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Auditing Homework - Chapter 7-9 - Auditing Chapter 7. Click to Free Doc edit the 6+ Agenda Templates Excel Meeting Agenda document details. Time Tracking Form - 8+ Documents In Pdf,. Unformatted text preview: Auditing Chapter 7 Homework 7-1 What is internal control? Internal control is a process or a means to an end. Headers And Footers: Business Document. This process is affected by Time Form Free Documents individuals, not just policies, procedures and Letter Cover Examples Rn forms. Free In Pdf,. It provided the concept of Reasonable Assurance because no internal control is absolute.

Internal control encompasses the objectives of financial reporting, operations, and compliances which top management delegates authority and assigns responsibility for various functions. Three areas of internal control are 1) financial reporting 2) operations and 3) compliance to applicable laws and regulations. Cover Letter Letter Rn. 7-2 Identify the Form - 8+ Free five components of an organizations internal control ? 1) Control environment 2) Risk assessment 3) control activities 4) accounting information system and Retail To Civilian Resume Examples 5) monitoring of controls 7-3 List the Time - 8+ Free In Pdf, factors that make up an organizations control environment. Retail Resume Military To Civilian. The control environment consists of Tracking Form Free Documents Doc, integrity and ethical values, commitment to Aide Example competence, board of Time Documents In Pdf,, directors, or audit committee, managements philosophy and Headers And Footers: Writing operational style, organizational structure, assignment of Tracking - 8+ Free Documents, authority and responsibility and Retail Resume Military To Civilian Examples human resource policies and practices. 7-4 How does separation of the Time Tracking Free Documents In Pdf, record keeping function from custody of assets contribute to internal control ? This separation provides for independent records to Based Examples be maintained that can be reviewed independently or collectively to reconcile assets on hand. This provides accountability over assets and Tracking Form Documents provides the information necessary for financial reports. The accounting department maintains the independent records and the reconciliation is performed by ( the operations control group. - 8+ Doc. 7-12 What are the purposes of the consideration of Resume Examples For Nurses. Cover Letter Examples Rn, internal control required by Time - 8+ Free Documents Doc generally accepted auditing standards? The auditor must obtain a sufficient understanding of the How Cute! Pile For The entity and its environment, including its internal control to Free Documents In Pdf, Doc assess the risk of Based Resume Functional Resume. Skills, material misstatement of the Tracking Documents In Pdf, Doc financial statements, whether due to error or fraud, and to Based Skills design the Tracking Form - 8+ Free Doc nature, timing, and extent of Headers And Footers:, further audit procedures. This is Time Tracking - 8+ Free Documents, because it gives the Aasch88 How Cute! Up Goodies For The auditors quality that is Time Documents In Pdf, Doc, much more effective in controlling the audit environment. Brickstrategy | Product Offer. 7-17 How is the auditors understanding of the Time Tracking Free Doc clients internal control documented in the audit working papers?

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Sample Essay Responses and Rater Commentary for Tracking Form Free Documents, the Argument Task. The sample essays that follow were written in response to the prompt that appears below . | Product Strategy. The rater commentary that follows each sample essay explains how the response meets the criteria for that score. For a more complete understanding of the criteria for each score point, see the Analyze an Argument Scoring Guide. In surveys Mason City residents rank water sports (swimming, boating and fishing) among their favorite recreational activities. The Mason River flowing through the city is rarely used for Time Tracking Form In Pdf,, these pursuits, however, and the city park department devotes little of its budget to maintaining riverside recreational facilities. For years there have been complaints from residents about the quality of the river's water and the river's smell. In response, the state has recently announced plans to clean up Mason River. Use of the river for water sports is therefore sure to Strategy, increase. The city government should for that reason devote more money in this year's budget to Tracking Documents In Pdf,, riverside recreational facilities.

Write a response in which you examine the stated and/or unstated assumptions of the Resume Skillbased Resume. Skills argument. Be sure to explain how the argument depends on the assumptions and what the implications are if the assumptions prove unwarranted. Note: All responses are reproduced exactly as written, including errors, misspellings, etc., if any. While it may be true that the Mason City government ought to devote more money to riverside recreational facilities, this author's argument does not make a cogent case for increased resources based on river use. It is easy to understand why city residents would want a cleaner river, but this argument is rife with holes and assumptions, and Time Form - 8+ Free Documents thus, not strong enough to lead to increased funding. Citing surveys of Examples Resume. Skills, city residents, the author reports city resident's love of water sports. It is not clear, however, the scope and validity of that survey. For example, the Tracking Free In Pdf, Doc survey could have asked residents if they prefer using the river for water sports or would like to For Nurses. Examples, see a hydroelectric dam built, which may have swayed residents toward river sports. The sample may not have been representative of city residents, asking only those residents who live upon the river.

The survey may have been 10 pages long, with 2 questions dedicated to river sports. We just do not know. Unless the survey is fully representative, valid, and reliable, it can not be used to effectively back the author's argument. Additionally, the author implies that residents do not use the river for swimming, boating, and fishing, despite their professed interest, because the water is polluted and smelly. While a polluted, smelly river would likely cut down on river sports, a concrete connection between the resident's lack of river use and the river's current state is not effectively made. Though there have been complaints, we do not know if there have been numerous complaints from a wide range of people, or perhaps from one or two individuals who made numerous complaints. To strengthen his/her argument, the author would benefit from implementing a normed survey asking a wide range of residents why they do not currently use the river.

Building upon the implication that residents do not use the river due to - 8+ Free Documents In Pdf,, the quality of the river's water and the smell, the author suggests that a river clean up will result in increased river usage. If the river's water quality and smell result from problems which can be cleaned, this may be true. For example, if the decreased water quality and Doc.#550712: Therapist (+92 More aroma is caused by Time Tracking Form - 8+ Doc pollution by factories along the river, this conceivably could be remedied. Resume Military To Civilian. But if the quality and aroma results from the Tracking Form - 8+ Documents In Pdf, natural mineral deposits in Writing, the water or surrounding rock, this may not be true. There are some bodies of water which emit a strong smell of sulphur due to the geography of the Time Tracking - 8+ Free Documents In Pdf, Doc area. This is not something likely to be afffected by a clean-up. | Product Offer. Consequently, a river clean up may have no impact upon Time Tracking Form Free In Pdf,, river usage. Regardless of whether the river's quality is able to be improved or not, the author does not effectively show a connection between water quality and river usage. A clean, beautiful, safe river often adds to a city's property values, leads to increased tourism and revenue from those who come to Resume To Civilian, take advantage of the river, and Tracking Form - 8+ Free a better overall quality of life for residents.

For these reasons, city government may decide to invest in improving riverside recreational facilities. However, this author's argument is not likely significantly persuade the city goverment to Brickstrategy | Product Offer, allocate increased funding. Rater Commentary for Time Free Documents In Pdf,, Essay Response Score 6. This insightful response identifies important assumptions and thoroughly examines their implications. The essay shows that the proposal to Professional Retail Resume Military Resume, spend more on riverside recreational facilities rests on three questionable assumptions, namely: that the survey provides a reliable basis for budget planning that the river’s pollution and odor are the only reasons for its limited recreational use that efforts to clean the water and Time Documents remove the odor will be successful. By showing that each assumption is highly suspect, this essay demonstrates the weakness of the entire argument. Health Resume Example ( For example, paragraph 2 points out that the survey might not have used a representative sample, might have offered limited choices, and might have contained very few questions on water sports. Paragraph 3 examines the tenuous connection between complaints and limited use of the river for recreation. Complaints about water quality and odor may be coming from only a few people and, even if such complaints are numerous, other completely different factors may be much more significant in reducing river usage. Time Tracking Documents. Finally, paragraph 4 explains that certain geologic features may prevent effective river clean-up. Details such as these provide compelling support.

In addition, careful organization ensures that each new point builds upon the previous ones. Home Health ( For example, note the clear transitions at the beginning of Tracking - 8+ Documents, paragraphs 3 and Retail Resume Examples 4, as well as the Free Documents In Pdf, Doc logical sequence of sentences within paragraphs (specifically paragraph 4). Although this essay does contain minor errors, it still conveys ideas fluently. Note the effective word choices (e.g., rife with . . . assumptions and may have swayed residents). In addition, sentences are not merely varied; they also display skillful embedding of Skill Resume Examples Resume. Skills, subordinate elements. Since this response offers cogent examination of the argument and conveys meaning skillfully, it earns a score of 6. The author of this proposal to Time Tracking Free Documents In Pdf, Doc, increase the budget for Mason City riverside recreational facilities offers an interesting argument but to Brickstrategy | Product Offer Strategy, move forward on Tracking Doc, the proposal would definitely require more information and thought. While the correlations stated are logical and probable, there may be hidden factors that prevent the City from diverting resources to this project. For example, consider the survey rankings among Mason City residents.

The thought is Examples that such high regard for water sports will translate into usage. But, survey responses can hardly be used as indicators of actual behavior. Many surveys conducted after the winter holidays reveal people who list exercise and Form - 8+ Documents In Pdf, weight loss as a top priority. Yet every profession does not equal a new gym membership. Even the wording of the survey results remain ambiguous and vague. While water sports may be among the residents' favorite activities, this allows for Based Examples Functional Skillbased Resume., many other favorites. What remains unknown is the priorities of the general public. Do they favor these water sports above a softball field or soccer field? Are they willing to sacrifice the municipal golf course for better riverside facilities? Indeed the survey hardly provides enough information to discern future use of improved facilities. Closely linked to Tracking Form - 8+ Free Documents In Pdf,, the surveys is the bold assumption that a cleaner river will result in increased usage.

While it is Cover Letter Examples For Nurses. Cover Examples Rn not illogical to Tracking Form Free Documents In Pdf,, expect some increase, at what level will people begin to use the river? The answer to this question requires a survey to find out the Business Document Writing reasons our residents use or do not use the Form - 8+ Free Documents In Pdf, river. Is river water quality the primary limiting factor to usage or the lack of docks and piers? Are people more interested in water sports than the recreational activities that they are already engaged in? These questions will help the city government forecast how much river usage will increase and to assign a proportional increase to the budget. Likewise, the author is optimistic regarding the state promise to clean the river. We need to hear the Therapist ? Counselor Resume More source of the voices and consider any ulterior motives. Is this a campaign year and the plans a campaign promise from the state representative? What is the timeline for the clean-up effort? Will the state fully fund this project? We can imagine the misuse of Tracking Free Documents Doc, funds in Home Example, renovating the Tracking Form - 8+ Free Documents In Pdf, riverside facilities only to watch the new buildings fall into dilapidation while the state drags the river clean-up.

Last, the author does not consider where these additional funds will be diverted from. Writing. The current budget situation must be assessed to determine if this increase can be afforded. In a sense, the City may not be willing to draw money away from other key projects from road improvements to Tracking Form Documents In Pdf, Doc, schools and education. The author naively assumes that the money can simply appear without forethought on Headers And Footers: Writing, where it will come from. Examining all the various angles and factors involved with improving riverside recreational facilities, the argument does not justify increasing the budget.

While the proposal does highlight a possibility, more information is required to warrant any action. Rater Commentary for Essay Response Score 5. Each paragraph in the body of this perceptive essay identifies and examines an unstated assumption that is crucial to the argument. Time Tracking Free Documents In Pdf, Doc. The major assumptions discussed are: that a survey can accurately predict behavior that cleaning the river will, in itself, increase recreational usage that state plans to clean the river will actually be realized that Mason City can afford to spend more on riverside recreational facilities. Support within each paragraph is both thoughtful and thorough. For example, paragraph 2 points out vagueness in the wording of the survey: Even if water sports rank among the favorite recreational activities of Mason City residents, other sports may still be much more popular. Thus, if the first assumption proves unwarranted, the Cover Letter For Nurses. Letter Examples argument to fund riverside facilities rather than soccer fields or golf courses becomes much weaker. Paragraph 4 considers several reasons why river clean-up plans may not be successful (the plans may be nothing more than campaign promises or funding may not be adequate). Time Tracking Form - 8+. Thus, the weakness of the Skill Based Functional Skillbased Skills third assumption undermines the argument that river recreation will increase and riverside improvements will be needed at all.

Instead of dismissing each assumption in isolation, this response places them in a logical order and considers their connections. Note the appropriate transitions between and within paragraphs, clarifying the links among the Documents In Pdf, assumptions (e.g., Closely linked to the surveys or The answer to Cover Letter Examples For Nurses. Cover Letter Examples, this question requires. Form - 8+ Free Doc. ). Along with strong development, this response also displays facility with language. Minor errors in Headers Business Document Writing, punctuation are present, but word choices are apt and Time Tracking Form - 8+ Free Documents sentences suitably varied in pattern and length. The response uses a number of rhetorical questions, but the implied answers are always clear enough to support the Strategy points being made. Thus, the response satisfies all requirements for a score of 5, but its development is not thorough or compelling enough for a 6. The problem with the arguement is the Time Tracking Free In Pdf, assumption that if the Mason River were cleaned up, that people would use it for water sports and recreation. Resume Cover Letter Examples For Nurses. Cover Letter Rn. This is Time In Pdf, not necessarily true, as people may rank water sports among their favorite recreational activities, but that does not mean that those same people have the financial ability, time or equipment to pursue those interests. However, even if the Retail Resume Resume writer of the arguement is correct in assuming that the Mason River will be used more by Form - 8+ Documents Doc the city's residents, the arguement does not say why the Military recreational facilities need more money.

If recreational facilities already exist along the Mason River, why should the city allot more money to fund them? If the recreational facilities already in existence will be used more in the coming years, then they will be making more money for themselves, eliminating the need for the city government to devote more money to them. According to the arguement, the Time - 8+ reason people are not using the Home Aide Resume ( Mason River for water sports is because of the smell and the quality of water, not because the recreational facilities are unacceptable. If the city government alloted more money to the recreational facilities, then the budget is being cut from some other important city project. Also, if the assumptions proved unwarranted, and more people did not use the river for recreation, then much money has been wasted, not only the money for the recreational facilities, but also the money that was used to Time Tracking - 8+, clean up the river to attract more people in And Footers: Document Writing, the first place.

Rater Commentary for Essay Response Score 4. This competent response identifies two unstated assumptions: that cleaning up the Mason River will lead to increased recreational use that existing facilities along the river need more funding. Paragraph 1 offers reasons why the first assumption is questionable (e.g., residents may not have the necessary time or money for water sports). Similarly, paragraphs 2 and 3 explain that riverside recreational facilities may already be adequate and may, in fact, produce additional income if usage increases. Tracking Form - 8+ Documents. Thus, the And Footers: Document Writing response is adequately developed and satisfactorily organized to show how the argument depends on questionable assumptions. However, this essay does not rise to Tracking Form - 8+ Doc, a score of 5 because it fails to consider several other unstated assumptions (e.g., that the Professional Retail Military To Civilian survey is reliable or that the Time Tracking Form Free Documents In Pdf, Doc efforts to clean the river will be successful). Skill Based Examples Functional Resume.. Furthermore, the Form - 8+ Free final paragraph makes some extraneous, unsupported assertions of its own.

Mason City may actually have a budget surplus so that cuts to other projects will not be necessary, and cleaning the river may provide other real benefits even if it is not used more for Offer, water sports. This response is generally free of errors in grammar and usage and displays sufficient control of language to support a score of 4. Surveys are created to Time Tracking, speak for the people; however, surveys do not always speak for the whole community. A survey completed by Mason City residents concluded that the residents enjoy water sports as a form of recreation. If that is so evident, why has the river not been used? The blame can not be soley be placed on the city park department. The city park department can only Offer Strategy, do as much as they observe. The real issue is not the residents use of the river, but their desire for a more pleasant smell and a more pleasant sight. Time In Pdf, Doc. If the city government cleans the river, it might take years for the smell to Business Document Writing, go away. If the budget is changed to accomodate the clean up of the Mason River, other problems will arise. The residents will then begin to complain about Time - 8+ Free Documents In Pdf, other issues in their city that will be ignored because of the Resume. great emphasis being placed on Mason River.

If more money is taken out of the Tracking - 8+ Free budget to clean the river an Home Aide Example (, assumption can be made. This assumption is that the budget for another part of cit maintenance or building will be tapped into to. In addition, to Time Tracking Form Documents In Pdf, Doc, the budget being used to clean up Mason River, it will also be allocated in increasing riverside recreational facilites. The government is trying to appease its residents, and one can warrant that the role of the For Nurses. Examples government is to please the people. Tracking Form - 8+ Free Doc. There are many assumptions being made; however, the government can not make the assumption that people want the river to be cleaned so that they can use it for recreational water activities. The government has to realize the long term effects that their decision will have on Based Examples Functional Resume. Skills, the monetary value of their budget. Rater Commentary for Essay Response Score 3. Even though much of this essay is tangential, it offers some relevant examination of the Free Documents In Pdf, argument’s assumptions. The early sentences mention a questionable assumption (that the Therapist ? Counselor Resume Example survey results are reliable) but do not explain how the Form Free survey might have been flawed. Then the response drifts to irrelevant matters a defense of the city park department, a prediction of budget problems and the problem of pleasing city residents. Some statements even introduce unwarranted assumptions that are not part of the original argument (e.g., The residents will then begin to Home Aide, complain about other issues and This assumption is Time Tracking Form - 8+ Free Documents In Pdf, that the budget for another part of city maintenance or building will be tapped into).

Near the Home Aide Example end, the response does correctly note that city government should not assume that residents want to use the river for recreation. Hence, the proposal to increase funding for riverside recreational facilities may not be justified. In summary, the language in this response is reasonably clear, but its examination of unstated assumptions remains limited and therefore earns a score of 3. This statement looks like logical, but there are some wrong sentences in it which is not logical. First, this statement mentions raking water sports as their favorite recreational activities at the first sentence.

However, it seems to have a ralation between the first sentence and the setence which mentions that increase the quality of the river's water and Form - 8+ Documents Doc the river's smell. This is a wrong cause and Skill Resume Resume. Skills result to solve the Time In Pdf, problem. Second, as a reponse to the complaints from residents, the state plan to clean up the river. As a result, the state expects that water sports will increase. Headers Business Document. When you look at two sentences, the result is Form Free Doc not appropriate for the cause.

Third, the | Product Strategy last statement is the conclusion. Time Tracking Form - 8+ Free Documents In Pdf,. However, even though residents rank water sports, the city government might devote the budget to another issue. This statement is also a wrong cause and result. In summary, the statement is not logical because there are some errors in it. Professional To Civilian. The supporting setences are not strong enough to support this issue. Rater Commentary for Essay Response Score 2.

Although this essay appears to Form - 8+ In Pdf, Doc, be carefully organized, it does not follow the directions for the assigned task. Resume Cover For Nurses. Examples. In his/her vague references to Time Form - 8+ Documents Doc, causal fallacies, the writer attempts logical analysis but never refers to any unstated assumptions. Furthermore, several errors in grammar and sentence structure interfere with meaning (e.g., This statement looks like logical, but there are some wrong sentences in Brickstrategy Strategy, it which is not logical). Because this response does not follow the directions for the assigned task and Tracking Free Documents In Pdf, contains errors in sentence structure and logical development, it earns a score of Examples Letter, 2. The statement assumes that everyone in Mason City enjoys some sort of Time - 8+ Free In Pdf,, recreational activity, which may not be necessarily true. The statement also assumes that if the state cleans up the river, the use of the river for water sports will definitely increase. Rater Commentary for Essay Response Score 1. The brevity of Retail Resume Military To Civilian Resume, this two-sentence response makes it fundamentally deficient.

Sentence 1 states an assumption that is actually not present in the argument, and Tracking - 8+ Free Documents sentence 2 correctly states an assumption but provides no discussion of its implications. Although the response may begin to Document Writing, address the assigned task, it offers no development. As such, it is clearly extremely brief . providing little evidence of an organized response and earns a score of 1. Register for the GRE General Test. Get never-before-offered official GRE practice tests, scores within minutes for Time Free In Pdf,, all three measures and explanations for correct answers! Show schools only the scores you want them to Skill Functional Skillbased, see only with the ScoreSelect ® option. Registration, Test Centers and Dates Ў Registration, Test Centers and Dates Ў Tests and Products. ETS Measuring the Power of Learning. ® Copyright 2017 by Educational Testing Service.

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CHAPTER 4. OSSICULAR DISCONTINUITY. As discussed in Chapter 3, the middle ear serves to Form Free Documents transmit sound energy from the ear canal to the cochlea. In order to facilitate the efficient transmission of this energy, the Health Aide Resume (, eardrum and ossicles act as an Tracking Form - 8+ Free, impedance-matching transformer, partially matching the high impedance of the cochlear fluids to Doc.#550712: Therapist the low impedance of air in Form - 8+ In Pdf, the ear canal. Any process that reduces the efficiency of this sound-conducting mechanism results in conductive hearing loss . There are many causes of conductive hearing loss (Harris and Functional Skillbased Skills Cueva, 1992); however, only hearing loss caused by discontinuity of the ossicular chain will be discussed in this work. The next section discusses the two most common types of ossicular discontinuities. Form - 8+ Documents In Pdf,. Surgical techniques used to repair the ossicular chain are discussed in Section 4.3. In Section 4.4, some of the mechanical issues related to the success of surgery are discussed. 4.2 COMMON DEFECTS. The most common ossicular defect is loss of the incudal long process; the second most common defect is combined loss of the incudal long process and the stapes superstructure (e.g., Austin, 1971; Sade and Based Functional Skillbased Resume. Luntz, 1991). - 8+ Free Documents In Pdf,. These situations are illustrated in Figure 4.1.

Austin (1971) has reported that loss of the Brickstrategy | Product Offer Strategy, incudal long process. Figure 4.1 Two types of ossicular discontinuities. a) Missing incudal long process. Time Tracking - 8+ Documents. b) Missing long process and stapes superstructure. For clarity, the eardrum and other middle-ear structures have not been shown. From Donaldson et al . (1992, p.250). alone represents 59% of all ossicular defects; the combined loss of the incudal long process and Home Example the stapes superstructure accounts for another 23%. Erosion and the ultimate loss of these bones is often caused by chronic middle-ear disease such as otitis media (inflammation of the Time Tracking - 8+ Documents In Pdf, Doc, middle ear). Discontinuities of the ossicular chain result in conductive hearing loss since vibrations of the eardrum can no longer be transmitted to the cochlea; moreover, the eardrum shields the cochlea from Headers And Footers: Business Document Writing, direct stimulation by sound.

The extent of hearing loss in Time Free In Pdf, humans is measured in terms of the Brickstrategy | Product, air-bone gap . By definition, this is the number of decibels (dB) by which the Time Tracking Form Free Documents Doc, air-conduction threshold exceeds the bone-conduction threshold (Katz, 1985; p. 1060). The air-conduction threshold is measured by applying an air-conducted stimulus to the ear canal; it is affected by ? Counselor Resume both the conductive and the sensorineural components of the auditory system. The bone-conduction threshold is measured by applying a mechanical stimulus to the skull; it is affected by the sensorineural components of the auditory system. It is not possible to tell from the air-conduction threshold alone whether hearing loss is conductive or sensorineural; however, the difference between the two thresholds, the air-bone gap, can be used as an indicator of conductive hearing loss. A large air-bone gap, say above 20 dB, indicates conductive hearing loss (Glasscock and Shambaugh, 1990). Vartiainen and Nuutinen (1992) measured hearing loss in 277 patients with chronic otitis media. Pure-tone audiograms (graphs of hearing threshold in dB versus frequency) were measured at 0.5, 1 and 2 kHz. The mean air-bone gap was determined from the audiograms by averaging the air-bone gaps at the three frequencies. They found that loss of the incudal long process resulted in a mean air-bone gap of 32 dB; loss of both the incudal long process and the stapes superstructure resulted in an air-bone gap of 38 dB.

In laboratory animals, hearing sensitivity can be determined by measuring the pressure required to maintain a constant cochlear microphonic (CM) over a range of frequencies. The CM is Tracking - 8+ In Pdf,, a stimulus-related electric potential generated by sensory receptors in the cochlea (Durrant and Lovrinic, 1984, pp. Skill Based Resume Skillbased. 152-156). It can be measured by placing an electrode on the round-window membrane. Presumably, the larger the pressure required to maintain a constant CM, the lower is the hearing sensitivity. Wever et al. (1948) determined the - 8+ Free, hearing sensitivity up to 10 kHz in cats before and after interruption of the incudostapedial joint. Therapist Resume. They found that after such an encroachment, larger sound pressure was required to maintain the same CM as before; in fact, the Tracking Form - 8+ Free In Pdf, Doc, sound pressure required was 60 dB larger than in the normal ear, indicating a hearing loss of 60 dB relative to the normal ear. 4.3 SURGICAL REPAIR. Methods of repair. The goals of surgery are to eliminate disease, prevent recurrent inflammation, and/or improve auditory function (Smyth, 1988). Resume.. Only techniques for improving auditory function will be discussed here.

These techniques have been described by a number of authors (e.g., Austin, 1971; Fisch, 1980; Smith and McElveen, 1988; Lambert and McElveen, 1993 ). In the case where only the long process of the incus is missing, sound transmission is re-established by Time Form Documents Doc fitting a prosthesis between the manubrium and the head of the stapes; often a homograft or autograft incus or malleus head is Resume, used to make the prosthesis (Emmett, 1989). (A homograft is a tissue transplanted between genetically nonidentical individuals of the same species. An autograft is Time Form Documents, a tissue grafted into a new position in the body of the same individual. An autograft malleus head would be obtained by Document Writing surgically removing it from its attachments to the ligaments and by cutting it from the - 8+ Documents, manubrium.) Essentially, the graft is shaped to form a slim strut, a hole is drilled into the medial end of the strut to accept the head of the stapes, and a groove is carved into the lateral end to articulate with the manubrium. Glue is sometimes used to secure the Brickstrategy, points of contact of the Form Doc, manubrium and stapes with the graft (Fisch, 1980). This surgical reconstruction is called a malleus-stapes assembly (MSA) and is shown in Figure 4.2a. When both the incudal long process and the stapes superstructure are missing, a prosthesis is fitted between the manubrium and the footplate. This reconstruction is called the malleus-footplate assembly (MFA) and is shown in Figure 4.2b. In both the MSA and the MFA, the prosthesis is sometimes made longer than required so it exerts tension on the eardrum and the annular ligament of the footplate. This tension stabilizes the strut. Many variations of the basic MFA and MSA exist (e.g., Fisch, 1980; Wehrs, 1982; Frootko, 1987; Mills, 1991).

Some of these variations have come about because of differences in the geometry of the ossicles among patients. For example, in some patients the manubrium is directly lateral to the stapes as shown in Figure 4.3a, but in (a)(b) Figure 4.3 Ossicular geometry. Home Health Aide ( a) Manubrium directly lateral to stapes. b) Manubrium lateral and anterior to stapes. c) Horizontal MSA used in situation (b). Parts (a) and (b) are from Frootko (1987, p.249) and Time Tracking - 8+ Free Documents In Pdf, part (c) is from Mills (1991, p.477). others it is located anterior to the stapes as shown in Figure 4.3b. Therapist More. In the latter case, placing a strut between the manubrium and the stapes in the manner shown in Figure 4.2a could result in considerable tilting of the stapedial footplate, a situation that is thought to be undesirable since volume displacements of the cochlear fluids would be reduced (Vlaming and Feenstra, 1986b). Time Tracking. To prevent this, the prosthesis may be positioned horizontally as shown in Resume Resume (+92 Figure 4.3c. Interest in Time Form - 8+ Documents Doc the use of synthetic materials for middle-ear surgery has also resulted in a great deal of variation in prosthetic design since these materials, unlike autograft bone, are available to the surgeon before entering the operating room; thus, much time can be spent on shaping them. Synthetic materials are also more readily available than ossicular bone, and their sterility and bonding properties make them suitable for use as graft material.

A variety of graft materials have emerged in the past few years. Among them, Plastipore, an inert high-density polyethylene sponge, has gained some popularity (Emmett, 1989). Two types of prostheses have been designed using Plastipore: the PORP (partial ossicular replacement prosthesis) and the TORP (total ossicular replacement prosthesis). Both prostheses are shown in Figure 4.4. The PORP is Therapist ? Counselor Resume (+92, similar to the MSA except that sometimes its platform makes contact with the eardrum, while the Time - 8+ Free In Pdf,, TORP is similar to the MFA. The porous nature of Plastipore allows tissue ingrowth, making the TORP and the PORP mechanically stable with age (Makek et al ., 1988). Recently, a modified version of the TORP, called the Fisch II Spandrel, has been developed (Williams and Lesser, 1992). It is shown in Figure 4.4c. Figure 4.4 Synthetic ossicular prostheses. a) PORP (Partial Ossicular Replacement Prosthesis). b) TORP (Total Ossicular Replacement Prosthesis). c) Fisch II Spandrel. Parts (a) and (b) are from Frootko (1987, p.257) and part (c) is from Doc.#550712: Therapist Resume ? Counselor (+92 More, Williams and Lesser (1992, p.263). Other materials used in middle-ear surgery include Bioglass, a chemically active glass (Merwin, 1986); Ceravital, a glass-ceramic material (Mangham and Lindeman, 1990); and hydroxyapatite, the main constituent of the mineral matrix of bone (Grote, 1986; Wehrs, 1989; Goldenberg, 1992).

Bioglass and Ceravital are bioactive, meaning that they are able to form chemical bonds with surrounding tissues. Hydroxyapatite comes in both bioactive and Tracking Free Doc porous forms. These materials have been used to produce a variety of prostheses; however, the Skill Functional Skills, basic MFA and MSA designed from ossicular bone remain popular (Emmett, 1989) and Tracking Form - 8+ Free Documents In Pdf, will be the only prostheses to be modelled in this work. The success of Therapist Resume ? Counselor Resume (+92 More, surgery in humans is assessed in terms of the reduction of Tracking - 8+, conductive hearing loss, which is Skill Resume Functional Resume., often measured by the degree of closure of the air-bone gap. Time Form - 8+ Free. However, there does not appear to be any consistent method of quantifying success. For example, Smyth (1987) has classified closure of the mean air-bone gap to within 11 dB as success; on the other hand, Goldenberg (1992) has defined success as closure to within 25 dB for | Product Offer Strategy, the PORP, using other definitions for other prostheses. Moreover, patients and Time Form - 8+ In Pdf, doctors may not necessarily agree as to what is successful (Smyth, 1987). In any case, some closure of the Resume Examples For Nurses. Letter, air-bone gap does result when the Time - 8+ Free Documents In Pdf, Doc, MSA and MFA are used. For instance, Vartiainen and Nuutinen (1992) reported closure of the air-bone gap to within 20 dB in 58% of patients when the MSA was used.

The situation was worse for Brickstrategy Strategy, the MFA: only 30% of the cases resulted in closure to within 20 dB. Tracking Free In Pdf, Doc. Results obtained by other authors are shown in Table 4.1. Resume Cover Letter. The performance of the MFA has been found to Form In Pdf, Doc be poorer than that of the MSA in all cases. Table 4.1 Post-operative hearing results for humans with two middle-ear conditions: 1) Absent incudal long process and 2) absent long process and absent stapes superstructure. Shelton and Cover Letter Letter Examples Rn Sheehy used PORP's and TORP's; MSA's and MFA's made from ossicular bone were used in the other studies. N indicates the Time Tracking Form - 8+ Free Documents In Pdf,, number of patients with the particular condition.

The percentage of patients with an air-bone gap of less than 20 dB is also indicated. The effectiveness of prostheses has also been determined in cats. Tonndorf and Pastaci (1986) measured hearing sensitivity over a frequency range of 10 Hz to 15 kHz in anesthetized cats with normal middle ears. They then broke the incudostapedial joint and removed the crura. The ear was then repaired using an MFA, and the post-operative hearing sensitivity was measured.

They reported a 20-dB loss in hearing sensitivity compared to the normal ear; this is an improvement over the 60-dB loss reported by Wever et al . (1948) in cats after interruption of the incudostapedial joint. Benitez et al. (1974) determined audiometric thresholds at 0.5, 1 and 2 kHz in Business three normal cats. They then disrupted the incudostapedial joint, fixed the ossicular chain using an MSA, and measured audiometric thresholds 31 to 33 months after surgery. They reported average hearing losses of 5, 11 and 26 dB in the three animals post-operatively. Once again this is an improvement over the 60-dB loss reported by Wever et al . after interruption of the Time Form - 8+ Documents In Pdf, Doc, ossicular chain. 4.4 MECHANICAL CONSIDERATIONS FOR THE MFA AND MSA. Relatively little work has been done to assess the Therapist Resume ? Counselor Resume Example More, mechanics of the surgically corrected middle ear or the importance of mechanical variables. Section 4.4.2 discusses the experimental work that has been done in this area, and Section 4.4.3 discusses the theoretical work that has been done. 4.4.2 Experimental Work. Several mechanical variables may be considered to be of interest in the application of the MSA and MFA: the position of the prosthesis, the tension exerted on Tracking Form In Pdf, the surrounding structures, and the types of connections formed between the prosthesis and the surrounding tissues. Cover Letter Examples. Vlaming and Feenstra (1986b) studied some of these issues in human cadaver middle ears using a laser Doppler interferometer.

These authors measured the Time Tracking Free Documents In Pdf, Doc, displacements of a few points on the stapedial footplate in the normal middle ear. They then disrupted the ossicular chain so that in some cases the crura were left intact, whereas in other cases the crura were destroyed. They surgically repaired the former discontinuity using an MSA; the latter discontinuity was repaired using a TORP. The displacements of the Skill Based Examples Functional Skillbased Resume., footplate were then measured after surgery. They suggested that hearing sensitivity is Time Tracking Form - 8+, related to the volume displacement of Headers And Footers: Business, cochlear fluids so that post-operative volume displacements should be comparable to pre-operative levels for successful results. For the TORP at low frequencies, Vlaming and Feenstra found that the Time Tracking - 8+ Documents, volume displacements of the cochlear fluids measured post-operatively were comparable to Doc.#550712: Resume Resume Example (+92 levels measured in the normal ear. On the other hand, volume displacements were lower than normal when the MSA was used, suggesting that the Time Tracking - 8+ Free, TORP should give better hearing results than the MSA. However, clinical results (see previous section) suggest that the MSA works better than the MFA. Since the MFA is Skill Based Examples Functional Resume., similar to the TORP if the Time Form - 8+ Documents, platform of the Headers And Footers:, latter does not contact the Time Form - 8+ In Pdf, Doc, eardrum, then, based on clinical results, it would be expected that the MSA also works better than the TORP.

Vlaming and Feenstra did not report whether the TORP contacted the eardrum or not in all of their preparations, but from their discussion it is likely that it contacted the drum in some cases; nevertheless, in all cases, they found the TORP to work better than the MSA. Business Document Writing. The discrepancy between the findings of Vlaming and Feenstra and those of clinicians may exist for several reasons. First, Vlaming and Feenstra used ears that were disease-free; however, when surgery is performed in living patients, the middle-ear is usually not free of disease. The extent of Time Free Documents In Pdf,, middle-ear disease necessitating the use of the TORP or the MFA is probably more advanced than that requiring the MSA or PORP. Diseases such as otitis media can affect the mechanical properties of the middle-ear structures (e.g., von Unge et al ., 1992) and Therapist Resume ? Counselor Example (+92 would thus account for differences between the results determined by Vlaming and Tracking Form - 8+ Free In Pdf, Doc Feenstra and those by clinicians. Second, it is possible that Eustachian tube function may be impaired in living subjects, thus affecting post-operative hearing results (Tos, 1979; Kumazawa et al ., 1993). Resume Resume (+92. Eustachian tube dysfunction results in pressures in the middle-ear cavities that are lower than normal (Tos, 1979); such changes could dampen eardrum vibrations (Vlaming, 1987), cause retraction of the eardrum (Tos, 1979), and result in an increase in the incremental stiffness of the middle-ear structures, all of which affect the mechanics of the middle ear.

Third, clinical studies are influenced by hearing loss due to sensorineural damage. The incidence of such damage is small (Tos et al ., 1984; Urquhart et al ., 1992) but could account for Form Documents In Pdf,, some of the discrepancies found between results obtained from cadavers and those from living subjects. Vlaming and Feenstra also studied how the | Product, position of a prosthesis affects the displacements of the footplate. They found that the position of the MSA along the manubrium was important. They suggested that the optimal orientation for the MSA is such that it lies along an imaginary line passing through the head of the stapes and Time Tracking Free Documents the centre of the footplate. In most cases this means that the MSA should contact the manubrium near the umbo. With respect to the MFA, Vlaming and Feenstra did not report the effects of positioning it along the manubrium. However, the position of the MFA on the footplate was varied, and it was found not to significantly affect the displacements of the Professional Resume Military, footplate. For both prostheses, they found that tension exerted on surrounding structures was quite important: increased tension resulted in smaller displacements of the footplate. Apparently, tension causes the annular ligament of the footplate to stretch, resulting in Time Documents Doc an increase in Headers And Footers: Writing its incremental stiffness.

Other authors have studied the effects of the mechanical variables just described in Time Form - 8+ Free Documents human cadaver middle ears by Home Aide Resume Example ( determining the amount of sound transmission that occurs pre-operatively and post-operatively. Andersen et al. (1962) applied sound to the oval window and measured the resulting pressure in the ear canal; presumably, the higher the degree of sound transmission, the better is the Time Tracking - 8+ Free Documents In Pdf, Doc, hearing sensitivity. In one of their experiments, the incus was removed and the degree of sound transmission was determined. The degree of transmission was then measured after placing a prosthesis between the drum and the footplate. They suggested that there is an optimal position for a prosthesis that can result in nearly normal sound transmission, whereas other positions may give poorer results. No detailed information was given as to how it should be placed. Elbrond et al . (1965) also measured sound transmission in the surgically corrected ear, using the MSA in their experiments. They applied sound to the ear canal and Professional Retail Resume Military To Civilian measured pressure variations in the vicinity of the round window caused by vibrations of its membrane.

Like Vlaming and Feenstra, their results also indicate that tension in the MSA is important: increased tension results in lower transmission, especially at Time - 8+ Free, low frequencies. Gundersen (1972) studied sound transmission in the reconstructed human middle ear, using a special prosthesis designed to Headers Business replace the incus. No details were given except that sound transmission was reduced on the average by Tracking - 8+ Free Doc 4 to 5 dB than in the normal ear. Very few studies have been done in cats. Tonndorf and Pastaci (1986) found that the position of a prosthesis along the manubrium is relatively unimportant for the MFA as long as the connection between the Resume Example (, manubrium and the prosthesis is Tracking Form - 8+ Doc, inflexible'. Home Resume. No results were given for a flexible connection. Benitez et al . (1974) attempted to correlate post-operative changes in hearing sensitivity in cats with histopathological findings. Their results indicate that the connections between the prosthesis and surrounding tissues are stabilized by the proliferation of - 8+ Free In Pdf,, fibres.

Hearing results were found to be the best in Home Aide Example one cat in which the Tracking Free Documents Doc, connections between the Brickstrategy | Product Offer, prosthesis and bones were deemed to be excellent'. This cat had a post-operative hearing loss of only 5 dB, compared with 11 dB and 26 dB in the other cats. 4.4.3 Theoretical Work. The only finite-element models of the reconstructed middle-ear are those of Form Free Documents Doc, Lesser et al. (1991) and Williams and Lesser (1992). Lesser et al . have developed a two-dimensional model of the MSA for Brickstrategy Offer Strategy, the human middle ear using the plane-strain assumption. Results of their model for various placements of the prosthesis along the manubrium indicate that the stress levels at Tracking Documents Doc, the prosthesis-stapes interface increase as the Resume Resume Example, prosthesis is moved down the manubrium. The results of their model are questionable as the plane-strain assumption may not be appropriate in this case: the eardrum is a three-dimensional structure which does not possess the type of symmetry required to permit the use of this assumption. Williams and Time Tracking Documents In Pdf, Lesser (1992) have developed a three-dimensional model for the Fisch II Spandrel prosthesis in the human middle ear. One objection to Home Health Aide Resume Example their model is that the footplate has been represented by a single point, implying that it moves in a piston-like manner. It is possible for the footplate to tilt in the surgically corrected middle ear depending on the placement of the prosthesis, and tilting of the Form - 8+ Documents Doc, footplate may affect volume displacements of the cochlear fluids and hence hearing sensitivity (Vlaming and Feenstra, 1986b).

Other techniques have also been used to study the Cover Letter Examples Cover, mechanics of the middle ear after surgery. For example, Wada et al. Form Free Documents In Pdf, Doc. (1990) have used analytical techniques to model the mechanics of an artificial auditory ossicle. Their model assumes a flat, circular eardrum; presumably, this was done to make the analyses manageable. However, the Brickstrategy Strategy, results of Funnell and Laszlo (1978) indicate that the three-dimensional shape of the eardrum is very important to its function. Peake et al . (1992) developed a lumped-parameter model of type IV tympanoplasty, a surgical technique used to shield the round window from acoustic stimulation when the eardrum, malleus and incus are missing; however, this technique is not in any way similar to Tracking - 8+ Documents In Pdf, the MSA or MFA.