This document provides an overview of auditory brainstem response (ABR) audiometry, which is a neurologic test that evaluates auditory brainstem function in response to auditory stimuli. It describes the basic procedure, physiology, and waveform components. The main applications of ABR audiometry are the identification of retrocochlear pathology and evaluation of symptoms of eighth nerve pathology. Factors that can influence ABR results are discussed, as well as findings suggestive of retrocochlear pathology and the sensitivity of ABR for detecting tumors of different sizes.
This document discusses the electroacoustic characteristics and clinical fitting techniques of hearing aids. It describes key parameters used to measure hearing aid performance such as gain, output sound pressure level (OSPL90), and frequency response. These measurements are standardized by ANSI and involve presenting specific input signals to measure the hearing aid's output. The document also discusses techniques for selecting appropriate hearing aids based on a patient's hearing loss, physical conditions, and preferences. Selection involves considering factors like circuitry, style, controls, and using trials to determine the best fitting device.
Voice therapy to treat voice disorders, basics , different techniques, methods advantages and disadvantages, where and what method to choose? otorhinolaryngology ent
This document provides guidance on performing speech audiometry tests, including speech reception threshold (SRT), word recognition score (WRS), and speech-in-noise tests. It discusses procedures for determining SRT and WRS, considerations for non-native English speakers and those with hearing loss, and the clinical significance of test results including how they can indicate site of lesion. Masking procedures are also outlined to limit interference between ears during testing.
The document discusses auditory brainstem response (ABR) testing, which is used to evaluate hearing in newborns. ABR testing uses electrodes to measure electrical activity in the brainstem in response to auditory clicks or tones. It is an effective screening tool for detecting hearing loss, with a high sensitivity and specificity. ABR testing can identify abnormalities in the auditory nerve or brainstem that may indicate conditions like acoustic neuromas. It provides objective information about hearing thresholds and neural conduction in the auditory pathway.
This document provides an overview of auditory middle latency response (AMLR) testing, including:
1. A brief history and the development of AMLR from early clinical studies to its current uses for evaluating auditory thresholds and cortical function.
2. Details on stimulus parameters like rate, intensity and transducer type that influence AMLR waveforms.
3. Descriptions of the anatomy and physiology underlying AMLR waves like Na, Pa and Pb, and how various pathologies can affect the waves.
4. Guidelines for acquisition parameters like electrodes, filtering and analysis windows to reliably detect AMLR components.
5. Factors like age, attention, drugs and medical
This document discusses the auditory steady-state response (ASSR), an auditory evoked potential used to estimate hearing thresholds. The ASSR uses modulated tones and statistical analysis to determine thresholds. It can be recorded from sleeping children and those without measurable auditory brainstem responses. While similar to ABRs, ASSRs analyze amplitude and phase in the frequency domain rather than waveform amplitude and latency. ASSRs also use repeated, modulated stimuli rather than clicks or tones. They provide more frequency-specific information and can estimate thresholds in more severe hearing losses than ABRs.
Immittance audiometry uses measurements of acoustic impedance and admittance to assess middle ear function. It is a non-invasive and non-behavioral test. Key measures include tympanometry to evaluate the mobility of the eardrum and ossicular chain, and acoustic reflex thresholds to assess the function of the middle ear muscles and brainstem pathways. Abnormal immittance test results can help diagnose conditions like middle ear fluid, ossicular discontinuity, or retrocochlear lesions.
This document discusses voice therapy for the management of benign voice disorders. It summarizes a study of 30 patients who underwent voice therapy with or without surgical procedures for conditions like vocal nodules, polyps, muscle tension dysphonia, sulcus vocalis, and others. Pre-therapy and post-therapy comparisons found improvements in voice quality ratings, patient quality of life measures, and laryngeal images. Voice therapy techniques discussed include vocal hygiene, exercises, massage, and various approaches. The study found voice therapy to be an effective non-surgical treatment for many benign voice disorders and helps prevent recurrence when used with surgery.
This document discusses the electroacoustic characteristics and clinical fitting techniques of hearing aids. It describes key parameters used to measure hearing aid performance such as gain, output sound pressure level (OSPL90), and frequency response. These measurements are standardized by ANSI and involve presenting specific input signals to measure the hearing aid's output. The document also discusses techniques for selecting appropriate hearing aids based on a patient's hearing loss, physical conditions, and preferences. Selection involves considering factors like circuitry, style, controls, and using trials to determine the best fitting device.
Voice therapy to treat voice disorders, basics , different techniques, methods advantages and disadvantages, where and what method to choose? otorhinolaryngology ent
This document provides guidance on performing speech audiometry tests, including speech reception threshold (SRT), word recognition score (WRS), and speech-in-noise tests. It discusses procedures for determining SRT and WRS, considerations for non-native English speakers and those with hearing loss, and the clinical significance of test results including how they can indicate site of lesion. Masking procedures are also outlined to limit interference between ears during testing.
The document discusses auditory brainstem response (ABR) testing, which is used to evaluate hearing in newborns. ABR testing uses electrodes to measure electrical activity in the brainstem in response to auditory clicks or tones. It is an effective screening tool for detecting hearing loss, with a high sensitivity and specificity. ABR testing can identify abnormalities in the auditory nerve or brainstem that may indicate conditions like acoustic neuromas. It provides objective information about hearing thresholds and neural conduction in the auditory pathway.
This document provides an overview of auditory middle latency response (AMLR) testing, including:
1. A brief history and the development of AMLR from early clinical studies to its current uses for evaluating auditory thresholds and cortical function.
2. Details on stimulus parameters like rate, intensity and transducer type that influence AMLR waveforms.
3. Descriptions of the anatomy and physiology underlying AMLR waves like Na, Pa and Pb, and how various pathologies can affect the waves.
4. Guidelines for acquisition parameters like electrodes, filtering and analysis windows to reliably detect AMLR components.
5. Factors like age, attention, drugs and medical
This document discusses the auditory steady-state response (ASSR), an auditory evoked potential used to estimate hearing thresholds. The ASSR uses modulated tones and statistical analysis to determine thresholds. It can be recorded from sleeping children and those without measurable auditory brainstem responses. While similar to ABRs, ASSRs analyze amplitude and phase in the frequency domain rather than waveform amplitude and latency. ASSRs also use repeated, modulated stimuli rather than clicks or tones. They provide more frequency-specific information and can estimate thresholds in more severe hearing losses than ABRs.
Immittance audiometry uses measurements of acoustic impedance and admittance to assess middle ear function. It is a non-invasive and non-behavioral test. Key measures include tympanometry to evaluate the mobility of the eardrum and ossicular chain, and acoustic reflex thresholds to assess the function of the middle ear muscles and brainstem pathways. Abnormal immittance test results can help diagnose conditions like middle ear fluid, ossicular discontinuity, or retrocochlear lesions.
This document discusses voice therapy for the management of benign voice disorders. It summarizes a study of 30 patients who underwent voice therapy with or without surgical procedures for conditions like vocal nodules, polyps, muscle tension dysphonia, sulcus vocalis, and others. Pre-therapy and post-therapy comparisons found improvements in voice quality ratings, patient quality of life measures, and laryngeal images. Voice therapy techniques discussed include vocal hygiene, exercises, massage, and various approaches. The study found voice therapy to be an effective non-surgical treatment for many benign voice disorders and helps prevent recurrence when used with surgery.
This document discusses auditory brainstem response (ABR) testing, which objectively assesses the integrity of the auditory nerve and brainstem pathways. ABR involves recording electrical potentials in response to auditory stimuli using electrodes placed on the scalp. Different wave components in the response reflect activity at different points along the auditory pathway from the auditory nerve to the brainstem. ABR is used to diagnose auditory nerve and brainstem disorders, estimate hearing thresholds, and screen for hearing loss in newborns. The document outlines the ABR procedure and interpretation of results.
ECochG is a variant of brainstem audio evoked response (ABR) where the recording electrode is placed as close as practical to the cochlea. We will use the abbreviation ECOG and ECochG interchangeably below. ECOG is preferable to us as it is shorter.
ECOG is intended to diagnose Meniere's disease, and particular, hydrops (swelling of the inner ear). ECOG may also be abnormal in perilymph fistula, and in superior canal dehiscence. The common feature connecting these illnesses is an imbalance in pressure between the endolymphatic and perilymphatic compartment of the inner ear.
ECOG can also be used to show that the cochlea is normal, in persons who are deaf. The cochlear microphonic of ECOG may be normal in auditory neuropathy (Santarelli and Arslan 2002) as well as other disorders in which the cochlea is preserved but the auditory nerve is damaged (Yokoyama, Nishida et al. 1999).
Finally, ECOG's have also been used to as a indicator of the temporary threshold shift that may follow noise injury (Nam et al, 2004).
This document discusses concepts related to loudness perception and discomfort for individuals with hearing loss. It defines key terms like dynamic range, loudness recruitment, most comfortable level, uncomfortable level, and loudness discomfort level. LDL testing involves using tones or noise to determine the level at which sounds become uncomfortably loud. LDLs measured in dB HL must be converted to dB SPL for real-ear comparison to hearing aid output, using RETSPL and RECD values. Comparing measured LDLs to real-ear saturation response can help ensure hearing aid output does not exceed discomfort levels.
This document provides information about middle ear implants (MEIs). It discusses the different types of MEIs, including piezoelectric, electromagnetic, and electromechanical designs. It also describes partial and total MEIs based on the placement of the processor. Several key advances in MEI development from the 1930s to present day are highlighted. Requirements for MEI candidacy include having a moderate to severe sensorineural or conductive hearing loss, symmetrical audiogram, and residual cochlear function.
Otoacoustic emissions are sounds produced by the inner ear and measured in the ear canal. There are four main types, including spontaneous and transiently evoked emissions produced without or in response to sound. Otoacoustic emissions are used clinically to screen hearing, estimate cochlear sensitivity, and differentiate sensory from neural hearing loss. They provide an objective, noninvasive window into cochlear function and can detect hearing losses as mild as 30-40 dB.
Acoustic immittance measurements objectively assess middle ear function using tympanometry, acoustic reflex thresholds, and acoustic reflex decay. Tympanometry involves placing a probe in the ear canal to measure how acoustic admittance changes as pressure is varied. Normal tympanograms are Type A, while abnormal types include flat (Type B), negative pressure (Type C), stiff (Type As), and flaccid (Type AD). Acoustic reflex thresholds measure the lowest level needed to elicit the stapedius muscle reflex, providing information about the middle ear, cochlea, auditory nerve and brainstem. Acoustic reflex decay tests the sustainability of the reflex over 10 seconds of continuous stimulation.
The document outlines the objectives and process for conducting a voice evaluation. The primary objective is to determine if the client has a voice disorder and evaluate symptoms. Additional objectives include patient education and establishing credibility. The evaluation should gather information on referral source, reason for referral, history of the problem, medical history, social history, and oral mechanism exam. Formal assessments include describing vocal qualities, respiratory status, and instrumental measures. The evaluator should rely on auditory perceptions over instrumentation and not make treatment recommendations without an ENT evaluation.
This document provides information about masking techniques used during audiometric testing. It defines masking and explains that the goal is to prevent the non-test ear from participating. Interaural attenuation values are discussed as well as when masking is needed for air and bone conduction tests. Types of masking noise, appropriate levels of noise, and risks of undermasking and overmasking are covered.
Otoacoustic emissions (OAEs) are sounds produced by the inner ear that can be measured in the ear canal. There are different types of OAEs including spontaneous, stimulus frequency, transient evoked, and distortion product OAEs. OAEs are believed to be generated by outer hair cells in the cochlea. Brainstem auditory evoked response (BERA) involves recording electrical activity in the brainstem in response to auditory stimuli. BERA can help identify lesions in the auditory nerve or brainstem by analyzing latencies and amplitudes of waves I-V. Abnormal findings on OAEs or BERA can indicate conditions such as acoustic neuromas or other inner
The document discusses paracusis, which refers to auditory perception disturbances other than hearing loss, and hyperacusis, an exaggerated reaction to ordinary sounds, providing neurological conditions associated with hyperacusis such as migraine and depression. It also examines theories of hyperacusis related to serotonin dysfunction and plasticity in the central auditory system due to sensory deprivation from hearing loss.
Universal Neonatal Hearing Screening (UNHS) enables early detection of deafness within 48 hours of birth, allowing for earlier intervention before language development is significantly impacted. While some argue screening should only target high-risk infants, studies show 50 cases of hearing impairment per 100,000 low-risk infants, indicating all newborns should be screened. Accepted screening methods include otoacoustic emissions testing, which is quick and minimally invasive, and auditory brainstem response testing, which is more sensitive but more complex. An effective UNHS program must include initial screening, evaluation of abnormal results, tracking and follow-up to ensure appropriate intervention by 6 months of age.
Intra-operative monitoring during cochlear implant surgery provides important information to assess device function and proper electrode placement. Key aspects of monitoring include impedance measures to check for abnormalities, ECAP recordings to confirm device function, and X-rays or C-arm imaging to visualize electrode array position. Monitoring aids in detecting issues immediately and preserving any residual hearing. Remote monitoring allows audiologists to oversee testing from a separate location for more efficient use of time.
Recent advances have expanded cochlear implant candidacy criteria in several ways:
(1) Younger pediatric patients down to 12 months can now receive implants, as early implantation leads to better language outcomes. (2) Adults who gain limited benefit from hearing aids and have speech recognition scores below 50% are candidates. (3) Patients with residual low-frequency hearing may be candidates for hybrid cochlear implants and hearing aids. New technologies continue to broaden candidacy and improve outcomes for patients.
Auditory neuropathy spectrum disorder (ANSD) is characterized by normal outer hair cell function but abnormal or absent auditory brainstem response, despite mild to profound hearing loss. A 27-year-old female presented with right-sided hearing loss, vertigo, and tinnitus for several years. Testing found normal outer hair cell function but abnormal auditory brainstem responses, consistent with progressive ANSD. Treatment options for ANSD are limited but may include hearing aids, cochlear implants, or speech therapy depending on the severity and progression of the hearing loss.
This document discusses hearing impairment and cochlear implants. It provides background on a 3-year-old male patient who was born with profound sensorineural hearing loss and was approved for cochlear implantation. The document covers topics like types of hearing loss, impact of hearing loss, who is a candidate for cochlear implants, how implants work, the surgery, and factors that influence success. It emphasizes that cochlear implants are effective for severe-to-profound deafness and require a multidisciplinary team approach including programming, therapy, and parental commitment post-surgery.
This document discusses assessment of hearing through various tests and examinations. It provides information on:
1) Key facts about prevalence of hearing loss globally and projections for 2050 from WHO data.
2) Components of patient history taking and examinations for hearing assessment, including audiometric tests like pure tone audiometry and impedance audiometry.
3) Interpretation of audiometry results and how to identify types of hearing loss like conductive, sensorineural, and mixed based on air and bone conduction thresholds.
Otoacoustic emissions (OAEs) are low-intensity sounds generated by the inner ear that can be measured in the ear canal. There are two main types - spontaneous OAEs which occur without external stimulation, and evoked OAEs which are elicited by presenting a sound stimulus. Evoked OAEs include transient evoked OAEs from clicks and distortion product OAEs from two simultaneous tones. OAEs are produced by the electromechanical activity of outer hair cells and reveal the integrity of cochlear amplification. Their presence indicates normal hearing, while absence suggests sensorineural hearing loss.
The document discusses various strategies used in cochlear implants to transmit sound information to deaf recipients. Early single-channel implants could only transmit loudness and rate information, while modern multi-channel implants can transmit both place-pitch and temporal information using multiple electrodes along the cochlea. Advanced strategies now analyze sound into frequency bands and selectively stimulate electrodes corresponding to bands with the most energy to provide better frequency resolution.
This document discusses various techniques used to assess hearing, including pure tone audiometry using an audiometer, air conduction versus bone conduction testing, and the types and causes of different hearing losses. It also covers tympanometry to evaluate middle ear function and auditory brainstem response testing to evaluate hearing at the brainstem level.
This document discusses instrumentation used to measure auditory evoked potentials, specifically auditory brainstem response audiometry (ABR). It describes the aims of ABR testing, including diagnosing auditory impairment in newborns and assessing neurologic disorders of the cochlear nerve. The document outlines the basic procedures for ABR testing, including acoustic click stimulation and placement of recording electrodes. It also discusses normal latencies and waves seen in ABR responses and how variables like age, gender and temperature can influence results.
This document discusses auditory brainstem response (ABR) testing, which objectively assesses the integrity of the auditory nerve and brainstem pathways. ABR involves recording electrical potentials in response to auditory stimuli using electrodes placed on the scalp. Different wave components in the response reflect activity at different points along the auditory pathway from the auditory nerve to the brainstem. ABR is used to diagnose auditory nerve and brainstem disorders, estimate hearing thresholds, and screen for hearing loss in newborns. The document outlines the ABR procedure and interpretation of results.
ECochG is a variant of brainstem audio evoked response (ABR) where the recording electrode is placed as close as practical to the cochlea. We will use the abbreviation ECOG and ECochG interchangeably below. ECOG is preferable to us as it is shorter.
ECOG is intended to diagnose Meniere's disease, and particular, hydrops (swelling of the inner ear). ECOG may also be abnormal in perilymph fistula, and in superior canal dehiscence. The common feature connecting these illnesses is an imbalance in pressure between the endolymphatic and perilymphatic compartment of the inner ear.
ECOG can also be used to show that the cochlea is normal, in persons who are deaf. The cochlear microphonic of ECOG may be normal in auditory neuropathy (Santarelli and Arslan 2002) as well as other disorders in which the cochlea is preserved but the auditory nerve is damaged (Yokoyama, Nishida et al. 1999).
Finally, ECOG's have also been used to as a indicator of the temporary threshold shift that may follow noise injury (Nam et al, 2004).
This document discusses concepts related to loudness perception and discomfort for individuals with hearing loss. It defines key terms like dynamic range, loudness recruitment, most comfortable level, uncomfortable level, and loudness discomfort level. LDL testing involves using tones or noise to determine the level at which sounds become uncomfortably loud. LDLs measured in dB HL must be converted to dB SPL for real-ear comparison to hearing aid output, using RETSPL and RECD values. Comparing measured LDLs to real-ear saturation response can help ensure hearing aid output does not exceed discomfort levels.
This document provides information about middle ear implants (MEIs). It discusses the different types of MEIs, including piezoelectric, electromagnetic, and electromechanical designs. It also describes partial and total MEIs based on the placement of the processor. Several key advances in MEI development from the 1930s to present day are highlighted. Requirements for MEI candidacy include having a moderate to severe sensorineural or conductive hearing loss, symmetrical audiogram, and residual cochlear function.
Otoacoustic emissions are sounds produced by the inner ear and measured in the ear canal. There are four main types, including spontaneous and transiently evoked emissions produced without or in response to sound. Otoacoustic emissions are used clinically to screen hearing, estimate cochlear sensitivity, and differentiate sensory from neural hearing loss. They provide an objective, noninvasive window into cochlear function and can detect hearing losses as mild as 30-40 dB.
Acoustic immittance measurements objectively assess middle ear function using tympanometry, acoustic reflex thresholds, and acoustic reflex decay. Tympanometry involves placing a probe in the ear canal to measure how acoustic admittance changes as pressure is varied. Normal tympanograms are Type A, while abnormal types include flat (Type B), negative pressure (Type C), stiff (Type As), and flaccid (Type AD). Acoustic reflex thresholds measure the lowest level needed to elicit the stapedius muscle reflex, providing information about the middle ear, cochlea, auditory nerve and brainstem. Acoustic reflex decay tests the sustainability of the reflex over 10 seconds of continuous stimulation.
The document outlines the objectives and process for conducting a voice evaluation. The primary objective is to determine if the client has a voice disorder and evaluate symptoms. Additional objectives include patient education and establishing credibility. The evaluation should gather information on referral source, reason for referral, history of the problem, medical history, social history, and oral mechanism exam. Formal assessments include describing vocal qualities, respiratory status, and instrumental measures. The evaluator should rely on auditory perceptions over instrumentation and not make treatment recommendations without an ENT evaluation.
This document provides information about masking techniques used during audiometric testing. It defines masking and explains that the goal is to prevent the non-test ear from participating. Interaural attenuation values are discussed as well as when masking is needed for air and bone conduction tests. Types of masking noise, appropriate levels of noise, and risks of undermasking and overmasking are covered.
Otoacoustic emissions (OAEs) are sounds produced by the inner ear that can be measured in the ear canal. There are different types of OAEs including spontaneous, stimulus frequency, transient evoked, and distortion product OAEs. OAEs are believed to be generated by outer hair cells in the cochlea. Brainstem auditory evoked response (BERA) involves recording electrical activity in the brainstem in response to auditory stimuli. BERA can help identify lesions in the auditory nerve or brainstem by analyzing latencies and amplitudes of waves I-V. Abnormal findings on OAEs or BERA can indicate conditions such as acoustic neuromas or other inner
The document discusses paracusis, which refers to auditory perception disturbances other than hearing loss, and hyperacusis, an exaggerated reaction to ordinary sounds, providing neurological conditions associated with hyperacusis such as migraine and depression. It also examines theories of hyperacusis related to serotonin dysfunction and plasticity in the central auditory system due to sensory deprivation from hearing loss.
Universal Neonatal Hearing Screening (UNHS) enables early detection of deafness within 48 hours of birth, allowing for earlier intervention before language development is significantly impacted. While some argue screening should only target high-risk infants, studies show 50 cases of hearing impairment per 100,000 low-risk infants, indicating all newborns should be screened. Accepted screening methods include otoacoustic emissions testing, which is quick and minimally invasive, and auditory brainstem response testing, which is more sensitive but more complex. An effective UNHS program must include initial screening, evaluation of abnormal results, tracking and follow-up to ensure appropriate intervention by 6 months of age.
Intra-operative monitoring during cochlear implant surgery provides important information to assess device function and proper electrode placement. Key aspects of monitoring include impedance measures to check for abnormalities, ECAP recordings to confirm device function, and X-rays or C-arm imaging to visualize electrode array position. Monitoring aids in detecting issues immediately and preserving any residual hearing. Remote monitoring allows audiologists to oversee testing from a separate location for more efficient use of time.
Recent advances have expanded cochlear implant candidacy criteria in several ways:
(1) Younger pediatric patients down to 12 months can now receive implants, as early implantation leads to better language outcomes. (2) Adults who gain limited benefit from hearing aids and have speech recognition scores below 50% are candidates. (3) Patients with residual low-frequency hearing may be candidates for hybrid cochlear implants and hearing aids. New technologies continue to broaden candidacy and improve outcomes for patients.
Auditory neuropathy spectrum disorder (ANSD) is characterized by normal outer hair cell function but abnormal or absent auditory brainstem response, despite mild to profound hearing loss. A 27-year-old female presented with right-sided hearing loss, vertigo, and tinnitus for several years. Testing found normal outer hair cell function but abnormal auditory brainstem responses, consistent with progressive ANSD. Treatment options for ANSD are limited but may include hearing aids, cochlear implants, or speech therapy depending on the severity and progression of the hearing loss.
This document discusses hearing impairment and cochlear implants. It provides background on a 3-year-old male patient who was born with profound sensorineural hearing loss and was approved for cochlear implantation. The document covers topics like types of hearing loss, impact of hearing loss, who is a candidate for cochlear implants, how implants work, the surgery, and factors that influence success. It emphasizes that cochlear implants are effective for severe-to-profound deafness and require a multidisciplinary team approach including programming, therapy, and parental commitment post-surgery.
This document discusses assessment of hearing through various tests and examinations. It provides information on:
1) Key facts about prevalence of hearing loss globally and projections for 2050 from WHO data.
2) Components of patient history taking and examinations for hearing assessment, including audiometric tests like pure tone audiometry and impedance audiometry.
3) Interpretation of audiometry results and how to identify types of hearing loss like conductive, sensorineural, and mixed based on air and bone conduction thresholds.
Otoacoustic emissions (OAEs) are low-intensity sounds generated by the inner ear that can be measured in the ear canal. There are two main types - spontaneous OAEs which occur without external stimulation, and evoked OAEs which are elicited by presenting a sound stimulus. Evoked OAEs include transient evoked OAEs from clicks and distortion product OAEs from two simultaneous tones. OAEs are produced by the electromechanical activity of outer hair cells and reveal the integrity of cochlear amplification. Their presence indicates normal hearing, while absence suggests sensorineural hearing loss.
The document discusses various strategies used in cochlear implants to transmit sound information to deaf recipients. Early single-channel implants could only transmit loudness and rate information, while modern multi-channel implants can transmit both place-pitch and temporal information using multiple electrodes along the cochlea. Advanced strategies now analyze sound into frequency bands and selectively stimulate electrodes corresponding to bands with the most energy to provide better frequency resolution.
This document discusses various techniques used to assess hearing, including pure tone audiometry using an audiometer, air conduction versus bone conduction testing, and the types and causes of different hearing losses. It also covers tympanometry to evaluate middle ear function and auditory brainstem response testing to evaluate hearing at the brainstem level.
This document discusses instrumentation used to measure auditory evoked potentials, specifically auditory brainstem response audiometry (ABR). It describes the aims of ABR testing, including diagnosing auditory impairment in newborns and assessing neurologic disorders of the cochlear nerve. The document outlines the basic procedures for ABR testing, including acoustic click stimulation and placement of recording electrodes. It also discusses normal latencies and waves seen in ABR responses and how variables like age, gender and temperature can influence results.
Auditory brainstem responses are generated by the
activity in structures of the ascending auditory
pathways that occurs during the first 8–10 ms
after a transient sound such as a click sound has
been applied to the ear.
This document provides information about brainstem evoked response audiometry (BERA), including:
- BERA objectively assesses the auditory system from the cochlea to the brainstem without requiring a conscious response.
- Stimuli elicit electrical potentials that are recorded via electrodes on the scalp. Peaks in the waveform correspond to structures in the auditory pathway.
- BERA is used to detect hearing loss, locate lesions, and assess auditory function in infants and patients who cannot respond consciously. Abnormal latencies or amplitudes can indicate lesions in specific parts of the auditory system.
- Threshold testing determines the lowest intensity at which peak V is present to estimate hearing threshold.
Evoked potentials and their clinical applicationfizyoloji12345
The document summarizes evoked potentials (EPs), which are electrical responses recorded from the brain or sensory pathways in response to stimulation. It discusses the three main types of EPs used clinically - auditory, visual, and somatosensory EPs. For each type, it describes the stimulation methods, recording techniques, clinical applications in diagnosis and monitoring, and how EPs provide objective assessment of sensory pathway function.
Auditory Brainstem Response (ABR) testing can screen for deafness or hearing loss in high-risk infants. It allows for early diagnosis and rehabilitation to reduce disability. ABR relies on external sound stimuli and measures electrical activity in the brainstem. It is useful for assessing hearing, even in infants. While clicks excite the entire cochlea, ABR responses mainly represent activity between 2,800-4,000 Hz. ABR can also screen newborns and is a valuable objective measure of hearing.
The Auditory Brainstem Response (ABR) test can screen for deafness or hearing loss in infants, allowing for early diagnosis and rehabilitation. The ABR measures electrical activity in the brainstem in response to clicks or tones. It is useful for objectively assessing hearing thresholds in adults and children, including infants. The ABR provides a screening tool for identifying deafness in newborns and high-risk infants.
Hearing tests like Rinne's test, Weber's test, and audiometry are used to evaluate hearing function and determine the cause of any impairment. Rinne's test compares bone conduction to air conduction, while Weber's test identifies whether a sound is louder on one side. Audiometry precisely measures hearing levels at different frequencies and can distinguish between conductive and sensorineural hearing loss based on bone conduction results.
Audiometry class by Dr. Kavitha Ashok Kumar MSU MalaysiaKavitha Ashokb
1. Pure tone audiometry is an objective test that measures air and bone conduction thresholds to evaluate the type and severity of hearing loss. It is helpful for documentation and diagnosis.
2. Impedance audiometry objectively measures middle ear function through tympanometry and acoustic reflex testing. It can detect middle ear pathologies and is a fast screening test.
3. Otoacoustic emissions are sounds originating from the cochlea that can help diagnose cochlear hearing loss through an objective, noninvasive test done in both children and adults.
This document discusses the assessment of both peripheral and central auditory function. It describes tests used to evaluate the peripheral auditory system including pure tone audiometry, speech audiometry, and otoacoustic emissions. It also discusses tests of central auditory processing such as the staggered spondaic word test, speech-in-noise test, and masking level difference test. The document emphasizes the importance of a multidisciplinary approach involving otologists, speech pathologists, and audiologists in evaluating both peripheral hearing and central auditory processing.
The document outlines various diagnostic tests used to evaluate ear function, including:
- Otoscopic examination to visually examine the ear canal and eardrum
- Whispered speech test and pure tone audiometry to test hearing ability
- Tympanogram, auditory brain stem response testing, and electronystagmography to evaluate middle ear and vestibular system function
- Additional tests include MRI, CT scans, and laboratory tests to further investigate causes of hearing or balance issues.
This document provides an overview of brainstem auditory evoked potentials (BAEPs). It discusses the history and development of BAEPs, the auditory pathway, stimulation and recording techniques, waveform identification, and clinical interpretation. Some key points:
- BAEPs evaluate the ear, auditory nerve, and brainstem pathways using electrodes on the scalp to record responses to click stimuli.
- Short-latency waves I-V arise from specific structures along the ascending auditory pathway from cochlear nerve to inferior colliculus.
- Stimulation is typically with clicks at 10-20 Hz through headphones, with masking of the contralateral ear. Recordings analyze responses over 10 ms.
-
Pure tone audiometry (PTA) is used to measure hearing thresholds through pure tones. It involves testing air conduction (AC) and bone conduction (BC) thresholds separately for each ear at different frequencies to determine the type and severity of hearing loss. PTA is done in a soundproof room using an audiometer to present tones through headphones for AC and a vibrator for BC. The results are plotted on an audiogram. PTA can identify conductive, sensorineural, and mixed hearing losses based on the thresholds and air-bone gap. It is useful for diagnosis, treatment monitoring, and hearing aid selection. Masking of the non-tested ear is sometimes needed to avoid cross-hearing.
Anatomy of Ear and BERA with its technical aspects. by Murtaza. March 2015.Murtaza Syed
BAEPs (Brainstem Auditory Evoked Potentials) assess the function of the auditory pathways by measuring the brain and brainstem's response to acoustic nerve stimulation. The responses originate from multiple sources along the auditory nerve, brainstem, and possibly higher structures. Wave V is considered the most reliable peak for interpretation as it has the lowest threshold, highest amplitude, and represents activity in the entire peripheral to central pathway. BAEPs are used to evaluate conditions affecting the auditory system like acoustic neuromas and multiple sclerosis.
Here are the comments on the hearing in the following cases:
1. Positive Rinne in each ear & Weber test referred equally to each ear:
- This indicates symmetrical hearing in both ears with normal hearing or bilateral equally reduced sensorineural hearing loss.
2. Negative Rinne on right & Weber referred to right:
- This suggests conductive hearing loss in the right ear.
3. Negative Rinne on left & Weber referred to left:
- This suggests conductive hearing loss in the left ear.
4. Negative Rinne bilaterally & Weber referred to left:
- This indicates conductive hearing loss in both ears, but worse in the left ear.
5.
The document provides an overview of audiological evaluation techniques, including:
1. Behavioral tests like play audiometry and pure tone audiometry that measure hearing sensitivity. Objective tests like ABR, OAEs, and electrocochleography are used for infants and difficult to test patients.
2. Middle ear assessment tools like tympanometry and acoustic reflex testing evaluate the function of the middle ear.
3. Evoked potential tests like ABR, ECochG and OAEs assess cochlear and neural hearing function without depending on behavioral responses. ABR in particular provides threshold information and can detect neurological abnormalities.
Similar to Auditory brainstem response audiometry overview, physiology, applications (20)
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
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Auditory Brainstem Response Audiometry
Updated: Mar 10, 2017
Author: Neil Bhattacharyya, MD; Chief Editor: Arlen D Meyers, MD, MBA more...
OVERVIEW
Overview
Auditory brainstem response (ABR) audiometry is a neurologic test of auditory brainstem function
in response to auditory (click) stimuli. First described by Jewett and Williston in 1971, ABR
audiometry is the most common application of auditory evoked responses. Test administration and
interpretation is typically performed by an audiologist. This article provides an overview of the test
and its most common applications. For purposes of clarity and brevity, specialized ABR techniques
and more technical issues have been omitted.
ABR audiometry refers to an evoked potential generated by a brief click or tone pip transmitted
from an acoustic transducer in the form of an insert earphone or headphone. The elicited waveform
response is measured by surface electrodes typically placed at the vertex of the scalp and ear
lobes. The amplitude (microvoltage) of the signal is averaged and charted against the time
(millisecond), much like an EEG. The waveform peaks are labeled IVII. These waveforms
normally occur within a 10millisecond time period after a click stimulus presented at high
intensities (7090 dB normal hearing level [nHL]). (See image below.)
Normal adult auditory brainstem response (ABR) audiometry waveform response.
Although the ABR provides information regarding auditory function and hearing sensitivity, it is not
a substitute for a formal hearing evaluation, and results should be used in conjunction with
behavioral audiometry whenever possible.
Physiology](https://image.slidesharecdn.com/auditorybrainstemresponseaudiometryoverviewphysiologyapplications-170403110315/85/Auditory-brainstem-response-audiometry-overview-physiology-applications-1-320.jpg)
![Auditory brainstem response (ABR) audiometry typically uses a click stimulus that generates a
response from the basilar region of the cochlea. The signal travels along the auditory pathway from
the cochlear nuclear complex proximally to the inferior colliculus. ABR waves I and II correspond to
true action potentials. Later waves may reflect postsynaptic activity in major brainstem auditory
centers that concomitantly contribute to waveform peaks and troughs. The positive peaks of the
waveforms reflect combined afferent (and likely efferent) activity from axonal pathways in the
auditory brain stem.
In the United States, the waveforms are typically plotted with the vertex site electrode in the
positive voltage input of the amplifier, resulting in I, III, and V wave peaks. In other countries, the
waves are plotted with a negative voltage.
Waveform components
Wave I
The ABR wave I response is the farfield representation of the compound auditory nerve action
potential in the distal portion of cranial nerve (CN) VIII. The response is believed to originate from
afferent activity of the CN VIII fibers (firstorder neurons) as they leave the cochlea and enter the
internal auditory canal.
A study by Lin et al indicated that in the assessment of ABR in patients with idiopathic sudden
sensorineural hearing loss (ISSNHL), wave I latency is significantly associated with hearing
outcomes, with a trend toward prolongation found between patients with complete hearing
recovery and those experiencing only slight recovery. [1]
A study by Bramhall et al indicated that in persons with normal puretone auditory thresholds,
those with a history of greater noise exposure tend to have smaller ABR wave I amplitudes at
suprathreshold levels. The study included military veterans exposed to high levels of military noise
and nonveterans with a history of firearm use, as well as veterans and nonveterans with less
noise exposure. Suprathreshold ABR measurements were made at 1, 3, 4, and 6 kHz, using
alternating polarity tone bursts, with the ABR wave I amplitudes at suprathreshold levels being
smaller at all four frequencies in the highnoiselevel groups. The amplitude differences between
the groups could not be attributed to either sex or outer hair cell function variability. The
investigators could not confirm whether the differences were due to synaptopathy without
postmortem temporal bone examination. [2]
Wave II
The ABR wave II is generated by the proximal VIII nerve as it enters the brain stem.
Wave III
The ABR wave III arises from secondorder neuron activity (beyond CN VIII) in or near the
cochlear nucleus. Literature suggests wave III is generated in the caudal portion of the auditory
pons. The cochlear nucleus contains approximately 100,000 neurons, most of which are
innervated by eighth nerve fibers.
Wave IV
The ABR wave IV, which often shares the same peak with wave V, is thought to arise from pontine
thirdorder neurons mostly located in the superior olivary complex, but additional contributions may
come from the cochlear nucleus and nucleus of lateral lemniscus.
Wave V
Generation of wave V likely reflects activity of multiple anatomic auditory structures. The ABR
wave V is the component analyzed most often in clinical applications of the ABR. Although some](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)