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55 Cards in this Set

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What does imittance measure?

Acoustic characteristics of TM and ME. Objective measure of ME function.

What is imittance able to identify?

Able to identify certain sites of dysfunction and where lesions are but NOT make a diagnosis

What are the different equiptment for immitance testing?

1.) Transducer: Provides tone at 85 dB spL 226 Hz


2.)Manometer: air pump that varies air pressure in the canal -200 to 400 daPa


3.) Microphone: measures sound that is reflected back from ear drum, compares SPL in ear canal to ref SPL

When does TM move most freely?

With low SPL and highest compliance, pressures inside and outside TM equal

What happens if pressure is GREATER on outside of TM?

high SPL and stiffness, ET tube dysfunction max reflection

What if pressure is greatest on the inside?

max stiffening, high SPL max reflection

What 3 things can tympanometry determine? What can it not do?

Where lesions are, What structures causing abnormalities, if acoustic characteristics are normal. CANNOT determine disease process

What is on the x-axis of a tympanogram? What are the units?

sound pressure level daPa or mmh2o

What is on the y-axis of a tympanogram? What are the units?

compliance, impedance (Z), admittance (Y), EV, relates to how ear drum moves

When is there the highest reflection?

High SPL and stiffness of ear drum

When is there the highest transmission?

Low SPL and flaccid ear drum

How are admittance and impedance related to each other?

Reciprocals of each other so if one is high the other is low. Establish EV

What is equivalent volume? What is it measured in?

A large volume of trapped air is more compliant than a smaller one. ml or cc

What is the procedure for tympanometry?

start at 200+ where the TM is stiff and EV is low, with an air tight seal so can build pressure, use probe to measure and then keep going down until you get to 0 where there should be maximum compliance

How do you measure EV? What are the normal ranges?

Measure: at +200 note compliance level.


Normal: .4-1.0 child .6-1.5 adult

What are some problems associated with EV?

SMALL VOL: ear wax, foreign object, clogged probe LARGE VOL: perforation, or open PE tube

How do you measure static compliance? What are the normal levels?

Look for max compliance and then subtract the EV


.2-.9 child


.3-1.4 adult

What are problems associated with static compliance?

LOW STATIC COMPLIANCE: TOO STIFF, OSSICULAR FIXATION, FLUID IN ME, LESION HIGH STATIC COMPLIANCE: TOO COMPLIANT, OSSICULAR DISCONTINUITY, PERFORATION

What is TPP? What is normal limit? What is problem w/ it?

Pressure at at point of peak compliance, less than -100 signals ET problem


normal: -100 to +50

What does the Type A look like?

Normal

What does the Type As look like? What is it associated with?

large tympanic gradient, wide tympanic width, TPP in normal range but admittance reduced




Stiffness, otosclerosis

What does type Ad look like? What is associated with it?

Normal pressure with very high compliance.


Flaccid ME, associated with ossicular discontunity

What does type B look like? What is associated with it?

Flat, no max admittance or TPP




Occurs with otitis media and impacted cerumen, extreme stiffness

Goals of school screening

Identify loss or sensitivity (1 in 2k born with severe HL), test for middle ear disease (1 in 25 under 2 have it) or BOTH

What are the 7 things testing should be?

Simple, easy to operate, easy to understand, accepted by public, reliable test/retest, reliable across examiners, valid

What is the difference between test sensitivity and test specificity?

Sensitivity is how well the test identifies hearing loss, low sensitivity tests can have a lot of false negatives


Specificity is how well the test identifies normal hearing. If it's too specific you can have a lot of false positives where they have normal hearing but fail

How are school screenings conducted in Ohio?

Externalobservation, pure tone AC audiometry (1, 2, 4, @ 20 dB both ears) is pass/failat even one freq. Test again within a week if failed and refer if fail twice

What children should you screen?

Newborns(UNHS), preschoolers (entry and annually) School aged TD at K, 1ST, 3RD,5TH, 9TH, new kids, kids who failed year before, sp edkids annually, all screened.

What kids should you not screen?

kidswith hearing aids, cochlear implants, known HL but follow up w/ parents

What is the best way to set up a school screening?

quietestroom possible, well lit, well ventilated, minimal visual distractions, checkaudiometer daily and calibrate once a yearD

What are some tips to make school screenings better?

Testyoungest kid earliest, have someone help move from room to room, have formsfilled out if possible, stay in one place with volunteers, supervisor certifiedaudiologist kids,

What are some problems with school screenings to look for?

sustainedtone, ear phones can slip so put foam, might want to have kids watch first ifscared, may be too much noise in environment, try to go quickly

Why should we communicate with teachers?

Can find 25-50% of problems if know what to look for, can inform kids of what screenings are like

What forms are needed for screenings?

recordingscreening data, parent notification letter, referral to audiologist

What are some problems with tympanometry?

probetip can get clogged up, use correct tip size, watch for artifcacts fromcough,head turn, etc. watch for probe against canal wall rapid follow up

What are some problems with speech audiometry screenings?

High false negatives because can guess on pictures



What is looked for in the risk based screenings (HRR)

Asphyxia, bacterial meninigitis, perinatal infection (HIV, rubella), defects of ear/pinna/nose/mouth, bilirubin lvl elevated , history of family HI in childhood, low birthweight

What percentage of HL are identified by HRR?

50%

How many newborns are born with a hearing loss each year?

2-3 in 1000

What are the 3 parts of the UNBHS?

Screening: Quick look at signs of HL


Audiologic Eval: Confirm HL through further testing


Early Intervention Improve communication, senses, thinking for academic and social life

What are the two ways to screen in the UNBHS?

OAEs and AABR

How do OAEs work and what are problems with it?

Look for inaudible emissions from cochlea, those with normal hearing produce them but over 25-30 db loss dont. Could be incorrect due to fluid in the ears and dont look at nerve function, only outer hair cell function.

How do AABRs work and what are problems with it?

Record brainwaves in response to sound through electrodes placed on head. Only good for after 34 weeks and child has to be sleeping but is not affected by fluid and can look at nerve and auditory pathway function

What are some reasons a child could fail UNBHS?

Couldfail due to fluid in the ear and debris, crying/moving, equipment fails,experienced tester. Repeat ASAP if fail

What is BOA?

Behavioral Observation Audiometry


used on birth-8mo


MRL to a loud auditory stimulus with expressive behaviors like eye widening, looking towards a sound, smiling in response to a sound

What are 4 stimuli methods for children?

Noisemakers: good for getting responses, hard to control for db level. Nor consistent or valid. Speech: child name noises: narrowband noises, but not for threshold testing tones: warble tones 2k + 500 hz

What is the SDT?

Speech detection threshold. minimum hearing level at which a child recognizes the presence of speech 50% of the time, doesnt have to know its speech just know sound is there. Same as SAT

What is VRA?

Visual Reinforcement Audiometry


6mo-2.5 yrs


Conditioned response to auditory stimulus by showing a visual cue like an animation with the tone. Get them to look when the tone plays on their own and lower until they stop responding

What is TROCA?

Tangible Reinforcement Operant Conditioning Audiometry


3-5 yrs and hard to test kids


Use warble tones and a game like blocks


Use same method as VRA but give them a food prize when they press the button when they hear the tone

Play audiometry

2-5 yrs


Do an auditory stimulus with a game like throwing blocks in bucket


Condition them to respond by throwing blocks in bucket when hear sound and do it until they dont show response

Speech Recognition Testing

Age 1-5 years, try to get a traditional speech test with age appropriate languge and nonverbal responses. Use spondees expect PBK

What are the age groups for the different SRT children tests?

WIPI: 5-10 yrs


NU-CHIPS: As young as 3



What is the PBK 50?

Tests word rec ability of lower grade school age kids with phonetically balanced words with a word list.

What are the different areas of the APGAR score?

Appearance, Pulse, Grimace, Activity, Respiration

What do the different APGAR scores mean?

A Apperance: 0= no cyanosis 1= blue 2= pink P Pulse 0= no pulse 1= under 100 2= over 100


G Grimace (reflex) 0=no response 1= feeble cry 2= pull away from stimulus


A


Activity 0=no muscle tone 1= some flexing 2= flexed arms and legs


R Respiration 0= none/weak 1=irregular/gasping 2= strong cry