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Advanced Audiometric testing

Ashkan Monfared, MD Director Otology, Neurotology George Washington University. Advanced Audiometric testing. Course Objectives. Be familiar with the use of Pure Tone Audiometry , Otoacoustic emissions, and Brainstem Auditory modalities

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Advanced Audiometric testing

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  1. Ashkan Monfared, MD Director Otology, Neurotology George Washington University Advanced Audiometric testing

  2. Course Objectives Be familiar with the use of Pure Tone Audiometry, Otoacoustic emissions, and Brainstem Auditory modalities Order appropriate audiometric testing for specific disorders Understand the interpretations of these modalities Develop appropriate medical and surgical treatment plans based on results of audiometric testing.

  3. Course Outline • Hearing loss: • Sensorineural • Conductive • Mixed • Some basics • Pure tone audio components • OAE’s • ABR • Treatment options: • Traditional hearing aids • Bone conduction hearing aids • Surgery for CHL • Surgery for SNHL • Sample cases

  4. Components of pure tone audio • Sound level: • Pure tone average • SAT (not commonly used) • Word Clarity • WRS • SRT • Tympanograms • Acoustic Reflexes

  5. Ancillary Audiology Tests From practical standpoint, all these tests are of very limited indication in most ENT practices They rarely contribute to diagnose of a disease • Hearing tests: • OAE • ABR • ECoG • Balance tests: • VEMP • VNG/ENG +/- calorics • Rotary Chair • Posturogrophy

  6. Otoacustic Emissions • OHC function • Different types: • SPOAE • TEOAE • DPOAE • Common Use: • Newborn screening • Sensory vs Neural HL • Tinnitus • Children • Non-cooperatives • Malingerers

  7. Auditory Brainstem Response • EEG response to sound • Ave responses to cancel noise • Waves I-V (ECOLI) • Common uses: • Newborn screening • Retro cochlear (Stacked ABR) • Children • Non-cooperatives • Malingerers • Intra-operative

  8. Treatment options: non-surgical • Traditional hearing aid • BTE, ITE, CIC, Lyric • CROS, BICROS • Bone conduction: • Bone anchored hearing devices • Soundbite • Hearing rehabilitation • TV ears • FM systems • Public places, looping

  9. Treatment options: Surgical • Conductive issues: • Tympanoplasty, OCR • Stapes surgery • Bone anchored hearing device • SNHL • Acoustic neuromas • Cochlear implants • ABI

  10. Advanced cases

  11. Case 1: Sudden hearing loss • 40 yr healthy woman • Can’t use phone R ear • What questions do you ask? • Symptoms: • Tinnitus • Vertigo • Pain • DDX: • CHL: URI, A/R • SNHL: ISSNHL, lyme, Syphilis, vascular, etc • RX: • Steroids (PO, IT)

  12. Case 2:Chronic ear disease • 50 yr DM man with bil hearing loss • COM • Questions: • Symptoms: • Tinnitus, vertigo • D/C, pain • RX: • Dry ear precautions • Surgery • HA’s

  13. Case 3: • 35 yr woman with gradual HL • Questions: • Symptoms: • Previous hx • FH • Tinnitus, vertigo, Tullio • DDX: • Otosclerosis • Ossicular fixation • SSCD • CNVII schwannoma • Encephaloceles

  14. Case 4: • 55 yr man prolonged MHL • Questions: • Hx • Tinnitus, vertigo • Functionality • RX: • HA • Stapedotomy • BAHA • CI

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