Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
72 Cards in this Set
- Front
- Back
|
variables that affect types and order of testing
|
- client variables (age, problem being described)
- clinic variables (time constraints, space and equipment available, personal preferences) |
|
|
categories of testing
|
- air conduction pure-tone (PT) thresholds
- bone conduction PT thresholds - speech audiometry (SRT, SDS) - immittance measures/tympanometry (reflex) - special tests (tone decay, CAPD) |
|
|
order of testing for older children and adults
|
- otoscopy
- immittance battery (at least tymps) - air conduction testing - speech audiometry - bone conduction testing (if necessary) - special tests (if necessary) |
|
|
otoscopy
|
physical examination of ears
|
|
|
PT
|
pure tone
|
|
|
hx
|
history
|
|
|
why is the order of testing air --> speech --> bone?
|
air and speech use the same method (ear phones) so you do not have to switch back and forth
|
|
|
order of testing for young children
|
- otoscopy (at least examining the pinna)
- tympanograms (may be placed at end if child is fearful) - speech reception thresholds - air conduction - bone conduction (if necessary and possible) - speech discrimination scores - special tests (if necessary) |
|
|
why is SRT first for young children
|
- more interesting
- if SRT is normal, then PT thresholds are normal |
|
|
what are the speech frequencies
|
500-4,000
|
|
|
why is immittance put last for children
|
- scariest part of testing for some
- other results may be affected if the child is upset |
|
|
what should you never say to a child while testing
|
"this won't hurt"
|
|
|
what is the "hearing threshold"
|
lowest intensity at which one barely hears a sound
|
|
|
what is a "pure-tone threshold"
|
the lowest intensity at which a person barely hears a pure tone during testing
|
|
|
what is the clinical definition of a threshold
|
softest intensity at which the client responds 50% of the time
|
|
|
why are people with hearing aids not tested with headphones
|
interference
|
|
|
what does an A on an audiogram mean
|
aided thresholds (wearing hearing aids and being tested with speakers instead of headphones)
|
|
|
what does HP on an audiogram mean
|
tested with hearing protectors in (you want a large distance between these thresholds and the normal hearing levels)
|
|
|
air conduction threshold tests
|
- under earphones or insert phones
- tests the entire auditory pathway - test one ear at a time - use pure tones from 250-8000 Hz - start with better ear (right if both are same) |
|
|
what ear do you test first
|
the better ear, if there is no better ear then the right one
|
|
|
why is testing started at 1000 Hz
|
it is where our hearing is the most sensitive
|
|
|
why is testing started at 55 dBHL
|
it is the level of a normal conversation, if you just had a conversation with them you can expect them to respond at this level
|
|
|
hughson-westlake approach
|
- "bracketing approach"
- down 10 up 5 |
|
|
when would you use ascending testing
|
for suspected malingerers
|
|
|
spondee
|
2 syllable word where both syllables are equally stressed
|
|
|
which test are spondees used for
|
- speech reception threshold
- speech recognition threshold - word recognition threshold - (dB) |
|
|
which test uses one syllable phonemically balanced words
|
- speech discrimination score
- word recognition score - speech recognition score - (%) |
|
|
how do you seat clients while testing them
|
facing away from you (children may be put sideways)
|
|
|
why do you seat the client away from you while testing
|
you don't want them to see what you are doing so they can't use visual cues to know when to respond
|
|
|
beginning instructions for testing
|
- clear but not too verbose
- firm with children and check for understanding - don't make them use the right arm for the right ear etc. (unnecessary) |
|
|
how big of a difference do you need to mask with supra-aural ear phones
|
40 dB difference between the air conduction of the two ears
|
|
|
how big of a difference do you need to mask with insert ear phones
|
60 dB or greater difference between the air conduction thresholds of the two ears
|
|
|
why is there a difference in the amount of difference needed to determine if masking is necessary for supra-aural and insert ear phones
|
- there is less chance of crossing over with inner ear phones
- sound can escape out of supra aural and be heard by other ear - supra-aural can also vibrate the skull more |
|
|
signs of sensorineural loss
|
- normal middle ear function
- no air-bone gap - low % of word recognition |
|
|
sequence of thresholds while testing
|
- 1000
- 2000 - (if difference of 20dB or more test at 1500) - 3000 - 4000 - 6000 - 8000 - re test at 1000 for first ear - 500 - 125 (only used for profound loss) |
|
|
why do you re-test the first ear at 1000 Hz
|
the person is now used to the test and may respond better (if the result is different you use the better result)
|
|
|
symbol for right ear ac unmasked
|
0
|
|
|
symbol for right ear ac masked
|
triangle
|
|
|
symbol for left ear ac unmasked
|
x
|
|
|
symbol for left ear ac masked
|
square
|
|
|
symbol for right ear bc unmasked
|
|
|
|
symbol for right ear bc masked
|
[
|
|
|
symbol for left ear bc unmsked
|
>
|
|
|
symbol for left ear bc masked
|
]
|
|
|
rules for audiogram symbols
|
- symbols placed on the frequency lines
- AC threshold are connected by solid lines - BC usually not connected (sometimes dotted line) - no response at the limits of the audiometer for any frequency is indicated by an arrow pointing in the direction of the test ear - no response symbols are not connected by lines |
|
|
can bone conduction levels ever be significantly worse than air conduction
|
no because the sound will never travel through the entire auditory system better than it does through the cochlea directly
|
|
|
classification of severity for older children and adults
|
- 10-25: normal
- 26-40: mild - 41-55: moderate - 56-70: moderately severe - 71-90: severe - >90: profound |
|
|
classification of severity for younger children
|
- 10-15: normal
- 16-25: minimal loss - 26-40: mild - 41-55: moderate - 56-70: moderately severe - 71-90: severe - >90: profound |
|
|
what is the difference in severity classes between adults and children
|
- "minimal loss" in children
- children should have better hearing - they need it to properly develop language - minimal loss is usually caused by fluid from ear infections |
|
|
when is a 2 frequency PTAs used
|
- when there is an outlier dB caused by a precipitous hearing loss
- use the best two numbers when calculating |
|
|
bone conduction thresholds
|
- reflect senorineural hearing
- generally require masking - recorded next to the frequency line of beside the ac threshold - threshold symbols are not connected |
|
|
what is a difference is bc from ac that is >10 dB called
|
an air-bone gap
|
|
|
what type of hearing loss does an air bone gap indicate
|
conductive
|
|
|
what does it mean if ac and bc is normal
|
hearing is normal
|
|
|
what does it mean if ac indicates a loss but bc is normal
|
the loss is conductive
|
|
|
what does it mean if bc is not normal
|
there is a sensorinearal component to the loss
|
|
|
what does it mean if bc is normal
|
there is no sensorineural loss
|
|
|
what does it mean if ac is not normal and ac = bc
|
the loss is sensorineural
|
|
|
what does it mean if neither ac nor bc is normal and there is an air-bone gap
|
mixed loss
|
|
|
can there be a conductive loss at some frequencies and normal hearing at others?
|
yes
|
|
|
can there be sensorineural loss at some frequencies and normal hearing at others?
|
yes
|
|
|
can there be mixed loss at some frequencies and sensorineural loss at others?
|
yes
|
|
|
can there be normal ac and bc thresholds with an air-bone gap?
|
yes (called "minimal conductive loss", no major hearing loss but still a conductive problem)
|
|
|
what things need to be described when looking at hearing loss
|
- degree of loss (mild, mod, severe, etc)
- configuration/frequency range ("high frequency," "upward sloping," etc) - type (SN, conductive, mixed) - ear (right, left, bilaterally) |
|
|
patient responses to testing
|
- hand raise
- button press - "i hear it" - for children: play audiometry, giggle |
|
|
what do patient responses to testing have to be
|
- consistent
- within an expected period of time - what would be expected from case hx and communication abilities demonstrated in the clinic/in-take area |
|
|
why do we mask
|
- makes sure a specific ear is being tested
- need to keep the other ear occupied while testing |
|
|
IA
|
interaural attenuation
|
|
|
what is interaural attenuation
|
- the number of dB "lost" as the sound travels through the skull over to the other ear
|
|
|
what is the IA with air conduction testing with supra-
aural headphones |
about 40 dB
|
|
|
what is the IA with ac with insert earphones
|
about 60 dB
|
|
|
what is the IA with a bc vibrator
|
about 0 dB
|
