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218 True/False questions

  1. Cholesteatoma-boney growths

          

  2. Pure-tone testing:
    Test Frequencies
    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

          

  3. Vibrotactile Limits and Symbols-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

          

  4. Manubrium of the Malleus-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.

          

  5. Two Attributes of pathogenic organisms required to produce disease:•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)

          

  6. How to Mask:
    BC
    •PL SRT(TE) - 35 dB

          

  7. Tympanoplastysmall or partial auricle

          

  8. False negative-C
    -Miss rate
    -pass screening
    = hearing loss

          

  9. Standards•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.

          

  10. Pure-tone testing:
    False Positive Response
    -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

          

  11. Symmetrical VS. Asymmetrical•Symmetrical: equal loss in both ears

    •Asymmetrical: loss in both ears, but one is worse than the other

          

  12. POSITIVE RINNE-no change in loudness is heard, no occlusion effect = Conductive HL

          

  13. Membranous layer of TM•Congruent with all the middle ear space.

          

  14. Central HL and Components-Anything past the cochlea is central
    -SNHL (retrocochlear)
    - Central aud. processing

    -Components of Aud. pathway: auditory cortex, med. geniculate body, inferior colliculus, cochlear nucleus

          

  15. Congenital InfectionsS.T.O.R.C.H. (Syphilis, Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes)

          

  16. How do we run a daily listening check on a tympanometer?• 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

          

  17. Umbolooks at performance at AC vs. BC

          

  18. Tympanosclerosis-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

          

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

          

  20. Symbols: Sound Field-Non ear specific: S

          

  21. How to facilitating good communication-Develop rapport
    -Sensitivity
    -Respect
    -Be empathetic
    -Be objective

          

  22. Unilateral VS. Bilateral•Unilateral: one sided (one ear)

    •Bilateral: two sided (both ears)

          

  23. Otoscope:
    What is considered abnormal?
    -Excessive Noise exposure
    -Genetics
    -S.T.O.R.C.H.
    -Hereditary

          

  24. Basic parts of a TympanometerDevice that measures the immittance of the middle ear system, or how well the middle ear is functioning.

          

  25. 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)

          

  26. 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

          

  27. Pre-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.

          

  28. General Types of HL•Peripheral
    •Central
    •Functional

          

  29. Otorrheawhat gets to the other side in the NTE

          

  30. Sensitivity•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
    •A/(A+C)

          

  31. Informal Observations-Look at their general affect
    -Age/Sex
    -Physical appearance
    -Use of hearing aids
    -Comprehension

          

  32. Parts of an audiometer•Attenuator- intensity dial
    •Frequency selector- lets you change the Hz you're testing
    •Transducer
    •Talk over dial
    •Talk back dial
    •VU meter- for speech

          

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

          

  34. What autoclave or chemical do we use for sterilization?-Genetics: Auditory Neuropathy
    -Hereditary: NF2

          

  35. Microtiasmall or partial auricle

          

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

          

  37. Configurationsreflection from the otoscope, if not there the TM is not pulled back properly

          

  38. Post exposure recordsEach office is to conduct annual training in infection control and document it

          

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

          

  40. 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.

          

  41. Auricle abnormalities•Otosclerosis
    •Chain discontinuity
    •Neoplasms
    •Cholesteatoma

          

  42. OE for BCsmall or partial auricle

          

  43. Efficiency•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
    •D/(B+D)

          

  44. Conductive HL and ComponentsS.T.O.R.C.H. (Syphilis, Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes)

          

  45. Mixed-both outer/middle ear and cochlea/nerve problems.

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

    AC worse BC

          

  46. Osteomano auricle

          

  47. Epithelial layer of TMoutside layer of skin

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

          

  48. Bullaelooks at performance at AC vs. BC

          

  49. Pure-tone test environment:
    Placement of Transducers
    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

          

  50. 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!

          

  51. Otoscopya form of bone overgrowth in the middle ear that causes progressive hearing loss

          

  52. 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

          

  53. TM abnormalities-Cauliflower ear
    -Keloid
    -Anotia
    -Microtia
    -Preauricular cysts
    -Pits

          

  54. Talk back-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.

          

  55. UndermaskingWhen the test signal will still be perceived in the NTE b/c of an insufficient amount of masking noise presented to the NTE

          

  56. Problem with clinician factorsOffice must document the treatment that has taken place and outcome following exposure.

          

  57. NEGATIVE BING-no change in loudness is heard, no occlusion effect = Conductive HL

          

  58. Degree: Children-no change in loudness is heard, no occlusion effect = Conductive HL

          

  59. Symbols: BCUnmasked
    -Right ear: <
    -Left ear: >
    -Forehead: ^
    Masked:
    -Right ear: [
    -Left ear: ]

    -Connect symbols w/ dotted lines

          

  60. How do we run a daily listening check on a OAEs?-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!!

          

  61. Pure-tone testing:
    BC
    -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

          

  62. Ear canal abnormalities•Attenuator- intensity dial
    •Frequency selector- lets you change the Hz you're testing
    •Transducer
    •Talk over dial
    •Talk back dial
    •VU meter- for speech

          

  63. Parts of an Otoscope•Attenuator- intensity dial
    •Frequency selector- lets you change the Hz you're testing
    •Transducer
    •Talk over dial
    •Talk back dial
    •VU meter- for speech

          

  64. Case History-A
    -Hit rate
    -failed screening
    = hearing loss

          

  65. Pure-tone test environment:
    Seating
    -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)

          

  66. Bing-both outer/middle ear and cochlea/nerve problems.

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

    AC worse BC

          

  67. Define: Congenital, Acquired, and AdventitiousS.T.O.R.C.H. (Syphilis, Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes)

          

  68. Overmaskinghappens 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

          

  69. Plateau MethodDevice that measures the immittance of the middle ear system, or how well the middle ear is functioning.

          

  70. What can cause a Retrocochlear HL?-Usually temporary: Medical intervention
    -Cerumen impaction
    -TM perforation
    -Otitis Media or Sterile -Fluid
    -Otosclerosis

          

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

          

  72. Cone of Light-A
    -Hit rate
    -failed screening
    = hearing loss

          

  73. Landmarks of the Outer Ear-Pre-Auricular area
    -Post-Auricular area
    -Auricle
    -Ear Canal
    -TM

          

  74. Implementation ProtocolsPatient could have a long standing unilateral loss

          

  75. Pure-tone testing:
    Hughson-Westlake Method
    -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.

          

  76. 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

          

  77. Absolute threshold•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

          

  78. Central masking shiftreflection from the otoscope, if not there the TM is not pulled back properly

          

  79. 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)

          

  80. IA Conservative Values:
    SRT
    •Headphones- 45 dB HL

    •Inserts- 50 dB HL

          

  81. Pure-tone testing:
    Find Initial Phase
    -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

          

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

          

  83. True positiveDevice that measures the immittance of the middle ear system, or how well the middle ear is functioning.

          

  84. Otosclerosis-Surfer's ear
    -abnormal growth of bone

          

  85. Pure-tone test environment:
    Max. Ambient Noise Level
    -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

          

  86. Quality Issues of Interviewing•Be a Good Interviewers
    •Facilitating Good Communication
    •Understand their motivation
    •Listening Skills

          

  87. Functional HLno auricle

          

  88. Pass ScreeningC. False negative (miss rate) - hearing loss
    D. True negative (correct rejection) - no loss

          

  89. Perceptual Consequences of a Retrocochlear HL-Distortion
    -Desynchronize firing
    -Fluctuating HL

          

  90. Fibrous layer of TMgives 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

          

  91. Red Flags for high risk-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.

          

  92. Pure-tone testing:
    Signal detection theory
    -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.

          

  93. 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

          

  94. Webertest 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.

          

  95. OSHA Requirements for Infection ControlSTEP 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.

          

  96. Anotiano auricle

          

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

          

  98. Weber ProblemsPatient could have a long standing unilateral loss

          

  99. What can cause a SNHL?•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

          

  100. Types of Audiometers: 1-4•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)

          

  101. Daily listen checks for hearing screenings•Be a Good Interviewers
    •Facilitating Good Communication
    •Understand their motivation
    •Listening Skills

          

  102. Step for Infection ControlS.T.O.R.C.H. (Syphilis, Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes)

          

  103. Pure-tone testing:
    Modifiers
    -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:

          

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

          

  105. 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!!

          

  106. Exposure ClassificationEach 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?

          

  107. Define: Temporary, Permanent, Progressive, and Fluctuating•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

          

  108. Pure-tone test:
    Purpose
    •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

          

  109. 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
    -May not have an ear canal, or only have a partial one
    -Auricle malformations (cupped, partially developed, etc.)
    -Atresia
    -Stenosis

          

  110. How to Mask:
    SRT
    •PL WR(TE) - 25 dB

          

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

          

  112. Fail Screening-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

          

  113. SNHL HL and Components-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)

          

  114. Exostosis-Surfer's ear
    -abnormal growth of bone

          

  115. Retrocochlearthe 8th nerve and beyond

          

  116. Hepatitis B Vaccination Records-paucity of research, no "gold standard"
    -Huge gap in our knowledge base
    -Service delivery factors

          

  117. Effective Masking-patient hears the occlusion effect = normal hearing

    or

    -patient hears the occlusion effect = SNHL

          

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

          

  119. Schwabach ProblemsPatient could have a long standing unilateral loss

          

  120. Abscissa VS. Ordinate•Abscissa (horizontal): freq. measured in Hz

    •Ordinate (vertical): dB HL; intensity (Amp.)

          

  121. What can cause a Conductive HL?-C
    -Miss rate
    -pass screening
    = hearing loss

          

  122. What type of audiometer do we usually take to schools?-Excessive Noise exposure
    -Genetics
    -S.T.O.R.C.H.
    -Hereditary

          

  123. A Tympanometer includes...• Tympanometry
    • Acoustic Reflexes
    • Acoustic Reflex Decay
    • Eustachian Tube Function

          

  124. How to Mask:
    WR
    Unmasked
    -Right ear: <
    -Left ear: >
    -Forehead: ^
    Masked:
    -Right ear: [
    -Left ear: ]

    -Connect symbols w/ dotted lines

          

  125. If cells are epithelial, what does that mean?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".

          

  126. 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

          

  127. 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

          

  128. Evidence-Based Practice (EBP)-Set into vibration
    -Place on mastoid (behind ear) and then beside ear canal
    -Ask which is louder

          

  129. False positive-B
    -False alarm
    -failed screening
    = no loss

          

  130. Hearing ScreeningsA. True positive (hit rate) - hearing loss
    B. False positive (false alarm) - no loss

          

  131. Parts of an Immittance Bridge•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

          

  132. Perceptual Consequences of a Conductive HL-Attenuation
    -Loudness
    -"Plugged up"

          

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

          

  134. 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.

          

  135. Pure-tone testing:
    False Negative Response
    -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

          

  136. Long forms-boney growths

          

  137. Case History:

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

          

  138. Auricle: Where & What are you looking for?-behind ear
    -Back area could be caved in where the mastoid is; there could be a scar, etc.

          

  139. 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

          

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

          

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

          

  142. Minimal Masking Level-how much is it going to take for that cochlea to not pick it up

    •crossover + pad (10 to 15 dB)

          

  143. Perceptual Consequences of a SNHL-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?

          

  144. Screening results: hearing loss-What mode we are using: raise hand, push button, toys for kids, ect.

          

  145. TM: 3 layers-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.

          

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

          

  147. Shadow Curvehearing 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.

          

  148. Talk overno auricle

          

  149. 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

          

  150. Screening results: no lossB. False positive (false alarm) - fail
    D. True negative (correct rejection) - pass

          

  151. Pure-tone test environment:
    Lighting
    -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

          

  152. Pars Tensa-boney growths

          

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

          

  154. The ear canal is made of what kind of cells?external epithelium

          

  155. Listening skills-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

          

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

          

  157. 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
    health)
    • Dizziness
    • Speech and Language status ( this includes problems with memory, anomia, or cognitive problems)

          

  158. Routes of Sound Transmission-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.

          

  159. Middle Ear Abnormalities•Otosclerosis
    •Chain discontinuity
    •Neoplasms
    •Cholesteatoma

          

  160. Symbols: ACUnmasked
    -Right ear: <
    -Left ear: >
    -Forehead: ^
    Masked:
    -Right ear: [
    -Left ear: ]

    -Connect symbols w/ dotted lines

          

  161. Why would it be important for a patient to get a hearing screening before getting a speech screening?•Temporary: will go away

    •Permanent: will always have

    •Progressive: keeps getting worse over time

    •Fluctuating: comes and goes

          

  162. Conservative Values-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.

          

  163. Parts of speech audiometer•Microphone
    •External inputs
    •VU meter
    •Talk over/talk back

          

  164. Calibration of audiometers•Microphone
    •External inputs
    •VU meter
    •Talk over/talk back

          

  165. When to Mask:
    SRT
    •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.)

          

  166. Degree: Adults-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

          

  167. Pure-tone testing:
    Test Phase
    Use either the Hughson-Westlake method, ascending method, or descending method

    **We use the Hughson-Westlake the most**

          

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

          

  169. 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

          

  170. Rinnetests the pt's occlusion effect

          

  171. Pure-tone testing:
    Describing a HL
    •Degree- AC
    •Configuration - AC
    •Nature - AC & BC
    •Modifiers

          

  172. When to Mask:
    AC
    •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.)

          

  173. Pure-tone testing:
    Descending Method
    -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.

          

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

          

  175. Weber: MIDLINE SENSATIONwhenever 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.

          

  176. Service delivery factorsdosage, scheduling, group vs. individual, direct vs. consultative

          

  177. Pseudohypacusis:

    Malingering
    VS.
    Psychological
    -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

          

  178. When to Mask:
    WR
    •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

          

  179. When making Evidence-Based Decisions consider:Research, clinical expertise, and client values

          

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

          

  181. Otoscopy:
    Procedure
    -Little white bump at the top of the malleus
    -Not attached to the TM, but pushes it out

          

  182. WHAT IS A DAILY LISTENING CHECK (DLC)?-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

          

  183. 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.

          

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

          

  185. Weber Advantages-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)

          

  186. Necrotizing Otitis Externa•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

          

  187. Client Valuesclient's unique characteristics and circumstances

          

  188. Define: Acute, Chronic, Sudden, and Gradual•Difficulties at birth (ICU? Ear infections?)
    •Speech-Lang. Development
    •Developmental Milestones
    •School Performance
    •Red Flags for high risk

          

  189. What is the most common mode of transmission for disease?Touching

          

  190. IA Conservative Values:
    WR
    •0 dB; but can vary from person to person

          

  191. Annual Training RecordsEach office is to conduct annual training in infection control and document it

          

  192. VU meter calibrationEach 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?

          

  193. Symbols: No ResponseAdd to any symbol:
    -Right ear: ↙
    -Left ear:↘

    -Don't connect

          

  194. IA Conservative Values:
    Pure-tone AC
    •Headphones- 40 dB HL

    •Inserts- 50 dB HL; depends on how well you got the insert in the ear

          

  195. Negative Rinnelooks at performance at AC vs. BC

          

  196. Crossoverwhat gets to the other side in the NTE

          

  197. Interaural Attenuation (IA)-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?

          

  198. True negative-A
    -Hit rate
    -failed screening
    = hearing loss

          

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

          

  200. Specificity•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
    •A/(A+C)

          

  201. Ototscopy: Purpose-beside ear is louder; AC more effective = Normal Hearing

    or

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

          

  202. Pure-tone testing:
    Instructions
    -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

          

  203. Pure-tone testing:
    Modes
    •Degree- AC
    •Configuration - AC
    •Nature - AC & BC
    •Modifiers

          

  204. How to Mask:
    AC
    •AGB ≥ 15 dB

          

  205. 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.)
    -Atresia
    -Stenosis

          

  206. Otoscope:
    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

          

  207. Masking with difficult populationsS.T.O.R.C.H. (Syphilis, Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes)

          

  208. 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.

          

  209. POSITIVE BING-patient hears the occlusion effect = normal hearing

    or

    -patient hears the occlusion effect = SNHL

          

  210. Pure-tone testing:
    Ascending Method
    -What mode we are using: raise hand, push button, toys for kids, ect.

          

  211. 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

          

  212. Pure-tone testing:
    Pure-Tone Average (PTA)
    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

          

  213. Otoscopy:
    What are we looking for ?
    • 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)

          

  214. When to Mask:
    BC
    •AGB ≥ 15 dB

          

  215. Rinne 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

          

  216. IA Conservative Values:
    Pure-tone BC
    •0 dB; but can vary from person to person

          

  217. Pars Flaccidano auricle

          

  218. Infection Control requires...Office must document the treatment that has taken place and outcome following exposure.