL ● Cochlear conductive: Structural changes in the basilar membrane
prohibits referrals to family members or entities with financial benefit
● Stark law
candidacy for implantable devices (i.e., BAHA)
● Those who can't wear a traditional HA (chronic infections/perfs), congenital malformations (microtia), large conductive HL, SSD. ▪ Single sided deafness, mixed or CHL ● Most effective for CHL b/w 30-35 dB ABG ● Bone PTA < 20 dB in good ear ● Mounted on DEAF EAR ▪ At least age 5 ▪ <65 dB HL BC PTA
APD test battery and interpretation
● USF APD Test Battery ○ WIN ....a low redundancy test ○ Competing Sentences ... a binaural separation task ○ Dichotic Digits: FR ... an integration task ○ Dichotic Digits: DR ... a separation task ○ MLD - Tonal ...an interaction task ● APD is present with a deficit in 2 or more areas ● 2 standard deviations below mean