Written COMP Flashcards

Question

What are some of the clinical applications for OAE's in adults?

Answer 1

- monitoring tinnitus and noise or music exposure - differentiation of cochlear vs. retrocochlear site of lesion - assessment in suspected functional hearing loss

Answer 2

A version of a DP gram with normative values from the 5th percentile to the 95th percentile used to indicate if hearing is normal, abnormal or borderline.

Answer 3

74-83 dB SPL

Answer 4

The 1st image is a good stimulus because it has a peak then flattens out.

Answer 5

The inner hair cells stimulated through basilar membrane movement

Answer 6

As the OAE moves from the cochlea to the ear canal, this reverse transmission is much less effective than forward transmission

Answer 7

a. TEOAE b & c. Reproducability isnt present at 3000,4000, or 5000 d. cant bc not reproducible

Answer 8

ANSD, mild losses, atypical configurations

Answer 9

OAE responses in a person with ANSD will be present early on but eventually the compromised blood flow to the lesion will cause a neuropathy making them absent.

Answer 10

When we record OAE's in the presence of abnormal negative ME pressure the lows will decrease because as the sound travels through the ear the TM and middle ear system are stiff. This means that the vibration of the ossicles will slow causing the wave to reach the high frequency areas but not the lows. Thus causing a decrease in the amplitude of low frequencies.

Answer 11

The absolute ampitude must be greater than -10 dB SPL, the SNR must be greater than 6 dB, and there must be reproducability. If all of these are present it means the patient has normal or near normal cochlear function.

Answer 12

- Hearing is better than or equal to approximately 15-20 dB HL - Cochlear outer hair cell function is normal or near normal

Answer 13

- H: history, relevent information - E: evaluation, what tests you did - A: audiologic results, what are the results of the test you ran - R: recommendations, who are you sending it to and what do you want them to do with this info.

Answer 14

VIIIth nerve (neural) auditory dysfunction & functional, non-organic, psychogenic hearing loss

Answer 15

hazardous noise/music exposure & ototoxicity

Answer 16

- ishchemia due to compromised blood flow - toxicty - platinum or other metals - formation of free radicals and metabolic stress - mechanical damage

Answer 17

- protect from loud sounds - hearing speech in noise - auditory attention

Answer 18

- Pure tone audiometry in conventional test frequencies - High frequency audiometry - Otoacoustic Emissions

Answer 19

According to this table Test A is the most sensitive because the d' is higher. d' is less sensitive when it is lower and more sensitive when it is higher.

Answer 20

The TEN test is able to identify a cochlear dead region by using calibrated masking to tell us if the response is coming from the actual place (on frequency) or not (off frequency). The noise played will mask any of the off frequency lsitening so the tone must be louder than the noise. Off frequency means the tone is detected away from the region of peak BM vibration meaning the tone is detected by the IHC at the edge of the dead region. On frequency means the frequency presented is the place on the BM that is actaully responding.

Answer 21

perceiving either one phoneme or another when VOT is gradually increased or decreased?

Answer 22

the ability to identify words in a stream of speech (if one is familiar with the language)

Answer 23

the ability to understand a speaker with a previously unheard foreign accent especially with repeated exposure to that accent

Answer 24

All information necessary to recognize sounds is contained in the acoustic signal and analyzed in the auditory pathway

Answer 25

stream of acoustic information is interpreted as speech and not just random sounds

Answer 26

- understanding information - mental activities or processes - storing and retrieving information (memory and recall

Answer 27

- Higher level cognitive operations are involved in identifying and analyzing speech sounds - Prior knowledge and expectations are involved in speech perception

Answer 28

- Attention; the ability to tend to a desired targetfor , example listening in noise - Processing Speed ; amount of time it takes to process a stimulus, reaction time - Inhibition ; ability to inhibit extranous info when repsoning to a target stimulus, example is the stroop test - Short term memory ; memory stores for a short period of time, example seeing how many numbers you can remember correctly in a row - Working memory ; memory stored for a long period of time, that you can use to help you understand - Executive funciton ; control of cognitive processes, example trail making (following a path of #'s in order) - Semantic Knowlede ; accumulated through lived experiences, example naming things by looking at pictures

Answer 29

semantic knowledge

Answer 30

inhibition

Answer 31

working memory

Answer 32

short-term memory

Answer 33

executive function

Answer 34

processing speed

Answer 35

- environmental noise - accent - predictability - if you know the person and how they speak

Answer 36

The predicative role in working memory helps us when we are talking to people we are familiar with. The postdicative role in working memory is more challenging and comes into play when we are talking to unfamiliar speakers or people with accents. If i meet someone from a place where the dialect is different I will struggle more to figure out what they are saying if I miss something. This is because I dont know them well and am unable to predict how they speak. The postdicative role helps me piece together my prior knowledge from past experiences and context to figure out what they were saying.

Answer 37

We use implicit processing to look for matches in our long term memory, if there is a match we will have automatic understanding, if there is not a match we will struggle to undersand unless there is context. Then we use explicit processing to pull information to understand. Implicit processing is automatic, example the speaker is familiar and therefore we can predict their speech. Explicit takes effort, it can be an unfamiliar speaker and we will have to use our working memory.

Answer 38

- recall task - tracking task - reaction time task - attention task

Answer 39

Physiologic - pupil response during listening Self reporting - answering questions Behavioral measures - 2 tasks performed individually then simultaneously, listening effort performance will decrease simulateously

Answer 40

mask an off-frequency response

Answer 41

d-prime is independent of pass-fail criteria

Answer 42

higher value

Answer 43

With hidden hearing loss/cochlear synaptopathy hearing in noise if affected and the fibers repsonsible for higher level inputs. The listener would be able to hear in quiet situations because they are able to to get soft input for the brain to process. They would struggle in noise because in noise you are no longer able to hear those soft sounds so the brain can not process them.

Answer 44

Two-tone suppression is when one tone is supressed when a second tone is present. It affects vowel perception and you lose the peaks meaning everything becomes a flat line. Distortion products is a 3rd tone is added when 2 tones are present together. These are caused by loss in the OHC and it affects speech because the OHC are our amplifiers so when these are lost if causes problems with our hearing. A person with this kind of damage will struggle with hearing speech in noise.

Answer 45

- masker evokes stronger neural excitation than target speech - takes place in the peripheral auditory system

Answer 46

- linguistic content interferes with speech perception - takes place at the auditory processing or cognitive level

Answer 47

- affects speech in noise processing - pure tone thresholds are unaffected - speech in quiet is not significantly impacted - affects the ability to process complex auditory information at suprathreshold levels

Answer 48

- implicit process - fast - component of RAMBPHO (initial processor of multimodal sensory information) - part of implicit processing

Answer 49

- explicit process - thought to be in play after a mismatch has already occurred - slow, deliberate

Answer 50

The number of older individuals (those over 65 years of age) is expected to decrease by 2030 driving healthcare costs down

Answer 51

vision, somatosensory, vestibular

Answer 52

Labyrinth & 8th nerve up to the point it enters the brainstem

Answer 53

Brainstem to cortex

Answer 54

The two sensory structures in the peripheral vestibular system are the crista ampullaris and the maculae. The crista ampularis is responsive to angular (rotational) movement and the maculae is responsive to linear (translational) movement and to gravity.

Answer 55

A- Common Crus of SCC B- Scarpas Ganglion C- Superior Vestibular Nerve Branch D- Inferior Vestibular Nerve Branch E- Posterior/Inferior SCC F- Saccule G- Utricle H- Horizontal/Lateral SCC I- Ampulla J- Anterior/Superior SCC

Answer 56

Left anterior SCC & Right Posterior SCC Left Horizontal SCC & Right Horizontal SCC Left Posterior SCC & Right Anterior SCC

Answer 57

excitatory, inhibitory

Answer 58

inhibitory, excitatory

Answer 59

Vestibuloocular Reflex (VOR) - produced equal and oppsite reactions to the direction of the head movement. The purpose it to stabalize gaze during head and body movement. Vestibulocollic Reflex (VCR) - works with the muscles in the neck to stabalize the head Vestibulospinal Reflex (VSR) - maintains posture

Answer 60

Oculomotor (III), Trochlear (IV) and Abducens (VI)

Answer 61

Jerk Nystagmus

Answer 62

Pendular Nystagmus

Answer 63

Left-Beating & Left eye

Answer 64

Vision Denied

Answer 65

Eye blink artifact

Answer 66

2Hz (120 bpm) or faster

Answer 67

For active head rotation the pateitn is directed to move their oown head and for passsive the examiner or moter driven chair moves the head

Answer 68

- it can be performed in all planes to evaluate all SSC's - the test is based upon the Halmagyi head thrust screening - Head acceleration must be rapid (>200 deg/sec)

Answer 69

gain: eye movement (VOR) relative to head movement re-fixation saccades: saccades which occur in response to those with abnormal VOR. Types are covert and overt.covert = saccades that occur during the head movement, difficult to impossible to see with the naked eye. overt = saccades that occur after the head movement, can be seen with the naked eye.

Answer 70

normal gain without re-fixation saccades for rightward impulses, reduced gain with both covert and overt re-fixation saccades for leftward impulses

Answer 71

Advantages: faster, more tolerable to patient, provides high frequency information (more natural), can be used on kids, can be used on people with ear pathology, can test all canals and bbith vestibular nerves, & gives us information about central compensation phase Disadvantages: can miss milder hearing loss, may not be sensitive to certain pathologies such as meniere's disease, most systems are monocular (single eye), technique can be challenging, & currently no CPT code for 3rd party reimbursement

Answer 72

Head Impulse Nystagmus Test of Skew Used to diagnose stroke from vestibulopathy in acute settings such as the ER, is more sensitive to and less costly than MRI for ear (<24 hours) stroke

Answer 73

1. Sinusoidal Harmonic Accelerations (SHA) 2. Impulse Accelerations (Step Velocities) 3. Visual Fixation (VFx) / Visual Enhancement (VVOR)

Answer 74

- to confirm of rule out bilateral vestibular hypofunction/loss - to evaluate central compensation - to evaluate rehab potential - serial monitoring for vestibulotoxicity - to gain more information regarding central vestibulopathy - to be used when calorics can not be performed such as in young children, handicapped, and atresia

Answer 75

- only tests VOR at low to mid frequencies with standard paradigms - only tells us about function of HSCC and SVN branch - cant be performed on some patients (clausetrophobic or greater than 300 lbs) - can miss mild to moderate unilateral HL - takes up a lot of space - costly and not readily available

Answer 76

Post-traumatic BPPV

Answer 77

Benign Paroxysmal Positional Vertigo Otoconia become dislodged from the utricle and end up in the SCC's. Movement of the head causes otoconia to shift and stimulates the vestibular system causing false sense of vertigo. Canalithiasis = otoconia freely moving in the endolymph Cupulothiasis = otoconia in contact with the cupula

Answer 78

- nystagmus is present in ALL positions - nystagmus changes direction in any single head position - nystagmus is equal or greater than 6 deg/sec in any head position - nystagmus is persistant in atleast 3 head positions

Answer 79

CPT 92540 (basic vestibular evaluation) & CPT 92537 (caloric irrigation bilateral bi-thermal)

Answer 80

The red arrows (blue lines) represent where the caloric values were measured (the maximum SPV of the response). It is significant because you want to be certain that you measure at the peak of the response which they did properly in these examples

Answer 81

- may be used when traditional bi-thermal irrigations are very low or to help confirm diagnosis of bilateral loss - may be useful for confirmation of successful abalative procedures such as gentamycin injections or vestibular nerve section - may be useful when there is a strong pre-existing spontaneous nystagmus (reversing the bias in the system) - may be useful to determine if there is any residual vestibular function in the system (even minimal) which may help determine further course of treatment either surgically or rehab

Answer 82

Left beating nystagmus that is suppressed with visual fixation (normal)

Answer 83

false - caloric perversion

Answer 84

supine head elevated 30 deg

Answer 85

the caloric position (supine head elevated 30 degrees) brings the horizontal SCC into an orthogonal relationship with the gravity vector thereby ensuring maximum amount of stimulation during irrigation. perpendicular to the floor for max stimulation.

Answer 86

warm air = 50 degrees cold air = 24 degrees irrigate for = 60 sec.

Answer 87

warm air = 44 degrees cold air = 30 degrees irrigate for = 30 sec.

Answer 88

COWS = Cold Opposite Warm Same a cold irrigation will produce a nystagmus that beats in the opposite direction of the ear being stimulated and warm irrigation will produce a nystagmus that beats in the same direction of the ear being stimulated. this has to do with the direction of endolymph flow (ampullopetal=less density = excitatory flow) (ampullofugal = more dense = inhibitory flow). the stimulus doesnt transfer to the other side of the head. it only tells you direction of the nystagmus based upon endolymph movement toward or away from ampullla (occurs on same side as irrigation).

Answer 89

(RW+RC) - (LW+LC) divded by (RW+RC+LW+LC) times 100 yes there is a left unilateral weakness of 33% which is abnormal

Answer 90

Total eye speed = RW+RC+LW+LC = 13 deg/sec this is low overall caloric repsonse (total SPV <26 deg/sec) concerning for bilateral vestibular hypofunciton or loss. I would recommend rotary chair or vHIT to conform results.

Answer 91

- only tests VOR at very low frequency and non-natural head movement (0.002-0.004 Hz) - only tells us about function of HSCC function and superior vestibular nerve function with no information from other canals or otolithic organs - variable and slightly uncomfortable for patients - cant be performed / evaluated on some patients such as young kids, those with microtia/anotia, surgical ears (perforation, PE tube, otorhhea) - can infer but not definite for bilateral vestibular loss (BVL) diagnosis

Answer 92

VNG testing only addresses horizontal SCC function and superior vestibular nerve branch function it is therefore possible to have lesions in other parts of the labyrinth that will not show up on VNG (otolithic or IVN branch dysfunction).

Answer 93

excitation inhibition inhibition excitation

Answer 94

treacher-collins syndrome or mandibulofacial dystosis - 40% of cases are autosomal dominant - 100% pentrances - 60% of cases are new mutations (majority are deletions or nonsense mutations) - abnormal facial structures from first pharyngeal arch syndrome - hypoplasia of zygomatic bones and mandible - coloboma of iris - larger fish like mouth - intelligence is typically normal - atresia - complete absence of ME implant - mild to moderate conductive HL

Answer 95

branchio-oto-renal (BOR) - autosomal dominant - affects structures developing from branchial arches - renal abnormalities including polycystic kidneys - oligohydraminos (too little amniotic fluid during pregnancy) - HL can be conductive, SNHL, or mixed - brachial fistulas on the lower 1/3 of the neck - stenosis - can be delayed onset, rarely progressive - unilateral or bilateral pre-auricular pits

Answer 96

oculo-auricular-vertebral (OAV) - multifactoral inheritance - may not be inherited but cases appear in clusters within a family - facial asymetry - cardiac and vertebral anomalies - deafness/blindess can be unilateral/bilateral - internal organs can be unilateral absent or underdeveloped - conductive HL is common, SNHL is rare - craniofacial structures developing from 1st and 2nd branch arches

Answer 97

CHARGE - Coloboma of the eye - Heart defects - Atresia of nasal choanae - Retarded growth and/or development - Ear anomalies and/or deafness (SNHL & progressive) also infertile, intellectual disabiltiy, and renal issues

Answer 98

ushers syndrome - autosomal recessive - mild to severe SNHL - progressive blindness (retinitis pigmentosa which typically develops in the 2nd decade) - difficulty seeing at night, tunnel vision, then blindness - Type 1: severe to profound SNHL, traditional amplification is ineffective, abnormal vestibular function, delayed motor milestones, gait ataxia - Type 2: mild to severe SNHL, hearing aids are effective, normal vestibular function - Type 3: (rare) progressive HL and vestibular function, possible founders effect in Ashkenazi jews and finnish

Answer 99

- autosomal dominant, autosomal recessive, and X-linked - neurological disorder (affects motor & sensory) - absent limb reflexes - muscle wasting below the elbows and thighs - 100% penetrance - age of onset 12-20 (not life-threatening) - slow SNHL progression from childhood (looks like ANSD)

Answer 100

- autosomal recessive - etiology is genetic or environmental (meaning infectious disorder due to viral involvement like mumps & measles) - present OAE's - present cochlear microphinic - abnormal/absent reflexes - severe impairment of speech perception especially in noise due to disruption of synchonrous CN8 firing

Answer 101

jervell & lange-neilsen syndrome (JLNS) - autosomal recessive - long QT syndrome - potassium channel causes congenital deafness and long QT - can have syncope, seizures, and sudden death, require a cardiologist to monitor them - genetic counseling is super important - avoid elevated heart rate

Answer 102

friedrich's ataxia - autosomal recessive - neurodegenerative - manifests before adolescence - hypoactive knee reflex, incoordination, nystagmus, dysarthria, absent babinski reflex, scoliosis, and large heart

Answer 103

waardenburg's - autosomal dominant - deficit of neural crest cells - 4 types , type 4 is very rare - different colored eyes - white strip of hair

Answer 104

- autosomal dominant - incomplete pentrance - more commonly a complex genetic disorder (many genes, hormones, the environment) - more common in white females - worse after pregnancy

Answer 105

described by the fast phase and meausred by the magnitude of the slow phase

Answer 106

(RW+RC) - (LW+LC) ÷ (RW+RC+LW+LC) x 100

Answer 107

(RW+LC) - (LW+RC) ÷ (RW+RC+LW+LC) x 100

Answer 108

normal - everything is in the white which is normal - no refixation saccades

Answer 109

left unilateral vestibular loss - the left side has low gain, putting it in the gray area which indicates abnormal - the left also has covert (during head movement) and overt (after head movement) refixation saccades

Answer 110

The left side superior vestibular nerve is affected - the left is low so are the left anterior canal (LA) in the second row, telling us the superior vestibular nerve is affected because that nerve is connected to the anterior canals - the left also has covert (during head movement) and overt (after head movement) refixation saccades

Answer 111

SVN: lateral and anterior canals IVN: posterior canals

Answer 112

bilateral loss vestibular loss - left and right are in the gray - covert and overt saccades in both ears

Answer 113

the right inferior vestibular nerve is affected - Right posterior canal (RP) is affected which is linked to the inferior vestibular nerve - covert and overt saccades in the right ear

Answer 114

difficulty in spatial awareness, following multi-speaker conversations and maintaining attention in a classroom

Answer 115

deficits can lead to problems with auditory discrimination or resolution, difficulty with reading, spelling, and writing

Answer 116

deficits lead to difficulty understanding speech in noisy environments leading to challenges in classroom discussions or group learning

Answer 117

deficits may affect understanding in noise affecting language learning, and academic success

Answer 118

challenges with decoding, crucial for reading and spelling, reading difficulties

Answer 119

deficits may affect phonemic processing, suprasegmental cuesand therefore language learning

Answer 120

age : 7+ hearing : normal and no ME dysfunction cognition : intelligence should not be a factor (meaning it needs to be ruled out) ADHD : must be ruled out S/L : minimum language should be at least 6 years or within a year of chronological age autism : must be ruled out

Answer 121

intermediate criteria

Answer 122

Abnormal performance on a single test (> 2 SD below mean) better sensitivity and poor specificity A more lenient approach, where failing just one test is enough to receive a CAPD diagnosis

Answer 123

Abnormal performance on at least 2 tests (> 2 SD below mean) Abnormal performance on at least 1 test (> 3 SD below mean) Most reliable criteria

Answer 124

Abnormal performance on all tests (> 2 SD below mean) better specificity and poor sensitivity Patients must fail every test they take in order to receive a diagnosis.

Answer 125

Caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and fort outcomes: short term (headache, nausea, dizziness, cognitive changes, emotional changes) and long term (depression, anxiety, Chronic traumatic encephalopathy, sleep distrubances) Concussions can impair listening abilities and processing auditory information Tinnitus An inability to ignore distracting sounds Inability to remember and follow oral directions Difficulty understanding speech in noisy environments

Answer 126

beleived to be caused by an accural of concussive events over time. rare neurodegenerative injury the symptoms of which do not manifest until years after the repeated head injuries. leads to mood disorders, short term memory loss, depression, cognitive decline, and dementia

Answer 127

type of CAPD where person cannot hear or recognize sounds and may appear deaf despite normal or near normal peripheral function acquired disorder causes: TBI, tumors, anoxia, infections, degenerative diseases, cerebral strokes SOL: bilateral A1, thalamic relay, bs s/s: cannot perceive speech and/or environmental sounds, able to speak read and write, normal OAEs and ABR

Answer 128

5-13 except for gap detection thats 8-13

Answer 129

NOHL - Inconsistency between pure tone thresholds and speech audiometry CAPD - may have issues with difficulty understanding speech but can detect sounds Dementia - PTs may not hear or respond to sound due to cognitive decline and not auditory deficits tumors - can directly affect central auditory structures causing symptoms mimicing central deafness but the symptoms are usually asymmetric, gradual, progressive and involve other neurological signs (vision, cognition, etc.)

Answer 130

3-6 format 1 = 3-4 format 2 = 5-6

Answer 131

central deafness, ANSD, ADHD, DLD, dyslexia

Answer 132

descibes the relatonships between the listeners cognitive resources, stimulus factors, and listeners knowledge of language and experience

Answer 133

procssing beginning with raw sensory input from the environment and builds to a perceptual experiences detect the physical stimulus, travels to the brain to be analyzed step by step doesn't require prior knowledge or context and the perception is built from the sensory information alone processes what you are actually hearing

Answer 134

processing influenced by prior knowledge, experience, expectations and context brain uses what it already knows to interpret the incoming stimuli to fill in gaps, make predictions and guide attentino to relevant cues predicts/fills in what you expect to hear

Answer 135

stresses link between speech perception and speech production assumes the listener is actively involved in interpreting speech by using: Cognitive resources (e.g., attention, working memory) Linguistic knowledge (e.g., syntax, semantics, phonology Contextual cues (e.g., the topic or speaker) uses top down processing

Answer 136

speech perception is almost entirely sensory little to no use of cognitive resources suggests that speech perception is mostly automatic and stimulus-driven, relying primarily on the acoustic signal without significant cognitive or linguistic effort bottom up processing

Answer 137

automatic, bottom up processing, low awareness, fast, ex: instantly recognize familiar voice

Answer 138

deliberate/intentinoal, top down processing, conscious awareness, high cognitive effort, slower ex: actively trying to understand someone in a noisy room

Answer 139

predictive roles you predict based on the knowledge of sound, the context, the speaker etc. implicit process predictive role of WM helps the brain anticipate upcoming information based on: Context Past experiences Syntax and semantics Conversational cues Postdictive roles you figure out what it was after and you use the context you heard to figure out the missing piece postdictive role of WM allows the brain to hold onto recent input and re-evaluate or reinterpret it in light of new information explicit process

Answer 140

reduced audibility, distorts the signal, Difficulty processing rapid changes in speech, Reduced ability to track pitch, intonation, or timing, The auditory system struggles with figure-ground separation (identifying speech from competing noise), increased cognitive load

Answer 141

- most common complaint and probably the reason they are in your office - gives us a more accurate understanding of how they do in real life - makes them feel like you care about their problem and are taking the time to test it

Answer 142

Place of articulation Prosody and rhythm Emotional and pragmatic cues Some phoneme visibility (but not all) Speechreading can compensate for reduced auditory clarity, especially in high-frequency hearing loss Visual cues fill in the blanks when auditory input is missing, unclear, or masked Helps reduce listening effort and supports language development, especially in people with hearing loss

Answer 143

simple: Low cognitive load: Auditory input is clear and easy to decode, Relies more on automatic, implicit processing, Less demand for active attention or complex manipulation complex: High cognitive load: Signal is unclear or masked by noise, Involves explicit, effortful processing requiring attention and executive control, actively engages WM

Answer 144

specific form of mental effort that occurs when a task involves listening

Answer 145

if they are having problems not related to their hearing loss/balance problems then refer out. ex: a divorce

Answer 146

denial, anger, bargaining, acceptance, guilt, etc. not linear you can bounce back and forth on how you feel

Answer 147

cultural awareness & humility communication styles language barriers health beliefs and practices attitudes toward disabilty and stigmas family involvemnet

Answer 148

client-centered counseling approach designed to help people resolve ambivalence and strengthen their motivation to change behavior

Answer 149

To measure severity or intensity of symptoms (e.g., “On a scale from 0 to 10, how loud is your tinnitus right now?”) To gauge difficulty or effort (e.g., “How much effort does it take to understand speech in noise?”) To assess motivation or confidence (e.g., “On a scale of 1 to 10, how ready do you feel to use your hearing aids consistently?”) To evaluate emotional reactions like frustration or anxiety.

Answer 150

resist correcting your patients

Answer 151

Carbon microphones collected acoustic signal & converted it into an analog (identical) electric signal, the receiver then converts the analog electrical signal back to an acoustic signal Process: sound wave comes into the mic, hits the diaphragm and compresses it when the diaphragm is moved in the carbon balls are pushed together creating a positive voltage flow and when it is moved out it decompresses it the compression and decompression of the carbon creates the + and - electrical current so that it matches the acoustic sign wave analog - same shape of the signal that comes out of the mic is the exact same as the signal that came in to the mic

Answer 152

Vacuum tube hearing aid Vactuphone?

Answer 153

high viscosity - thick, provides resistance during flow, stretches the aperture of the ear canal low viscosity - runny, flows easily with resistance, does not stretch the canal, more suitable for devices requiring deep insertion

Answer 154

in order to get a well-fitted earmold if we do not do this we get an uncomfortable earmold because the skin rubs against the plastic

Answer 155

Immunocompromised? Diabetes? Are you on blood thinner? History of ear surgery? Allergies?

Answer 156

must remove excessive cerumen, can not do with active infection, collapsing canal may limit depth, may have to trim hair, malformation requires special precautions, perf/PE tubes

Answer 157

better HF gain & output deeper canal fit gets the sound closer to the eardrum reducing resonant losses and improved HF sounds reduced feedback allows for more gain with less acoustic leakage more retention & secure fit engages the bony portion of the canal reducing the likelihood it slips out reduced occlusion effect When the canal portion extends into the bony portion of the canal, movement-related vibrations (like chewing or talking) are less likely to cause the occlusion effect

Answer 158

it increases the size of the aperture in order to get a snugger fit of the earmold

Answer 159

Audibility softer phonemes are more difficult Dynamic range Range from threshold to uncomfortable listening level or the range between the softest audible sound and the loudest tolerable sound Individuals with threshold loss perceive sound shifting from too soft to too loud more rapidly Frequency resolution: Auditory systems ability to detect discrete frequencies in the cochlea Sharp peak supplies the frequency resolution needed for speech intelligibility in noise and with HL, the tuning curves become broad (no longer stimulate one frequency on bm, they stim a couple frequencies) leading to upward spread of masking temporal resolution: AS ability to detect small time related changes in acoustic stimuli over time gap detection: important to separate sounds in individual words, sentences etc and without it words form together Phonemic duration: Similar words are distinguished from one another by minute differences in duration and order temporal ordering: Time related aspects of acoustic signal suprasegmentals: Provides us with meaning (is it a question, a demand, etc.) spatial awareness

Answer 160

Range from threshold to uncomfortable listening level or the range between the softest audible sound and the loudest tolerable sound with sensory loss, OHC damage results in loss of amplification of soft signals while IHC continue to detect louder signals Individuals with threshold loss perceive sound shifting from too soft to too loud more rapidly *complaint = increased sensitivity to loud signals

Answer 161

Auditory systems ability to detect discrete frequencies in the cochlea Sharp peak supplies the frequency resolution needed for speech intelligibility in noise with HL, the tuning curves become broad (no longer stimulate one frequency on bm, they stim a couple frequencies) the primary signal is no longer enhanced making it difficult to differentiate the desired signal from the undesired signal leads to upward spread of masking (Intense low frequencies mask weaker higher frequencies)

Answer 162

AS ability to detect small time related changes in acoustic stimuli over time gap detection: important to separate sounds in individual words, sentences etc and without it words form together Phonemic duration: Similar words are distinguished from one another by minute differences in duration and order temporal ordering: can we retain order the sounds come in to as or do they get mixed up/smeared suprasegmentals: Provides us with meaning (is it a question, a demand, etc.)

Answer 163

ability to determine the direction of a sound source Localization relies on subtle differences in: Interaural Time Differences (ITD): Timing differences between ears Interaural Level Differences (ILD): Loudness differences between ears Hearing loss, especially asymmetric or bilateral, disrupts these cues

Answer 164

difference in the volume between the ears reliance of high frequency signals (>3 kHz) to identify ear to ear head shadow level differences Impact of head shadow on HF signals High-frequency waves have short wavelengths, which the head effectively block Low-frequency waves have long wavelengths that easily diffract (bend) around the head

Answer 165

The head acts as a physical barrier that blocks or attenuates sounds traveling to the far ear creating differences in sound intensity bw ears High-frequency sounds have short wavelengths (shorter than the size of the head) These short wavelengths do not bend (diffract) well around the head, so the head blocks much of the sound energy therefore the ear farther from the source receives an attenuated signal

Answer 166

Binaural Loudness Summation: When the same sound is heard in both ears, the perceived loudness is greater than hearing it in just one ear (about 3-6 dB louder) Reduced audibility of HF sounds means less spectral information available in both ears making the sound to seem less loud binaural squelch/suppression: The brain uses differences in timing and level between ears to separate speech from background noise, improving speech understanding in noise. with lack of HF information it is harder for the as to distinguish speech from noise leading to poorer speech in noise understanding

Answer 167

amount of time between sound arriving to one ear compared to the other ear reliance on low frequency signals The impact of monaural spatial cues (HRTF) has on spatial awareness Sounds from one side reach the near ear slightly earlier than the far ear Low-frequency sounds have long wavelengths (longer than the head diameter)

Answer 168

describes how an incoming sound is filtered by the shape of the head, outer ear (pinna), and torso before reaching the eardrum Binaural cues (ILDs, ITDs) mainly help with horizontal (left-right) localization. Monaural spectral cues from the pinna (HRTF) provide information about whether a sound is coming from above, below, or level with the ears The frequency shaping by the pinna helps distinguish sounds coming from in front vs. behind Some aspects of HRTF contribute to perceiving how far away a sound source is crucial for vertical localization and front-back sound discrimination, helping create a full 3D auditory spatial awareness beyond left-right cues.

Answer 169

Access to binaural cues (ILD, ITD & HRTF) these are essential for localizing sound sources and separating speech from background noise Binaural loudness summation Results in PT perceiving greater loudness w/ bilateral devices Less gain is needed to reach comfortable listening levels improved localization Bilateral input improves the ability to determine the direction and distance of sound sources Binaural squelch (binaural release of masking) improved intelligibility in noise & ability to focus on 1 signal while ignoring others by taking advantage of these differing SNRs Minimizes risk of “unaided ear effect” Bilateral amplification helps preserve auditory processing abilities in both ears, reducing the risk of long-term decline in the unaided ear Suppresses bilateral tinnitus Amplification in both ears can provide masking and distraction from tinnitus, especially when speech and environmental sounds are audible in both ears.

Answer 170

occurs when using both ears together leads to worse auditory performance (like speech understanding or sound localization) than using the better ear alone Progressive age-related atrophy of the corpus callosum reduces speech intelligibility with binaural inpu Reported in 5-10% of older PTs with bilateral amp

Answer 171

The microphone is located deep in the canal, past the concha bowl and near the ear canal entrance to preserve the natural pinna and concha effects reduced sound energy loss because it is closer to the ™ reduces OE effect being past the cartilaginous portion greater gain before feedback loops

Answer 172

CROS Contralateral routing of sound Single sided deafness - one ear is normal and poorer ear is unaidable no localization BiCROS Bilateral contralateral routing of sound Bilateral asymmetric HL - one ear has threshold loss & poorer ear is unaidable no localization AmpCROS For asymmetric HL bad ear is not good for hearing aids (poor discrimination etc.) but not unaidable fits two HA’s on the PT’s ear but in the two is a transmitter so you amplify both ears but then also routing the poor ear over to the other ear for extra boost of understanding May support some aspects of binaural hearing if auditory input is well-matched

Answer 173

Better delivery of high-frequency speech cues, like /s/ and /ʃ/, important for speech clarity. Improves speech understanding, especially in noise he closer the receiver is to the TM, the less influence the ear canal has on shaping the frequency response Less sound energy is lost to the ear canal wall or dissipated along a long sound tube Deep placement increases the physical distance between the receiver and microphone (especially in custom devices) improving feedback stability Deep fittings can go beyond the bony-cartilaginous junction of the ear cana to reduce the OE

Answer 174

indicates the degree of protection a device has against: Solids (like dust) Liquids (like water, sweat, humidity) important when selecting hearing aids for patients based on their lifestyle, occupation, or environment

Answer 175

vinyl: use with high gain devices, infants, firm ear textures; adv: snug fit, easy to modify; disadv: shrinks quickly, needs annual replacement acrylic/lucite: use with adults, floppy or soft pinnas; adv: durable, easy to modify, easy to insert/remove; potential for injury, will not easily fit narrow/tortuous bends, increased risk of feedback w/ head movement silicone: use with high gain aids, allergies, or facial flex problems; adv: snug fit, little shrinkage, lower allergy reactions; disadv: hard to modify, tubing cannot be glued

Answer 176

full shell: max retention and acoustic seal skeleton: max retention and acoustic seal canal mold: need 2mm past bend for retention; low acoustic seal canal lock: some retention half shell: improved retention

Answer 177

50-60 dB at 500: .5 to no vent 40-49dB at 500: 1-2mm 30-39dB at 500: 2-3mm or power 20-29dB at 500: 2-3.5 mm or closed

Answer 178

to allow air and low-frequency sounds to pass between the ear canal and the outside environment. allows low-frequency sound (like the user's own voice) to escape, making speech sound more natural reduces the occlusion effect ( "boomy" or echoey sound people hear when talking or chewing while wearing a tightly sealed earmold) preserves residual hearing

Answer 179

below 500 and up to around 1000Hz

Answer 180

this is because the 500 Hz threshold is most affected by venting

Answer 181

impacts low to mids occurs when sound waves reflect and interfere within the vent tube causes constructive or destructive interference, leading to peaks and dips in the frequency response of the hearing aid

Answer 182

Vent size doesn’t directly reduce high-frequency output, but indirect factors like feedback management and reduced acoustic seal can limit how much high-frequency amplification is usable or effective

Answer 183

Vent size & stabalizing the device in the bony canal are two management techniques to reduce OE Move past cartilage to bony portion stopping vibrations & vent allows more energy to flow through

Answer 184

hollow tube or channel inside an earmold or hearing aid shell through which the amplified sound travels from the hearing aid receiver into the ear canal

Answer 185

Earhooks Usually in the 1000–4000 Hz range, depending on length and diameter Peaks and dips in mid-to-high frequencies, causing uneven sound quality and possible distortion or feedback sound bore Often affects 2000–6000 Hz frequencies Can cause sharp boosts or cancellations in high frequencies, impacting clarity and comfort

Answer 186

Thin Tubes greater HF rolloff because of increased acoustic impedance and greater viscous and thermal losses narrower diameter raises the resonant frequency of the tube, boosting narrower and HF band ideal for open-fit fittings where amplified low-frequency sound is not needed, but less effective for patients needing high-frequency amplification and for mild losses Standard tubes wider diameter supports broader resonance peaks and lower frequencies Better high-frequency transmission

Answer 187

dampen internal vibrations and external sound transmission helps prevent feedback (whistling), especially in high-gain fittings Reduces standing wave resonances within the tubing

Answer 188

Tube lock Used w/ silicone molds Designed with brass grommet for increased friction fit into the mold tube retention system Designed to allow for a friction fit into earmold that is less damaging on removal Libby Horn as amp signal goes thru tube to horn you get a boost of amp in the high frequencies increase output of highs by about 6dB Continuous flow adapter (CFA) Used for small canals that cannot accommodate standard tube sizes Maintains internal diameter of sound bore bw a BTE & ear mold providing a continuous inner diameter & unimpeded flow of amplified sound Dry Tube Helps reduce moisture buildup problems in tubing white coating inside the tube roughens it up so moisture cannot collect

Answer 189

Length shrinks Displaces mold causing increased feedback Irritation on pinna Hardens HF gain reduces as inner diameter shrinks

Answer 190

Lucite/Acrylic Thin cement Heavy cement Vinyl Vinyl cement Super glue Only if ABSOLUTELY needed to hold the tube in place Difficult to remove

Answer 191

Acoustic resistor Physical barrier to reduce sound Smooths the resonances in the final frequency response Does so by attenuating sounds slightly to smooth the peaks

Answer 192

Sound waves enter the microphone, and consists of alternating areas of compression (+) and rarefaction (-) the pressure changes vibrate a thin diaphragm in the mic diaphragm moves inward during compression and outward during rarefaction backplate is attached to the diaphragm as the diaphragm moves the distance between the backplate and it changes altering the area causing electrical voltage that is analogous to the acoustic signal

Answer 193

twisting, compressing or distorting a thin electrified crystal creates a +/- electrical voltage required to make an analog electrical signal *same mic, have salt crystal to replace carbon balls *this mic was short because it was affected by humidity and temps >110 deg

Answer 194

ECM benefit Still has a backplate & diaphragm but now backplate is coated to hold an electric charge for as long as it is in good condition no longer required to drain a battery to electrify the plate meaning HA’s battery lasted longer and didn’t need to charge the mic Stability: years of humidity, moisture, dirt, debris etc. degrades the mic & reduces sensitivity of the mic Diaphragm can absorb moisture causing sensitivity fluctuations Thick & heavy so it doesn’t move well and collect sounds as well Backplate loses charge at high temps (110) Environmental conditions break down the glue of diaphragm MEMS benefit: Diaphragm is now free-floating silicone disk and a pre-charged backplate that has a charge pump that automatically recharges the electrical field to maintain mic sensitivity Stability: more stable Silicone doesn't absorb moisture Has decreased battery drain in the device due to space being smaller bw diaphragm and backplate Stability remains even under harsh environment conditions due to the charge pump (-40 to 185 deg F)

Answer 195

Analog mic = 115 dB SPL (can collect input signals up to this before input distortion Digital mic = ONLY 96 dB SPL (anything > results in input distortion)

Answer 196

~ 25 dB SPL Anything that causes diaphragm to move will transduce into an electrical signal Acoustic - gasses & air flowing around us goes into sound port and moves the diaphragm Electrical - comes from circuits in HA that are after the mic in ha

Answer 197

Front end distortion occurs when sounds picked up by the mic exceeds its dynamic range cause: overloading the mic results in distortion management: yes, WDR, AGC, dual mics

Answer 198

directional mics: type of microphone that is more sensitive to sound from certain directions (usually the front) and less sensitive to sound from others

Answer 199

Mic focuses sound collection towards one azimuth while attenuating sensitivity from others uses two or more microphone ports separated by a small distance. These microphones capture sound from the environment with a slight timing and amplitude difference, depending on the direction the sound comes from When sound comes from the rear (or other unwanted direction), it hits the two mic ports at different times When combined, sounds from certain directions (like the rear) become out of phase and cancel each other out—creating a null in sensitivity in that direction Null: refers to the point of maximum attenuation Where mic stops collecting the sound Directional response happens when signals of two omnidirectional mics are combined HA has front and back mics As sound comes in it arrives to one mic at a different time than the other mic The delay aligns the signals adding them together to reduce level of sounds from behind Adaptive directional mics adjust the delay to steer the null or a shift in position of level reducing directional null

Answer 200

If Signal was 76 and noise 74 what is SNR? 2 dB Real world snr is 2-3 because of head shadow and polar plots +10 = Speech is 10 louder than the noise -10 = speech is softer by 10 than the noise

Answer 201

correctly understanding 50% of the speech material in background noise +2 to +3 dB SNR

Answer 202

Real world snr is 2-3 because of head shadow and polar plots

Answer 203

Directional roll off- cause and clinical solutions cause: phase cancellation reduces HF sounds solution: boost HF gain, adaptive mics, FL Importance of parallel mic port placement cause: mic ports are not parallel when worn solution: adjust placement, earmold fit and user counseling Microphone drift cause: mic degradation over time solution: test mics regularly and clean/replace when needed

Answer 204

Directional mics tend to attenuate high-frequency sounds more than omnidirectional mics

Answer 205

The two mic ports must be perfectly parallel and level with the ground when worn, or the directional pattern will be distorted

Answer 206

Over time, microphone sensitivity can change, especially if one mic degrades faster than the other. This is known as mic drift and it alters directional performance Moisture, debris, or aging components can cause mic mismatc

Answer 207

Telecoil uses this principle to transduce an electromagnetic signal to an analog electrical signal Mic is turned off (NO ACOUSTIC SIGNAL) Induction principle: takes electromagnetic signals and transduces it into an electrical sine wave Electromagnetic signals move a magnet with a copper coil This movement bw copper coil & magnet turns electromagnetic signals to a +/-analog electrical signal without adding an additional power source

Answer 208

an electronic component that increases the strength (amplitude) of an electrical signal without altering its original content

Answer 209

automatically adjusts gain to keep sounds within the listener’s usable hearing range it amplifies soft sounds more and loud sounds less.

Answer 210

Purpose: prevent loud sounds from exceeding uncomfortable or damaging output levels at the hearing aid receiver Protects the listener’s residual hearing and prevents distortion caused by overloading CR: Very high compression ratio, often 10:1 or higher; >/= 5:1 Compression activates only for very loud inputs TK Set at a high input level, typically near the maximum comfortable loudness level (e.g., ~85-90 dB SPL or higher) Limitations Peak clipping is a simpler form of limiting that abruptly cuts off output peaks, causing distortion and unpleasant sound quality Improves: OLC smoothly compresses peaks rather than abruptly clipping them This reduces distortion, preserves sound quality, and improves comfort

Answer 211

Limitations Peak clipping is a simpler form of limiting that abruptly cuts off output peaks, causing distortion and unpleasant sound quality Improves: OLC smoothly compresses peaks rather than abruptly clipping them This reduces distortion, preserves sound quality, and improves comfort

Answer 212

Purpose: To restore loudness perception by compressing the wide dynamic range of environmental sounds into the reduced dynamic range of the hearing-impaired listener Improves audibility of soft sounds while keeping loud sounds comfortable CR Moderate ratios, typically 1.1:1 to 4:1 lower than output limiting TK set at lower input level between 20-50 dB SPL

Answer 213

Restore Soft sounds get more amplification (higher gain) to be audible Loud sounds get less amplification to avoid discomfort This mimics the natural loudness growth curve in normal hearing, soft sounds become audible, and loud sounds don’t become uncomfortably loud

Answer 214

Purpose: To reduce the gain for very soft sounds near or below the hearing aid’s noise floor Helps improve signal-to-noise ratio (SNR) by making the hearing aid less sensitive to low-level ambient noise CR: Really low CR (lower than linear; <.9:1)

Answer 215

lowering the TK to a softer input intensity will not change the output of the louder input signals raising the TK to a loader input signal decreases the output of signals below the TK lowering the TK to a softer input intensity increases the output of signals below the TK Practically, shift TK down if a PT needs more clarity of soft consonant sounds & shift TK up to reduce audibility of soft low frequency background noise

Answer 216

Attack time= time it takes for level detector to identify input is loud enough to turn on and compress the signal Faster AT (<10ms) = Rapidly compresses sudden loud sounds (e.g., a door slam). Limitations: May make sound seem unnaturally squashed if too fast, Can degrade speech envelope cues (e.g., soft consonants following loud vowels) Slow AT (>30ms) = speech signals. May let brief loud sounds through, Preserving natural sound. Limitations: Risk of output overshoot, especially with sudden loud inputs, Might be uncomfortable or even unsafe for sensitive users. Release Time = How quickly the hearing aid restores gain after a loud sound ends Fast RT (<100ms)Quickly restores gain for soft sounds after loud ones, Improves speech audibility in fluctuating noise. Limitations: can cause noticeable fluctuations in background noise Slow RT = Comfort in steady or quiet environments fluctuations less noticeable. Limitations: May miss soft sounds immediately after a loud sound, making speech less audible in fluctuating environments

Answer 217

Frequency Shaping Bands (ROWS) Frequency range is defined by the frequencies included in range based on dynamic range of loss Changing frequency band doesn’t change CR Gain for all input signals increase equally Compression shaping channels These are adjusted to shape compression characteristics into individuals dynamic range to restore normal loudness growth use these channels to squeeze gain for soft & loud into the persons dynamic range

Answer 218

a type of nonlinear compression in which the compression ratio continuously changes as input levels increase, rather than remaining fixed Allows more natural loudness growth and better sound quality compared to abrupt changes in gain

Answer 219

transforms continuous analog sound signals (like your voice or environmental sounds) into digital signals (binary code) that can be processed by a digital hearing aid electricle signal is sent through here and it samples the analog signal at regular intervals and quantifies it into a series of digital numbers. The digital signal represents the original waveform as discrete points, capturing the amplitude and frequency of the sound wave

Answer 220

sampling= process of measuring an analog sound wave at regular time intervals to convert it into a digital signal Nyquist frequency = half the sampling rate, represents the highest frequency that can be accurately captured (without distortion) during sampling Nyquist Frequency = ½ × Sampling Rate

Answer 221

16 bit HA can only collect up to 96 dB dynamic range of the mic

Answer 222

Quantization is the process of rounding each sampled analog signal to the nearest digital value during analog-to-digital (A/D) conversion Relationship Higher bit depth = more amplitude steps = finer detail and less rounding error Lower bit depth = fewer steps = greater quantization error Quantization Error difference between the actual analog value and the digitized value after rounding introduces distortion, often heard as background hiss or graininess

Answer 223

Digital to Analog Conversion translates the digital signal into an analog waveform, which is then amplified and sent to a speaker or other output device

Answer 224

process of manipulating sound signals in a digital format using mathematical algorithms Microphone captures analog sound. ADC (Analog-to-Digital Converter) converts it to digital. DSP algorithms: Clean up background noise Amplify speech Apply compression for comfort Reduce feedback Manage directionality DAC (Digital-to-Analog Converter) converts it back to analog. Receiver delivers sound to the ear

Answer 225

automatically senses if it is noisy or not & decides if omni or directionality is needed Function Omnidirectional mode: Mic picks up sound equally from all directions (best for quiet or one-on-one conversations) Directional mode: Focuses mic sensitivity toward the front and reduces input from sides/rear (best for noisy environments) improves speech understanding, best for those who cannot manually change programs, pediatrics, reduces listening effort

Answer 226

Adaptive: null repositions itself (steer) to the loudest signal behind the person Uses all the polar plots automatically adjust the directionality of the microphone based on the location of noise sources enhance sounds from the front (like a conversation partner) while reducing unwanted noise from other directions Broadband Adaptive Directional Microphones Treat the entire frequency range as one unit when adjusting directionality Microphone sensitivity pattern based on where the strongest noise is detected, across the full bandwidth Multiband Adaptive Directional Microphones Divide incoming sound into multiple frequency bands and apply adaptive directionality independently within each band Directional patterns for each band based on the location of noise in that frequency range

Answer 227

Clinical purpose Improve speech intelligibility in noisy environments without sacrificing environmental awareness Helps patients focus on a talker in front of them (e.g., at a restaurant) while reducing distracting background sounds

Answer 228

Directional mic focuses in on a very narrow field (25-30 deg) Good for talking with one person at a time and block out as much sound as possible use multiple microphones (often two or more) to create a highly focused "beam" of sensitivity toward a specific sound source typically the front of the listener Standard directional mics reduce sound from specific directions based on fixed or slowly adaptive patterns Beamforming mics create a precise, steerable beam that dynamically focuses on the speech target, offering greater noise suppression and clarity in complex environments

Answer 229

Fixed environments with relatively stable noise sources improves SNR when noise is predictable older adults & those less tech-savvy Adaptive Dynamic/noisy environments where noise sources move or multiple noise sources exist Maximize speech understanding by dynamically adjusting to noise changes younger, more active patients or those who frequently report difficulty in complex noise environments

Answer 230

Modulation rate How fast the amplitude (loudness) of a sound changes over time Speed of the signal Speech = slow rate Noise = fast rate Modulation depth Amplitude variations bw loudest and softest portions of the signal Intensity of the variations Speech = highly variable Noise = steady over time fast modulation rate & depth is stable over time = noise

Answer 231

determined by DSP algorithms that estimate and compare the levels of speech and noise in real-time, using acoustic, spectral, temporal, and spatial cues When the noise level is close to or greater than the speech level, the SNR is considered poor, triggering adaptive noise management strategies

Answer 232

Acts on any signal that is steady over a long period of time Steady state noise Idling engine, hair dryer, vacuum etc. Only acts on fast mod rates & low mod depths Attenuated signal: noise components that have been dynamically turned down to enhance speech understanding and listening comfort

Answer 233

Limitation doesn’t improve speech intelligibility Benefits Can improve listening comfort, reduce listening effort, reduce cognitive load

Answer 234

cutting LF noise improves speech clarity by focusing on mid/high frequencies critical for speech Hearing aids analyze the frequency content of incoming sounds to control amplification The theory behind reducing low-frequency output is based on the idea that: Most noise energy tends to be concentrated in the low frequencies (below about 1.5 kHz). Speech understanding mainly depends on mid- and high-frequency sounds. So, by attenuating (reducing) low-frequency amplification, the hearing aid aims to reduce noise and improve speech intelligibility in noisy environments.

Answer 235

Non-Digital (Mechanical/Physical) Methods to Reduce Feedback Reduce external feedback loop Improving mold snugness - makes the fit tighter, reducing the size of gaps (“slit leaks”) where sound can escape and re-enter the mic Decreasing vent size - smaller vents reduce the path for sound to leak back from the receiver to the microphone Digital Feedback Suppression Methods Digital Notch Filtering hearing aid identifies the feedback frequency (usually between 2–4 kHz) and applies a narrow notch filter to reduce gain specifically in that frequency range prevents amplification at the problematic feedback frequency, stopping feedback from occurring limitations Since 2–4 kHz is critical for speech intelligibility (about 35% of speech cues come from this range), applying a notch filter reduces audibility of important speech sounds reduction in speech clarity & intelligibility Digital Feedback Cancellation (Adaptive Feedback Suppression) monitors for steady-state tonal noises in the 2-4 kHz range (feedback) and when detected the algorithm creates a phase-inverted “clone” (a duplicate signal 180° out of phase with the feedback) This inverted signal is combined with the original amplified output, canceling out the feedback sound by destructive interference

Answer 236

Wind can increase output by 20-25 dB and perceived as fluctuating, distracting noose reduces speech intelligibility How it works Wind noise is mostly concentrated in low frequencies (~300 Hz) Hearing aids detect wind by identifying uncorrelated low-frequency signals between microphones Once wind is detected, the hearing aid applies low-frequency filtering to reduce amplification in the affected range where wind noise energy is highest Microphone Signal Exchange (Cross-Streaming) Wind turbulence typically affects only one microphone diaphragm at a time (e.g., the microphone facing the wind) Hearing aids use wireless communication between the two hearing aids The cleaner audio signal from the least affected microphone is streamed to the hearing aid on the wind-affected side This signal is overlaid or replaces the noisy low-frequency content, effectively masking or cancelling the wind noise The directional microphones switch to an omnidirectional mode in the low-frequency channels because wind noise interferes mainly with directional mic performance helps stabilize the signal and reduce distortion caused by turbulence

Answer 237

Linear Frequency Transposition (LFT) Moves a band of HF sounds down by one octave to the LF region (cut & paste) and mixes it with existing LF sounds Useful for steep HF loss, shifts critical HF speech sounds down to audible range. Can cause spectral overlap, distortion by mixing transposed with original LF, some listeners dislike the altered sound quality Nonlinear Frequency Compression (NLFC) Compresses the HF region into a smaller LF band; maintains relative frequency spacing (squishes HF sounds into lower frequencies while preserving tonotopic order) More natural sound quality, better preservation of frequency relationships Some distortion possible, adaptation needed, complex fitting to avoid artifacts Spectral Envelope Warping (SEW) Keeps HF sounds in original place but also copies and lowers a portion of HF into LF region (simultaneous presence in both areas) Provides access to HF info while preserving some natural HF cues Can be confusing perceptually, may increase processing load and battery use

Answer 238

enables adaptive programming where the devices share information about the acoustic environment and coordinate digital feature settings Benefits Adaptive Acoustic Scene Analysis and Feature Control hearing aids detect the type of environment Wind Noise Management The hearing aid with clearer input shares its signal to the affected side, improving signal-to-noise ratio (SNR) and reducing perception of wind noise Dual Phone Streaming one hearing aid receives the audio and streams it wirelessly to the opposite ear Volume changes or program switches made on one hearing aid are automatically mirrored in the other Wide Dynamic Range Compression (WDRC) Coordination One ear may signal the other to reduce gain changes This preserves ILDs and improves spatial hearing, especially in noisy environments By sharing data, the hearing aids maintain natural loudness differences between ears This supports localization and helps in better separating speech from noise As it arrives to second ear it is lower and wdr adds more gain on that same side so the ILD are gone so you cannot hear well in noise so binaural wireless the one ha tells that ha to not add as much wdrc One ear will tell the other ear to not add as much wdrc so it doesn’t lose ILD when WDRC works independently in each hearing aid, it can cancel out ILDs: Example: A sound on the left is louder in the left ear and softer in the right If the right hearing aid adds more gain (because the sound is softer there), both ears now hear it at the same loudness, and the listener loses the ILD cue Result: Poor localization and more difficulty in noisy environments

Answer 239

low-output receiver + long/narrow bore = HF roll-off, leading to muffled sound powerful receiver + wide/short bore + horn = brighter, crisper sound, especially in HFs Mismatch between the two may result in poor sound quality, unmet gain targets, or increased risk of feedback

Answer 240

After the hearing aid microphone picks up sound and the processor amplifies and modifies it, an electrical signal is sent to the receiver Inside the receiver is a coil of wire and a small diaphragm The electrical signal passes through the coil, creating a magnetic field The magnetic field causes a tiny armature or diaphragm to move or vibrate The diaphragm's vibration matches the waveform of the amplified electrical signal As the diaphragm moves, it pushes and pulls air, creating sound waves These sound waves are then directed through the soundbore into the ear canal

Answer 241

Receiver sizes determine the final HF output Smaller contemporary receivers are capable of highr frequency responses As high as 10-12 kHz Large receivers (for severe losses) limit output bandwidth (frequency response) HF are lost due to increase armature flexibility Solution: two receiver system (dual receivers?) Output from both receivers added together when it reaches the ™ One is for LF One is for HF Benefit: Extended HF bandwidth in moderately high output receiver without compromising the LF Reduced battery drain Reduces saturation distortion potential

Answer 242

Receiver Saturation This happens when the receiver output is reached resulting in peak clipping or the receiver having a higher voltage and battery drain HA output range has been exceeded leading to distortion due to peak clipping Shock damage Caused by a dislodged receiver where the vibration goes back into the mic adding extra frequencies to the input signal leading to distortion cerumen/moisture/debris **break because of moisture, debris, oil, gets into it and clogs it up Can block the receiver diaphragm and cause reduced output of the receiver

Answer 243

Loudest possible output point device can produce for a 90 dB input signal & represents a single frequency measures the maximum output a hearing aid can deliver when presented with a pure tone at 90 dB SPL, with gain control full-on and no volume limiting determine the maximum output level a hearing aid can produce Ensures the device doesn’t exceed safe loudness levels that could cause discomfort or damage to the user’s residual hearing

Answer 244

Calculates the average OSPL 90 output for 1, 1.6 and 2.5 kHz Gives a generalized view of how loud the hearing aid gets in the speech frequency range Helpful for comparing models or settings without analyzing every individual frequency

Answer 245

Measures signal distortion Determines if output signal contains harmonic frequencies that were not present in the input signal Should be below 5-10% High DL are indicators the device is close to failing (most likely the receiver) & needs sent in for a repair

Answer 246

Electromagnetic test signal that is emitted from TMFS Simulates the magnetic field generated by a telephone handset

Answer 247

SPL in a vertical magnetic field Looped environment Measures the output of the telecoil when exposed to vertical magnetic fields, which simulate telephone placement output of telecoil

Answer 248

Measures the output (SPL) of the hearing aid when receiving a signal via telecoil through a magnetic field from the TMFS SPLITS - measured output response of the HA w/ electromagnetic signal in the horizontal field Signal starts at telecoil, goes through all the other circuits until it gets to receiver and output going out of it is the SPLITS

Answer 249

standardized setting for programming the hearing aid during telecoil testing calculates the difference between the mic output and the telecoil output (SPLITS) + RSETS = telecoil output it louder than the mic output PT will turn HA down when telecoil is on - RSETS = telecoil ouput is softer than the mic output PT will turn HA up when telecoil is on

Answer 250

Functional limitation: structure and body function (actual diagnosis) Ex: cochlear hair cell loss at the base like severe HF SNHL, stiffening of stapes footplate in oval window (OTSC), & dislodging of otoconia causing BPPV Activity limitations: restrictions experienced when executing an activity or specific task Ex: issues hearing in background noise, difficulty localizing a sound source, difficulty hearing and understanding the TV Participation restrictions: when a person avoids certain activities or experiences that they would normally participate in due to their activity limitation Ex: not attending family dinners because they cannot follow the convo in noise, avoid watching TV or raising the volume to hear it, & avoiding a symphony they used to attend due to not hearing it and sounding distorted now

Answer 251

Audio is a measure of individual’s ability to detect quiet tones when using headphones Audio thresholds ONLY diagnoses functional sensory deficits Not an indicator of degree of communication deficit

Answer 252

a measure, ranging from 0 to 1, that quantifies the proportion of speech information available to a listener, essentially indicating how well someone can understand speech

Answer 253

Certain medical conditions such as diabetes, cardiovascular disease, or autoimmune disorders can affect hearing. A thorough case history can help audiologists identify these conditions and understand their potential impact on auditory health. By reviewing symptoms across different systems, audiologists can differentiate between primary auditory disorders and those secondary to other health issues the entire systemic process interacts with the as and impacts it in some way

Answer 254

Audiological factors HL, speech understanding, processing skillsm tinnitus, vestibular status functional needs - daily listening environments - communicaiton partners - phones & streaming - specific listening challenges - assistive technology - language and cultural - considerations - social and lifestyle factors - values and preferences

Answer 255

COSI = Helps to tailor interventions that address the technical aspects of hearing as well as the emotional and pyschological needs the patient expresses HHIE (Hearing Handicap Inventory for the Elderly) = Identifies perceived participation restrictions in daily life due to hearing loss; informs counseling and intervention needs APHAB (Abbreviated Profile of Hearing Aid Benefit) = Measures both unaided and aided listening challenges to quantify hearing aid benefit and participation restrictions Social Network Index = Evaluates potential social participation limitations due to hearing loss by assessing social engagement and support ECHO (Expected Consequences of Hearing Aid Ownership) = Helps predict adherence and satisfaction; identifies unrealistic expectations that could hinder participation in care HASP (Hearing Aid Selection Profile) = Guides hearing aid selection while considering personal factors that may affect consistent use and participation

Answer 256

cognitive goals (desired environments that require improvements) -affective goals (desired improvements relating to feelings/emotional needs)

Answer 257

impacts their ability to follow treatment plans, perform certain tasks with the devices, see instructions or parts, motivation, limitations with other medical conditions, reduce participation and affect adaptatioin with the new devices or strategies

Answer 258

Occupation = Work environment may present specific communication, noise exposure, or physical demands that affect device choice, rehabilitation goals, and accommodations needed Lifestyle = Daily activities, hobbies, and routines influence the type of interventions that are realistic and meaningful for the patient. For example, active versus home-based lifestyles may require different device features Support systems = Family, friends, and caregivers play a critical role in encouraging device use, providing reminders, assisting with care tasks, and offering emotional support. Lack of support may require additional counseling or services

Answer 259

deformity of the ear, active drainage within the previous 90 days, sudden or rapidly progressive HL within the previous 90 days, acute/chronic dizziness, unilateral HL within the previous 90 days, ABG at 500/1000/2000 Hz, significant cerumen accumulation and pain in the ear

Answer 260

type 1 : pure tone swept over frequencies type 2 : complex speech like signals with random frequencies

Answer 261

REUR = measurement of the absolute SPL level of an open ear canal response, across all frequencies, at the tympanic membrane REOR = measurement of insertion loss occurring because of the presence of a mold/dome in the ear canal REAR = absolute aided output and frequency response when a hearing aid is turned on REIG = difference between the AIDED response and the UNAIDED response of the ear canal RECD = difference in decibels across frequencies, between an ear canal resonance and the resonance of the 2cc coupler

Answer 262

Substitution method - soundfield equalization - Done before the PT arrives, placed at where subject’s head would be, stored as a reference point, used to calibrate the reference mic and probe - Impacts results if the subject changes location or moves

Answer 263

Concurrent equalization reference mic monitors test signal throughout test to equalize and adjust, calibration signal replays every 10 seconds (pink noise segment) Stored equalization probe is calibrated one time on PT’s ear & stored for fitting process Used to avoid ref mic contamination (stops it) - happens when amp output escapes ear canal through open dome

Answer 264

reference microphone contamination occurs when the amplified output escapes the ear canal through open domes -reference microphone measures and reacts to the intensity of the HAs output signal lowering the intensity of the speakers input signal

Answer 265

- causes peaks and nulls in amplitude resulting in inaccurate measurements - distortion - move the probe tube

Answer 266

present pink nosie while inserting probe tube. once correct distance is found move the marker

Answer 267

premeasure the probe tube marker to a premeasured position male 30 mm female 28 mm child 20-25 mm

Answer 268

probe tube places along the outer ridge of the intertragal nothc of device

Answer 269

REM, RECD measurement and test box programming, aided functional gain, aided speech intelligibilty measures, aided subjective ratings

Answer 270

difference in decibels across frequencies, between an ear canal resonance and the resonance of the 2cc coupler PERFORMED Measure coupler resonance measure REM placement of tube with constant depth and acoustic methods place recd transducer in earmold and place earmold in PTs ear measure real ear PRACTICAL PURPOSE correct & convert individuals HL audiometric thresholds to SPL values (allows for precise adjustments for differences in ear canal volume and impedance variations) & predicts the real–ear output when the HA measurements are made in the test box

Answer 271

constant depth acoustic method

Answer 272

Compares aided thresholds to unaided thresholds using puretone signals in the sound field Patient position: 0º azimuth to soundfield speaker Signal: pulse pure tone or warble signals Masking is presented via headphone to opposite ear to assess one device at a time Unaided SF thresholds obtained for key octaves 500 - 4k Hz to ensure accuracy of measurement You can’t use the audiogram threholds Aided SF thresholds obtained for the same frequencies Aided Verification of Adaptive Speech in Noise Performance Test signal: Adaptive QuickSIN Performed in soundfield at 50 dB HL (increase to soundfield MCL, if needed)

Answer 273

- frequency-dependent measure of time averaged sound pressure level of speech - calculated by averaging a measured signal for 10 seconds - Visual representation of modulated speech sounds

Answer 274

NAL2. = balances perception of loudness, targets for tonal lanuguages, use if Pt is desiring increased intelligibilty, adults only NAL-RP = more gain for sounds that contribute to speech intelligibility (severe to prof HL) DSL = assist in language development, use it patient is desiring increased comfort or REUR is not avaerge, adults and kids

Answer 275

crest +12 valleys -18

Answer 276

Long-Term Average Speech Spectrum. Basically, it shows which frequencies are louder or softer on average during everyday talking.

Answer 277

Crest factor measures the ratio of peak to average loudness in music, indicating dynamic range. Acoustic valleys are the quieter gaps or dips in sound energy within the music or frequency spectrum, contributing to the overall texture and contrast.

Answer 278

asymmetric - benefit from bilateral HA even though they wont get the full binaural advantage, try 1 or more formula reverse slope - add 15 to 20 dB in lows and mids, add 10 to 15 at 2k and above if they are WNL NIHL - basically try to get audibilty where they dont have it severe to profound - very low CR, use NAL-RP conductive - additional gain is needed

Answer 279

occlusion Increased perception of ones own voice when there is something blocking the ear canal Physical blockage of the ear canal (e.g., deep ear mold, closed fitting) trapping low-frequency energy ampclusion sensation of loudness or distortion of one's own voice due to hearing aid amplification settings Over-amplification, especially of low frequencies

Answer 280

party noise = increase HF CR slightly, raise HF TK to 60 dB paper crinkling - reduce loud channel for all freq toilet flushing - decrease LF loud channels water running - decrease MPO utencils - lower loud channel for all freq dishes clattering - decrease loud HF gain to increase CR speech in LF (malls) - decrease LF below 1500 Hz, increase HF above 1500 Hz HA is booming - decrease LF bands, decrease overall gain and MPO I cant hear well with HA - increase over gain, HF, and MPO plugged - increase vent size and LF band gain

Answer 281

functional = Problems with body functions or structures (physical or mental) that impact a person's capabilities. activity = Difficulties performing basic tasks or actions due to functional limitations. participation = Problems being involved in life situations or social roles.

Answer 282

fluid = The ability to reason, solve novel problems, and think abstractly without relying on prior knowledge. crystalized = The ability to use knowledge, experience, and skills that have been accumulated over time.

Answer 283

subjective - HHIA, APHAB, GHABP, SSQ, COSI objective - Aided Quicksin

Answer 284

Respect for Patients’ Values and Preferences Coordination and Integration of Care Information and Education Physical Comfort Emotional Support Involvement of Family and Friends Continuity and Transition Access to Care

Answer 285

Improved communication skills Enhanced hearing-related quality of life Increased use and benefit of hearing devices Peer support and motivation Cost-effectiveness Reduced listening effort and fatigue

Answer 286

a model that deals with how our brain integrates information of speech into separate groups based on spoken words and visual representation of words automatically

Answer 287

the first hour of evaluation of auditory function for surgically implanted devices, candidacy or post-op status

Answer 288

-18 years + -SNHL in the moderate to severe range -WRS greater then 40-60% (depends on manufacturer) -normal ME anatomy/function -experience with appropriately fit HAs -ABGs no larger than 10 dB

Answer 289

Has moderate to severe sensorineural hearing loss and cannot use or benefit sufficiently from conventional hearing aids due to issues like chronic ear infections, ear canal problems, or feedback issues. Has conductive or mixed hearing loss where traditional hearing aids are ineffective or not tolerated. Experiences discomfort, cosmetic concerns, or limitations with conventional hearing aids. Requires improved sound quality and clarity, especially in challenging listening environments. Has intact middle ear structures suitable for implantation. Has realistic expectations and motivation for undergoing surgery and device use.

Answer 290

The key differences between partially and totally implantable middle ear hearing devices** lie in how much of the system is placed inside the body versus outside, and how the components are powered and managed. partially implantable the power source is outside while totally implantable the power source is inside the head.

Answer 291

-conductive HL -retrocochlear or central auditory disorders -active or history of recurrent ME infections -TM perforations -disabling tinnitus -any skin or scalp conditions/sensitivities

Answer 292

advantages: greater gain, improved comfort, higher fidelity sound, not needing as much gain due to the nature of the implants, aesthetic appeal, and good for patients who want continuous wear disadvantages: surgical procedure, cost is high as insurance does not often cover the devices, hearing implications as a result of disarticulation potentially needing to occur, not MRI compatible beyond 1.5 T and there are troubles with verification as there is no acoustical output to measure within the canal

Answer 293

-average BC of less than or equal to 65 dB HL -average ABG of greater than 30 dB HL (additional consideration and not necessary)

Answer 294

-poor ear has profound SNHL of greater than or equal to 80 dB HL -good ear has a PTA of less than 20 dB

Answer 295

-external sound processor, captures the signal and converts it to mechanical vibrations, delivering those vibrations to the internal components -titanium component which is surgically implanted in the skull and uses those mechanical vibrations to the cochlea through bone conduction -abutment, sits on the fixture holding it into place

Answer 296

skin drive: vibrations are transmitted to the bone through the skin using an external device that is placed on the skin surface direct drive: vibrations are directly transmitted to the bone through an implanted transducer, without the need for skin transmission

Answer 297

active: transducer is implanted and the generated vibration is directly applied to the bone. gives optimum BC sound transmission as it is not attenuated. transducer is within the implant passive: transducer is within the speech processor and the stimulation is applied from the outside onto the skin.less optimal as the skin attenuates the signal before it reaches the bone. transducer is within the speech processor on top of the skin

Answer 298

percutaneous: the skin is not intact as the implant is penetrating the skin. titanium fixture is implanted into the skull and protrudes outward transcutaneous: the skin is intact and the vibrations from the sound processor are transmitted across the skull. titanium component is coupled to a magnetic plate that rests on top of the skull

Answer 299

the process in which bone cells attach/adhere to the surface of a metal titanium surface -the bone cells adhere to the surface of the fixture implant screw is surgically placed and eventually will become osseointegrated to the temporal bone -one stage process occurs when implant and abutment is placed as a single piece -two stage process occurs when the implant is implanted first then at another date the abutment is placed after osseointegration has taken placed

Answer 300

Percutaneous bone conduction implants feature an abutment that penetrates the skin, allowing direct vibration transmission to the skull bone for efficient sound conduction but requiring regular skin care and posing a higher risk of skin infections. In contrast, transcutaneous implants are fully implanted beneath intact skin and use magnetic coupling to transmit sound vibrations through the skin, offering better cosmetic results and fewer skin complications, though with slightly reduced sound efficiency. The choice between these implants depends on patient factors like skin condition, hygiene, cosmetic preference, and the need for optimal hearing performance.

Answer 301

-microphone picks up sound, amplifies it and converts it to an electrical signal -electrical signal goes to speech processor -processor converts the signal to digital information -this then gets sent to the transmitting coil which transmits both this signal and power to the internal receiver -the receiver decodes the signal and delivers electrical stimulation pulses to the electrode array that is within the cochlea -the electrodes stimulate the auditory nerve terminals using current pulses

Answer 302

monopolar - ground is larger, common ground is extracochlear, results in broad excitaton, requires less current, not good at showing short circuit anomalies bipolar - next to eachother, requires more current, focused stimulation

Answer 303

speech coding strategies are the algorithms used to convert incoming sounds (especially speech) into electrical signals that stimulate the auditory nerve. They determine which electrodes are activated, when, and with how much intensity, based on the input sound.

Answer 304

-absent cochlea/cochlear nerve -neurological damage impeding auditory processing -damaged auditory cortex -medical conditions preventing surgery -any medical risks of surgery that exceed the expected benefits

Answer 305

labeled : manufacturer defined indications listed on the package insert off label : provisions of a CI to a patient who does not meet the approved indications

Answer 306

Better ear PTA equal to or worse than 60dB ear (60+) Better ear UNAIDED WRS score equal to 60% or worse (60% and below) When the study was done you needed both now some of the studies say one or the other

Answer 307

least amount of stimulation a recipient can detect when electrical signal are delivered to individual electrodes -T levels, THR

Answer 308

upper limit of electrical stimulation, the loudest that they can tolerate -M, MCL or C levels

Answer 309

the difference b/w the patients T & M levels different for each electrode bc each threshold is different

Answer 310

the controls how frequencies are delivered across active channels

Answer 311

too little stimulation = the patient not getting enough sound/auditory input, understimulation too much stimulation = overstimulation, loss of speech clarity

Answer 312

-holding breath -exhibiting facial expressions of mild concern -looking to caregiver for reassurance -tensing or stiffening of the body -playing more actively -wringing hand, clothes or toes -producing blinks in response to the stimulus

Answer 313

ESRT: measuring the contraction of the stapedial muscle in response to intensive electrical stimulation from the CI -we are evoking it from the implant -preferable method for setting M levels in children ECAP: shows the auditory nerve response to electrical stimulation from the cochlear implant. It reflects activity from the nerve fibers near the implant. - ECAP thresholds almost always occur above T levels and they tend to occur in the upper portion of the behavioral dynamic range -more likely to exceed the M levels for faster stimulation rate

Answer 314

reduce stimulation levels, widen the pulse width

Answer 315

refers to the techniques designed to minimize intracochlear trauma, preserve residual hearing and to optimize electrode placement within the scala tympani

Answer 316

-SF thresholds better than 30 dB -10+ hours per day with data logs -post operative CNC scores in the implanted ear of around 56% or better OR patients score in the implanted ear have improved by at least 20%

Answer 317

-larger diameter which avoids damage to the nerve fibers -allows for insertion below the cochlear duct -closer proximity to the round window -less intracochlear trauma -better preservation of residual hearing -better implantation outcomes and reduced postoperative vertigo

Answer 318

measure of the opposition to electrical current flow across an electrode when a certain voltage is applied -confirms that electrodes are functioning properly

Answer 319

partial circuit, short cicuit, open circuit

Answer 320

incomplete path for current to flow, a discontinuous circuit -infinite resistance, prohibiting the flow of current -anything greater than 30

Answer 321

low resistance between two points in a circuit that differ in potential which are separated by higher resistance resulting in an increase in current flow -anything less than 1

Answer 322

characterized by relatively low resistance resulting in increased current flow, but less so than for a true short circuit -impedances decreasing over time and those impedances changes relative to the other electrodes

Answer 323

there is a fixed amount of current that is specified within the software, and if those impedances are using an amount of fixed voltage that agrees with the battery, then it is in compliance -this level cannot be exceeded, and if it is, then the device is out of compliance

Answer 324

software specifies a fixed amount of current if voltage amount that agrees with the battery = in compliance can not exceed this level or it is out of compliance

Answer 325

surgically implanted device that provides auditory sensation to individuals who cannot benefit from a CI

Answer 326

-12+ that are diagnosed with NF2 -rendered deaf due to bilateral resection of neurofibromas of the nerve

Answer 327

the cochlear nucleus of the brainstem

Answer 328

signs such as facial stimulation when levels continue to be increased

Answer 329

-presence of non auditory sensations -more central focus of stimulation -uncertainty and irregularity of tonotopic stimulation -potential central disease from

Answer 330

Oxidative stress happens when there’s an imbalance oxidation = A chemical reaction where a molecule loses electrons. reduction = A chemical reaction where a molecule gains electrons.

Answer 331

disturbance/imbalance between the production of reactive oxygen species (ROS) ROS: free radicals and peroxides Disturbances in the redox environment results in too much ROS —> can damage cell components like proteins, lipids, and DNA Antioxidants can combat excess ROS Oxidative stress and inflammation go hand in hand, resulting in: Aging, neurodegeneration, and diseases (diabetes, cancers, atherosclerosis, Parkinson’s, and Alzheimer’s) Severe oxidative stress results in cell death (necrosis) Moderate oxidative stress results in apoptosis (cell “popping” and dying) ROS can be beneficial: kills pathogens and helps cells signal Overproduction of ROS causes cell death, so we use antioxidants to prevent this (through natural body processes or nutrition)

Answer 332

enzymes and substrates can have specific shapes so if they don't match a reaction may not occur OR the enzyme can slightly modify its shape to accommodate several substances

Answer 333

acetylocholine - voluntary movement of skeletal muscles norepinephrine - arousal dopamine - wanting pleasure, addiction and love serotoin - memory, emotion

Answer 334

part of the immune response of vascular tissues to stimuli such as: pathogens, physical, and chemical trauma It is a necessary response that allows us to destroy invaders and repair itself (wound healing) In some disorders, the immune system can’t repair itself and it can result in a chronic inflammatory disease

Answer 335

cost and time

Answer 336

essentially what the body does with the drug. there are 4 major components: absorption, distribution, metabolism, excretion

Answer 337

enteral - given directly into the gastointestinal tract (oral or rectal). pros- easy administration, portable. cons - exposes the drug to harsh environments, stomach can affect absorption rate topical - applied to bodys surface. parenteral - usually injectable. pros - bioavaibibilty, more controlled. cons - high addiction tisk, costs more, most dangerous route

Answer 338

cell membrane BBB BLB BPB

Answer 339

phase 1 - modifies chemical structure of a drug through oxidation reduction & liver has enzymes to facilitate these rxns phase 2 - Conjugation/Hydrolysis. these reactions hydrolyze or conjugate a drug to a larger polar molecule by adding other molecular groups such as glutathione, sulfate, and acetate This reaction inactivates the drug or enhances the drug solubility and excretion rate into urine or bile

Answer 340

(also called first-pass metabolism) is a process where the concentration of a drug is significantly reduced before it reaches systemic circulation.

Answer 341

cell membrane, blood brain barrier, blood labyrinth barrier and the blood placental barrier

Answer 342

Drugs move from the bloodstream into body tissues primarily through passive diffusion, where the free (unbound) portion of the drug crosses capillary walls and enters surrounding tissues. This process is influenced by factors like blood flow to the tissue, the drug’s fat or water solubility, and whether it can pass through barriers like the blood-brain barrier. Fat-soluble, small, and uncharged drugs cross cell membranes more easily, while others may require special transport proteins. Once in the tissue, drugs may bind to components like fat or muscle, affecting how long they stay in the body and how they work.

Answer 343

also called drug metabolism if the process by which biochemical reactions alter within the body

Answer 344

redistribution to a nonspecific sites will terminate the drug’s action

Answer 345

drugs are eliminated from the body through two main steps: metabolism and excretion. metabolism - The liver breaks down the drug into smaller, less active parts. This makes it easier for the body to get rid of. excretion - After metabolism, the drug (or its pieces) leaves the body, mainly through: urine and feces

Answer 346

zero order elimination - elimination of a constant quantity per time unit, rare occuring mostly when the elimination system is saturated first order elimination - elimination of a constant fraction per time unit of the drug

Answer 347

the amount of time required for the drug concentration to decrease to 50%

Answer 348

higher initial dose of drugs administered to compensate for drug distribution in the tissues from plasma

Answer 349

agonist: Binds to a receptor and activates it, causing a biological response. antagonist: Binds to a receptor but blocks or prevents activation. It does not trigger a response.

Answer 350

once steady state is reached, subsequent drug doses must replace only what is lost through metabolism and excretion

Answer 351

how well a drug produces its intended effect in the body.

Answer 352

a molecule that binds to a specific site on a target protein—usually a receptor, enzyme, or ion channel—to trigger a biological response or block activity.

Answer 353

refers to the amount of a drug needed to produce a certain effect.

Answer 354

therapeutic = The intended, beneficial effect of a drug when it is used properly. adverse = An unintended, harmful, or undesired effect that occurs when taking a drug at normal doses.

Answer 355

quantal - describes the effects of various drug doses on a population graded - effects of various drugs on an individual

Answer 356

toxicity reaction = A harmful, potentially serious or dangerous effect caused by excessive drug levels (overdose) or prolonged use. drug side effect = An unintended, usually mild or moderate effect of a drug that occurs at normal therapeutic doses.

Answer 357

drug allergy = An immune system reaction to a drug, where the body mistakenly identifies the drug as harmful. anaphylaxis shock = A severe, rapid-onset allergic reaction that can be life-threatening.

Answer 358

abnormal and harmful immune responses to a medication. Unlike common side effects, these reactions involve the immune system and can range from mild to life-threatening.

Answer 359

refers to the ability of a drug or substance to cause birth defects or developmental abnormalities in a fetus when a pregnant person is exposed during pregnancy.

Answer 360

will still be approved by the FDA if the therapeutic benefit outways the risk and physician lableing clearly contraindicates use during preganacy

Answer 361

the study of how a person’s genetic makeup affects their response to medications.

Answer 362

gene mutations make individuals highly susceptible to aminolycoside ototoxicity

Answer 363

complex, time consuming, knowing a persons genetic make up will not be helpful if 2 drugs available are contraindicated and no other alternative is avaible, little incentive for manufacturers to spend huge amounts of money for a small portion of the population

Answer 364

especially ask about medical and drug history. gives us incite into what we might see based on history and can help explain results

Answer 365

age, pregnancy, diet, environment, disease, preexisting disorders, polypharmacy

Answer 366

the degree to which a patients behavior matches medical advice factors: intellectual status & physical status

Answer 367

Alternating because it will cancel out the cochlear microphonic

Answer 368

Children and elderly patients have important physiological differences that affect how drugs are processed in the body. In children, immature liver and kidney function, as well as differences in body composition (more water, less fat), can slow drug metabolism and excretion, requiring careful weight- and age-based dosing. In the elderly, decreased kidney and liver function, changes in body fat and protein levels, and increased drug sensitivity often lead to slower drug clearance and longer drug effects. These differences mean that both groups are more vulnerable to side effects and require careful dose adjustments and monitoring.

Answer 369

ideally no drug should be given during pregnancy because we are worried about teratogenicity and side effects

Answer 370

ED50 = It measures how much drug is needed to achieve effectiveness in half of the people treated. LD50 = how much drug is needed to be fatal to half of the subjects (usually tested in animals).

Answer 371

taking 5 or more medications at the same time, meaning within a 24 hour time period

Answer 372

ear poisoning—damage to the inner ear (cochlea or vestibular system) caused by certain drugs or chemicals.

Answer 373

measures how safe a drug is TI = TD50 ÷ ED50

Answer 374

damage to the vestibular system—the part of the inner ear responsible for balance—caused by certain drugs or toxins.

Answer 375

liver damage caused by a harmful substance—usually a drug, chemical, or herbal supplement.

Answer 376

kidney damage caused by a drug, chemical, or toxin.

Answer 377

damage to the nervous system caused by a harmful substance—like a drug, chemical, or heavy metal.

Answer 378

ecause the base of the cochlea, where high-frequency sounds are detected, is more exposed, more metabolically active, and more vulnerable to damage from toxic drugs.

Answer 379

antibiotic synergism: When two antibiotics together work better than the sum of their effects alone. antibiotic antagonism: When two antibiotics together interfere with each other, making the combination less effective than one alone.

Answer 380

dosage (higher the dose, the more of a risk there is), hepatic function (liver diseases impact metabolism, increasing risk), renal function (increase risk with any renal impairment), polypharmacy, age (very young and very old are at higher risk), pre-exisiting SNHL

Answer 381

SNHL that can be progressive, onset typically will occur within a few days or weeks, tinnitus, aural fullness, recruitment, abnormal/absent OAEs, abnormal/absent reflexes and poor speech perception

Answer 382

gram-positive: bacteria that stain dark blue/violet by gram staining because of high amounts of peptidoglycan in cell wall gram-negative: bacteria cannot retain the crystal violet stain because they lack the outer membrane found in gram-positive bacteria

Answer 383

Antimicrobial combination therapy can improve effectiveness, broaden coverage, and prevent resistance—but it also carries risks like toxicity, drug interactions, and higher cost. It should be used judiciously, usually in serious, resistant, or mixed infections, and guided by clinical judgment and lab results.

Answer 384

ototoxicity - cochlea vestibulotoxicity - Vestibular apparatus (semicircular canals, utricle, saccule)

Answer 385

aminoglycosides macrolides (generally reversible) Loop diuretics (generally reversible, irreversible when given with IV aminoglycosides)

Answer 386

penicillin cephalosporin macrolides

Answer 387

While combination chemotherapy can improve cancer treatment by targeting tumor cells in multiple ways, it poses challenges including increased toxicity, drug interactions, resistance risk, patient variability, complexity of treatment management, and higher costs. Successful use requires careful planning, monitoring, and individualized care.

Answer 388

cisplatin - Causes oxidative stress and damage to cochlear hair cells, especially outer hair cells in the cochlea’s basal turn, leading to high-frequency hearing loss. It accumulates in the inner ear fluids and generates reactive oxygen species that damage sensory cells. carboplatin - Less ototoxic than cisplatin but can still cause hearing loss at high doses or with prolonged use. Similar mechanism of cochlear damage.

Answer 389

HF tinnitus and a reversible SNHL (mild-mod)

Answer 390

NSAIDs can cause systemic issues like renal impairment by reducing kidney blood flow and prostaglandins, and ototoxic effects such as tinnitus and mild reversible hearing loss, especially with high or prolonged dosing.

Answer 391

Cinchonism from quinine presents with systemic symptoms like headache, dizziness, nausea, and visual changes, along with ototoxic signs such as tinnitus, hearing loss, and vertigo. Symptoms are often dose-dependent and reversible with drug discontinuation but can become permanent in severe cases.

Answer 392

no reported temporary or permanent ototoxic or vestibulotoxic however overuse/abuse can cause rapidly progressive profound permanent SNHL -which only occurs with multi-ingredient substances such as vicodine (acetaminophen and hydrocodone)

Answer 393

allows for informed medical decisions -performed for two purposes including early detection of changes to hearing status and audiologic intervention can occur when significant hearing impairment has occurred

Answer 394

small nicks can lead to severe bleeding -it is important when making impressions, particularly deep canal impression, and cerumen management -clearance from a physician or written consent from patients informing risk is prudent

Answer 395

baseline evaluation should occur before or no later than 24 hours after administration of chemotherapeutic drugs, prior to each dose, 1-2 times per week for patients receiving ototoxic antibiotics. frequency of monitoring depends on drug regimin and physician recommendations

Answer 396

- greater than 20 dB puretone shift at one frequency - greater than 10 dB shift at 2 consecutive test frequencies - threshold response shifting to "NR" at three consecutive test frequencies

Answer 397

it can damage any of the auditory structures within the radiation field, extending from the external ear to the higher auditory pathways conductive - radiation can degrade the external ear and middle ear systems through thickening the TM, stenosis of the ear canal, changes in the ET and ossicles resulting in temporary or permanent conductive HL SNHL - as dose increases, it can cause degeneration of the OHCs, IHCs and the 8th nerve fibers

Answer 398

because when you damage the OHC with ototoxic drugs it shows absent/reduced OAE. Meaning that even though your IHC are not damaged you will not get OAEs

Answer 399

a condition where the external ear canal is underdeveloped or completely absent.

Answer 400

Tymp - abnormal ECV & peak compliance OAE - absent/reduced Reflex - absent/elevated

Answer 401

literally what it sounds like the canals collapse causing occlusion as much as 50 dB. typically in younger children and older adults because of soft and deteriorating cartilage

Answer 402

a chronic autoimmune disease that affects the central nervous system (CNS)—which includes the brain and spinal cord. HALLMARK IS PLAQUES

Answer 403

A rare condition where there is an abnormal opening (dehiscence) or thinning in the bone that covers the superior semicircular canal of the inner ear. This opening creates a “third window” in the inner ear, disrupting normal fluid movement and balance/hearing signals.

Answer 404

the most common cause of vertigo of peripheral orgin. acute: resolves spontaneouly over 3 months intermittent: active and inactive periods over several years chronic: continuous symptoms over long durations

Answer 405

labyrinthitis - Inflammation of the entire inner ear (labyrinth), including both the cochlea (hearing part) and vestibular system (balance part). neuritis - Inflammation of the vestibular nerve only (the nerve that carries balance signals from the inner ear to the brain).

Answer 406

A rapid onset of hearing loss, usually in one ear, that develops within 72 hours.

Answer 407

Coloboma of the eye Heart defects Atresia Retarded growth Genital and/or urinary abnormaltiies Ear anomalies or deafness

Answer 408

refers to a type of hearing impairment where a person has normal results on a standard hearing test (audiogram) but still experiences difficulty hearing, especially in noisy environments.

Answer 409

Age-related hearing loss (presbycusis) is a gradual, bilateral, and symmetric decline in high-frequency hearing that typically begins in middle to older age, causing difficulty understanding speech, especially in noisy environments. In contrast, noise-induced hearing loss (NIHL) results from acute or chronic exposure to loud sounds and is characterized by a distinct high-frequency notch around 4,000 Hz on the audiogram. NIHL often presents earlier with prominent tinnitus and may be asymmetric depending on noise exposure. Both types primarily affect high frequencies but differ in onset, pattern, and progression.

Answer 410

is a condition where one or more of the tiny bones in the middle ear—called the ossicles (malleus, incus, and stapes)—become disconnected or separated from each other.

Answer 411

is an abnormal, noncancerous growth of skin cells in the middle ear or mastoid (the bone behind the ear).

Answer 412

cant get an IEP (specific disorder, formal document. request more and get more) but they can get a 504 (assessibilty stuff, sit at front, fm system)

Answer 413

information processing that is guided by higher level cognitive processes that draw on experiences and expectations to contract perceptions -occurs any time a higher level concept influences interpretation of lower level sensory data

Answer 414

information processing that is guided by input -most sensory information such as sound is a example -senses allow us to interpret the scene around us

Answer 415

ADHD: top down global disorder (C)APD: bottom up primarily auditory perceptual disorder -can differentiate with the digit span test in auditory and visual modalities, if does not do well in visual then would be looking more at ADHD

Answer 416

the detection of a tone masked by a modulated noise will improve significantly if if another band of noise with the same temporal characteristics is added. detection of the tone improves bc the two modulated bands of noise are percentually grouped by the CANS

Answer 417

there are two sound cues used for localization, ITD & ILD.

Answer 418

How good a test is at detecting people who have the condition. of true positives

Answer 419

forward masking: When a loud sound comes before a quieter sound and makes the quieter one harder to hear. backward masking: When a loud sound comes after a quieter sound and still makes the quieter one harder to hear.

Answer 420

How good a test is at identifying people who do not have the condition. of true negatives

Answer 421

MLD is a test that checks how well your brain can tell apart sounds in noisy environments using both ears. The “difference” in how loud the sound needs to be before you can hear it in different setups is called the Masking Level Difference.

Answer 422

the right ear crossed pathway has direct input to the left hemisphere which is predominant for language

Answer 423

these drugs enter the liver prior to entering circulation which allows for any unnecessary toxins to be removed -occurs to enteral

Answer 424

time required for the drug concentration to decrease by 50%

Answer 425

the study of drug outcomes as documented in observations of clinical data from large populations f typical patients receiving routine care

Answer 426

drugs that have some potential for abuse of dependence

Answer 427

(combination of oxidation and reduction): reactions that transfer electrons Reactions are a matched set, with only one, it’s called a half-reaction Oxidation: loss of electrons Reduction: gain of electrons All metal atoms can be oxidized (lose electrons), which forms a cation (positively charged ion). The electrons released are then reduced onto a non-metal (which is then an anion)

Answer 428

redness, swelling, heat (fever), pain, and loss of function

Answer 429

regulating manufacturing, marketing, and distribution to protect the public health

Answer 430

LD50 ÷ ED50 If LD50 is 10 mg and ED50 is 2 mg then the margin of safety is only 5. This means the lethal dose is only 5x the effective dose.

Answer 431

Quinine from tree bark treats malaria (banned in the US) 1st specific drug to treat an infectious disease!

Answer 432

medications that can cause birth defects or developmental abnormalities in a fetus when taken by a pregnant person

Answer 433

Non-Steroidal Anti-Inflammatory Drugs. A class of medications used to reduce pain, inflammation, and fever without using steroids.

Answer 434

a syndrome caused by quinine toxicity, characterized by a group of symptoms affecting the ears, eyes, and nervous system. It typically occurs with high doses or prolonged use of quinine, a drug used to treat malaria.

Answer 435

the most ototoxic drug used for germ cell tumors, bladder cancer, gynecological, lung tumors, tumors of the head/neck region and from childhood tumors such as neuroblastomas

Answer 436

a type of antibiotic that is used to treat infections caused by gram negative bacteria that can cause life threatening infections such as endocarditis, septicemia and kidney infections

Answer 437

medications that help your body get rid of excess salt and water by increasing urine production.

Answer 438

brand name tylenol useful for treating mild pain and fever but it is not an anti-inflammatory agent. no reported temporary or permanent ototoxic or vestibulotoxic effects.

Answer 439

sleeping pills, pain medications, & otoalcohol

Answer 440

severe, progressive, whole-body allergic reaction to a chemical that has become an allergen

Answer 441

the study of the role of the genome in drug response - a combination of pharmacology and genetics

Answer 442

graded dose response - relationship that describes the effect of the various drug doses on an individual quantal dose response - relationship describes the effect of various drug doses on a population

Answer 443

controlled substances schedule 1 - the most dangerous, no current accepted medical use and they have a high potential for abuse. potentially severe psychological/physical dependence ex: heroin schedule 2 -high potential for abuse but less than schedule 1. can potentially lead to severe psychological/physical dependence. ex: morphine and fentanyl schedule 3 - moderate to low potential for physical/psychological dependence, abuse potential is less than schedule 1 and 2. ex: ketamine and marijuana schedule 4 -low potential for abuse. ex: xanax and ambien

Answer 444

an important homeostatic mechanism that protects the inner ear. disruption of the BLB can result in a functional disruption of the auditory system.

Answer 445

taking 5 or more medications at the same time. increases the risk of adverse drug interactions.

Answer 446

the fraction of the administered drug that reaches the systemic circulation

Answer 447

the degree to which a patients behavior matches medical advice

Answer 448

When the patients wants and needs are the priority. The audiologist and the patient work together to make decisions.

Answer 449

occurs when the audiologist’s approach does not align with the patient’s needs or expectations

Answer 450

When the patient & the family work with the audiologist to develop a plan

Answer 451

An organizational tool used to review a set of treatment options. This opens up conversations with the patients to help them decide on a treatment option. gives information for each option and has boxes the patient can check if they are interested in learning more.

Answer 452

when we use technology to improve hearing (HA’s) components: audiometry, HAs, HA orientation, real-ear verification, and accessories

Answer 453

Helps patients with hearing loss adapt to their condition and manage it. It is personalized based on the needs and preferences of each patient. It should also reflect whole-person healthcare. Stresses the importance of having aspects other than technology involved components: patient story, self assessment of auditory wellness, technology, communication strategies, speech/visual perception training, peer support and validation

Answer 454

reduce deficits related to loss of function, activity limitations, participation restrictions and quality of life enhance conversational fluency recognize HL imposes a multi-dimensional loss of function (impacts the body, and mind, as well as social aspects)

Answer 455

Function: loss of integrity of the sense organ Activity: sensory loss limits the ability to understand communication, especially in noise Participation: limited desire to participate in life Quality of life: lack of participation leads to isolation and reduction of self-worth

Answer 456

We can test them with their hearing aids in quiet and in noise. If we want to increase the difficulty we can also take away their visuals.

Answer 457

Questionnaires can be used as a baseline and again after their fitting to analyze the benefit. They can also help us determine the patient’s quality of life & auditory wellness.

Answer 458

An echoic memory of the signal is created (replica), then pattern recognition occurs, then it goes to short term memory, and lastly long term memory

Answer 459

higher levels of attention allow us to select a limited amount of information we want to focus on and block out the irrelevant information

Answer 460

when there is more load (amount of energy that must be expended) than capacity (total energy available) it leads to fatigue, causing the processing speed to slow.

Answer 461

broader neural tuning curves with diminished frequency resolution, neural recovery taking longer and diminished brain connectivity slows hemispheric transmission

Answer 462

music training and physical activity

Answer 463

Slow-acting compression does not change the speech envelope but fast-acting compression does. It retains the speech envelope and the fine temporal cues needed in order to match to long term memory

Answer 464

Learning to play an instrument teaches the brain to extract critical information. Musicians show better abilities with brainstem encoding because music engages intricate systems in the brain (corpus callosum).

Answer 465

Provides patient-centered benefits because it provides expectations, rehabilitation process, habituation, and involves the whole family. It helps patients recognize that amplification is just one component.

Answer 466

They are auditory-based so if the patient can not hear the directions or questions the information you get will not be accurate

Answer 467

Pattern recognition occurs. This can be impacted by audibility, situational content, attention, and knowledge of language.

Answer 468

Variations in Loudness: changes in stress of syllabes which leads to words having different meanings Variations in Pitch: changes in intonation which leads to different meaning Variations in Duration: changes to vowels, syllables, or sentences to convery a different meaning

Answer 469

When the auditory signal that arrives to the brain is degraded by the auditory system and therefore does not match the auditory memory. This is more prevalent in complex listening environments.

Answer 470

Used to improve someone’s ability to perceive and understand speech auditory discrimination, auditory closure, auditory memory and auditory attention

Answer 471

The ability to fill in missing speech sounds.

Answer 472

The ability to distinguish between similar sounds.

Answer 473

The ability to retain and recall auditory information

Answer 474

The ability to focus on relevant auditory information and ignore background noise.

Answer 475

The ability to use skills, experimental knowledge, and repetitive activities and skills

Answer 476

The ability to think logically, solve problem, & think through challenges.

Answer 477

Asking clarifying questions, using visual cues and gestures, & and repairing communication breakdowns (asking people to repeat)

Answer 478

Familism - a sense of obligation, the family’s needs are more important than mine Stigmatism - HL is something to hide bc it negatively reflects on me

Answer 479

Feeling confident and comfortable in social situations, and minimizing anxiety and frustration

Answer 480

+3-5 dB (greater than the noise) There is a decrease in neural ability as we age - decreased neural firing & longer refractory periods.

Answer 481

The ability to understand speech in noise despite age-related hearing loss and auditory structure changes. Muscians = in their brain speech & music overlap Tonal language speakers = can identify subtle changes in words that change the meaning Bilingual speakers = better at encoding the fundamental frequency

Answer 482

Proposes that music facilitates speech encoding when -neural networks for speech & music OVERLAP -music entails more PRECISE processing than speech -music brings strong positive EMOTION -REPETITION in the signal -listening requires focused ATTENTION

Answer 483

It can help them acquire language faster

Answer 484

When the brain reorganizes itself because it lacks input like vision or hearing, it uses that area for something else. Research shows that if we can fit patients with well fit amplification, we can promote typical cortical function and provide them with cognitive benefits.

Answer 485

The perception of sound

Answer 486

A clear amplified signal with low distorion

Answer 487

uses top down processing to take in and analyze info without attempting to identify every word or sound

Answer 488

uses bottom up processing to improve recognition of phonemic speech elements

Answer 489

training tasks that match the patients desired outcome

Answer 490

use of training stimuli that activate language processing centers of the auditory cortex just like real communication

Answer 491

recognizes that emotional factors block effectiveness of listening skills

Answer 492

listener’s speech recognition skills, speaker’s delivery of the message, environment, and message complexity

Answer 493

detect the breakdown (requiring attention and active listening), choose a course of action, and take a course of action

Answer 494

giving specific information regarding what was missed exactly, both conversation and supportive repair strategies

Answer 495

not adding specific information in for what you did not understand or what you missed -can be simply saying ‘what’ or ‘huh’ -leading to simple repetition of the phrase

Answer 496

leads to the individual missing out on visual cues and will be more impacted by their HL due to the dual sensory loss

Answer 497

when the PHL prepares for conversational interactions in advance by anticipating conversational content and potential listening environments

Answer 498

coping behaviors that provide short-term benefits with long-term consequences -can look like dominating the conversation, ignoring the CP, bluffing, overreacting to miscommunication and withdrawing from social interactions

Answer 499

listener instructs the speaker on a specific way to change the delivery of the message -explanation, specific direction, and positive reinforcement

Answer 500

listener asks close-ended questions to limit potential answers and the amount of repetition required by the speaker

Answer 501

methods to counteract maladaptive behaviors (emotions) that stem from HL -can use relaxation techniques or grounding techniques

Answer 502

an attempt to identify and avoid communication breakdowns from occurring -including both nonspecific and specific strategies

Answer 503

actions are taken to change an environment for improved communication -lighting, visual, angles, distance, reverberation, noise, and visual distractions

Answer 504

forming clear and distinct sounds

Answer 505

techniques to reduce stress

Answer 506

a disability of family members due to the health condition of their significant other -describes a range of activity limitations and participation restrictions experienced by the CP

Answer 507

a line or area that seperates regions where different dialects are spoken

Answer 508

hearing intervention provided significant benefits to a heart-healthy group of subjects

Answer 509

4-6 weeks after fitting. occurs after the patient has adjusted and is used to see if the Pt’s goals were achieved. compare aided assessments to pre-fitting. demonstrates the benefit.

Answer 510

utilizes visual, auditory, gestural and contextual cues to understand speech

Answer 511

phonemic = mouth and lip prosodic = eye area

Answer 512

sounds that look identical when produced

Answer 513

words that look identical on the mouth when produced

Answer 514

visible elements will appear different depending on the surrounding sounds -impacts lipreading by how surrounding sounds impact the current sound both by visual cues and auditory cues

Answer 515

word groups which contain many words that sound and/or look the same -processing speed slows down

Answer 516

word groups which contain few words that sound and/or look the same -processing speech is faster

Answer 517

audio visual integration -by using what we saw and what we heard, we are able to integrate that to a smaller subset of potential words based on the context

Answer 518

reviewing datalogging to determine patterns of daily usage -can use any aspects to counsel and talk with the patient regarding their experience with the technology

Answer 519

Increase level by 20 dB and try again

Answer 520

all of the above

Answer 521

Measure threshold at 1000 Hz in the left ear

Answer 522

lack of auditory feedback

Answer 523

Ling 6 sounds

Answer 524

NU-CHIPS, closed set

Answer 525

all of the above

Answer 526

A much higher risk for educational difficulties exists for this child than for children with two normal hearing ears.

Answer 527

Minimum response levels

Answer 528

4:7 months

Answer 529

Severe SNHL

Answer 530

all of the above

Answer 531

visual reinforcement audiometry

Answer 532

Introducing the infant to multiple languages early to speed up language acquisition.

Answer 533

Eye widening

Answer 534

KJ did not start babbling until she turned 7 months old

Answer 535

500 Hz; 2000 Hz

Answer 536

WIPI closed set

Answer 537

apgar scores

Answer 538

NU-CHIPS, closed set

Answer 539

Explain to the parents that mild hearing loss can pose substantial challenges in noisy environments, and that hearing aids can help Jamie better follow classroom discussions and alleviate his frustration.

Answer 540

all of the above

Answer 541

specificity

Answer 542

Medical Home

Answer 543

child with family history of hearing loss and early progressive HL AND 3 month old who was in neonatal intesive care unit for 7 days after birth

Answer 544

Ped earhooks, tamper-resistant battery doors and a retention cord

Answer 545

Children acquire language through aided sound

Answer 546

Use of click or chirp stimuli

Answer 547

remake the earmolds to be a full shell with a helix lock for better retention

Answer 548

all of the above

Answer 549

Air- and bone-conduction ABR thresholds

Answer 550

a false response

Answer 551

BTE with traditional tube and custom earmold

Answer 552

corrected age

Answer 553

Compensated tymps (essentially removes the influence of the ear canal's volume and acoustic properties from the overall measurement, allowing clinicians to better isolate and analyze the behavior of the middle ear.)

Answer 554

critical period

Answer 555

ECochG, ABR, AMLR, ALR, P300

Answer 556

A click has a rapid onset and wide bandwidth which stimulates a broad portion of the cochlea and causes many neurons to fire at one time & Because many neurons fire at one time, a click stimulus evokes a larger amplitude response than most tonal AER stimuli & A click contains energy from many frequencies but correlates best with thresholds in the 2000-4000 Hz range

Answer 557

Condensation polarity

Answer 558

Rarefaction polarity

Answer 559

Alternating polarity

Answer 560

Rarefaction polarity

Answer 561

Alternating polarity

Answer 562

Alternating polarity

Answer 563

Condensation polarity

Answer 564

A - Cz B - Fz C - Fpz D - A1 E - M1 F - M2 G - A2

Answer 565

Pre-amp box

Answer 566

ABR is a test of hearing

Answer 567

Wave I - distal CN8 Wave II - Proximal portion of the CN8 Wave III - cochlear nucleus Wave IV - superior olivary complex Wave V - lateral lemniscus and inferior colliculus

Answer 568

A - normal hearing B - CHL C - cochlear HL D - retro cochlear (neural) HL

Answer 569

2-3 years old

Answer 570

You would perform a rate study if an individual presents with asymmetric hearing loss, they have unilateral tinnitus or if they have unexplained dizziness/vertigo.

Answer 571

You would perform a threshold ABR in newborns or if you were unable to get reliable behavioral results like in a patient with nonorganic hearing

Answer 572

threshold toneburst

Answer 573

You can braid the lead wires, try to reduce the noise in the room like turning off or moving cell phones and moving other electrical devices away from the testing, or you can make sure the patient is relaxed and not tense.

Answer 574

The click stimulus is a transient stimulus, so it is brief and has a rapid onset. The click stimulus includes a broad range of frequencies so it is not very frequency specific but it creates nice big waves in order for interpretation. These are short duration stimuli and are great for use in a rate study. The chirp stimulus is a narrowband stimulus and is more close to the tonebursts. It is more frequency specific and is good to use for threshold ABRs. These are long duration stimuli.

Answer 575

Right ear normal ABR, Left ear prolonged Ill and V waves and abnormal interpeak latencies with poorer overall morphology. Results suggestive of left retro-cochlear pathology.

Answer 576

conductive 50 dB HL

Answer 577

right ear = normal hearing sensitivity left ear = a severe to profound SNHL

Answer 578

ECochG is an endogenous response

Answer 579

SP/AP ratio of 45-50% or greater

Answer 580

Tiptrode Tymptrode (or canal electrode) Trans-tympanic needle electrode

Answer 581

Utilize a slower rate Utilize a higher intensity Try to get your electrodes closer to generator site (i.e., deeper in canal)

Answer 582

A = Tiptrode electrode B = Trans-tympanic needle electrode C = Tymptrode Wick (canal electrode) D = Tymptrode Gel (canal electrode)

Answer 583

up to 72 hours

Answer 584

3 days to 21 days after injury onset

Answer 585

The left side is the injured side and based upon ENOG value, immediate medical intervention is likely warranted Masseter mucle response

Answer 586

Normal SP/AP ratios for the left ear and Elevated SP/AP ratios for the right ear. Results suggest right cochlear dysfunction of the type commonly seen with active endolymphatic hydrops (Meniere's) or third window fistula.

Answer 587

Prolonged peak latencies but with normal interpeak latencies most likely consistent with conductive hearing loss. Should perform BC testing next to confirm.

Answer 588

The N2 component of the auditory late response (ALR)

Answer 589

Is a negative exogenous ALR response

Answer 590

Central auditory processing disorder (CAPD)

Answer 591

The variability of AMLR responses within normal individuals & Effects of sleep stages on the responses

Answer 592

Making sure the patient is alert and awake during the recording explanation: The image shows a stimulus artifact — a sharp deflection occurring immediately after the stimulus, before any neural response like wave Na. This type of artifact is electrical in nature, typically caused by the stimulus delivery system or electrode configuration, not by the patient's state or behavior.

Answer 593

Ventral and dorsal cochlear nuclei

Answer 594

It is a cognitive or discriminatory auditory evoked response & It reflects brain processing associated with stimulus recognition and novelty

Answer 595

Severe Alzheimer’s disease

Answer 596

50 ms = Pb/P1/P50 30 ms = Pa 40 ms = Nb 20 ms = Na 10 ms = P0

Answer 597

Hemispheric laterality/asymmetry:AMLR ADHD: P3/P300 Benefits of auditory training: ALR/P1 Predisposition to alcoholism: P300/P3 Sensory gating: Pb/P50/P1

Answer 598

Patients with SSD being assessed for cochlear implantation

Answer 599

They provide direct sound transmission for optimal signal delivery and secure retention, especially for active users

Answer 600

Isolating the test ear during assessment in the soundfield

Answer 601

A patient with profound SNHL in the poorer ear and PTA ≤ 20 dB HL in the better ear

Answer 602

Center for Devices and Radiological Health

Answer 603

Floating Mass Transducer

Answer 604

high frequency

Answer 605

reduction of the head shadow effect

Answer 606

they eliminate issues realted to ear canal occlusion and acoustic feedback

Answer 607

Administer a closed-set speech perception measure such as the ESP or NU-CHIPS

Answer 608

Electromagnetic

Answer 609

Device manufacturers

Answer 610

Transcutaneous, passive, non-osseointegrated

Answer 611

Recommend a formal trial with a bone conduction implant for the left ear to assess potential benefit

Answer 612

premarker approval (PMA)

Answer 613

20-30 warble

Answer 614

speech noise

Answer 615

- poor ear profound SNHL (80+) - good ear PTA 20 dB or better

Answer 616

- average BC less than or equal to 65 dB - average ABG greater than 30 dB

Answer 617

- 5+ - CHL cant benefit from HA - MHL with mild-mod SNHL & BC thresholds 65 or better - skull thickness 2.5 mm

Answer 618

- 5+ - skull thickness 2.5 mm - skin thickness 3 mm - BC 45 or less

Answer 619

- 18+ - mod-profound bilateral SNHL (lows are more moderate and highs are profound) - limited HA benefit

Answer 620

- 5+ - unilateral severe-profound SNHL (poor ear) - normal or mild-mod SNHL (better ear) - limited HA benefit - CNC score less than 5%

Answer 621

- bilateral severe-profound or profound SNHL - no HA benefit 3-6 months

Answer 622

- 18+ - normal-moderate LH HL - severe to profound HF HL

Answer 623

Mr. Hearmore will be able to hear through his implant, but the overall outcome is less likely to be optimal

Answer 624

Limited output and narrow bandwidth

Answer 625

Patients with bilateral severe to profound sensorineural hearing loss being considered for Cls

Answer 626

Partial insertion results in low-frequency input being mapped to more basal, high-frequency regions, causing spectral mismatch. Auditory training may help the brain adapt to the shifted input over time

Answer 627

implant soft failure

Answer 628

cochlear nucleus

Answer 629

Discuss bone conduction devices as a more appropriate option given her middle ear status

Answer 630

The patient is likely experiencing overstimulation because we want a dynamic range of only 40-60

Answer 631

upper stimulation levels

Answer 632

pulse width

Answer 633

To minimize intracochlear trauma and preserve residual hearing

Answer 634

The trade-off between increasing electrode contacts and the risk of channel interaction

Answer 635

Kinked array causing contact between adjacent electrodes

Answer 636

Exceeding voltage compliance can lead to imbalanced loudness across the electrode array

Answer 637

To position the electrode closer to the auditory nerve fibers for more focused stimulation

Answer 638

Her performance is consistent with typical outcomes for ABI users with NF2

Answer 639

- Closer proximity to spiral ganglion cell bodies - Lower risk of intracochlear trauma - Improved potential for residual hearing preservation

Answer 640

piezoelectric, electromagnetic, and electromechanical

Answer 641

this transducer possesses a unique property, as when they come in contact with electricity,y they oscillate -when they are coupled to the ME, the material delivers mechanical energy, converting sound-induced vibrations into electrical signals for processing -the intensity and frequency generated are proportional to the intensity and frequency of the driving force

Answer 642

there is no external power source required, and they have relatively robust durability

Answer 643

may not provide enough amplification due to limited output and a narrow bandwidth

Answer 644

this transducer features a biocompatible magnetic coupled to the ossicular chain or ME structure and is positioned near a wired coil within the canal -as an electrical current goes through the coil, it generates a fluctuating magnetic field, causing the magnet to oscillate and transfer mechanical energy to the ossicular chain -the magnet moving along with the ossicle,s giving a back-and-forth movement between the magnet/coil

Answer 645

the output depends on the magnet-coil proximity -decreasing with longer distance -with this type of transducer, since the magnet is on the ossicular chain and the wire is in the canal, the fluctuations that occur depend on the proximity

Answer 646

this transducer was designed to eliminate the limitation of distance with electromagnetic transducers -the coil and magnet are within one unit, ensuring mechanical energy transfer to the coupled structure within the ossicles

Answer 647

delivers higher output levels/wider frequency response and is not impacted by variable output due to changes in magnet coil distance

Answer 648

complex design and is more prone to mechanical failure

Answer 649

evaluation that all newborns receive shortly after birth to detect obvious abnormalities -used to identify if the baby is in distress -based on heart rate, respiratory effort, reflex irritability, muscle tone and color

Answer 650

24-26 weeks -the auditory nerve is hooked up

Answer 651

no babbling or gesturing by 12 months, no single words by 16 months, no 2 word combinations by 24 months, no 3 word combinations by 3 years, unintelligible speech at 3, limited number of consonants at 2 years, simplified grammar at 3.5 years, difficulty formulating ideas and using vocab at 4 years and language not used communicatively

Answer 652

method of testing hearing in toddlers and preschoolers through conditioned motor response to sound using game activities -ages 30 months to 5 years

Answer 653

false responders, reluctant responders and off responders

Answer 654

closed set picture pointing, scored as a percentage -ages 3 to 5

Answer 655

consists of picture plates containing 6 images with 4 rhyming -ages 5 to 8

Answer 656

open set, scored as a percentage and required a verbal response -ages 5 to 8

Answer 657

speech in noise test that uses sentences that are recorded in four talker babble on the same channel of the CD -ages 5+

Answer 658

audiometric technique that involves training the infant to make a conditioned head turn in response to a stimulus -5/6 months to 36 months -child needs to be able to turn their head to identify the sound

Answer 659

measuring an infant's awareness of sound, it doesn't provide threshold information -birth to 6 months, but can be used on older children with developmental delays or other disorders preventing body responses

Answer 660

posterior SCC

Answer 661

anterior SCC

Answer 662

anterior or posterior SCC

Answer 663

horizontal scc

Answer 664

toward the ampulla

Answer 665

away from the ampulla

Answer 666

eye movement relative to something else head impulse →eye movement relative to head movement rotary → eye movement relative to chair movement pursuits → eye movement relative to target moving in front

Answer 667

Performed as part of a neuro exam to evaluate balance, proprioception (requires healthy function of dorsal colums in spinal cord & location of joints), and coordination (ataxia)

Answer 668

a test that assess for PC/AC BPPV

Answer 669

it is a positional test that assesses for HC BPPV

Answer 670

1. Nystagmus that changes direction in any head position 2. It is present in at least 3 head positions 3. It is intermittent in all head positions (little here, little there) 4. One or more positions that has a slow phase magnitude (velocity) >/=4-6 deg/s

Answer 671

most treatment for canalithiasis AC/PC BPPV

Answer 672

treatment for cupulolithiasis AC/PC BPPV

Answer 673

treatment for horizontal canal BPPV used for the geotropic/canalithiasis variant

Answer 674

treatment for horizontal canal BPPV used for the ageotropic/cupulolithiasis variant

Answer 675

canalithiasis is a delayed onset and lasts for less than a minute cupulothiasis is an immediate onset and doesn't fatigue

Answer 676

canalithiasis, posterior SCC treatment = epley

Answer 677

cupulothiasis, posterior SCC treatment = semont

Answer 678

canalithiasis, anterior SCC treatment = epley

Answer 679

cupulothiasis, anterior SCC treatment = semont

Answer 680

canalithiasis, horizontal SCC treatment = BBQ roll

Answer 681

cupulothiasis, horizontal SCC treatment = modified semont

Answer 682

7 and above

Answer 683

5 years old

Answer 684

occurs after evaluation by the CI team and manufacturer -can only be confirmed by a removal examination

Answer 685

an uncommon occurrence in which the device malfunction is suspected but cannot be proven -declining performance, aversive symptoms such as popping or shocking and intermittent function

Answer 686

when a device malfunction is suspected and indeed confirmed with the available assessment tools

Answer 687

implant integrity testing shows device malfunction AND a noticeable drop in a patients performance

Answer 688

exogenous: early and mids ; an obligatory response endogenous: most lates ; arising from components that depend on cognitive processing

Answer 689

also known as the startle reflex, it is a normal, involuntary reaction in newborns. triggered by a sudden loss of support or a loud noise causing the baby to extend their ams and legs and quickly rin them back in. this reflex typically disappears by 3-6 months.

Answer 690

Closed-set tests are typically used for individuals with limited language or speech production skills, or when assessing specific aspects of auditory perception, like phoneme recognition, in a controlled environment. Open-set tests are used when a more comprehensive assessment of real-world listening and speech understanding is desired

Answer 691

12-20 ms. similar to wave Na which occurs at 18-20 ms

Answer 692

birth to 6 weeks

Answer 693

7 weeks to 3 months

Answer 694

after 4 months

Answer 695

8-10 months

Answer 696

approx 12 months

Answer 697

18-20 months

Answer 698

after 30 months

Answer 699

CHL, SRT in agreement with PTA, normal WRS, abnormal tympanograms, present/absent OAEs, & present/abnormal/elevated ARTs

Answer 700

tinnitus, vertigo normal tymps, abnormal or absent reflexes on the affected side, unilateral sudden onset of SNHL or normal hearing, WRS/SRT abnormal or normal, ABR normal or prolonged waves I-III absolute latencies

Answer 701

Type B or A tymps, Normal or CHL, SRT matching HL but with normal WRS, present/absent OAEs, ARTs present or elevated/absent

Answer 702

CHL, Type B tymps w/ SECV, Elevated SRT & normal WRS, absent/elevated ARTs, Absent, reduced OAEs

Answer 703

acoustic reflexes are absent or abnormal

Answer 704

otoscopy (Bulging or retracted TM, discolored, Perforations, Fluid lines/bubbles, & Discharge), Immittance, Type B tymp (High ECV w/ perf or Normal ECV intact TM) OR Type C tymp (ET dysfunction), ARTs with UNILATERAL OM will be abnormal/absent on affected side of ipsi & Elevated/abnormal contra, ARTs with BILATERAL OM will be Ipsi and contras bilaterally abnormal or absent, Pure tones can be WNL/CHL/MHL/SNHL, SRT & PTA in agreement, WRS normal

Answer 705

otoscopy normal or perforation, pure tones can be WNL/MHL they can also be conductive if ossicular disarticulation has occured Immittance Depending on size, location, and what has been damaged A = normal As = stiffness in ME cavity Ad = ossicular disarticulation B LECV = perf & ME space is filled B HECV = perf & ME not filled

Answer 706

Otoscopy usually normal but can have the schwatze sign (reddish glow to the TM), only middle ear disrder with normal tymps, ARTs abnormal or absent, tone decay is negative (tests retrocochlear)

Answer 707

Otoscopy normal/performation/bleeding from the ears, type Ad tymps, abnormal ARTs, Pure tones CHL & MHL

Answer 708

Pulsatile tinnitus, red ™ & CHL, SNHL, FN dysfunction, vertigo, smaller w/ earlier symptoms

Answer 709

Silent for years, grows large, CHL/SNHL/MHL, otalgia, aural fullness, vertigo, hoarseness & dysphagia

Answer 710

otoscopy is normal, pure tones will be late onset, progressive & profound SNHL by age 3-5 (CI candidates)

Answer 711

normal otoscopy, normal tymps, sudden onset bilateral/unilateral SNHL, poor WRS ARTs Affected ear = absent/elevated ipsi & contra Unaffected ear = normal ipsi & contras

Answer 712

NIHL: Temporary threshold shift (TTS): reversible shift that can resolve 15 mins after exposure or persists up to 14 hours OR Permanent threshold shift (PTS): persistent change in sensitivity, persists after approx. 14 hrs Presbycusis: Slow progressive HF sloping SNHL seen in older PTs

Answer 713

Normal ARTs since it is not a true ME pathology, so there isn’t a true ABG CHL or fluctuating HL mimicking OTSC or Meniere’s Most have LF ABG from 250-1000 Hz *not a true CHL because BC bypasses the dehiscence, causing artificially large ABGs even with normal ME

Answer 714

SNHL is neither an initial symptom or a prominent one but you might see a bilateral low-frequency rising hearing loss

Answer 715

nilateral HF SNHL (asymmetry), tone decay can be positive, OAE are probably normal as long as the hearing loss is not significant, WRS worse than expected especially in noise, positive rollover ratio, normal tymps, ARTs can be abnormal/absent (not 100% sensitive for finding schwannomas), abnormal ABR (increased wave 5 latency & interwave latencies)

Answer 716

Pure tones any configuration & severity, Poor WRS in noise, absent reflexes, ECochG - absent, ABR - absent w/ presence of CM with reversal of polarities OAEs Present (unless ischemia) Absent contralateral suppression

Answer 717

Audiological findings: normal tymps, ARTs present but lower SL, ECochG - >.42 SP/AP ratio Pure tones Usually unilateral but some bilateral Early - LF rising SNHL Middle - reverse cookie bite Late (burnout) - flat severe SNHL & rarely progressing

Answer 718

right ipsi and contra reflex values would be low

Answer 719

right ispi and contra reflexes values would be high

Answer 720

right ipsi and left contra

Answer 721

ispi of both ears

Answer 722

left contra and right ipsi

Answer 723

testing r ART stim - right probe - right

Answer 724

testing L ART stim - right probe - left

Answer 725

testing L ART stim - left probe - left

Answer 726

testing R ART stim - left probe - right

Answer 727

below 20-25% is normal for unilateral weakness

Answer 728

below 30-35% is normal for directional preponderance

Answer 729

anything less than 26

Answer 730

when the patients nystagmus increases when they look the same way of the beating & decreases or is eliminated when they look the opposite way. in order for it to be alexanders law they MUST have central gaze nystagmus

Answer 731

time bw each stimulus Why it matters (refractory periods) Too short = neural elements do not recover and miss or have weak waves Long enough = full neural recover and have clearer, stronger responses

Answer 732

ADHD is top down and has vision issues while CAPD is bottom up

Answer 733

depends on who they are sent to, we would diagnose as CAPD while a SLP would say learning disability. No significant performance differences

Answer 734

reading issues

Answer 735

ANSD will have abnormal ABR

Answer 736

pure tones and WRS scores will be inconsistent in central deafness. can hear but dont understand so would do bad WRS

Answer 737

stimulus: ASSR is a continuous tone with variations, ABR is a transient stimuli measurement: ASSR is time locked to a period of time, ABR is time locked to a stimulus detection: ASSR is looking at phase and amplitude, ABR is looking at latency

Answer 738

both are EPs, both can be used to estimate thresholds for patients who cannot do behavioral measures, same electrode set ups

Answer 739

ASSR can assess multiple frequencies in both ears at once, ASSR can assess hearing at higher stimulus levels (up to 100-120), ASSR is measured in nanovolts whereas ABR is measured in microvolts

Answer 740

-at slower modulation rates we are assessing the auditory cortex -at faster modulation rates we are assessing the brainstem

Written COMP Flashcards

disorders, speech, amp 1 & 2, OAE, pharmacology, peds, counseling, CAPD, aural rehab, vestib 1, implantables, evoked responses, (846 cards)