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Aural Rehab
Midterm
143
Audiology
Undergraduate 4
10/16/2013

Additional Audiology Flashcards

 


 

Cards

Term
What does an audiometer measure?
Definition
  • hearing at different frequencies
  • finds hearing threshold (lowest level that can be heard)
Term

What does a hearing screening tell us?

How is one performed?

Definition
  • tells if a loss is present but not where
  • pick one level and play several frequencies at that level
  • pick a level at the upper limit of normal
Term
What can a diagnostic evaluation tell us?
Definition
  • finds the lowest level that the person can hear (hearing threshold for different types of sounds)
  • gives better info on where the hearing loss may be occuring
Term
What is a pure tone threshold?
Definition
the lowest level at which a pure tone can be heard
Term
How do we test air conduction?
Definition
headphones, speakers, insert earphones
Term
How do we test bone conduction?
Definition
  • bone vibrator on mastoid
  • sound vibrates and goes through mastoid to the inner ear and auditory nerve
Term

When is masking helpful?

How is it done?

Definition
  • helpful when hearing loss is different between ears
  • noise is played in the good ear to prevent it from hearing pure tones so that the bad ear's ability to recognize the pure tone is tested without help from the good ear
Term
What is VRA?
Definition
Visual Response Audiometry
Term
When is VRA used and how is it done?
Definition
  • used when child/infant can turn head toward the sound (as young as 6 months old)
  • condition child to look at a visual reinforcement when sound is played
  • move to playing the sound alone and providing visual reinforcement when child looks toward sound
  • use lower sound levels to see how low child can hear
Term

What is CPA?

How is it done?

Definition

Conditioned Play Audiometry

Make the response into a game (e.g. put block in basket when you hear the soud)

Term
What is involved with conventional audiometry and what populations can it be used with?
Definition
  • Can be used with adults and older children who can follow the directions
  • raise hand when hear the pure tone
Term
What information do we get from using VRA, CPA, and conventional audiometry?
Definition
all ways to obtain pure tone thresholds
Term
Range in dB HL for normal hearing
Definition
-10 to 15
Term

Range for minimal hearing loss

What might be difficult with this type of loss?

Definition

16 to 25

faint or distant speech may be difficult to hear

Term

Range for Mild Hearing Loss

Challenges?

Definition

26 to 40

can hear speech but might miss pieces of words resulting in misunderstanding; speech may sound mumbled; vowels may more easily heard while high pitched consonants are more difficult

Term

range for moderate hearing loss

challenges?

Definition

41-55

may understand familiar conversational speech up to 3-5 feet away

Term

range for moderately severe hearing loss

challenges?

Definition

56-70

may only understand loud speech

Term

range for severe hearing loss

challenges?

Definition

71-90

may hear a loud shout one foot from the ear

Term

range for profound hearing loss

challenges?

Definition

91 and up

hearing cannot be used for communication

Term
What are Hertz?
Definition

frequency

cycles per second

Term
What is pitch?
Definition
our perception of frequency
Term
Where is the problem in sensorineural hearing loss?
Definition

most likely the cochlea in the inner ear


possibly auditory nerve

Term
Problem area in conductive hearing loss
Definition
outer or middle ear
Term
problem area for mixed hearing loss
Definition
middle or outer ear plus inner ear
Term

where is the problem in auditory neuropathy?

what kind of hearing loss is it?

Definition

problem w/ auditory nerve

kind of a more specific type of sensorineural hearing loss

Term
What does audiogram look like for sensorineural HL?
Definition
bone conduction is within 10 dB HL of air conduction
Term
What does an audiogram look like for conductive HL?
Definition

Bone conduction is normal

Air conduction will show the hearing loss

Term
What does an audiogram look like for mixed HL?
Definition
Bone and air conduction will show a loss and are not within 10 dB HL of one another
Term
What does an upward configuration look like?
Definition

X

   X

      X

         X

            X

               X

                  X

Term
What does a downward sloping configuaration look like?
Definition

X

        X   

X      

X         

X            

X               

X                  

 

Term
Flat configuration?
Definition

 

 

 

 

X   X   X   X   X   X   X   X   X   X   X

Term
Cookie bite configuration?
Definition

X                                X

   X                          X

      X                    X

         X              X

            X        X

               X  X

Term
Reverse cookie bite configuration?
Definition

X

X   X

X       X

X             X

X                  X

X                       X

Term

What is PTA (pure tone avg)?

Where do we like PTA to be?

What does a higher number mean?

Definition
  • take thresholds at 500, 1000, and 2000 Hz and average them
  • like PTA to be within 10 dB of speech awareness or speech recognition thresholds
  • the higher the number the worse the hearing loss
Term
What is speech awareness threshold?
Definition
the lowest level at which speech can be heard but not necessarily understood
Term
What is speech recognition threshold?
Definition
lowest level at which speech can be understood
Term
What is involved in a speech recognition score?
Definition

A list of words is played at a fixed level

Pt attempts to repeat back the list

Score is how many words they recognize

Term

What is sensation level?

What does it tell us?

Definition
  • the difference between level of sound and the hearing threshold (measured in dB)
  • can tell the ability of some patients
Term
If a sound was played at 70 dB and a the person's hearing threshold is 30 dB, what is the sensation level?
Definition
70 - 30 = 40 dB
Term
What is the "audiogram of familiar sounds"?
Definition
shows pictures of sounds that may be at a certain frequecy and intensity to demonstrate to patients what types of things may and may not be audible for different degrees of hearing loss
Term
Put the 4 types of HL in order from least to most detrimental.
Definition
  1. Conductive
  2. Mixed
  3. Sensorineural
  4. Auditory Neuropathy (nerve is damaged so access to acoustic info is limited)
Term
When is a HL considered prelingual?
Definition
before 3 years of age
Term
When is HL considered postlingual?
Definition
After 3 years of age
Term
Give an example of an activity limitation vs a participation limitation.
Definition

activity = talking on the phone

participation = gossiping 

Term
What is involved in the Medical Model?
Definition
diagnostics and treatment
Term
What is involved in the social model?
Definition
  • interaction of a person with society
  • change society to accomodate person's impairment
Term
What is audibility and what influences it?
Definition
  • the ability to hear
  • influenced by hearing thresholds and masking
Term
what type of diagram to we see the speech banana?
Definition
audiogram
Term

Where will we see the "speech bacon"?

what does it represent?

Definition

SPLoGram

represents conversational speech

Term
On an SPLoGram, the pt's threshold is plotted.  Can the pt hear what's above or below the threshold?
Definition
can hear anything above the threshold; not below
Term
When do we usually use the SPLoGram?
Definition
to test ability with hearing aids
Term
What is "best evidence"?
Definition
scientific proof that exceeds all others
Term
what is bias in research?
Definition
the influence of factors other than the treatment on outcomes
Term
What are the 6 levels of evidence from high to low?
Definition
  1. Meta Analysis
  2. Randomized Controlled Trial
  3. Nonrandomized Intervention Study
  4. Nonintervention Studies
  5. Case Reports
  6. Expert Opinion
Term
What is meta analysis?
Definition
  • a systematic review of research literature along with statistical analysis of the data
  • helps determine efficacy of a tx by combining info from several studies
Term
What is involved in a randomized controlled trial?
Definition
conditions are randomly assigned to participants; can be double blind where participants and researchers neither one know who is receiving placebo vs. real tx
Term
How are participants separated in nonrandomized intervention studies?
Definition
  • one group contains participants with hearing loss
  • other group doesn't have HL
Term
What are the 5 steps of EBP?
Definition
  1. Formulate clinical question
  2. search for evidence
  3. evaluate the evidence
  4. integrate scientific evidence, clinical expertise, and pt preferences for clinical decision-making
  5. evaluate the process
Term
Is it easier to find evidence when the target is more or less specific?
Definition
more specific = harder to find evidence
Term
What is internal validity?
Definition
was the outcome r/t tx or other factors (acclimation, particpants dropping out, differences btwn groups)
Term
How are hearing aids today better than older one?
Definition
smaller, more features, digital
Term
What are the components of the hearing aid fitting process?
Definition
  1. Assessment
  2. Selection
  3. Verification
  4. Orientation
  5. Outcome Evaluation
Term
During assessment for HA, what are you looking for?
Definition
  • presence of HL
  • participation limitations
  • activity limitations
Term
What is BOAT?
Definition

Benefits of Amplification Tool

combines open-ended and more formal questions to assess the pt's feelings/perspective of the HL

Term
What are the goals when hearing aids are chosen?
Definition
  • overcome limitations
  • better hearing
  • incidental learning (over hearing others speech)
  • improve mood, social life
  • improve academic performance
  • occupational opportunites
  • speech and language development
  • improved behavior
Term
How do hearing aids work?
Definition
  • pick up sound and amplify it
  • acoustic

 

 

Term
What are some limitations of HA?
Definition
  • can't make sounds loud enough to hear everything
  • even though more is heard, what is heard isn't as clear as for someone with normal hearing
  • can't be used for people with sensorineural HL
Term
What are some of the pros and cons of behind the ear (BTE) HA versus In the Ear (ITE)?
Definition
  • more amplification but less natural sounds
  • used w/ kids because their ears are still growing
    • can just replace the ear mold so much less expensive than constantly having to replace the whole system
  • more reliable; less exposure to fluids/wax
  • ITE -- smaller but less powerful and less reliable
Term
Label parts of a hearing aid...
Definition

battery door

volume control

microphone

tone hook

receiver/speaker

earmold

Term
What do directional microphones do?
Definition
  • amplify sounds coming in front more than behind
  • allow person to orient toward speaker
  • less amplification of background noise
  • evidence of improved speech recognition
  • may not be best for kids who might miss out on classroom discussion (other reasons too ... )
Term
What is frequency compression?
Definition
squeezes higher frequency sounds down to make them lower
Term
what is frequency transposition?
Definition
takes higher frequency sounds and plops them onto lower frequencies
Term
why do we use frequency compression & transposition?
Definition
  • some people hear lower frequencies better than higher ones so these can help w/ speech recognition
  • common for people to hear lower frequencies better

 

Term
what is contralateral routing of sound (CROS)?
Definition
  • take sound f/ one side of head and move it to the other side 
  • used when can hear out of one ear and not the other
Term
What is BICROS (bilateral and contralateral routing of sound)?
Definition
  • same as CROS but also amplifies sound
  • used when there is a loss in both ears but one side is better than the other
Term
What is transcranial CROS?
Definition
  • amplify sound with HA on bad side so much that the sound transfers through the skull to the other side
  • not common
Term
What is involved in the verification portion of a HA fitting?
Definition
  • make sure HA output is appropriate for the HL
  • done by matching HA output to targetsbased on degree of HL
Term

What is involved in Real Ear?

 

Definition
  • Speaker generates sounds (actual speech)
  • place a probe in the ear and then the HA to measure how loud the HA is
  • this is how we get the SPLoGram
Term
What are some common problems that may occur w/ HA?
Definition
  • dead battery
  • dead microphone
  • distorted speaker
  • plugged earmold or tonehook
Term
How to do a listening check...
Definition
  • connect stethoscope to the hearing aid
  • listen for degree of amplification (weak/good, distorted/clarity)
Term
Why are listening checks important?
Definition
  • ensures child is receiving consistent access to sound
Term
What type of hearing loss can be amplified w/ bone anchored hearing aids (osseointegration)?
Definition
conductive; not appropriate for sensorineural!
Term

How does bone conduction work? 

4 parts ... 

Definition
  1. processor worn on skull behind ear to detect sound
  2. sound is transformed into vibrations
  3. connector on head band or implanted component receives vibrations
  4. vibrations are sent to the cochlea (bipassing outer and middle ear) then to hearing nerve
Term

Things to consider for surgical candidacy for bone conduction hearing aids ... 

In other words, who can use this type of amplification?

Definition
  • inability to use traditional amplification (maybe r/t cranofacial abnormalities or outer ear malformations)
  • adults and children ≥ 5 y/o
  • meet criteria for mixed or conductive HL
  • meet criteria for single sided deafness
    • profound HL in one ear; normal in the other
Term
What would an audiogram of a conductive HL look like in a candidate for bone conduction HA?
Definition

bone conduction = normal

air conduction = loss

 

Term
What would an audiogram look like for mixed HL in a candidate for bone conduction HA?
Definition

no normal thresholds

loss in both bone and air conduction

Term

How should you attach a bone conduction HA to the softband or abutment? 

Why?

Definition
"tilt" or "rock" method to decrease wear and tear
Term
How many people in the world have received CI?
Definition
188,000
Term
How many people in the US have received CI?
Definition
67,000
Term
How is the cochlea organized?
Definition

Tonotopographically

  • low frequencies in top (apex)
  • high pitch sounds at base
Term
What is the physiology of normal hearing?
Definition
sound waves come in and make hair cells move, stimulating nerves to fire when hair cells hit the tectorial membrane on the organ of corti
Term
What is damaged in sensorineural hearing loss?
Definition
hair cells in the cochlea
Term
What does a CI do for people w/ sensorineural HL?
Definition
provides electrical stimulation to the tectorial membrane because hair cells can't
Term
What are some quailfying factors for cochlear implantation in children?
Definition

12 months old -- bilateral profound HL

18 months -- bilateral severe to profound HL

Term
What is the first step of CI function?
Definition
  • capture sound by microphone
  • digitize/analyze sound in processor
  • signal is coded in processor to form that will produce electircal pulses in the electrode
Term
Step 2 of CI function
Definition
  • electrical pulses sent to headpiece/coil that's magnetically attached
  • headpiece transmits signal through scalp via radio waves (RF - radio frequency)
Term
Step 3 CI Function
Definition
  • coded info is received by implantable cochlear stimulator
  • signal is passed to electrode in cochlea
Term
Step 4 CI Function
Definition
  • electrical pulses f/ electrode stimulate auditory nerve
  • nerve sends signal to auditory cortex in brain
  • brain interprets neural signal as sound
Term
How do HA and CI process sound differently?
Definition

HA -- processes into sound waves

CI -- processes sound waves into electical waves

CI has narrower band of frequencies

sound is picked up the same in both CI and HA

Term
Factors in considering candidacy for CI
Definition
  1. degree of loss
  2. aided performance
  3. family/pt expectations
  4. physical/developmental limitations
  5. medical contraindications
Term
What is involved in CI Candidacy Evaluation?
Definition
  • ENT evaluation
  • audiometric testing and HA check
  • vestibular testing (can help choose which ear -- put in ear w/ worse vestibular function bc CI can disrupt even more so want to leave best ear intact)
  • CI orientation/eval of aided speech perception
  • speech-lang. eval/functional communication
  • discuss expectations
  • more appt as needed
Term
What degree of HL is required to be candidate for CI?
Definition

profound bilateral loss in 12-18 mos

severe to profound if > 18 mos

Term
How is "aided performance" assessed?
Definition
  • FDA says need to try 3-6 mos w/ other amplification and aural rehab
  • child fails to make progress in basic auditory skills
  • limited benefit/progress w/ other amplification
  • speech perception test scores are low
Term

Degrees of communication on the 

Communication Continuum

Definition
  • A (primarily auditory)
  • Av (auditory w/ visual support at times)
  • Va (visual communicator but can use auditory info)
  • V (primarily visual communicator; CI helps w/ sound awareness)
Term
What factors may impact audibility/speech recognition?
Definition
  • presentation level
  • distance
  • reverberation
  • talker characteristics
  • classroom acoustics
Term
How does HL impact frequency resolution?
Definition
decreases ability to hear different frequencies
Term
How does HL impact temporal resolution?
Definition
decreases ability to hear sounds that change over time (intonation, ups/downs in volume)
Term
What % of the teacher's speech was understood by normal hearing students sitting in the front row?
Definition
83%
Term
What % of the teacher's speech was understood by normal hearing students in the middle rows?
Definition
66%
Term
What % of the teacher's speech was understood by normal hearing students sitting in the back rows?
Definition
55%
Term
What factors can be modified to optimize auditory access?
Definition
  • technology
  • noice
  • distance
  • volume
  • rate
Term
Describe how a soundfield FM system works
Definition
  • FM transmitter picks up sound f/ microphone & transmits it wirelessly to a speaker
  • benefits whole classroom
Term
Describe how a personal FM system works
Definition
  • Student either has small speaker on desk or wears headphones
  • amplifies all frequencies; less selective than HA
  • only benefits that student
Term
How does a personal FM + HA system work?
Definition
child can hear what is coming through the FM system as well as what the HA is amplifying
Term
What are some limitations to FM systems?
Definition
  • set up -- teacher needs to be trained
  • all devices must be set to the same channel
  • speaker has to use microphone 
    • so either pass mic. around when students talk or teacher needs to repeat what others say
Term
What are some cultural factors that may impact use of assistive listening devices?
Definition
  • beliefs about causality (things happen to me vs. i can control some things)
  • appearance 
  • coping strategies
  • finances
    • perceived value or willingness to spend $$ (is hearing important enough for them to spend $)
  • Knowledge (awareness of difficulties caused by HL & solutions; do they acknowledge they have a problem or blame others for "mumbling")
Term
What is reverberation
Definition
  • continuation of sound due to reflections
  • elongates speech -- smearing
  • increases w/ larger rooms and harder surfaces
    • our classroom has the auditory foam on the ceiling
Term
Rehabilitation Act 1973
Definition
  • reasonable accommodations for employment
  • covers voc rehab -- help ppl w/ disabilities get jobs
  • covers employers subsidized by federal funds & higher edu.
Term
Individuals w/ Disabilities Education Improvement Act
Definition
  • free and appropriate edu.
  • least restrictive environment
  • school must provide interpreter if needed
  • can't just send all deaf kids to a different school bc may not be best environment for all students
Term
Developmental Disabilities Assistance & Bill of Rights Act
Definition

provides financial assistance to states for assistive tech.

Voc. Rehab

Neb. Commission for Deaf/Hard of Hearing

Term
How can people pay for ALD?
Definition

Medicaid generally covers cost/service

Medicare -- most won't cover

Private Insurance -- probably won't cover; some states require them to cover HA

Term
What is the maximum in dB for conductive HL?
Definition
60 dB
Term
What is a pro of home-based therapy?
Definition
client will be in natural, everyday environment so carryover skills may be supported
Term
A con of home-based therapy...
Definition

may not be the most productive environment

distractions

may wind up focusing on behavioral issues or "social work" type of problems

Term
Why are routines important for children?
Definition
  • repetive; practice
  • work skills into routines to promote generalization
  • intrinsically motivating to child
  • one skill can be incorporated into many routines
  • many skills can be incorporated into one routine
  • supports carryover
Term
What is the SCALES approach?
Definition
  • considers performance in different environments
  • school, home, community
  • Social Emotion
  • Cognitive
  • Auditory
  • Language
  • Extra
  • Speech
Term
What % of children w/ HL have other disabilities?
Definition
40%
Term
Why use Auditory First method?
Definition

gives child chances to listen

lets us know when they start understanding speech alone w/o other supports

Term
What are some physiological factors affecting auditory development?
Definition
  1. degree of HL
  2. age of onset
  3. type of HL
  4. cognitive abilities
  5. additional conditions
Term
What are some environmental factors that affect auditory development?
Definition
  1. age of beginning intervention
  2. use of amplification
  3. family involvement
  4. multiple languages
  5. quality of intervention
  6. resources available to family
Term
What are the prerequisites to auditory based intervention?
Definition
  1. appropriate amplification/hearing technology
  2. family commitment to developing listening and spoken language skills
Term

Hearing vs. Listening

which comes first?

Definition
  • hearing: accoustic access to brain
  • attending to acoustic events w/ intention

 

hearing must be made available before listening can be taught

Term

What are the levels of Erber's Hierarchy of Auditory Skils?

(from more simplistic to most complex)

Definition

detection

discrimination

identification

comprehension

Term
What is involved in "detection"
Definition
only know that a sound is there but do not respond meaningfully
Term
What is involved in "discrimination"?
Definition
  • know that 2 sounds are different ("ah" vs. "ee")
  • still no meaning
  • helps decide if the problem is w/ perception or production
  • more of a dx tool so don't really have goals at this level
Term
What is involved in "identification"?
Definition

sound is being attached to meaning

(ex. look at dog every time it barks)

  • vocab, key word ID
Term
What's involved in "Comprehension"?
Definition

messages can be process

understanding

(ex. story retell)

Term

Define the Visual Approach to communication.

Goals?

Definition
  • bilingual (ASL & English)
  • acquisition of English using ESL strategies
  • Goals:
    • age appropriate language 
    • positive self-image & cultural ID w/ deaf culture
    • basis for learning written English
Term

Describe the Auditory Verbal approach

Goals

Definition
  • emphasis on spoken language through listening
  • doesn't rely on visual cues
  • Goals
    • develop spoken language by listening 
    • develop skills for mainstreaming
    • positive self-image through natural family & social interactions using spoken lang.
Term

Discuss Cued Speech

Goals

Definition
  • auditory visual -- combines hand cues w/ natural mouth movements of speech
  • Goals
    • provide clear communication in spoken lang.
    • develop phonemic lang. base to achieve full literacy in conversation, reading, writing
    • support speech reading and auditory skills
Term

Discuss Auditory Oral communication

Goals

Definition
  • teaches child to use remaining hearing w/ amplification + speech reading, natural gestures, visual cues to help in lang. understanding
  • does not encourage any form of sign language
  • Goals
    • develop spoken lang. through listening & natural gestures/visual cues
    • develop spoken lang. & communication skills for academic success & integration into hearing community
Term

Discuss Simultaneous Communication

Goals

Definition
  • uses spoken & sign lang. simulataneously
  • uses English-based sign lang. system that can involve speech, speech reading, finger spelling, natural gestures, & use of residual hearing
  • Goals
    • bridge to developing spoken lang
    • communication btwn child & family, teachers, peers using sign lang.
    • support integration into both the hearing & deaf communities
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