Amplification Flashcards
Pediatric Amplification
- changing ear acoustics (smaller ears, different acoustics)
- children have limited ability/no ability to tell you behaviorally what’s going on–cannot ask, how does it sound (tiny, muffled, too loud, too quiet)–have nothing as a point of reference
- when you have a kid who has HL, their HA are their link to the auditory world to communication, spoken language to parents’ voices, crucial to get this step right
- HA and ear mold considerations are different than they are with an adult
- procedures you do carry a completely different weight
Overamplifying Peds Hearing Aids
dBHL at outside ear—-then go to dBSPL at the eardrum
HL-obtain based on dB SPL for an adult
for a kid, put in dB HL 60 to ear canal, by the time it reaches ear drum, acoustics change sound and SPL is louder when it gets to the TM
-2cc coupler you will overamplify the kid—because ear canals are small
Real Ear to Coupler Difference
difference in dB between the coupler and real ear measurements
can be up to a 20dB difference in RECD from infant to adult in the HF
need to remeasure anytime the ME status changes or need to change the earmold in an infant up until the age of 9
Tips for measuring RECD
if ABR is being done, try and do this also
use oto ease to make probe tube easier to go in
use mirror so an older child can see what is being done
best done when kid is quiet/sleeping, make sure kid cannot grab the probe lenght–if kid is crying this can be affected
Predicted RECD values
available for kids 6 months-5 years
for tips and earmolds
for every frequency
BUT high variability between infants so it is best if you can use your own measures
How to fit a hearing aid
need ear specific, frequency specific info–
if cannot get this from a VRA, BOA, CPA then you can use ABR as long as stimulus is tone bursts NOT clicks
90% accuracy at 500Hz and 99% accuracy at 4kHz for ABR to behavioral responses
DSL software will do the math & equations for you to fit ABR thresholds to HA
Are all alogrithms weighing speech equally?
No! At the greatest properity algorithm for same hearing loss there was 20 dB difference in HF
Type of HA
BTE durable, water proof earhooks direct audio input lock for volume control
Why BTEs?
More durable, easier access for repair, more flexibility in programming, needs to always be compatible with an FM system
Earhooks
help to lock BTE in place, need to have a filter than attenuates at least 6dB at 1000Hz
Verification
Determine whether the HA is doing what you intended it to do from audibility standpoint–gain HA can provide matches prescribed targets–acoustic targets
Validation
not that the HA is fit, what is the kid doing with it–am I doing what needed to be done—speech perception abilities
Residual Auditory Capactiy
kid with severe-profound HL (not a lot of residual hearing), evaluate this kid for CI–is this kid able to get enough information from HA to promote speech and language development or are they an appropriate implant candidate–need to make sure you verified the HA appropriate —make sure to verify the appropriateness and accuracy of HA
Tests for Validation
Word rec, SRT, aided soundfield thresholds, ITMAIS
ITMAIS
Infant toddler meaningful auditory integration scale
assess spontaneous response to sound—when he is in his room doing something and you call his name, how often does he turn around on the first try
with CI kids: could be silent in morning, put implant on he starts babbling, take it off and he is silent again–good evidence that his vocal activity is strongly rooted in his CI
-not just word, are they getting super-segmental information from speech? angry vs happy intonation
structured interview with parents about how their children are doing with amplification
