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59 Cards in this Set

  • Front
  • Back
What does an audiologist do?
Screens hearing--identify problem
Measure hearing loss
evaulate and dispense technology
teach others to manage/cope with HL
moniter hearing in persons with HL risks
Evaluate vesibular problems
What does _____ measure?
spl- physical scale measurement of sound
HL- hearing compared to normal values
SL- amount above an individual's threshold
How to convert from...
dB HL to SPL

dB SL to HL
HL-->SPL: Add dBHL at given frequency to "norm" vaule at that frequency

SL-->HL: Add values to get total in HL
Layers of the Tympanic Membrane:
pars tensa: 3 layers (skin fibers, mucus membrane)

Pars flacida: 2 layers (skin and mucus membrane
Muscles of the middle ear
stapedius and tensor tympani
If a 2000Hz tone is presented at 25dBSL to someone with a threshold at 10dBHL, what level will the tone be in HL?
25 + 10 = 35dB HL
A 500Hz tone at 50DBHL is at what level in SPL?
50 + 11 = 61dB SPL
Explain occlusion effect and how it influences testing
Occlusion effect: When ear is occluded, BC sounds appear louder than when not occluded.

This affects testing because the lack of this effect suggests a Conductive hearing loss.
What do we look for in an otoscopic check?
--cone of light
--translucent TM
--manubrium of malleus
--foreign objects, excessive cerumen
Schwabach test:
proceedure, expected results
--strike fork and place on forehead/mastoid of patient. When tone cannot be heard, tester places on own head.
--diminished: tester can hear longer
--prolonged: they hear it longer
--normal: both hear it as long
Rinne test:
proceedure, expected results
--strike fork and either outside ear until it cannot be heard and then place on mastoid, or
--alternate fork between mastoid and EAC, ask which is louder
--positive: hear better by AC (normal hearning or SN HL)
--negative: hear better by BC (conductive HL)
Bing Test:
Proceedure, expected results
--Strike fork, hold on mastoid, have patient press tregus in/out
--Positive: hear "pulse" in sound (normal or SN HL)
--negative: no change (conductive HL)
Weber test:
proceedure, expected results
(patient reports Unilateral HL)
--strike fork an place to forehead
--Louder in Problem ear: conductive HL
--Louder in Good ear: SN HL
--Both same: normal, or bilateral HL
Air Conduction, Unmasked symbols
Right: O

Left: X
Air Conduction, MASKED
Right: ^ (triangle)

Left: [] (square)
BC, Mastoid, UNmasked
Right: <

Left: >
BC, Mastoid, MASKED
Right: [

Left: ]
BC, Forehead, UNmasked
Right and Left: l-l
BC, Forehead, MASKED
Right: 7

Left: F
What do the values on a correction chart mean? How to you account for them on an audiogram?
+ sound too strong
- sound too weak

add or subtract as symbol says to vaule obtained in testing
Speech Threshold Testing:
(lowest level speech can be understood)
--Spondees, 2 syllable equal stress words
--familiarize patient with words, present (voice or CD) thru earphones to obtain threshold
--threshold reached when 1/2 are correct
Speech Detection Threshold:
what it tests
when you use it
--lowest level where PRESENCE of speech can be DETECTED
--done when ST cannot be obtained
--often used for infants
--use any speech as stimulus
Speech Understanding/Word Recognition testing:
--uses PB (phonetically balanced) word lists, 50 words
--NOT familiarized with words
--presented in Carrier Phrase (ie "say ____")
--scored in % correct
When to use Masking for AC

Minimum masking level
Level Tone NTE - IA > BC (/) NTE

AC (/) NTE + 15
When to use Masking for BC

Minimum Masking Level
A-B gap TE > 10

AC (/) NTE + 15 + OE
OE Used in Low Frequencies:


P: -100 to +100 daPa or mmH20

C: .3 to 1.6ccs

V: Kids: .3 to .9cc
Adults: .9 to 2.0cc
How does Immittance audiometry work? how can we infer middle ear pressure using this procedure?
Tones are presented into EAC while pressure is varried; amount of tone reflected from TM is measured. Measures compliance indirectly--most compliant when P on both sides are equal
What does abnormal middle ear compliance infer?

too low

too high
low: fluid blocking TM from vibrating

high: discontinuity in ossicles or scar tissue over perferation
What 2 aspects of the acoustic reflex do we measure?
AR Threshold: Lowest level at which reflex occurs.

AR Decay: stapedius muscle releases when tone still present.
Acoustic reflex response in Conductive HL
--cannot measure compliance
--reflex appears absent
--no decay
Acoustic Reflex response in Cochlear HL
--reflex present at tones <60dBSPL
--reflex absent in severe HL (cannot make it loud enough)
--no decay
Acoustic Reflex response in 8th nerve/BS problems
--ABNORMAL reflexes
--absent, or at levels higher than normal
--decay present
Acoustic Reflext response with Auditory Cortex HL
--normal reflexes
Symptoms which may suggest an auditory nervous system problem
--unilateral SN HL
--unilateral tinnitus
--vestibular problems, dizziness
--facial nerve problems (numbness, paralysis, twitching)
--asymmetric speech perception (with equal hearing abilities in each ear)
What is recruitment, and what are two ways to meausure it?
-->abnormal growth of loudness

-High Level SISI
Describe the SISI test
Tone presented 20 dB SL, and tone 1dB above is "blipped" into it. Count blips. SN HL can detect changes at low SLs
describe the High Level SISI test
play tone around 85 db HL, play "blips" into it.

Auditory nervous problems cannot detect Blips.
What is abnormal adaptation, and what are two tests that measure it?
-->hear tone when first presented, then tone decays in intensity

-threshold tone decay test
-super threshold adaptation test (STAT)
Describe the threshold tone decay test
-tone presented at 20dB SL for 60 seconds--indicate how long you can hear tone (hand up, etc)
-increase tone in 5dB increments until tone is heard for all 60 seconds
--increase = "x"dB tone decay
- >30dB = 8th nerve HL
Describe the STAT test
-present tone at 100db SPL
-if tone ever deays, test is positive for 8th nerve problems
Why do we test the Auditory BS Response, and how are the results interpreted?
-used in neonatal screening or when lesion is suspected in BS or 8th nerve
--look for absolute latency, interpeak latency, and morphology of peaks 1 3 and 5
Decribe the 2 types of Otoacoustic Emitions. When are OAEs absent?
--Transient evoked OAEs: use clicks as stimulus
--Distortion product OAEs: test 2 tones together, expet response at frequency difference (ie 4K and 1K, response at 3K)
--absent when SN HL > 25-30dB
Auditory Evoked Potentials: Cochlea
-how it's measured
-0 to 2 ms
-surface electrodes deep in ear canal, gives 'clicks'
-identifies meniere's disease
AEP: Auditory BS Repsonse
-how to measure
-when it's used
-2 to 10 ms
-surface electrodes on earlobes and forehead
-insert phones deliver clicks
-used in neonatal screening
-measure info from peaks on graph delivered afer 5 minutes
AEP: Middle Latency Response
-where problem is
-15 to 60 ms
-bigh BS, Auditory Cortex
-test affected by state of conciousness
AEP: Late Responses
-where problem is
-more than 50 ms
-detects problem in cortex
-play 2 tones, identify when "oddball" tone is played
-used in research, not clinically
Audiograms/details: Conductive HL
-flat accross frequencies, or worse in LOWS
-air-bone gap noticed
-may have tinnitus in f of most HL
-patients often speak more softly than normal
Audiograms/details: Sensorineural HL
-any configuration audiogram
-attenuation and distortion noticed
-caused by noise exposure or aging, affecting high fs more than low
recruitment noticed
-can have tinnitus in f of most HL
Aduiograms/details: mixed HL
-air bone gap, with BC levels below normal as well.
-characteristics of both types
-usually have more than one auditory stystem problem.
What does a tympanogram measure?
Compliance, volume, and pressure relating to the TM
What are 3 ways to hear via BC?
Compression: skull vibrates cochlear fluid
Inertial: ossicles lag behind skull movement
Osseotympanic: skull vibrates--> pressure waves
What might cause a BC threshold to be lower than an AC threshold?
-machine calibrated improperly
-headphones/BC osscilator not set on head correctly
-central masking
-statistical variability (machine goes in 5db increments)
Levels of severity of HL on an audiogram, in dBHL
<25: Normal
25-40: Mild
40-55: Moderate
55-70: Moderatly severe
70-90: Severe
>90: Profound
What is Intraural Attenuation, and what value do we commonly use?
-how much sound skull attributes to which side of head sound came from.
What is Central Masking?
-when case is boarderline as to whether masking is necessary
-present masking, threshold goes up by 5db
--even at louder levels, 5db increase remains the same
what does negative middle ear pressure on a tympanigram indicate
otitis media
what does abnormally high volume on a tympanogram indicate?
perforation in ear drum
What is shown in a tympanogram of type:


A: nomal pressure/compliance/volume

Ad: normal pressure, too much compliance
Type ____ Tympanogram



As: norm. pressure, too little compliance

B: "flat," peak is beyond -200, cannot measure compliance (otitis media)

C: neg. pressure, normal compliance (eustachian tube not working)