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109 Cards in this Set

  • Front
  • Back
what are the three groups of electrophysiological tests
immitance
evoked potential
otoacoustic emissions
what two tests make up immittance testing
1. tympanogram
2. acoustic reflex
immitance testing measures the _______ encountered by an accoustic wave
opposition
what three characteristics does the immittance test look at
mass, stiffness, resistance
immittance tests measure the _____of the ear canal
volume
static compliance
how ear drum will move/how flexible/ how compliant
immittance testing looks at t...
typmanometry
acoustic reflex muscles..
pull with loud noise/ protective reflex/ decay
ear canal volume is measured at
+200mm H2O
volume of ear canal is based on
age
ear canal volumes greater than 2.5 suggest
perforation (hole), patent PE tube- in kids (open means functioning) (PE Tube doing its job)
if there is normal movement in an immittance test done on a kid with tubes then...
the tube is clogged and must go to physician
tympanometry measures
how easily ear drum will move with ear pressure. what's going on behind the TM
in Tympanometry...what is put into the ear? what is presented to the ear? what happens to the TM? this is all done at what level?
putting probe into ear, and presenting positive ear pressure, pushing TM in, (feels like blowing into ear), at +200
then...do what to the pressure? ...which does what to the TM
slowly reduce the pressure down to zero and continue to negative 200, sucking TM out
TM should be most compliant at...
zero pressure
if a person has a normal peak..what does that say about their hearing
it can either be normal hearing or potentially sensorineural loss
what are 4 reasons a persons TM might be too compliant
1. more flexible with age
2. a lot of scaring on ear drum from chronic ear infections
3. ossicles not working together or not attached
4. disarticulation
what does it mean if the Tympanometry shows a shallow response? who is this found in? what does it mean about their ears?
no peak, not flexible enough. found in kids with ear infections- fluid behind the ear drum.

otosclerosis- ossicles stiff- not moving
what does it mean if there is no moveemnt on the tympanometry? hl?
middle ear fluid that is gooey and has been sitting there for very long. conductive component to hl
what does it mean if there is no response and the Ear canal volume exceeds the normal volume?
perforation or tubes- hole- can't move
what does it mean if the max compliance is negative? what might not be working right? what are some causes of this?
the TM is being sucked in- like on an airplane. the eustacian tube is not working right. neg. pressure builds up and pulls TM in. allergies. Ear infection may be resolving or starting
what does AD represent and what kind of HL is associated with it
too compliant. conductive loss, may just be b/c of scarring with no conductive loss
A represents... hl...
normal or sensorineural loss
AS
shallow- conductive to start- can becomes sensorineural- can be mixed
B- normal EC Volume
no movement. conductive loss
B- large EC
conductive-
C
neg. compliance. not much HL
AP
peak is possitive. very rare. bubbles in ear. may be conductive test. wouldn't do test- send to physician
static compliance what is it? acceptable range?
movement- peak. acceptable range is 0.2- 2.5.
is the static compliance is less that0.2 what does it mean
could be otosclerosis, fluid, tympanosclerosis (stiffness)
if the static compliance is more than 2.5 what does it mean
flaccid TM, disarticulation
what is the name of the second test that is part of immittance testing
acoustic reflex testing
what does acoustic reflex testing measure
looks at bilateral contraction of stapedious m. with it reacts to loud sound it pulls TM and stiffens. the equipment measures a change
what do you put where? equipment will present what at what?
put a probe in both ears to test contraction on both sides. equipment will present a pure tone at 500, 1000, 2000 Hz.
when testing Acoustic reflexes what dB do you start at
70 dB pure tone (loud)
when doing acoustic reflex testing are you looking for threhold?
yes, softest leve that this muscle will pull at
if you get a response at 70 dB you will...

if you don;t you will....

don't go over....

person must be...
you will stop

you go up 10, down 5

115- will damage ear

sitting still and quiet
acoustic reflexes: if presenting somethign very loud to one ear will..
go to other side
normal hearing people will have acoustic reflexes at
`70-95 dB
with a person with conductive HL...(3)
- won't be able to measure refelxes
- can't get tone loud enough
- conductive problem is keeping things too quiet
a person with mild sensori neural HL will have reflexes at
nomal to a little louder
a person with severe cochlear SN will ahve
no response. can't make it loud enough
a person with damage to the acoustic nerve will have
no reflexes or a very high intensity
a person wtih damage to facial nerve(or any other auditory pathway stop) will have
no reflexes on side that is effected.
acoustic reflex test is used as
cross check- absent reflexes- can be normal hearing- can be some hidden problem
acoustic reflex decay test
a reflex with decay or go away after starts.
reflex decay occurs in high or low pitch much more quickly
high pitch
is reflex decay typical on low frequencies
no
a significant/rapid decay of reflexes can mean
a lesion/problem with auditory nerve (acoustic neuroma) or problem beyond that
inorder to do acoustic reflex decay test you need.
acoustic reflex threshold
why?
will help determine how loud will present signal- always present 10dB higher than threshold.
if someone has no reflexes...you can or can't do decay test
can't
at what 2 hertz do you test reflex decay
500 and 1000
do most audiologists do reflex decay test
not unless they have a reson to
when stimulus is presented, equipment will record
reflex and time how long till it decays
what is acoustic reflex decay testing
looking to see how long it takes reflex to decay by 50%- then the test stops.
what is screening mode
autostart. fast mode. as soon as equipment is in there. for kids. 500- 1000
what does otoacoustic emissions (OAE) test
function of cochlea and inner ear
when was OAE first reported what did it discover?
first reported in 1979- discovered that normal cochlea produces sound without external stimulation
when doin OAE test you are meausring...
acoustic response
who is this test used with
infants- to tell if the cochlea/inner ear is working
what are two types of OAE
1. spontaneous emissions
2. evoked emission
people have spontaneous emission
any stimulation
spon. emm. occurs in what percentage of population
1/2 population with normal hearing
spontaneous emission is..
continous signal our cochlea puts off that we can record
evoked emission is what
can be controled. stimulating the ear and causing emission.
what are two types of evoked emission testing
1. DPOAE- distortion product otoacoustic emission
2. TEOAE- transient Evoked OAE
what do you do with DPOAE
-present?
-cochlea will?
-way to measure?
present 2 tones that vary. our cochlea will respond by producing an acoustic response to that. way for us to measure a normal funcioning cochlea.
can you have a conductive loss and have emissions
NOOOO
what do you do with TEOAE
presenting clicks. wider frequency range-noisier. recording cochlea's response. anyone with normal hearing should have TEOAE. seen more typically with these becasue get a broader response. negative pressure will effect this test.
how do you test OAE
-place a probe into ear. will test the range that it is set to test. record emissions. needs to be quiet...equipment is very sensitive. baby should be sleeping- not movin
who started the state mandated newborn hearing test-what is it good for?
ri- good to identirfy hearing impaired children earlier.
how early can children be fit with hearing aids
as early as 4 months
what is auditory evoked potentials-what does it measure? who is it good to use with?
measures brainwaves. electrical response with electrodes on head for those who cannot do behavioral test.(dev delayed)
if a baby fails OAE what is the next step
Auditory evoked potential
what is the name of an evoked potential that you can record- the one seen most often
ABR- Auditory Brainstem Response
how does ABR work
-person must be calm/quiet/sleeping. put electrodes on forehead/top of head/ or behind ears. recording electrical brainstimulation. need skin contact. put in insert ear phones and present sound. use clicks first- broad spectrum sound. record brains response to that click-we see wave forms on screen. typical locations for waves to be if hearing is normal. typcial peaks test one ear at a time- mask the other ear.
when doing ABR what wave are you looking for
wave 5. used for threshold testing. to check hearing potential. starts at pretty loud level.
to find threshold...
decrease volume of click a step (10) at a time until wave five goes away. that will estimate threshold. looking at size and location of wave- statistics tell us what is normal.
ABR is more or less specific than OAE testing
more specific
ASSR
Auditory Steady State Response- another type of evoked potential test. faster than ABR. still record brain activity. A newer type of test
kids: threshold
kids do not understand threshold- they will not respond. something neds to be clearly audible for a kid to respond.
what are examples of responses froma very young child
startle, eye wideing, involuntary responses, crying, change in vocalization.
0-4 months- normal hearing will to speech sound respond at ? will respond to warble tone at
45 dB

75dB
4-6 months will respond to speech at?
warble at?
25 dB
50 dB
14-24 months will respond to speech at? warble at?
10, 25
why must you think of dev. delay when testing earing
may not have HL is at a dev. level that is younger than actual age
what is BOA? what age?what looking for?
behavioral observation audiometry. used with children under age 1. looking for changes in their behavior in response to a sound/clapping/singing/ bells
what will an infant do if you imitate what they're doing
will stop.
what is sound field audiometry
test booth with speakers. speakers on walls-instead of headphones. toys on walls. use various diff sounds/ speech.
what are two methods of doing sound field audiometry
1. cor-conditioned orientation reflex
2. VRA- visual reinforcement audiometry
what is used with COR
use lights present the sound along with lighted stimulus. teach/condition child to look fo the light when they hear the sound
what is used wtih VRA
toy/picture/light/animated toy. condition teo turn to toy when hear sound. very effective testing. done in sound field/ no headphones. sometimes can get insert phones
what is imp. with sound field testing? regarding test results
cannot give parent ear specific test resutls. info about a better ear- if there is one. heraing is good enough in better ear.
what kid of sound is used a lot with kids
speech. point to body part...sing-sing back....
how many audiologists ideally when doing sound field testign
2- one in booth keep kid and parent on task. the other aud. doing the testing.
what about speed of testing
critical. attention span is very short.
what is the worst age to test
2-3- dont want to sit.
how do 3-5 test
--will repeat spondee words, will wear headphones usually.
during case history what is it helpfult o do
observe behaviors of child. look at activity level to see how fast you neeed to test.
what age can repeat words? what age do they use the book
at 5 can repeat words. younger can use picture books. -may beable to use book behaviorly but not vocabwise.
what is troca
tangible reinforcement operant conditioning audiometry- used in past and with dev. delayed. use food/toy/buzzer/that the person likes as a tangible reinforcer the person can touch it/eat it/ when respond to tone
what is play audiometry
used with kids who are not old enough to raise hand or push button. it is a step between sound field and adult testing.
how does play audiometry work
kids can be taught to respond to sound, but not taught to raise hand. will be asked to put a block in a bucket when hear a sound. child hold block in hand next to ear test when hear- throw block in bucket-do with them many times until they get it.
when doing plaoy audiometry what do you have to be careful of
that the arent' giving false positives- may have to retrain.
more than one session
it is possible to take more than one session in pediatric case- many have colds, attention span problems.
at what age can a child be tested as an adult
5.
what is hearing screening in schools used for
used to find temporary issues like ear infetions or fluid. not meant to find kids with HL. if fails- referred to pediatrician aud. eval. often not tested in quiet place with lots of distraction.