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148 Cards in this Set

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Auropalpebral reflex
24-25 week fetus
Auditory Development
Arousal from sleep
Auditory Development
Newborn – 3 months
Eye widening
Auditory Development
Newborn – 3 months
Beginning sucking
Auditory Development
Newborn – 3 months
Slow head turn toward sound
Auditory Development
Newborn – 3 months
Cessation of sucking
Auditory Development
Newborn – 3 months
Change in breathing
Auditory Development
Newborn – 3 months
Startle reflex
Auditory Development
Newborn – 3 months
Makes vowel sounds “oo” and “ahh”
Speech/Lang. Development
Newborn – 3 months
Calms to familiar voices
Speech/Lang. Development
Newborn – 3 months
Changes voice pitch at will
4-7 months
Speech/Lang. Development
Makes a variety of sounds “ba-ba” and “ga-ba”
4-7 months
Speech/Lang. Development
Enjoys babbling
4-7 months
Speech/Lang. Development
Direct turn toward sound
4-7 months
Auditory Development
Head turns on lateral plane only
4-7 months
Auditory Development
Wobbly head turn toward sound
4-7 months
Auditory Development
says “da-da” or “ma-ma”
7-9 months
Speech/Lang.
Begins identifying the location of sound with direct head turn
7-9 months
Aud.
Responds to own name
7-9 months
Speech/Lang.
Localizes to side and directly below
7-9 months
Aud.
Imitates speech with non-speech sounds
7-9 months
Speech/Lang.
Plays with voice repetition, “la-la-la-la”
7-9 months
Speech/Lang.
Understands “no” and “bye-bye”
7-9 months
Speech/Lang.
Listens attentively to music and singing
7-9 months
Speech/Lang.
Follows simple directions
9-13 months
Speech/Lang. Development



Stops in response to “no”
9-13 months
Speech/Lang. Development
Gives up toys when asked
9-13 months
Speech/Lang. Development
Uses two or three simple words correctly
9-13 months
Speech/Lang. Development
Jabbers in response to human voice
9-13 months
Speech/Lang. Development
Turns head quickly toward loud or soft sounds
9-13 months
Speech/Lang. Development
Responds differently to happy or angry talking
9-13 months
Speech/Lang. Development
Localizes in any plane above or below eye level
9-13 months
Aud. Development
Has a vocabulary of 20 words or more
13 months and older
Speech/Lang. Development










Recognizes sounds in the environment
13 months and older
Speech/Lang. Development
Follows simple commands
13 months and older
Speech/Lang. Development
Speaks in understandable two word phrases
13 months and older
Speech/Lang. Development
Willful inhibition of localization response
13 months and older
Aud. Development
Gestures with speech appropriately
13 months and older
Speech/Lang. Development
Talks in what sounds like sentences
13 months and older
Speech/Lang. Development
Can tell you what he or she wants
13 months and older
Speech/Lang. Development
Locates directly a sound at any angle
13 months and older
Aud. Development
Bounces in rhythm with music
13 months and older
Speech/Lang. Development
Identifies people, body parts, and toys on request
13 months and older
Speech lang. development
13 months and older
Localizes directly all signals to side below and above
13 months and older
Aud. development
Cartilaginous stapes formed
Fetal Week 15
Ossification of malleus and incus begins
Fetal Week 16
Stapes begins to ossify
Fetal week 18
Maturation of inner ear; inner ear adult size
Fetal week 20
Auricle is adult shape but continues to grow until age 9
Fetal week 20
Meatal plug disintegrates, exposing tympanic membrane
Fetal week 21
pneumatization of tympanum
Fetal week 30
External auditory canal continues to mature until age 9
Fetal week 30
Malleus and incus complete ossification
Fetal week 32
Mastoid air cells develop
Fetal week 34
Antrum is pneumatized
Fetal week 35
Epitympanum is pneumatized; stapes continues to develop until adulthood; tympanic membrane changes relative position during first 2 years of life
Fetal week 37
Auditory placode; auditory pit begin to develop
Fetal week 3
tubotympanic recess begins to develop
Fetal week 3
Auditory vesicle (otocyst); Vestibular-cochlear division
Fetal week 4
Tissue thickenings begin to form
Fetal week 4
beginning of vestibular labyrinth present
Fetal week 5
First Trimester
Primary auditory meatus begins
Fetal week 5
Utricle and saccule present; semicircular canals begin
Fetal week 6
Six hillocks evident; cartilage begins to form
Fetal week 6
One cochlear coil present; sensory cells in utricle and saccule (cristae & maculae)
Fetal week 7
First trimester
Auricles move dorsolaterally
Fetal week 7
Ductus reunions present: sensory cells in semicircular canals
Fetal week 8
Incus and malleus present in cartilage; lower half of tympanic cavity formed including Eustachian tube
Fetal week 8
Outer cartilaginous third of external canal formed
Fetal week 8
Three tissue layers at tympanic membrane are present
Fetal week 9
Two and one-half cochlear coils present; nerve VIII attaches to cochlear duct
Fetal week 11
Sensory cells in cochlea; membranous labyrinth complete; otic capsule begins to ossify
Fetal week 12
When does the major formation of palate happen?
Fetal week 6
At what fetal week does the proper terminology change from embryo to fetus?
Fetal week 8
What do the letters in the acronym APGAR mean?
Appearance, Pulse, Grimace, Activity, Respiration
Stimulus and Level of Response
Auditory Behavior
0-6 weeks
Noise Makers ( dB SPL):50-70
Warbled Pure Tones:75
Speech:40-60
Startle to speech: 65
Stimulus and Level of Response
Auditory Behavior
6 weeks –
4 months
Noise Makers ( dB SPL):50-60
Warbled Pure Tones:70
Speech:45
Startle to Speech:65
Stimulus and Level of Response
Auditory Behavior
4-7
months
Noise Makers ( dB SPL):40-50
Warbled Pure Tones:50
Speech:20
Startle to Speech:65
Stimulus and Level of Response
Auditory Behavior
7-9
months
Noise Makers ( dB SPL):30-40
Warbled Pure Tones:45
Speech:15
Startle to Speech:65
Stimulus and Level of Response
Auditory Behavior
9-13
months
Noise Makers ( dB SPL):25-35
Warbled Pure Tones:38
Speech:10
Startle to Speech:65
Stimulus and Level of Response
Auditory Behavior
13-16
months
Noise Makers ( dB SPL):25-30
Warbled Pure Tones:30
Speech:5
Startle to Speech:65
Stimulus and Level of Response
Auditory Behavior
16-21
months
Noise Makers ( dB SPL):25
Warbled Pure Tones:25
Speech:5
Startle to Speech:65
Stimulus and Level of Response
Auditory Behavior
21-24
months
Noise Makers ( dB SPL):25
Warbled Pure Tones:25
Speech:5
Startle to Speech:65
Expected response
Auditory Behavior
0-6 weeks
Eye-widening, eye-blink, stirring or arousal from sleep, startle
Expected response
Auditory Behavior
6 weeks –
4 months
Eye-widening, eye-shift, eye-blink, quieting; beginning rudimentary head turn by 4 months
Expected response
Auditory Behavior
4-7
months
Head-turn on lateral plane toward sound; listening attitude
Expected response
Auditory Behavior
7-9
months
Direct localization of sounds to side, indirectly below ear level
Expected response
Auditory Behavior
9-13
months
Direct localization of sounds to side, directly below ear level, indirectly above ear level
Expected response
Auditory Behavior
13-16
months
Direct localization of sound on side, above and below
Expected response
Auditory Behavior
16-21
months
Direct localization of sound on side, above and below
Expected response
Auditory Behavior
21-24
months
Direct localization of sound on side, above and below
Ectoderm (Outermost layer) forms the...
Epidermis of the skin
Much of the teeth
Entire nervous system
Hair
Nails
Epithelial tissue of mouth and pharynx
Sense organs – Outer & Inner Ear

(Every Monday Ella had noodles, eggplant, & sauce.)
Mesoderm (Intermediate layer) froms the
Forms most of the connective tissue.

Bones (ossicles, bone surrounding inner ear)
Muscles
Blood vessels
Cartilage
Kidneys
Reproductive organs

(Both men & boys can kill rabbits)
Endoderm (Deepest layer)
Forms epithelial lining of :

the entire digestive tract
the entire respiratory tract
Embryo
Greek word meaning to swell
Term for developing baby for the first 8
weeks of life
Fetus
Latin word meaning offspring
Term used the remainder of gestation
Nervous system development
week 4
Ganglion cells from
VIII nerve arise
Nervous system development
week 5
Nerve fibers enter
expanding cochlea
Cochlear portion fans
out in synchrony
with curving cochlea
Nervous system development
11th and 12th weeks
Radial dendrites
contact IHCs
Nervous system development
14th Week
Spiral fibers contact
base of the OHCs
Nervous system development
15th - 22nd Weeks
Efferent 1st, then
afferent inneveration
with axons
Neurological Development
7th Month
All synapses formed
Conditions for beginning to hear.
Connections between the apex of hair cells
and the tectorial membrane
Adequate internal structure of hair cells
Mature synapses between base of hair cells
and nerve fibers
Maturity of ganglion cells
Thinning of the basilar membrane
Degeneration of pseudo stratified
epithelium of the inner spiral sulcus
Maturity of pillar cells
Freeing of the inferior margin of the
tectorial membrane from the organ of Corti
Forming of spaces in the tunnel of Corti
and around the OHCs
Sensorineural system mature enough to
experience sensation of sound near
what month?
6th 0r 7th
1st Branchial Arch

Called Mandibular or Meckel’s Arch
Lower lip
Muscles of mastication
Mandible
Anterior portion of the tongue
Malleus
Incus
2nd Branchial Arch

Called Hyoid or Reichert’s Arch
Gives rise to:
Upper body and lesser horns of the hyoid bone
Stapes
Muscles of facial expression
3rd Branchial Arch
Lower body of the hyoid bone
Posterior portion of the tongue
4th and 5th Branchial Arches Give rise to:
Cricoid and arytenoid cartilages of the larynx
Cartilages of the trachea
6th Branchial Arch
Intrinsic laryngeal muscles
Possibly the cricoid cartilage
Auropalpebral reflex
An involuntary eyeblink in response to a loud
transient acoustic stimulus
Acute OM
– Sudden onset
– Severe ear pain
– Red TM, can be bulging
– Fever
– Usually a sequel to URI
– Can be with or without effusion
(OME vs. OM)
– Lasts 0-21 days
• Subacute
– Lasts 22 days – 8 weeks
• Chronic OM
– Persists for longer than 8 weeks
– Slow onset
– Large TM perforation
– Ear discharge
Early Hearing Detection and
Intervention goal- 1 month
1 month: all newborns
should have access to
hearing screening
using a physiologic
measure
Early Hearing Detection and
Intervention goal- 3 month
– 3 months: all infants
who do not pass the
initial hearing screen
and rescreening should
have a diagnostic
audiologic evaluation
Early Hearing Detection and
Intervention goal- 6 month
6 months: all infants
with confirmed hearing
loss should receive
intervention services
Birth through 6 Months
Screening criteria for passing
Pass

• Reliable responses in BOTH ears
• ABR 35 dBnHL or lower
• OAE if acceptable reproducibility is reached
7 Months through 2 Years
Screening criteria for passing
• Reliable responses in BOTH ears
• VRA with earphones at 1K, 2K, 4K Hz at 30 dB HL
• Play audiometry at 1K, 2K, 4K Hz at 20 dB HL
What is the first age professionals other than AUDs can screen hearing?
Age 3
3-5 Years
Screening criteria for passing
• Reliable responses at screening criteria 2/3 times at each
frequency in BOTH ears
• Play audiometry at 1K, 2K, 4K Hz at 20 dB HL
5 through 18 Years
Screening criteria for passing
• Reliable responses at screening criteria at each frequency in
BOTH ears
• Audiometry at 1K, 2K, 4K Hz at 20 dB HL
When do you Refer for Complete
Audiological Evaluation?
Child fails both pure tone and immittance
screening
• Immittance screening is abnormal one week
after initial screening or following medical
treatment
• Child fails pure tone screening but passes
immittance
• Child fails pure-tone rescreen with no
immittance screening performed
Pediatric Case History includes...
Birth history including:

Birth weight, APGAR scores, NBHS results,
hyperbilirubinemia, other risk factors, etc.



Medical history including:

trauma, ototoxic meds, serious illnesses, middle ear
pathology, surgery, noise exposure



Physical and neurological development
Communicative behavior and development
When was hearing loss suspected and why
Family history of hearing loss

(BSL makes physical communication wonderfully fast)
BOA is...
Doesn’t incorporate
reinforcement

Active response from
an infant passively
involved in the task at
hand
BOA Advantages
Efficiency in time
Lack of special equipment
BOA disadvantages
Difficult to eliminate tester bias
Responses quick to reach extinction
Definition of response – wide variety
Parameters of the acoustic stimulus
State of the infant or child
BOA reflexive behaviors
Startle response
Arm or leg jerks
Slow limb movements
Auropalpebral reflex
(APR)
Change in sucking
behavior
Eye-blinks
Facial twitches
(so as she already commented earlier friday...)
BOA Attentive Behaviors
Quieting responses
Increase in ongoing
activity
Change in breathing
or sucking rate
Onset of vocalization
Sudden stopping of
vocalization
Starting or stopping
crying

Eye widening
Searching or
localization
Head turning
Smiling or other
change in facial
expression
Brow furrowing
Shriek of surprise
Look at parent
What is the most reliable response for BOA 0-6 months?
sucking
WHen can you start using conditioned responses?
Between 6-8 months depending on the child.
How is VRA done?
Parents or assistants in the room
may need to wear hearing
protection
Speech stimuli are more effective
than warble tones
Can be used for aided responses as
well
Use only 1 reinforcer, usually placed
on top of loudspeaker

Can be performed via soundfield,
inserts, or earphones!
What does VRA reinforcement do?
Maintains the child’s responses longer
Reduces habituation to the stimulus
New research trying to maintain the
interest of the child longer

“Frequency specific” animal sounds

Paired with the corresponding animal
Paired with a different animal

Video reinforcement
Pediatric Case History includes...
Birth history including:

Birth weight, APGAR scores, NBHS results,
hyperbilirubinemia, other risk factors, etc.



Medical history including:

trauma, ototoxic meds, serious illnesses, middle ear
pathology, surgery, noise exposure



Physical and neurological development
Communicative behavior and development
When was hearing loss suspected and why
Family history of hearing loss

(BSL makes physical communication wonderfully fast)
BOA is...
Doesn’t incorporate
reinforcement

Active response from
an infant passively
involved in the task at
hand
BOA Advantages
Efficiency in time
Lack of special equipment
BOA disadvantages
Difficult to eliminate tester bias
Responses quick to reach extinction
Definition of response – wide variety
Parameters of the acoustic stimulus
State of the infant or child
BOA reflexive behaviors
Startle response
Arm or leg jerks
Slow limb movements
Auropalpebral reflex
(APR)
Change in sucking
behavior
Eye-blinks
Facial twitches
(so as she already commented earlier friday...)
BOA Attentive Behaviors
Quieting responses
Increase in ongoing
activity
Change in breathing
or sucking rate
Onset of vocalization
Sudden stopping of
vocalization
Starting or stopping
crying

Eye widening
Searching or
localization
Head turning
Smiling or other
change in facial
expression
Brow furrowing
Shriek of surprise
Look at parent
What is the most reliable response for BOA 0-6 months?
sucking
WHen can you start using conditioned responses?
Between 6-8 months depending on the child.
How is VRA done?
Parents or assistants in the room
may need to wear hearing
protection
Speech stimuli are more effective
than warble tones
Can be used for aided responses as
well
Use only 1 reinforcer, usually placed
on top of loudspeaker

Can be performed via soundfield,
inserts, or earphones!
What does VRA reinforcement do?
Maintains the child’s responses longer
Reduces habituation to the stimulus
New research trying to maintain the
interest of the child longer

“Frequency specific” animal sounds

Paired with the corresponding animal
Paired with a different animal

Video reinforcement
COR
Conditioning and Testing phases are
the same as for VRA
Major difference is that 2 reinforcers
are used and localization is
expected before a response is
recorded
VRA Order of Test Stimuli
Assume each threshold is your last
Try to start with 2000 Hz

If you think loss is SNHL

Then go to 500 Hz
Followed by 4000, 1000 and 250 Hz

Or 1000 Hz first if big difference b/w
2000 and 500 Hz

Earphones/inserts then bone
conduction if possible
Tangible and Visual Reinforcement
Operant Conditioning Audiometry
(TROCA) is...
Child pushes button when sound is
heard and a tangible reinforcement
is received, usually accompanied by
secondary social approval
Most useful with children 2-4 years
Takes longer than VRA
CPA is appropriate for what age?
Cognitive age of 30 months
Conditioned Play Audiometry
(CPA) is...
Ages 30 months up to 5
years
ear-specific results
frequency-specific
stimuli
AC and BC
may need serial tests or
long breaks
conditioning phase and
testing phase
Examples of CPA toys
blocks in bucket
 rings on pole
 pegs in board
 pieces in a puzzle
 computer pictures
(BTNRH)