SLHS 4801 EXAM 2 2024/2025 QUESTIONS WITH COMPLETE SOLUTIONS

SLHS 4801 EXAM 2 2024/2025 QUESTIONS WITH COMPLETE SOLUTIONS How much of hearing losses are genetic? - RIGHT ANSWER -50% Nonsyndromic - RIGHT ANSWER -no other associated abnormalities Syndromic - RIGHT ANSWER -hearing loss many may accompany other structures and systems such as craniofacial structures, kidneys, skin, eyes, etc. Autosomal Dominant (ASD) Inhearitance - RIGHT ANSWER -Deaf parent Dd& Hearing parent dd Deaf parent passes the D to two kids and the d to the other two kids The hearing parent passes a d to each kid The two kids with Dd are deaf and the two kids with dd are hearing Autosomal Recessive (ASR) Inheritance - RIGHT ANSWER -Carrier father Rr and carrier mother Rr The hearing kid receives RR 2 Hearing carrier receives Rr One deaf kid receives rr X-linked inheritance - RIGHT ANSWER -Hearing father XY Hearing carrier mother Xx Hearing boy XY Hearing girl XX Deaf boy xY Hearing carrier girl Xx Affected males. female carriers Mitochondrial Inheritance - RIGHT ANSWER -Only inherited from the mother's egg Only females can transmit the the trait to offspring They pass it to all of their offspring Prenatal - RIGHT ANSWER -prior to birth in utero Perinatal - RIGHT ANSWER -shortly before or after birth (~8 weeks to +4 weeks) Postnatal - RIGHT ANSWER -after birth Congenital - RIGHT ANSWER -before birth (they are born with it) Ear Pain is known by what term? - RIGHT ANSWER -otalgia Discharge is known by what term? - RIGHT ANSWER -otorrhea ot- or oto- - RIGHT ANSWER -refers to the ear -itis - RIGHT ANSWER -refers to some type of inflammation myco: - RIGHT ANSWER -refers to fungal issues A- - RIGHT ANSWER -something missing; complete absence Dys- - RIGHT ANSWER -something malformed or malfunctioning Mryingo- & tympano- - RIGHT ANSWER -refers to TM -plasty - RIGHT ANSWER -refers to surgery -plasia - RIGHT ANSWER -refers to growth of organ algia - RIGHT ANSWER -refers to pain Dysplasia - RIGHT ANSWER -abnormal growth of an organ tissue/ ear Aplasia - RIGHT ANSWER -absense of an organ or tissue/ outer ear Microtia - RIGHT ANSWER -abnormally small pinnae Agenesis - RIGHT ANSWER -absent pinnea Hearing loss cause by deformities of the pinna or auricle - RIGHT ANSWER -The onset of HL is congentia conductivel, most cases genetic ,often syndromic external otitis - RIGHT ANSWER -Swimmer's ear symptoms; otalgia (ear pain), feels "full", discharge, "muffled, itching Treatment: topical medication antibiotics Rarely any HL Viral bollous mryngitis (painful blister on TM) Atresia - RIGHT ANSWER -closure of the EAM (can cause a conductive loss, may be remedied by surgery Stenosis - RIGHT ANSWER -narrowing of the ear canal (due to infections sometimes, congenital others) Microtia with atresia - RIGHT ANSWER -Small pinna with closed EAM Bilateral conductive HL, maximum air-bone gap, use masking for BC in both ears Match the following 1. Microtia A. agnenesis (absent) of pinna 2. Stenosis B. small pinna 3. atresia C. Narrow ear canal 4. Anotia D. Closure of ear canal - RIGHT ANSWER -1. Microtia B. small pinna 2. Stenosis C. Narrow EAM 3. Atresia D. closure of ear canal 4. Anotia - Absent pinna Otitis Media - RIGHT ANSWER -ear infection, inflammation of the middle ear cavity Otitis Media w/ Effusion (OME) - RIGHT ANSWER -eustachian tube malfunction, absorption of air in ME space, retraction of TM w/ negative pressure, secretion of clear fluid Suppurative OM & Purulent - RIGHT ANSWER -ear infection with discharging of pus Tmpanosclerosis - RIGHT ANSWER -A pseudo tumor is created around the ossicles from hard masses of connective tissues Cholesteatoma - RIGHT ANSWER -accumulation of celluar debris from perforation of the TM: pseudotumor; may cause erosin of the ossicles; HL may vary 15-55 dB Monomeric TM - RIGHT ANSWER -an area of thin, tranparent tympanic membrane, typically occurs after TM perforation Result of TM healing after perforation, the fibrous layer doesn't re-form Mastoiditis - RIGHT ANSWER -An infection that affects the mastoid bone, a complication of chronic otitis media Inflammation of the mastoid process A baterial infection of the mastoid air cells surrounding the inner and middle ear otosclerosis - RIGHT ANSWER -build-up of bone (spongy) in area of oval window - stapes footplate is immobilized What type of hearing loss results from otosclerosis? - RIGHT ANSWER -progressive conductive hearing loss What is the special characteristics of the audiogram for otosclerosis? - RIGHT ANSWER -A notch in bone conduction thresholds at 2000 Hz called "Carhart notch" IS otosclerosis more prevelent in men or women? - RIGHT ANSWER -Women (2.5x more) may be exacerbated during pregnancy Is otosclerosis genetic or non-genetic? - RIGHT ANSWER -genetic With otoslcerosis is hearing loss stable or progressive? - RIGHT ANSWER -progressive Klippel-Feil Syndrome Hearing loss - RIGHT ANSWER -congenital but not progressive often severe sensorineural or mixed loss May have abnormal ossicles Treacher Collins syndrome - RIGHT ANSWER -Mandibulofacial dystosis May have conductive or mixed loss Malformation of osscles or labyrinth Deformed/ sloping features Head trauma - RIGHT ANSWER -Skull Fractures Conductive: damage to typanic membrane or ossicles Sensorinueral: damage to cochlea What are some other patholgoes of the ossicular chain? - RIGHT ANSWER -discontinuity, erosion, and fixation results in conductive loss Name some populations that have a higher prevelance of OME? - RIGHT ANSWER -Children w. cleft paleate Children w/ down syndrome Native Americans Children from inner cities Children in day care What is a PE tubes? - RIGHT ANSWER -Tiny hollow tubes that are inserted to decrease the frequency of ear infections PE = Pressure Equalization When are they used? during a myringotomy, to place in the TM in order to frain the fluid form the ME space & equalize pressure in ME space OME has increased ____% from - RIGHT ANSWER -178% What can a TM look like with serous otitis media? - RIGHT ANSWER -Red or bulging Retracted, possibly with ai bubbles When does a retracted TM look like? - RIGHT ANSWER -It bulges inward due to negative pressure in the middle ear. What are the differences between adult and children eustachian tube? - RIGHT ANSWER -Children's are more horizontal Adults are at a 45 degree angle What does the Eustachian tube connect? - RIGHT ANSWER -The nasopharynx to the middle ear What is the degree of hearing loss of OM? - RIGHT ANSWER -Hearing loss varies, can be between 15-55 dB, average around 20-30 dB Adhesive OM - RIGHT ANSWER -the ear drum is sucked into the middle ear space and sticks (adheres to) the ossicles Describe the tree actions of the middle ear that overcome the transmission loss of sound in air to sound in fluid? - RIGHT ANSWER -The area difference from the tympanic membrane and the stapes footplate/oval window is 17 to 7.1 (this is the biggest amplifier) -The tympanic membrane is curved and buckles to contribute a 2:1 amplification -The ossicles shaped in a lever also contributes a small amount of amplification to overcome the transmission loss when going from sound in air to fluid What causes otitis externa (swimmer's ear) - RIGHT ANSWER -Fungal (otomycosis) or bacterial (pseudomonas, staphalococcus) Furunculosis (infection of the hair follicles) What is a skin tag? Would a skin tag anlone with a normal or slightly malformed pinna result in a hearing loss always? - RIGHT ANSWER -No. A skin tag is a formation of soft skin resulting a growth. It can be found throughout the body but also located on the ears. A slightly malformed Pinna does not always result in hearing loss. What causes malformation of the pinna? - RIGHT ANSWER -Genetics, accompanying a syndrome, or in a rare cases as a result of an insult to embryo or fetus When do malformation of the pinna occur? - RIGHT ANSWER -prenatally, usually genetic Congenital what type of hearing loss would come from malformations of the pinna? - RIGHT ANSWER -Conductive What is an otoscope? - RIGHT ANSWER -a device used to look into the ears What land marks should you look for on a normal TM? - RIGHT ANSWER -Color, cone of light, status, canal walls, cerumen What is the cone of light? - RIGHT ANSWER -it is the reflection of light we see form the light of the otoscope. If the cone of light is in a different spot, it can help diagnose certain abnormalities in the middle ear or in ossicles. No cone of light can mean otitis media. How many layers does the TM have? - RIGHT ANSWER -3 WHat is the pars tensa? - RIGHT ANSWER -it is taut and has most of the area What is the pars flaccida? - RIGHT ANSWER -it is smaller in area on the top portion of the membrane. It appears less tense than the pars tensa. What color should the TM be? - RIGHT ANSWER -pearly grey & translucent What is the resonance of the EAM? - RIGHT ANSWER -Peak resonance at about hz (important for speech) The lateral one third of the EAM is? - RIGHT ANSWER -Cartalige The medial two thirds of the EAM are? - RIGHT ANSWER -Bony How much of an increase in level does the pinna, tympanic membrane, and middle ear cause? - RIGHT ANSWER -10 -15 dB in a frequency range of 1500 Hz to 7000 Hz Concha at 5000 Hz. Collapsing ear canals - RIGHT ANSWER -malformation of the ear canal when the cartilaginous portion is flaccid and will collapse w/ pressure Vibrotactile thresholds - RIGHT ANSWER -when a client can feel sound due to vibrations but not necessarily hear it. Preliminary phase of SRT - RIGHT ANSWER -Start at 30 db above PTA for one ear(Ex: PTA is 40 dB HL for one ear, so start testing at 70 dB HL) Present 1 spondee per level. Correct reponse = decrease 10 dB until word is missed. When first error occurs, present a secound word at the same level If the second word is missed, the starting level will be 10 dB above where patient made two errors What is the starting level for SRT? - RIGHT ANSWER -10 dB above the level at which the patient made two speech errors What is the test phase of SRT? - RIGHT ANSWER -Present 5 spondes at starting level Decrease in 5 dB steps Continue presenting 5 spondees at each level STOP when all 5 words are incorrect How do you calculate SRT threshold? - RIGHT ANSWER -SRT = starting level - #of correct words + 2 dB conversion factor What procedure do you use to find SDT? - RIGHT ANSWER -10 down - 5 up procedure What is the goal of SDT? - RIGHT ANSWER -Find the level (in dB HL) at which the patient can detect 50% of the target words/sentences What is Sensation level? - RIGHT ANSWER -30 dB SL = 30 db above a patients hearing threshold level in dB HL Ex. is threshold is 35 dB then 30 dB SL would really be 65 dB HL Test ear - RIGHT ANSWER -the ear we are intentionally testing Non-test ear - RIGHT ANSWER -the ear we don't want to test and will mask Contralateral masking - RIGHT ANSWER -pure tone test signal in one ear and masker (narrow band noise ) in opposite ear When do we mask? - RIGHT ANSWER -1. we mask for BC when the gap between the AC thresholds of one ear and the BC thresholds of the other ear are more than 35 dB 2. We mask for BC if there is an air-bone gap in the same ear greater than 10 dB 3. We mask AC when the thresholds are different by 40 (superaural) to 60 (insert) dB What is a shadow curve type of audiogram and what causes it? - RIGHT ANSWER -When the AC threshold of the worse ear is poorer with masking (means unmasked thresholds were a shadow curve) This is due to interaural attenutation - the better ear could be compensating for the poorer ear. What is the occlusion effect? - RIGHT ANSWER -when the outer ear is occluded by an earphone during testing bone conduction thresholds and increases intensity of sound delivered to the inner ear What happens to the increase in sound pressure created by the occlusion effect when you have a conductive HL? - RIGHT ANSWER -it is attenuated At which frequencies does the occlusion effect occur? - RIGHT ANSWER -30db at 250 Hz 20 dB at 500 Hz 10 db at 1000 Hz 0 dB at 2000 & 4000 When masking for BC thresholds how do you compensate for the occlusion effect/ - RIGHT ANSWER -Add 30db at 250 Hz 20 dB at 250 Hz 10 db at 250 Hz after you already added the 10 to 15 dB cushion to the AC thresholds What is the initial masking level? - RIGHT ANSWER -10-15 dB higher than AC thresholds EX. AC = 10 dB initial masking level = 25 dB noise What is interaural attenuation? - RIGHT ANSWER -the amount of sound that the skull buffers from separate ears What is the interaural attenuation of AC? - RIGHT ANSWER -40 (supraural) -60 (insert) dB HL What is cross hearing? - RIGHT ANSWER -for certain types of hearing loss, sounds can be intense enough at the ear we want to test that the sound travels across the head and actually stimulates the opposite ear first. High risk register for cochlear pathology? - RIGHT ANSWER -family history of hearing loss, congenital infections (rubella), craniofacial anomalies, ow birht weight, hyperbilirubinemia, ototoxic medications, bacterial meningitis, What does (S)TORCH stand for? and what type of hearing loss and is it genetic? - RIGHT ANSWER -S- Syphilis TO- Toxoplasmosis R-Rubella C- Cytomegalovirus (CMV) H- Herpes simplex birus Sensorineural ad not genetic Normal Hearing - RIGHT ANSWER -</= 25 dB HL No difficulty with faint speech Mild hearing loss - RIGHT ANSWER -26-40 dB HL difficulty only with faint speech Moderate hearing loss - RIGHT ANSWER -41-70 dB HL frequent difficulty with faint speech/may ask for repetition severe hearing loss - RIGHT ANSWER -71-90 dB HL can only understan shouted or amplified speech (hearing aid help with intensity) Profound hearing loss - RIGHT ANSWER -91+ dB HL usually can't understand amplified speech (cochlear implants are an option) Conductive - RIGHT ANSWER -thresholds for BC normal AC abnormal Air-bone gap present Mixed HL - RIGHT ANSWER -Both BC and AC are abnormal but BC is better Air-bone gap present Sensorinerual HL - RIGHT ANSWER -AC and BC are both abnormal No air-bone gap Syphilis Hearing loss - RIGHT ANSWER -progressive (low frequency?) SNHL Toxoplasmosis hearing loss - RIGHT ANSWER -Moderate, progressive SNHL Rubella Hearing loss - RIGHT ANSWER -severe- profound SNHL Cytomegalovirus (CMV) Hearing loss - RIGHT ANSWER -congenital mild - profound, can be progressive, most often severe-profound SNHL Herpes Simplex Virus Hearing loss - RIGHT ANSWER -moderate- to-severe SNHL Syphilis - RIGHT ANSWER -sexually transmitted bacterial infection, most severe effects in 1st trimester, progressive (low frequency) SNHL Accompanying problems: notched incisor teeth, chronic inflammation of cornea Toxoplasmosis - RIGHT ANSWER -Protozoan origin in cat feces or uncooked meat, moderate progressive SNHL, Accompanying problems: Microcephaly (small head), Hydrocephaly, intellectual deficits, eye disorders Rubella - RIGHT ANSWER -German measles, viral infection, severe-profound SNHL Accompanying issues: heart & kidney disorders, intellectual deficits, visual defects Cytomegalovirus (CMV) - RIGHT ANSWER -Most common viral (herpes-type) cause of congenital HL, can contract w/ close contact w/ child Accompanying issues - microcephaly, intellectual deficits, liver disease Herpes simplex virus - RIGHT ANSWER -sexually transmitted viral disease, can be trasmitted during pregnancy or birth, moderate-sever SNHL Accompanying issues: microcephaly, growth deficiencies, retinal issues perinatal period - RIGHT ANSWER -status at birth (apgar score), birth weight, prematurity Apgar Scale - RIGHT ANSWER -screening tool for health care providers to determine if immediate care is needed to help stabilize a new born. Five categories are assessed - heart rate, respiratory effort, muscle tone, reflex irritability, &color, each scoring a 0,1, or 2. Normal ranges from 8-10, less than 8 infant needs stablizing. When is the Apgar scale assessed? - RIGHT ANSWER -Twice one minutes after birth to determine how well the infant handled the birthing process Five minutes after birth to determine how well the infant is adapting to the environment low birth weight (LBW) - RIGHT ANSWER -<5.5 lb very low birth weight (VLBW) - RIGHT ANSWER -< 3 lb 5 oz Extremely low birth weight (ELBW) - RIGHT ANSWER -< 2 LB 3 oz Preterm birth - RIGHT ANSWER -< 37 weeks gestation very preterm birth - RIGHT ANSWER -< 32 weeks gestation Hyperbilirubinemia - RIGHT ANSWER -Jaundice can cause a non-genetic SNHL Infant is given phototherapy Can be Rh incompatibility - mother is Rh-negative and infant is Rh-positive, the mother develops antibodies to the fetus in utero, red blood cells are broken down and not excreted by the liver, a condition called kernicterus that can cause brain damage. Postnatal infections - RIGHT ANSWER -bacterial meningitis, mumps, measles, herpes zoster oticus Bacterial Meningitis Hearing loss - RIGHT ANSWER -bilateral severe-profound SNHL Mumps Hearing loss - RIGHT ANSWER -unilateral SNHL (high frequency) Measles hearing loss - RIGHT ANSWER -Sudden onset Bilateral severe-profound SNHL Herpes Zoster Oticus Hearing loss - RIGHT ANSWER -Severe high frequency SNHL Bacterial Meningitis - RIGHT ANSWER -Acute cental nervous system infection, can result in brain damage and/or bilateral sever-profound SNHL Has been caused by HiB Cochlea may ossify after meningitis Mumps - RIGHT ANSWER -one of the most common causes of aquired unilateral SNHL in children Sudden onset, degree varies but profound is most common Herpes Zoster Oticus - RIGHT ANSWER -facial paralysis, vertigo, sever high-frequency SNHL Meniere's disease hearing loss - RIGHT ANSWER -progressive or fluctuating SNHL (low frequency) often Unilateral Meniere's disease - RIGHT ANSWER -symptom complex affecting the membranous inner ear, caused by endolymphatic hyprops. Most often seen between 30-50 years, symptoms include: progressive or fluctuating SNHL (low frequency), often unilateral, episodic vertigo, tinnitus(low pitched), feeling of fullness/pressure in the ear. Meniere's disease treatment - RIGHT ANSWER -low sodium diet, use of diuretics, vestibular suppressants, stress avoidance/management, surgery (endolymphatic sac decompression, vestibular neurectomy, labyrinthectomy) Ototoxic hearing loss - RIGHT ANSWER -Moderate -severe SNHL (high frequency) Ototoxixc drugs bad for hearing - RIGHT ANSWER -"myclin drugs-streptomycin, neomycin, kanamycin, gentamycin "Platin drugs" - cisplatinum & carboplatin Furosemide (Lasix): loop diuretics, Ethacrynic acid Asprin (can cause tinnitus & HL, reversible) Quinine Degree of Ototoxicity - RIGHT ANSWER -depend on drug dosage, susceptibility of patients and if they are simultaneously using other ototoxic agents noise-induced hearing loss (NIHL) - RIGHT ANSWER -Damage to outer hair cells resulting in a SNHL with a notch at 4000 Hz either in a temporary threshold shift or permanent Noise factors - RIGHT ANSWER -intensity, duration, spectrum of noise, length of exposure, susceptibility of individual. Why do you see a notch @ 4000 Hz in Noise-induced HL? - RIGHT ANSWER -Because resonance of outer and middle ear @ 2-4 kHz increase level Perlymphatic Fistula - RIGHT ANSWER -leak in perilymph due to a hole in the cochlea, usually at oval or round window, caused by explosion, barotrauma, straining, or surgical error, results in sudden hearing loss anf vertigo, but can be surgically repaired. Presbycusis hearing loss - RIGHT ANSWER -Bilateral sloping high frequency SNHL Presbycusis - RIGHT ANSWER -Hearing deteriorates past age 50 progressively (more rapid in men) and has some hereditary compnent, also could see degeneration of brain stem and cortical areas. maybe a combination of outer & middle ear, cochlear and central effects. Retrocochlear Pathology - RIGHT ANSWER -damage to the nerve fibers along the ascending auditory pathways from the internal auditory meatus to the cortex May observe almost no loss by pure tones VIII Nerve Tumors - RIGHT ANSWER -(acoustic neuroma, vestibular schwannoma, neurofibromatosis) Symptoms: tinnitus, dizziness, unilateral SNHL, & headaches Speech may be understood well in quiet, but poorer degraded Acoustic Schwannoma/Neuroma audiogram - RIGHT ANSWER -Unilateral (high frequency) SNHL Auditory Neropathy/ dys-synchrony - RIGHT ANSWER -outer hair celss not affected (otoacoustic emissions are present), Auditory brainstem responses are absent or abnormal Inner hair cells likely affected, along with synapses, nerves and hearing level/thresholds are scattered Genetic factors account for ____-____% of congenital and early-onset deafness(moderate-profound HL) - RIGHT ANSWER -50-60% What is the Autosomal dominant gene for deafness and what percent of does it make up of non-syndromic genetic HL? - RIGHT ANSWER -Gene DFNA 20% What is the Autosomal recessive gene for deafness and what percent of does it make up of non-syndromic genetic HL? - RIGHT ANSWER -gene DFNB 75-80% What is the X- linked recessive gene for deafness and what percent of does it make up of non-syndromic genetic HL? - RIGHT ANSWER -gene DFNX 1-2% What percent of does Mitochandrial make up of non-syndromic genetic HL? - RIGHT ANSWER -<1% There are more than ______ types of genetic hearing loss. 70%= 30%= - RIGHT ANSWER -400 nonsyndromic syndromic Syndromic Genetic hearing loss: conductive & Mixed - RIGHT ANSWER -CHARGE Assosication, Klippel-feil Syndrome, Apert Syndrome, Treacher Collins Syndrome sensorineural hearing losses- non-genetic origin - RIGHT ANSWER -(S)TORCH Complex, perinatal origin, hyperbilirubinemia, postnatal infections CHARGE association - RIGHT ANSWER -C- Coloboma (defect of the eye) H- Heart defects A- Atresia of chanea (opening of the nasal cavity into the nasopharynx) R- retarded growth & development G- genital hypoplasia E- Ear abnormalities ( abnormalities of the pinnae (short wide or cup-shaped) hearing losses may be conductive or sensorineural) CHARGE association Hearing loss - RIGHT ANSWER -Cause by Ear abnormalities ( abnormalities of the pinnae (short wide or cup-shaped) hearing losses may be conductive or sensorineural) Kippel-Feil Syndrome - RIGHT ANSWER -Head appears to sit directly on the trunk, Limited mobility laterally of the neck, Frequent facial asymmetry, and Variable fusion or 1+ cervical vertebrae High prevalence in females Multifactorial inheritance suspected Hearing loss is congenital and not progressive, it is often a severe sensorineural or mixed loss May have preauricular skin tags, atresia, abnormal ossicles, abnormal semicircular canals, underdevelopment of the bony labyrinth. Klippel-Feil Syndrome HL - RIGHT ANSWER -Congenital, not progressive, severe SNHL or Mixed Apert Syndrome - RIGHT ANSWER -Autosomal dominant (but sporadic) Intellectual deficit, ocular hypertelorism (widely space pupils) syndactyly of hand or feet Conductive Hearing Loss Apert Syndrome HL - RIGHT ANSWER -Conductive Treacher Collins Syndrome - RIGHT ANSWER -Mandibulofacial dysostosis, downward sloping palpebral(eyelid) fissures, depressed cheekbones & receding chin. Deformed pinnae, may have conductive or mixed loss Malformation of ossicles or labyrinth Autosomal dominant Treatment with a bone-anchored hearing aid Treacher collins Syndrome HL - RIGHT ANSWER -Conductive or mixed Syndromic Hearing loss: SNHL - RIGHT ANSWER -Usher's syndrome, Waardenberg syndrome, NF2 Usher's syndrome - RIGHT ANSWER -Retinitis pigmentosa (RP) causes blindness), & a congenital sensorineural HL (SNHL) which may be profound and maybe be associated with balance disorders Type I - congenital profound SNHL, RP & balance problems Type II - congenital moderate-to-severe SNHL, RP & no balance problems Type III - progressive SNHL, RP, & possible balance problems RP causes gradual loss of vision (total blindness by age 50 in about 40% of population) Autosomal recessive condition Usher's Syndrome Type 1 HL - RIGHT ANSWER -congenital profound SNHL Ushers Syndrome Type 2 HL - RIGHT ANSWER -Congenital moderate-severe SNHL Usher's Syndrome Type 3 HL - RIGHT ANSWER -progressive SNHL autosomal dominant disorders - RIGHT ANSWER -Apert Syndrome, Treacher Collins, Waarenberg Syndrome, NF2? autosomal recessive disorders - RIGHT ANSWER -Usher's syndrome Waaardenberg Syndrome HL - RIGHT ANSWER -About 50% have SNHL Waardenberg Syndrome - RIGHT ANSWER -Widely spaced medial canthi (angle of the eye), flat nasal root, confluent eyebrows, white forelock, patchy areas of pigmentation, heterochromia About 50% have SNHL Autosomal dominant Neurofibromatosis Type 2 HL - RIGHT ANSWER -SNHL, progressive unilater or bilateral (95%) of patients Neurofibromatosis Type 2 - RIGHT ANSWER -Vestibular schwannomas (acoustic neuromas) and neural hearing loss Tumors may be unilateral or bilateral (95% of patients) Hearing loss is progressive Profound neural deafness results in post-surgery for tumors May see come cafe au lait spots & skin roughening (more prevalent in Type I) Genetic Hearing loss with associated chromosomal disorders - RIGHT ANSWER -Down Syndrome, Trisomy 21 Down Syndrome HL - RIGHT ANSWER -75% have hearing loss- conductive losses most prevalent, with sensorineural or mixed observed too. High incidence of middle ear effusion Progressive HL Disorders - RIGHT ANSWER -Apert?, Usher Syndrome type 3, NF2, otosclerosis When does OM become persistent? - RIGHT ANSWER -When it fails to get better after 6-8 weeks of treatment What is the purpose of the Eustachian tube? - RIGHT ANSWER -ventilation (maintain middle ear pressure), drains fluid, & prevent infectous matierial from entering the ME space. What type of hearing loss results from different type of OM? - RIGHT ANSWER -Conductive or mixed What is the degree of hearing loss for OM? - RIGHT ANSWER -Hearing loss caries, can be between 15-55dB, average is around 20-30 dB Treatment of OM - RIGHT ANSWER -antimicrobials (ampicillin, amoxycillin, augmentin) combat ME infection; sterile fluid may still remain; myringotomy with tubes; adenoidectomy Erythromycin Sulfa drugs (bactrim or cechlor) Myringotomy- small surgical incision in lower quadrant of tympanic membrane Placement of pressure equalizer tubes What are the axis for the psychometric function Perfromace-intensity function of spondees? - RIGHT ANSWER -Y-axis - %correct X-axis SPL How do you find SRT on the performance-intensity function? - RIGHT ANSWER -At 50% correct go down to find the SPL (18 dB SPL) ASHA guidelines for SRT - RIGHT ANSWER -Permit audiologist to use standardized procedures for measurement. Each word, whether recorded or monitored live voice, will be presented with a carrier phrase "say the word ...." Performance intensity Function - RIGHT ANSWER - Subjective Tests - RIGHT ANSWER -Most comfortable level (MCL) Uncomfortable loudness and Loudness discomfort levels (UCL, LDL) Most Comfortable Loudness Level (MCL) - RIGHT ANSWER -the hearing level at which speech is most comfortably loud or the level at or near a patient's speech-recognition ability is at its maximum Uncomfortable Loudness Level (UCL) & Loudness Discomfort Level (LDL) - RIGHT ANSWER -the point at which speech becomes uncomfortably loud. Objective tests - RIGHT ANSWER -word recognition & sentence test (measures performance by counting th enumber of words/sentences that are repeated correct) What is the equation you could use to see if you need to mask aC? - RIGHT ANSWER -AC thresholds- IA >/= BC IF the resulting value is SMALLER than the unmasked bone conduction threshold, you DO NOT need to measure masked air conduction thresholds for this ear. IF the resulting value is GREATER than the unmasked bone conduction threshold, you DO need to measure masked air conduction thresholds for this ear. IF the resulting value is _______ than the unmasked bone conduction threshold, you __ ___ need to measure masked air conduction thresholds for this ear. IF the resulting value is _______ than the unmasked bone conduction threshold, you____need to measure masked air conduction thresholds for this ear. - RIGHT ANSWER -SMALLER than AC DO NOT MASK GREATER than AC DO MASK What is the initial level (dB HL) of pure tones when performing masking? - RIGHT ANSWER -should be equal to the level of unmasked BC thresholds, because the could be that good or worse, but not better. Step 1 in performing masking - RIGHT ANSWER -turn on the masking noise in the non test ear (in this case it will be at 15 dB HL) then present the pure tone equal to the level of unmasked BC threshold (in this case 0 dB) into the test ear. Imagine that when we present the pure tone, the listener raises her hand; she heard the tone. To make sure she heard it on the test side, we want to continue to flood the non-test ear with more masking noise. If she is truly hearing the tone in the test ear, she should still be able to hear the tone at 0 dB HL, even though we are putting more noise in the opposite ear. If the threshold increases, that suggests that she was ACTUALLY hearing the tone in the non-test ear and that adding more noise covered up the tone that she heard in the non-test ear. So, the next step is to raise the level of the masking noise another 5 dB and see what happens. Step 2 in performing Masking - RIGHT ANSWER -We raised the masking noise by 5 dB HL (to 20 dB HL) in the non-test ear. We presented the pure tone at 0 dB HL, no response We then raised the level of the pure tone by 5 dB to 5 dB HL and the listener raised her hand. The fact that the threshold in the left ear increased when we increased the level of the masking noise in the non-test ear tells us that she was actually hearing the sound in her non-test ear, not the test ear. Increase the masking noise in the non-test ear another 5 dB. If 5 dB HL is her true bone conduction threshold for the left ear, the threshold will not change; it will remain at 5 dB HL, if she was still hearing that sound in her non-test ear the threshold will increase another 5 dB to 10 dB HL. Step 3 in performing masking - RIGHT ANSWER -We increased the level of the masker another 5 dB to 25 dB HL in the non-test ear and the bone conduction threshold in the test ear increased to 10 dB HL. That means that, in step 2, this person was still hearing the tone in her non-test ear. Next increase the level of the masking noise another 5 dB. Step 4 in performing Masking - RIGHT ANSWER -We increased the masking level another 5 dB in the non-test ear to 30 dB HL and remeasured the threshold in the test ear, the pure tone threshold increased by another 5 dB to 15 dB HL. Increase the level of the masking noise another 5 dB and see if the test ear bone conduction threshold changes. Step 5 in performing masking - RIGHT ANSWER -We've increased the level of the masking noise by 5 dB to 35 dB HL in the non-test ear, the pure tone threshold in the test ear STAYED THE SAME @ 15 dB HL. This suggests that we may have reached the true test ear threshold! After we raised the noise level for the 5th time. The bone conduction threshold we measured for the left ear in steps 4 and 5 were identical. The test ear bone conduction threshold has stayed the same at 15 dB HL for a total change of 10 dB of masking noise in the non-test ear. We call this 10-dB range of masking noise the plateau. Let's add 5 dB more of masking noise and see what happens. Step 6 in performing masking - RIGHT ANSWER -We've raised the masking noise in the non-test ear by 5 dB it looks like the threshold increased another 5 dB to 20 dB HL. Because this happened after the plateau, this suggests we are now putting in too much masking noise. When the threshold starts to increase after a plateau, it means that the masking noise presented to the non-test ear is now crossing over to the test ear and interfering with the listener's ability to hear the tone in the test ear. So, at this point, we can stop testing. Final result of masking - RIGHT ANSWER -On the audiogram, we would now indicate that the true bone conduction threshold (is 15 dB HL) and report that the range over which the threshold stayed the same (was 30-35 dB HL.) Plateau of masking - RIGHT ANSWER -happens in 5 dB steps, each time we increase the level of masking noise, we remeasure the BC thresholds. We will reach the true thresholds when the pure tone threshold we measure in the test ear stops changing. Three phases -under masking, masking plateau, and over masking Under masking - RIGHT ANSWER -Not enough masking noise in the non-test ear to prevent cross hearing Masking Plateau - RIGHT ANSWER -when the threshold in the test ear stayed constant as we increased the level of masking noise Over-masking - RIGHT ANSWER -when we increase the level of masking noise above and beyond the masking plateau region, the masking noise was crossing over to the test-ear preventing it from hearing the pure tone.