218 Multiple choice questions
- •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.
- •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
- -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
& 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
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.
- -A DLC is when the clinician checks all the audiological equipment before testing a patient.
-Should be performed on all patients
- -boney growths
- Anything that touches blood or body fluids should be sterilized. Cerumen is not contaminated however, it does contain blood
- •AGB ≥ 15 dB
- •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)
- •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
- When the test signal will still be perceived in the NTE b/c of an insufficient amount of masking noise presented to the NTE
- -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)
- •Manubrium of the Malleus
•Cone of light
- •Headphones- 45 dB HL
•Inserts- 50 dB HL
- -May not have an ear canal, or only have a partial one
-Auricle malformations (cupped, partially developed, etc.)
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?
- -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).
- -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!!
- -NOISE ALWAYS IN BETTER EAR!! (NTE)
-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.
- B. False positive (false alarm) - fail
D. True negative (correct rejection) - pass
- -Set into vibration
-Place fork on patient's forehead
-Say "I want you to tell me where you hear this sound."
- small or partial auricle
- -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
- • 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
- -behind ear is louder; BC is WNL & AC is abnormal
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:
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.
- C. False negative (miss rate) - hearing loss
D. True negative (correct rejection) - no loss
- •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
= no loss
- the 8th nerve and beyond
- -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
- -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.
- -no change in loudness is heard, no occlusion effect = Conductive HL
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.
- 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
- -looks like scar tissue and hard to see through
-takes part of the ear canal wall to fix the big hole.
- •Difficulties at birth (ICU? Ear infections?)
•Red Flags for high risk
- -Pre-Auricular area
- -no ear canal
-Can have a partial ear canal, the bone is there but not the cartilage, or vice versa
- -Usually temporary: Medical intervention
-Otitis Media or Sterile -Fluid
- -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.
- 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.)
- -Cauliflower ear
- external epithelium
- -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
- -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.
- outside layer of skin
•Can get dry or flakey, especially from swimming
•Grows from the center of tympanic membrane and spreads out.
- If you are performing otoscopy correctly you should see the
• 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
- Device that measures the immittance of the middle ear system, or how well the middle ear is functioning.
- my voice; make sure it's not turned up all the way; so pt. hears you
- •Headphones- 40 dB HL
•Inserts- 50 dB HL; depends on how well you got the insert in the ear
- Check BOTH ears!
• Make sure you can hear sounds playing out of each ear.
• If you have normal hearing you should have present OAEs
- -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
- •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.
- -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
- Actual steps that will be take in your office to implement universal precautions
- 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
- -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
- -Examiner must not suggest what patient's response should be
-Difficulty determining which ear is being tested
-If ears are asymmetrical
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.
- •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
- -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.
- -Surfer's ear
-abnormal growth of bone
- -patient stops hearing before examiner
- 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
- -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
- -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
- •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.)
-Necrotizing Otitis Externa
-Carcinomas (or neoplasms; cancer)
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
- is not simply research support but integration of best research with clinical expertise and client values
- -Speculum (adult or child tip)
- •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
- •250 Hz: 20 dB
•500 Hz: 15 dB
•1000 Hz: 5 dB
- -The rest of the TM
-TM is more stiff in this portion to be able to send info
- -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
- -Little white bump at the top of the malleus
-Not attached to the TM, but pushes it out
- -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.
- -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)
- cleaning, disinfecting, and sterilizing
- Inspection of the outer ear and ear canal using a otoscopic light
- 2% glutaraldehyde
soak items to be sterilized for 4-8 hrs; overnight is best
- -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?
- -behind ear
-Back area could be caved in where the mastoid is; there could be a scar, etc.
- A. True positive (hit rate) - fail
C. False negative (miss rate) - pass
- -both outer/middle ear and cochlea/nerve problems.
-AC = BAD
-BC = BAD
-ABG = YES
AC worse BC
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
- no auricle
- -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
- client's unique characteristics and circumstances
- 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
- small triangular portion at the top of the TM; more flaccid than the rest of the TM
- A. True positive (hit rate) - hearing loss
B. False positive (false alarm) - no loss
- -swimmer's ear
-white cottage cheese looking
-Drops help return the pH to normal, good for swimmers.
- -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!
- -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
- •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
- 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.
- •Congruent with all the middle ear space.
- •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).
- -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.
- •Probe (3 holes)- mic, pressure, sound generator
•Daily Check- cavities (if volume off, could be holes), shelf-check
-Right ear: O
-Left ear: X
-Right ear: Δ
-Left ear: ⃤
-Connect symbols w/ line
- -Anything past the cochlea is central
- Central aud. processing
-Components of Aud. pathway: auditory cortex, med. geniculate body, inferior colliculus, cochlear nucleus
- -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
- dosage, scheduling, group vs. individual, direct vs. consultative
- 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.
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.
- -Usually due to damage to the cochlea or auditory nerve
-AC = 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)
- tests the pt's occlusion effect
- -Distortion of speech
-Hearing in noise
-Difficulty hearing HF sounds
- -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)
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
- •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)
- S.T.O.R.C.H. (Syphilis, Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes)
- -patient hears as long or longer than examiner, patients hearing in low pitches may appear better than normal
- -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
- •Be a Good Interviewers
•Facilitating Good Communication
•Understand their motivation
- Research, clinical expertise, and client values
- •Better ear + Pad (10 to 15 dB)
•AC(NTE) + pad (10 to 15 dB)
- •Unilateral: one sided (one ear)
•Bilateral: two sided (both ears)
- -how much is it going to take for that cochlea to not pick it up
•crossover + pad (10 to 15 dB)
- 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
- •Degree- AC
•Configuration - AC
•Nature - AC & BC
- •PL WR(TE) - 25 dB
- -What mode we are using: raise hand, push button, toys for kids, ect.
-Precipitous (> 20 dB diff. in θs b/w 2 adjacent freq.)
-Trough ("cookie bite")
-Carhart's Notch (2K)
-Noise Notch (b/w 3K-6K; comes back up after 6K-8K)
-High Freq. (drops ~3K and above)
- •PL SRT(TE) - 35 dB
- "innovators tend to be believers"
= hearing loss
- Office must document the treatment that has taken place and outcome following exposure.
- -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!
- •Accuracy in correctly rejecting patients without disorder
•Want to be high
•D = they passed it and they don't have a problem
•Talk over/talk back
- -Acts like they can't hear, but there is no damage.
-Pseudohypacusis (malingering or psychological)
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.
- -Set into vibration
-Place on mastoid (behind ear) and then beside ear canal
-Ask which is louder
components that let you take a particular signal, specifically pure
tone, control the frequency and you can handle ears separately with 2
-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
- -paucity of research, no "gold standard"
-Huge gap in our knowledge base
-Service delivery factors
- •Abscissa (horizontal): freq. measured in Hz
•Ordinate (vertical): dB HL; intensity (Amp.)
- •Temporary: will go away
•Permanent: will always have
•Progressive: keeps getting worse over time
•Fluctuating: comes and goes
- •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
- • 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.
- -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
= hearing loss
- -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
- -Excessive Noise exposure
- smelly discharge that comes out from the ear common w/ otitis externa
- -250 Hz = 25 dB HL
-500 Hz = 55 dB HL
-1K-8K Hz = 70 dB HL
-Right ear: <vt?
- will probably see this 1st; look towards the middle to find the umbo
•Right ear: 1 o'clock
•Left ear: 11 o'clock
- • 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
• Speech and Language status ( this includes problems with memory, anomia, or cognitive problems)
- -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
- -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
- •Congenital: born with it
•Acquired: developed after birth
•Adventitious: something took advantage of the system and there is a sudden HL
- Add to any symbol:
-Right ear: ↙
- -Look at their general affect
-Use of hearing aids
- • 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.
- •Information-Getting or information counseling
•Obtain a statement of the problem
•Formulate a hypothesis
•Aid in making referrals
- •0 dB; but can vary from person to person
- pt's voice; to hear them
- •Symmetrical: equal loss in both ears
•Asymmetrical: loss in both ears, but one is worse than the other
- •Better ear + pad (10 to 15 dB) + OE
•AC(NTE) + pad + OE
- looks at performance at AC vs. BC
- •To ANSI standards
•Annually → most people hire a company to calibrate
•Quarterly →only if we test in noisy environments, only for OSHA
•Daily checks → we do this if we are the 1st person in the clinic
- -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***
- -based on occlusion effect; stronger at lower freq., so use low freq. tuning fork
- what gets to the other side in the NTE
- what we mark, the lowest level they respond at 50% of the time
- -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)
- -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
- •Positive Pressure
•Negative Pressure (retraction)
•Fluid or Otitis Media
- 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
- -Genetics: Auditory Neuropathy
- 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!!!!
- in the center; connects to the TM
- -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.
- a nick, cut or irritations is necessary to facilitate infection via the ear canal
- -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
- • Tympanometry
• Acoustic Reflexes
• Acoustic Reflex Decay
• Eustachian Tube Function
-Right ear: <
-Left ear: >
-Right ear: [
-Left ear: ]
-Connect symbols w/ dotted lines
- -Usually due to outer or middle ear problems
-AC = BAD
-BC = GOOD
-ABG = YES
-Components: O.E., E.C., T.M., & M.E.
- •Attenuator- intensity dial
•Frequency selector- lets you change the Hz you're testing
•Talk over dial
•Talk back dial
•VU meter- for speech
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.
- • Cannot see the tympanic membrane at all because of
• Blood in the ear canal
• Discharge in the ear canal
• Object in the ear canal
• Hole in the ear canal (perforation)
- -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
= no loss
- Use either the Hughson-Westlake method, ascending method, or descending method
**We use the Hughson-Westlake the most**
- -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
- -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
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".
- Patient could have a long standing unilateral loss
- a form of bone overgrowth in the middle ear that causes progressive hearing loss
- Each office is to conduct annual training in infection control and document it
- (A written Infection Control Plan)
-Hepatitis B Vaccination Records
-Post exposure records
- -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
- -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.
- always perform a listening check on the screening audiometer before taking it out of the clinic
- -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
- -Ear canal gets very narrow.
-Cerumen can completely build up the canal.
- reflection from the otoscope, if not there the TM is not pulled back properly
- •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)
- -Non ear specific: S
- • 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)
- -beside ear is louder; AC more effective = Normal Hearing
-beside ear is louder; same degree of loss by both AC & BC = SNHL
- -Develop rapport
- Has to be calibrated to each voice, use VU meter and strive for 0. Adjust while giving instructions
- a description of a patient's audiological, medical, developmental (etc.) history.
- -patient hears the occlusion effect = normal hearing
-patient hears the occlusion effect = SNHL