Term
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Current challenges when testing young infants:
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Definition
- Identify the children at risk and needing further evaluation
- Determine if theres an actual hearing loss and quantification of the loss
- Assess preschoolers with possible CAPD, identify, refer, and quantify
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Term
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The challenge for audiologists and the SLP:
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Definition
- Once these children are identified and found, what are the referrals to be made
- Are there professionals ready to immediately begin the necessary habilitation
- Are we prepared for the influx due to universal infant screening. If not, all our screenings and early detection is meaningless.
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Term
| Case history additional questions: |
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Definition
- Were there any problems during the pregnancy or birth? If so, what?
- Is there any history of ear infections?
- Were the child’s developmental milestones to date normal?
- Do you have any concerns about hearing, speech/language development, or general development?
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Term
| Language Development in 3 & 6 month olds: |
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Definition
3 months - There is no difference in response to stimuli between the hearing and deaf infant
6 months - They go from reflexive babbling to intentional babbling and vocal play. A deaf baby will revert to reflexive babbling if they cannot hear themselves. If they don’t make this transition out of reflexive babbling, they will never rise to higher levels.
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Term
| Language Development in 12-36 month olds: |
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Definition
At 12 months of age they start linking words to meanings.
At 18 months of age there is one new word every 2 hours.
At 24 months of age, there are 2-word phrases.
At 36 months of age, they make short phrases.
At 30 – 36 months, they apply the rules to language and overgeneralize rules.
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Term
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Definition
Raspberries, mama, dada, change voices, this stimulates the auditory system and encourages further development of the auditory system between the ears. |
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Term
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Definition
The left hemisphere is for concrete language and the right hemisphere is for suprasegmentals and the abstract. The
2 halves together give the full reception and expression of language.
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Term
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Definition
In central system analysis, they look for frequency shifts to identify speech and send it to the left hemisphere. Only speech produces frequency transitions with the exception of computer-generated synthesized speech. Sounds determined not to be language are sent to the right hemisphere.
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Term
| Frequency regions development in babies: |
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Definition
- Low and mid frequency regions develop first. The high frequency region develops after birth.
- At 4 days after birth, an infant can distinguish the mother’s language from others.
- At 6 – 10 months of age, babies can differentiate phonemes.
- At 6 months of age, syllable pattern recognition begins and then comes the baby’s first word – NO!
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Term
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Definition
- Infants learn language by shared experience. They learn syllable patterns. This is important to brain development and the development of listening skills.
- The auditory brain map is formed by 12 months of age. An absence of stimuli between 6 – 12 months produces a measurable speech delay.
- The most critical period for speech learning is birth – 12 months.
- 2nd most important period for this is 12 – 36 months.
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Term
Hearing loss Prevalnce in the US:
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Definition
| Ranked 6th in prevalence of chronic conditions in the US. Thus, it occurs more often than many other disorders that we currently screen for. |
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Term
10 High Risk Factors for Hearing Loss |
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Definition
1. Family history of congenital or delayed-onset childhood SNHL
2. In utero infection associated with SNHL (i.e. CMV, rubella, etc.)
3. Craniofacial anomalies, including those of pinna and ear canal
4. Birth weight less than 1500 grams (about 3.3 lbs)
5. Hyperbilirubenemia aqt levels needing exchange transfusion
6. Ototoxic meds, & diuretics used in combination with the drugs
7. Bacterial meningitis
8. Severe depression at birth, including low Apgar scores
9. Prolonged mechanical ventilation of at least 5 days
10. Stigmata or other findings associated with a syndrome known to include SN or conductive hearing loss
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Term
Risk factors that would suggest the necessity of a screening during the first 2 years: |
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Definition
- Concern regarding hearing, speech, language, &/or developmental delay
- Bacterial meningitis or other infections associated with SNHL
- Head trauma associated with concussion or skull fracture
- Stigmata or other findings associated with syndromes known to include SNHL
- Ototoxic medications and diuretics
- Recurrent or persistent OM with effusion for at least 3 months
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Term
Indicators associated with delayed onset of SNHL are:
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Definition
- Family history of hereditary childhood hearing loss
- In utero infection like CMV, rubella, syphilis, herpes, etc.
- Neurofibromatosis & certain neurodegenerative disorders
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Term
Indicators associated with conductive hearing loss are:
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Definition
- Recurrent or persistent otitis media with effusion
- Anatomic deformities or other disorders affecting Eustachian tube function (i.e. Treacher-Collins)
- Neurodegenerative disorders
With the high risk registry, only about 50% of newborns with hearing loss are caught because the other 50% did not have the high risk factors.
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Term
| Different Techniques for Screening Newborns: |
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Definition
- Cardiac response
- Respiration audiometry, alternation of sucking, and startle response
- Crib-o-gram
- High Risk Registry
- ABR - (Auditory Brainstem Response) aka BAER (brainstem Auditory “Evoked Response aka BERA (brainstem evoked Response Audiometry)
- AABR - (Audomated Auditory Brainstem Response) aka BAER (brainstem Auditory “Evoked Response aka BERA (brainstem evoked Response Audiometry)
- ABR with High Risk Registry
- OAE - Otoacoustic Emissions aka Evoked Otoacoustic Emissions
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Term
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ABR (screening for newborns)
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Definition
| Was the first real way of testing that gave better sensitivity. When combined with acoustic reflex testing, it produced a more sensitive and specific approach to new born testing. |
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Term
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OAE (screening for newborns)
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Definition
| These are even more cost effective. There is no need to use electrodes and clean the skin. It is a simple tip in the ear and very quick. It is less sensitive to environmental noise, making it excellent for the NICU. |
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Term
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Definition
1. Casually observe the child.
2. Personally, I like to listen to the mother. Parents know their child and are more sensitive than most pediatricians to the presence of hearing loss.
3. Listen to the child vocalizations. Severe hearing loss can be detectable in their vocalizations.
4. Behavioral Observation Audiometry (BOA) in sound field |
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Term
Behavioral Observation Audiometry (BOA) 0 – 1yr
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Definition
This is conducted in a sound field environment through speakers. Speech, various noises, warble tones, etc. may be presented and we look for:
a. Cessation of activity whether it be sucking, crying, or breathing or even eyeblinks.
b. Localization to the speaker where the sound comes from by 8 months old. Prior to that, a searching behavior should be noted.
Some children will respond to the sound off rather than when the sound is turned on.
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Term
Visual Reinforcement Audiometry (VRA)
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Definition
| This is the same as BOA, however, at this time the child is trying to localize to the source of the sound. Localization or sound acknowledgement is rewarded by a clapping toy or lighted toy, etc. |
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Term
Testing 1 – 5 years of age
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Definition
| Young children fatigue quickly, therefore you jump in and get what you can. Before 3 years of age, the VRA is most likely to be used. At 2, they may even repeat some words. If nothing else works, you can ask them to point to body parts or ask questions like “where is mommy?”. Listen to their vocalizations, if they are almost silent, there may be hearing loss suspected. |
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Term
Conditioned Play Audiometry (CPA)
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Definition
| By 3 – 5, you can try conditioned play audiometry. They respond to the stimulus most often by placing a block in a box or a ring on a post, or a peg in a hole. They may also respond to the command “put it in”. For most, at this point, you can probably perform this task under headphones. |
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Term
THE CROSS CHECK PRINCIPLE
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Definition
| According to your book, “no single test result obtained during pediatric assessment should be considered valid until you have obtained an independent cross-check of its validity”. |
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Term
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Central Auditory Processing (CAPD)
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Definition
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May be involved in the following:
- Sound localization
- Separation of signal from noise
- Detection of signal in noise
- Preprocessing for pattern identification
- Providing the foundation for concrete language
- Processing the abstract portions of language
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Term
Language delays may occur due to:
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Definition
- Hearing
- Drugs/alcohol
- Environmental
- And high frequency hearing loss can be responsible for language delay
Most of these children have normal peripheral hearing.
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Term
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Definition
- Poor listening skills
- Easily distracted
- Slow responsiveness
- Articulation disorders
- Language delay
- Short attention span
- Poor memories and reading comprehension
- difficulty in linguistic sequencing
- problems in learning to read and spell
- difficulty recognizing speech in the presence of background noise
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Term
Auditory processing symptoms in social behavior might be:
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Definition
- Hyperactive
- Disruptive
- Passive
- Fatigues
- Withdrawn
- Slow Starter
- Lethargic
- Poor memory
- Fail to complete task
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Term
Effects of Hearing Loss and/or CAPD |
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Definition
Social, intellectual, and emotional development.
Some of the effects may include egocentricity, difficulty in empathizing with others, rigidity, impulsivity, coercive dependency, and a tendency to act up.
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Term
Auditory Processing Therapy:
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Definition
There may be environmental manipulations
- One to one contact
- Personal FM system
- Preferential seating
- Multi-modality input
- Manipulations of temporal/spectral characteristics of sound
- Decrease presentation velocity for improved processing then gradually increase presentation velocity
- “Velocity”
- Memory exercises
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Term
Music in assistance of development of the right side: |
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Definition
- Development of spacio-temporal reasoning
- Development of math skills
- Development of pattern analysis
- Perception of meaning
- Music, math, and logic may be connected
The neurons are exercised by music. This strengthens the same circuits used for mathematical reasoning. Therefore, preschoolers taking piano or singing lesions improve spatial reasoning. The melody must be identifiable however.
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Term
| Adequately Servicing Infants detected with HL: |
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Definition
1. Facilitate speech and language development
2. Properly counsel parents and give unbiased information of all possible educational routes that can be taken
3. Provide support programs
4. Mitigate some of the psychological consequences of hearing loss on the child and the family.
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Term
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Definition
Hearing aids that were body worn |
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Term
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Definition
| Allowing for more power and smaller aids |
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Term
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Definition
Some type of aid to hearing has been utilized throughout history, ranging from animal horns and seashells to ear horns, even using a hand cupped behind the ear. Whether these primitive methods, or more modern hearing aids, they all collect and direct sound energy.
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Term
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Definition
Further miniaturizing hearing aids and completely replacing vacuum tube aids. |
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Term
| Digital Signal Proecessing |
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Definition
- Computer Technology
- Wireless Connectivity
- Integrated Circuits
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Term
Rule of thumb for fitting one or two hearing aids:
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Definition
1. if all is symmetrical, both hearing and speech discrimination, fit both ears
2. if asymmetric and both ears have good speech discrimination, try fitting both ears
3. if asymmetric and speech is much better in one ear than the other, fit the ear with better speech discrimination
4. if symmetrical but speech is much better in one ear than the other and other issues have been ruled out, fit the ear with better speech discrimination
5. if asymmetric and there is a severe to profound loss on the bad side, fit the good side only
6. if profound loss bilaterally with poor to no speech discrimination, consider referral for cochlear implant if used to be part of hearing world, otherwise leave in Deaf Comm.
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Term
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Definition
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Hearing aids consist of a microphone, amplifier, and receiver and are used to amplify sound and deliver it to the user’s ear. Sounds strike the microphone (input transducer), are amplified, and transmitted to the output transducer (receiver or loudspeaker) and into the external ear canal. For those for whom, for some reason, a standard hearing aid cannot be used, a bone conduction hearing aid may be feasible. Reasons for not being able to use standard hearing aids may include atresia, stenosis, chronic middle ear drainage, perforation, dermatologic problems, etc.
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Term
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Definition
| So hearing aids are signal processors, they alter the signal input to improve it for the wearer. |
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Term
Analog Hearing Aids (Hearing Aid Circuits):
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Definition
| Similar to an LP, the waves coming out are like those going in. They modify a continuous electric signal. Fine tuning is very limited to the type of circuit. |
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Term
Hybrid Hearing Aids (Programmables): |
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Definition
These use both analog and digital technology. They shape the sound digitally but use analog processing. While more precise in fine tuning than the analog aids, they are not as fine tunable as the digital aids. |
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Term
Digital Hearing Aids (Hearing Aid Circuits):
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Definition
| These are the newest. Sound waves are converted to binary digits (computer talk using 0’s and 1’s) much like data storage. It changes the output via analog-to-digital converter. Advanced processing operations can then be carried out and the altered signal changed back to analog form by the digital-to-analog (D/A) converter. They provide improved clarity of signal and better signal to noise ratio. They may separate wanted sound from unwanted sound but are still not perfect. They also allow for more fine tuning than ever before. |
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Term
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Electroacoustic Characteristics of Hearing Aids
Output Sound Pressure Level:
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Definition
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The maximum sound pressure the hearing aid can produce at high input levels. Also known as saturation sound pressure level. This is especially important in the case of babies. Failing to be careful may cause a noise-induced hearing loss if there are dangerously high sound levels.
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Term
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Electroacoustic Characteristics of Hearing Aids
Frequency Gain:
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Definition
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This is the difference between the input signal and the output signal. For example, if a signal of 60dB goes into the hearing aid and 110dB comes out of the hearing aid into the ear, then 110 – 60 = 50dB of gain. That is the amount amplified to get the output.
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Term
Electroacoustic Characteristics of Hearing Aids
Frequency Response:
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Definition
| The range over which the hearing aid provides amplification. With advances in technology, we can cover a wider range of frequencies. The microphone and receiver of the aid are the prime limiters of the frequency range. With today’s hearing aids, we can set the response for each hearing loss specifically. |
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Term
Electroacoustic Characteristics of Hearing Aids
Distortion:
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Definition
| This occurs when the sound leaving the hearing aid is very different from what went in. It reduces clarity and intelligibility. Most common is harmonic distortion. The greater the distortion, the poorer the quality of amplified speech. |
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Term
Electroacoustic Characteristics of Hearing Aids
Input-Output Characteristics:
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Definition
| Describes how the hearing aid functions at different loudness levels. Tells how much the amplification is increased with increase in the input signal. You can see if this is linear or nonlinear. Unless the loss is sever to profound, almost all amplification is nonlinear. |
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Term
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Electroacoustic Characteristics of Hearing Aids
Compression, Peak Clipping, Output Limiting, Wide Dynamic Range Compression (WDRC), Automatic Gain Control (AGC):
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Definition
| There are additional parameters that limit the output of the hearing aid as sounds gets louder to avoid peaking at an individual’s uncomfortable listening level. |
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Term
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Definition
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A more subjective method of verification. This is similar to acoustic gain. It is measured by obtaining hearing levels in sound field without the hearing aid and with the hearing aid. May be done with warble tones or speech.
This allows to show how much gain the individual actually perceives when using the hearing aid and their improvement as compared to how they do at the same level without the hearing aid.
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Term
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Definition
May be defined as a determination of whether the disability has been reduced and goals addressed, may be established through clinometrics, or questionnaires/scales. |
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Term
Probe-Microphone Measurements and Speech Mapping: |
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Definition
Another method of establishing you fit the individual properly. Real ear Gain, measured by probe mic equipment, shows us the amount of gain delivered to the ear directly. A loudspeaker is placed close to the patient’s ears, a thin tube inserted into the ear canal close to the TM and attached to a mic. Sounds are presented out the speaker and the hearing aid response in the patient’s ear is recorded.With Speech Mapping, ongoing speech is presented via the probe mic at a fixed level and the output displayed. The hearing aid parameters can then be adjusted as needed.
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Term
Parts of Hearing Aids
The microphone:
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Definition
| In addition to what was stated earlier, we now consider whether we will be omnidirectional (sensitive to sounds from everywhere), or directional (sensitive to sounds in front of a person), directional fixed or automatic directional adaptive (comes and goes as needed for noise and sensitive to sounds from where the speech comes) |
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Term
Parts of Hearing Aids
The amplifier:
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Definition
| Controls how much amplification occurs at different frequencies, may boost sounds differently, and may be able to limit sound from becoming too loud. (The last used to be known by many names over the years including output limiting, peak clipping, compression limiting, etc). |
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Term
Parts of Hearing Aids
The receiver:
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Definition
| Considered the loudspeaker and it is a transducer that changes electrical energy back to acoustical energy. With RIC or RITE hearing aids, the receiver is placed in the ear canal itself rather than being part of the body of the hearing aid. |
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Term
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Parts of Hearing Aids
Potentiometers:
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Definition
| These are screwset controls, present on old analog hearing aids and some of the older programmable aids, to set high and low tones, limit loudness, limit gain. We no longer need this as things are adjusted by computer. |
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Term
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Parts of Hearing Aids
Controls:
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Definition
Remote Controls - not available for all hearing aids but many manufacturers have optional remotes for adjusting volume, program, or wireless connectivity.
Manual Controls - Older hearing aids have an MTO (mic/telephone/off) switch. Even some digitals have a pushbutton control or toggle to change volume or program. |
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Term
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Parts of Hearing Aids
Battery door:
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Definition
| Found on all aids except disposables, some current manufacturers offer to charge batteries while in the hearing aid |
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Term
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Parts of Hearing Aids
Earhook (on standard BTEs):
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Definition
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Term
Parts of Hearing Aids
DAI:
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Definition
| Direct Audio-Input, usually at the battery door of a BTE so other systems such as FM can be connected |
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Term
Parts of Hearing Aids
Earmold:
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Definition
| Part that attaches to the BTE earhook to send the sound into the ear. Sometimes also used with RIC/RITE hearing aids. |
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Term
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Parts of Hearing Aids
Auto T: |
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Definition
| Much more common now, and option which allows a hearing aid to go into telephone mode without having to move any switches on the hearing aid or hit anything on the remote control |
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Term
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Parts of Hearing Aids
Ear Domes:
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Definition
| The disposable tips that fit the end of the RIC/RITE/thin tubes in the ear canal |
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Term
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Parts of Hearing Aids
Connectivity: |
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Definition
| Special remotes and other parts to change televisions, phones, iPods, etc into Bluetooth devices for the hearing aids (i.e. Oticon Streamer, Siemens Tek, Phonak iCom, etc) Now there is even a mic for others to talk into and sent via Bluetooth without getting a FM system |
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Term
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Parts of Hearing Aids
Noise/Feedback Reduction:
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Definition
| most use noise cancellation technology today so feedback is not the issue it used to be. |
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Term
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Definition
| Can change the acoustics or frequency response of the hearing aid. This is known as earmold acoustics. There are different types of earmold and various degrees of venting. |
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Term
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Definition
| The earmolds block the ear canal to various degrees. High frequency hearing losses use open earmolds that do not fully block the canal. The more severe hearing losses use earmolds that fully seal the ear canal to prevent sound leakage that cause feedback from high power hearing aids. See figure 13-18 for examples of 3 types of molds. |
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Term
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Definition
| A vent is nothing more than an opening in the mold that allows air and sound to escape. Depending on the loss, it will vary in diameter. Most commonly is the SAV or select-a-vent that allows the fitter to vary the diameter by using plugs with varying diameters. The vent usually runs parallel to the channel containing the tubing. It would be minimal for severe losses and large for minimal losses. |
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Term
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Definition
| Can increase the high frequencies. One way is to use a Libby horn which is a tubing that increases from 2mm to 3mm or 4mm going into the mold. Another way to obtain this is to widen the bore at the end of the mold or “bell” the bore. |
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Term
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Definition
This may be a filter or piece of damping material that is placed into the earhook of the hearing aid or into the earmold to decrease and smooth out peaks in the amplitude of the hearing aid response.
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Term
Venting, horn effect, and damping all affect different portions of the frequency response:
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Definition
Venting - low frequencies
Damping - mid frequencies
Horn Effect - high frequencies
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Term
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Definition
- Body Aids (used with earmolds)
- Eyeglass hearing aids (used with earmolds)
- Behind-the-ear (BTE) hearing aids (used with earmolds)
- OTE open ear fit RITE/RIC
- OTE open ear thin tube fit
- In-the-ear hearing aids (ITE)
- Half shell hearing aids
- In-the-canal hearing aid (ITC)
- Completely-in-the-canal hearing aids (CIC)
- CROS and BiCROS hearing aids
- Bone-conduction hearing aids
- Implantable Bone Conduction devices/BAHA
- Middle ear implants
- Cochlear implants
- Auditory brainstem implants – for NF2 patients – can’t use CI so implant electrode in brainstem and an external sound processor sends electrical stimulation to the auditory neurons of the CN, hoping to improve the client’s ability to detect or understand incoming speech information
- Vibrotactile devices (ie tactaid)
- For the future: completely implantable hearing aids
- Hair cell regeneration
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Term
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Definition
| The transmitter hearing instrument (HI) microphone located on your poor ear picks up sound from that side of your head and sends it to the receiver HI on your better ear to hear. |
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Term
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Definition
| The transmitter hearing instrument (HI) microphone located on your poor ear picks up sound from that side of your head and sends it to the receiver HI located on your better ear. Since the better ear has some hearing loss, a second microphone on the receiver HI picks up sound at the better ear and amplifies all sounds to help you hear more effectively. |
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Term
Assistive Listening Devices or ALDs: |
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Definition
- FM systems
- Personal amplifiers (Pocket Talker)
- Closed captioning
- Infra-red systems
- Amplifying headsets
- Personal sound field amplification systems
- Large room sound field amplification systems
- Amplified telephones
o built in amplifiers
o portable amplifiers
- TTY/TTD and relay services
- Cap-Tel
- Video Remote Access
- Sign language interpreters
- Hearing dogs
- Voice recognition technology
- Alerting devices: Vibrating, blinking, flashing, beeping devices for alarm clocks, doorbells, smoke detectors, baby-crying detectors, etc.
- Bluetooth device connection is here now
- CART
- Notetaker
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Term
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Definition
In the future, a way to ensure compliance of treatment and verification/validation of treatment. With telemedicine, treatment or therapy is conducted via computer and monitors and cameras and even testing can be performed in this manner.
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Term
| Adults: Suffering from a Degree of HL |
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Definition
- outer ear: loss of cartilage elasticity, perhaps resulting in collapsing ear canals
- middle ear: arthritic changes causing stiffness of ossicles and/or tympanic membrane
- inner ear: sensori-neural hearing loss, especially of high freq
- 8th nerve and neural processing: these changes may include degeneration of the auditory nerve, brainstem, and auditory association areas of the brain, thus compromising the ability to understand, especially in noise, and compounding the peripheral changes discussed above
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