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222 Cards in this Set
- Front
- Back
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Eardrum goes this way with (-) pressure
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Out
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Eardrum goes this way with (+) pressure
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In
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Name the three type of Immittence Tests
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-Static Acoustic Compliance
-Tympanometry -Acoustic Reflex Threshold |
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Static Acoustic Compliance
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-Ease of flow of acoustic energy through the middle ear
-hermadic=airtight seal -c2= outer & inner -c1= outer |
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Normal Static Acoustic Compliance
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.28-2.25 cm3
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Equivalent Ear Canal Volume
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Estimate of volume of ear canal between probe tip and eardrum
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Tympanometry
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Objective measure for evaluation of the mobility of the Tympanic Membrane and condition of middle ear.
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Type A Tympanogram
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-Normal middle ear
-Intensity lowest at 0 daPa -range +/- 100 DaPa |
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Type B Tympanogram
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-No maximum compliance
-Occurs with conductive loss -bad middle ear -added mass in middle ear (cholesteotoma, fluid) -needs medical attention |
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Type C Tympanogram
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-peak exceeds -100 daPa
-negative ear pressure -eustachian tube not properly functioning -middle ear infection |
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Type Ad Tympanogram
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(deep, discontinuous)
-high static acoustic compliance -overly mobile eardrum -ossicles are broken |
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Type As Tympanogram
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(shallow, stiff)
-stiffened ossicular chain -otosclerosis -conductive loss -low acoustic compliance |
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Tensor Tympani Muscle
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(Trigeminal CN V)
pulls back eardrum making it stiff |
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Stapedius Muscle
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(Facial Nerve XII)
when contracted affects fluids -reaction to loud sound |
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What dB is needed to spark acoustic reflex
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above 85 dB
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Acoustic Reflex Testing
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-Contraction causes middle ear to stiffen
-both sides contract, stronger in side where it is delivered or better |
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Acoustic Reflex Threshold
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lowest intensity needed to elicit a middle ear muscle contraction
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Which frequency is problematic in Acoustic Reflex Threshold
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4000 Hz
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Which freq (high or low) evokes best responses during Acoustic Reflex Threshold
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Best at LOW frequncies
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Which type of hearing loss is Acoustic Reflex Testinf sensitive to
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Conductive Hearing Loss
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What change signifies a reflex in ART
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.02 cm3
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What Intensity is used to start ART
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70 dB
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DPOAE
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Distortion Product Otoacoustic Emission
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DPOAE
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Distortion Product Otoacoustic Emission
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TEOAE
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Transient Otoacoustic Emission
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TEOAE
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Transient Otoacoustic Emission
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Tympanometry
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Determines the maximum compliance of middle ear from pressure-compliance function
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Tympanometry
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Determines the maximum compliance of middle ear from pressure-compliance function
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Acoustic Reflex
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Monitors contraction of Inra-Aural muscles of the middle ear in response to intense sounds
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Acoustic Reflex
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Monitors contraction of Inra-Aural muscles of the middle ear in response to intense sounds
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Static Acoustic Compliance Measure Procedure
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1) select probe
2) increase to +200 daPa, eardrum inward and stiff, measure c1 3) decrease to 0 daPa, maximally compliant, take C2 |
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Static Acoustic Compliance Measure Procedure
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1) select probe
2) increase to +200 daPa, eardrum inward and stiff, measure c1 3) decrease to 0 daPa, maximally compliant, take C2 |
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DPOAE
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Distortion Product Otoacoustic Emission
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TEOAE
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Transient Otoacoustic Emission
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Tympanometry
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Determines the maximum compliance of middle ear from pressure-compliance function
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Acoustic Reflex
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Monitors contraction of Inra-Aural muscles of the middle ear in response to intense sounds
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Static Acoustic Compliance Measure Procedure
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1) select probe
2) increase to +200 daPa, eardrum inward and stiff, measure c1 3) decrease to 0 daPa, maximally compliant, take C2 |
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DPOAE
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Distortion Product Otoacoustic Emission
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TEOAE
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Transient Otoacoustic Emission
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Tympanometry
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Determines the maximum compliance of middle ear from pressure-compliance function
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Acoustic Reflex
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Monitors contraction of Inra-Aural muscles of the middle ear in response to intense sounds
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Static Acoustic Compliance Measure Procedure
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1) select probe
2) increase to +200 daPa, eardrum inward and stiff, measure c1 3) decrease to 0 daPa, maximally compliant, take C2 |
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How do you measure SAC?
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C2 - C1 will get you state of middle ear only
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Tympanometry Procedure
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1) airtight seal
2) +200 daPa, take compliance reading 3) decrease pressure and take multiple measurements 4) -200 daPa take final reading. |
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Inpedance (Frictional Resistance)
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Determined by ligaments of ossicles
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Reactance (Frictional Resistance)
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Mass and stiffness combined
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______ has the largest effect on Impedance during high frequencies.
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Mass
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________ has the greatest affect on Impedance in low frequency sounds.
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Stiffness
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Probe in immittance measure delivers _______ (high/low) frequencies.
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Low
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Which muscle gradually relaxes in Acoustic Reflex Decay
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Stapedius
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Electrocochleography
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Early
Latency: 2-3 ms Site: cochlea Peaks: SP and AP (summating and action potentials) |
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Auditory Brainstem Response
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Fast
Latency: 0-10 ms Site: Brainstem Peaks: I-V |
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Middle Latency Response
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Middle
Latency: 10-50 ms Site: Thalamus and Cortex Peaks: Na, Pa, Nb Patient has to be calm but alert assessment of hearing threshold in lower frequencies |
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Late Auditory Evoked Response
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Late
Latency: >100 ms Site: Cortex Peaks: P1, N1, P2 |
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Auditory P300 Response
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Slow
Latency: 300 msec Site: Diffuse Sites Peaks: P3 |
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Equipment Needed for Auditory Evoked Responses
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-Stimulus Generator and Transducer
-Electrodes -Analog Section (amplifiers) -Digital Section (Signal Averager) -Output Section (plotter, oscilloscope, etc) |
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Stimulus in ABR
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click or tone "pip" 10 seconds or faster
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We want impedence during ABR to be less than _____
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5 ohms
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Absolute Latency
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Time at which an evoked response wave component (peak) occurs after presentation of a stimulus
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Interpeak Latency
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Time interval between absolute latencies of 2 wave components.
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Source of ABR wave I
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Auditory Nerve distal portion (as leaves cochlear nucleus)
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Source of ABR wave II
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Auditory Nerve Proximal portion (as enters brainstem)
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Source of ABR wave III
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Cochlear Nucleus
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Source of ABR wave IV
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Superior Olivary Complex
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Source of ABR wave V
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Lateral Lemniscus
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Auditory Evoked Potential
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electrical potentials or activity caused by a signal
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Auditory Evoked Potential Equipment Needs
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-Differential Amplifier
-Signal Averager -Filters -Stimulus Generator -Transducer to Deliver Stimulus -Electrodes -Response Delay |
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Auditory Evoked Potential - Electrodes
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Noninverting electrode (signal plus noise)
InvertingInverting electrode (noise only) When you inverting the inverting one, noises cancel out and enhances output (signal) |
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Applications of Auditory Evoked Potentials (AEP)
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Neonatal Screening
Prediction of Sensitivity Diagnosis of nervous system function Interoperative Monitoring |
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Transtympanic electrocochleography
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Tiny needle electrodes through eardrum on surface of oval window
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electrode placement - extratympanic
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less invasive placement
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Auditory Brainstem Response stimulus
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clicks or short tone pips
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Click stimulus
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brief transient sounds with spectral representation
-energy across representations -wideband energy with a lot of different freqs |
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transient
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short duration sounds
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Tone burst
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more frequency specific than click
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ABR Threshold
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lowest intensity at which wave V can be detected
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Within what range of ABR is behavioral?
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10-20 dB
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Maturational Growth of ABR
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birth: I and V
6 mos: I, II, V 1 year: I, II, III, V 18 mos: I, II, III, IV, V |
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What does the hashed portion of the Latency Intensity Function represent
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Normal range from normal hearing population
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ABR in conductive loss
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Higher intensity needed to evoke a response, so the level we obtain ABR at is higher. Latency Intensity Function will be higher than normal hashed range
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ABR high frequency cochlear loss
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Cochlear hearing loss exhibits recruitment, so elevated ABR thresholds but higher freqs are in normal range. Wave V appears normal
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ABR procedure
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1) moderately high intensity (1000-4000 Hz)
2) decrease till wave V disappears (lower 5 dB steps) 3) replicate all waveforms 4) document wave V latency 5) plot LI function |
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Clicks are _________ stimulus
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wideband
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ABR is used to screen _________
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newborns
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Auditory Steady State Response (ASSR)
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-not affected by state of patient
-brainstem or aud cortex, determined by sound played -sounds are mudulated -mainly use amplitude modulated tones -defined by frequenc content of neural response -goes up to 120 nHL |
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Limitations of ABR
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-clicks are not freq specific
-not good at low freqs -takes time -interpretation of waveform |
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________ tones are typically used in ASSR tests.
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AM (Amplitude Modulated)
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Carrier Frequency in ASSR
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modulated at fast or slow rates (approx 60 Hz)
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_______ is RARELY used un ASSR tests
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FM (Frequency Modulated tones)
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ASSR goes up to _____ nHL while ABR only goes up to ______ nHL
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80, 120
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ASSR is defined by ________ of neural response
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Frequency Content
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ASSR locks into ________
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rate of modulation
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ABR in Otoneurological Assessment is used to detect ______ lesions.
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retrocochlear
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ABR is considered neurologically abnormal if
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-absent waveform componants
-prolonged IPL -Interaural wave V latency difference -large shift in wave V latency with high stimulation rates -wave V/I aplitude ratio - no norms -poor morphology |
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Retrocochlear lesions ______ neural conduction velocity
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slow
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Typical time between waves I-V in ABR
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4 ms
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IPL (interpeak latencies)
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if generator from I-V is extended, this indicates a lesion on the auditory pathway
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What causes peak V to be missing
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lesion affects high up in brainstem
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ABR VIII nerve tumor - auditory nerve
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-peaks after wave I are often delayed
-IPLs are longer than normal -poor morphology (shape of the response) |
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ABR Braintsem Tumor
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wave V may be missing or have longer latencies
-IPLs are longer than normal -poor morphology |
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ABR misses ______% of small tumors
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30-50
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Reliability
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how well is a test repeatable
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Validity
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does test measure what it is supposed to measure
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Sensitivity
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how well does it correctly diagnose a disorder
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specificity
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how well does it correctly reject the incorrect
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Standard ABR tests cannot detect small tumors _____ cm
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<1
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Sensitivity in ABR
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% of tumor cases detected (true-positive)
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Specificity in ABR
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% of non-tumor cases correctly identified
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_______ important to the acoustic reflex arc
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Facial (VII) nerve
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Stacked ABR
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-Based on activity from different regions of auditory nerve
-combination of these make up the amplitude of auditory brainstem response -need a sound that willl activate all these regions 1) activate all the regions 2) separate responses to different frequency regions of inner ear (masking and subtraction) 3) stacking the responses |
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Masking used in stacked ABR
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High pass masking noise
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Frequencies used in Stacked ABR
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8000, 4000, 2000, 1000, 500 Hz
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4 kHz high pass masking noise means _______
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4 kHz is the cutoff freq of the high pass filter, no freqs high than it will be detected
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Stacked ABR has ________ sensitivity and _______ specificty
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95 sens, 85 spec
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Which freqs (high or low) are activated first in stacked ABR and why?
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high, because they are located at the base of the basilar membrane
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How many ms does it take to reach apical end of basilar membrane
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1ms
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How many ms does it take to reach apical end of basilar membrane
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1ms
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What stimulus is used to elicit a response in AEP
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clicks
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Which AEO can be used in the diagnosis of meniere;s disease
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Electrocochleography
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How many seconds after stimulus presentation should all waves occur
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10 ms
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retrochochlear has to do with ____ and ____ structures
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auditory nerve and brainstem
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ABR is used to detect ________ problems
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retrocochlear
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If peak V is missing there is a problem in the ______
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brainstem
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ABR detects ______% of large tumors
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90-95
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What type of injuries are physician induced?
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Iatrogenic
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What 2 associations count Interoperative monitoring as part of an audiologists scope of practice.
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ASHA and AAA
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Interoperative Monitoring
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-Inexpensive and effective method for detecting changes in function
-real time or nearly real time monitoring of function -imaging methods are difficult to use in the operating room and provide only information about structure. |
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Auditory (introperative monitoring) is used to preserve which cranial nerve
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8th cranial nerve
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Indentification of specific neural tissue in intraoperative monitoring
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localization of the auditory and vestibular nerves in the cerebello-pontine angle for section of the vestibular nerve
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IOM (intraoperative monitoring) objectives
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-to avoid intraoperative injury to neural structures
-to facilitate specific stages the the surgical procedure -to reduce the risk of post-operative neurologic injury 0to assist the surgeon in identifying specific neural structures (vestibular portion of the 8th cranial nerve) |
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The ______ end of the basilar membrane is associated with high frequencies
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base
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the ______ end of the basilar membrane is associated with low frequencies.
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apical
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what is the "sweet spot" on the basilar membrane that is associated with maximum dispacement
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center
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inner hair cells
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-neural transduction
-receptor cells in inner ear towards CNS and brain -AFFARENT to brain within cochlea change sound single row 3,500 located in medialis (central core of the inner ear) mechanoelectrical transduction (change sound to neural info) |
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Outer Hair Cells
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-not a lot of affarent information
-inner ear, change mechanical property of cochlea, this is HOW the basilar membrane vibrates -motion of these changes the way the membrane vibrates -increase magnitude of vibration -makes our threshold more sensitive by having increased displacement 3-5 rows 12,000 outside of cochlear spiral |
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cuticular plate
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top of the hair cells, there are sterocilia on these
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how many sterocilia are on the outer hair cells
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150-160
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how many sterocilia are on the inner hair cells
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40
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What are the 2 classes of OAE
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-spontaneous OAE (SOAE)
-Evoked OAE (EOAE) |
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Outer Hair Cells
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-not a lot of affarent information
-inner ear, change mechanical property of cochlea, this is HOW the basilar membrane vibrates -motion of these changes the way the membrane vibrates -increase magnitude of vibration -makes our threshold more sensitive by having increased displacement 3-5 rows 12,000 outside of cochlear spiral |
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cuticular plate
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top of the hair cells, there are sterocilia on these
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how many sterocilia are on the outer hair cells
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150-160
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how many sterocilia are on the inner hair cells
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40
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What are the 2 classes of OAE
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-spontaneous OAE (SOAE)
-Evoked OAE (EOAE) |
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3 types of EOAEs
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-Stimulus frequency OAE
-Transient OAE -Distortion Product OAE |
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What types of hearing loss obscure detection of OAE
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-conductive loss
-cochlear loss of worse than 35 dB |
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Intermodulation Distortion equation
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2F1-F2
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DPOAE
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predicts when distortion product will occur
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DPOAE stimulus
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F2 always higher than F1 in stimulus pair,
-frequency separation of 2 tones -relative levels (difference between tones is typically 10 dB) -range of freq tested is 1.5-10 kHz |
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_____ (low or high) tones are problematic for DPOAE
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low
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this type of hearing loss will result in an absent OAE
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conductive
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if the DPgram goes below the yellow line it is (absent or present)
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absent
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DPOAEs can be conducted for cochlear loss up to _______ dB HL
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60
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Functions of the Outer Ear
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-Shape and amplify sounds
-sound collector -assist us to locate sound -protects eardrum |
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Ear Canal
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-sound propegates down ear canal
-pull differently in kids than adults to see -lined with epithelial tissue -outer 1/3 is cartilaginous cerumen producing glands -medial 2/3 is bony (osseous) portion of the ear |
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Tympanic Membrane
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outer layer - cartilaginous tissue that lines inner ear
middle layer - fibrous connective tissue like trampoline inner layer - mucous lining inside (easily infected) |
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traits of a healthy tympanic membrane
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pearly white, semi-transparent, cone of light, cone shaped
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middle ear serves as a __________ to deal with a problem known as ________.
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acoustical to mechanical transformer, impedence mismatch
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functions of the middle ear
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-converts acoustic energy into mechanical energy
-amplify sounds - transfer function -match impedence of air filled outer ear with fluid filled inner ear -middle ear muscles control ossicular chain |
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parts of the middle ear
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-tympanic membrane
-airfilled space called middle ear cavity -tube known as eustachian tube -mechanican lever system (3 ossicles) -2 muscles (tensor tympani and stapedius) -axial ligaments to hold middle ear bones |
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the name of the flaccid portion of the tympanic membrane
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pars flaccida
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name the three bones of the middle ear
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mealleus, incus, stapes
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the largest middle ear bone that is coupled to the tympanic membrane is the
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malleus
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incus bone
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runs medially and forms the lenticular process
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stapes bone
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footplate is embedded in the oval window
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malleoincudal joint
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malleus and incus
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incudostapedial joint
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incus and stapes
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the purpose of the ligaments of the middle ear is to _____
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-minimize component of impedence
-minimize resitance |
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anterior ligament
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-connects to malleus
-origin is the anterior wall |
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posterior ligament
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-in the incus
-holds the short process of the incus to the anterior wall of the middle ear space |
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Chorda Tympani nerve
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a branch of the facial nerve responsible for taste from anterior 2/3 of tonge
-runs between malleus and incus |
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Eustachian tube
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-opens into nasopharynx
-pressure equalization -prevents us from hearing our own voices -drainage of fluid from middle ear to throat |
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Tensor palatini muscle
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contracts to raise velum and close off nasopharynx
-controls openining of eustachian tube |
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_______ is ear pain when pressure changes suddenly
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otalgia
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the angle f the eustachian tube in adults is ______ degrees, the angle of the eustachian tube in children is ______.
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10, 45
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arial ratio
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-surface area of eardrum and stapes footplate
-TM = 55 mm 2 -stapes footplate = 3.2 mm 2 -ratio = 17 force transmitted is greater pressure but increased at oval window -LARGEST CONTRIBUTOR TO OVERCOMING IMPEDANCE MISMATCH -think of heel hurting more than boot |
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three methods of overcoming impedance mismatch
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-arial ratio
-lever ratio -buckling motion of eardrum |
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Disorders related to the Eustachian Tube
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-Type C tymp bc of the negative pressure in the ear
-megative pressure due to cold, sinus infection, etc -barotrauma which is the sudden change in air pressure diving, airplane, violent sneeze -Manubrium is so retracted because of negative pressure that the manubrium becomes prominent |
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valsalva maneuver
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plug nose and blow out through cheeks
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toynbee maneuver
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plug nose and swallow
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Basic Treatments of Eustachian Tube Dysfunction
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-decongestants, antihistamines for allergies
-antibiotics for sinus infection -steroid treatment if ET is swollen |
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Patulous Eustachian Tube
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ET opens too much
-popping and pressure during swallowing -autophony (head in the barrel, reverberations of own voice) |
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Cholesteotoma
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-Disease in which skin cells/debris collect and grow in ME cavity
-increase in size and tissue collects, destroys surrounding tissue -Epidermal Cyst=skin in the wrong place -insidious-when eardrum is intact *can form a conductive loss |
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Symptoms of Cholesteotoma
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mild to moderate hearing loss
-type B tymp with low static acoustic compliance -elevated air conduction thresholds -otorrhea (AWFUL smell) -Chalky white substance -dizziness -weakness in the face |
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Causes of Cholesteotoma
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-tympanic mebrane perforation (debris)
-Eustachian tube dysfunction (most common) |
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Audiologists role for cholesteotomas
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1) recognize symptoms because this requires imediate medical referral
2) complete audiologic evaluation before and after surgery to ensure no damage |
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Cholestetoma acquired
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unknown prevalence
-HIGH reoccurance rate -ossicular chain errosion (most require prosthetic middle ear) |
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Mastoidectomy
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procedure used to remove cholesteotoma near mastoid
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Disarticulation of the ossicles
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Common cause is jolt to the head (trauma)
-subluxation is an incomlete dislocation or sprain of the ossicles -loosening of joints impacts impedence properties |
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disarticulation of the ossicles audiometric profile
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mild to moderate hearing loss
-PTA and SRT elevated -word recognition scores close to 100% -Type Ad -Acoustic reflex is elevated or totally absent -maximum 60 dB hearing loss |
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disarticulation of the ossicles treatment
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surgical - requires medical referral
ME can be rebuilt with prostheses for ossicles |
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Otosclerosis
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AKA otospongiosis
-hardening of the ear -affects stapes and bony labrynth of cochlea -imobolizing the stapes footplate -2.5 times more common in women -bilateral in 85% of patients blueish around eyes |
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otosclerosis - audiological manifestations
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progressive conductive loss
-tinnitus -ear discomfort CARHART NOTCH AT 2000 Hz due to innertial changes -affects low freqs first Tymp As - |
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paracusis willisii
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sign of otosclerosis
-can hear speech better in the presence of background noise |
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schwartze sign
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behind the tympanic membrane-median wall. Red glow on promontory because of increased blood flow
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Treatment for otosclersis
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Surgery because it is a progressive disorder
or amplification such as hearing aids |
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stapedectomy/stapedotomy
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scrape bone growth or replace with prosthetic device
-success rate is 90-95% |
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Otitis Media
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Most common reason that children receive antibiotics or undergo surgical care
-35 million children receive 3-5% of visits to a medical doctor 75% of children experience at least 1 episode of OM by age 3 -diagnoses has increased by 150% between 1975 and 1990 -half will have 3 or more ear infections during the first 3 years. |
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Prevalence
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totaly number of people who had the disease at any given time
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incidence
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annual number of people who have a case of a particular condition
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Otitis media is more common in males or females
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males
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what seasons is otits media most common in
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spring and winter
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risk factors for otits media
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-downs syndrome (fragile x)
-cleft palate and other craniofacial disorders -kids in inner cities or kids who attend daycare |
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Ethnic groups who have high rates of OM
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-native americans
-eskimos -aboriginee in australia |
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Predisposing factors for otitis media
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-at risk groups
-poorly functioning eustachian tube -trauma in pressure changes -anatomic dysformities of middle ear space -gender/demographics -mucous membrane not functioning correctly |
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effusion
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escape of fluid into tissue or cavity
-cause of transient conductive loss in children |
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Acute (time course of OM)
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short term (less than 21 days) rapid onset, resolves self
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Chronic (time course of OM)
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persitant, long term (longer than 8 weeks) slower onset, perforation and discharge
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Recurrent (time course of OM)
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3 or more bouts of acute withing a 6 month time period)
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Serious/nonsuppurative (fluid types of OM)
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thin STERILE fluid that looks like water.
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Purulent/suppurative (fluid type of OM)
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pus in fluid, white blood cells, debri, bacteria
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mucoid (fluid type of OM)
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thick, opaque and mucous-like. not always infected, sometimes is
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Sanguinois (fluid type of OM)
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blood contained in the fluid
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Audiometric profile of OM
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type B tymp, low static acoustic compliance
-mild to moderate hearing loss |
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_______ pressure leads to OM
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negative
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Disease pathway of OM
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1) upper respiratory infection
2) nasal secretions infect ET 3) Inflamed ET 4) middle ear cavity absorbed oxygen and has lower than normal ME pressure 5) pressure drops, creates vaccum, tympanic membrane goes in 6) sucks fluid out of lining of middle ear 7) bacteria is in middle ear space 8) bacteria into fluid 9) INFECTION 10) can cause perforation, white blood cells, |
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most common treatment of OM
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antibiotics
*bacteria killed some fluid may remain |
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myringotomy
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small incision of the TM
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tympanostemy (pressure equalization) tubes
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used to treat eust tube dysfunction
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barotrauma
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bursting
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Eustachian tubes (open)
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type B tmyp, hi SAC, large volume
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Eustachian tubes (clogged)
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type B tymp, low SAC, low volume
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