1/27/2015

AudiologicAssessmentFinal#2flashcards|Quizlet

Audiologic Assessment Final - #2

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SPECIALTESTSOFCOCHLEAR
ANDRETROCOCHLEARFUNCTION

...

Define:

...

Validity

Howwelldoesthetesttestforwhatitis
supposetobetestingfor.Howvalidis
thetest

Reliability

ifyoutestagain,wouldyougetthesame
results?

Sensitivity

howwellthetestpicksupwhatitis
supposetotest

Specificity

howwelldoesthetestnotpickupon
otherstuffnottesting

Efficiency

Allusingaseriesofteststhatgo
together

1.DELINEATETHEKEY
INDICATORSOFRETROCOCHLEAR
PATHOLOGY

Asymmetricsensorineuralhearingloss
Asymmetricspeechrecognitionabilities
Suddensensorineuralhearingloss
Asymmetrictinnitusofrecentorigin
Vestibularsymptomssuchasdizzinessor
imbalance

ANYASYMMETRICAL
SENSORINEURALHEARINGLOSS
ISA_______________________

TUMORUNTILPROVEN
OTHERWISE

2.RETROCOCHLEARPROCEDURES
(recognizedescription)(4)

ToneDecay
(SuprathresholdToneDecay)
PIPBRollover
PhysiologicTests(best)
ABR
AcousticReflexDecay

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adecreaseinsensitivityto/lossof
audibilityofanongoingstimulatingtone

ToneDecay

ToneDecay:
Canbethresholdor_________

suprathreshold
70%

"Hitrate":__%forboththresholdand
suprathresholdprocedures
Cantestevenifcan'tgetacoustic
reflexes/decay
Recommended:____________Threshold
ToneDecayTest:

ModifiedCarhart

Obtainthreshold
Presenttonecontinuouslyat5dBSL
Whensubjectresponds,begintiming.If
subjectindicatesthattonalityhas
changedortoneisnolongeraudible,
raisetheintensity5dBwithout
interruptionandbegintiming
againRepeat#3untilsubjectindicates
perceptionoftonalstimulusfor60
seconds
Endinglevelbeginninglevel=Amount
oftonedecay
Interpretation:>30dBindicativeof
retrocochlear(between20and30dB
eachdBoftonedecayincreasesindexof
suspicion)
Testat500,1000and2000Hz
Subjectshouldsignalaslongasheorshe
hearsthesound/thenontestearismasked
with90dBSPLwhitenoise
Present500Hztoneat110dBSPLfor
60secondsoruntilsubjectnolonger
hearsit
Negative:subjecthearsthetoneforthe
full60seconds
Positive:subjectfailstorespondforfull
60seconds
Toensurepatientunderstandstask:do
thesamewithpulsedtones
Notassensitiveasthresholdtonedecay,
butshorter
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Suprathresholdtonedecay

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Testwordrecognitionabilityatseveral
intensitiesandplotPIfunctions

PIPBRollover
PerformanceintensityofPBwords

Lookforsignificant"rollover"
decrementinperformanceathigh
intensitylevels
RolloverRatio=(PBMaxPBMin)/
PBMax

75%

>.45=possibleretrocochlear
Hitrate:____%
TheMOSTsensitivetestsof
retrocochlearfunctionareNOT
behavioral,theyare________

physiologic
AuditoryBrainstemResponse(ABR)
AcousticReflexDecayTesting

However,degreeofhearinglossand/or
pathologymay______ABRandAR
testing

preclude
Imaging

________(e.g.,MRI)mostsensitivefor
detectionoftumorshowever,doesNOT
provideinformationregardingneural
function
2.COCHLEAR
PROCEDURES/DESCRIPTIONS

...

Whatdoesitmeanifsomeonetests
negativeforcochlearpathology?

Justnegativeforcochlearpathology.
DoesNOTmeanretrocochlear
pathology.

BasedonFowler(1928):Recruitment
(abnormalgrowthofloudnessfor
suprathresholdsignals)

LoudnessBalanceProcedures
(2types)

Whatonlyhappensinacochlear
pathology?

Recruitment

Loudnessbalancingproceduresrequires
loudnessbetweenafrequencywithin
normallimits(<25dB)andone
showing______.

aloss

Whatarethe2mostcommonprocedures
forloudnessbalance?

ABLB(AlternatingLoudnessBalance
TestFowler,1936)
MLB(MonauralLoudnessBalanceTest
Reger,1936)

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Comparesloudnessgrowthperception
betweentwodifferentfrequencies(one
normal,oneabnormal)withinthesame
ear
Intensityisheldconstantatone
frequency(reference)andvariedatother
frequencyuntiltheyareofsameloudness
tolistener

MLB(MonauralLoudnessBalanceTest
Reger,1936)
(loudnessinbadeargrowsmorerapidly)

Comparesloudnessgrowthperception
betweenearsforsamefrequency
Intensityisheldconstantinoneear
(reference)andvariedinotherearuntil
theyareofsameloudnesstolistener

ABLB(AlternatingLoudnessBalance
TestFowler,1936)

WhattypeofhearinglossisABLBused
for?

unilateralhearingloss

Howcanyouplotresultsforloudness?

laddergramsandgraphs

whenreferenceandvariable
ears/frequenciesarejudgedequallyloud
at+10dBHL

completerecruitment

whenreferenceandvariable
ears/frequenciesarejudgedequallyloud
atequalSLs

norecruitment

whenreferenceandvariable
ears/frequenciesarejudgedequallyloud
betweencompleteandnorecruitment
levels

Partialrecruitment

whenequalloudnessjudgementsshow
SLdifferenceof15dBormoreinthe
poorear(orfrequency)thaninthegood
ear

Decruitment

ClinicalUtilityofLoudnessBalancing
Tests:(summary)
Betteratdetecting_____pathology

cochlear
500or1000

Maybenecessaryifbettertests(e.g.,
ABR)arenotavailable
Moreefficientat___________Hzthanat
4000Hz

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Requireslistenertodetectsmall
increasesinintensityintonalsignals

ShortIncrementSensitivityIndex(SISI
Jergeretal.,1959)

Basedonprinciplethatrecruitment(as
foundincochlearpathology)will
increaselistener'ssensitivitytosmall
intensityincreases
SISIassessesdifference______(DLs)
forintensity

limens

SISI
_______Pathologycanhear1dB
increments

Cochlear(becauseofrecruitment)
Normal/Retrocochlear

_________canhear5dBbutnot1dB
increments
SISIprocedure:
Numberofstimuli
Presentonly10ifclienteitherhearsnone
or1(010%),or9or10(90100%)
Carriertoneintensity
Highcarriertoneintensitylevels(i.e.,
75dBHL)mayidentifycochlear
disordersbetterretrocochleardisorders
mayshowfalsepositivesathighlevels.
Therefore,use75dBHLunless>60dB
hearingloss.With>60dBhearingloss,
use20dBSL

...

SISIInterpretationfromresults:020%=
"low"SISInegativeforcochlear
disorderpossible8thnervedisorder

...

70100%="high"SISIpositivefor
cochleardisorder(ornormal)
2565%=highlevelSISImayhelpto
eliminatetheseresults
PHYSIOLOGICtestsforCOCHLEAR
pathology

...

assessOHCfunctionabnormalin
sensoryhearingloss>30dBusedin
newbornhearingscreening

OAEOtoacousticEmissions

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TheMOSTsensitivetestofcochlear
(outerhaircell)functionisNOT
behavioral,itisphysiologic:

OAE

_______resultsmayalsobesuggestiveof
cochleardysfunction(e.g.,high
percentageofindividualswithsignificant
cochlearhearinglossstillexhibitARs)

AcousticReflexThreshold

Summary:
LoudnessbalanceandSISIprocedures
relativelyefficientfordetectionof
cochleardisordersnotasgoodfor
detectingretrocochleardisorders,but
maybenecessaryifABRandARtesting
isnotpossible

...

Rarelyusedanymorewithadventof
physiologictesttools

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