1 - Audiology, Audiologists, & ASHA Flashcards
Where did the study of Audiology begin?
At the end of WWII when many veterans had hearing problems due to lengthy exposure to loud sounds
Audiology
The study of human hearing
What was the original focus of Audiology?
Rehabilitation:
- Auditory training - Lipreading - Hearing aids
What other areas do audiologists work in besides hearing?
Evaluation of the vestibular or balance system
Monitoring the neural status of individuals undergoing certain surgeries or treatments
What degree do you need to be an Audiologist?
PhD or AudD
Audiology Assistants
Ofter are seen in military settings
Do filing, ship hearing aids, maintain equipment, take inventory, troubleshoot hearing aids, prepare equipment, assist audiologist with patients.
May only perform tasks planned, delegated, and supervised by the audiologist
Relationships between Audiologists and Physicians
Physician: Rules out any disease and/or pathology requiring surgery or medication
Audiologist: Analyzes the hearing mechanism and assists in disease diagnosis
Audiometrist
Performs hearing screenings and basic hearing tests
Typically works in schools
May also administer hearing conservation programs in industrial environments
What is the study of the treatment of Ear, Nose, & Throat called?
Otolaryngology
What is the tool used to measure hearing sensitivity is called?
Audiometer
Have audiologists always sold hearing aids?
No. In the beginning, ASHA would not allow audiologists so sell hearing aids
Professional Requirements for Audiometrists
Varies from state to state
Usually six semester (or eight quarter) units of approved coursework
Professional Requirements for Audiology Assistants
Varies by state
Spans from a high school diploma to enrollment in a masters program
National Certification for Audiologists
Given by ASHA and/or the American Board of Audiology
Requires a passing score on the PRAXIS
CCC
Certificate of Clinical Competence
CCC-A
Certificate of Clinical Competence in Audiology
CCC-SLP
Certificate of Clinical Competence - Speech Language Pathology
State Licensure for Audiologists
Very similar state by state. They mostly follow requirements as set by ASHA
Dispersement of hearing aids requires a separate license and usually requires a passing score on the state’s own exam
Three Reasons It Is Difficult to Determine the Impact of Hearing Loss
Many ear diseases, conditions, and causes underlie hearing loss
There is a wide variability in degree and/or severity
A combination of development, psychology, and environmental factors (time of onset, time intervention occurs, other disabling conditions, etc.)
Hearing Impairment
Hearing Loss
All-inclusive expressions
Encompass varying degrees and types of reduced hearing sensitivity due to some unspecified problem
An identification
Hearing Disability
Hearing Handicap
The effect of hearing loss
Used to describe the functional limitations caused by hearing loss
The ability or inability to cope
Deaf
Hearing disabled to the point that speech may not be understood with or without a hearing aid
Hard-of-Hearing
Hearing disabled to the point where speech is difficult to understand with or without a hearing aid or where it affects a child’s educational performance
Deaf Community
Deaf Culture
A group of individuals who use some visual form of communication
Are all deaf people members of the deaf community?
No. They must use a form of sign
Can individuals who are hard-of-hearing be part of the deaf community?
Yes - if they use sign as their primary form of communication
Hearing impairment is estimated to affect ______ Americans
31.5 million
Causes of Medically Treatable Hearing Loss
6
Otitis Media
Ossicular Disruption
Otosclerosis
Build up of Cerumen
Obstruction to the outer ear canal
Inner ear disease
Ear wax
Cerumen
Middle ear infection
Otitis Media
___% of all children who have had at least one episode of otitis media
75%
Separation of the ossicles
Ossicular Disruption
Calcified growth around the ossicles
Otosclerosis
Common Causes of Permanent Hearing Loss
6
Genetic syndrome
Neural disorder
Vascular disorder
Infection or trauma (can occur during fetal development, birth, childhood and/or adulthood)
Exposure to loud sounds
Aging
What is hearing loss that is attributed to loud sounds called?
Noise-Induced Hearing Loss
Any sound louder than ___dB with a daily exposure of ___ hours will produce permanent hearing loss.
75 dB, 8 hours
Hearing loss is the ____ most common chronic condition experienced by the elderly.
3rd
What is hearing loss due to age is called?
Presbycusis
____% of adults over ___ experience some degree of hearing loss
30-35%
65 years
What is hearing loss that occurs prior to normal speech and language development called?
Prelingual
What is hearing loss that occurs after normal speech and language development called?
Postlingual
Newborn hearing loss occurs in ____/_____ live births
1.2-5.7/1000
Is hearing loss the most common birth defect?
Yes
The Two Categories of Hearing Loss
That treatable via medication or surgery
That which is medically nonthreatening but reduces overall quality of life and effective communication
Intervention to alleviate communication difficulties
Audiologic Rehabilitation
Audiologic Rehabilitation Strategies
6
Hearing Aid Fitting
Counseling
Educating
Listening
Training
Speech reading
Audiologic Habilitation
Intervention for those who have not yet developed speech & language skills
What does a hearing aid consist of?
4
Microphone
Amplifier
Speaker/Receiver
Power Supply
What do Audiologist do with hearing aids?
Help in their selection
Fit the hearing aid
Program the hearing aid
Examples of Audiological Rehabilitation Therapy
Reading visual cues
Observing body language
Learning lipreading
What is often the first sign of hearing loss in young children?
The lack or difficulty in normal speech & language development
Assistive Listening Devices
Wireless FM systems that have a microphone used by the speaker. This information is then conveyed to the listener’s device
Infrared System
Similar to an assistive listening device but it uses infrared light waves to transmit information
Usually used for television sets or at movie theaters
IDEA
Individuals of Disabilities Education Act
Guarantees that all children with disabilities receive a free, appropriate, and public education designed to meet their unique needs
NCLB
No Child Left Behind
ADA
American with Disabilities Act
Its goal is to eliminate discrimination against anyone with a disability
SHHH
Self Help for Hard of Hearing
CICI
Cochlear Implant Club International
Government Groups Supporting the Hearing Impaired
IDEA
NCLB
ADA
Support Groups Supporting the Hearing Impaired
SHHH
CICI
Parent/Family Referral
A referral for diagnosis made by a family member
Usually only occurs after a long struggle
Professional Referral
A referral made by a physician, school nurse, SLP, or another professional working in a medical or school setting
Case History
A series of questions designed to provide the professional enough information to focus on the patient’s concerns and complaints
Hearing History
Looks at how hearing difficulties vary according to the environment
Tries to find out how hearing loss affects communication and quality of life
Hearing History: Questions Asked
4
How long have you had difficulty hearing?
Did this occur suddenly or gradually?
When is it most noticeable?
Is it worse in one ear or equally bad in both?
Medical History
Focused on disorders of the ear
Medical History: Questions Asked
4
Have you ever had medical or surgical treatment to overcome a disease in your ear?
Have you taken medication to overcome a disease in your ear?
Do you experience any dizziness?
Do you experience tinnitus?
Noise History
Looks at noise in one’s personal environment
Noise History: Questions Asked
4
Do you or have you worked in an environment with extreme noise?
Did you experience such an environment in the military?
Due you pursue any recreational activities with loud noises (motorcycles, jet skis, etc.)?
Do you pursue any hobbies or work at home with loud noises (lawnmowers, air blowers, woodworking, etc.)?
Family History
Looks at hereditary factors
Need to separate family members with noise induced hearing loss vs. hearing loss due to age vs. hearing loss from genetic factors
Rehabilitation/Academic History
Looks at what intervention the patient has received from previously diagnosed hearing loss
Rehabilitation/Academic History: Questions Asked
4
Have you had any previous experience with hearing aids? How was your experience?
Has the child had any previous auditory habilitation?
What is the impact of hearing loss on the patient’s academic performance?
What kinds of services has the patient received (speech therapy, etc.)?
What is the first step in an audiologic evaluation?
Otoscopy
Otoscopy
Visually assessing the status of the outer ear
What is the handheld device used to visually inspect the outer ear?
Otoscope
What are the parts of an otoscope?
Light source
Magnifier
Sterile or disposable speculum
What does an otoscopy look for?
4
Cerumen buildup
Foreign Objects
Growths
Inflammation of the skin
What does an otoscopy look for on the tympanic membrane?
Perforations
Inflammation
Abnormalities
What is NOT the goal of an otoscopy?
To diagnose a pathological condition
If an obvious abnormality is found (draining ears, inflammation, bleeding, skin abrasions, pain), a referral should be made to a physician
Audiologist & Cerumen
An audiologist can remove the cerumen or refer the patient to a physician
Usually an audiologist will only remove earwax if it will interfere with the test results
What is a combination of a standard otoscope with a video camera and a color monitor called?
Video Otoscope
What is/was the use of noise makers by audiologists?
They have been used in the past to test hearing
They are still sometimes used with very young patients and those with severe disabilities.
What is the downside to using noisemakers?
They can only give an informal indication of hearing status
What is/was the use of tuning forks by audiologists?
4
They were used in the mid-19th and 20th centuries.
The goal was to refine the noise maker tests
Are no longer used by audiologists
Some otolaryngolists still use them as an informal measure
What is/was the use of general conversation by audiologists?
If a patient is able to communicate a normal level, this usually rules out severe hearing loss.
If a patient continually has difficulty conversing, this usually indicates severe hearing loss.
What was the predecessor to ASHA?
The American Academy of Speech Correction
When was the American Academy of Speech Correction formed?
1925
Where was the American Academy of Speech Correction formed?
At a National Association of Teachers of Speech meeting
What happened to ASHA name in 1947?
It became the American Speech and Hearing Association
What happened to ASHA name in 1978?
It became the American Speech-Language-Hearing Association
What is ASHA?
The national professional, scientific, and credentialing association for audiology and speech language pathology
How many members does ASHA currently have?
More than 166,000 members and affiliates
What sort of professionals may be members of ASHA?
5
Audiologists
Speech-language pathologists
Speech, language, and hearing scientists
Audiology and speech-language pathology support personnel
Students.
What is the difference between audiologists and SLPs?
Audiologists:
Prevent and assess hearing and balance disorders
Provide audiologic treatment, including hearing aids.
Speech-language pathologists:
Identify, assess, & treat speech, language, & swallowing issues
What is ASHA’s vision
To make effective communication, a human right, accessible and achievable for all
What is ASHA’s mission?
4
To empower and support SLPs, audiologists, and speech, language, and hearing scientists by:
Advocating on behalf of persons with communication and related disorders
Advancing communication science
Promoting effective human communication
What is ASHA’s definition of an audiologist?
Audiologists are professionals engaged in autonomous practice to promote healthy hearing, communication competency, and quality of life for persons of all ages through the prevention, identification, assessment, and rehabilitation of hearing, auditory function, balance, and other related systems
Do audiologists assist in the writing of IEPs?
Yes
What other organization has a separate definition of audiology? How is it different?
American Academy of Audiology
It is very similar to ASHA’s. It just uses slightly different language and omits SLPs
What other practice areas overlap with audiology?
Intraoperative monitoring
Vestibular Assessment/Rehabilitation
Cerumen Management
How many members did pre-ASHA have in 1925?
25
How many audiologists were members of ASHA in 2012?
12,000
What requirements must be met in order to be an Audiologist?
At least 75 hours of post-baccalaureate study (effective 1/2007)
12 months full-time, supervised experience (effective 1/2007)
Doctoral degree (effective 1/2012)
What is the difference between a PhD and an AudD?
PhD is a research degree
AudD is a clinical degree
Why do audiologists join professional organizations?
It makes it easier to network and meet with likeminded people
What sorts of professional organizations are there besides ASHA?
(4)
Military
Education
Hearing Aid Dispersement
Pediatrics
Etc.
Do Audiologists need a license to practice?
Yes
How long does a license to practice Audiology last?
ASHA: Every 3 years with 30 professional credit hours
Arizona: Every year with 10 professional credit hours
Why is licensure important?
It validates a professional’s competency
It assures that professionals stay within their scope of practice
Are audiologists required to be certified?
No. This is voluntary
What are the benefits to certification?
It is often required or encouraged by employers
What is certification?
A self-governing standard to inform consumers, peers, and other health care professionals of the SCOPE of practice and TRAINING of the certificate holder.
What is licensure?
A government process that gives someone individual permission to practice a profession within the state
Are more audiologists entering private practice?
Yes
Are many national hearing aid companies hiring audiologists as part of their dispensing teams?
Yes
Are many audiologists training technicians to take over some of the routine duties in their private practices (troubleshooting, hearing aid orientation, taking case histories, etc.)?
Yes
What seriously impacts the science basis of our field and the ability to train new professionals?
There is a serious shortage of PhD faculty in communication sciences, including audiology.
Do insurance companies reimburse for all audiologic services?
No. Many routine services such as rehabilitation are not covered
Is the scope of practice for audiologists broadening?
Yes
What are some Audiologist Roles?
6
Clinician
Therapist
Teacher
Consultant
Researcher
Administrator
Relationship between Audiologist and SLP
SLP diagnosis whether hearing loss has caused speech and/or language delay and recommends therapy
Audiologist recommends solutions to assist with hearing loss
Relationship between Audiologist and Educators
Educators are skilled at determining each child’s unique needs due to their day-to-day interaction with the child
Audiologist fits the child with rehabilitation and amplification support
Relationship between Audiologist and Hearing Instrument Specialists
There can sometimes be a conflict between these two due to changes in state licensure requirements and other regulations
Usually they share the same goals
What are some Audiologist Job Settings?
6
Schools
Hospitals
Manufacturing
Industry
Universities
Private Practice
What are some of the focus areas in Audiology?
5
Diagnostics
Treatment
Rehabilitation
Hearing Function
Balance Function
What is the most important part of the otologic examination?
The case history
What are the four main questions that patients want the answers to?
Is there a problem?
If so, how serious is the problem?
What caused the problem?
What type of treatment will reduce and/or overcome the problem?
How can a case study be gathered?
Written or orally
What are the advantages to written case histories?
They can fill them out in the privacy of their own home or the waiting room
You usually get more information
There is a written record you can refer back to
What are the disadvantages to written case histories?
You sometimes get incorrect information (a patient may check all the boxes in order to make their condition look serious)
What are the advantages to oral case histories?
You are developing a relationship with the patient during the assessment
What are the disadvantages to oral case histories?
It can be very time consuming
How does the ASU clinic perform case histories?
They start with a written assessment then use an oral assessment to expand upon this
What is the importance to observation while gathering the audiologic history?
You can determine…
…if the patient can follow general conversation
…if they favor one ear over the other
…if they appear to hear well in the current environment
What is some essential information to gather during an audiologic history?
(4)
Identifying information
Health history of self and close family (diabetes, high blood pressure, medications, etc.)
Hearing history of self and close family (amplifcation use, work environment, etc.)
Any previous evaluations and findings
What is some essential information to gather during an audiologic history if the patient is a child?
Developmental history including a summary of developmental milestones
Educational history including any speech, language, psychological, or any other services
What are the categories of questions that might be asked?
Questions about symptoms
Questions about communication
What are some questions related to symptoms?
8
What brought you here today?
Where do you think the problem began?
Does you problem affect one or both ears?
Did the problem begin gradually or suddenly?
Do you have a ringing in your ears?
Do you have a history of ear infections?
Have you noticed any pain in or discharge from your ears?
Do you experience dizziness?
What are some questions related to communication?
7
Do you have concerns about your hearing?
Do you have greater difficulty hearing women’s, men’s, or children’s voices?
Do others comment on the volume setting of your television?
Has someone said that you speak too loudly or softly in conversation?
Do you hear people speaking but can’t understand what they are saying?
Do you have any history of exposure to noise in recreational activities, at work, or in the military?
Are there situations where it is particularly difficulty for you to follow conversation? Noisy restaurant? Theatre? Car? Large groups?
During a otologic history, what are some areas that are focused on?
(5)
Hearing Loss
Tinnitus
Dizziness or Vertigo
Pain
History of Drainage
What are some questions regarding hearing loss?
5
Unilateral or bilateral?
Did this occur in the last 90 days? (bad sign!)
Symmetric or asymmetric hearing
Fluctuating hearing
Progressive or sudden?
What is the point of asking questions regarding hearing loss?
You are looking for a medical condition that affects hearing
Most hearing loss is __________.
A slow, progressive disorder
What are some questions regarding tinnitus?
Unilateral or bilateral?
What are some characteristics? Is it roaring, tonal, etc.?
Frequency of occurance
Some tinnitus can be caused __________.
By another condition such as cardiovascular disease
What are a some questions regarding dizziness or vertigo?
5
Unsteadiness vs. spinning sensation
Frequency of episodes
Duration of episodes
Related symptoms - nausea, tinnitus, fullness, etc.
Acute or chronic?
Otalgia
Ear pain
What are some questions regarding otolgia?
Localized or referred
History of episodes
Related incidents
Otorrhea
Ear drainage
What are some questions regarding otorrhea?
Unilateral or bilateral
When
Treatments
What are the forms of Otoscopy?
4
Basic Otoscopy
Pneumatic Otoscopy
Otomicroscopy
Video Otoscopy
Basic Otoscopy
Slight Magnification
Pneumatic Otoscopy
Slight magnification
Air pressure changes in ear canal (by way of a bulb that you squeeze)
Otomicroscopy
Operating Microscopy (Surgical Microscope)
Offers the best view of the TM
Video Otoscopy
Continuous video feed of the ear canal and TM
Requires a fiber optic probe in the ear canal
What are some limitations of otoscopy?
Subtle lesions are difficult to detect
Results from pneumatic otoscopy can be difficult due to nonuniform pressure
What are some lesions that can be hard to distinguish during an otoscopy?
Specific type of otitis media
Retraction of the TM
Dark colored TM (Is it bad, indifferent, etc.?)
What are some advantages of otoscopy?
It’s an easy way to identify gross abnormalities of the outer or middle ear
Video otoscopy allows for storage of digital images that can be used later for comparison
They can rule out misdignosis due to things like foreign objects and impacted cerumen
How should an otoscopy by interpreted?
Within the context of everything else in a full diagnostic evaluation
How do you perform an otoscopic evaluation?
7
Hold it properly at the head.
Don’t place it further than you need to obtain a clear view of the ear canal & TM
Anchor your hand against the patient’s head
The patient’s head should be vertical
Pull the ear up and back with the opposite hand to straighten the ear canal
Use the largest speculum possible without touching the sides of the canal to allow as much light as possible
Position the otoscope before you view
What are characteristics of a normal tympanic membrane?
TM should be pearly white & translucent
The ossicles are often visible
Should be able the see the Umbo, the Manubrium, and the Cone of Light
What are characteristics of a normal ear canal?
Pink
Clear of Debris
No impacted cerumen, foreign objects, growths, etc.
How long does it take someone diagnosed with hearing impairment to seek treatment?
Usually six years
What sort of issues are audiologists concerned with?
Communication issues, not physiological issues
What is the difference beteen Audiologic and Otologic Examinations?
Audiologic focused on hearing information affecting communication
Otologic focuses on the medical aspects
The prevalence of hearing loss is ______.
Increasing
The number of household containing someone with hearing loss is _____.
Increasing
The average age of someone reporting hearing loss is _____.
68.8 years
