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Pediatric Audiology
BYU - Dr. Blair--ComD 442
124
Other
Undergraduate 4
02/12/2009

Additional Other Flashcards

 


 

Cards

Term
quasi-resonant nuclei
Definition
non-crying vowel-like sounds with brief consonant-like elements during feeding or response to smiling
Term

Birth- 2 mo.

Comm Dev - Lang 

Definition
-suck-swallow rhythmic pattern
-reflexive sounds (fuss, cry, burp, swallow)
-quasi-resonant nuclei
-cries (hunger, pain and temper)
Term
hunger cry 
Definition
loud crying pattern, silence, whistling inhalation and rest.
Term
pain cry
Definition
one long cry followed by a long breath-holding and short whimpers
Term
temper cry
Definition
exasperated sound because of the great volume of air released
Term

Birth - 2 mo

Comm Dev - Hearing 

Definition
-middle/inner ear are adult size
-ME still fluid-filled
-Auditory cortex not mature
-still can't integrate sounds
-can distinguish loudness and duration of sound 
Term

Birth - 2 mo

dB levels & response

Definition
-Preference to human voice.
-0-6 wks: responds to noise 50-80 dB SPL
-Warbled pure tones: 75 hB HL
-Speech:40-60 hB HL
 
Response: eye widening, eye blink, stirring or arousal from sleep, startle. 
Term

2 - 6 mo.

Comm Dev - Lang 

Definition
-oral muscle control to stop/start movement (2 mo)
-production of back consonants and middle/back vowels--incomplete resonance (2 mo)
-vocalization in response to speech (3 mo)
-sustained laughter (4 mo)
-imitate a few sounds, tone & pitch (5 mo) 
Term
babbling
Definition
imitation of sounds, tone and pitch immediately after a vocal model
Term

2 - 6 mo

dB & Response 

Definition
-Pure tone (in noise): 90 dB
-Pure tone (in silence): 50-70 dB SPL 
-Warbled tone: 70 dB HL
-Speech: 20 dB HL
 
Response:
-startled (0-4 mo)
-turn head toward sound on lateral plane (3-6 mo)
Term
reduplicated babbling
Definition
long strings of consonant-vowel syllable repetitions or self-imitations
Term
echolalia speech
Definition
imitate immediate communication of others
Term
jargon
Definition
long strings of unintelligible sounds with adult-like prosodic patterns
Term

6 - 12 mo

Comm Dev - Lang 

Definition
-single syllable sounds (6-7 mo)
-experiments with reduplicated babbling (6-7 mo)
-begins echolalia speech (7-8 mo)
-use gestures to communicate w/out vocalization (8-9 mo)
-beginnings of jargon (9 mo)
-recognize own name, speaks one+ words (12 mo) 
Term

7 - 9 mo

dB & Response 

Definition
-Noise: 30-40 dB SPL
-Warbled pure: 45 dB HL
-Speech: 15 dB HL
 
Response:
-direct localization of sounds to the side (but not above or below) 
Term

9 - 12 mo

dB & Response 

Definition
-Noise: 25-35 dB HL
-Warbled pure: 40 dB HL 
-Speech: 10 dB HL
 
Response:
-Direct localization of sounds to side and below (+ indirectly above). 
Term

12 - 24 mo

Comm Dev - Lang 

Definition
-single words/jargon for speech
-dev combine words
-rate of vocab growth increases
-expressive vocab of 150-300 words 
Term

13 - 16 mo

dB & Response 

Definition
-Noise: 25-30 dB HL
-Warbled tone: 30 dB HL
-Speech: 5 dB HL
 
Response:
-Direct localization of sound on the side,above and below. 
 
Term

16 - 21 mo

dB & Response 

Definition
-Noise: 25 dB HL
-Warbled tone: 25 dB HL
-Speech: 5 dB HL
 
Response:
-Direct localization of sound on side, above and below. 
Term

21 - 24 mo

dB & Response 

Definition
-Noise: 25 dB HL
-Warbled tone: 25 dB HL
-Speech: 5 dB HL
 
Response:
Direct localization of sound on side, above and below.
(by 24 mo. VRA can be used for clinical testing). 
 
Term

VRA

(Visual Reinforcement Audiometry) 

Definition
Conditioning the child to a connection between an auditory signal and a flashing lighted toy. The reinforcement is the lighted toy and social praise during the test.
Term

3 yrs

Comm Dev - Lang 

Definition
-expressive vocab 900-1000 words
-mastered vowel sounds
-subject-verb-object sentences
-begin to use negation
-learning to use -ing and -ed
-beginning to formulate lang rules
 
Term

3 yrs old

Comm Dev - Hearing 

Definition
-remains constant after 2 yrs
-can be taught play-conditioning techniques for play audiometry
-VRA can still be used 
Term

4 yrs old

Comm Dev - Lang 

Definition
-simple stories
-more complex sentences
-ave vocab of 1500-1600 words
-4-5word sentences
-relates events in order
-use of conjunctions
-good usage of declative, negative, interrogative and imperative forms
 
Term

3 yrs old

Comm Dev - Hearing 

Definition
-can be clinically tested through TROCA
 
Term
TROCA
Definition
auditory stimulus cues the child that a behavior specific response (such as pushing a button) will immediately produce a positive and tangible reinforcement (such as food or a trinket)
Term

5 yrs old

Comm Dev - Lang 

Definition
-Vocab of 2100-2200 words
-Discusses feelings
-Can follow 3-step command
-90% grammar acquisition
-language more adult-like
-still has difficulty with a few consonant blends 
Term

5 yrs old

Comm Dev - Hearing 

Definition
-can still use TROCA to test these children clinically
-Play Audiometry
-can do adult testing/screening 
Term
acute
Definition
condition characterized by rapid onset usually of short duration
Term
effusion
Definition
liquid or fluid
Term
eustachian tube
Definition
channel that runs between the middle ear cavity and the nasopharynx (aka auditory tube)
Term
myringoplasty
Definition
a surgical procedure that is used to seal a perforation of the tympanic membrane
Term
myringotomy
Definition
an incision made into the tympanic membrane generally to alleviate pressure, allow fluid to drain, or to place pressurization tubes
Term
otitis media
Definition

-infection or inflammation of the middle ear cavity or the tympanic membrane

-characterized by presence of negative middle ear pressure or possible effusion 

 

Term
otorrhea
Definition
any discharge from the external auditory canal due to infection
Term
otalgia
Definition
ear pain
Term
PE tubes
Definition
pressure equalizing tubes
Term
serous effusion
Definition
sterile, waterlike fluid in the middle ear
Term
suppurative
Definition
pus-producing sore
Term
tympanoplasty
Definition
blanket term for any surgery of the middle ear or tympanic membrane to restore hearing function
Term
tympanosclerosis
Definition
calcium formations in the middle ear or on the TM because of otitis media
Term
general categories of OM
Definition
-OM without effusion
-acute OM
-OM with effusion
-OM with perforation of the TM 
Term
duration classifications
Definition
-acute: short duration (0-21 days)
-subacute: 22 days-8 weeks
-chronic: more than 8 weeks 
Term
effusion classifications
Definition
-serous: thin,sterile, watery fluid (no infection)
-purulent: pus-like fluid
-mucoid: think, mucus-like fluid 
Term
cause of OM
Definition
OM is nearly always the result of poor Eustachian tube function (often associated with upper respiratory infections).
Term
functions of Eustachian tube
Definition
1. protection in middle ear from invading microbes
2. clearance of middle ear secretions
3. equalization of pressure between middle ear cavity and nasopharynx 
Term
child vs. adult Eustachian tubs
Definition
-child: horizantal
-adult: more vertical 
Term

tonsils/adenoids

what?

where?

associated with OM by? 

Definition
-what? glandular tissue
-where? in the back of the throat
-association? may contribute infection to OM if adenoids/tonsils are infected 
Term
Risk Factors of OM
Definition
1. Age (before 2 yrs)
2. Gender (boys)
3. Race (Native Amer, Eskimos, White, over black).
4. Genetics (70% hereditary)
5. Socioeconomic (poor sanitation, overcrowding)
6. Seasonal (more prone in winter) peak = March
7. Eating position (supine = more OM)
8. Special Pop. (syndromes, diff facial structures)
9. Allergies & Smoke (if more susceptible to allergy)
10. Daycare (being exposed to other children) 
Term
possible symptoms of OM
Definition
1. Otalgia
2. Rubbing or tugging of ears
3. Hearing impairment
4. Otorrhea
5. Fever
6. Temperament disorders - irritability
7. Restless sleep
8. Low-grade discomfort 
Term
Diagnosis of OM
Definition
-TM may appear yellow or red (19% of time will be red)
-Fever (67% will have one)
-Pain (28% will have it)
-Tympanometry (will not +/- pressure or if there is fluid--flat tympanogram)
-Hearing evaluation 
Term
Treatment of OM
Definition
-Do nothing
-Prescription antibiotics (augmentin/zithromax) 
-Myringotomy
    -without PE tubes
    -with PE tubes
Term

Possible Treatment of OM

(initial, 3 mo, 4-6 mo, recurrent) 

Definition
-initial management: observation or perscribed antibiotics
-3 mo: -hearing test loss <20 db may continue IM
          ->20db: antibiotics/PE tubes
-4-6 mo: -PE tubes are placed
-recurrent OM: PE tubes are placed (make sure lang/artic/hearing/tymp screenings happen) 
Term
Treatments NOT recommended for OM
Definition
-Steroid medications (perscribed for sudden sensorineural hearing loss)
-Antihistamine/decongestant medications (may recommend for relieving symptons)
-Adenoidectomy (not a treatment/cure)
-Tonsillectomy (not a treatment/cure) 
Term
Complications associated with OM
Definition
-Hearing loss
-Perforated TM
-TM retraction
-Cholesteatoma
-Mastoiditis
-Adhesive OM
-Tympanosclerosis
-Ossicular discontinuity
-Facial paralysis
-Labyrinthitis
-Meningitis 
-Encephalitis
-Brain abscess
-Sinus thrombosis 
Term
cholesteatoma
Definition
growth that can errode bone
Term
mastoiditis
Definition
infection of the mastoid bone
Term
adhesive OM
Definition
thickening of the TM
Term
Labyrinthitis
Definition
infection of inner ear/balance system
Term
Meningitis
Definition
infection of meninges (lining of the brain)
Term
Encephalitis
Definition
infection of the brain
Term
Brain Abscess
Definition
accumulation of pus-like fluid that can errode brain
Term
Sinus thrombosis
Definition
bloodclot of the sinuses
Term
OM effects on Speech & Lang Dev
Definition
-Lang Delay (receptive/expressive)
-Cognition (lower IQ scores)
-Auditory Processing Disorderes (may have difficulty processing sound) 
Term
Responsibilities of Parents
Definition
-Talk to children (expose them to more language)
-Look at child (visual cues)
-Control distance (no further than 5 ft)
-Loudness (a little bit louder --not yelling)
-Be a speech model (enunciate & correctly articulate)
-Play and talk
-Read (make associations with sounds/words/pictures) 
Term
3 parts of auditory system
Definition
1. conductive system
2. sensory system
3. neural system 
Term
conductive system
Definition

responsible for the transduction of airborne acoustic energy into mechanical energy

 

anatomical structures

-pinna, EAC, TM, ossicles 

Term
congenital malformations of the external ear/EAC
Definition

1. Anotia

2. Atresia

3. Stenosis

4. Microtia

5. Supernumerary hillocks 

Term
anotia
Definition
complete absence of pinna
Term
atresia
Definition
complete closing off of the ear canal
Term
stenosis
Definition
narrowing of the ear canal
Term
microtia
Definition
abnormally small ear (unilateral)
Term
supernumerary hillocks (ear tags)
Definition
extra skin tags near pinna
Term
Disorders associated with hearing loss
Definition
-Auditory Discharge
-Perforations of the TM
-Bony Growths
-Inflammatory Conditions 
Term
Types of Aural Discharge
Definition
1. Serumen (wax)
2. Clear fluid discharge
3. Otorrhea (cloudy fluid)
4. Blood (from perforation/trauma)
5. Foreign bodies (ie beans) 
Term
Types of Bony Growths
Definition
1. Multiple Growths (exostoses--grows fast, needs to be surgically removed)
2. Osteoma - single growth in EAC
Term
Inflammatory Conditions
Definition
1. Otitis Externa (swimmer's ear--pain, discomfort, itch)
2. perichondritis (wrestler's ear--inflammation of the skin covering the cartilage of the pinna)
3. Furuncle (pimple--can occur around the ear or in canal) 
Term
Conductive System best Assessed by:
Definition
-Visual inspection (otoscopy)
-Tympanometry 
Term
Tympanometry measures
Definition
1. TM mobility
2. Middle Ear pressure (+/-)
3. Static Compliance (how well does sound travel)
4. Patency of ear tubes (still open & functioning)
5. Ear canal volume (range of normal limits) 
Term
Components of Static Compliance
Definition
-mass: ossicles
-friction: muscles & ligaments supporting ossicular chain (hopefully little friction)
-stiffness: footplate of stapes at oval window (needs to be able to move in and out to start current in cochlea) 
Term
Congenital Malformations of the Middle Ear
Definition
-occur with anomalies like atresia, cleft palate, microtia, etc
-abnormalities
-fusion
-absence of ossicles 
Term
Disorders Associated with Hearing Loss
Definition

-OM

-Cholesteatoma

-Otosclerosis (70% hereditary;prevalent in white women)

 

Term
Schwartze
Definition
rosy glow seen through eardrum because of new bony growth in ossicular chain (sign of otosclerosis)
Term
Carhart's Notch
Definition
200 Hz, BC worse than AC (one excetpion for BC better than AC on audiogram)
Term
Types of Tympanograms
Definition
1. Type A ( normal)
2. Type B (flat)
3. Type As (shallow peak)
4. Type C (shallow, negative pressure)
5. Type Ad (disarticulation of ossicles, flaccid ear drum) 
Term
Type A
Definition
Term
Type B
Definition
Term
Type As
Definition
Term
Type C
Definition
Term
Type Ad
Definition
Term
Pediatric Norms for Tymp Results
Definition
-Ear Canal volume (.3 - 1.5)
-Static Immittance (.2 - 1.05)
-Pressure (-139 - +20) 
Term
acoustic reflex
Definition
-may be used to assess conductive system
-serves as an important cross check of findings
-AR normal: 80-85 dB
-AR absent with a conductive or sensorineural hearing loss 
Term
Sensory System
Definition

responsible for the transduction of mechanical energy into electrical energy

 

anatomical structures:

-cochlear and VIIIth nerve 

Term
Congenital Malformation of the Inner Ear
Definition
-Almost always congenital
-Aplasia
    -Michel aplasia
    -Mondini aplasia
    -Scheibe aplasia 
Term
aplasia
Definition
the failure of any system, organ, nerve, etc to reach full development
Term
michel aplasia
Definition

complete failure of inner ear and auditory nerve development

 

-pinna normal, malleus/incus present, usually stapes absent/abnormal

-thalidomide a cause in 1950's used in pregnancy to treat morning sickness 

-bilateral 

Term
mondini aplasia
Definition

incomplete development or malformation of the inner ear

 

-ME, EAC anomalies seen as well

-unilateral or bilateral

-flattening of cochlear & only a single turn

-affects auditory nerve and vestibular

-Rare 

Term
scheibe aplasia
Definition

degeneration of the inner ear

 

-most common

-involves the membranous portion of IE: sacule,  cochlea, organ of corti, strivascularus, tectoral membrane

-attacking inner ear

-usually associated with syndromes (rubella) 

Term
Disorders Associated with Hearing Loss
Definition
1. Meningitis
2. TORCH
        Toxoplasmosis
        Other bacterial infections (syphilis)
        Rubella virus or German Measles
        CMV (cytomegalovirus)
        Herpes Simpex Virus
3. Ototoxicity
4. Genetics or Hereditary Hearing Loss
 
Term
Meningitis
Definition
-inflammation/infection of the meninges of the brain
-1/3 of survivors will have hearing loss
-Sensorineural hearing loss
-Mild to profound, bilateral, symmetrical, irreversible
-ABR (diagnosis)
Term

TORCH

T = Toxoplasmosis 

Definition
-Parasitic infection (can be fatal)--most common
-child infected by mother
-may cause premature birth, cerebral palsy, blindness, mental retardation, hydrocephaly, microcephaly, deafness
-newborns may appear normal but will show signs later on in childhood 
Term

TORCH

O = Other bacterial infections, including syphilis 

Definition
-Syphilis = STD, mother may not be aware
-Mother transfer it to unborn child
-May cause CNS abnormalities--including hearing loss
-Bilatereal, symmetrical, severe-profound hearing loss
-Problems manifested before 2 yrs for severe cases
-Most cases won't manifest until 20-30 yrs
-Treatment: strong antibiotics for syphilis (hearing aid/cochlear implant not very successful)
 
Term

TORCH

R = Rubella Virus or German Measles 

Definition
-viral infection transmitted through air
-transmitted through air & mother to child
-90% will have problems if contract rubella in first 11 weeks
-50% incidence of hearing loss
-other concerns: heart disease, cataracts/glaucoma, neromoter development delays
-hearing loss may be present at birth or appear later in life
-IMMUNIZATIONS ARE KEY 
Term

TORCH

C = CMV or cytomegalovirus 

Definition
-most common virus infection at birth; not infectious, not affecting carrier
-Infected by: infants through mother or poast-nasally
-Other concerns: mild to profound, bi/unilateral, progressive, hearing loss; problems with dev of CNS, motorfunction problems, mentally handicapped
-No treatment (hope through mother's possible antibodies). 
Term

TORCH

H = Herpes Simplex Virus 

Definition
-Types: Coldsores; Genital (STD--more common and most serious for child if mother has first outbreak during pregnancy)
-Transmission to child through birth process or through breast feeding
-50% mortality rate
-If they live, skin lesions, infections affecting all major organs of the body (including hearing loss) 
Term
Ototoxicity
Definition
1. Aminoglycosides
2. Chemotherapy drugs
3. Aspirin and quinine
4. Loop Diuretics 
Term
Aminoglycosides
Definition
-Drugs administered to children and adults to save their lives
-ie Kanamycin, neomycin 
-Causes hearing loss: mild to profound
-FACTORS: amount of drug, how long drug is administered, weight of child, combinations with other medications 
Term
Chemotherapy drugs
Definition
-Cisplatin, carboplatin (permanent hearing loss)
-Given specifically for brain tumors
 
Term
Aspirin & quinine
Definition
-Usually temporary hearing loss
-Hearing threshold full or partially reverses when medication is stopped
-Permanent hearing loss very rare
-Quinine treats malaria
-(Sign)Tinnitus: ringing in ears 
Term
Loop Diuretics
Definition
-Alone may cause hearing loss, but when combined with other meds may cause ototoxicity
-Furosemide and ethacrynic acid
-Give for types of kidney impairments
-Stays in the body for longer 
Term
Genetics or Hereditary Hearing Loss
Definition
Patterns of Inheritance
-Autosomal Dominant -Homozygous
        -50% chance of inheritance
-Auosomal Recessive -Heterozygous
        -25% chance of being affected
        -50% chance of being a carrier
-Sex linked X-linked
        -50% daughters carriers
        -50% sons affected
-Polygenic
Term
Sensory System best assessed by:
Definition
-Audiogram (hearing threshold and speech threshold)
-Otoacoustic emissions 
Term
Otoacoustic emissions
Definition
-measure of out hair cell function
-one of the best methods for identifying cochlear hearing loss
-need to see OAE in 3 of 5 tested frequencies 
Term
Presence of OAEs suggest:
Definition
-very little nor no conductive hearing loss
-reflects normal outer hair cell function
-in the presence of sensorineural hearing loss indicates normal outer hair cell function 
Term
Absence of OAEs suggests:
Definition
-does not eliminate the possibility of a cochlear or retrocochlear loss
Term
Neural System
Definition

responsible for the transmission of the electrical impulses throughout the PNS and CNS

 

anatomical structures:

-all neural structures of auditory system 

Term
Neural system best assessed by:
Definition
-temporal and processing aspects of audition
-brain imaging
-auditory evoked potentials
-functional MRI 
Term
Auditory Evoked Potentials
Definition
1. Electrocochleography (ECog)
2. Auditory Brainstem Response (ABR)
3. Auditory Middle Latency Response (AMLR)
4. Auditory Late Response (ALR)
5. P300 
Term
ECoG
Definition
-Electrocochleography
-LATENCY: 1.5 - 2 MSEC
-Patients can sleep during procedure
-Uses different amplitudes to diagnose Meniere's Disease or auditory neuropathy
-If present, should have OAEs
-Potentials:
    P - summating potential (gen by inner hair cells)
    AP - action potential (gen by distal portion of VIIInerve)
    CM - cochlear microphonic (Wave I of ABR)- gen by outer hair            cells
Term
ABR
Definition
-LATENCY: 2-10 MSEC
-Patients can sleep during procedure
-Normal: Amplitudes increase as intensity level decreases as latency increases.
-Peaks I, III, V (robust responses)
-Used as screening procedure; can do specific freq ABR to estimate freq thresholds for infants/mentally handicapped
-generated between 8th nerve and the medial geniculate bodies in the brainstem 
Term
ALMR
Definition
-LATENCY: 12-60 MSEC
-Patients need to be awake.
-Can be used to esimate thresholds like ABR (would not use for infants or challenging patients)
-Generated in auditory thalamus and the primary auditory cortex 
Term
ALR
Definition
-LATENCY: 75-200 MSEC
-Generated at auditory cortex specifically at the Sylvian fissure and the superior temporal plane of the temporal bone
-Used to document high level central auditory dysfunction
-Can pin down cite of lesion
-Used for reading disorders
-Used to diagnose and validate treatments 
Term
P300
Definition
-LATENCY: 220-600 MSEC (generally 300msec)
-Used to assess high level auditory processing
-Generated in the hippocampus (medial temporal lobe) 
Term
Disorders of the Neural System of Infants & Children
Definition
-Auditory Processing Disorder
-Auditory Neuropathy
-General Hearing Loss 
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