Audiometrics Test 1

Front 1

What are the basic components of an audiometer?

Back 1

1) power switch
2) Interrupter
3) Stimulus mode switch (tone, etc)
4) Frequency control/dial
5) Hearing level (attenuator) dial
6) Output Selector (phone, bone, etc)

Front 2

Special Option Components on an audiometer?

Back 2

1) Masking/noise interrupter; level dial
2) Microphone input
3) Recorded speech input (tape, CD)
4) Special tests
5) Patient response sig
6) Patient response microphone
7) Comp interface
8) Printer interface

Front 3

What are the 3 kinds of output transducers?

Back 3

1) earphones
2) Bone conduction vibrators/oscillators
3) Loudspeakers

Front 4

What are the 2 types of earphones?

Back 4

insert & supraural

Front 5

What are the 2 ORGs that set calibration standards?

Back 5

American National Standards Institute (ANSI)

International Standards Org (ISO)

Front 6

What should have electroacoustic calibration?

Back 6

1) output transducers (earphones, bone oscilliator, soundfield/loudspeakers)

2) Basic parameters (freq., intensity, linearity, duration, rise/fall times, distortion, etc.)

Front 7

Never ________ the equipment is working properly.

Back 7

assume

Front 8

What should you do before screening?

Back 8

listening check & biologic calibration (at the very least daily; should be done frequently through screening)

Front 9

Why do you do a listening check?

Back 9

to detect probs before patients are seen so erroneous/invalid results are not obtained

Front 10

What is the listening check procedure?

Back 10

1) turn audiometer on
2) put headphones on
3) Set HTL dial to 40 dB, test all freq. for right & left earphones
4) Set to 1000 Hz & move HTL dial across all intensities (0-110 dB)
5) wiggle headphone cables to make sure connected w/ no static
6) If no problem, proceed to biological calib
7) If prob, troubleshoot audiometer

Front 11

What is the biological calib procedure?

Back 11

check hearing thresholds of someone already known @ each freq. & for each earphone (pref on another listener BUT can be done on self if necessary)

Front 12

Test environment: permissible ambient noise levels are calibrated differently for?

Back 12

ears uncovered vs. covered

Front 13

What is the basic audiologic eval?

Back 13

1) Case history
2) Visual & otoscopic examination
3) Pure tone audiometry
4) Speech audiometry
5) Immittance audiometry

Front 14

What is the single most important piece of info necessary for establishing an audiologic/otologic diagnosis?

Back 14

case history

Front 15

A case history is a patient's chief __________ & associated ___________________ explored w/ specific ________. (e.g._________)

Back 15

complaint; symptomatology; Qs ( what are the signs & symptoms; who, when, why, how much, how long, etc)

Front 16

Case history includes info about the patient & provides insight about his auditory status.
It also contributes to what 3 things?

Back 16

1) development of a diag. impression
2) plan for audiological remediation
3) app. referrals to other professionals

Front 17

Basically the rationale for why we obtain a case history?

Back 17

1) obtain relevant info
2) basis for further testing
3) basis for further referral

Front 18

What biographical info should the C.H. include?

Back 18

name, DOB, gender, address, phone #, SS#, med insurance carrier, referral source, etc

Front 19

Auditory & comm. status info in a case history?

Back 19

presenting complaints/concerns
specific symptoms
previous test & results
previous recommendations, etc

Front 20

Medical info in a C.H.?

Back 20

illnesses
previous conditions
signs & symptoms
previous & current meds
testing & results
recommendations, follow-up, & results

Front 21

Dev info in C.H.?

Back 21

pregnancy, delivery & birth, infancy & early childhood milestones, etc

Front 22

Edu info in C.H.?

Back 22

academic performance, current school status, school personnel concerns, etc

Front 23

Fam info in C.H.?

Back 23

hereditary factors, fam structure, etc

Front 24

What rationale would an audiologist give/have for further testing from C.H.?

Back 24

directions for inital test protocols and sequence of protocols

-hints for what may be further required beyond the basic battery

Front 25

What would be reasons for further referral/what kinds of referrals may an audiologist make from C.H. info?

Back 25

medical, counseling/psych, vocational, hints for remediation & directions

Front 26

Rationale/basis for further referral?

Back 26

medical, counseling/psych, vocational, hints for remediation & directions

Front 27

C.H. format?

Back 27

1) form/questionnaire
2) Interview (structured or open ended)
3) Combo

*a matter of personal style & interviewing skills

Front 28

When would a patient complete his form/questionnaire?

Back 28

sometimes completed in advance then reviewed/clarified in person

sometimes completed @ time of session

Front 29

Formal C.H. forms have very specific _______________.
What is the format?

Back 29

area related Qs e.g. HL or dizziness

pencil & paper

Front 30

What are some limitations to formal questionnaires?

Back 30

reading skills, cog. level

Front 31

What is the best format for a C.H. obtained by interviewing? Why?

Back 31

structured but somewhat open ended Qs b/c allows clinician to maximize info

Front 32

When to obtain C.H.?

Back 32

1) before testing
2) during testing
3) after testing

Front 33

When is info obtained the most during C.H.?

Back 33

before testing (optimal)

Front 34

Why would you obtain C.H. info during testing?

Back 34

data may reveal something you have Qs about

Front 35

Why would someone obtain C.H. after testing?

Back 35

may help to avoid biases/give clues to Qs

Front 36

Time required to obtain a C.H. depends on?

Back 36

-complexity of patient history
-age
-cog level
-physical cond
-lg. skills
-reading skills
-rapport & comfort level
-cultural influences, etc

Front 37

To help establish patient comfort & rapport you should...?

Back 37

-Intro yourself/your role in clinic
-Address patient w/ app. title
-Give brief explanation of what you will be doing
-Ensure CONFIDENTIALITY

*Don't be too informal!

Front 38

To help ensure accuracy of C.H...?

Back 38

-write down or record ALL relevant info
(IF recording get permission 1st)

Front 39

What is the rationale for an otoscopic exam?

Back 39

-info on current status
-info on previous status
-info on curent func.

Front 40

What are you looking for in an otoscopic exam (referring to current status)?

Back 40

-preauricular tags
-malformations
-obstructions
-swelling/edema
-effusion/drainage

Front 41

What are you looking for in an otoscopic exam (referring to previous conditions)?

Back 41

-surgery
-reconstruction
-scar tissue

Front 42

Current status & previous conditions provide info on _____________, which in turn has implications for audiologic _____ procedures & findings

Back 42

current function; test

Front 43

What types of instruments are used in an otoscopic exam?

Back 43

1) hand held otoscopes
2) video otoscopes

Front 44

How to conduct an otoscopic exam:

Back 44

1) seat patient in an easy accessible chair
2) explain what you are doing (do not remove hearing aides until AFTER instructions have been given)
3) Visual & Physical inspection
4) If pass visual & phys. inspection then procede w/ otoscope

Front 45

Visual inspection includes:

Back 45

-carefully inspect the pinna & posauricular skin
-assess size, shape, & position of EACH auricle
-check both auricles for symm
-check for surgical scars
-check for congenital anomalies (e.g. preauricular tags or fistulas)
-inspect entrance of EAC for debris or pus that may interfere w/ further oto. exam
-gently palpate pinna for tenderness check

Front 46

Otoscope part of otoscopic exam includes:

Back 46

1) place a clean eartip/speculum on the otoscope head (chose LARGEST size comfortable w/ patient)
2) Hold oto like a pencil; make sure ulnar aspect of hand is placed on patient cheek for pt of r
3) Straighten out EAC
4) turn on oto & check for light

Front 47

Straightening of the outer ear canal makes ___________ of the speculum easier & ____________ of the ear canal & TM clearer

Back 47

insertion; visualization

Front 48

How do you straighten out an adult's ear canal?

Back 48

pull pinna up & back

Front 49

How do you straighten out a child's ear canal?

Back 49

pull pinna horiz & back

Front 50

What landmarks should you be able to identify in a normal, healthy ear?

Back 50

umbo, cone of lt., manubrium of the malleus, trans/pearl gray color, long process of incus, pars tensa, annular ligament

Front 51

What type of otoscope would you use to check for possible middle ear effusion (i.e. looks @ ME mobility)?

Back 51

pneumatic otoscope

Front 52

Results & interpretations should include:

Back 52

1) if auricle has a # of landmarks (normal landmarks are indicative of embryo. dev. patterns)
2) TM color & status
3) Normal landmarks (inside ear e.g. c of l, malleus, etc)
4) condition of EAC
5) cerumen presence & amount
6) note presence of foreign obj. (including PE tubes)
7) discharge/effusion,etc (note any abnormalities, conditions, etc visualized during oto exam)

Front 53

When should you note the amount of earwax?

Back 53

some earwax is normal; note excessive wax or impacted wax plug

Front 54

If any abnorms, conditions, or for. obj are noted what should you do?

Back 54

report it to the patient & make a med referral

Front 55

What tests do manual pure tone audiometry consist of for diagnosis?

Back 55

AC; BC

Front 56

What is the rationale/purpose of manual pure tone audiometry?

Back 56

1) asses hearing capabilities, specifically sensitivity

AC to specify the amount of a patient's HEARING SENSITIVITY @ various freq

BC to specify the patient's SENSORINEURAL SENSITIVITY @ various freq

Front 57

What is the big diff b/w screening & diagnosis pure tone audiometry?

Back 57

don't do BC in screening

Front 58

BC reveals?

Back 58

"potential to hear"

Front 59

What is the #1 Q pure tone air conduction answers?

Back 59

Does the person have a HL?

Front 60

If yes, then need to answer:

Back 60

1) At what freqs?
2) What is the degree/magnitude?
3) Uni or bi?
4) Same in both ears or not? (symm or asymm)

Front 61

What is the #1 Q pure tone BC sets out to answer?

Back 61

Does the person have a HL?

Front 62

If a person has a hearing loss in AC (which revealed the freqs of loss, uni or bi, degree of HL, etc) &/or BC testing, what does this help you to determine (in general)?

Back 62

where the possible site/prob/cause is of the disorder

Front 63

How an ind. compares to others who have no hearing diffs & no probs w/ their auditory system is?

Back 63

norms

Front 64

What does calibrated imply?

Back 64

normative data

Front 65

Average threshold for a particular sound for a pop of normal ppl?

Back 65

Normal hearing (0 dB HL)

Front 66

0 dB HL corresponds to a diff ______ @ each test freq.

Back 66

#SPL

Front 67

Smallest intensity of a sound that a person needs to detect its presence

Back 67

Threshold

Front 68

The softest level or lowest intensity that a person can just barely hear 50% of the time

Back 68

Threshold (clinically)

Front 69

physical measurement of sound; uses arb. ref of 20 uPa

Back 69

dB SPL

Front 70

perceptual scale; uses softest avg. normal-hearing human listener can hear @ a freq (ref level)

Back 70

dB HL

Front 71

What range of freq. require the least amount of energy/effort (lowest dB SPL)?

Back 71

mid-range freq

Front 72

What is the ref level for dB SL?

Back 72

patient

Front 73

Overall, dBs must have a ___________ to mean anything

Back 73

qualifier; ref level

Front 74

Whole system refers to (in regards to which pure tone test)?

Back 74

AC

Front 75

Inner ear on up (in regards to which pure tone test)?

Back 75

BC

Front 76

Supra-aural or insert earphones give test results for which ear?

Back 76

individual ear

Front 77

BC & loudspeakers give test results for which ear?

Back 77

better ear UNLESS masked

Front 78

What are the pretest considerations when doing manual pure tone audiometry (i.e. what should you have already done)?

Back 78

1) case history
2) behavioral obs
3) oto exam

Front 79

What are the 3 options for patient orientation during testing?

Back 79

1) full face frwd
2) In b/w full face & profile
3) face away

Front 80

What are some probs w/ full face frwd?

Back 80

unintended visual cues TO patient:

1) clinician gestures, facial expression, body lg., etc

2) test equipment (e.g. manipulation of dials, sig. light indicator illuminated

Front 81

Some advantages for full face forward?

Back 81

1) unintended & intended visual cues FROM patient:
-patient gestures, body lg., etc
-speechreading cues for clinician w/ or w/out HL

2) more efficient & effective for testing b/c:
-give re-instructions
-provide reinforcement
-patient comfort/ease
-patient/clinician safety
-less likely to have errors due to patient falling asleep

Front 82

What should you check during instrumentation setup in regards to audiometer controls?

Back 82

-audiometer on, etc (daily look & listen check)
-interrupter switch to manual/off
-dB increment to 5 dB
-stimulus selector to tone
-transducer to phone (or insert or bone)
-stimulus route (R or L phone)

Front 83

Instrument setup: transducer selection & placement?

Back 83

-remove any interfering hair, earrings, etc
-R or L over/in correct ear
-diaphragm must be over ear opening
-forehead vs. mastoid bone placement of vibrator

Front 84

After you've checked equipment settings, what do you do next?

Back 84

give instructions/explain procedure

Front 85

You may need to modify your instructions based on?

Back 85

age, lg, cog level, HL, etc

Front 86

In regards to response, what methods are preferred over verbal?

Back 86

raising fing/hand or button pushing

Front 87

You may need to modify response mode due to?

Back 87

age, physical capabilities, cog level, etc

Front 88

When interpreting response behavior, latency of the "on-response" should be ______________. Each response should have an __________ & a _________.

Back 88

consistent

onset; offset

Front 89

What are the two types & defs of false responses?

Back 89

1) false positive: "yes" when no tone is present

2) false negative: "no" when tone is heard

Front 90

Why might someone give a false negative?

Back 90

-personality (they like to be 100% sure/correct)

-fakers

Front 91

Both false positives & false negatives require?

Back 91

-re-instruction

Front 92

threshold of hearing is defined arbitrarily as?

Back 92

the lowest dB HL @ which the response occurs in @ least 1/2 of a series of ASCENDING trials

Front 93

The minimum # of responses needed to determine threshold is?

Back 93

3 @ a single level (ASHA '78)

2 out of 3 @ a single level (ASHA 2005)

Front 94

What is the initial part of the test sequence called? A what freq & dB level do you start?

Back 94

familiarization phase; 30 dB @ 1000 Hz

Front 95

Must have familiarization phase @ every freq (T/F).

Back 95

T

Front 96

5 up & 10 down is used during?

Back 96

threshold seeking

Front 97

The patient's threshold at each test freq is recorded on a(an) ____________.

Back 97

audiogram

Front 98

What is the range on the y-axis (ordinate)?

Back 98

typically -10 to 120 dB HL intensity range

Front 99

What is the range on the x-axis (abscissa)?

Back 99

typically 125 to 8000 Hz freq range

*expanded for high freq testing to 20,000 Hz

Front 100

What are the 3 kinds of audiograms?

Back 100

1) graphic audiograms
2) Numeric audiograms
3) Bekesy/self tracking audiogram

Front 101

Test interpretation: If AC=BC (WNL), what kind of hearing does the patient have?

Back 101

Normal hearing

Front 102

Test interpretation: If AC=BC (outside of normal limits), what kind of hearing does the patient have?

Back 102

SNHL (in SNHL, AC & BC scores are the same)

Front 103

Test interpretation: If AC>BC (BC is WNL), what kind of hearing does the patient have?

Back 103

Conductive HL

Front 104

Test interpretation: If AC>BC (outside of normal limits), what kind of hearing does the patient have?

Back 104

Mixed HL

Front 105

What is a sig air bone gap (ABG)?

Back 105

10+ dB

Front 106

Normal HL (degree)

Back 106

< or equal to 15 dB

Front 107

Slight HL

Back 107

16-25 dB

Front 108

Mild HL

Back 108

26-40 dB

Front 109

Mod`HL

Back 109

41-55 dB

Front 110

Mod-severe HL

Back 110

56-70 dB

Front 111

Severe HL

Back 111

71-90 dB

Front 112

Profound HL

Back 112

90+ dB

Front 113

Pure tone averages: 2 types measured?

Back 113

1) 3 freq, "speech freq"
-500, 1k, 2k Hz

2) 2 freq, "Fletcher"
- 500, 1k Hz (usually)

Front 114

What should you be able to specify about HL in your report (i.e. specific terminology)

Back 114

1) uni or bi
2) symm or asymm
3) same vs. diff degrees
4) does AC=BC?

Front 115

What may be the underlying problem be w/ a patterns of hearing loss/audiogram configuration: FLAT

Back 115

may be typical of meniere's

Front 116

What may be the underlying problem w/ a patterns of hearing loss/audiogram configuration: GRADUALLY SLOPING

Back 116

normal wear and & tear due to how BM is stimulated

Front 117

What may be the underlying problem w/ a patterns of hearing loss/audiogram configuration:
PRECIPITOUSLY SLOPING

Back 117

can be wear & tear but more likely OTOTICITY

Front 118

What may be the underlying problem w/ a patterns of hearing loss/audiogram configuration:
RISING

Back 118

-early pattern of meniere's
-can happen w/ otitis media w/ effusion BUT bone score's will be different

Front 119

What may be the underlying problem w/ a patterns of hearing loss/audiogram configuration:
SAUCER

Back 119

-rare, usually congenital, meningitis

Front 120

What may be the underlying problem w/ a patterns of hearing loss/audiogram configuration:
TROUGH/"COOKIE BITE"

Back 120

rare, congenital (put together w/ medical history)

Front 121

What is the occulsion effect?

Back 121

collapsing of cartilaginious portion of ear canal allowing additional energy to reach the cochlea b/c energy does not escape out...it's held in

Front 122

How might the occulsion effect occur?

Back 122

bone oscillator slips over ear or placement of supra-auarl earphones

Front 123

What does the occulsion effect result in (refering to test results)? Why?

Back 123

-"artificial" improvements of bone conduction thresholds

-BC is calibrated for hearing through the air not phones

Front 124

For what type of hearing does the occulsion effect occur?

Back 124

normal or sensorineural hearing loss

Front 125

For what type of hearing does it the occlusion effect not occur?

Back 125

conductive HL

Front 126

For what freqs is the occlusion effect greatest? How much can the dB level increase (range)?

Back 126

125, 250, 500 Hz increase by 15-30 dB

Front 127

For what freqs is the occlusion effect the least &/or negligible? How much can the dB level increase (range)?

Back 127

effect is small (5-10 dB) @ 1000 Hz & negligible @ higher freqs

Front 128

Besides occulsion effect, what are some patient related influencing factors on test results?

Back 128

-tactile (instead of hearing), vibratory responses to low freq. sigs
-patients ability &/or willingness to cooperate
-age & related cog levels
-response criteria/personality
-attention/interest in task
-fatigue level
-interferring "head noises" or tinnitus
-auditory distortion (diplacusis or pitch distortion

Front 129

What are some clinician related influencing factors on test results?

Back 129

-clarity of instructions
-accuracy of tsting procedure
-timing cues, visual cues, etc
-proper placement of earphones
-criterion for response acceptance (too lax-->too strict)
-knowing when to use masking, etc

Front 130

What are some equip/enviro related influencing factors on test results?

Back 130

-malfunction

-out of calibration

-inappropriate testing enviro (if you are going to test someone somewhere map it out first!)