Audiology Final Exam

Front 1

2007 position statement

Back 1

>includes a condition called neuropathology and auditory neuropathy (auditory dyschrony) babies found in NICU.
>if babies spend more than 5 days in NICU have ABR screening.
>if babies fail screening reffered to audiologist to be rescreened. When rescreened both ears tested again even if only fails at one ear.
>if a baby is readmitted during first month of life and condition is associated with potential hearing loss baby should be rescreened regardless if in well or NICU.
>some hospitals use ABR some use OAE.

Front 2

2007 Position Statement- Audiological Evaluation

Back 2

>audiologists with skills in diagnosing should provide services
>at least one ABR test is recommended at confirmation for those under 3 years.
>those who want amplification should have there infant fitted within one month of identification.

Front 3

2007 Position Statement-medical evaluation

Back 3

>those with confirmed hearing loss a genetic consultation should be offered.
>should visit otarlaryngolost and have visual exam.
> congiental and acquired combined into a single list.

Front 4

Intervention

Back 4

> all families with infant bilateral or unilateral should be considered eligable for service.
>recognized points that ensure services for infants with confirmed hearing loss.
>home based and center based offered.
>access to professionals such as SLPs and educators of deaf

Front 5

Appendix 2

Back 5

1.)caregiver concern.
2.) family history of permenant childhood hearing loss.
3.)NICU more than 5 days.
4.)in utero infections such as syphalis, herpes, rubella, toxoplasmosis.
5.)craniofacial abnormalities.

Front 6

Appendix 2 Cont.

Back 6

6.)physical indicators such as white forelock associated with syndrome.
7.)syndromes associated with hearing loss.
8.)Neogenerative disorders
9.)cultaral postive post natal infections associated with hearing loss like virus or bacteria.
10.) head trauma
11.) chemotherapy

Front 7

Behavioral Observation Audiometry (BOA)

Back 7

>used in NICU with high intensity broad band stimulus centered at 3000 Hz. child rests in the crib and responses are recorded.

Front 8

common type of BOA

Back 8

crib o gram is a common type used.
-> uses motion sensative transducer placed under the crib to detect responses high level of noise presentation.

Front 9

limitations BOA

Back 9

>only identify child severe forms of hearing loss
>bc sound field possible SN HL not detected
>sensativity and specificity concerns

Front 10

Auditory Brainstem Response (ABR)

Back 10

> recommended reliable indicator hearing sensativity in infants.

Front 11

Advantages of ABR

Back 11

>the use of less intense near threshold stimuli making it possible to detect milder forms hl.
>detect both unilateral and bilateral hl.
>use of physiological measures that depend completely on sensory response.

Front 12

limitations ABR

Back 12

> cost
> sophisticated nature of instrument
>a click makes primarily sensative to high frequency
>prescence of ABR does not mean individual can hear

Front 13

Patterns

Back 13

> pattern of OAE and ABR- a robust ABR could not be measured or wave latencies were prolonged despite the prescence of perfectly normal OAEs. This led to discovery of auditory neuropathology. it is believed to indicate disorder of inner hair cells.

> when you fail an OAE but pass ABR this is considered pass because the ABR is more extensive. Cannot pass OAE but fail ABR this is just considered fail.

Front 14

Otoacoustic Emissions

Back 14

>OAE tool identify hearing loss in neonates.
> debate over whether transient evoked OAE or Distortion Product OAE should be used or whether used together.
>OAE thought to be generated in OHC of cochlea and can be detected and recorded by small mictophones in external auditory meatus.

Front 15

advantages using OAE to assess:

Back 15

>objective
>noninvasive
>repeatable and precise
>specific to OHC and the preneural in origin
>present in approx. 100% of ears
>absent of reduced in hearing impaired ears.
>testing can be administered by support personal
>provide frequency specific information

Front 16

Transient Evoked OAE

Back 16

recorded by stimulating the ear with brief click while recording the sound level in the ear canal with a tiny microphone.
>sometimes low level echo can emerge.

Front 17

Distortion Product OAE

Back 17

can be introduced in a variety of ways but the most common way is to introduce stimulus tones simultaneously.
>occurs at frequency close but seperate from input so possible to use sounds of longer duration to evoke emission.

Front 18

who should be screened??
-can economically screen everyone in schools

Back 18

1. children with pre existing hearing loss.
2. children enrolled in sped programs
3. children with multiple handicaps
4. children frequent colds or ear infections.
5. children delayed language
6. children return to school after serious illness.
7. children school failure
8. children reffered by classroom teacher
9. children who are new to school

Front 19

Equpiment, Calibration, and Test Enviroment

Back 19

>equipment sturdy and portable.
>Performance characteristics must stay stable over time.
>audiometers often used in school often fail to meet calibration standards.
>tests should be done in sound treated rooms. some schools have these but most do not.

Front 20

Indentification Tests and Procedures

Back 20

> hearing tests for school aged children classified as group or individual.
>the group tests were developed to save time but are not widely accepted.
>most use individual screenings.

Front 21

Individual Screening Tests

Back 21

>The NCIA wrote general guidelines this type of test.
>screening be conducted at frequencies of 500,1000,2000,4000, and 6000 Hz.
>screening occur in sound treated room
>ASHA differs do not reccomend sound treated room nor test 500 and 600 Hz. also rescreening all failures is required.

Front 22

things to include diagnostic eval for birth to 6-

Back 22

Infants birth to six months-
Frequency specific ABR (we should use something like a toneburst)
A click evoked ABR because we want 2 different stimuli with differing phase differences- condensgating click (causes diaphragm of earphone to move in positive direction toward tympanic membrane) & rarefaction click (diaphragm of earphone moves in negative dir away from tympanic membrane)
Tympanometery with 1000Hz probe tone.
Sound field measurements to look for behavioral observations (Visual Reinforcement Audiology)
We do this in each ear to detect hearing losses in each ear separately

Front 23

electroacoustic immitance

Back 23

it identifies middle ear problems in children.

Front 24

Middle Ear Implants (MEI)

Back 24

1.) Symphonix vibrant soundbridge
2.)Esteem

Front 25

Symphonix Vibrant Soundbridge

Back 25

>external auditory processor parasurgically implanted in mastoid.
>the external auditory processor picks up a signal and sends it to the internal reciever which converts it to an electrical signal.
> it is then sent to floating mass transducer which is attatched to the incus.
the transducer vibrates causing the ossicular chain to move and sound transmitted to the inner ear.
>originally created for conductive hl can be used for mixed and sensineural
>broad freq response up to 8000 Hz.

Front 26

Esteem

Back 26

>only FDA approved middle ear implant with no external component
>sound goes down ear causing ear drum to vibrate
>has two transducers.
>one sensor picks up vibrations and sends them to internal reciever which converts them to electrical signal.
>the second driver is attatched to stapes and picks up electrical aignal causing stapes rock in and out of oval window.

Front 27

Aural Rehibilitation and Habilitation Process

Back 27

> the intervention phase begins with selection and appropraite fitting of rehibiliatitive devices.
>followed by extensive training with the device in communication situations

Front 28

Types of Hearing Aids (HA)

Back 28

5 Basic types
-eye glasses no longer count

1.)body Aid
2.)in the canal (ITC)
3.) behind the ear (BTE)
4.) in the ear (ITE)
5.) completely in the canal (CIC)

Front 29

CIC

Back 29

> smallest commercially available ha.
>cannot adjust controls manually instead adjusted with automatic volume control (AVC)
>most expensive hearing aid on market
> two problems- deep ear mold and verification of good fit

Front 30

3 components of hearing aid

Back 30

1.) the incoming signal is transduced (changed) into an electrical signal using a microphone
2.)electrical signal altered in some fashion
-contains amplifier to make signal stronger or filter
3.)the loudspeaker (or reciever) transduces the electrical signal back into a sound wave.

Front 31

Earmolds

Back 31

-for ITE and ITC directed by small peice tubing
-other hearing aids earmold required.

Earmold:
>constructed silicone or lucite material
>impression of outer ear

Front 32

used to be analog hearing aids now digital... Advantages of DIGITAL

Back 32

>provide variety signal processing strategies
>provide flexible programming
>greater flexibility and control response characteristics
>more precise and variable filter responses
>reduces feedback
>decrease background noise
>automatic volume control

Front 33

ANSI (american national standards institute) s3.22-2003

Back 33

1.) hearing aid analyzer
2.)gain
3.)OSPL
4.)frequency response

Front 34

Hearing Aid Analyzer

Back 34

generator that generates various fequencies bc you can adjust the different input levels. should be centered over a loudpseaker so when the signal is on it generates tone.

Front 35

Gain

Back 35

measured at 1000,1600, and 2500 Hz. and the values are averaged. Commonly reffered to as high frequency average.

Front 36

Full on Gain

Back 36

with 50 or 60 dB input signal and output measures tgese 3 then average with control turned fully on. usually done in 2 cc coupler because earmold inserted.

Front 37

Refrence Test Gain

Back 37

obtained with volume control adjusted so that HF average gain is 17 dB below the OSPL.

Front 38

Use gain (as-worn gain)

Back 38

the gain realized by the patient. get by adjusting the volume control to normally worn position.
-> means control in center of usable range.

Front 39

OSPL

Back 39

audiologist should adjust OSPL carefully to optimize the amount of gain available to the wearer while simulataneously minimizing liklihood hearing aid will produce uncomfortably loud output.

Front 40

OSPL90

Back 40

the maximum power output of a hearing aid 2 cc coupler.
-measured with volume control fully on and input intensity adjusted to 90 dB SPL.

Front 41

Frequency Response

Back 41

gain of the hearing aid as measured across range of frequencies.
-determined by subtracting 20 DB from refrence test gain and drawing line from low and high intensities ends. cutoff points reflect frequency response of ha.

Front 42

matching OSPL to LDL

Back 42

> setting max. output too high can result in sounds overamplified.
>this amplitude is excess LDL and would lead to rejection amplification.
>to obtain approp. match OSPL to LDL clinician must know LDL at several frequencies.

Front 43

Linear Amplification

Back 43

Direct relationship between input and output (the slope is 1)

Front 44

Nonlinear Amplification

Back 44

produces input/output less than 1.
(SEE NOTES))))

Front 45

Candidacy for amplification

Back 45

1.) examine degree of hearing loss: in range of frequencies ( 500-2000 Hz.)
2.)patients motivation: people who have job that requires hearing or school.
-if patient not interested can not change mind.
3.) acceptance of hearing loss: has to do with how motivated you are.
4.) cosmetic concerns

Front 46

Air Conduction Type

Back 46

-body aid
-behind the ear
-in the ear
-in the canal
-completely in the canal

Front 47

About these air conduction types

Back 47

-BTE,ITC,CIC, and ITE make up most of ha sales
-BTE typically used by children (75%)

Front 48

why is the BTE typically used by children?

Back 48

>due to changes in growth and cost associated with eharing aid
>in severe hearing loss more difficult to achieve adequete gain due to ear canal size
>saftey questions

Front 49

Bone conduction types

Back 49

>medical conditions cause no air conduction
>BC reciever placed on mastoid
>small wire connects BC to BTE ha and system transmits sound to BC threshold measurements

Front 50

BC disadvantages

Back 50

> frequency response poor so more energy to transmit sound
>not cosmetically appealing

Front 51

monaural vs. binaural

Back 51

most people fitted binaural because provide more advanatges.

-auditory deprivation effect: when the deteroraition of the hearing impaired ear left unattended.

Front 52

binaural advantages

Back 52

> better sound localization
>binaural summation
>improved speech recognition in noise
>subjective preference
> auditory deprivation

Front 53

CROS hearing aid

Back 53

contralateral crossing of signal
-designed minimal or mild hl in one ear and deaf in other
-microphone bad side picks up signal and sends to good.
-may be localization problems
-can cause problems for those with good ear and deaf ear because sound from bad side can be too loud in good ear.

Front 54

Bi Cros

Back 54

-for hearing loss in one ear and deaf in other
-has two microphones that helps pick up sound on deaf side and to amplify sound on ear that has hearing loss.

Front 55

determining optimal parameters

Back 55

>goal-provide sufficent acoustic cues to maximize speech ability and comprehension
>comparative methods
>prescriptive methods
1/2 gain rule: only have to give back half.
>nonlinear: set gain to vary with input levels (low, medium or high)
>OSPL90: measure the max. output of hearing aid. usually ospl is adjusted to be slightly lower than LDL this way the audiologist can ensure output will not exceed max. tolerance of the patient.

Front 56

probe microphone procedures

Back 56

real ear verification (ha gain and output measured in real ear vs a 2 cc coupler). measure the SPL near eardrum with and without ha in place through a tiny microphone made of plastic.

Front 57

REUR

Back 57

when sound presented from loudspeaker in 70 dB SPL pure tones inc. from 100 to 10000 Hz and measured in open ear canal with probe tube a freq response obtained. it shows 15 to 20 dB resonant boost provided by ear canal and pinna.

Front 58

REAR

Back 58

they both sit at same place but this extends 5/16 of inch beyond canal portion.

Front 59

REIG

Back 59

shows how much real insertion gain from 100 to 10000 hz as result of hearing aid insertion. compares reir to target values and fine tunes hearing aid till the two are close.

Front 60

Functional assessment

Back 60

>used to estimate auditory ability
>speech measurements taken
-in noise
-in quiet
> threshold measurements
>questionares
_parent and teacher where child concerned.

Front 61

Hearing Aid Orientation

Back 61

>instruction on recare and use of hearing aid.
>told limitations
>strategies to maximize benefit
>relate positive and negative experiences with the instrument.
>should voice complaints about function-sometimes earmold needs to be adjusted and could need electronic adjustments.

Front 62

Hearing Aid Orientation Con't..

Back 62

>usually 30 day trial period where you are encouraged to come in several times to figure all this stuff out.
>it is important to remember clients always think too loud at first because not used to hearing.
>maximize benefit because just helps dosnt create hearing

Front 63

Bone Anchored Hearing Aid (BAHA)

Back 63

>some patients cannot use normal ha bc pinna abnormalities, atresia, or chronic disease this is when use BAHA.
>strictly for conductive hl and mixed hl, also suggested single side deafness
>implants usually dealyed prior to age 5. before 5 can wear elastic band

Front 64

How do BAHA work?

Back 64

titanium screw implanted near the mastoid and titanium abutment is attatched to screw. BAHA attaches to the adutment.

Front 65

Cochlear Implants

Back 65

>implanted with stimulating electrode array inserted directly into cochlea.
>contains 1-22 channels

Front 66

How cochlear implants work?

Back 66

>the electrode is used to stimulate the auditory nerve directly with the electric current.
>microphone used to convert the acoustic signal to electrical one.
>The electrical signal is amplified and processed different ways in seperate body worn component (the stimulater)
>high frequency basal locations and low frequency apical regions

Front 67

candidates for cochlear implants

Back 67

profound bilateral SN HL after acquiring a language
-put in by otolaryngolist and other types of professionals.

Front 68

Amplified Systems and Education

Back 68

>education of all handicapped act - eha Pl 94-142 (1975)

Front 69

what is PL 99-457 (1990)

Back 69

amendment to education of all handicapped
-new program that says 3-5 year olds and intervention for handicapped infants and toddlers

Front 70

Individuals with Disabilities Education ACt (IDEA)

Back 70

>rename of EHA by PL 105-17 (1997)
>schools must provide services needed such as hearing aid eval, amplification, fm systems, and provide enviroment conductive to learning.

Front 71

Part H of IDEA

Back 71

the early intervention program for infants and toddlers with disabilities.
>said age includes 3-5 in preschool and intervention infants -2.

Front 72

classroom enviroment

Back 72

>classrooms are very noisy-noise level ranges from 40-67 dB
-normal convo speech is 65 dB
>noise is external to the building (traffic, construction)
>noise external to the classroom (hallways, adjacent classrooms, cooling/heating systems)

Front 73

classroom enviroment cont.

Back 73

>S:N recommended +15 to +30
>typical S:N +6 to -6 dB
>reverberation-the time it takes for a signal to decrease by 60 dB after termination of signal.
-affected by surronding surfaces(hard walls, heigh ceilings, windows, tole floors, etc.)

Front 74

classroom enviroment cont.

Back 74

>reverberation time can be shortened with acoustic treatments (carpet, curtains, acoustic tile on ceiling).
>speech recognition varies inversely with reverberation time
>increasing distance between talker and listener decreases S:N.

Front 75

minimal hearing loss

Back 75

minimal hearing loss encompasses unilateral, mild (between 20 and 40 dB) and children with hearing thresholds greater than 25 dB in the high frequencies. These children have a high risk factor.