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47 Cards in this Set

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air conduction testing frequency order

1000, 2000, 4000, 6000, 8000, retest 1000, 500, 250

threshold bracketing technique

1) familiariation trial: present signal at 30dB at 1000Hz, patient responds start threshold search, patient doesn't respond increase to 50 dB then in 10dB increments until patient responds

2) threshold search: start at 10dB BELOW familiarization trial level... then begin down 10, up 5 process.

bone conduction test frequencies

500, 1000, 2000, 4000hz

when do you do bone conduction testing?

when AC threshold indicates hearing loss (> 15 dB)

when does IA occur in air conduction?

occurs when the sound delivered to TE is loud enough that it crosses over by BC to the NTE

when do you mask for AC

1) when there is a >= 40 dB difference between AC thresholds of both ears

2) when there is a >= 40 dB difference between AC threshold of TE & BC threshold of NTE

IML for AC

take AC threshold of NTE + 10 = ____ EM HL

IML for BC

take AC threshold of NTE + 10 + OE = ____ EM HL

occlusion effect numbers

250 hz - 20 dB

500 hz - 15 dB

1000 hz - 5 dB

when do you mask for BC

- when there is an ABG > 10 dB between BC and AC at any frequency

types of speech stimuli

1) recorded test material: more consistent, already calibrated

2) monitored live voice: more flexible, less control over stimuli, audiologist speaks into microphone

Speech DETECTION threshold

- does NOT require patient to recognize the word being said

- softest level at which a person detects the presence of absence of voice/speech 50% of the time

- recorded in dB HL

- masking = speech noice

Speech RECEPTION threshold

- softest level at which a patient recognizes the word and can REPEAT it back 50% of the time

- uses spondee (polysyllabic) words, equal stress on both syllables

- should correlate with PTA

- patient responds by repeating words, writing down, pointing to pics...

most comfortable level

level at which patient finds listening to speech most comfortable

uncomfortable listening level

level at which patient finds listening to speech uncomfortably loud

speech DISCRIMINATION testing

- evaluates how well a patient can recognize/repeat back speech at a fixed level (intensity stays the same)

- given at supra-threshold level (near MCL)

- uses monosyllabic, phonemically balanced words (CVC)

Speech Discrimination Score/Word Recognition Score

- normal hearing expected to score 90-100% for words at 30 dB SL or greater re:SRT (around MCL)

- 25-50 words presented to each ear, # of correct responses added

- Minimum IA = 40 dB, use masking whenever difference in presentation level of speech presented to TE and the best BC of NTE is > 40 dB

test in noise

- muti-talked babble

Quick SIN

- determines SNR loss-- level of SNR required to recognize 50% of words

- typical normal hearing persons: 2 dB SNR


phonemically balacned sentences presented in quiet and noise

Signal Noise Ratio (SNR)

difference in intensity between the target (signal) and noise

ex: +5 SNR means that the target signal was 5 dB louder than the noise (word presented at 55 dB and noise presented at 50 dB)

Immittance Testing

- assessing the manner in which energy flows through the outer & middle ear through admittance & impedance

- verifies pure tone/speech results

- assits in differential diagnosis

- also helpful in differentiating cochlear from retrocochlear disorder


- suggests what type of conductive pathology is present

- always use tympanometry

middle ear analyzer

1) generators: generate probe tone signal and reflex activating tone

2) air pump: provides controlled variation in air pressure

3) microphone: measures and monitors the probe tone SPL in the ear

tympanogram features (quantitative evaluation)

1) peak static acoustic admittance (Ya)

2) ear canal volume (VEC)

3) middle ear pressure (TPP)

4) gradient/width

procedure for tympanometry

- probe placed into ear (airtight seal)

- probe tone delivered into ear canal at 226 Hz

- ear canal pressure is varied from + 200 daPa to a negative pressure

- changes in Ya = changes in air pressure are plotted on tympanogram

Typmanometric Peak Pressure

- normally -150 daPa -> + 50 daPa

- air pressure value at which the peak occurs

- used to estimate air pressure in the middle ear space (greatest Ya occurs when air pressure on both sides of the TM are equal)

acoustic imepdance

- Za

- resistance to sound flow

- depends on mass, friction, stiffness

acoustic admittance

- Ya

- ease of sound flow

- healthy ear will allow admittance

what does imittance determine?

- middle ear pressure

- ear drum mobility

- eustachian function

- volume of ear canal

-continuity/mobility of middle ear ossicles

- integrity of acoustic reflex arc

air pressure used to measure Ya

- measured in daPa

- 0 daPa 0> pressure is equal in outer and middle ear

- positive pressure (+100 daPa) -> pressure is greater in middle ear than outer ear

- negative pressure (-100 daPa) -> pressure is less in middle ear than outer ear

Jerger's classifcation - Qualitative Evaluation

- Type A: normal

- Type As: shallow/stiffening, peak height reduced, reduction of energy flow (otosclerosis most common)

- Type Ad: Deep/discontinuity, normal pressure, peak height increased, increased Ya, excessive movement of TM, too much energy absorbed

- Type B: flat, reduced Ya, absence of admittance peak, nearly all energy reflected back, something behind ear drum is preventing it from moving

- Type C: negative pressure, normal Ya but TPP is > -150 daPa, eustachian tube dysfunction

Equivalent Ear Canal Volume

- estimated ear canal volume from probe tip to TM (if TM intact)

- normal VEC: middle ear pathology

- abnormally large VEC: functioning tympanostomy tube, TM perforation

- abnormally small VEC: cerumen impaction

- Normal VEC: 0.5cc-1.5cc

Pathologic Conditions

- middle ear pathologies will change the Ya of the middle ear system

- High Ya pathology -> increase in mass (flaccid ear drum, ossicular diarticulation)

- Low Ya pathology -> increase in stiffness

Acoustic Reflex Threshold testing (ART)

- softest level of sound that is required to stimulate

- normal is 70-110 dB

- elevated is > 110 dB

- absent -- no reflex at intensity output limits

Acoustic Reflex Threshold frequency signals

- pure tones at 500, 1000, and 2000 hz (between 70-110 dB)

acoustic reflex

- measures stiffening/contraction of stapedius & tensor tympani muscle in response to self-vocalization or loud/intense sounds

- stiffening = decrease middle ear Ya which reduces the amount of sound energy that reaches cochlea


- use same instrumentation as tympanometry

- ear canal is pressurized to point of maximum TM mobility (compliance)

- activate signals (70-110 dB) presented

- Probe measures middle ear Ya (if acoustic reflex occurred when stimulus presented, Ya will decrease)

- changes in Ya will be seen as deflections (dips)

- level of sound is decreased/increased in 5-10 dB steps to determine lowest intensity level that stimulates acoustic reflex

Acoustic Reflex Arc

middle ear -> cochlea -> auditory nerve -> brainstem -> facial nerve -> middle ear (stapedius & tensor tympani)

Relationship between ART and Pure Tone Threshold

Acoustic Reflex Threshold (ART) usually 60-80 dB above patients pure tone threshold for that frequency

Conductive Hearing Loss - Acoustic Reflex

- ipsilateral reflex: elevated or absent AR when probe is in ear with conductive pathology

- contralateral reflex: elevated or absent bilaterally

Cochlear Pathology - Acoustic Reflex

- bilateral cochlear loss -> ipsilateral & contralateral ART normal, elevated or absent depending on degree of HL

- unilateral cochlear loss--> ipsilateral and contralateral reflex elevated/absent in ear with hearing loss (> 50 dB HL)

Cochlear Pathology - ART and Pure Tone Threshold

- pure tone threshold 20-50 dB HL then ART normal

- pure tone threshold 55-75 dB HL then ART elevated

- pure tone threshold > 80 dB HL then ART absent

retrocochlear pathology

- auditory nerve or beyond

- ART elevated but higher than cochlear loss

- or ART absent (out of proportion to thresholds)

- Absent ART in patients with little to no SNHL = significiant indicator of retrocochlear pathology

- bilateral -> neuropathy (ipsilateral and contralateral ART's absent or elevated out of proportion)

- unilateral -> auditory nerve tumor (ipsilateral and contralateral reflex elevated/absent in affected ear)

Acoustic Reflex Decay

- meausres whether the stapedius muscle & tensor tympani contraction is maintained during continuous stimulation

- holding deflection in place

- should be able to last at least 5 seconds before decay

acoustic reflex decay

- meausred with same probe as tympanometry and ART

- ear canal is pressurized

- probe tone presented to ear, measure changes in Ya as AR is initiated and maintained

- activating tone (500 and 1000 hz only) and presented continuously for 10 secs

- presentation level at 10 dB ABOVE ART

- test is completed when reflex has decayed 1/2 its original magnitude or at the end of 10secs

abnormal AR decay

- 50% reduction in reflex magnitude within first 5 seconds

- aka positive decay