1.01 - Hearing Assessment Review Flashcards
Does an Audiogram tell us the whole story of someone’s hearing?
No
What is an Audiogram?
A general description of magnitude and type of hearing loss
What does an audiogram not tell us?
All of the communication difficulties that may be experienced
What implications about hearing abilities can be made from an audiogram?
Predictions about sound access
Need for listening device usage
What are the goals of Audiometric Testing?
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Determine the TYPE & DEGREE of hearing loss
Determine the FREQUENCIES affected
Determine WHICH EARS are involved (Unilateral vs. bilateral (laterality), symmetry)
Estimate SPEECH UNDERSTANDING abilities
What is an air-bone gap?
The difference between air and bone conduction levels
When is an air-bone gap clinically significant?
When it is greater that 10 dB
What is Conductive Hearing Loss?
The damage or insult is in the outer or middle ear
Air conducted signal transmission is “blocked” from reaching the cochlea
Bone conduction transmission is better than air conduction
What is Sensorineural hearing loss?
Generally due to abnormality from damage to the inner or outer hair cell sensory receptors or other structures within the cochlea
Results in a decrease in the clarity of the auditory signal
Can also be caused by problems with auditory nerve fibers, the auditory auditory nerve (VIII) or auditory central nervous system from the brain stem to the cerebral cortex
What is mixed hearing loss?
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Conductive and sensorineural hearing loss combined.
Bone conduction thresholds are outside the normal limits
Can be temporary (impacted cerumen, perforated tympanic membrane, etc.)
Can be permanent (disarticulation that is not surgically correctable, eardrum that cannot be repaired)
What is nonorganic hearing loss?
The feigning or exaggeration of a hearing impairment, usually for ulterior motive
Psychogenic hearing loss or hysterical deafness (a physical manifestation as a result of severe anxiety or emotional trauma.)
What are two other names for nonorganic hearing loss?
“Functional” HL
“Malingering” HL
Why are there Hearing Aid Limitations in SNHL?
SNHL is not just a reduction of sound intensity
SNHL also
- Causes differences in how loudness is perceived - Causes differences in how brief sounds are processed - Reduces ability to resolve frequencies.
“The perceptual consequences of SNHL” are more “than ______ represented by an audiogram.”
Reduced sensitivity
What are the four main characteristics of sensorineural hearing impairment?
Reduced sensitivity (things need to be louder)
Recruitment
Reduced frequency selectivity (some pitches are more distinct than other pitches)
Reduced temporal resolution
What is Recruitment?
Abnormal growth of loudness,
Sounds are judged to be louder than they actually are
Loudness grows abnormally in perception
What is Temporal Resolution?
The ability to process acoustic signals over time.
This includes the order of sounds, discrimination between similar words and consonants
Why is temporal resolution so important?
If you can’t process acoustic signals over time properly, it will effect your ability to understand speech and parts of speech
Why is temporal resolution so important to speech?
Speech occurs rapidly over time
If you don’t get all the frequency resolution and timing, you will have trouble understanding
The auditory system must be capable of ______ & ______ the fast changes in the acoustic signals of speech.
Processing
Analyzing
Damage in the ______ of the ear and auditory pathways causes problems (smearing) in processing the ______ of sound.
Sensory and/or neural components
Temporal features
Why is amplification not enough to help with compromised temporal resolution?
The distortions in the speech will be perceived by the individual even if it is made louder
When does temporal resolution begin to decrease?
When we get older
“The cochlea is a dynamic system that operates on the auditory signal in a ______ and ______ manner.”
Nonlinear
Time-varying
The specific dynamics have an impact on how brief sounds—transients in music, consonants in speech—are perceived and can affect our ability to ______.
To hear them over competing background noise or simultaneous instruments.
The temporal envelope of speech, which codes ______, is distorted by an impaired auditory system, resulting in ______.”
Significant information
Distorted speech perception
Can a normal ear can detect small changes in frequency?
Yes!
The ability of the ear to resolve sound components of ______ is an important aspect of speech perception and hearing in general.
Different frequencies
If the frequency resolving capability is compromised, then formants may become more difficult to identify, impairing the ability to ______. Background noise would worsen this ability as the ear becomes less able to separate the ______.
Understand speech
Masking noise from the target speech
What is a Formant?
A resonance in the vocal tract where a speech signal has more energy in some frequencies than other frequencies
What is the Fundamental Frequency?
First frequency band
What is Formant 1? f1
1st frequency band above the fundamental frequency that demonstrates high energy in the speech signal
What does f1 stand for?
Formant 1
What is Formant 2?
The second frequency band above the fundamental frequency that demonstrates high energy in the speech signal.
What is f2?
Formant 2
What do the first 2 formants help us distinguish?
One vowel from another
Vowels produced w/ a wider mouth opening will have a ______ that a vowel produced w/ a narrower mouth opening.
Higher 1st formant
Hot has a 1st formant of ______.
730 Hz
Heat has a 1st formant of ______.
270 Hz
Vowels produced w/ an ______ will have a higher 2nd formant that a vowel that is produced w/ a ______.
Anterior vocal tract constriction
Posterior constriction
Bee has a 2nd formant of ______.
2290 Hz
Boo has a 2nd formant of ______.
870 Hz
Why do formants matter?
Most people w/ hearing loss will have better hearing in the low frequencies than in the high frequencies
Vowels w/ first formant differences will be easier to detect than those vowels that differ in the 2nd formants
Most people with hearing loss have the most difficulty hearing and understanding speech in ______.
Noisy areas
Why is it always important to ask when HL occurred?
Because it may involve other health issues
What are pure tone tests?
Air conduction
Bone conduction
What is the weakness of pure tone tests?
They do not give us the whole picture only the type and severity
What are some Speech Tests?
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Speech Recognition (Reception) Threshold (SRT)
Word Recognition Score (WRS)
Competing message or degraded speech tests
What does SRT stand for?
Speech Recognition (Reception) Threshold
What does WRS stand for?
Word Recognition Score
What kinds of words does a Speech Recognition Threshold test use?
Two Syllable words with equal stress on each syllable
Spondees
What should the results from a Speech Recognition Threshold test mirror?
The results of a pure tone tests
What kinds of words does a Word Recognition Score test use?
One syllable words
Under what conditions are Word Recognition tests performed?
In quiet and in noise
Why are Word Recognition tests performed in noise?
Because very few people complain about not being able to hear in quiet environments
What are the three categories of Electrophysiological (Objective) Tests?
Tympanometry
Otoacoustic Emissions
Evoked Potentials
What does Tympanometry measure?
Acoustic Reflexes
Test of middle ear function
How are Tympanometries performed?
By combining air pressure and sound and measuring how the eardrum responds
What do Otoacoustic Emissions measure?
How the inner ear is functioning
Test of outer hair cell mobility
What do Evoked Potentials measure?
How sound is moving up the auditory pathways
What does PTA stand for?
Pure-tone average
What are Pure-tone averages?
The average of hearing thresholds at 500, 1000, and 2000 Hz
Can use best 2 frequencies if there is steeply sloping HL
What can we do with pure tone averages?
Assign degree of hearing loss
Summarizes hearing status
Do pure tone averages provide best estimate of hearing limitations (handicap)? Why or why not?
No
Most communication takes place in less than ideal conditions (noise, distance, reverb)
Individual differences in speech recognition abilities
What is considered normal hearing for an adult?
PTA of 20-25 dB HL or better
What is considered normal hearing in a child?
PTA of 15-20 dB HL or better
What is considered Slight / Minimal HL for a child?
PTA between 20-25 dB HL
What is considered a lack of hearing loss?
PTA of -10 dB 15 dB HL
What is considered a Slight HL?
PTA of 16 to 25 dB HL
Do all ASHA documents refer to PTAs of 16 to 25 dB HL as being Slight HL? Why is this important?
No but this can have significant effects on our ability to understand language. This is especially important for children as they are developing language!
What is considered Mild HL?
PTA of 26 to 40 dB HL
What is considered Mild to Moderate HL?
PTA of 41 to 55 dB HL
What is considered Moderately-Severe HL?
PTA of 56 to 70 dB HL
What is considered Severe HL?
PTA of 71 to 90 dB HL
What is considered Profound HL?
PTA of >90 dB HL
What is a Flat HL Configuration?
Thresholds only change less that 15 dB across all frequencies
What is a Sloping HL Configuration?
There is better sensitivity in the low frequencies than in the high frequencies
What is a “Gently” Sloping HL Configuration?
The thresholds at adjacent octaves differing by less than 20 dB
What is a “Precipitously” or “Steeply” Sloping HL Configuration?
The thresholds at adjacent octaves differing by more than 20 dB
What is a Rising HL Configuration?
There is poorer sensitivity in the low frequencies than in the high frequencies
What is a Saucer-Shaped or Cookie-Bite HL Configuration?
There is poorer sensitivity in the mid frequencies than in either the low or high ones
What is a Corner HL Configuration?
When there is only minimal hearing in the low frequencies
This is usually seen in the profoundly deaf
What is a Irregular HL Configuration?
A combination of sloping and rising across Hz
In Sloping HL the ______ are compromised. In Rising HL, the ______ are compromised.
High-frequencies
Low-frequency
Can Neural Presbycusis & Auditory Neuropathy be quantified by pure-tone thresholds?
No
What is Neural Presbyacusis?
Atrophy of nerve cells in the cochlea and central neural pathways
What is Auditory Neuropathy?
The inner ear functions normally but the transmission of signals from the inner ear to the brain is impaired
What can cause a Central HL?
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Concussive injuries
Developmental issues [(C)APD]
Structural congenital defects
What does (C)APD stand for?
(Central) Auditory Processing Disorder
Is time of onset an important aspect of HL?
Yes
Is whether the HL is Congenital or Acquired an important aspect of HL?
Yes
Is whether the HL is Progressive or Sudden an important aspect of HL?
Yes
Is whether the patient is a Child or an Adult an important aspect of HL?
Yes
Is whether the HL is Temporary or Permanent an important aspect of HL?
Yes
Is whether the HL is Stable, Progressive, or Fluctuating an important aspect of HL?
Yes
Is the Time Course of the HL (Sudden or Gradual?) an important aspect of HL?
YEs
Is the reliability/validity of patient/test results an important aspect of HL?
YEs
You can only test for (C)APD once a child has reached ___ years of age.
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