Exam (elaborations)
IHS STUDY QUESTIONS AND ANSWERS RATED A+
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Exam of 52 pages for the course IHS at IHS (IHS STUDY)
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IHS STUDYCase History - answer-medical history
-lifestyle and vocational info
-impact of hearing loss on communication
-family concerns
-preferences regarding hearing instrument
Helps build report
Primary goal is to identify any issues requiring medical refferal
Red Flags - answer-Visible congenital or traumatic deformity of the outer ear
- History of active drainage from ear within last 90 days.
-History of sudden or rapidly progressing hearing loss in the last 90 days
-Acute or chronic dizziness
-Unilateral hearing loss of sudden or recent onset with in 90 days
-Audiometric air-bone gap equal to or greater than 15 db at 500, 1000, and 2000Hz
-visible evidence of significant cerumen accumulation of a foreign body in the ear canal
-Pain or discomfort in the ear
Drainage, ear pain or discomfort, dizziness/ vertigo and aural fullness sometimes
require medical clearance prior to fitting. Note if previously treated for symptoms` -
answer
Bracing (Bridge and bracing) - answerMaking the hands and the instrument become
one single unit.
-Used to prevent accidental damage or injury to the ear
pg 82 in book for description of technique
If patient comes in with an outside audiogram it is necessary to verify the audiometric
data to determine pre-fitting. - answer
The primary goal of retesting - answerto obtain accurate and comprehensive info about
the individual and the impact of the hearing loss, as well as the expectations and
attitude toward remediation options
A comprehensive hearing test inculdes - answerPure tone air and bone conduction
audiometry and a battery of speech tests that includes:
-Speech Recognition or Speech Recognition Thresholds (SRT)
-Most comfortable listening level (MCL)
-Uncomfortable Listening level (UCL)
-Word Recognition testing (WR)
-Speech in noise testing
,some may include tympanometry and acoustic reflex measures
Pre- Audiometric Assessment - answer-Case history about patients medical history as it
relates to the auditory system,
-reports about their hearing challenges,
-info concerning their lifestyle and activities.
-Self- assessment questionnaire
Audiometry - answerThe measure of hearing sensitivity.
Thresholds represent auditory acuity and are defined as the softest intensity levels at
which a patient can hear 50% of the time.
-Pure tone air "air scores" and bone conduction "bone scores" thresholds are recorded
for each ear
- this graph is called an audiogram
- The word " scores is discouraged in the context of PTA the correct term is "
Thresholds"
Speech Recognition Threshold (SRT) - answerThreshold to which uses speech as a
test signal
Threshold measurements require - answerobjective, psychophysical procedure to
determine auditory acuity.
Suprathresholds - answerthe presentation level louder than the threshold.
-WR-uses speech
-MCL-using speech
-UCL-uses pure tones, can also use speech
Word recognition - answerprovides a measure of speech understanding ability in terms
of percent correct,
-typically preformed at 40 db SL (sensation level)
-aka speech discrimination
Audiometer - answera sound generator that produces pure tones which are presented
at various frequencies and levels in order to measure thresholds and generate an
audiogram
-must be calibrated at least annually
Audiogram - answer-simple graph that displays hearing threshold levels as a function of
frequency.
-vertical lines- frequency Hz (left to right from 125 or 250 Hz to 8000Hz)
-Horizontal line- pure tones in dB hearing level (dB HL) from -10 to 110 or 120 db HL
,Octave frequencies: 250, 500,1000, 2000, 4000, and 8000 Hz.
interoctave frequencies: 750, 1500, 3000 and 6000
- The best practices require that hearing thresholds be measured for ALL octave and
interoctave audiometric frequencies...
Prescriptive fitting formulas - answertargets include octave as well as interoctave
frequencies through 6000Hz.
It is often taught that thresholds need to measured for the interoctave frequencies only
when thresholds between adjacent octaves differ by 20dB or more.
However.. since fitting targets are prescribed for audiometric frequencies and since
adherence to a standardized, consistent approach to fitting hearing instruments
increases wearer satisfaction and benefit, the recommended audiometric procedure is
to measure thresholds at octave and interoctave frequencies. SHORTCUTS not
acceptable
Octave - answerdoubling of frequencies.
- interoctave frequencies occur at the mid point of each octave.
earphones are calibrated specifically for one audiometer and can not be switched
between audiometers. - answer
Insert ear phones - answer- are recommended for audiometric testing.
-The signal travels from the audiometer to the receiver box (typically clipped to patients
clothes) via a tube.
Supra aural or circumaural earphones - answer-AKA (TDH- telephonics dynamic
Headphones)
-held in place using an adjustable headband.
-Always tilt from front to back to check that diaphragm (center) is placed over concha
Advantages of insert vs TDH - answer-greater interaural attenuation bc less sound is
leaking around the head to the other ear ad there is less earphone material touching the
head.
-better patient comfort
-better sanitation and infection control (foam used once and thrown away)
-Collapsed canals are less likely to impact threshold measures
Inserts should not be used - answer-with a patient who has very soft or liquid cerumen
or drainage could become blocked or plugged.
-patients with very small ear canals may find them uncomfortable.
Biologic check and calibration - answer-a biologic check must be preformed at the
beginning of every work day.
, Calibrations must be preformed by a technician. ANNUAL.
low frequencies are processed at the apical turn of the cochlea
high frequencies are processed at the basal turn of the cochlea - answer
Air conduction symbols are placed on the intersection of frequency tested and the
intensity that represents the thresholds.
Bone conduction is placed? - answerThe bone conduction symbols are placed to the
right or left of the frequency line next to the air conduction symbol present
Air Conduction (AC) - answeris a precise procedure that has validity, reliability and is
standardized among all hearing health care prof.
-present 1000 at 40dB , if no response go to 60dB, go in 20dB till initial response
rule to remember: if there is a response then decrease by 10dB, if there is no response
increase by 5dB "down 10, - up 5"
retesting 1000 hz` - answeris essential to establishing response constancy and
threshold reliability.
the initial rested thresholds must be in +- 5dB. (-+ 5dB is allowable variability)
(if outside, STOP, re instruct patient, and retest the test, may also be necessary to verify
transducer placement )
Bone conduction (BC) - answer- is the same for AC thresholds with few considerations.
-measure BC immediately after AC for both ears.
- start with better ear or right if no difference measure in AC
test in this order 1000, 2000, 3000, 4000 then rest 1000, 500 and 250 Hz.
-Inaccurate placement of bone oscillator is the most common cause around 500HZ
When testing start with better ear or right ear if there was no difference measured. -
answer
Masking - answerused to eliminate any participation of the non test ear (NTE) during
threshold determination of the test ear (TE).
The correct application of masking eliminates the uncertainty regarding which ear heard
the signal and allows for accurate threshold measurements
Interaural Attenuation (IA) - answerInteraural refers to "between ears"
attenuation is defined as decrease in signal intensity. IA is a decrease in signal intensity
as the sound travels intracranially through bone conduction from one cochlea to the
other .
IA values directly relate to the rules of masking:
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