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49 True/False questions

  1. Why: Concealed Handicaps-If it will keep them out or away from a certain situation

    -EX: workers comp, military

          

  2. Stenger Test-For lip reading

    -Made of homophemous words - words you can not tell apart of the lips (e.g., bud - mud); can only way to tell apart by voicing

          

  3. Lombard: Result

    Lombard Reflex
    if the patient is malingering a hearing loss, he/she will react to background noise and raise their voices while they read a test

          

  4. SPAR-Legal Involvement
    -Bizarre Scheduling
    -Desire for Control
    -Lack of Eye Contact
    -Lipreading Skills
    -Deaf Speech
    -Oblivious to Everything
    -All symptoms
    -Improbable Cause
    -Military Obligations
    -Worker's Comp
    -Threshold Variability
    -SRT < PTA
    -BC > AC
    -Flat Configuration
    -No Shadow Curve
    -Ascending vs. Descending
    -Speech Results
    -ARTs below Threshold

          

  5. Lombard EffectWhenever you are in a situation and you start hearing noise (party/football game), you will raise your own voice when there is noise present

          

  6. Dichotic Digits Test-A unilateral test

    -Also an auditory processing task

          

  7. DAF: Results-Normal: Avg-BBN = > 20

    -Mild: Avg-BBN = 15-20

    -Moderate: Avg-BBN = 10-15

    -Severe: Avg-BBN = 1-10

          

  8. Statistics-Objective test

    -Put a sound into the ear, if the peripheral system is working properly it will take the sound and put it back out through the ear

    -Usually gone w/ a mild to moderate cochlear loss

    -Once there gone, you can't rank the loss

    -So someone comes in with a moderately severe HL, if there is nice pretty OAEs they are either faking or it's a retrocochlear loss

    -If retrocochlear, do WRS testing

    -With WRS if there is no roll-over there are faking

          

  9. Why: Equipment-If it will keep them out or away from a certain situation

    -EX: workers comp, military

          

  10. Falconer: Procedure1. Instruct the patient to respond by raising his/her hand when they hear the signal.

    2. Present two signals simultaneously, one in each ear.

    3. Present signal 10 dB above threshold in the better ear.

    4. Present signal 10 dB below threshold in the poorer ear.

    5. Record results

          

  11. Malingering-For unilateral loss

    -Based on the Stenger principle

          

  12. Dichotic Digits: Procedure-A unilateral test

    -Also an auditory processing task

          

  13. Stenger: Procedure1. Instruct the patient to respond by raising his/her hand when they hear the signal.

    2. Present two signals simultaneously, one in each ear.

    3. Present signal 10 dB above threshold in the better ear.

    4. Present signal 10 dB below threshold in the poorer ear.

    5. Record results

          

  14. SPAR: Results-Normal: Avg-BBN = > 20

    -Mild: Avg-BBN = 15-20

    -Moderate: Avg-BBN = 10-15

    -Severe: Avg-BBN = 1-10

          

  15. Stenger Principle1. Instruct the patient to respond by raising his/her hand when they hear the signal.

    2. Present two signals simultaneously, one in each ear.

    3. Present signal 10 dB above threshold in the better ear.

    4. Present signal 10 dB below threshold in the poorer ear.

    5. Record results

          

  16. Why: What could be there problem?-Equipment
    -Misinterpreted results
    -Poor motivation/attention
    -Unable to respond
    -Concealed handicaps
    -Monetary

          

  17. Counting: Results-For children

    -They are too busy counting, so they don't remember level they were faking at

          

  18. Dichotic Digits: Results-A unilateral test

    -Also an auditory processing task

          

  19. Why: Monetary-If it will keep them out or away from a certain situation

    -EX: workers comp, military

          

  20. Yes/No Test-For children

    -Trick the patient

    -Be very careful not to get into a pattern - This could effect the results

          

  21. Red Flags-Objective test

    -Put a sound into the ear, if the peripheral system is working properly it will take the sound and put it back out through the ear

    -Usually gone w/ a mild to moderate cochlear loss

    -Once there gone, you can't rank the loss

    -So someone comes in with a moderately severe HL, if there is nice pretty OAEs they are either faking or it's a retrocochlear loss

    -If retrocochlear, do WRS testing

    -With WRS if there is no roll-over there are faking

          

  22. Stenger: Results

    Normal Stenger
    FAKING HEARING LOSS

    The patient chooses not to respond when the tone is louder in the poorer ear.

          

  23. Pitch Patterns Test-For children

    -Change the pitches b/w the beeps

    -Then have them tell you the pattern

          

  24. Why: Unable to Respond-Check equipment first, always blame yourself first

    -Check headphone

    -Check setting are correct

          

  25. Delayed Auditory Feedback (DAF) Test-Have the patient read, and assess his/her voice quality

    -Not incredibly accurate at finding an exact threshold

          

  26. Functional-Objective test

          

  27. Stenger: Results

    Positive Stenger
    FAKING HEARING LOSS

    The patient chooses not to respond when the tone is louder in the poorer ear.

          

  28. Falconer: Results-True hearing loss: approximately 6 words correct

    -Malingering (fake) hearing loss: > 6 words correct

          

  29. Falconer Test-For lip reading

    -Made of homophemous words - words you can not tell apart of the lips (e.g., bud - mud); can only way to tell apart by voicing

          

  30. Pitch Patterns: Results-True hearing loss: abnormal/absent OAE responses

    -Malingering hearing loss: normal OAE responses

          

  31. Counting Test-For children

    -They are too busy counting, so they don't remember level they were faking at

          

  32. Switched Speech: Procedure1. Instruct patient to listen to the story on the CD.

    2. Ask the patient questions about the story.

    3. Determine whether the story information was fused.

          

  33. SPAR: Procedure1. Instruct the patient to read a passage or pages of a book.

    2. Place the transducer on the patient's ears (headphones or inserts).

    3. Select a level at approximately 30 dB HK below the patient's threshold.

    4. Instruct the patient to start reading.

    5. Using an app or recording equipment record the patient as he/she reads.

    6. Play the recording. The patient will hear a delayed recording of his reading.

    7. If the patient stutters or has difficulties reading then this suggests malingering.

          

  34. Switched Speech Test-For unilateral loss

    -If you go back and forth from one ear to the other fast enough, you will hear in both ears b/c you can't tell which side its coming from

    -CD plays two stories, one in each ear; together they create a third fused story

          

  35. Lombard Test-Objective test

    -You can measure as the different neurons fire

    -Measuring the electrical potentials of the nuclei

    -You can know that the nerve fired and we add up the nerve fires

    -If it fires every time we know they are hearing it

    -A test that the nerve is firing!

          

  36. Why: Poor Motivation/Attention-If they are tired

    -If they are bored

    -Could have poor attention, so have an activity

          

  37. Pitch Patterns: Procedure-For children

    -Change the pitches b/w the beeps

    -Then have them tell you the pattern

          

  38. ABR Test-Objective test

    -Put a sound into the ear, if the peripheral system is working properly it will take the sound and put it back out through the ear

    -Usually gone w/ a mild to moderate cochlear loss

    -Once there gone, you can't rank the loss

    -So someone comes in with a moderately severe HL, if there is nice pretty OAEs they are either faking or it's a retrocochlear loss

    -If retrocochlear, do WRS testing

    -With WRS if there is no roll-over there are faking

          

  39. Why: Misinterpreted Instructions-Not always a handicap, but might be hiding that they are hurting (e.g., missing someone, being bullied, etc.)

    -Could be an actual handicap or and emotional situation they are trying to avoid

    -Kids would rather say they can't hear, rather than saying they are hurting physically/emotionally

          

  40. Specialized Tests-For unilateral loss

    -Based on the Stenger principle

          

  41. Pseudohypacusis-Apparent loss of hearing sensitivity without an organic pathology to explain that loss.

    -Nonorganic: either functional or malingering

          

  42. Counting: Procedure1. Place the transducer on the patient's ears (headphones or inserts).

    2. Place a sound meter or turn on the speaker and the mic on the audiometer (use 2 channels) to monitor the patient's speech levels.

    3. Ask the patient to read a passage from a book.

    4. Introduce noise in both ears. The level of the noise will be dependent on the pure-tone scores. If the patient indicates that his threshold is at 60 dB HL, then play the noise at a level that the patient would definitively not hear if he/she had a hearing loss such as 30 dB HL.

    5. If the patient reacts to the noise or starts reading at a higher level because of the noise then that is indicative of malingering or exaggerating the hearing loss.

    6. Increase the noise level by 5 dB HL. If the patient increases the level of his/her voice then this is an additional sign of malingering.

          

  43. Change Test Method-For unilateral loss

    -Based on the Stenger principle

          

  44. Lombard: Procedure1. Place the transducer on the patient's ears (headphones or inserts).

    2. Place a sound meter or turn on the speaker and the mic on the audiometer (use 2 channels) to monitor the patient's speech levels.

    3. Ask the patient to read a passage from a book.

    4. Introduce noise in both ears. The level of the noise will be dependent on the pure-tone scores. If the patient indicates that his threshold is at 60 dB HL, then play the noise at a level that the patient would definitively not hear if he/she had a hearing loss such as 30 dB HL.

    5. If the patient reacts to the noise or starts reading at a higher level because of the noise then that is indicative of malingering or exaggerating the hearing loss.

    6. Increase the noise level by 5 dB HL. If the patient increases the level of his/her voice then this is an additional sign of malingering.

          

  45. OAE Tests-Objective test

    -Put a sound into the ear, if the peripheral system is working properly it will take the sound and put it back out through the ear

    -Usually gone w/ a mild to moderate cochlear loss

    -Once there gone, you can't rank the loss

    -So someone comes in with a moderately severe HL, if there is nice pretty OAEs they are either faking or it's a retrocochlear loss

    -If retrocochlear, do WRS testing

    -With WRS if there is no roll-over there are faking

          

  46. Yes/No: Procedure1. Instruct the child to say "yes" if they hear a beep, or "no" if they do not hear a beep.

    2. Make sure you do not create a pattern while presenting the tones.

          

  47. DAF: Procedure1. Perform normal reflexes, both ipsi and contra at 500, 1000, and 2000 Hz, then with BBN

    2. Then you have a choice to put in something other than tone, you can put in broadband noise (BBN) instead

    3. The noise should come in lower b/c more of the BM is responding so start LOWER and stop at 100 dB

    4. Then average the results together

    5. Take the average then subtract the broadband noise from it

          

  48. What to do-Objective test

    -Put a sound into the ear, if the peripheral system is working properly it will take the sound and put it back out through the ear

    -Usually gone w/ a mild to moderate cochlear loss

    -Once there gone, you can't rank the loss

    -So someone comes in with a moderately severe HL, if there is nice pretty OAEs they are either faking or it's a retrocochlear loss

    -If retrocochlear, do WRS testing

    -With WRS if there is no roll-over there are faking

          

  49. Yes/No: Results-For children

    -Trick the patient

    -Be very careful not to get into a pattern - This could effect the results