Exam 1 All - Clinical
Medicine III
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** Questions with Verified Answer
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,Social Impacts of Untreated Hearing Loss in Adults - Depression and anxiety
- Fatigue
- Embarrassment
- Anger
- Social isolation
- Safety issues
- Reduced job performance
- Increased number of falls
- Loss of productivity
- Cognitive decline
Social Impacts of Untreated Hearing Loss in Pediatrics • Delayed speech and language development
• Delayed development of cognitive skills like working memory
• Behavioral concerns
• Emotional concerns
• Isolation
Statements Related to Hearing Loss • "I always have to ask for repetition."
• Saying "What?"
• "I can hear, but I cannot understand what is being said."
• "My wife says I talk to loudly."
• "My husband says I have the TV too loud."
• "I cannot hear over the ringing in my ears.
Signs and Symptoms of Hearing Loss • Muffled hearing
• Tinnitus (ringing, buzzing, hissing)
• Speech/language delay
• Does not startle at loud sounds
• Ear pain, pressure, popping or fullness, vertigo
Risk Factors for Hearing Loss • History of noise exposure
• Family history of hearing loss
• Chronic middle ear infections
• Admin. of some medications (ototoxicity; aminoglycosides, loop diuretics,
cisplatin)
• Aging
• Head Trauma
Pediatric Specific Risk Factors for Hearing Loss • NICU stay
• Premature birth
• Prenatal exposure to TORCHES
• Failed newborn or school hearing screening
TORCHES TOxoplasma gondii
Rubella
CMV
HIV/HSV2
Syphilis
,Behavioral Testing in Pediatric Patients • Video Reinforcement Audiometry (VRA)
• Conditioning Play Audiometry (CPA)
Visual Reinforcement Audiometry (VRA) Used for children ages 6 months to 2-3 YO
• Child is trained to turn toward reward when they hear the sound
Conditioning Play Audiometry (CPA) Used for ages 3-5 YO
• Child is taught to play a listening game such as putting a toy in a bucket when
they hear a sound
Objective Diagnostic Testing in Pediatric Patients • Distortion Product Otoacoustic Emissions (DPOAE)
• Auditory Brainstem Response (ABR)
OAE (Otoacoustic Emissions) low-intensity sound generated by the inner ear in response to a sound
stimulation
Distortion Product Otoacoustic Emissions (DPOAE) Sounds are played in the ear
- If the outer, middle and inner ear hair cells are
functioning normally, we will be able to measure this response
• Pass or Refer = Can pass with mild loss
• Tests mid to high frequencies
DPOAE Tests... Mid to high frequencies
Auditory Brainstem Response (ABR) Sounds are played into the ear and the auditory nerve response is measured
using surface electrodes
• Tests the cochlea and auditory brain pathways
• Both screening and diagnostic versions
• Tests low, mid, and high frequencies during diagnostic ABR, screener is high
frequency
ABR Use Used to rule out auditory neuropathy spectrum
disorder
• Can be used for adults if non-organic hearing loss is suspected
ABR Tests... Diagnostic = Low, mid, and high frequencies
Screener = High frequency
Diagnostic Testing for Adults Comprehensive Hearing Evaluation
• Pure tone audiogram
• Speech reception threshold (SRT)
• Word recognition/discrimination (WRS)
Pure Tone Audiogram Searching for threshold (how soft they can hear)
- "Push the button when you hear the beeps"
, Speech Testing - Speech Reception Threshold (SRT)
- Word Recognition Score (WRS)/Speech Discrimination Score (SDS)
Speech Reception Threshold (SRT) Describes the lowest level of hearing (measured in decibels) at which a person
can correctly recognize and repeat 50% of spoken words
• Used as a cross-check for behavioral testing
Word Recognition Score (WRS)/Speech Discrimination Assesses how clearly a person can understand speech once it's loud enough
Score (SDS) to be heard
• Used for counseling
Normal Adult Hearing 20 Decibels
Tympanometry The use of air pressure in the ear canal to test for disorders of the middle ear
- measure is the eardrum and middle are moves normally (checks for fluid or
puncture)
Type A Tympanometry Normal (peak between +50 to -100 daPa)
Type B Tympanometry No movement
- indicates fluid behind eardrum or a hole in eardrum
Type C Tympanometry Negative Pressure
- indicates Eustachian tube dysfunction
Acoustic Reflex The contraction of the stapedius muscle elicited by the presentation of an
acoustically loud sound
- When either ear is presented with a loud sound, the stapedius muscles on
both sides contract
Acoustic Reflex Testing Can provide/confirm information about the type (conductive, sensorineural)
and degree of hearing loss
Normal Hearing - Overview Patient reports occasionally needing repetition when at bars during ball games,
otherwise no concerns
• Tympanogram: Type A
• Rinne: AC > BC (+)
• Weber: Midline
• Puretones: 20 dB HL or better for adults
Medicine III
** 100% Guaranteed Pass
** Expert-Verified Explanation
** Questions with Verified Answer
** Latest Edition | Updated
,Social Impacts of Untreated Hearing Loss in Adults - Depression and anxiety
- Fatigue
- Embarrassment
- Anger
- Social isolation
- Safety issues
- Reduced job performance
- Increased number of falls
- Loss of productivity
- Cognitive decline
Social Impacts of Untreated Hearing Loss in Pediatrics • Delayed speech and language development
• Delayed development of cognitive skills like working memory
• Behavioral concerns
• Emotional concerns
• Isolation
Statements Related to Hearing Loss • "I always have to ask for repetition."
• Saying "What?"
• "I can hear, but I cannot understand what is being said."
• "My wife says I talk to loudly."
• "My husband says I have the TV too loud."
• "I cannot hear over the ringing in my ears.
Signs and Symptoms of Hearing Loss • Muffled hearing
• Tinnitus (ringing, buzzing, hissing)
• Speech/language delay
• Does not startle at loud sounds
• Ear pain, pressure, popping or fullness, vertigo
Risk Factors for Hearing Loss • History of noise exposure
• Family history of hearing loss
• Chronic middle ear infections
• Admin. of some medications (ototoxicity; aminoglycosides, loop diuretics,
cisplatin)
• Aging
• Head Trauma
Pediatric Specific Risk Factors for Hearing Loss • NICU stay
• Premature birth
• Prenatal exposure to TORCHES
• Failed newborn or school hearing screening
TORCHES TOxoplasma gondii
Rubella
CMV
HIV/HSV2
Syphilis
,Behavioral Testing in Pediatric Patients • Video Reinforcement Audiometry (VRA)
• Conditioning Play Audiometry (CPA)
Visual Reinforcement Audiometry (VRA) Used for children ages 6 months to 2-3 YO
• Child is trained to turn toward reward when they hear the sound
Conditioning Play Audiometry (CPA) Used for ages 3-5 YO
• Child is taught to play a listening game such as putting a toy in a bucket when
they hear a sound
Objective Diagnostic Testing in Pediatric Patients • Distortion Product Otoacoustic Emissions (DPOAE)
• Auditory Brainstem Response (ABR)
OAE (Otoacoustic Emissions) low-intensity sound generated by the inner ear in response to a sound
stimulation
Distortion Product Otoacoustic Emissions (DPOAE) Sounds are played in the ear
- If the outer, middle and inner ear hair cells are
functioning normally, we will be able to measure this response
• Pass or Refer = Can pass with mild loss
• Tests mid to high frequencies
DPOAE Tests... Mid to high frequencies
Auditory Brainstem Response (ABR) Sounds are played into the ear and the auditory nerve response is measured
using surface electrodes
• Tests the cochlea and auditory brain pathways
• Both screening and diagnostic versions
• Tests low, mid, and high frequencies during diagnostic ABR, screener is high
frequency
ABR Use Used to rule out auditory neuropathy spectrum
disorder
• Can be used for adults if non-organic hearing loss is suspected
ABR Tests... Diagnostic = Low, mid, and high frequencies
Screener = High frequency
Diagnostic Testing for Adults Comprehensive Hearing Evaluation
• Pure tone audiogram
• Speech reception threshold (SRT)
• Word recognition/discrimination (WRS)
Pure Tone Audiogram Searching for threshold (how soft they can hear)
- "Push the button when you hear the beeps"
, Speech Testing - Speech Reception Threshold (SRT)
- Word Recognition Score (WRS)/Speech Discrimination Score (SDS)
Speech Reception Threshold (SRT) Describes the lowest level of hearing (measured in decibels) at which a person
can correctly recognize and repeat 50% of spoken words
• Used as a cross-check for behavioral testing
Word Recognition Score (WRS)/Speech Discrimination Assesses how clearly a person can understand speech once it's loud enough
Score (SDS) to be heard
• Used for counseling
Normal Adult Hearing 20 Decibels
Tympanometry The use of air pressure in the ear canal to test for disorders of the middle ear
- measure is the eardrum and middle are moves normally (checks for fluid or
puncture)
Type A Tympanometry Normal (peak between +50 to -100 daPa)
Type B Tympanometry No movement
- indicates fluid behind eardrum or a hole in eardrum
Type C Tympanometry Negative Pressure
- indicates Eustachian tube dysfunction
Acoustic Reflex The contraction of the stapedius muscle elicited by the presentation of an
acoustically loud sound
- When either ear is presented with a loud sound, the stapedius muscles on
both sides contract
Acoustic Reflex Testing Can provide/confirm information about the type (conductive, sensorineural)
and degree of hearing loss
Normal Hearing - Overview Patient reports occasionally needing repetition when at bars during ball games,
otherwise no concerns
• Tympanogram: Type A
• Rinne: AC > BC (+)
• Weber: Midline
• Puretones: 20 dB HL or better for adults
