Central focus is concerned with all auditory impairments and their relationship to disorders of communication.
Profession of Audiology (AAA Scope of Practice Statement)
Person who by virtue of academic degree, clinical training, and license to practice and/or professional credential, is uniquely qualified to provide a comprehensive array of professional services related to the prevention of hearing loss and audiologic id, assessment, dx, tx, of persons with impairment of auditory & vestibular function, & prevention of impairments assoc. with them.
What are 6 roles an audiologist can serve as?
Who made the term "audiology" famous during/after WWII in 1945?
When did it become required for audiologists to receive a doctorate in audiology to practice in the field and to become certified by national organizations?
January 1, 2007
__________ is a legal requirement to practice in the field of audilogy. How many hours of clinical practicum must you have?
Oklahoma's State Licensing body for audiology
ASHA'S certifying body for audiology
CCC--Certicate of Clinical Competence
AAA's academic profiency certification/licensure
FAAA-Fellow of the American Academy of Audiology
Board Certified Audiologists receive this status through _______.
What's the prevalence of tinnitus?
What's the prevalence of hearing damage due to exposure to hazardous noise levels?
What's the prevalence of people that are hard of hearing?
What's the prevalence of people with some degree of permanent noise-induced hearing loss?
What's the prevalence of people that are classified as deaf?
What's the prevalence of people that were born with hearing impairment?
Approx. 6 out of 1,000
What percentage of school-age kids may fail a school hearing screening due to an ear infection?
Before age 6, what percentage of children in the U.S. will have had at least one ear infection?
Impact of hearing loss is greatest on _________ _________, but also affects other children and adults due to ________ aspects.
__________ of a hearing loss is essential to maintain language acquisition, interact with family/peers, decrease negative educational impact and for psychological well-being and self-perception.
How many baby boomers ages 41-59 have a hearing loss?
1 out of 6
What are annual costs for tx of childhood ear infections in the U.S.?
Around $2 billion
What ratio of people with a hearing loss seek tx?
1 out of every 4
In regard to Audiology, what is within SLP's scope of practice?
Basic checks of Hearing Aid Performance
Which job setting contains the largest amount of audiologists and work in dx assessment and aid medical doctors in final dx?
Which job setting do audiologist work where there is less than 1/2 the amount needed and they work to identify and refer kids with hearing loss to medical.
Which job setting for audiologist focuses on dx & aural rehab of children and focus primarily on parent's roles.
What job setting do audiologist work primarily to fit and dispense hearing aids and provide aural rehab and work most often in private practice.
What job setting do audiologist work to prevent noise-induced occupational hearing loss and set up hearing conservation programs, provide info on hearing protection, and monitor hearing sensitivity?
What percentage of audiologists consider themselves clinical service providers?
What are the 2 major areas of employment setting for audiologists?
The outermost portion of the hearing mechanism, filled with air, whose primary function is to carry sounds to the middle ear.
Auricle of the external ear.
Channel in the external ear from the concha of the auricle to the tympanic membrane.
External Auditory Canal (EAC)
Air-filled cavity containing a chain of three tiny bones whose function is to carry energy from the outer ear to the inner ear.
Vibrating membrane that separates the outer ear from the middle ear.
Chain of three tiny bones found in each middle ear (malleus, incus, and stapes).
First and largest bone in the ossicular chain of the middle ear, connected to the typanic membrane and the incus.
Second bone in the ossicular chain, connecting the malleus to the stapes.
Third and smallest bone in the ossicular chain of the middle ear, connected to the incus and standing in the oval window.
Channel connecting the middle ear with the nasopharynx on each side. It's lined with mucous membrane and is sometimes called the auditory tube.
Portion of the hearing mechanism, buried in the bones of the skull, that converts mechanical energy into electrochemical energy for transmission to the brain.
Tiny, oval-shaped aperture beneath the footplate of the stapes; separates the middle ear from the inner ear.
Cavity in the inner ear resembling a snail shell and responsible for converting sound waves into an electrochemical signal that can be sent to the brain for interpretation.
Small, round aperture containing a thin but tough membrane; separates the middle ear from the inner ear.
Three loops in the vestibular portion of the inner ear responsible for the sensation of turning.
VIIIth Cranial Nerve, which comprises auditory and vestibular branches, passing from the inner ear to the brainstem.
Cartilaginous appendage of the external ear.
Ability of an animal to determine the specific location of a sound source.
Area where the back of the nose and the throat communicate.
Course of sounds that are conducted to the inner ear by way of the outer ear and middle ear.
Course of sounds that are conducted to the inner ear by way of the bones of the skull.
Loss of sound sensitivity produced by abnormalities of the outer ear and/or middle ear.
Conductive hearing loss
Decrease in the strength of sound energy.
Formerly called perceptive loss or nerve loss, this term refers to loss of hearing sensitivity produced by damage or alteration of the sensory mechanism of the cochlea or the neural structures that lie beyond.
Sensorineural Hearing Loss (SNHL)
Sensorineural hearing loss with superimposed conductive hearing loss. The air-conduction level shows the entire loss; the bone-conduction level, the sonsorineural portion; and the air-bone gap, the conductive portion.
Mixed Hearing Loss
Exaggerated elevation of auditory thresholds.
Nonorganic Hearing Loss
Conscious, willful, and deliberate act of feigning or exaggerating a disability (such as hearing loss) for personal gain or exemption.
Nonorganic hearing loss produced at the unconscious level, as by an anxiety state.
Psychogenic Hearing Loss
Metal instrument with a stem and two tines. When struck, it vibrates, producing an audible, near perfect tone.
Tuning fork test that compares an individual's hearing by bone conduction with the hearing of an examiner (who is presumed to have normal hearing).
Tone emitted by a tuning fork will stop being heard by both patient and examiner at approximately the same time.
Patient stops hearing the tone emitted by a tuning fork much sooner than the examiner pointing to sensorineural hearing loss due to impaired bone conduction hearing.
Tuning-fork test that compares hearing by air conduction with hearing by bone conduction.
Rinne Test (Stem-mastoid; Tines-pinna)
When a tone emitted by a tuning fork will be heard louder when the fork is next to the ear than when it's behind the ear.
Positive Rinne (occurs in normal hearing and also in sensorineural hearing loss)
If a patient has more than a mild conductive hearing loss, their bone-conduction hearing is normal, and they hear a louder tone with the stem of the fork behind the ear (bone conduction) than with the tines at the ear (air conduction).
Test reading that occurs when the inner ear not deliberately being tested responds to the tone emitted by a tuning fork...Opposite cochlea responds (crossover)
False Negative Rinne
Tuning-fork test that utilizes the occlusion effect to test for the presence or absence of conductive hearing loss and is observed primarily for low-pitched sounds.
Impression of increased loudness of a bone-conducted tone when the outer ear is tightly covered or occluded. This effect is evident in patients with sensorineural hearing loss, but it's absent in patients with conductive hearing loss.
Occlusion Effect (OE)
Test reading when normal hearers and those with sensorineural hearing loss hear a pulsating sound that seems to get louder and softer when examiner alternately closes and opens the ear canal.
Test reading for patients with conductive hearing losses where no change in loudness of sound is noticed when examiner alternately closes and opens the ear canal.
Tuning-fork test testing laterization performed in cases of hearing loss in one ear to determine if the impairment in the poorer ear is conductive or sensorineural. (Stem is placed on the midline of the forehead)
Impression that a sound introduced directly to the ears is heard in the right ear, the left ear, or the midline.
What type of hearing does a patient have when the test results of a Weber test report a midline sensation?
Normal Hearing or Equal Hearing Loss in Both Ears (conductive, sensorineural, or mixed)
What type of hearing does a patient have when the test results of a Weber test report hearing the tone in their better ear?
Sensorineural Hearing Loss
What type of hearing does a patient have when the test results of a Weber test report hearing the tone in their poorer ear?
Conductive Hearing Loss
When two tones of the same frequency are presented to both ears simultaneously, only the louder one is perceived.
Test for unilateral nonorganic hearing loss based on the Stenger principle.
Sound defined as an auditory experience--the act of hearing something.
Psychological Sense of sound
Sound defined as a series of disturbances of molecules in an elastic medium such as air (essentially a form of energy).
Phsyical Sense of sound
Ability of a mass to return to its natural shape; increases as the distance between molecules is decreased.
To-and-Fro movements of a mass. The mass is displaced from its position of rest and allowed to oscillate without outside influence. When forced, the mass is moved back and forth by applying an external force. (Source of the creation of sound)
Series of moving impulses set up by a vibration; sucession of mulecules being shove together an pulled apart...made up of successive compressions and rarefactions.
(1) Portion of a sound wave where the molecules of the medium are compressed together; also called condensation.
(2) Decrease in pressure. In a hearing aid, a method of limiting the amplification of louder sounds relative to weaker sounds.
When molecules are forced closely together and thus create increase or higher pressure.
Portion of a sound wave where the molecules become less densely packed per unit of space. When molucules move further apart and create decreased or lower pressure.
What are the 2 types of waves?
Wave in which the motion of the molecules of the medium is perpendicular to the direction of the wave.
Transverse Wave (Ex. dropping a pebble in water)
Wave in which the particles of the medium move along the same axis of the wave; don't have crests or troughs b/c they don't move up and down.
Longitudinal Wave (Ex. wheat in the wind)
Energy of a mass that results from its motion.
Energy resulting from a fixed and relative position, as a coiled spring. (essentially stored up energy)
Complete sequence of events of a single sine wave through 360 degrees; one compression and one rarefaction of a sound wave.
Number of complete oscillations of a vibrating body per unit of time. In acoustics, the unit of measurements is cycles per second (cps) or hertz (Hz).
Measurement term most commonly used instead of cps for cycles per second when describing the unit of frequency of sound.
Back and forth movement of a vibrating body.
Waveform of a pure tone showing simple harmonic motion.
Sinusoidal or Sine Wave
Tone of only wone frequency (i.e. no harmonics)
As __________ decreases, frequency increases. (Ex. strings on an instrument)
Length (shorter string=higher frequency)
As __________ increases the frequency decreases.
Mass (increased thickness of musical strings=lower tones)
As _________ increases, the frequency at which the body is most easily made to vibrate decreases.
Ability of a mass to vibrate at a particular frequency with a minimum application of external force; when an object is oscillating at an optimum rate of vibration and amplitude.
Frequency at which a mass vibrates with the least amount of external force; the natural frequency of vibration of a mass. (why a glass may shatter when a high note is sung)
Extent of the vibratory movement of a mass from its position of rest to that point farthest from the position of rest; distance from the baseline to the point of maximum displacement of a wave. Determines the intensity of sound and is related to the force with which the original particle disturbance was created.
Amount of sound energy per unit of area. An objective term (able to be seen; measureable; physical)
Subjective impression of the power of a sound. (Not tangible; psychological...how humans perceive intensity)
Speed with which a sound wave travels from the source to another point. Elasticity, Density, and Temperature all influence ___________.
Length of a wave measured from any point on a sinusoid to the same point on the next cycle of the wave. The distance between the exact same point (in degrees) on two successive cycles of a tone.
Wavelength=Velocity of sound/Frequency
Longer wavelengths of the ___________ frequency sounds of vowels more easily move around corners and obstructions.
Relationship in time between two or more waves.
Sound that has all its energy at one frequency, creating a pure tone. (Doesn't occur naturally...created by tuning forks and pure-tone audiometers)
Sound energy at more than one frequency such sounds are created with the human voice, musical instruments and other environmental sounds.
Lowest rate (frequency) of a sound's vibration in a complex wave; the lowest resonant frequency determined by physical properties of the vibrating body.
By raising or lowering the tongue and moving it forward or back, it changes the _________ and ________ that emphasize some harmonics more than others, changing the __________.
The __________ __________ in the human voice is controlled by the vocal folds in the larynx.
All frequency whole-number multiples of the fundamental frequency of a complex wave.
Fundamental frequency equals the first harmonic...2nd harmonic is twice the fundamental.
Peak of energy in the spectrum of a vowel sound.
Is it male or female fundamental voice frequency that averages around 85-150 Hz?
Is it male or female fundamental voice frequency that averages around 175-250Hz?
This is generated whenever force is distributed over a surface area.
Unit of measurement used in audiology for intensity expressing the ratio between two sound pressures or two sound powers.
Decibel (dB) is 1/10 of a Bel
What are the 5 important aspects of the Decibel?
1) Involves a RATIO
2) Utilizes a LOGARITHM
4) Expressed in terms of VARIOUS REFERENCE LEVELS
5) It's a RELATIVE UNIT OF MEASURE
We can compress a wide range of sound pressure between the highest toleralbe sound pressure and the sound pressure theat can be heard into a manageable scale ranging from ______ to ______ dB.
140 to 0 dB
The decibel has no absolute ________.
Expression of the power of sound per unit of area. Audiologist don't use this level clinically. Primarily used for electrical systems or equipment.
Intensity Level (IL)--measured in watts (W)
Expression of the pressure of a sound in ratios.
Sound Pressure Level (SPL)
.0002 dynd/cm2 or 0 dB SPL
When sound pressure levels are doubled, the # of decibels are increased by __ because they are ratios.
(Ex: 60 dB + 60 dB = 66 dB)
What is the smallest amount of sound pressure (SPL) that will set a human eardrum into motion?
0 dB SPL
What is the ear threshold of pain?
140 dB SPL
What's the lowest sound intensity that stimulates normal hearing?
Zero Hearing Level (HL)
What's the range of pressure hearing level that most people are sensitive to for stimulating hearing?
1000-4000 Hz range
Number of decibels above an average normal threshold for a given signal...this is measured on an audiometer calibrated in db HL.
Hearing Level (HL)
Number of decibels above the hearing threshold of a given subject for a given signal. Auditory threshold of a given individual.
Sensation level (SL)
In audiometry, the level at which a stimulus, such as a pure tone, is barely perceptible. Usual clinical criteria demand that the level be just high enough for the subject to be aware of the sound at least 50 percent of the times it is presented.
Pure Tone Threshold
Number of decibels above the hearing threshold of a given subject for a given signal.
Sensation Level (SL)
In order to state the person's dB SL, the threshold of the individual (the reference) must be known.
Factors of sound that remain the same with or without human perception.
Study of the relationship between physical stimuli and the psychological responses to which they give rise.
Subjective impression of the highness or lowness of a sound; the psychological correlate of frequency.
What is the range of human hearing approximately?
20 to 20,000 Hz (frequencies)
Subjective impression of the power of sound.
_______ and __________ of sounds contribute to the sensation of loudness.
Duration and Frequency
Results from complex interactions between both ears.
Thought to be and early survival skill in the human species.
Highly dependent on phase differences.
When 2 sounds are heard at the same time, the intensity of one sound may be sufficient enough to cause the other to be inaudible; the change in the threshold of a sound caused by a sound with which it coexists.
Opposition to sound-wave transmission. It comprises frictional resistance, mass, and stiffness and is influenced by frequency.
Oppostion to a force.
Impedance is determined by what 2 factors?
Simple resistance--NOT influenced by frequency of vibration
Complex resistance (reactance)--influenced by frequency; opposition to energy varies with frequency
Contribution to total acoustic impedance provided by mass stiffness, and frequency.
Quantity of a body as measured in terms of its relationship to inertia. The weight of a body divided by its acceleration due to gravity.
As physical mass of an object or the frequency at which the object vibrates is increases, so does the ______ reactance.
As physical stiffness of an object increases, so does _________ __________. The inverse relationship happens when frequency increases, this decreases.
What 2 kinds of measurements are Audiologist interested in making?
1) Hearing ability of patients with possible hearing disorder
2) Sound pressure levels in the environment
Intensity at which a tone is barely audible.
Number of dB above/below the average normal hearing person's thresholds for different pure tones (0 dB HL).
Device for determining the thresholds of hearing. Pure tones at various frequencies are generated, and their levels are increased and decreased until thrsholds are found. Outputs may include earphones for air-conduction testing, a bone-conduction vibrator for bone-conduction testing, and one or more soudspeakers for sound-field testing.
When testing with Pure Tone Audiometer, each tone is amplified to a max of about ______ dB from ________ Hz, with less output above/below these frequencies.
Tones are ________ by using a manual dial or electronic attenuator.
ASHA recommends starting testing at _____ Hz...Dr. Vincent recommends starting testing at ________ Hz.
1000--right in the middle
Air Conduction Audiometry starts testing at 1000 Hz and ascends to higher frequency. Why at this level?
Thought to have better test reliability
Most easily heard by majority of people.
The purpose of Air Conduction Audiometry is to specify the amount of a patient's hearing sensitivity at various _________. Results can specify the _______ of loss but not the ________ of loss.
Supra-aural earphones should be checked for proper placement over the ear canal and to check for a _________ ________.
Insert earphones can be advantageous for what reasons?
Decrease need for checking placement of supra-aural earphones and collapsed canal
Decreases background noise
Difference between two tones separated by a frequency ratio of 2:1.
What is the frequency ranges tested in pure-tone testing?
Cookie bite hearing loss noted in genetic syndromes will usually be evident also by facial anomalies.
Most hearing losses are low or high
When conducting a hearing screening, what octaves/signals by an audiometer are typically tested for Air Conduction (AC)?
Mid-octaves (750, 1500, 3000, & 6000 Hz) are tested when a difference of ____ dB is noted between adjacent octaves.
What dB is quiet level noise/sound?
What dB is Conversational level sound/noise?
What type of device do you place on the patient when testing Air Conduction (AC)?
What type of device do you place on the patient when testing Bone Conduction (BC)?
Bone Conduction Oscillator
At what intensity might you begin testing an adult patient?
0, 5 or 10 dB or
30 dB & ascend/descend
& for fakers
At what intensity might you begin testing a younger child so that you are fairly certain that they will hear the tone and understand the task?
At what intensity do ASHA guidelinessay a tone must be presented to see if they respond?
30 dB HL
If a patient is presented a tone at 30 dB intensity and they do not respond what level then is presented? If still no response, by what increment level do you increase the intensity until the tone is heard?
Increase by 10 dB until heard
After presentation of tone is heard at the beginning of testing the next step is then to lower the tone by what increment level until no response is made? By what increment to you increase intensity until heard again? Why?
Down 10 / Up 5
Decrease by 10 dB
Increase by 5 dB
Threshold searching for the lowest intensity that can be heard at that frequency
Repeat threshold searching until what percent threshold criterion is met?
(2 out of 3 presentations)--Dr. Vincent
What are the advantages of using automatically pulsed tones vs. manual or continuous?
Increased awareness by patients
Tone stands out in presence of interfering ear/head noise
Warbled tones (frequency modulated) can aid in patient response (eliminate standing waves)
Graphic representation of audiometric findings showing hearing thresholds as a function of frequency.
Used to help check reliability of testing, average of the hearing levels at 3 frequencies (500, 1000, 2000 Hz) for each ear, as obtained on a pure-tone hearing test; useful for predicting the threshold for speech thereby establishing the degree of communication impact imposed by hearing loss.
Pure Tone Average (PTA)
What professional most often states hearing loss as a percentage and what are the problems with stating hearing loss in this way?
Negates the concepts of frequency and intensity
Ignores audiometric configuration and only looks at the average hearing loss
What audiogram symbol stands for the left ear and what color is it?
What audiogram symbol stands for the right ear and what color is it?
What audiogram symbol stands for unmasked bone conduction for the left ear?
What audiogram symbol stands for unmasked bone conduction for the right ear?
What audiogram letters stand for No Response (to audiometer limits)?
What audiogram letter stands for Soundfield testing?
Both ears are being tested
What audiogram letter stands for Aided Soundfield testing?
Frequency on an audiogram is shown on the _________ line and goes from ______ to _____ frequency, from ______ to _______.
Low to High Frequency
Left to Right
Intensity (dB HL) on an audiogram is shown on the ______ line and increases in intensity from _____ to ______.
Top to Bottom
Audiogram symbols are plotted after a _______ is obtained under the _______ frequency and corresponding number (dB HL).
What type of audiometry determines the patient's sensorineural sensitiviy?
Bone Conduction Audiometry
Hearing by Bone Conduction arises from what 3 phenomenon?
1. Distortional BC
2. Inertial BC
3. Osseotympanic BC
Response to a sound stimulus evoked when the skull is deformed by a bone-conduction vibrator, distorting the cochlea and giving rise to electrochemical activity within the cochlea; identical to the activity created by an AC signal. (Shearing/Movement/Vibration)
Distortional Bone Conduction
Stimulation of the cochlea caused by lag of the chain of middle-ear bones, or inner-ear fluids, when the skull is deformed, resulting in movement of the stapes in and out of the oval window.
Inertial Bone Conduction
Contribution to hearing by bone conduction created when the vibrating skull sets the air in the external ear canal into vibration, causing sound waves to oscillate/pass down the canal, impinging on the eardrum membrane, and being conducted through the middle ear to the cochlea.
Osseotympanic Bone Conduction
Why is the placement usually on the mastoid process (sometimes the forehead) in bone conduction audiometry?
BC tones are loudest from the mastoid in normal hearing persons
Proximity to the ear being tested
Testing procedure itself is similar to air conduction
In BC Audiometry, both ears must be uncovered due to increase in sound intensity when the ear is occluded (occlusion effect) and effects frequencies from ________ Hz and below.
In regard to audiogram interpretation, what type of hearing loss would be associated with:
1) Bone conductive component being WNL across all frequencies
2) Air conduction results show the loss of sensitivity
3) ABG shows difference between the air and bone conduction thresholds?
Conductive Hearing Loss
In regard to audiogram interpretation, what type of hearing loss would be associated with:
1) AC results show the TOTAL amount of loss
2) BC results show the amt of SNHL
3) ABG is 0-10 dB, showing No conductive involvement?
Sensorineural Hearing Loss
In regard to audiogram interpretation, what type of hearing loss would be associated with:
1) AC thresholds show a conductive hearing loss
2) BC thresholds show a sensorineural hearing loss
3) ABG shows a conductive component and a gap greater than 10 dB
Mixed Hearing Loss
Hearing by BC is the same by AC in individuals with normal hearing or _______.
Hearing by AC is poorer than by BC in patients with __________ or ________ hearing losses (some air bone gap).
In the presence of severe losses, it is not possible to tell whether responses obtained at the hightest limits of the audiometer in bone conduction testing are _________ or ________.
When hearing sensitivity is significantly better in one ear; the possiblility of _______ exists.
Loss of energy of a sound presented by either air conduction or bone conduction as it travels from the test ear to the nontest ear; the numer of decibels lost in cross-hearing.
Interaural Attenuation (IA)
What's the minimum interaural attenuation for AC supra-aural earphones?
What's the minimum interaural attenuation for AC insert earphones?
When the air conduction threshold of the test ear exceeds the bone conduction threshold of the nontest ear by the intraural attenuation value of _______ dB or more, we have to assume the air conduction thresholds will not be any poorer.
Crossover is always possible for BC due to the __________ positioning of the cochleas.
What's the minimum interaural attenuation for BC?
Air bone gaps over _______ dB are considered significant.
Process by which the threshold of a sound is elevated by the simultaneous introduction of another sound; delivering a noise to the nontest ear to remove it from the test.
When ___________ is suspected, the nontest ear must be removed to determine if the original responses were obtained throught the nontest ear and if they were the nontest ear responses, what are the true ________ of the test ear?
Masking of a pure tone is most effective by using ________ immediately surrounding that pure tone.
Minimum amount of noise required just to mask out a signal (under the same earphone) at a given hearing level (Ex. 40 dB EM will just mask out a 40 dB HL signal)
Effective Masking (EM)
Occurs when a masking noise presented to the nontest ear is of sufficient intensity to shift the threshold in the test ear beyond its true value; the masking noise crosses from the masked ear to the test ear by bone conduction.