Aud 705 Diagnostic Audiology Exam 1

Front 1

What are the three primary planes of reference?

Back 1

Coronal, transverse, sagittal

Front 2

What are the divisions of a coronal cut?

Back 2

Anterior and posterior

Front 3

What are the divisions of a transverse cut?

Back 3

Superior and inferior

Front 4

What are the divisions of a sagittal cut?

Back 4

Lateral and medial

Front 5

Name all the divisions shown in this picture.

Back 5

Lateral, medial
Superior, inferior
Anterior, posterior
Dorsal, ventral
Posterior, anterior
Caudal, rostral

Front 6

What part of the temporal bone would you find the cochlea, semicircular canals, saccule, and utricle?

Back 6

Petrous

Front 7

What are the major divisions of the auditory system and what structures define these parts?

Back 7

Conductive and Sensorineural
Conductive: outer ear and middle ear
Sensorineural: inner ear, 8th nerve, brainstem, central system

Front 8

List 7 basic components of a clinical (diagnostic) audiometer.

Back 8

1) Power (on/off)
2) Frequency selector (oscillator)
3) Intensity selector (attenuator)
4) Router (left, right, both)
5) Presentation button – continuous/ interrupter selector
6) Patient response indicator
7) Transducer selector

Front 9

Air conduction transducers

Back 9

Supra-aural, Insert, High frequency (circumaural), and soundfield

Front 10

Supra-aural model number

Back 10

Telephonics TDH-39, 49, 50

Front 11

Insert model number

Back 11

ER-3A or ER-5A
Etymotic or Ear-Tone

Front 12

High frequency (circumaural) model number

Back 12

Sennheiser HAD 200

Front 13

Sound field (SF) model number

Back 13

No standard used

Front 14

Bone conduction transducers model number

Back 14

Radioear B71 or B72

Front 15

How do you know that you have the correct earphones on the correct ears?

Back 15

Red right. Blue left.

Front 16

How are the two types of AC earphone transducers "sanitized" between patients?

Back 16

New foam cuffs for inserts. Covers for supra-aural.

Front 17

How do air conduction (AC) and bone conduction (BC) testing provide information about a person's conductive and sensorineural portions of the ear?

Back 17

AC tests conductive and sensorineural portion of the ear. BC tests sensorineural portions of the ear. AC-BC gives you the conductive info. Air-Bone gap means there is a conductive problem.

Front 18

Advantages of insert earphones over supra-aural earphones

Back 18

1) Reduced background noise
2) Higher interaural crossover
3) Reduced occulsion effect (with proper placement)
4) Less likely to have ear canal collapse

Front 19

Problems with insert earphones

Back 19

1) Need proper insertion depth
2) Some, especially children, find inserts a little uncomfortable or don't want something in their ear
3) Can sound funny/unnatural
4) Cerumen may block tube
5) Different calibration standards/procedures

Front 20

What are the "talk forward" and "talk back" microphones used for?

Back 20

Communicating with the patient

Front 21

Why do audiometers have a selector for continuous tone and interrupted tone?

Back 21

Continuous for speech or masking. Interrupted for pure-tone testing.

Front 22

Label these parts of the cochlea

Back 22

Front 23

Describe the position of the auditory and vestibular structures in the skull

Back 23

Cochlea: tip points anterior and laterally. Located anterior and medial to vestibular system.
Vestibular system: Posterior and lateral to cochlea.
What type of cut is this?

Hint 23

Transverse

Front 24

Types of Audiometers

Back 24

Clinical (diagnostic) audiometer
-Computer based or non-computer (stand alone hardware)
Portable audiometer
Screening audiometer
Automated
-Bekesy
-Otogram
Remote (online)

Front 25

List some additional compotents of an audiometer (besides the basic 7)

Back 25

Masking noise selector and router
Speech channel (microphone, CD, computer)
VU Meter
Talk over/talk back system
Special tests (e.g. MLD, tinnitus)

Front 26

What does a spectrum show us?

Back 26

Amplitude (y-axis) as a function of frequency (x-axis)

Front 27

Problems with supra-aural earphones

Back 27

Potential ear canal collapse
Sound leakage
Background noise
Lower interaural attenuation. Less pressure needed to get skull to vibrate.
Occlusion effect

Front 28

Occlusion Effect

Back 28

An artificial improvement in low frequency (1000 Hz and below) bone conduction thresholds when the opposite side ear is covered with a supra-aural earphone or insert earphone without deep enough insertion depth. This is due to vibrations of the cartilaginous part of the ear canal.

Front 29

Problems with Bone Oscillator

Back 29

Limited frequency response
Reduced output limits
Not good for speech testing
Can be felt (vibro-tactile) in low frequencies/moderate level
Placement is a little tricky, especially when also putting on supra-aural earphone
Have to switch sides

Front 30

Problems with Speakers

Back 30

No standardized models
Standing waves with pure tones (should use warble tones)
Patient may change head position
Only information from better ear
Calibration
Height differences with adults and children
May get feedback (loud hum) between speaker and room microphone

Front 31

Transducer

Back 31

An instrument that converts energy from one type to another.

Front 32

Sound field

Back 32

Testing in a free field such as with speakers.

Front 33

VU meter

Back 33

A monitoring meter to adjust the input level so that the output level is in calibration with the audiometers intensity.

Front 34

Audiometer

Back 34

An instrument used to test hearing.

Front 35

Ossicular chain

Back 35

Malleus, incus and stapes. Converts acoustic energy to mechanical energy.

Front 36

Internal auditory canal

Back 36

Opening into posterior wall of petrous. Where 7th and 8th cranial nerve exits to the brain.

Front 37

What transducers are these spectra for?

Back 37

1) TDH-49 Earphone (ER-3A has similar spectrum)
2) Radioear B-71 Bone Vibrator

Front 38

What is the flat part of the temporal bone called?

Back 38

Squamous

Front 39

Why do audiologists perform otoscopy?

Back 39

1) To inspect the tympanic membrane
2) To check for any blockages in the canal

Front 40

What is the name of the disposable tip we attach to the end of the otoscope?

Back 40

Specula

Front 41

What is meant by bridging? How would you accomplish that?

Back 41

Using you hand to brace against the patients head.

Front 42

What are the functions of cerumen?

Back 42

1) Lubricate canal
2) Repel water
3) Trap dust and dirt
4) Protect tympanic membrane from insects, bacteria and fungus

Front 43

What are the two areas of the tympanic membrane called?

Back 43

Pars tensa and pars flacida (Shrapnell's membrane)

Front 44

Which direction/location would you expect to see the cone of light?

Back 44

Anterior and inferior

Front 45

What is the model/brand of clinical audiometers we currently have in our clinic?

Back 45

Otometrics Madsen Austera

Front 46

How would you adjust the talk back and talk forward levels on our clinic audiometer?

Back 46

Hold the talk back button with the little triangle next to it while turning the attenuator up or down.

Front 47

Types of Otoscopy

Back 47

Standard otoscope
Pneumatic otoscope: used for very basic tympanometry by doctors. Air pump on side.
AC powered vs portable
Binocular microscope
Video otoscopy

Front 48

Cerumen

Back 48

Secreted by ceruminous glands (similar to sweat glands) along cartilaginous section and combines with sebaceous (oil secreting) glands of the skin.

Front 49

Types of cerumen

Back 49

Dry (Japanese, Koreans, Chinese, American Indians, Eskimos)
Wet (whites, blacks, African populations)
Hard or soft
Light or dark

Front 50

Identify the areas of the tympanic membrane

Back 50

Lateral process
Manubrium
Umbo
Cone of light
Pars flaccida (a.k.a. Shrapnell’s membrane)
Pars tensa
Tympanic annulus
Ear canal wall

Front 51

What is the name of the cavity in the middle ear that contains the ossicles?

Back 51

Epitympanic recess

Front 52

What is the range of normal human hearing?

Back 52

20-20,000 Hz

Front 53

Why do we only test a portion of the normal human hearing range in conventional audiometry?

Back 53

Speech sounds are only 200-7000 Hz

Front 54

Give a working definition for threshold in pure-tone testing based on ANSI (2004) and ASHA (2005).

Back 54

A pure-tone threshold is the lowest sound level of a pure-tone that the patient voluntarily responds to at least 50% of the time in a specified number of trials. (At least 3)

Front 55

Describe the modified Hughson-Westlake audiometric procedure for pure-tone threshold testing.

Back 55

"Up 5, down 10"

Front 56

What procedure do we use for pure-tone threshold testing?

Back 56

Hughson-Westlake

Front 57

Is the Hughson-Westlake an ascending or descending procedure

Back 57

Ascending

Front 58

RETSPLs

Back 58

Reference Equivalent Threshold Sound Pressure Levels. The SPLs measured in an acoustic coupler.

Front 59

RETFLs

Back 59

Reference Equivalent Threshold Force Levels. The force levels measured on a mechanical coupler. The force levels that are equal to normal hearing or 0 dB HL.

Front 60

What is the aspect ratio of an audiogram?

Back 60

20 dB/octave

Front 61

Identify all the symbols for an audiogram.

Back 61

Front 62

Draw a rough graph illustrating how the threshold of audibility (in dB SPL) varies as a function of frequency.

Back 62

Front 63

dB SL

Back 63

dB Sensation Level
Based on patients own threshold.

Front 64

Audibility Curve

Back 64

The amount of dB SPL we need to hear each frequency at the same level dB HL.

Front 65

Define Conductive Hearing Loss

Back 65

AC abnormal, BC normal, ABG greater than 10 dB

Front 66

Define Sensorineural Hearing Loss

Back 66

AC abnormal, BC abnormal, ABG less than 10 dB

Front 67

Define Mixed Hearing Loss

Back 67

AC abnormal, BC abnormal, ABG greater than 10 dB

Front 68

Explain why BC thresholds, theoretically, should not be poorer than AC thresholds

Back 68

For AC you are testing the whole system (conductive and sensorineural), for BC you are only testing the sensorineural portion. Any problem that effects the sensorineural mechanism would effect BC and AC. There could also be a problem in the conductive mechanism but that would only affect AC. Meaning that AC could be worse than BC but not vice versa.

Front 69

What does the audiogram show?

Back 69

Limits of the equipment.

Front 70

What does this audiogram show?

Back 70

Tactile response.

Front 71

What does this audiogram show?

Back 71

Collapsed canals.

Front 72

List the degrees of loss

Back 72

Front 73

List the configurations of loss

Back 73

Front 74

What frequencies do we test for AC?

Back 74

250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz

Front 75

What frequencies do we test for BC?

Back 75

250, 500, 1000, 2000, 3000, and 4000 Hz

Front 76

What are some of the reasons that speech testing is preformed?

Back 76

1) Determine the lowest level (threshold) the patient can hear speech
2) Validate pure-tone threshold results
3) Measure ability to understand speech at supra-threshold level(s)
4) Assess significant differences between ears, across time, or hearing aids
5) Provide differential diagnosis of cochlear vs. 8th nerve pathologies

Front 77

Why is it necessary to calibrate the speech materials?

Back 77

For consistancy

Front 78

How does one calibrate for speech testing using MLV?

Back 78

Use the VU meter and make sure your voice is peaking at 0 dB.

Front 79

How does one calibrate for speech testing using CD materials?

Back 79

For CD materials a 1000 Hz tone is played at the beginning. You adjust the output.

Front 80

What is the expected output reference level for speech stimimuli?

Back 80

12.5 dB above the reference value for a 1000 Hz calibration tone.
Supra-aural phones: 20 dB SPL
Insert phones: 18 dB SPL

Front 81

Describe the characteristics of the speech materials used for SRT

Back 81

Spondee words (2 syllables, equal stress on each), picture spondee words, could also use pointing to body parts or numbers in the teens. Familiarization phase to rule out words not understood.

Front 82

Describe the characteristics of the speech materials used for WRS

Back 82

Depends on what you want to know (Conversation level? Comfortable level? PBmax?) Single syllable words or nonsense syllables (CVC) that are phonemically balanced to represent occurrences in English. Most common is CID W-22 (older), NU-6.
Open set. No familiarization. Carrier phrase. Whole word or phoneme scoring.

Front 83

Downs and Minard (1996) SRT Test

Back 83

1) Instruct patient
2) Familiarize patient with list of spondees
3) Rapid approx (1 word in 10 dB ascending steps until 1 correct)
4) Establish starting level (decrease 15 dB below approximated threshold)
5) Present 2, 3, or 4 spondees at Starting Level and at each 5 dB increment until 2 correct

Front 84

ASHA (1988) SRT Test

Back 84

1) Instruct patient
2) Familiarize patient with list of spondees
3) Rapid approx (1 word in 10 dB descending steps until incorrect; present 2nd word; decrease 10 steps until two words are missed
4) Establish Starting Level (increase 10 dB above approximated threshold)
5) Present 5 spondees at start level and at each 5 dB decrement until all 5 are missed (keep track of correct and misses at each level)
6) Start level - # correct + 2 (correction factor) = SRT

Front 85

Speech Detection Threshold

Back 85

Sometimes called Speech Awareness Threshold (SAT)
Only used when SRT cannot be obtained
Choice of material not critical
Familiarization not done
Ascending approach prefered
Bracketing procedure like for pure-tone test
Usually 5-10 dB better than SRT
Not good predictor of audiogram; response due to best hearing frequency

Front 86

Guthrie and Mackersie (2009)

Back 86

UCL - 5 for WRS level
2 kHz dB SL method:
<50 dB HL; use 25 dB SL
50-55 dB HL; use 20 dB SL
60-65 dB HL; use 15 dB SL
70-75 dB HL; use 10 dB SL

Front 87

Identify the parts of the temporal bone

Back 87

External ear canal
Tympanic
Mastoid
Squamous
Petrous
Internal auditory canal
Zygomatic process
Styloid process

Front 88

CASPA

Back 88

Computer-Aided Speech Perception Assessment
A clinical measure for speech recognition that uses 10-item isophonemic word lists to derive performance intensity (PI) functions for adult listeners. It is advantageous for WRS testing because you can quickly obtain a PI-PB function.

Front 89

PI-PB

Back 89

Performance intensity function for phonemically balanced words. The maximum score is called PBmax.

Front 90

Define Immittance

Back 90

A term used in audiology that refers to a group of tests that allows one to infer the status of different parts of the auditory system by measuring changes that occur in the dB SPL of a tone (called probe-tone) that is delivered to the ear canal.

Front 91

Define Impedance

Back 91

Opposition to the flow of energy.
Z Ohms
Z=1/Y

Front 92

Define Admittance

Back 92

Amount of energy admitted.
Y mmhos
Y=1/Z

Front 93

What are the labels and units for the X and Y axes for admittance tympanograms?

Back 93

Y-axes: Admittance (mmho)
X-axes: Air Pressure (daPa)