Audiology Flashcards
Name and define the three types of hearing loss.
Conductive: problem in outer/middle ear spaces resulting in sound not being properly conducted to inner ear.
Sensroineural: problem in inner ear (damage to the inner hair cells of the cochlea or auditory nerve), permanent.
Mixed: both a contribution from an outer/middle ear problem and an inner ear problem.
What are some perinatal risk factors forbearing loss?
Family history of pediatric HL
Low birth weight
Prematurity (<= 30 weeks)
Persistent pulmonary hypertension of the newborn
Hypoxic-ischemic encephalopathy
Intraventricular & periventricular hemorrhage
Congenital diaphragmatic hernia
Ventilation support
Infections at birth (HIV, measles, mumps, TORCH, CMV, meningitis)
Obvious craniofacial malformation of external ear canal
Severe neonatal sepsis
Severe hyperbilirubinemia/ kernicterus
Severe neonatal asphyxia/hypoxia/respiratory failure/cardiopulmonary failure
Syndromes including Down syndrome, CHARGE, Usher’s, Waardenburg, Treacher Collins, Hunter, and more
What are some outer ear pathologies that could result in hearing loss
Microtia: under-development of the pinna
Atresia: closing or absence of an ear canal resulting in permanent conductive hearing loss.
Stenosis: narrowing of the ear canal
Otitis externa: water pooling in the ear causing bacteria to grow in the eat canal and cause infection (swimmer’s ear)
Otomycosis: fungal infection caused by overuse of ear drops.
TM perforation: rupturing of the eardrum caused by excessive fluid in middle ear (otitis media), trauma, or object insertion.
Benign growth: exostoses (surfers ear - irregular bony growth in EAM), osteromas (smooth bony know in cartilage-bony junction)
Collapsed ear canal
Foreign bodies and impacted cerumen (wax)
Congenital malformations
Structural changes secondary to infection or trauma
Medical conditions
What is auditory processing?
Auditory processing ability is the capacity with which the central auditory nervous system transfers information from the 8th cranial nerve to the auditory cortex. APD is an impairment in this function of the central auditory nervous system
What is auditory processing disorder?
Auditory Processing = when the brain recognizes and interprets sounds and surpasses unwanted sounds
APD means that something is adversely affecting the processing or interpretation of the information
Can hear information but have difficulty attenting to, storing, locating, retrieving, and/or clarifying that information to make it useful.
What are some possible causes of APD?
Possible Causes in Children:
○ Auditory deprivation (i.e. history of otitis media)
○ Genetic factors
○ Birth trauma
○ Maturational delays in CNS
Possible Causes in Adults:
○ 8th cranial nerve (i.e. Cochleovestibular Schwannoma)
○ Brainstem (i.e. multiple sclerosis)
○ Cortex (i.e. tumour, trauma)
○ Diffuse (i.e. meningitis, toxicity, deprivational effects of peripheral pathological conditions, degenerative effects of aging)
What are the different degrees of hearing loss?
Slight (16-25dB): hearing across the speech spectrum is sufficient in quiet situations, difficulty with higher frequency consonants in noise may cause impaired speech perception.
Mild (26-40dB): louder components of the speech spectrum (ie. vowels) are audible, some crucial consonant sounds (/th, /f/, /s/, /k/, /t/) may be difficult to hear or missed, even in good environments.
Moderate (41-55dB): much of the speech spectrum is barely audible, with mostly vowels and only a few consonants heard, listening at a distance of in noise is very difficult and listening is fatiguing at all times.
Moderate-severe (56-70 dB): normal conversational speech is essentially inaudible, louder environmental sounds, such as car horn or fire alarm, are audible.
Severe (71-90dB): speech is not audible unless spoke next to the ear, louder environmental sounds may be audible but soft.
Profound (91+ dB): total lack of hearing, may rely mainly on lip-reading and/or SL, or cochlear implant.
Why is hearing important to speech?
Hearing supports the acquisition & production of speech and language in several ways. Hearing allows infants to be aware of environmental and speech sounds, as well as makes it possible to understand
spoken language.
Hearing is necessary in monitoring one’s own production of speech and language (how & what we say). People with hearing impairments have challenges in monitoring their speech, language, and voice productions.
What are some variables that that impact the effect hearing loss has on speech, language and voice?
Age of onset of the hearing loss & the degree of loss.
Congenital hearing loss (present at birth) has a greater impact than hearing loss acquired later in adult life.
Pre-lingual hearing loss = the individual experiences hearing loss before they acquire speech & language
Post-lingual hearing loss = the individual experiences hearing loss after the acquisition of speech and some language (usually after 5 years old)
How does hearing loss impact speech in children?
Distortion of sounds (especially fricatives & stops)
Children with hearing loss often cannot hear /s/, /sh/, /f/, /t/, /k/, so they do not include them in their speech & as a result, their speech may be difficult to understand
Omission of initial & final consonants
Consonant cluster reduction
Substitution of voiced consonants for voiceless consonants (e.g. /g/ for /k/)
Omission of /s/ in almost all positions of words
Substitution of nasal consonants for oral consonants (e.g. mat/bat)
Increased duration of vowels
Imprecise production of vowels
Epenthesis, or adding a schwa sound to consonant blends
How does hearing loss impact language?
Use of limited variety of sentence types
Sentences of reduced length & complexity
Difficulty comprehending and producing compound, complex, and embedded sentences
Limited oral communication, including lack of elaborated speech and reluctance to speak
Slower acquisition of grammatical morphemes
Omission or inconsistent use of many morphemes (e.g. past tense & plural inflections, present progressive -ing, prepositions, conjunctions, etc.)
Poor reading comprehension
Writing that reflects oral language problems (e.g. deviant syntax, limited variety of sentence types, omission of grammatical morphemes)
How does hearing loss impact voice, fluency, and resonance?
Hypernasal or hyponasal resonance
Abnormal phrasing, flow, or rhythm of speech
Monotone speech with lack of appropriate intonation
Improper stress patterns
Restricted pitch range
Too fast or too slow rate of speech
Inappropriate pausing
Inefficient breathing, including breathiness
Deviations in voice quality, including hoarseness & harshness
Discuss how the various levels of hearing loss may impact speech understanding.
Slight/Minimal HL = individual may miss 10-20% of speech signal is the speaker is more than 3 feet away or the room is noisy
Mild Loss = miss between 25-50% of the speech signal
Moderate Loss = miss 50-75% of speech signal
Severe Loss = can miss up to 100% of the speech signal
Individuals with unilateral hearing loss may have difficulty with soft speech or speech at a distance, as well as hearing in noise
Define air and bone conduction.
Air: measures sensitivity of entire auditory system, indicates overall degree of hearing loss, client responds to sound by holding up hand or pressing switch
Bone: bypasses outer and middle ear, directly into inner ear, indicates nature of hearing loss. Bone vibrator is placed on forehead or behind ear.
What is speech audiometry?
easures how well a person understand speech and can discriminate between sounds.
Speech Detection/Awareness: Minimum hearing level at which the individual can just hear speech material 50% of the time (they don’t need to be able to distinguish what is being said, they just need to show awareness that speech is present).
Speech Reception: Minimum hearing level at which the individual can understand 50% of the speech material (i.e. they must repeat the word back or point to a picture correctly)
Word Recognition: % score which reflects an individual’s ability to understand monosyllabic words. It establishes how well a person discriminates between words by having the client repeat monosyllabic words from a list.
