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138 Cards in this Set
- Front
- Back
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Audiology
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The study of hearing and balance and hearing and balance disorders.
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Audiologists
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Primary health-care professionals who diagnose, treat and manage adults or children with hearing or balance disorders
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What are some audiology specialties?
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Medical, Pediatric, (Re)habilitation, Geriatric, Educational, Industrial, etc.
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What are some audiology service delivery models?
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Hospital, Clinic, Schools, Industry, Military, etc.
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What are some disorders of the outer ear?
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Trauma, Otitis Externa, Obstruction, Growths in the Ear Canal
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What kinds of trauma frequently happen to the pinna?
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Lacerations
Contusions |
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What is Hematoma Auris?
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Blood clot that results from blunt trauma to the ear
Classic boxer's injury |
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What could happen if trauma to the pinna is not properly treated?
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Disfiguration
Loss of Blood Supply |
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What kinds of trauma frequently occur in the external ear canal?
What are they usually caused by? Severity of HL? |
Lacerations and abrasions
Caused by penetrating wounds or self-trauma (Q-tip) or during audiology related procedures Usually minor but can result in temporary, minor or moderate conductive hearing loss. |
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What is Otitis Externa?
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Most common condition that affects the ear canal
Inflammatory condition of the skin lining |
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What are the types of Otitis Externa?
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Acute
Chronic Diffuse Localized |
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Treatment and typical results of Otitis Externa
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Medical referral for management
Typically no hearing loss but can cause temporary, mild or moderate conductive hearing loss. |
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What can cause acute diffuse Otitis Externa?
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Bacterial Infection
Allergic reaction to material in a hearing aid |
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What are the symptoms of acute diffuse Otitis Externa?
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Itching
Severe ear ache |
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What causes acute localized Otitis Externa?
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Bacterial Infection
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What are the symptoms of acute localized Otitis Externa?
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Edema
Boil-like eruptions in the hair follicles Infection of the EAC and/or TM |
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What is an example of chronic Otitis Externa?
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Dermatitis
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What are symptoms of chronic Otitis Externa?
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Dry, greasy scaling inflammation
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What is the purpose of the outer ear system?
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To capture and funnel sounds toward the TM
Amplify mid-frequencies |
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What is included in the peripheral auditory system?
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Outer Ear
Middle Ear Inner Ear Auditory Nerve |
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What is the purpose of the middle ear system?
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Protection
Impedance Matching |
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What is the purpose of the inner ear system?
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Frequency and intensity analysis
Transduction |
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What is the purpose of the Auditory Nerve?
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Transmission of neural impulses to the central auditory system in the brain
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What are the energy transductions that take place in the auditory system?
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Acoustic Energy
Mechanical Energy Hydraulic Energy Electrochemical Energy |
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What is the Auricle made of?
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Cartilage
Skin |
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What is the concha and what does it do?
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The deep bowl in the auricle
It helps to amplify sound |
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What color is a healthy tympanic membrane?
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Opaque
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Organ of Corti
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Sits on the basilar membrane
Bathe in endolymph Contains supporting cells Contains sensory receptor cells (inner and outer hair cells) |
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Outer hair cells
-rows -number -pattern of stereocilia |
3-4 rows
12,000-20,000 Stereocilia in W or V pattern |
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Inner hair cells
-rows -number -pattern of stereocilia |
1 row
3,500 Stereocilia in U or straight line pattern |
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How are hair cells stimulated?
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Stapes moves
Perilymph pushed Scala vestibuli displaced Reissner's membrane displaced Endolymph agitated Tectorial membrane displaced Basilar membrane displaced Cilia of hair cells bent |
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What is included in the central auditory system?
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Ascending/Afferent pathways
Auditory Cortex (temporal lobe) Descending/Efferent pathways |
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What are the purposes of the vestibular system?
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Regulate orientation of body in space
Helps control posture, balance and equilibrium Helps to produce sensation of motion Provides info on gravity, rotation and acceleration Inputs to spinal cord to influence muscle tone and reflex activity |
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What is the peripheral vestibular system?
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5 sensory organs:
3 semicircular canals Utricle Saccule |
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Where is the peripheral vestibular system housed?
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In the membranous labyrinth, which is filled with endolymph
Membranous labyrinth is suspended in the body labyrinth, which is filled with perilymph |
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What are the two major divisions of the peripheral vestibular system?
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Semicircular canals
Utricle and Saccule |
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How are the 3 semicircular canals labeled?
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Superior
Posterior Lateral |
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At what angles (to each other) are the semicircular canals situated?
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90 degree angles
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Ampula
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The widening found in each semicircular canal
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Crista Ampullaris
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Located in the Ampula
Contains specialized hair cells imbedded in a gelatinous material to form the cupula |
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Cupula
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Gelatinous material containing the crista ampullaris
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What happens when the head undergoes ANGULAR acceleration or deceleration?
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Endolymph in the SCCs lags behind and initially moves in the opposite direction
Cupula is moved from its original position Cilia undergo a shearing action Sensory hair cells translate mechanical information into neural impulses |
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What happens when the head undergoes LINEAR acceleration or deceleration?
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The saccule and utricle detect head position relative to gravity
Maculae are responsive to the effects of gravity and aid in mechanical movement (shearing) of the hair cells Hair cells translate mechanical information into neural impulses |
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Maculae
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Located in the utricle and saccule
Contain hair cells embedded in a gelatinous material covered with otoconia |
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Otoconia
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Located in the utricle and saccule
Calcium carbonate crystals that cover the hair cells |
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Central Vestibular System
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Begins at the brain stem and bifurcates
Ends as far rostral as the cerebral cortex Extends as far caudal as the spinal cord |
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Acceleration, deceleration or rotational movement results in:
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Excitation of one system (ear) and inhibition of the other system (ear)
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What is an embryo?
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Baby during first 8 weeks of gestation
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What is a zygote?
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A fertilized ovum
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When does the zygote divide for the first time?
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A few hours after fusion
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How often do the cells of a zygote divide?
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Every 12-15 hours
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Morula Stage
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Ball of cells
Develops after about 2 days |
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Blastula Stage
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Cavity forms in the ball of cells
After about 4 days |
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How long until the blastocyst implants itself?
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About 8 days
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Neural Tube
-When is it formed? -What are the 3 germinal layers called? |
About 3 weeks after conception
3 germ cell layers: ectoderm, mesoderm, endoderm |
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Top of tube will become:
Swellings on side near the top will become: |
The brain
The branchial arches (which will later become structures of the face, throat and inner ear) |
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Ectoderm
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In General: outer skin, nervous system, sense organs
Auditory System: Outer ear, lateral layer of TM, membranous labyrinth, organ of corti |
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Mesoderm
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In General: circulation structures, reproductive organs, skeletal structures
Auditory System: Ossicles, temporal bone, fibrous layer of TM |
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Endoderm (Entoderm)
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In General: Digestive System, respiratory System
Auditory System: Middle ear cavity, Eustachian tube, medial layer of TM |
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What is the time span of the development of the auricle?
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3 - 20 weeks
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When does the auricle begin to move dorsolaterally?
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At about 7 weeks
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How long until the auricle is finished forming?
What happens then? |
20 weeks
It then continues to grow in size until age 9 |
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What is the time span of the development of the external auditory canal?
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5 weeks - age 7
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When does the meatal plug disintegrate?
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Week 21
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What is the time span of the development of the middle ear cavity?
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3 -37 weeks
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What is the time span of the development of the ossicles?
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5 weeks - adulthood
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When do the malleus and incus begin to ossify?
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Week 16
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When does the stapes begin to ossify?
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Week 18
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When are the malleus and incus fully formed?
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Week 32
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When is the stapes fully formed?
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It continues to develop until adulthood
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When is the TM formed?
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After the meatal plug disintegrates (about week 21)
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When will TM change into adult position?
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2 years old
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What is the time span of the development of the inner ear?
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Week 3 - 20
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What are the categories of hearing loss and what do they include?
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Hearing Impaired - all types
Hard of Hearing - Slight (>15dB) through severe (90 dB HL); useful hearing and are able to acquire and use oral language Deaf - Greater than severe loss (>90 dB HL); cannot hear or understand conversational speech under normal conditions |
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Exogenous
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Originating outside the organism/genes
Ototoxicity, noise, infections, trauma, etc. |
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Endogenous
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Originating within the organism/genes
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Other classifications of HL:
Congenital- Acquired- Sudden- Progressive- Prelingual- Postlingual- |
Congenital: Present at birth
Acquired: Not present at birth Sudden: Acute, rapid onset Progressive: slow onset, advancing Prelingual: before dev. of speech and lang. (before age 3-5 years) Postlingual: after dev. of speech and lang. (after age 5-10 years): speech and lang. patterns already developed |
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deaf
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Hearing loss at birth or at childhood; audiologically deaf
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Deaf
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Hearing loss at birth or at childhood; culturally deaf
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Deafened
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Hearing loss occurs after completion of education (late teens and older)
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Minimal Hearing Loss
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16-25 dB HL
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Mild Hearing Loss
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26-40 dB HL
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Moderate Hearing Loss
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41-55 dB HL
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Moderately Severe Hearing Loss
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56-70 dB HL
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Severe Hearing Loss
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71-90 db HL
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Profound Hearing Loss
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90 and greater dB HL
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What are the configurations of hearing loss on an audiogram?
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Sloping
Rising Flat Cookie Bite Noise Notch |
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How are hearing disorders classified by site?
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Outer Ear - Central Nervous System
Cochlear vs. Retrocochlear Peripheral vs. Central |
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Types of Hearing Impairment
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Conductive: loss of sound conduction to middle ear; can be temporary or permanent
Sensorineural: Inner ear and/or auditory nerve; reduction of loudness and clarity; usually more loss in high frequencies; usually permanent Mixed: Conductive and Sensorineural; permanent loss and temporary Central (auditory processing disorder): Problem at brainstem and cortical levels; clarity and understanding issues; hearing sensitivity is within normal limits Functional: Apparent hearing loss without an organic basis; often in children seeking attention or adults seeking monetary gains |
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What is the treatment for a conductive HL?
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Medication or surgery
-Medical referral for diagnosis of possible cause -Possible monitoring or auditory (Re)habilitation |
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What is the treatment for a sensorineural HL?
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Many times it is not treatable with medication or surgery
-Medical referral for diagnosis of possible cause -Possible monitoring or auditory (Re)habilitation |
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What is the treatment for a mixed HL?
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Possible remediation of conductive component
-Medical referral for diagnosis of possible cause -Possible monitoring of auditory (Re)habilitation |
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What is the treatment for a central HL?
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Advanced audiological testing
-Medical referral for diagnosis of possible cause -Possible monitoring or auditory (Re)habilitation |
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What is the treatment for a pseudohypacusis (Functional) HL?
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Advanced audiologic testing to define true hearing capabilities
Medical referral for diagnosis of possible causes for patient claims Possible other referrals: counseling, psychological, legal, etc. |
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The severity of congenital anomalies of the outer ear can range from ______ to ______.
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Can range from slight to severe.
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Aural agenesis
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Total failure to develop
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Aural dysgenesis
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Partial failure to develop
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Anotia
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Absent pinna/auricle
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Microtia
-definition? -typically unilateral or bilateral? -usually right or left side? -usually males or females? |
Abnormally small pinna/auricle
Usually unilateral 4X more likely to occur on the right side More frequent in males |
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Spectrum of Microtia
What usually occurs with severe microtia? |
Mild to severe
Atresia of EAC usually occurs with severe microtia |
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Constricted ear
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Hooding or folding of the helical rim
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Lop ear
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Top of the ear is folded down and forward
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Cupped ear
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Malformed protruding ear with the top folded down and a large concha
Ear seems small due to the folds |
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Spahl's ear
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Extra fold and pointed top
"Spock's ear" |
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Macrotia
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Ear is too large
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Microtia
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Ear is too small
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Preauriclar pits/fistulae
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Pit-like depressions or holes near the auricle
Abnormal development of auricular hillock |
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Preauricular rudiments/tags
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Appendages found at or near the area of the auricle
Accessory auricular hillock |
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Stenosis
-definition -causes |
Narrowing of the external ear canal
Can be caused by a consequence of an acquired outer ear disorder (chronic otitis externa) Can be congenital (Down's syndrome) |
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Aural/Ear Canal Atresia
-definition -usually occurs with _______ -is pinna always malformed? -often associated with _______ -what is located in the place of the meatus? -what is used to differentiate between bony/fibrous mass? |
Complete closure of the External Auditory Meatus and/or absence of the external ear canal
Usually occurs with severe microtia Can occur with a normal pinna Often associated with middle ear abnormalities Shallow pit and soft tissue or a thin bony plate where the meatus should be CT scans differentiate between bony/fibrous mass |
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Aural/Ear Canal Atresia:
-typically unilateral or bilateral? -typically on right or left side? -typically found in males or females? |
Unilateral
On the right side (4:1) In males |
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Congenital outer ear (and other craniofacial) anomalies are often associated with what?
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Branchial Arch Syndromes
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Treacher Collins (Mandibular Dysostosis)
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Autosomal dominant
Flattened nasofrontal angle Hypoplastic Maxilla +/- mandible Microtia (85%) usually bilateral EAC Atresia (30-40%) usually bilateral Middle ear anomalies (conductive HL typical) Sensorineural and mixed HL occasional |
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Medical/Surgical intervention for abnormalities of the pinna
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Cosmesis
Hearing Restoration/Otologic Surgical Procedures |
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Cosmesis for abnormalities of the pinna
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Prosthesis - bone anchored mounts
Pinnaplasty (otoplasty) - implants with local soft tissue, cartilage or synthetic material |
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Hearing Restoration/Otologic Surgical Procedures
-when are they usually performed? -what is the ideal situation? |
Especially in cases of bilateral atresia
Best if inner ear/Cochlear function is normal |
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Meatoplasty
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Repair/Reconstruction of ear canal
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Tympanoplasty
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Repair/Reconstruction of tympanic membrane
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Ossiculoplasty
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Repair/Reconstruction of the ossicular chain
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Hearing restoration through non-surgical means
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Make sounds louder to overcome the air-bone gap
-Traditional and bone anchored hearing aids Aural Rehabilitation -Selection and fitting of hearing aid -Training in amplification use and maintenance -Speechreading and auditory training -Training in development of compensatory strategies |
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What is involved in a basic audiologic evaluation?
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Case History
Visual and otoscopic evaluation Pure tone audiometry Speech audiometry -threshold -suprathreshold Immittance audiometry -tympanometry -acoustic reflex threshold |
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Case History
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Necessary for establishing a diagnosis
Specific questions -what are the symptoms/signs? -who, when, why, where, how, how long, how much |
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Visual Exam and Otoscopy
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Size, shape and location of each auricle
Compared for symmetry Check for abnormalities Information on current status, previous conditions and current function |
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Basic Audiological Test Battery
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Pure Tone Tests
Speech Recognition Threshold Word Recognition Score Impedance/Admittance/Immittance Tests -tympanometry, acoustic reflex test |
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Pure Tone Test
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Tests sensitivity to frequencies
Sampled between 250 and 8000 Hz Air conduction and bone conduction |
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Speech Recognition Threshold
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Determine threshold for 2-syllable words (ex. cowboy)
Faintest intensity for which the words can be repeated at 50% accuracy |
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Word Recognition Score
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Ability to correctly repeat single syllable words presented at a comfortable intensity
Reflects how clearly or distinctly words are understood |
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Tympanometry
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Shows efficiency of middle ear using air pressure
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Acoustic Reflex Test
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Gives info about the function of the inner ear, auditory nerve and facial nerve
How well the ossicles transduce sound |
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Otoacoustic Emissions
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Tests cochlear outer hair cell function/integrity
Selected to screen for hearing loss If no response, presence of HL is possible |
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Auditory Evoked Potentials
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Tests function and integrity of the auditory system from the outer ear up to the cortical areas
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Auditory Brainstem Evoked Response (ABR)
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Used to assess function and neurologic integrity up to the mid brainstem level
Used to estimate hearing sensitivity |
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Balance Assessment
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Differentiate between "dizziness" and vertigo
Differentiate between an inner ear problem or other sites Pattern of nystagmus helps to determine the origin of the problem |
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Nystagmus
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Involuntary jerky or rapid eye movements
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Electronystagmography (EMG)
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Recording eye movements with surface electrodes
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Videonystagmography (VNG)
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Video recording of eye movements
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Other audiologic assessment procedures
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Tinnitus Evaluation
Hearing Conservation Hearing aid evaluation and fitting Cochlear implant assessment and mapping |
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Keys to success of aural (Re)habilitation
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Knowledge about hearing loss and hearing help
Supportive family, friends and co-workers Speechreading, auditory training, communication and self-help strategies Appropriate use of technologies |
