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Electroneuronography
Physiologic Measures 2
30
Audiology
Graduate
11/26/2018

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Term
History:
-Became a common clinical practice since about ___  
-AKA ___ nerve evoked response  
-Truly a ___ muscle response recording in response to stimulation of ___ nerve  
-Part of the scope of practice according to ___ and ___  
-Profession has evaluated facial nerve response since ___ ___ testing
Definition
1980; facial; facial; facial; AAA; ASHA; acoustic reflex
Term
Does the patient need to be sedated?
Definition
No
Term
Does state of arousal influence the results?
Definition
No
Term
Is averaging required?
Definition
Little to none
Term
Analysis is based on ___
Definition
symmetry (test both sides of the face)
Term
Reliability and validity depend a large part on ___ and ___ of tester
Definition
experience; technique
Term
House-Brackman Clinical Grading Sytem-Mild Dysfunction:
-___ weakness
-___ tone and symmetry at rest
-Eye ___
-Slight ___ asymmetry
Definition
Slight; Normal; closure; mouth
Term
House-Brackman Clinical Grading Sytem-Moderate Dysfunction: -Obvious ___ between sides -___ symmetry at rest -Eye closure with ___ -Eye closure with ___ ___
Definition
difference; Normal; effort; maximum effort
Term
House-Brackman Clinical Grading Sytem-Moderately-Severe Dysfunction:
-Obvious ___ and disfiguring ___
-___ symmetry and tone at rest
-___ eye closure
Definition
weakness; asymmetry; Normal; Incomplete
Term
House-Brackman Clinical Grading Sytem-Severe Dysfunction:
-Barely perceptible ___
-___ at rest
-___ eye closure
Definition
motion; Asymmetry; Incomplete
Term
House-Brackman Clinical Grading Sytem:
Characterized by no movement
Definition
Total paralysis
Term
What are the 6 House-Brackman Clinical Grading Scales?
Definition
1. Normal
2. Mild Dysfunction
3. Moderate Dysfunction
4. Moderately-Severe Dysfunction (IV)
5. Severe Dysfunction (V)
6. Total Paralysis (VI)
Term
What are some ways of testing the facial nerve?
Definition
This test, EMG, acoustic reflexes, maximal nerve stimulation tests, and blink reflex test
Term
Indicate two methods for assessing facial nerve function are within the scope of practice for audiologists
Definition
ART and electroneuronography
Term
Indicate in which segment of the facial nerve damage is most likely to occur and result in Bell’s palsy
Definition
Stylomastoid foramen
Term
Portions of the Facial Nerve:
-Each facial nerve contains some ____ fibers  
-___ of fibers are motor  
-___ of fibers are sensory (aka nervous intermedius)  
-About __ of nerve fibers need to intact and functioning for normal facial nerve function
Definition
10,000; 2/3; 1/3; ½
Term
What are the 3 types of facial nerve injuries?
Definition
Neuropraxia, axonotmesis, and neurotmesis
Term
What is the most common facial nerve injury?
Definition
Neuropraxia
Term
Neuropraxia:
-Associated with ___ ___  
-Patient experiences paralysis ___ nerve degeneration  
-___ or ___ ENoG response  
-Nerve fibers and sheath ___  
-Patient cannot move facial muscles ___  
-Usually reverses ___ over time
Definition
Bell’s Palsy; without; Normal; reduced; intact; voluntarily; spontaneously
Term
Axonotmesis:
-____ of nerve fibers despite an intact outer casing
-ENoG measurement will yield ___ ___ response
Definition
Disruption; no detectable
Term
Neurotmesis:
-Most ___ facial nerve outcome
-Represents a total anatomic ___ of the nerve; it's no longer ___
-ENoG waveform ___
-Prognosis for return of function is ___
Definition
serious; separation; intact; flatline; poor
Term
Wallerian degeneration:
-Occurs approximately ___ hours after facial nerve injury  
-Process of ___ of neural fibers  
-Relatively ___ process  
-Occurs from ___ to ___ anatomy  
-May get ___ negative responses in early hours of Bell’s palsy onset  
-Important to wait until ___ hours post onset prior to ENoG
Definition
72; degeneration; slow; proximal; distal; false; 72
Term
What are some instructions for the patient for this test?
Definition
Some wires will be taped to your face near the nose and mouth. Stimulation will be applied just behind the ear in order to test the facial nerve. You will feel a quick tapping sensation, but after a few minutes the feeling will decrease. Sit comfortably and tell me if you experience excessive discomfort at any time during the procedure
Term
Stimulus Parameters:
-Transducer: ___ electrode or prong
-Type: ____
-Site: ___ ___
-Mode: ___
-Duration: ___ ms
-Rate: __ per second
-Laterality: ___
-Intensity: ___ to ___ mA
Definition
disc; electrical; stylomastoid foramen; continuous; .2; 1; unilateral; 15-40
Term
Acquisition Parameters:
-Electrode sites: ___ ___
-Positive electrode: ___
-Negative electrode: ___ region of nose
-Amplification: X___ or less
-Filter settings: ___ to ___ Hz
-Analysis time: ___ ms
-Prestimulus baseline: ___ ms
-Number of sweeps: <___
-Response analysis: compare amplitude ___ to ___
-Anesthesia: Relevant?
Definition
Nasolabial fold; mouth; Alar; 5000; 3-5000; 30; 1; 20; side to side; No
Term
What does the waveform look like with paralysis?
Definition
Flat
Term
What wave are you looking at and what should it look like?
Definition
P1 and robust
Term
What are 9 potential causes of facial nerve paralysis?
Definition
-Idiopathic Bell’s palsy  
-Temporal bone injury  
-Herpes zoster oticus (aka Ramsay-Hunt syndrome)  
-Otitis media with or without cholesteatoma  
-Neoplasia (tumor)  
-Congenital facial paralysis (Treacher-Collins syndrome)  
-Central nervous system disorder (stroke)  
-Guillan-Barre syndrome  
-Melkersson-Rosenthal syndrome
Term
Progression of symptoms in Bell's Palsy:
-___ tendency for onset  
-Site of lesion most often at narrowest region of ___ canal
-Onset of unilateral paralysis develops within __ to ___ hours  
-Wallerian degeneration occurs within __-__ hours  
-Recovery complete for __-__% beginning within 3 weeks of onset  
-__% of patients have residual weakness  
-__% of patients have severe or total paralysis  
-May recur in __-__% of patients
Definition
Familial; fallopian; 24 to 48; 48-72; 75-80; 15; 5; 7-10
Term
Incidence of Bell's Palsy is ___ to ___ per 100,000 depending on geographic location
Definition
13 to 18
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