Aural Rehab 1

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Hearing Loss

Back 1

The invisible condition

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Aural rehabilitation

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-intervention aimed at minimizing and alleviating the communications difficulties associated with hearing loss
-often involved assistive devices
-for persons who have not developed listening, speech and language skills

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Audiologic Rehabilitation

Back 3

used interchangably with aural rehab., may entail greater emphasis on the provision and follow-up of listening devides and less emphasis on communication strategies and auditory speech reading

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Conversational Fluency

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related to how smoothly conversation unfolds

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Hearing-related disability

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loss of function imposed by hearing loss
multi-dimensional

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impairment

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structural or functional impairment of the auditory system

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Handicap

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consists of the psychosocial disadvantages that result from a functional impairment.
*Use of this term is discouraged by WHO

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Activity Restriction

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change at the level of the person brought about by an impairment at the levels of body structure

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Participation Restriction

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effect of an activity limitation that results in a change in the broader scope of a patient's life

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Frequent Communication Partner

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persons with whom another often converses (e.g. family member, coworker)

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Psychosocial factors

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and individual's feelings, self-image, motivation

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Social factors

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prevailing viewpoints of one's society

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Pure-tone Average

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-average of hearing thresholds at 500, 1000, and 2000

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Configuration

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the extent of the hearing loss at each frequency and gives an overall description of the hearing loss

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Hard of hearing

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having a hearing loss, but usually does not refer to a profound hearing loss

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Deaf

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usually means having minimal or no hearing

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Prelingual

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hearing loss acquired prior to acquisition of spoken language

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Congenital

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present at birth

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Acquired

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implies hearing loss was started after birth

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Perilingual

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during language aquisiton

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Postlingual

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language has been acquired

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conductive loss

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results from an obstruction within the outer or middle ear and prevents sound from reaching the sensorineural structures in the inner ear

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Microtia

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congenitally small external ear

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Atresia

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closure of the external auditory canal

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Cerumen

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ear wax

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Otitis Media

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inflammation of the middle ear, often accompanied by accumulation of fluid in the middle ear cavity

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Sensorineural Hearing Loss

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-hearing loss that has a cochlear or retrocochlear origin
-typically permanent
-causes: otoxotic drugs, meningitis

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Meningitis

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common cause of childhood sensorineural hearing loss caused by bacterial or viral inflammation of the meninges (the membranous linings of the brain and spinal cord)

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Encephalitis

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inflammation of the brain

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Mixed Hearing Loss

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hearing loss that is both conductive and sensorineural

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Progressive Hearing Loss

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hearing loss that occurs over time

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Sudden Hearing Loss

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acute or rapid onset

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Medicare

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program under the SSA that reimburses hospitals and physicians for medical care they provide to qualified people who are 65 years or older

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Medicaid

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reimburses hospitals and physicians for providing health care to qualified people who cannot otherwise afford services

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5-Step (EBP) for clinicians to follow

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1. Ask straight forward question
2. Find the best evidence to answer your question
3. Critically asses the evidence - does it apply to your patient?
4. Integrate evidence with clinical judgment and patient values
5. Evaluate performance after enacting plan

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Speech Recognition/Perception

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The ability to perceive a spoken message and make decisions about its lexical composition using auditory and sometimes visual information

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Speech Recognition Testing

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-determines how well a person can recognize speech units
-more than an audiogram, shows how a person may be affected by their hearing loss

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Degrees of Hearing Loss

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NORMAL: 25dBHL or bettter
MILD: 26-40 dBHL
MODERATE: 41-55 dBHL
MODERATE-SEVERE: 56-70 dBHL
SEVERE: 71-90 dBHL
PROFOUND: 90+ dBHL

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Speech Reception Threshold

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the lowest presentation level for spondee words at which 50% can be identified correctly

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Spondee

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two-syllable words spoken with equal stress on each syllable

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Speech Discrimination Score

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(not used)
the percentage of monosyllabic words presented at a comfortable listening level that can be correctly repeated

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Most Comfortable Loudness (MCL)

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-The level at which sound is most comfortable for the listener
-determined by listening to running speech

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Uncomfortable Loudness Level (ULL)

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the level at which sound becomes uncomfortably loud for the listener

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Dynamic Range

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the difference in decibels between a person's threshold for just being able to detect speech and the person's threshold for uncomfortable listening

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Sound Field Testing

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determines hearing sensitivity or speech recognition ability by presenting signals in a sound field through a loudspeaker

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Why do SRT?

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-determine the need for amplification
-compare performance (w/o) hearing device
-show value of visual speech info
-examine environment related issues
-assess performance longitudinally (over time)
-determine need for speechreading
-determine placement within a training curriculum
-evaluate placement in ed. setting
-determine if goals are being met

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Communication mode

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the means used by a sender to share information with a receiver and may include using speech, sign, writing, hand gestures

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Information Transmission Analysis

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statistical procedure that analyzes the transmission of speech features by scoring confusions between test stimuli that are grouped based upon the presence or absence of those features

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Multidimensional scaling

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statistical procedure whereby data points are represented in a geometric space

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cluster analysis

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statistical approach to information in a database that aims to determine which data points fall into groups or clusters

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Optimal Test Environment

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Sound-treated booth

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Patient variables

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(such as cognitive/linguistic skill) influence the selection of test materials

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Two major trends of hearing aid design

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1. miniaturization
2. enhanced signal processing

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Multiple memories

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the patient can adjust the hearing aid for different situations

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Noise Reduction

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the difference in the sound pressure level (SPL) of a noise measured at two different locations

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Acoustic Feedback Cancellation

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reduces the squeal that occurs when the microphone picks up amplified sound from the hearing aid and reamplifies it

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Hearing Aid Components

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1. microphone (audio signal to electronic signal)
2. amplifier (increases the intensity of the sound)
3. battery (cell that provides electrical power)

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Gain

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the difference in decibels between the input level of an acoustic signal and the output level

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3 stages of amplification devices

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1. preamplifer (signal from mic is amplified)
2. signal-processing stage (signal is manipulated to enhance or extract component information)
3. output (the process signal is boosted)

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Maximum Power Output

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maximum intensity level that a hearing aid can produce

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Peak-clipping

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method of limiting hearing aid output in which a constant or linear amount of gain is provided across a range of input levels until it reaches a saturation level, at which time the amplifier begins to "clip" off the peaks of the signal

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Functions of Compression

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1. limit the max output of hearing aid
2. provide a range of sounds within the dynamic range
3. provide varying amount of gain of speech signal function

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Kneepoint

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point at which compression is activated

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Compression Ratio

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The decibel ratio of acoustic input to amplifier output

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attack time

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time between when a signal begins to the onset of its steady-state amplified value

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release time

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amount of time it takes for the amplifier to return to it's steady state after a loud sound ends

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Hearing Aid benefit

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1. benefit
2. satisfaction
3. use time
4. residual activity limitations
5. residual participation restrictions
6. impact on others
7. quality of life

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Hearing Aid Orientation

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-description of function of each part for hearing
-patient practice
-review of maintenance
-patient practice: phone
-review of expectations
-set use pattern
-troubleshoot
-printed information
-set followup date

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Tonotopic Organization

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structures within the peripheral and central auditiory nervous system are arranged topographically

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Cochlear Implant

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-The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin
-provide sensation by directly stimulating the nerve

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Candidates for CI

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-severe or profound sensorineural hearing loss
-good general health

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Assistive Listening Devices (ALDs)

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Primarily address face-to-face communication
-Wireless
-FM Systems
-Infrared
-Induction Loop
-Hardwired
-Other