Audiology Exam Review

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What is Sensory Presybycusis?: - loss of hair cells and atrophy of 8th nerve
- steep sloping high frequ loss
Neural Presbycusis: degeneration of neurons in auditory pathway and cochlea
Metabolic (strial) Presybycusis: atrophy of stria vascularis (needed for energy for cochlea) due to defects in physical and chemical processes of energy production
- flat audiogram
Mechanical Presybycusis: - cochlear, conductive
- possible increase in stiffness of structures of scala media, resulting in HF loss
Name 4 types of Presbycusis: - remember M-MSN
- mechanical
- metabolic (strial)
- sensory
- neural
In which type of presbycusis is speech ability maintained?: Metabolic, since neurons are spared
What shows up in tests of those w/ presbycusis?: - bilateral
- type A tymp and normal static compliance
- varying refexes
- abnormal speech tests )probs w/ filtered speech, temporal timing, and background noise in speech)
List 5 things that contribute to Presybycusis: - effects of environmental noises
- loss of hair cells
- hereditary factors
- aging
- health
- side effects of meds
impairment: involves the abnormality of the auditory system (audiogram)
disability: refers to the functional consequenses of the hearing loss (ex: trouble on phone)
handicap: social consequenses of impairment
List the 5 etiologies of hearing loss in older adults: 1) presbycusis
2) noise induced hearing loss
3) ototoxicity
4) metabolic conditions and vascular disease
5) neurologic disorders (ex: MS)
What percentage of children with hearing loss in Canada have at least one additional impairment?: 25-40%
What are 3 auditory features of autism?: - Auditory agnosia (reduced awareness of sound)
- Hyperacusis (increased sensitivity to sound)

- they rarely present w/ a permanent SN loss
What does TROCA stand for? What is it?: Tangible
Reinforcement
Operant
Conditioning
Audiometry

- involves a bar press response coupled w/ either tangible or visual reinforcement
What are some auditory characteristics of children with Down's syndrome?: - prone to Otitis Media
- collapsing canals
- stinosis
- 15-20 db is their best hearing
- hypertonia
Stinosis: narrow ear canals
hypertonia: perform motor tasks more slowly
Etiology of cortical deafness (3): - congenital
- meningitis
- cerebral infarcts
symptoms of cortical deafness: - inconsistent response to sound...may clinically appear deaf
- poor speech production and understanding
- poor localization
-inconsistent response to pure tones and poor agreement b/w speech/hearing Thresholds
-variability of puretone TH
Which tests are normal and which are abnormal for cortical deafness? (OAE, ABR, reflex, MLF, MRI): OAE, ABR, and reflexes are NORMAL

Middle Latency Response and MRI tests are abnormal
- MRI shows degeneration of temporal lobe(s)
How do you treat Cortical Deafness?: - hearing aids DONT help
-sign language
List some KEY points about Auditory Neuropathy: - looks like central auditory processing disorder
- outer hair cells OK!!!
- ABR = abnormal
- speech comp is poor in quiet/noisy environments
- normal sounding speech
- poor localization
- normal to profound loss
- may be probs w/ inner hair cells, VIII nerve, aud pathway
- OAE = normal
- ABR = abnormal
- reflexes = absent
- no evidence of space-occupying lesion
- need sign language, and hearing aids can help
Cochlea is fully formed by _ weeks gestation: 26
newborns more responsive to __ freqencies: low
greatest threshold improvement between the ages of...: 3-6 months
high freq thresholds mature at: 8 years
low freq thresholds mature at age: 10
4 contributors to development of threshold in children: 1) maturity of outer and middle ear during infancy and childhood

2)peripheral sensitivy and peripheral syaptic efficiency DON'T contribute as cochela fully formed at birth

3) maturity of auditory system

4) non-sensory factors like attention and motivation to respond
What is BOA: Behaviour Observation Audiometry

- watching a baby to see what type of behavioral response they elicit when a tone is presented
4 reasons why BOA shouldn't be used...: 1) response isn't reinforced
and infant loses interest
2) non-reinforced responses improve w/ increasing age
3) BOA thresholds show much variability
4) stimulus infant interested in isn't necessarily the stimulus needed for assessment
What is an OAE?: Otoacoustic Emission Test

- determines COCHLEAR status, specifically hair cell function
- measures ONLY the peripheral auditory system which includes outer ear, middle ear and cochlea
What ISN'T an OAE?: it is NOT a direct test of hearing, but an objective measure of cochlear (outer hair cell) function
OAE's can be absent when... (6): 1) hearing loss greater than 20 db(TEOAE) or 30db (DPOAE)

2) abnormal middle ear function ( fluid or -ve pressure)

3) debris in ear canal

4) noisy patient or room

5) poor probe placement

6) malfunctioning equipment
OAE's can be used for...: - neonatal screening
- impact of ototoxic drugs
- detecting early signs of noise exposure
- following meniere's disease
- tinnitus
- site of lesion testing
- assessment of functional hearing loss
- pediatric audiometry
ABNORMAL OAE, plus NORMAL audiogram may be... (4): - tinnitus
- exsessive noise exposure
- ototoxicity
- vestibular pathology
NORMAL OAE plust ABNORMAL audiogram may be...: - functional loss
- reduced attention
- 8th nerve auditory dysfunction
- central auditory nervous system dysfuction
What is ABR?: Auditory Brainstem Response Test

- a test of synchonous neural firings
- NOT a direct hearing test
clinical applications of ABR (4): 1) predict hearing sensitivity in the very young
2) neonatal hearing screening
3) diagnostic assessment of 8th nerve and brainstem dysfunction and 4) monitoring these interoperatively
What is VRA?: Visual Reinforcement Audiometry

- in VRA, head turn responses to a stimulus are reinforced by a pleasureable visual event
- can be used by 6 months
What area the 4 advantages of VRA over BOA?: 1) VRA thresholds show narrower range of variability than BOA thresholds and test-retest reliability of VRA is excelletn

2) can obtain individual ear, AC thresholds for all freq by coupling VRA w/ insert earphones

3) can measure BC thresholds

4)can identify degree and configuration of loss with VRA
At what frequencies do you test children in play audiometry?: 500, 2000, 4000 HZ
What is the difference between validity and reliability?: Validity = the ability of a test to measure what it was designed to measure

Reliability = ability of test to provide consistent results for teh same person under different conditions
What are the 3 stages of the Infant Hearing Program?: 1) Screening
2) Diagnosing
3) Intervention
The purpose of the IHP is to identify hearing impairment by __ and have them recieving intervention by __. The primary goal of the IHP is ________. High risk factors only identify __% of babies with SN loss.: - identified at 3 months
- intervention by 6 montsh
- EARLY INTERVENTION
- 50%
What is the - DPOAE - AABR And what do they test?: DPOAE - distortion product otoacoustic emission
- measures 2000-4000hz

AABR = Automated auditory brainstem response audiometry
- measures responses at 30 or 35 db
What is a - false positive - false negative - true positive - true negative: false positive = positive test result but no hearing loss

false negative = negative test results but there IS a hearing loss

true positive = positive result with hearing loss

true negative = negative result without a hearing loss
Why screen babies?: to start early intervention which will minimize the impact of hearing loss on language development
8 ways to minimize false positives with DPOAE: 1) screen right after feeding
2) screein in quiet area of nursery
3) screen as late after birth as possible, but before discharge from hospital
4) limit OAE data collection to 2000-5000hz
5) use well designed neonatal probe tips
6) manipulate the ear canal prior to feeding
7) rescreen failures prior to discharge
8) practice
List 7 Outer Ear Disorders: 1) external otitis
2) atresia and microtia
3) collapsing canals
4) Tymp membrane perforation
5) impacted cerumen
6) tympanosclerosis
7) benign tumours
External Otitis - what is it? - symptoms? - risk factors - treatment: - common, painful infection of ear canal

- symptoms are stenosis (narrowing) of cartilagenous portion of ear canal from inflamation of the skin covering it
- causes tenderness of pinna/tragus

- risk factors = swimming in freshwater and not removing all water in ear canal (called swimmer's ear)
- pseudomona's cause infection

-treatment = topical agent
What is - Atresia - Microtia: Atresia
- closing or absense of ear canal
- complete occlusion causes hearing loss of 50-60 db

Microtia
- underdevelopment of the pinna; ear can look small, or non-existent (skintags)
- can occur w/ atresia, but without it may not cause hearing problem
Collapsing Canals - cause? - resulting loss?: Collapsing canals are caused when pressure compresses the pinna against the side of teh head, causing a narrowing or closing of the canal

- patients usually have small narrow canal openings or flaccid canals

- leads to a temporary conductive loss with AC threshold shifts of 5-50 db
Tympanic Membrane Perforation - what is it? - cause? - effects?: TM perf occurs when excessive fluid in teh middle ear space from OM causes eardrum to rupture
- drum may implode from blow to head or waterskiing, objects inserted too deeply, or from tubes

- loss dependent on size/location
- may be useful for fluid drainage
What is tympanosclerosis?: It is a severe form of scarring. Dense white plaqu of hyaline substance is deposited on the middle layer of the tympanic membrane
Benign Tumours * exostoses * osteomas: Exostoses
- bony growth of the EAM produces round nodules of bone covered by skin
- bilateral near eardrum
- cause is cold swimming
- usually no hearing loss

Osteomas
- less common - a single bony growth often located unilaterally at the cartilidge bony junction
List 9 Middle Ear Disorders: 1) otitis media
2) Otosclerosis
3) Cholesteatoma
4) mastoiditis
5) discontinuity of ossicular chain
6)facial nerve disorder
7) down's syndrome
8) cleft lip/palate
9) treacher collin's syndrome
What is Otitis Media?? What causes it?: It is inflammation of the middle ear, often due to poor eustachian tube function
1) bacteria from nasopharynx causes mucosal lining of eust tube (ET) to become inflamed
2) ET can't open to equalize pressure in middle ear with pressure in ear canal
3) then O2 gets trapped in Middle ear space and it gets absorbed in the lining, which inflames it
4) fluid then drawn into ME(middle ear) cavity from lining
5) fluid has nowhere to go because ET blocked, so stays in ME
6) adenoid tissue in nasopharynx also becomes inflamed and blocks ET where it opens to nasopharynx

--> like I'm EVER going to remember that!!!
OM types based on duration 1) acute: 1) acute = rapid onset within 3 weeks and rapid resolution in most cases w/in 1-2 weeks
- fever, pain, irritability, bulging TM, upper resp tract infection

2)
Chronic OM has a __ onset _____ infection, lasts ____ and symptoms are___ and ___: - slow onset
- with or without infection
- 2-3 months or longer
- central perforation and discharge of fluid from perf
Subacute OM: persists beyond acute stage (>22 days) but not yet chronic
Recurrent OM __ or more episodes within __ months: 3 or more within 6 months
2 types of OM based on fluids = ...

** these 2 will be on the final for sure **: Suppurative (purulent) OM

or

Serous OM
Suppurative OM - most often found with... - contains... - treatment:: - found with Acute OM and chronic OM
- bacteria and debris in the fluid
- usually clears in 1-2 weeks without treatmen, but can be treated w/ amoxicillin which kills bacteria...but Eust tube must drain the fluid
Serous OM - different from supperative because... - also referred to as... - should antibiotics be used? - fluid usually clears within... - if fluid remains... - quick action needed if kids....: - middle ear fluid WITHOUT bacteria/debris/pain/symptoms
- OM with effusion
- Antibiotics should NOT be given as fluid usually clears within 3 months 90% of the time
- if it doesn't, M&T needed (myringotomy) where fluid drained and venntilation tube inserted in pars tensa
- action needed if kids already have SN loss
How do you diagnose OME? - in otoscopy? - impedance audiometry?: - in otoscopy, Tymp membrain is dull, no cone of light due to fluid
- impedance audiometry shows absent ear drum mobility and peak pressure
How does OME affect hearing?
- depends on...
- loss is...
- average loss is _-_db***
- hearing best at...: - degree depends on amount of fluid in Middle ear space
- loss is conductive, mild to moderate
- average loss is 20-25db***
- hearing best at 2000hz and for simple speech sound (spondees) rather than pure tones
4 Long term effects of recurring OM in early childhood...: 1) poor auditory processing in loud environments
2) poor localization
3) greater risk for academic failure
4) poor narrative and discourse skills
5 Populations at greater risk for OM: 1) downs syndrome
2) cleft lip/palate
3) fetal alcohol syndrome
4) children in general
5) native canadians
7 other factors influencing occurence of OM: 1) family history
2) seasonal variation (greater in fall/winter)
3) child care environment
4) infant feeding (breast vs bottle)
5) passive smoking
6) gender (greater in males)
7 children under 2

~ kids with multiple cases before 18 months have greater chance than kids with first case after 12 months ~
Otosclerosis - what is it? -loss? type - what age does it affect? - ___ notch...what is it? - treatment: - disease of bony labyrinth...bone growth affects the round/oval windo
- genetic, bilateral
- mild to mod conductive loss
- *test* occurs between 15-45 years
- Carhart notch...poorer bone conduction TH at **2000hz**
- treated by replacing damaged portion of spapes
Cholesteatoma - complication of... - what is it? - treatment?: -** complication of Otitis Media **...result of chronic Suppurative OM

- benign tumor caused by skin of eardrum grows thru the hole of a TM perf into the middle ear
- the cyst in ME is filled w/ toxins that can destry tissue and bone of ME

- surgically removed, causing permanent, conductive hearing loss if ME bones are removed
Mastoiditis: - also a complication of OM

- bacterial infection in the air cells of the mastoid cavity

- acute mastoiditis mainly affects kids under 2

- pain and fever after acute OM most common feature
Facial Nerve Disorder: - can be complication of OM

- CNVIII not related to hearing/balance but related to ear due to location below middle ear
Bell's palsy =: unilateral facial weakness
Down's Syndrome- __% have hearing loss, usually __ due to __: 75% have hearing loss, usually conductive due to impacted cerumen from small canals
Cleft lip/palate _-_% have a __ loss at high risk for ___ (%)caused by ___________ treatment =: - 50-100% of children have a conductive loss

- at high risk for OM (90%) due to poor eustachian tube function

- treament = myringotomy with tube insertion
Treacher Collins Syndrome - pinna malformation in _% and __ have atresia - malformed ___ - type of loss - treatment: - pinna malformation in 85%
- 1/3 have atresia
- malformed ME bones
- bliateral conductive loss (slight to moderate)
- Bone condcution hearing aid if absent earcanal

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