Audiological Techniques Phase 2
What are the 3 components of a tympanometer probe?
Puff of air
Microphone
Pump
Frequency
Pure Tone
Speaker
When checking a 2.0cm3 test cavity, what is the maximum value you should accept?
2.0cm3
2.1cm3
2.2cm3
2.3cm3
Which of these is the correct normative value for middle ear compliance?
-50 to +50daPa
0.6-2.5cm3
0.3-1.6cm3
Is partial stenosis an absolute or cautionary contraindication for tympanometry?
Absolute
Cautionary
Which of these is the correct normative value for ear canal volume?
-50 to +50daPa
0.6-2.5cm3
0.3-1.6cm3
What value would you expect to find on the X axis on a tympanogram?
Middle ear compliance
Middle ear pressure
Ear canal volume
What is wideband tympanometry and what is it useful for? Select all that apply.
Provides more accurate results
A combination of a tympanometry and acoustic reflex test
Useful for detecting different pathologies
It allows estimation of ear canal volume from the tip of the probe to the tympanic membrane
Enables use of different frequencies so you can analyse the movement on the tympanic membrane
Provides a graphic representation of the relationship of air pressure in the external ear canal to impedance of the tympanic membrane and middle ear
An ipsilateral reflex is where......
The simulation is played in the right ear and the tone is played in the left ear
The simulation is played in the left ear and the tone is played in the right ear
The tone is played in the left ear and the simulation is played in the left ear
The tone is played in the right ear and the simulation played in the left ear
Which of these is the correct normative value for middle ear pressure?
-50 to +50daPa
0.6-2.5cm3
0.3-1.6cm3
What type of test is Tympanometry?
Subjective
Objective
What does Tympanometry measure?
The impedance of the middle ear to sound and from this we infer the functions of the middle ear
How loud the ear percieves a sound
How floppy the tympanic membrane is
How high the pressure is inside the mastoid cavity
What is the name of the muscle that causes the acoustic reflex?
Facial
Stapedius
Tensor Tympani
Cochlea
What is the first nerve an acoustic reflex must past through?
Cochlear nerve
Vestibular nerve
Facial nerve
Optical nerve
Name the two cautionary contraindications for acoustic reflexes only (i.e. One not indicated for tympanometry)
Tinnitus, Hyperacusis, Recruitment
Stenosis
General Anesthetic
Drugs, Alcohol
What is the minimum compliance change needed to define an acoustic reflex is present?
0.04ml
0.03ml
0.02ml
0.01ml
How many decibels above pure tone thresholds do acoustic reflexes normally occur at?
50-80dB HL
60 – 85dB HL
75-95dB HL
100dB HL and above
Tympanometry & AR - What frequency is used for patients over 6 months?
1000Hz
550Hz
431Hz
226Hz
What disorders can an acoustic reflex test identify?
Conductive disorder
Cochlea pathology
Brainstem pathology
Cochlear tumours
Facial nerve pathology
Non-organic hearing loss
With a sensori-neural hearing loss of 50-80dB HL, what acoustic reflex would you expect?
Present
Absent
Elevated
Decreased
Is ABR a subjective or an objective test?
Objective
Subjective
What does ABR measure/detect?
Sound
Electrical Signals
Movement
Where does the action potential originate?
Cochlear
Brainstem
Tympanic Membrane
What generates an action potential from the brainstem?
Auditory stimulus
Environmental noises
Body movement
What is latency?
Amplitude
Time
Frequency
Which wave on the wave form results is the most important/ obvious one?
Wave 3
Wave 1
Wave 5
Sound travels to the cochlear, changes to electrical energy and then travels where?
Superior olivary complex, inferior colliculus, medial geniculate body
Medial geniculate body, superior olivary complex, inferior colliculus
Inferior colliculus, superior olivary complex, medial geniculate body
What are ELPs?
Early latency potentials
Energy latency potentials
Electrical latency potentials
What is the expected latency time in milli- seconds for an early latency response?
0-10ms
0-5ms
0-8ms
For the most reliable results we would ask that the patient be?
Awake and alert
Asleep
Accompanied by other family members
1sec
ABR - On a results chart what would be on the X and Y axis?
Latency and amplitude
Frequency and amplitude
1 microvolt is equal to?
10-6
10+2
10+6
ABR - Which statement is true?
The higher up the signal travels the longer the latency result will be
The higher up the signal travels the shorter the latency result will be
What is the Thalamus?
Primary way station for information between brainstem and cortex
Primary wat station for information between brainstem and inferior colliculus
What is the medial geniculate body- MGB?
The auditory nucleus of the brainstem
The auditory nucleus of the thalamus
Which of the following may influence the ABR results? Select 3 answers
The voltage is very small
The body makes a lot of noise
Narrow ear canals
Involuntary neck/ jaw movement
A perforation
Is the following statement true or false - Cold body temperature can increase ABR peaks and latency and decrease wave amplitude
True
False
Which of the following patient factors may affect results? Select 3 answers
Age ( wear and tear of the auditory system in elderly)
Gender ( latency if different between males and females. Females have a shorter response)
Obesity
Medication (ototoxic medication can affect ABR. Wave forms )
Which of the following is signal related and less affected by the subject state?
Exogenous
Endogenous
ABR - Which filters do the amplifiers use?
High
Low
Both
ABR - Why use both filters for amplifiers?
To ensure only the intended signal range is examined
To ensure the signal is not too high
Name the two electrodes generally used for testing? However, be aware some machines use 3 , the third being (ground)
Active and defer
Active and deactivate
Active and reference
What is the best test environment?
Quiet room
Quiet room with minimal eccentrical noise
Quiet room with windows
How many electrodes are normally used for testing?
2-3
3-4
1
How many sweeps would the ABR software go through?
Hundreds
Thousands
Millions
Is the following statement true or false - Band- pass filter is set to reject or reduce noise within the anticipated spectral range of response signal – improves signal to noise ratio
True
False
Why are inserts better for testing ABR?
Better comfort
Greater interaural attenuation
Resonance of middle ear cavity
Easier to use for the practitioner
What is mode rejection?
Only the common electrical activity across both sides remain, noise is cancelled
Only one side of electrical activity remains
Which of the following is the active electrode?
+VE non- inverting
-VE inverting
Ground is also an electrode, what is its job? Select 2 answers
Works alone
Measures all electrical energy across active and reference
Helps to improve common mode rejection
Balances the other electrodes
ABR - Which of the following is the reference electrode?
+VE non- inverting
- VE inverting
In ABR testing, where are the electrodes placed on the body.
Forehead and mastoid
Forehead and pinna
Forehead and neck
For ABR tests, it is recommended the electrodes have a distance of?
2cm
3cm
4cm
In ABR tests, the impedance of all three electrodes must be similar?
True
False
What is electrical impedance?
The measure of the opposition that a circuit presents to a current when a voltage is applied
The slowing down of electrical pulses
ABRs use pure tone
True
False
Which of the following do ABRs use? Select 4 answers.
Clicks
Tone burst
White noise
Beeps
Narrow band chirps
Chirps
ABR - Which of the following are frequency dependent?
Tone burst
Clicks
Chirp sounds stimulates the larger area of the cochlear and is thought to be x2 greater amplitude than clicks
True
False
ABR click sounds are...
Short broad band 2-4k
Wide range 250- 8k
Which of the following explains Threshold ABR?
Focuses on neurological analysis of the auditory system
Gives an objective estimate of what stimulus level a synchronous neural response happens
Which of the following explains Diagnostic ABR
Gives an objective estimate of what stimulus level a synchronous neural response happens
Focuses on neurological analysis of the auditory system
For ABRs we need this impedance to be: As low as possible (< 10 kOhms mandatory, ideally < 5 kOhms)
True
False
Define NIHL
Hearing loss induced by noise alone
Hearing loss induced by noise and age
Hearing loss induced by noise and perception
Hearing loss induced by noise and medications
Which of the following is not a type of NIHL?
Temporary Threshold Shift (TTS)
Permanent Threshold Shift (PTS)
Acoustic Trauma
Semi-permanent Threshold Shift (SPTS)
WHO estimates that what percentage of the world’s population is exposed to sounds loud enough to cause NIHL?
50%
10%
12%
25%
Which factors dictate how harmful a sound may be in causing NIHL?
Duration
Intensity
Origin of sound
Frequency
Which of the following is the definition for TTS?
Reduction in hearing ability following exposure to loud sound
Reduction in hearing following exposure to a single event involving an extremely intense noise
Reduction in hearing where hearing thresholds can no longer make a full recovery
Reduction in hearing due to ageing
Which of the following is the definition for PTS?
Reduction in hearing due to ageing
Reduction in hearing ability following exposure to loud sound
Reduction in hearing following exposure to a single event involving an extremely intense noise
Reduction in hearing where hearing thresholds can no longer make a full recovery
Which of the following is the definition for Acoustic Trauma?
Reduction in hearing where hearing thresholds can no longer make a full recovery
Reduction in hearing due to ageing
Reduction in hearing ability following exposure to loud sound
Reduction in hearing following exposure to a single event involving an extremely intense noise
Does NIHL happen….. Select 2 answers
Gradually through longstanding continued exposure to noise?
Gradually through some exposure to noise?
Instantaneously because of disease?
Instantaneously because of a single event?
TTS hearing loss is….
Sensorineural
Conductive
Mixed
None of the above
Permanent Threshold Shift is a common occurrence and may take place progressively in small amounts following many TTS experiences.
True
False
Acoustic Trauma can result in permanent damage to which parts of the ear?
Ear drum
Cochlea
Ossicular Chain
All of the above
Masking is the practice of temporarily raising the threshold of the non-test ear in order to prevent cross hearing, using a special ‘masking’ stimulus centred around the test frequency under test.
True
False
What are the mechanisms for TTS?
Synaptic fatigue – synapse starts action potential, fails and no sound is heard
Metabolic fatigue of either stria vascularis or the hair cells – can’t produce all products to create an action potential
Changes in cochlea blood flow
All of the above
What is the name of the neurotransmitter that the inner hair cells release to activate the afferent dendrites?
Dopamine
Histamine
Glutamate
Serotonin
Which of the following is NOT a TTS is caused when an excessive amount of glutamate is released which causes excitotoxicity in the afferent dendrites which inhibits their function. Over a period of time, the excess glutamate is carried away the via the blood and hearing thresholds may resume. Of earmould
True
False
What the mechanisms for PTS?
Mechanical trauma – resulting from the hydro-mechanical force of an intense sound which can damage the inner ear structures
Changes in cochlea blood flow – can be result of loud sounds
Metabolic overstimulation – intense noise exposure may overload the pathways responsible for maintaining homeostasis which lead to metabolic changes which compromise the system
Synaptic fatigue – synapse starts action potential
NIHL - Prolonged excitotoxicity is not thought to be the main mechanism.
True
False
PTS is generally bilateral with the greatest loss at around 4kHz.
True
False
Which of the following statements regarding PTS is incorrect?
There will be outer hair cell death
It is generally symmetrical
There will be inner hair cell death
It gives a characteristic audiometric notch
In NIHL why do we see a characteristic notch?
Poor blood supply to the 3-6kHz region of the cochlea
Hair cells / supporting structures are more susceptible to damage in this region
Mechanical force from the stapes footplate is aimed towards hair cells in the 3-6kHz region
All of the above
Noise exposure has its greatest effect approximately one half octave above the peak frequency of incoming sound. Since incoming sounds are enhanced at 3kHz by the outer ear resonance, the greatest loss would occur in the 4-6kHZ range.
True
False
Diagnosis of NIHL rests on proof of…..
Sufficient noise exposure
Patient perception
Audiometric pattern consistent with NIHL
Age
A HAD is able to diagnose NIHL.
True
False
What is the maximum exposure limit an individual is allowed in work according to ‘The control of Noise at Work Regulations 2005?
87dB
85dB
82dB
88dB
At what volume is an employer required to provide hearing protection?
78dB
80dB
85dB
87dB
At what volume is an employer required to risk assess and provide training and information to staff regarding hearing?
77dB
80dB
82dB
84dB
Non – custom expandable foam ear plugs, custom moulded ear plugs, musician ear plugs with acoustic filters, noise cancelling headphones and circum-aural ear defenders are all recommended types of hearing protection devices.
True
False
NOHL can be also known as:
Functional hearing loss
Pseudohyperacusis
Functional hearing loss & pseudohyperacusis
None of these
Who could have NOHL?
Adults
Children
Both adults & children
Infants
What % of children ages 6-17 have NOHL?
2%
5%
3%
7%
NOHL - Why might someone deliberately want to be deafer than they are?
Attention and Financial Gain
Avoid desirable situations
Medical discharge from Forces
All of these
What is Psychogenic hearing loss? Psychogenic hearing loss:
Is where the individual is unaware that they are simulating a hearing loss
Is where an individual is aware that they are simulating a hearing loss
Is where an individual is exaggerating a hearing loss
Is where individual thinks they have a hearing loss.
Things to consider if you suspect NOHL in an individual?
Age
Psychological welbeing & social stressors
Occupation & referral pathway
All of these
What should we do if we suspect NOHL?
Consider it is yourself? Maybe you didn’t explain the test correctly
Consider it’s the equipment? Check cables? Connections?
Consider this might be NO behavior? Is there any other signs or obvious reasons?
All of these in order.
What is a subjective test?
We do not rely on the patient to get a response
Where we rely solely on the patient’s response
Where we rely on equipment to let us know the response
None of these
What is an objective test?
Where we rely on equipment let us know the response
Where we do not rely on the patient to get a response
Where we rely on the patient’s response
None of these
Who would you perform an objective test on?
Infants & babies
People with learning difficulties
NOHL patients
All of these
Which of the following are subjective tests?
Lombard test
Stenger test
Tunning forks
All of these
None of these
What is the Lombard test?
When two tons of identical frequency are simultaneously played in both ears, only the louder one is perceived
Where we involuntarily raise our voice volume when we hear a loud sound.
Where we involuntarily play a random sound at a random frequency at any time
Where we involuntarily reduce our voice when we hear a quiet sound
What is the Stenger test?
Where we involuntarily raise our voice volume when we hear a loud sound
Where we involuntarily play a random sound at a random frequency at any time.
When two tons of identical frequency are simultaneously played in both ears, only the louder one is perceived
Where we involuntarily reduce our voice when we hear a quite sound
Which of the following are objective tests?
Tympanometry
OAE’s
Acoustic Reflexes & ABR
All of these
None of these
NOHL - If objective tests aren’t at your disposal what should you do?
Send to GP
Refer to ENT
Repeat the tests
Send to another audiologist for a second opinion
What could you do to treat NOHL?
Hearing aids
Counselling and Cognitive behavioral therapy
Medications
None of these
True or false: The ear not only receives sounds, it is also capable of producing sounds
True
False
True or false: The sounds produced by the cochlear are called otoacoustic emissions or OAE's
True
False
True or false: Indicates normal cochlear function which is consistent with normal or near normal hearing thresholds
True
False
True or false: OAEs are caused by the motion of the cochlea’s sensory OUTER hair cells as they energetically respond to auditory stimulation.
True
False
Which of the following is correct: Select all that apply
Outer hairs cells actively vibrate to sharpen the resonant peaks on the basilar membrane. Thus increasing amplification and frequency selectivity of sound vibrations.
OAEs can only be generated if the cochlear amplifier mechanism is present
The cochlear amplifier process is necessary to replace lost energy from the travelling wave as it passes through the viscous inner ear fluids.
All of these
None of these
Hearing aids will solve the problems cochlear dead regions create?
True
False
Could cochlear implants help a cochlear dead region?
Yes
No
Frequency transposition is
Transporting the sounds to a louder level
Copying the frequency and moving it to another frequency more accessible to the patient
Different types of hearing aid amplification strategies may help to support a cochlear dead region?
True
False
Which hearing aids features could support a cochlear dead region? Select 3 answers
Frequency compression
Frequency transposition
Increased amplification
Filtered amplification
Psychophysical tuning curves (PCT) why is this test not regularly used in clinic?
It is too expensive
It is time consuming
It is not precise
Threshold equalizing noise ( TENs) is used in clinic to detect a cochlear dead region ?
True
False
During a PCT test the ear will only hear the louder of two sounds of a similar frequency?
True
False
Which of the following would indicate a cochlear dead region ?
Frequency of effective masking =frequency of pure tone = point of PCT
Point of PCT shifts to the left
Threshold equalizing noise test (TENs) uses just one special masking noise
True
False
PCT testing is used to.... Select 2 answers
Measure broad frequency range
Give a precise estimate of edge frequency
Detect pathologies
There are two versions of TENs testing
True
False
TENs SPL is.....
An extended frequency range but limited intensity range
Limited frequency range 500Hz to 4000 Hz higher intensity limit
The TENS test frequencies are spaced
One and a half octave apart (same as PTA testing)
One octave apart
TENs testing can be difficult for a severe/profound loss due to Noise intensity not enough to deliver masking
True
False
TENs testing start
5 dB above threshold
10 dB above threshold
10 dB below threshold
Cochlear dead region is described as Inner hair cells at certain places along the basilar membrane maybe completely non- functioning. Also, the auditory neutrons may not be functioning
True
False
Cochlear dead region can also be known as
Gap in auditory pathway
Hole in hearing
Cochlear dead region is more common in
High Frequency
Low Frequency
Most common dead regions occur where?
Apex - low frequency
Basal portion of membrane where high frequency are intercepted
Low frequency sounds could be affected by late stages of Ménière's disease
True
False
Outer hair cells are
Cochlear amplifiers
Cochlear transducers
Inner hair cells are
Cochlear transducers
Cochlear nerves
Inner hair cells relay information to the
Brainstem
Cochlear
Cochlear dead region is non- functioning inner hair cells, damage to inner hair cells reduces the efficiency of transduction
True
False
Damage to outer hair cells
Impairs the ability to hear softer sounds
Causing severe headaches
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