Speech Audiometry
What are different types of word recognition lists that can be used?
NU-6, W22, Maryland CNCs
What is the normal range for acoustic reflexes for hearing level and sensation level?
70-100 dB HL and 70-100 dB SL
What frequency is single component tympanometry measured at?
226 Hz.
What is the masking rule of air conduction for supra-aural heads phones and insert earphones.
40 dB (supra-aural) and 60 dB (inserts) difference between two air scores
40 dB (supra-aural) and 60 dB (inserts) difference between worse air and the bone score
What is the main muscle contracting in acoustic reflex testing?
Stapedius muscle
What level should you start at to find a patient's MCL?
Start 40 dB SL above PTA.
What is a reduced sensation level indicative of? What is an elevated level indicative of?
Reduced sensation level is indicative of cochlear involvement.
Elevated sensation level is indicative of retrocochlear OR conductive involvement.
What does a Jerger type B tymp signify? What could be the possible etiology?
Small ear canal volume: cerumen impaction
Large ear canal volume: perforation, PE tubes
Normal ear canal volume: fluid
What is the masking rule for bone conduction?
Greater than 10 dB difference between same side air and bone score
The procedure used for threshold searching in air and bone conduction
Modified Houston Westlake
What is the equation to test for the performance intensity function? What is significant for rollover?
(PBmax - PBmin)/PBmax
Positive for rollover: Greater than .4
Negative for rollover: Less than .4
There are two stimuli used in acoustic reflexes testing. What are they and what is their purpose?
Probe: The measurement of the acoustic reflex.
Stimulus/activator: The pure tone being presented in the ear.
What are the normative ranges for pressure, compliance, and volume?
VOLUME: norm: .8 - 2.2 cc
PRESSURE: norm: -105 to +5 daPa
COMPLIANCE: norm: .3 - 1.5 mmho
What frequencies does the occlusion effect apply to and the dB?
Occlusion effect at
250 Hz: +30 dB
500 Hz: +20 dB
1000 Hz: +10 dB
Describe the Rinne tuning fork test and a positive Rinne test result.
The patient judges whether sound is louder when presented by AC or by BC. AC is presented by holding the fork in front of ear, BC is presented by fork being placed on mastoid.
Result:
AC > BC : positive Rinne
List 3 ways to choose a presentation level for word recognition testing
30-40 dB SL regarding SRT.
MCL
PTA < 25 dB Levels 40 dB & 60 dB and PTA > 25 dB Levels 80 dB & 100 dB
List the auditory structures that sound would travel through in an ipsilateral pathway?
Middle ear, cochlea, 8th nerve, cochlear nucleus, superior olivary complex, 7th nerve, middle ear
What does a Jerger type Ad tymp signify? What could be the possible etiology?
High compliance, normal pressure, normal volume
Possible etiologies: disarticulation of ossicles, frequent perforations, monomeric membrane
What is the masking dilemma?
Results when the width of the masking plateau is very narrow or nonexistent. The presence of significant hearing loss in the non-test ear requires higher initial masking levels.
What anatomical structures should you look for during an otoscopic evaluation?
Cone of light
Umbo
Pars tensa
Lateral process of malleus
Pars flaccida
Annulus
When do you know you have found a patient's appropriate speech recognition threshold?
They respond correctly 50% of the time (3 out of 6 words) at one level.
What are the pathologies for a sound effect?
What are the pathologies for a probe effect?
Sound effect: cochlear or 8th nerve pathology
Probe effect: middle ear or 7th nerve pathology
What does a Jerger type C tymp signify? What could be the possible etiology?
Excessively negative middle ear pressure; ear drum retracted
Fluid
Eustachian tube dysfunction
Early stages of OME
What is cross-hearing?
Occurs when a stimulus presented to the test ear "crossed-over" and is perceived in the contest ear. Is the result of limited intramural attenuation.
What are some indicators of retrocochlear involvement?
Normal to near normal hearing with complaints of understanding speech.
Reflex pattern consistent with retrocochlear findings.
Poor word recognition scores (disproportionately poor for their hearing thresholds)
Asymmetrical hearing loss, typically worse in the high frequencies.