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Audiological Evaluation   A  to  Z  Dr.Osama Hamed Audio-Vestibular Medicine Specialist KAUH
AUDIOLOGY ,[object Object],[object Object],[object Object],[object Object],[object Object]
The nature of sound and hearing Stimulus:  sound (sine wave)
MECHANICAL ELECTRICAL/SENSORY
SOUND Sound is a form of  vibration Vibration  is the to-and-fro motion of an object (guitar string, vocal folds, diaphragm on an earphone or loudspeaker, tuning fork)
For sound to occur, must have a  SOURCE :  Something has to be  disturbed. FORCE :  Something has to disturb it. MEDIUM  (e.g. air):  Something has to  carry  the disturbances. SOUND
http://www.glenbrook. k12 .il.us/gbssci/phys/Class/sound/u11l1c.html When air molecules are displaced, pressure waves occur
SOUND:  PRESSURE WAVE
Characteristics of the waveform  ( amplitude x time) CYCLE :   One complete period of compression and rarefaction of a sound wave
PERIOD :  The amount of time that it takes to complete one vibratory cycle. Characteristics of the waveform  ( amplitude x time)
FREQUENCY :   The number of cycles that occur in one second.
FREQUENCY Hertz (Hz) :  Unit of measurement of frequency Pitch :  Psychological percept of frequency.  100 cycles per second = 100 Hz e.g., low frequency sounds = low pitch
Frequency Range of Hearing Sensitivity ,[object Object],[object Object],[object Object],[object Object]
The Minimal Audible Pressure Curve (dB SPL) Indicates the minimum average sound pressure levels by frequency for a group of people with normal hearing
The quantity or magnitude of sound. Amplitude Intensity
AMPLITUDE/INTENSITY Decibel (dB):   Unit of amplitude used most frequently in clinical audiology. Loudness :  The psychological correlate of amplitude (measured in sones, phons).
 
Hearing loss prevention ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Types of Tests ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Age based hearing assessment BEHAVIOURAL OBJECTIVE BIRTH TODDLER SCHOOL-AGED + Need to   consider individual’s functional age Request responses Observe responses Measure responses Condition responses BOA VROA PLAY AUDIOMETRY PURE TONE AUDIOMETRY
Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Behavioural Observation Audiometry (BOA) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infants 7 months-3 years ,[object Object],[object Object],[object Object],[object Object],[object Object]
Visual Reinforcement Oreintation Audiometry (VROA) ,[object Object],[object Object],[object Object]
Play audiometry 3-9 years ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Screening with Play Audiometry ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pure Tone Audiometry ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pure Tones ,[object Object],[object Object],[object Object],[object Object]
Assessment of thresholds ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ranges of Hearing Loss ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Normal Hearing
Conductive Hearing Loss
Sensorineural Hearing Loss
Mixed Hearing Loss
Speech Audiometry ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Masking ,[object Object],[object Object],[object Object],[object Object]
Shadow Curve
Clinical Masking cont. ,[object Object]
Plateau method ,[object Object],[object Object]
Objective Audiological Tests
Electrophysiological Tests ,[object Object],[object Object],[object Object]
Immittance ,[object Object],[object Object],[object Object],[object Object]
Ear Canal Volume ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tympanometry ,[object Object],[object Object]
Tympanogram Types
Type A Tympanogram A Normal or SN BC OE ME IE AN CNS AC
Type A D  Tympanogram BC Disarticulation OE ME IE AN CNS AC A D
Type A S  Tympanogram BC Otosclerosis OE ME IE AN CNS AC A S
Type B Low  Tympanogram BC OME OE ME IE AN CNS AC B Low
Type B Hi  Tympanogram BC Perforation OE ME IE AN CNS AC B Hi
Type C Tympanogram BC Eustachian Tube Dysfunction C OE ME IE AN CNS AC
Static Compliance (Peak Compliance) ,[object Object],0.2 0.9 Flaccid:  disarticulation, flaccid TM, etc. Normal mobility Stiff:  otosclerosis  fluid, tympanosclerosis, etc . 1.4 0.3 Child Adult
ART
Acoustic Reflex Threshold ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical application of ASR ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Reflex Decay
otoacoustic emissions
Background ,[object Object],[object Object],[object Object]
Otoacoustic Emissions ,[object Object],[object Object],[object Object]
Purpose of OAE’s ,[object Object],[object Object],[object Object],[object Object],[object Object]
Types of OAE’s Types Spontaneous OAE’s (SPOAE’s) Distortion Product  OAE’s (DPOAE’s) Transient Evoked  OAE’s (TEOAE’s)
Spontaneous OAE’s ,[object Object],[object Object],[object Object],[object Object]
Distortion Product OAE’s ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DPOAEs ,[object Object],[object Object]
RESPONSE NOISE
Transient Evoked OAE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
TEOAE results Severe SN HL Normal hearing High frequency HL
TEOAE & DPOAE
Recording OAE’s ,[object Object],[object Object]
Left Auditory cortex Right Auditory cortex Cochlea Medial geniculate nucleus Inferior colliculus Superior Olivary nucleus Ipsilateral Cochlear nucleus Auditory nerve fiber anatomy
Response detected SOUND IN EAR CANAL SOUND IN EAR CANAL TRAVEL THRU ME FWD COCHLEA BWD COCHLEA TRAVEL THRU ME
OAEs ,[object Object],[object Object],[object Object]
Types of OAEs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Evoked OAEs ,[object Object],[object Object],[object Object],[object Object],[object Object]
Acquisition ,[object Object],[object Object]
clinical applications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
clinical limitations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
electrocochleography
history ,[object Object],[object Object],[object Object]
components ,[object Object],[object Object],[object Object],[object Object]
Left Auditory cortex Right Auditory cortex Cochlea Medial geniculate nucleus Inferior colliculus Superior Olivary nucleus Ipsilateral Cochlear nucleus Auditory nerve fiber anatomy
stimulus & acquisition ,[object Object],[object Object],[object Object],[object Object],[object Object]
clinical applications ,[object Object],[object Object],[object Object]
clinical limitations ,[object Object],[object Object],[object Object],[object Object],[object Object]
auditory brainstem response
history ,[object Object],[object Object],[object Object],[object Object]
What is an ABR? ,[object Object]
How is an ABR recorded? ,[object Object],[object Object]
components Response occurs within 5-6ms after stimulus is presented
Generators of the ABR I II IV III VI V
Latency, ms
anatomy Distal VIIIth nerve proximal VIIIth nerve Multiple generators
stimulus & acquisition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Stimulus generator Transducer (HP) Trigger Signal averager Analog filter Differential amplifier Display/analysis
Example Normal Hearing 18 Month-Old – 2000 Hz Tone-Burst 70 dBnHL 10 dBnHL
clinical applications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Why use ABR testing? SCREENING FOR HEARING LOSS THRESHOLD TESTING (FREQ SPECIFIC) DIAGNOSIS OF SOME CONDITIONS
Left Auditory cortex Right Auditory cortex Cochlea Medial geniculate nucleus Inferior colliculus Superior Olivary nucleus Ipsilateral Cochlear nucleus Auditory nerve fiber
Retrocochlear lesion

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