Diagnostic Audiology Midterm flashcards |

This is a Free Service provided by Why Fund Inc. (a 501 C3 NonProfit) We thank you for your donation!

(1. Click on the course Study Set you wish to learn.) (2. If you wish you can click on "Print" and print the test page.) (3. When you want to take a test...click on anyone of the tests for that Study Set.) (4. Click on "Check Answers" and it will score your test and correct your answers.) (5. You can take all the tests as many times as you choose until you get an "A"!) (6. Automated college courses created from lecture notes, class exams, text books, reading materials from many colleges and universities.)


Long-Term Learning

Learn efficiently and remember over time.

Start Long-Term Learning

Get personalized study reminders at intervals optimized for better retention.
Track your progress on this set by creating a folder

Two Attributes of pathogenic organisms required to produce disease:

1. The microbe must be able to metabolize and multiply in or on a host. (If it gets to our hands and we wash it off you should be good.)

2. If 1 is met, the pathogen must be able to resist the defenses of the host sufficiently to be able to replicate to the higher numbers required to produce the disease.

For Transmission of disease two things are important:

1. A vehicle of transmission must be available (i.e. airborne, blood borne)

2. Microbes must normally locate a cut, nick, or body opening for their transmissions. The mouth, nose, and eyes are particularly vulnerable because they are open membranous material.

What is the most common mode of transmission for disease?


The ear canal is made of what kind of cells?

external epithelium

If cells are epithelial, what does that mean?

a nick, cut or irritations is necessary to facilitate infection via the ear canal

Infection Control requires...

cleaning, disinfecting, and sterilizing

Step for Infection Control

STEP 1: Cleaning- removing the gross contamination but not necessarily killing any germs.

STEP 2: Disinfection- means that you are killing germs

STEP 3: Sterilization- you are killing 100% of the vegetative microorganisms and their endospores. Microbes can convert to spores, which are harder to kill so the sterilization must kill these too--This would be to autoclave, or chemically kill with 2% glutaraldehyde, or heat.

What autoclave or chemical do we use for sterilization?

2% glutaraldehyde

soak items to be sterilized for 4-8 hrs; overnight is best

What needs to be sterilized?

Anything that touches blood or body fluids should be sterilized. Cerumen is not contaminated however, it does contain blood

OSHA Requirements for Infection Control

(A written Infection Control Plan)
-Implementation Protocols
-Exposure Classification
-Hepatitis B Vaccination Records
-Post exposure records

Implementation Protocols

Actual steps that will be take in your office to implement universal precautions

Exposure Classification

Each employee is classified on the basis of their potential exposure to blood and other infectious substances. The front office staff has no classification, so you need to take care of everything. How likely are you to be exposed?

Hepatitis B Vaccination Records

Employees who have the potential for encountering blood or other infectious substances should get Hep B - have you gotten yours? It is on your shoulders to let supervisors know

Annual Training Records

Each office is to conduct annual training in infection control and document it

Post exposure records

Office must document the treatment that has taken place and outcome following exposure.

True positive

-Hit rate
-failed screening
= hearing loss

False positive

-False alarm
-failed screening
= no loss

False negative

-Miss rate
-pass screening
= hearing loss

True negative

-Correct rejection
-pass screening
= no loss

Fail Screening

A. True positive (hit rate) - hearing loss
B. False positive (false alarm) - no loss

Pass Screening

C. False negative (miss rate) - hearing loss
D. True negative (correct rejection) - no loss

Screening results: hearing loss

A. True positive (hit rate) - fail
C. False negative (miss rate) - pass

Screening results: no loss

B. False positive (false alarm) - fail
D. True negative (correct rejection) - pass


•Accuracy in correctly identifying disordered subjects
•Accurately identifying that they have a disorder
•A= they passed it and they do have problems
•Want to be high
•Few under-referrals


•Accuracy in correctly rejecting patients without disorder
•Want to be high
•Few over-referrals
•D = they passed it and they don't have a problem


•Your over all accuracy
•Ability to accurately identify differentially the disorder
•Need to look at for each test we use to see how well it tells us what we want to know for example reduced sensation levels. If it is positive it has a high sensitivity; however, if it is negative it does not mean you do not have a cochlear loss so the specificity is high. You need to realize what each of your tests is saying or not saying. •(A+D)/(A+B+C+D)

When making Evidence-Based Decisions consider:

Research, clinical expertise, and client values

Evidence-Based Practice (EBP)

is not simply research support but integration of best research with clinical expertise and client values

Client Values

client's unique characteristics and circumstances

Clinician expertise

"innovators tend to be believers"

Problem with clinician factors

-paucity of research, no "gold standard"
-Huge gap in our knowledge base
-Service delivery factors

Service delivery factors

dosage, scheduling, group vs. individual, direct vs. consultative

Case History

a description of a patient's audiological, medical, developmental (etc.) history.

Why is case history important?

-Tells us why the patient has come in to see us
-Guides us in our testing
-Helps us come up with an overall diagnosis

• Symptoms tells us more then results from tests
• You need to make sure you answer the one question the patient comes in asking

Purpose of getting a case history

•Information-Getting or information counseling
•Obtain a statement of the problem
•Formulate a hypothesis
•Cross-check results
•Aid in making referrals

Quality Issues of Interviewing

•Be a Good Interviewers
•Facilitating Good Communication
•Understand their motivation
•Listening Skills

How to be a good interviewer

-Talk through probs, LISTEN!!
-Review intake info before appointment, so we can dev. a hypothesis and think of what kind of questions to ask.
-ASK about things that are NOT present on the intake forms!!

How to facilitating good communication

-Develop rapport
-Be empathetic
-Be objective

Listening skills

-Concentration →Pay attention to what's going on when pt. and sup. are talking!!
-Active Participation → say things back that indicates you are listening
-Comprehension →Know what's going on
-Objectivity → be objective

Long forms

-intake form or an interview form
•ADVANTAGES: meds in front of them, have access to info
•DISADVANTAGES: If not filled out, it takes a long time to fill out, sometimes it can trigger guilt asking in person so they may tell you more in person

Short forms

-narrows list down; most people using these after they become comfortable with case history
•ADVANTAGES: allows for specific question, narrows down long form, short, we can write down what we want specifically
•DISADVANTAGES: not as many questions might not be specific enough, leaves things out.

Informal Observations

-Look at their general affect
-Physical appearance
-Use of hearing aids

Formal Questions

-Statement of the problem → What is the prob? What brings you in?
-Onset of the problem → When did you 1st notice and how long ago?
-Prior testing/Remediation → What did you get done? What did they do for you?
-Serious Illness/Trauma → hospitalization? Can cause neural probs; ever use anesthesia? (can cause temporary loss)
-Dizziness/Tinnitus → can be vestibular prob; ringing from loud noises?
-Noise exposure → can cause tinnitus and hearing loss; how much?
-Family history → Other adults in fam. have loss? Other children?

Adult questions

• Audiological history (Diagnosed HL?, history of HAs, asymmetry, gradual or sudden, tinnitus)
• Family history
• History of ear infections or ear surgeries (we call this otologic
• Dizziness
• Speech and Language status ( this includes problems with memory, anomia, or cognitive problems)

Pediatric questions

•Difficulties at birth (ICU? Ear infections?)
•Speech-Lang. Development
•Developmental Milestones
•School Performance
•Red Flags for high risk

Red Flags for high risk

A - Anoxia: lack of oxygen at birth (look at Apgar score: # given to describe child's functions at birth)
B - Bacterial (or viral) Meningitis
C - Congenital Infections (infection your born with)
D - Defects of Head & Neck (cleft? Other physical dev. probs)
E - Elevated Bilirubin: jaundice (yellow skin)
F - Family history
G - Gram birth weight (<1500 grams or 3lbs.)

Case History:

Differences b/w a SIGN & SYMPTOM VS. an AUD.

-Sign & Symptom: something that you can include in your report that suggests a relationship to why the person is having hearing or balance problems (e.g., otitis media). As an audiologist you are not technically allowed to diagnose anything no audiological but you can list is as a sign and symptom you

-Audiological Diagnosis Code: is the code you designate based on the test results you perform

Congenital Infections

S.T.O.R.C.H. (Syphilis, Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes)


-A DLC is when the clinician checks all the audiological equipment before testing a patient.
-Should be performed on all patients

Purpose of Daily Listen Checks?

• Save time
• If there is problem with the equipment, we would like to fix it or find a solution BEFORE the patient is seen
• Ensure that test results obtained are accurate
• Is the person not responding because they have a HL or is it
because our equipment isn't functioning?
• RED FLAGS: Asymmetrical HL, No response in soundbooth but patient can hear just fine in person.
• Professionalism

How do we run a daily listening check?

-You will need a partner to be in the sound booth. --First check, air conduction testing while using the headphones.
-The person in the booth should be able to hear the signal at each frequency (250-8000 Hz).
-Next, use the bone oscillator and to the same.
-Finally check sound field speakers.
-There is a checklist in the booths


Device that measures the immittance of the middle ear system, or how well the middle ear is functioning.

A Tympanometer includes...

• Tympanometry
• Acoustic Reflexes
• Acoustic Reflex Decay
• Eustachian Tube Function

Basic parts of a Tympanometer

• Immittance Bridge or the "Box" - holds the probe and stimulus tubes
• Probe tips - placed on the end of the probe, come in different sizes (adult - pediatric)

How do we run a daily listening check on a tympanometer?

• 1. You can check your own ear and should see normal
• 2. Use a 2 cc. Coupler that is in the clinic. You should see a volume of 2ml.

Otoacoustic Emmission (OAEs)

Device that tests the outer hair cell function of a person. You put a probe that plays an sound into each ear.
• Can be software installed on a computer
• Can be a handheld screener

How do we run a daily listening check on a OAEs?

Check BOTH ears!

• Make sure you can hear sounds playing out of each ear.
• If you have normal hearing you should have present OAEs

Daily listen checks for hearing screenings

always perform a listening check on the screening audiometer before taking it out of the clinic


•International Organization for Standardization (ISO)
•International Electrotechnical Commission (IEC): showing electronically it won't hurt anyone
•American National Standard Specification for Audiometers (ANSI): depending on the class of audiometers they are putting out the same thing
•Acoustical Society of America (ASA)
•ASHA: require that if we take out a portable audiometer we fill out checklist and it needs to be completed before you screen (ANSI and licensure board require the same)
•Texas Requirements: fill out green cards
•On the General Audiometer Checklist (Ideally all should be checked "no" but #12 should be checked "yes.")
•Required to check the Audiometers.

Parts of an audiometer

•Attenuator- intensity dial
•Frequency selector- lets you change the Hz you're testing
•Talk over dial
•Talk back dial
•VU meter- for speech

Types of Transducers

•Standard (regular headphones)
•Inserts (makes sound louder so you have to adjust for that)
•High freq. or Supra-aural headphones (whole ear is inside & lets us test 8K Hz)
•Sound field (height, distance, and locations matter in terms of calibration)
•Bone oscillator (calibrated on forehead or mastoid)

Parts of speech audiometer

•External inputs
•VU meter
•Talk over/talk back

Microphone caliration

Has to be calibrated to each voice, use VU meter and strive for 0. Adjust while giving instructions

External inputs calibration

-Tape players, CDs, iPods, MP3s.
-Must be calibrated daily.
-Tones usually played at a 1000 Hz, but you need to adjust the tone at 0 on the VU meter.

VU meter calibration

-If you listen/use the microphone, it has to be calibrated through your voice. Strive to be right at 0.
-Works for your voice and external inputs

Talk over

my voice; make sure it's not turned up all the way; so pt. hears you

Talk back

pt's voice; to hear them

Types of Audiometers: 1-4

-1 is the best for diagnostics. Has all inputs
-4 is pure tones. NO speech, best for hearing screenings.
-Some may be able to turn up louder than they are calibrated for, so always check

Types of Audiometer: channels

-Internal components that let you take a particular signal, specifically pure tone, control the frequency and you can handle ears separately with 2 channels
-1 Channel: can only use one transducer at a time
-1 ½ Channels: let's you do some things at the same time; just can't do two different transducers
-2 Channel: very expensive; handles ears complete separately

Types of Audiometers: A-C

-Type A: (the best) let's you do anything (i.e. microphone, CD) for speech testing.
-Type C: limited options (maybe a tape); least amount of speech ability

What type of audiometer do we usually take to schools?


Calibration of audiometers

•To ANSI standards
•Annually → most people hire a company to calibrate
•Quarterly →only if we test in noisy environments, only for OSHA
•Monthly→ booths
•Daily checks → we do this if we are the 1st person in the clinic

Parts of an Immittance Bridge

•Probe (3 holes)- mic, pressure, sound generator
•Daily Check- cavities (if volume off, could be holes), shelf-check

Landmarks of the Outer Ear

-Pre-Auricular area
-Post-Auricular area
-Ear Canal

Pre-Auricular Area: Where & What are you looking for?

-area in front of ear
-Look to see if there are any pits (or holes), tags that are hanging on (excessive skin), sores.
-Look behind ears too

Post-Auricular Area: Where & What are you looking for?

-behind ear
-Back area could be caved in where the mastoid is; there could be a scar, etc.

Auricle: Where & What are you looking for?

-the ear itself
-Look for malformations
In development, there are hillocks. (if they're are not joined together well)
-If one ear is higher/lower or smaller/larger than the other -→ developmental problem.
-Can be craniofacial problems or issues with the cochlea.
-Too small/big (check children)
-Cupped shape = too small →from craniofacial abnormalities
-Older males tend to have large ears because of excessive cartilage.
-Looking for sores and potential signs skin cancer (e.g. crusty melanomas).

Auricle abnormalities

-Cauliflower ear
-Preauricular cysts

Ear canal: Where & What are you looking for?

-May not have an ear canal, or only have a partial one
-Auricle malformations (cupped, partially developed, etc.)

Ear canal abnormalities

-Otitis Externa
-Necrotizing Otitis Externa
-Cerumen blockage
-Foreign bodies
-Rashes, sores
-Carcinomas (or neoplasms; cancer)


no auricle


small or partial auricle


-no ear canal
-Can have a partial ear canal, the bone is there but not the cartilage, or vice versa


-Ear canal gets very narrow.
-Cerumen can completely build up the canal.

Otitis Externa

-swimmer's ear
-white cottage cheese looking
-Drops help return the pH to normal, good for swimmers.


smelly discharge that comes out from the ear common w/ otitis externa

Necrotizing Otitis Externa

-Seen if a patient with otitis externa has a compromised immune system (diabetes or auto immune disorder, HIV positive).
-Causes fungus to become aggressive and starts eating the tissue in the ear b/w cartilage and bone (eats cranial nerves).
-Looks like bloody cottage cheese and lies at the bottom of the ear


-boney growths


-Surfer's ear
-abnormal growth of bone

TM: 3 layers


Epithelial layer of TM

outside layer of skin

•Can get dry or flakey, especially from swimming
•Grows from the center of tympanic membrane and spreads out.

Fibrous layer of TM

gives elasticity

•Fibers crisscross each other
•This is the layer that makes the TM appears more translucent, and not clear.
•Can be stiff or flaccid; opaque or translucent, but not perfectly clear

Membranous layer of TM

•Congruent with all the middle ear space.

Landmarks of TM

•Manubrium of the Malleus
•Lateral process
•Cone of light
•Pars Flaccida
•Pars Tensa

Manubrium of the Malleus

will probably see this 1st; look towards the middle to find the umbo
•Right ear: 1 o'clock
•Left ear: 11 o'clock


in the center; connects to the TM

Lateral Process

-Little white bump at the top of the malleus
-Not attached to the TM, but pushes it out

Cone of Light

reflection from the otoscope, if not there the TM is not pulled back properly

Pars Flaccida

small triangular portion at the top of the TM; more flaccid than the rest of the TM

Pars Tensa

-The rest of the TM
-TM is more stiff in this portion to be able to send info

TM abnormalities

•Positive Pressure
•Negative Pressure (retraction)
•Fluid or Otitis Media
•Skin Graph
•P.E. tubes


-Calcium deposits will stick to eardrum on the backside of the TM; means they've had a lot of ear infections
-Could attach to ossicles themselves


-looks like scar tissue and hard to see through
-takes part of the ear canal wall to fix the big hole.


-if TM stays pulled back for a long period of time, the skin will start to peel and fall to the bottom of the E.C.
-Looks like little white lumps or pearls
-Very acidic; eats decaying skin, but can also eat through the TM, ossicles, bone, etc.


-blisters between the fibrous and epithelial layer of eardrum. Like a blood blister, hurts very badly.
-Most common way to get it is trauma (e.g. q-tip) , candling, hot water, etc.

Middle Ear Abnormalities

•Chain discontinuity


a form of bone overgrowth in the middle ear that causes progressive hearing loss


Inspection of the outer ear and ear canal using a otoscopic light

Parts of an Otoscope

-Speculum (adult or child tip)
-Viewing window

Ototscopy: Purpose

1. To inspect the outer ear
2. To determine if we can see the eardrum and all landmarks look to be normal
3. To give us an idea if we should proceed with testing


1. Bridge (if you don't bridge 1st you will FAIL test)
2. Pull to straighten E.C. (Child: down and back; Adult: up and back)
3. Insert: look while inserting to check if partial atreria
4. Look at eye level: find umbo then follow up malleus, then circle and look around outside edge
5. Reverse: same order but backwards! REMOVE BRIDGE LAST!!!!

What are we looking for ?

If you are performing otoscopy correctly you should see the
following landmarks:

• Tympanic Membrane
• Pars Flaccida (Membrane of the eardrum)
• Handle of the Malleus (the first ossicle)
• Umbo of the Malleus
• Short process of the Malleus (hard to see for most people)
• Cone of light

What is considered normal/clear visualization?

• Need to see the main landmarks (from the previous slide)
• Having clear visualization of the tympanic membrane is the most important
• Some cerumen (earwax) is normal as long as you can visualize some part of the eardrum

What is considered abnormal?

• Cannot see the tympanic membrane at all because of
cerumen impaction
• Blood in the ear canal
• Discharge in the ear canal
• Object in the ear canal
• Hole in the ear canal (perforation)


-based on occlusion effect; stronger at lower freq., so use low freq. tuning fork

Schwabach Procedure

-Set into vibration
-Place stem on patient's mastoid (behind ear)
Patient indicates if tone is heard
-When patient no longer hears the tone, examiner uses a watch to determine # of secs sound is audible after patient stops hearing it.
-Examiner MUST have normal hearing!

Schwabach Results

-NORMAL HEARING: examiner and patient stop hearing tone at approximately the same time
-SNHL: patient stops hearing before examiner = DIMINISHED SCHWABACH
-CONDUCTIVE HL: patient hears as long or longer than examiner, patients hearing in low pitches may appear better than normal = PROLONGED SCHWABACH


-patient stops hearing before examiner


-patient hears as long or longer than examiner, patients hearing in low pitches may appear better than normal
-Conductive HL

Schwabach Problems

-Interpretation is difficult with mixed HL
-Difficulty determining which ear is being tested
-FALSE NORMAL SCHWABACH: if ears differ, patient's response will be related to the better ear
-Deciding which fork to use; you must state which you used


looks at performance at AC vs. BC

Rinne Procedure

-Set into vibration
-Place on mastoid (behind ear) and then beside ear canal
-Ask which is louder

Rinne Results

-NORMAL HEARING: beside ear is louder; AC more effective = POSITIVE RINNE
-SNHL: beside ear is louder; same degree of loss by both AC & BC = POSITIVE RINNE
-CONDUCTIVE HL: behind ear is louder; BC is WNL & AC is abnormal = NEGATIVE RINNE

Negative Rinne

-behind ear is louder; BC is WNL & AC is abnormal
-Conductive HL


-beside ear is louder; AC more effective = Normal Hearing


-beside ear is louder; same degree of loss by both AC & BC = SNHL

Rinne Problems

-Difficulty determining which ear is being tested
-Can't tell if there is an asymmetric loss
-FALSE NEGATIVE RINNER: inner ear of NTE is responding, patient is comparing AC of one ear to BC of the other ear (improper diagnosis of conduction HL if non-test BC is better than TE)


tests the pt's occlusion effect

Bing Procedure

-Set into vibration
-Place fork on mastoid
-Push tragus in and out of ear
-If it sounds like "wooo wooo woooo" then you created an occlusion effect , which signifies normal hearing

Bing Results

-NORMAL HEARING: patient hears the occlusion effect = POSITIVE BING
-SNHL: patient hears the occlusion effect = POSITIVE BING
-CONDUCTIVE HL: no change in loudness is heard, no occlusion effect = NEGATIVE BING


-patient hears the occlusion effect = normal hearing


-patient hears the occlusion effect = SNHL


-no change in loudness is heard, no occlusion effect = Conductive HL

Bing Problems

-Examiner must not suggest what patient's response should be
-Difficulty determining which ear is being tested
-If ears are asymmetrical


test of lateralization (where patient hears the tone: right ear, left ear, both, or midline); if they pick an ear, do Bing test to pick results.

Weber Procedure

-Set into vibration
-Place fork on patient's forehead
-Say "I want you to tell me where you hear this sound."

Weber Results

-NORMAL HEARING: equally loud in both ears, cannot tell a difference, tone originates in middle of forehead = MIDLINE SENSATION
-Equal amounts of the same type of hearing loss (conductive, SNHL, mixed) = MIDLINE SENSATION
-SNHL (in one ear): hear tone in better ear; possibly due to Stenger principle
-CONDUCTIVE HL (in on ear): hearing tone in poorer ear; results poorly understood, possibly result of prolonged BC (see Schwabach test)


-Equally loud in both ears, cannot tell a difference, tone originates in middle of forehead = normal hearing


-Equal amounts of the same type of hearing loss (conductive, SNHL, mixed)

Stenger Principle

-2 tones identical except for loudness presented at the same time in both ears, only the louder tone will be perceived
-If same tone presented to both ears, one of which has poorer BC sensitivity
-Perception that tones are louder in ear with better sensitivity
-Only louder tone (better BC sensitivity) will be heard; patient responds they only hear it in one ear

Weber Advantages

-Can be used to verify diagnosis of Schwabach or Rinne

-FALSE NORMAL SCHWABACH or FALSE NEGATIVE RINNE: both due to better ear responding rather than test ear
-Weber can verify unilateral SNHL

Weber Problems

Patient could have a long standing unilateral loss

Rinne: negative, in that the patient heard louder tone when fork was behind the ear on the mastoid than with tones near the ear canal

•Assuming that BC is WNL and AC is not normal
•Want to know these results could be due to other ear responding

•PERFORM WEBER: sound heard in 1 ear.

General Types of HL


Peripheral HL

-SNHL (cochlear)

Conductive HL and Components

-Usually due to outer or middle ear problems


-Components: O.E., E.C., T.M., & M.E.

What can cause a Conductive HL?

-Usually temporary: Medical intervention
-Cerumen impaction
-TM perforation
-Otitis Media or Sterile -Fluid

Perceptual Consequences of a Conductive HL

-"Plugged up"

SNHL HL and Components

-Usually due to damage to the cochlea or auditory nerve


-ALL Components: cochlea, hair cells, 8th CN, spinal ganglion, central aud. path

-Sensory Components: cochlea, hair cells (Peripheral)

-Neural Components: 8th CN, Spinal ganglion, central Aud. path (Central)

What can cause a SNHL?

-Excessive Noise exposure

Perceptual Consequences of a SNHL

-Distortion of speech
-Hearing in noise
-Difficulty hearing HF sounds

What can cause a Retrocochlear HL?

-Genetics: Auditory Neuropathy
-Hereditary: NF2

See More

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions above and try again


Reload the page to try again!


Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

Voice Recording

This is a Plus feature

Create Study Set