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  1. Degree: Adults
  2. Red Flags for high risk
  3. Types of Audiometers: A-C
  4. Screening results: hearing loss
  5. Shadow Curve
  6. Why would it be important for a patient to get a hearing screening before getting a speech screening?
  8. Unilateral VS. Bilateral
  9. Service delivery factors
  10. True positive
  11. Efficiency
  12. Weber
  13. Routes of Sound Transmission
  14. Implementation Protocols
  15. Pure-tone testing:
  16. Peripheral HL
  17. Pure-tone testing:
    Describing a HL
  18. IA Conservative Values:
  19. Perceptual Consequences of a Retrocochlear HL
  20. Short forms
  21. Fibrous layer of TM
  22. Ear canal abnormalities
  23. Schwabach Problems
  24. What autoclave or chemical do we use for sterilization?
  25. Middle Ear Abnormalities
  26. Functional HL
  27. What can cause a Conductive HL?
  28. Pure-tone testing:
    Signal detection theory
  29. Daily listen checks for hearing screenings
  30. Hearing Screenings
  31. Ear canal: Where & What are you looking for?
  32. OSHA Requirements for Infection Control
  33. How to Mask:
  34. Otoscopy:
    What are we looking for ?
  35. Pure-tone testing:
    Hughson-Westlake Method
  36. Otosclerosis
  37. Pure-tone testing:
    Descending Method
  38. EXAMPLE:
    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
  39. Otoscopy:
  40. When to Mask:
  41. Configurations
  42. Bing Procedure
  43. Lateral Process
  44. How to Mask:
  45. Pure-tone testing:
  46. If cells are epithelial, what does that mean?
  47. SNHL HL and Components
  49. Parts of an audiometer
  50. Why is case history important?
  52. Otoscope:
    What is considered normal/clear visualization?
  53. Pass Screening
  54. Client Values
  55. Masking with difficult populations
  56. Informal Observations
  57. Two Attributes of pathogenic organisms required to produce disease:
  58. A Tympanometer includes...
  59. Rinne Problems
  60. Pseudohypacusis:

  61. Step for Infection Control
  62. Landmarks of TM
  63. Pure-tone testing:
    False Negative Response
  64. Overmasking
  65. Pure-tone test environment:
  66. IA Conservative Values:
    Pure-tone BC
  67. Cholesteatoma
  68. Stenger Principle
  69. Exostosis
  70. Umbo
  71. Clinician expertise
  72. Otoscope:
    What is considered abnormal?
  73. Infection Control requires...
  74. Central HL and Components
  75. Rinne Procedure
  76. Otoacoustic Emmission (OAEs)
  77. Standards
  78. Absolute threshold
  79. Otorrhea
  80. Pure-tone testing:
    Test Frequencies
  81. Talk back
  82. Tympanosclerosis
  83. Degree: Children
  84. Fail Screening
  85. How do we run a daily listening check on a OAEs?
  86. Pure-tone test environment:
  87. Negative Rinne
  88. Pars Tensa
  89. Effective Masking
  90. False negative
  91. Pediatric questions
  92. Weber Results
  93. Schwabach
  94. Symbols: BC
  95. Retrocochlear
  96. Pure-tone testing:
    False Positive Response
  97. How do we run a daily listening check on a tympanometer?
  98. Case History:

    Differences b/w a SIGN & SYMPTOM VS. an AUD.
  99. Vibrotactile Limits and Symbols
  100. Symbols: Sound Field
  101. Evidence-Based Practice (EBP)
  102. Bing Problems
  103. How to facilitating good communication
  104. Weber Advantages
  105. How to be a good interviewer
  106. Case History
  107. Post exposure records
  108. Auricle: Where & What are you looking for?
  109. When to Mask:
  110. Hepatitis B Vaccination Records
  111. What is the most common mode of transmission for disease?
  112. Define: Acute, Chronic, Sudden, and Gradual
  113. Manubrium of the Malleus
  114. Symmetrical VS. Asymmetrical
  116. Cone of Light
  117. Formal Questions
  118. Pure-tone test environment:
    Placement of Transducers
  119. Tympanoplasty
  120. When to Mask:
  121. Conductive HL and Components
  122. Anotia
  123. Landmarks of the Outer Ear
  124. Microphone caliration
  125. Sensitivity
  126. Pure-tone test environment:
    Max. Ambient Noise Level
  127. Ototscopy: Purpose
  128. Talk over
  129. Pure-tone test:
  130. Perceptual Consequences of a Conductive HL
  131. Congenital Infections
  132. Pure-tone testing:
  133. Symbols: No Response
  134. Adult questions
  135. Otoscopy
  136. Central masking shift
  137. How do we run a daily listening check?
  138. Screening results: no loss
  139. Rinne
  140. Long forms
  141. Tympanometer
  142. How to Mask:
  143. Pure-tone testing:
    Test Phase
  144. Types of Audiometers: 1-4
  145. Define: Congenital, Acquired, and Adventitious
  146. What can cause a Retrocochlear HL?
  147. Symbols: AC
  148. Basic parts of a Tympanometer
  149. Exposure Classification
  150. Define: Temporary, Permanent, Progressive, and Fluctuating
  151. Schwabach Procedure
  152. Bing
  153. IA Conservative Values:
    Pure-tone AC
  154. Pre-Auricular Area: Where & What are you looking for?
  155. Post-Auricular Area: Where & What are you looking for?
  156. Annual Training Records
  157. Calibration of audiometers
  158. Quality Issues of Interviewing
  159. TM abnormalities
  160. Parts of speech audiometer
  161. What needs to be sterilized?
  162. General Types of HL
  163. Perceptual Consequences of a SNHL
  164. Purpose of Daily Listen Checks?
  165. Bing Results
  167. For Transmission of disease two things are important:
  168. Interaural Attenuation (IA)
  169. Pure-tone testing:
    Find Initial Phase
  170. How to Mask:
  171. What type of audiometer do we usually take to schools?
  172. Pure-tone testing:
    Ascending Method
  173. Specificity
  174. External inputs calibration
  175. False positive
  177. Pure-tone testing:
  178. True negative
  179. TM: 3 layers
  180. Weber Procedure
  181. Weber Problems
  182. Purpose of getting a case history
  183. Conservative Values
  184. Mixed
  185. Parts of an Otoscope
  186. The ear canal is made of what kind of cells?
  187. Problem with clinician factors
  188. Otitis Externa
  189. IA Conservative Values:
  190. Minimal Masking Level
  191. Parts of an Immittance Bridge
  192. Epithelial layer of TM
  193. Bullae
  194. Masking
  195. Stenosis
  196. Pure-tone testing:
    Pure-Tone Average (PTA)
  197. When to Mask:
  198. Plateau Method
  199. Rinne Results
  200. Osteoma
  201. Types of Audiometer: channels
  202. Membranous layer of TM
  203. When making Evidence-Based Decisions consider:
  204. Crossover
  205. Pars Flaccida
  206. Auricle abnormalities
  207. Undermasking
  208. Necrotizing Otitis Externa
  209. Microtia
  210. Types of Transducers
  211. Listening skills
  212. Atresia
  213. VU meter calibration
  215. Abscissa VS. Ordinate
  216. OE for BC
  217. Schwabach Results
  218. What can cause a SNHL?
  1. a -Non ear specific: S
  2. b -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)
  3. c -Excessive Noise exposure
  4. d • 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)
  5. e -What mode we are using: raise hand, push button, toys for kids, ect.
  6. f Add to any symbol:
    -Right ear: ↙
    -Left ear:↘

    -Don't connect

    -The noise that you put in the ear you're not testing.
    -We mask b/c it is possible that the good ear is hearing the sound.
  8. h •Headphones- 40 dB HL

    •Inserts- 50 dB HL; depends on how well you got the insert in the ear
  9. i -Usually due to damage to the cochlea or auditory nerve

    -AC = BAD
    -BC= BAD
    -ABG = NO

    -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)
  10. j tests the pt's occlusion effect
  11. k -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
  12. l -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).
  13. m 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.
  14. n -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
  15. o -patient hears the occlusion effect = normal hearing


    -patient hears the occlusion effect = SNHL
  16. p -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
  17. q -Epithelial
  18. r -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.
  19. s -Speculum (adult or child tip)
    -Viewing window
  20. t •For ASHA- 20 dB for 500, 1000, 2000, 4000 (do they hear it?)
    •For Texas- 25 dB for 1000, 2000, 4000 Hz (test odd school yrs.)

    •Familiarization - so they know they know what to look for
    •Testing- Do they hear it?
    •Recording- pass or fail
  21. u •PL SRT(TE) - 35 dB
  22. v small or partial auricle
  23. w -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!
  24. x Inspection of the outer ear and ear canal using a otoscopic light
  25. y -Acts like they can't hear, but there is no damage.
    -Pseudohypacusis (malingering or psychological)
  26. z •AGB ≥ 15 dB
  27. aa -no ear canal
    -Can have a partial ear canal, the bone is there but not the cartilage, or vice versa
  28. ab -Start at 60 dB, go down then back up, then down then back up;
    -Used for degenerative diseases b/c they can't keep in their brain what they are listening for so this is the easiest method.
  29. ac •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)
  30. ad 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.
  31. ae will probably see this 1st; look towards the middle to find the umbo
    •Right ear: 1 o'clock
    •Left ear: 11 o'clock
  32. af •Information-Getting or information counseling
    •Obtain a statement of the problem
    •Formulate a hypothesis
    •Cross-check results
    •Aid in making referrals
  33. ag whenever you put noise in the ear, your brain tries to shut the noise down b/c it recognizes that its noise and it tries to turn it down to "ignore" it -> this is how we hear in noise. When you out noise in their threshold may shift 5-10 dB because of the noise.
  34. ah Actual steps that will be take in your office to implement universal precautions
  35. ai dosage, scheduling, group vs. individual, direct vs. consultative
  36. aj • 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)
  37. ak no auricle
  38. al -no change in loudness is heard, no occlusion effect = Conductive HL
  39. am small triangular portion at the top of the TM; more flaccid than the rest of the TM
  40. an -Average 500, 1000, 2000 Hz, this checks reliability, do this before you make a report
    -If steeply sloping or steeply rise you will preform a two-tone PTA (Fletcher Avg.) you avg the best two of the three!
  41. ao -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)
  42. ap -both outer/middle ear and cochlea/nerve problems.

    -AC = BAD
    -BC = BAD
    -ABG = YES

    AC worse BC
  43. aq -Distortion of speech
    -Hearing in noise
    -Difficulty hearing HF sounds
  44. ar -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
  45. as 2% glutaraldehyde

    soak items to be sterilized for 4-8 hrs; overnight is best
  46. at •Unilateral: one sided (one ear)

    •Bilateral: two sided (both ears)
  47. au -A DLC is when the clinician checks all the audiological equipment before testing a patient.
    -Should be performed on all patients
  48. av •Manubrium of the Malleus
    •Lateral process
    •Cone of light
    •Pars Flaccida
    •Pars Tensa
  49. aw 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.
  50. ax hearing loss that mimics the other ear that is only different by Interaural attenuation. When you mask it, it will shift and become something else. Uncertain of the hearing loss when you mask it.
  51. ay -Genetics: Auditory Neuropathy
    -Hereditary: NF2
  52. az • 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
  53. ba -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.
  54. bb -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
  55. bc my voice; make sure it's not turned up all the way; so pt. hears you
  56. bd -Anything past the cochlea is central
    -SNHL (retrocochlear)
    - Central aud. processing

    -Components of Aud. pathway: auditory cortex, med. geniculate body, inferior colliculus, cochlear nucleus
  57. be -At least: if we don't have a masked score for AC or in sound field b/c we don't know which ear; At least a moderate, but it could be worse...

    -Unable to mask: the degree and configuration become unclear; At least a moderate, but it could be worse b/c I was unable mask

    -Maximum bone: either SNHL or mixed loss, we do not know which one b/c we reached max. limit for BC (for nature)

    -In at least one ear:
  58. bf -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)
  59. bg you are more accurate in testing if you know what you are listening for. So you start with something that you think that can for sure hear.
  60. bh When the test signal will still be perceived in the NTE b/c of an insufficient amount of masking noise presented to the NTE
  61. bi •Temporary: will go away

    •Permanent: will always have

    •Progressive: keeps getting worse over time

    •Fluctuating: comes and goes
  62. bj -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.
  63. bk cleaning, disinfecting, and sterilizing
  64. bl Patient could have a long standing unilateral loss
  65. bm -you could start without the pad, you will just have to turn it up a lot more; the minimum it is going to take mask

    -Plateau: start at starting level, present tone. If they get it the noise goes up. If they don't turn the tone up. You need to turn the noise up 3 5 dB steps in order to get the plateau
  66. bn -Ear canal gets very narrow.
    -Cerumen can completely build up the canal.
  67. bo -patient stops hearing before examiner
  68. bp -It's best to seat them where you can still see their face, but not straight on, so that they can't see you and get hints
    -We want to see them, but we don't want to too really see us
    -45 degrees is good for children b/c we can see their face
    -Has to be under the x or dot (in the center) to be in the correct spot in the sound booth if doing sound field
    -If the parent is in there, they have to sit away from the speakers, so they don't block them
  69. bq •Use for masking AC & BC
    •Range of intensities (b/w under- and over- masking) that will permit effective masking. This is possible when the thresh in the TE remains the same when masking is successfully increased in the NTE by 5 dB (3x consecutively)

    •The starting point is the masking level for either AC or BC
    •If they hear the tone, masking goes up 5 dB
    •If they don't hear tone, the tone goes up 5 dB
    •When we reach their real threshold, it doesn't matter how loud the masking gets
  70. br -They DO NOT raise their hand when they actually heard it

    -Due to: faking, yawning, falling asleep, don't want to be there, don't understand the instruction that to respond way they barely hear it
    -Not good if you have a lot- we need to readjust and check everything
  71. bs Has to be calibrated to each voice, use VU meter and strive for 0. Adjust while giving instructions
  72. bt -Surfer's ear
    -abnormal growth of bone
  73. bu •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.
    •POSSIBLE RESULTS: unilateral SNHL
  74. bv •Attenuator- intensity dial
    •Frequency selector- lets you change the Hz you're testing
    •Talk over dial
    •Talk back dial
    •VU meter- for speech
  75. bw Office must document the treatment that has taken place and outcome following exposure.
  76. bx •Positive Pressure
    •Negative Pressure (retraction)
    •Fluid or Otitis Media
    •Skin Graph
    •P.E. tubes
  77. by -Usually due to outer or middle ear problems

    -AC = BAD
    -BC = GOOD
    -ABG = YES

    -Components: O.E., E.C., T.M., & M.E.
  78. bz 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.
  79. ca -Cauliflower ear
    -Preauricular cysts
  80. cb -Clinical experience will have a clinician decide when to not use conservative values
    -Can view patient's own Interaural attenuation to make decision as well
    -Methods may also affect with plateau allowing person to be able to allow higher levels.
  81. cc -D
    -Correct rejection
    -pass screening
    = no loss
  82. cd -beside ear is louder; AC more effective = Normal Hearing


    -beside ear is louder; same degree of loss by both AC & BC = SNHL
  83. ce 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
  84. cf C. False negative (miss rate) - hearing loss
    D. True negative (correct rejection) - no loss
  85. cg -looks like scar tissue and hard to see through
    -takes part of the ear canal wall to fix the big hole.
  86. ch -Make sure noise is NOT too loud; it will not be too loud if you close both sets of doors
    -If there is no noise outside the booth you can leave one or both doors open depending on the situation.
    -Parent can sit in booth with child IF they are quite
    -We must keep it at a standard loudness level in the booth.
  87. ci AC- you will start at 1000 Hz, do the octaves for sure
    •1000, 2000, 4000, 8000 Hz then go back and recheck 1000, then 500, and 250
    •For HA testing/fitting add 3000 & 6000 b/c you can fine tune the frequencies better)

    BC- you will not do anything above 4000 HZ b/c it will be vibrotactile
    •Only do 3000 Hz when you make sure the audiometer is calibrated for 3000 Hz
    •1000, 2000, 500, 250 Hz
  88. cj -Attenuation
    -"Plugged up"
  89. ck -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
  90. cl •Congenital: born with it

    •Acquired: developed after birth

    •Adventitious: something took advantage of the system and there is a sudden HL
  91. cm -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
  92. cn -Keep in mind case history (don't ask someone to raise their hand if they can't physically move)
    -In person before transducer is on or after if they can hear it.
    -For kids you can use toys

    Can vary,"when you hear the sound, you need to... (what they need to do)", "it's okay to respond if you think you heard it, if you aren't sure go ahead and respond!" So MAKE SURE YOU TELL THEM:
    -What the are listening for
    -What they need to do
    -It's okay to guess!

    -FOR BC- tell them in need to stay right there and you'll go fast b/c its uncomfortable
  93. co a form of bone overgrowth in the middle ear that causes progressive hearing loss
  94. cp •PL WR(TE) - 25 dB
  95. cq -swimmer's ear
    -white cottage cheese looking
    -Drops help return the pH to normal, good for swimmers.
  96. cr •Acute: severe developed fast (mostly used w/ ear infections); typically for conductive loss

    •Chronic: has lasted a long time; typically for conductive loss

    •Sudden: woke up one day and all of the sudden can't hear

    •Gradual: slowly over time
  97. cs •PL WR(TE) - SRT(NTE) ≥ 35 dB HL
    •PL WR(TE) - Beat Bone(NTE) ≥ 35 dB HL

    •When SRT(NTE) and WR(TE) differ by 30 dB
  98. ct -behind ear
    -Back area could be caved in where the mastoid is; there could be a scar, etc.
  99. cu •Better ear + pad (10 to 15 dB) + OE
    •AC(NTE) + pad + OE
  100. cv -When they raise their hand, but there was nothing there. No signal was present when they pressed their hand.

    -Due to- Most of the time the presenter (make sure you vary your presentation so it's not predictable, b/c they have most likely gotten a cueing); when they are trying really hard sometimes they raise their hand a few times when nothings there b/c they think they might have heard something.
  101. cw -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
  102. cx Anything that touches blood or body fluids should be sterilized. Cerumen is not contaminated however, it does contain blood
  103. cy client's unique characteristics and circumstances
  104. cz -Amount of sound energy lost as sound travels from one ear to another via bone conduction
    -Most often related to bone conduction
    -Varies from person to person (we mask to be sure)
    -Varies across signal
    -You have to be above this level before they can hear it; how much is lost
  105. da -Atresia
    -Otitis Externa
    -Necrotizing Otitis Externa
    -Cerumen blockage
    -Foreign bodies
    -Rashes, sores
    -Carcinomas (or neoplasms; cancer)
  106. db -it's easier if they can't see your face, if they are facing you, so have it darker on your side vs. their side.
    -If they can see you they can get clues from you or read your lips
  107. dc the 8th nerve and beyond
  108. dd •35 dB HL

    •WR is 30 or 40 dB SL above SRT threshold. Because we jump so much louder Interaural attention will crossover much quicker b/c we are louder.
  109. de looks at performance at AC vs. BC
  110. df • 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)
  111. dg -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!!
  112. dh EXAMPLE:
    You can mask for a child that doesn't understand the directions or has intellectual disabilities or deficits by "listening for the birdie in the wind".
  113. di is not simply research support but integration of best research with clinical expertise and client values
  114. dj a nick, cut or irritations is necessary to facilitate infection via the ear canal
  115. dk •Better ear + Pad (10 to 15 dB)

    •AC(NTE) + pad (10 to 15 dB)
  116. dl -Little white bump at the top of the malleus
    -Not attached to the TM, but pushes it out
  117. dm -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
  118. dn -Conductive
    -SNHL (cochlear)
  119. do smelly discharge that comes out from the ear common w/ otitis externa
  120. dp •Headphones- 45 dB HL

    •Inserts- 50 dB HL
  121. dq •Symmetrical: equal loss in both ears

    •Asymmetrical: loss in both ears, but one is worse than the other
  122. dr Touching
  123. ds Normal= -10 to 15 dB HL
    Slight= 16 to 25 dB HL
    Mild= 26 to 40 dB HL
    Moderate= 41 to 55 dB HL
    Moderately Severe= 56 to 70 dB HL
    Severe= 71 to 90 dB HL
    Profound = >90 dB HL
  124. dt •Malingering: flat out faking, doing it on purpose

    •Psychological: no cause for it, but have a hearing loss, but using it for help to cope with a traumatic situation (bombings, PTSD).
  125. du S.T.O.R.C.H. (Syphilis, Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes)
  126. dv •Degree- AC
    •Configuration - AC
    •Nature - AC & BC
  127. dw Unmasked:
    -Right ear: O
    -Left ear: X

    -Right ear: Δ
    -Left ear: ⃤

    -Connect symbols w/ line
  128. dx -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
  129. dy Each office is to conduct annual training in infection control and document it
  130. dz •250 Hz: 20 dB
    •500 Hz: 15 dB
    •1000 Hz: 5 dB
  131. ea B. False positive (false alarm) - fail
    D. True negative (correct rejection) - pass
  132. eb • 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
  133. ec -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?
  134. ed -A
    -Hit rate
    -failed screening
    = hearing loss
  135. ee -Starts at 0 dB and goes up 5 dB until you get a response, then go down 20 dB and try again
    -This is what we do when we recheck 1000 Hz and correct is +/- 5 dB, you might get a little higher dB b/c they aren't getting that signal detection.
    -If they are faking, it will help to do this b/c they will guess lower
  136. ef what gets to the other side in the NTE
  137. eg -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
  138. eh •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
  139. ei a description of a patient's audiological, medical, developmental (etc.) history.
  140. ej -based on occlusion effect; stronger at lower freq., so use low freq. tuning fork
  141. ek A. True positive (hit rate) - fail
    C. False negative (miss rate) - pass
  142. el -Look at their general affect
    -Physical appearance
    -Use of hearing aids
  143. em Unmasked
    -Right ear: <
    -Left ear: >
    -Forehead: ^
    -Right ear: [
    -Left ear: ]

    -Connect symbols w/ dotted lines
  144. en •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.
  145. eo •Difficulties at birth (ICU? Ear infections?)
    •Speech-Lang. Development
    •Developmental Milestones
    •School Performance
    •Red Flags for high risk
  146. ep 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
  147. eq -B
    -False alarm
    -failed screening
    = no loss
  148. er 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!!!!
  149. es always perform a listening check on the screening audiometer before taking it out of the clinic
  150. et •SRT(TE) - AC(NTE) ≥ 45 dB HL (50 dB)
    •SRT(TE) - Best Bone(NTE) ≥ 45 dB HL (50 dB)

    •PTA and SRT are not in agreement (7-10 dB diff.)
  151. eu -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
  152. ev "innovators tend to be believers"
  153. ew -Earphones- Put them on from the back, extend all the way up, push hair back, then place them on directly over the ear canal opening, (right side in right hand and vice versa)
    -Inserts- clip on the back (so no one messes with them), still from behind them, (right side in right hand and vice versa)
    -Supraral Headphones- make sure the entire ear is covered
    -Soundfeild- be under calibrated spot
    -BC- place on the mastoid where there is no hair, the box needs to be flat, and the other side is on the other side towards the front of the head so that the band is flat.
  154. ex Check BOTH ears!

    • Make sure you can hear sounds playing out of each ear.
    • If you have normal hearing you should have present OAEs
  155. ey in the center; connects to the TM
  156. ez -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
  157. fa •0 dB; but can vary from person to person
  158. fb • 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.
  159. fc -Set into vibration
    -Place on mastoid (behind ear) and then beside ear canal
    -Ask which is louder
  160. fd -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
  161. fe -May not have an ear canal, or only have a partial one
    -Auricle malformations (cupped, partially developed, etc.)
  162. ff -how much is it going to take for that cochlea to not pick it up

    •crossover + pad (10 to 15 dB)
  163. fg -Test 500, 1K, 2K, and 4K Hz
    -we don't test 6000 or 8000, we can't go as loud due to the vibrotactile response
    -We usually start 10 dB above their AC threshold.
    -We use signal detection, so they can hear it
    -If conduction HL- start below threshold
    -If SNHL- start 10 dB above threshold.
    -Do the Hughson-Westlake
  164. fh A. True positive (hit rate) - hearing loss
    B. False positive (false alarm) - no loss
  165. fi -behind ear is louder; BC is WNL & AC is abnormal
    -Conductive HL
  166. fj -Usually temporary: Medical intervention
    -Cerumen impaction
    -TM perforation
    -Otitis Media or Sterile -Fluid
  167. fk -Flat
    -Precipitous (> 20 dB diff. in θs b/w 2 adjacent freq.)
    -Trough ("cookie bite")
    -Inverted Trough
    -Carhart's Notch (2K)
    -Noise Notch (b/w 3K-6K; comes back up after 6K-8K)
    -High Freq. (drops ~3K and above)
  168. fl •Congruent with all the middle ear space.
  169. fm •A 40 dB difference b/w AC of the test ear and the non-test ear

    •AC(TE) - AC(NTE) ≥ 40 dB HL (50 dB HL)
    •AC(TE) - BC(NTE) ≥ 40 dB HL (50 dB HL)
  170. fn •AC: looks for conductive loss
    -Tells degree and configuration of loss

    •BC: shakes fluid in the middle ear to see if there are other components to the loss by bypassing the O.E. & M.E.
    -Tells nature of loss
  171. fo what we mark, the lowest level they respond at 50% of the time
  172. fp -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
  173. fq -250 Hz = 25 dB HL
    -500 Hz = 55 dB HL
    -1K-8K Hz = 70 dB HL

    -Right ear: <vt?
    -Left ear:>vt?
  174. fr -C
    -Miss rate
    -pass screening
    = hearing loss
  175. fs • Tympanometry
    • Acoustic Reflexes
    • Acoustic Reflex Decay
    • Eustachian Tube Function
  176. ft reflection from the otoscope, if not there the TM is not pulled back properly
  177. fu pt's voice; to hear them
  178. fv -Pre-Auricular area
    -Post-Auricular area
    -Ear Canal
  179. fw 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.)
  180. fx Use either the Hughson-Westlake method, ascending method, or descending method

    **We use the Hughson-Westlake the most**
  181. fy 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?
  182. fz •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
  183. ga •Otosclerosis
    •Chain discontinuity
  184. gb •Be a Good Interviewers
    •Facilitating Good Communication
    •Understand their motivation
    •Listening Skills
  185. gc -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.
  186. gd Device that measures the immittance of the middle ear system, or how well the middle ear is functioning.
  187. ge -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
  188. gf 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
  189. gg •Abscissa (horizontal): freq. measured in Hz

    •Ordinate (vertical): dB HL; intensity (Amp.)
  190. gh -Set into vibration
    -Place fork on patient's forehead
    -Say "I want you to tell me where you hear this sound."
  191. gi •Peripheral
  192. gj 4,1,C
  193. gk •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)
  194. gl •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
  195. gm -paucity of research, no "gold standard"
    -Huge gap in our knowledge base
    -Service delivery factors
  196. gn -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
  197. go -The rest of the TM
    -TM is more stiff in this portion to be able to send info
  198. gp external epithelium
  199. gq -patient hears as long or longer than examiner, patients hearing in low pitches may appear better than normal
    -Conductive HL
  200. gr -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
  201. gs We need to be able to determine if there is a receptive language problem due to a potential HL before we assume there is a speech or expressive language problem.
  202. gt -We perform hearing tests to assess a person's hearing status or sensitivity.

    -Pure tone testing is an audiological assessment that allow us to determine hearing status and often used as diagnostic information to determine if someone is a candidate for amplification or cochlear implant. We can also infer if there are auditory processing problems or receptive language problems

    -To test the two pathways of sound and determine the nature of a hearing loss (if any)
  203. gu 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
  204. gv -boney growths
  205. gw -Distortion
    -Desynchronize firing
    -Fluctuating HL
  206. gx -Typically we start at 40 dB HL, unless they cannot hear you can jump up by 10 dB or 20 dB (If 40 go 10 dB higher for the next freq.) If you aren't sure where to start, start at 30 dB- this is not set it stone, it just needs to be audible

    -If they do NOT respond, increase by 10 dB or 20 dB until you get to where they can hear.
    -If they respond you start to drop by 10 dB, until you get to where they can not hear, which is known as the initial phase.
  207. gy •Microphone
    •External inputs
    •VU meter
    •Talk over/talk back
  208. gz -Develop rapport
    -Be empathetic
    -Be objective
  209. ha •Probe (3 holes)- mic, pressure, sound generator
    •Daily Check- cavities (if volume off, could be holes), shelf-check
  210. hb Research, clinical expertise, and client values
  211. hc -Examiner must not suggest what patient's response should be
    -Difficulty determining which ear is being tested
    -If ears are asymmetrical
  212. hd -If they hear it go down 10 dB until they don't
    -If they don't then up 5 dB

    -We are looking for criteria of 50% off the time (we typically look for 3 out of 6 times, can be more or less, just whenever you got 50%)

    ***We use this the most***
  213. he Normal= -10 to 25 dB HL
    Mild= 26 to 40 dB HL
    Moderate= 41 to 55 dB HL
    Moderately Severe= 56 to 70 dB HL
    Severe= 71 to 90 dB HL
    Profound = >90 dB HL
  214. hf -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
    -Check EVERYTIME
  215. hg 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
  216. hh (A written Infection Control Plan)
    -Implementation Protocols
    -Exposure Classification
    -Hepatitis B Vaccination Records
    -Post exposure records
  217. hi outside layer of skin

    •Can get dry or flakey, especially from swimming
    •Grows from the center of tympanic membrane and spreads out.
  218. hj happens when there is a conductive component in both ears. The noise can crossover too. When the level of the IA for noise is over 40. You can no longer get a threshold on the side you are testing. Use inserts b/c the IA is higher, therefore you will have less crossover