1. Audiological Evaluation A to Z Dr.Osama Hamed Audio-Vestibular Medicine Specialist KAUH

3. The nature of sound and hearing Stimulus: sound (sine wave)

4. MECHANICAL ELECTRICAL/SENSORY

5. 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)

6. 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

7. http://www.glenbrook. k12 .il.us/gbssci/phys/Class/sound/u11l1c.html When air molecules are displaced, pressure waves occur

8. SOUND: PRESSURE WAVE

9. Characteristics of the waveform ( amplitude x time) CYCLE : One complete period of compression and rarefaction of a sound wave

10. PERIOD : The amount of time that it takes to complete one vibratory cycle. Characteristics of the waveform ( amplitude x time)

11. FREQUENCY : The number of cycles that occur in one second.

12. 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

14. The Minimal Audible Pressure Curve (dB SPL) Indicates the minimum average sound pressure levels by frequency for a group of people with normal hearing

15. The quantity or magnitude of sound. Amplitude Intensity

16. AMPLITUDE/INTENSITY Decibel (dB): Unit of amplitude used most frequently in clinical audiology. Loudness : The psychological correlate of amplitude (measured in sones, phons).

20. 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

31. Normal Hearing

32. Conductive Hearing Loss

33. Sensorineural Hearing Loss

34. Mixed Hearing Loss

37. Shadow Curve

40. Objective Audiological Tests

45. Tympanogram Types

46. Type A Tympanogram A Normal or SN BC OE ME IE AN CNS AC

47. Type A D Tympanogram BC Disarticulation OE ME IE AN CNS AC A D

48. Type A S Tympanogram BC Otosclerosis OE ME IE AN CNS AC A S

49. Type B Low Tympanogram BC OME OE ME IE AN CNS AC B Low

50. Type B Hi Tympanogram BC Perforation OE ME IE AN CNS AC B Hi

51. Type C Tympanogram BC Eustachian Tube Dysfunction C OE ME IE AN CNS AC

53. ART

56. Reflex Decay

57. otoacoustic emissions

61. Types of OAE’s Types Spontaneous OAE’s (SPOAE’s) Distortion Product OAE’s (DPOAE’s) Transient Evoked OAE’s (TEOAE’s)

65. RESPONSE NOISE

68. TEOAE results Severe SN HL Normal hearing High frequency HL

69. TEOAE & DPOAE

71. Left Auditory cortex Right Auditory cortex Cochlea Medial geniculate nucleus Inferior colliculus Superior Olivary nucleus Ipsilateral Cochlear nucleus Auditory nerve fiber anatomy

72. Response detected SOUND IN EAR CANAL SOUND IN EAR CANAL TRAVEL THRU ME FWD COCHLEA BWD COCHLEA TRAVEL THRU ME

79. electrocochleography

82. Left Auditory cortex Right Auditory cortex Cochlea Medial geniculate nucleus Inferior colliculus Superior Olivary nucleus Ipsilateral Cochlear nucleus Auditory nerve fiber anatomy

86. auditory brainstem response

90. components Response occurs within 5-6ms after stimulus is presented

91. Generators of the ABR I II IV III VI V

92. Latency, ms

93. anatomy Distal VIIIth nerve proximal VIIIth nerve Multiple generators

95. Stimulus generator Transducer (HP) Trigger Signal averager Analog filter Differential amplifier Display/analysis

96. Example Normal Hearing 18 Month-Old – 2000 Hz Tone-Burst 70 dBnHL 10 dBnHL

98. Why use ABR testing? SCREENING FOR HEARING LOSS THRESHOLD TESTING (FREQ SPECIFIC) DIAGNOSIS OF SOME CONDITIONS

99. Left Auditory cortex Right Auditory cortex Cochlea Medial geniculate nucleus Inferior colliculus Superior Olivary nucleus Ipsilateral Cochlear nucleus Auditory nerve fiber

100. Retrocochlear lesion