1. AUDIOLOGY IN ORL DR. BANDAR MOHAMMED AL- QAHTANI, M.D KSMC

2. 2 Tympanic mem & Ossicular Amplification 22:1 in total 1.3:1 maleus to incus (lever action) 17 :1 TM surface to stapes footplate problem in transmission leads to CHL

3. 3 Anatomy of hearing organ THE COCHLEA

4. 4 Traveling wave & Tonotopic organization High frequency at base and low frequency at apex problem inside the cochlea transmission leads to SNHL

5. 5 Auditory Assessment Clinical vs audiometric tests Clinical vs audiometric tests Clinical : Clinical : - finger friction - finger friction - watch test - watch test - speech test - speech test - tuning fork test - tuning fork test

6. 6 Audiometric tests : Audiometric tests : subjective vs objective tests subjective vs objective tests - pure tone audiometry - pure tone audiometry - speech audiometry - speech audiometry - impedance audiometry - impedance audiometry a-tympanometry a-tympanometry b-acoustic reflex b-acoustic reflex

7. 7 Anatomy

8. 8 Audiometric Assessment Audiometric Assessment Pure Tone Audiometry Pure Tone Audiometry Speech Audiometry Speech Audiometry Acoustic Immittance (impedance test ) Acoustic Immittance (impedance test ) Auditory Brainstem Responses Auditory Brainstem Responses Electrocochleography Electrocochleography Otoacoustic Emissions Otoacoustic Emissions

9. 9 Pure Tone Audiometry Most common,subjective test Most common,subjective test Air conduction testing Air conduction testing Frequencies 125,250,500,1000,2000,4000,8000 HZ Bone conduction testing Bone conduction testing 250,500,1000,2000,4000 HZ 250,500,1000,2000,4000 HZ

10. 10 Pure tone audiometry

11. 11 USES USES As baseline test (pre op and post op) As baseline test (pre op and post op) To differentiate the conductive vs sensorineural pathway To differentiate the conductive vs sensorineural pathway The degree of handicap or heaing loss and which frequencies The degree of handicap or heaing loss and which frequencies

12. 12 Crossover Audiometric results are only valid when the results are actually of the test ear. Audiometric results are only valid when the results are actually of the test ear. Interaural attenuation reflects crossover. Interaural attenuation reflects crossover. Air conduction from 40-80dB Air conduction from 40-80dB Bone conduction Bone conduction even at 0dB even at 0dB

13. 13 Masking The audiometric technique used to eliminate responses by the non-test ear. The audiometric technique used to eliminate responses by the non-test ear. An appropriate noise is presented to the non-test ear while the test ear is being tested. An appropriate noise is presented to the non-test ear while the test ear is being tested. Masking level must exceed the non-test ear threshold, but not create crossover. Masking level must exceed the non-test ear threshold, but not create crossover.

14. 14 Speech Audiometry Determines how well a person hears and understands speech,subjective test. Determines how well a person hears and understands speech,subjective test. Spondee words Spondee words SRT 50% of spondees SRT 50% of spondees SRT should be in close correlation with PTA +- 10 db of PTA. SRT should be in close correlation with PTA +- 10 db of PTA. Discrimination score (DS) (90-100% in normal or conductive Discrimination score (DS) (90-100% in normal or conductive DS is 60-70 in sensory hearing loss DS is 60-70 in sensory hearing loss

15. 15 DS -( normal,CHL, COCHLEAR &RETROCOCH ROLLOVER )

16. 16 USES -malingerer patients -for fitting Hearing Aids -for cochlear implant patients -to differentiate cochlear than retro-cochlear lesion USES -malingerer patients -for fitting Hearing Aids -for cochlear implant patients -to differentiate cochlear than retro-cochlear lesion

17. 17 Acoustic Immittance Impedance: resistance to acoustic flow,objective test Impedance: resistance to acoustic flow,objective test Admittance: ease of acoustic flow Admittance: ease of acoustic flow Tested by: Tested by: Tympanometry Tympanometry Acoustic Stapedial Reflex Acoustic Stapedial Reflex

18. 18 Tympanometry by Jerger

19. 19 A normal between 100-(-100) A normal between 100-(-100) As stiff type otosclerosis or stiff TM. As stiff type otosclerosis or stiff TM. Ad flaccid type ossicular discontinuity Ad flaccid type ossicular discontinuity B flat –fluid in ME or thick TM B flat –fluid in ME or thick TM C more in negative –retracted TM C more in negative –retracted TM

20. 20 Acoustic Stapedial Reflex to elicit a stapedial muscle contraction, objective test. 3 primary acoustic reflex characteristics 3 primary acoustic reflex characteristics Presence or absence of the reflex Presence or absence of the reflex Reflex threshold Reflex threshold Reflex Decay Reflex Decay It tests VIII,brain stem,VII It tests VIII,brain stem,VII Good for screening in infants and malingerer Good for screening in infants and malingerer

21. 21 Acoustic Reflex Decay Measures the ability of the stapedius muscle to maintain sustained contraction. Measures the ability of the stapedius muscle to maintain sustained contraction. Lower frequency tone/noise for 10 seconds Lower frequency tone/noise for 10 seconds

22. 22 Facial Paralysis Absent or abnormal stapedial reflex when the recording probe is ipsilateral to the side of the lesion. Absent or abnormal stapedial reflex when the recording probe is ipsilateral to the side of the lesion. Can also be helpful in locating lesions proximal or distal to the stapedial muscle. Can also be helpful in locating lesions proximal or distal to the stapedial muscle.

23. 23 Eighth nerve lesions Absent reflexes when stimuli is presented to the affected ear. Absent reflexes when stimuli is presented to the affected ear. Reflexes in eighth nerve lesions are not dependent on the degree of hearing loss. Reflexes in eighth nerve lesions are not dependent on the degree of hearing loss. Rapid reflex decay Rapid reflex decay

24. 24 Auditory Brainstem Responses Impulses that are generated by the auditory neural pathway that can be recorded on the scalp. Impulses that are generated by the auditory neural pathway that can be recorded on the scalp. objective test objective test Not affected by sleep, sedation, or attention. Not affected by sleep, sedation, or attention.

25. 25 Bone Conduction ABR As reliable and repeatable as air conduction ABR. As reliable and repeatable as air conduction ABR. Particularly useful in structural abnormalities Particularly useful in structural abnormalities Canal Atresia or stenosis Canal Atresia or stenosis

26. 26 ABR Primary goal is a clear and reliable Wave I Primary goal is a clear and reliable Wave I Wave I : distal 8 th nerve Wave I : distal 8 th nerve Wave II : proximal 8 th nerve Wave II : proximal 8 th nerve Wave III : cochlear nuclei Wave III : cochlear nuclei Wave IV : SOC Wave IV : SOC Wave V : Lateral Lemniscus Wave V : Lateral Lemniscus

27. 27 ABR

28. 28 Otoacoustic Emissions Low energy sounds produced by the cochlear outer hair cells,objective test. Cochlear amplification. Cochlear amplification. Spontaneous emissions Spontaneous emissions Not present in greater than 25dB hearing loss. Not present in greater than 25dB hearing loss. Evoked Emissions Evoked Emissions Transient evoked Transient evoked Distorted Product Distorted Product

29. 29 OAE and middle ear pathology Transmission properties of the middle ear directly influence the OAE characteristics. Transmission properties of the middle ear directly influence the OAE characteristics. Otitis media Otitis media Newborns Newborns Tympanic membrane perforations Tympanic membrane perforations

30. 30 ANY QUESIONS