Aural Assessment and Intervention Flashcards
Auditory system that is sensitive in the 500 - 4,000 Hz is an important element underlying the ______________ and ______________
Production and comprehension
True or False. A child with severe hearing loss will have difficulty decoding the sound signal, thus they will perceive words differently than normal hearing.
True
Children with hearing impairment learn speech discrimination and production by:
Watching how sounds look on the face
Vibrations
Distorted auditory signal → acoustic properties are incorrect
True or False. If a severe loss has been present since birth, normal acquisition of language is difficult.
True
True or False. If the age of onset is early and age of detection is late, specialized instruction and other interventions are necessary to develop speech and language. Such instruction may rely on visual, tactile, and kinesthetic cues and signing.
True
True or False. Children and adults with acquired hearing loss will retain speech sound production patterns for a time. However, when amplification is not present, their articulation skills deteriorate eventually.
True
According to Gold (1980) speakers with congenitally severe or profound hearing loss have _______ intelligibility
20% intelligibility
A person with hearing loss will have problems at both _______ and _______ levels.
Segmental and suprasegmental levels
Segmentals: errors on both consonant and vowels
Suprasegmental: Slower rate than normal-hearing speakers because of a longer duration during sound production
Most commonly seen speech errors seen in deaf speech
Errors of omission–omission of final consonants, /s/ in all contexts, initial consonants
Errors of substitution–voiced for voiceless consonants, nasal for oral consonants (hypernasal like), low feedback substitutions (substitution of sounds with easily perceived tactile and kinesthetic feedback for those with less; e.g., /w/ for /r/ substitution), substitution of one vowel for another
Errors of distortions–degree of force, hypernasality associated with vowel productions, imprecision and indefiniteness in vowel articulation, duration of vowels, temporal values in diphthongs
Errors of addition–insertion of a superfluous vowel between consonants, unnecessary of final stop consonants, diphthongization, superfluous breath before vowels
Speech sounds error patterns observed in both children who use hearing aids and children who use cochlear implants
Developmental patterns–assimilation errors, consonant cluster reduction, final consonant deletion, liquid simplification, palatal fronting, stopping, unstressed (weak) syllable deletion, velar fronting
Nondevelopmental patterns–initial consonant deletion, glottal stop substitution, backing, vowel substitution, diphthong simplification
For language form of a child with hearing loss
Sequence of phonemes roughly similar to that of hearing children
Protracted in development
More likely to produce voicing errors, extra nasality, and ICD
True or False. Early use of cochlear implants can alter the development trajectory → close to typical levels of receptive vocabulary.
True
True or False. In terms of language use, early exposure to language and communication in socially meaningful contexts is more important than hearing status per se.
t
Why do audiologists need to perform hearing measurement?
Purpose: describe what the patient hears and how they hear it, describe the communication ability, determining the site(s) of lesion(s) within the auditory system, basis from which a plan of habilitation can be developed
Vibrator placed behind the ear on the mastoid process rather than headphones. What conduction test is this?
Bone conduction test
True or False. Speech audiometry is an objective assessment.
False. Speech audiometry is a subjective assessment.
True or False. The stimulus used in speech audiometry are spoken materials that are provided at controlled sound pressure levels.
True
What is the speech recognition threshold (SRT)?
Minimum hearing level for speech at which an individual can recognize 50% of the speech material
Selects item from a closed set of choices
Repetition/indication of recognition 50% OTT
True or False. With SRT, spondee words are commonly used
True
What is speech/word recognition testing?
Estimate of ability to understand everyday speech
Phonetically balanced words presented
Phonetically balanced words, nonsense syllables, monosyllables
Response: Open (vocab), closed (multiple choice)
What is the speech detection threshold?
Lowest intensity level that can be detected; also corresponds with PTA
No discrimination or identification needed only detection
True or False. Objective measures only estimate auditory ability. They are an indicator of hearing ability, but cannot stand alone.
True
What are the subjective assessments for young children?
Behavioral Observation Audiometry (BOA)
Visual Reinforcement Audiometry (VRA)
Conditioned Play Audiometry (CPA)
What is behavioral observation audiometry (BOA)?
Loud stimulus through speakers
Observing the child’s response
Screening
What is visual reinforcement audiometry (VRA)?
Conditioning to look at visual reinforcer when audio stim (speech, warbled tone) are presented.
What is conditioned play audiometry (CPA)?
Conditioning to perform a task (e.g., shoot ball, etc) in response to stimuli (pure tones, speech)
What are the objective measures of hearing skills?
Immittance audiometry
Otoacoustic Emission
ABR
ASSR
Tympanometry
What does an immittance audiometry do?
Testing the middle ear function
Differentiates cochlear from retrocochlear disorder
(1) Acoustic impedance: opposition to transfer of AE
(2) Acoustic admittance: ease of sound flow
Give a type of immittance audiometry
Tympanometry
What is tympanometry?
Measurement of the reflected sound energy from the ear drum
Systematically changing air pressure in the ear canal
Checks functioning at: middle ear
Eustachian tube, tympanic membrane, ossicles
Can you use this to assess babies?
No. We don’t do this with babies.
We use this to 2-3 years old up to adulthood
What are auditory evoked response?
Recorded using electrodes/compute
Waveforms reflect neural synchrony and neural transmission to acoustic stimuli along the retrocochlear pathway.
Ideal for newborns and young infants
This detects damage to the cochlea, auditory nerve, and auditory pathways
What is an auditory steady state response?
Electrophysiologic response to rapid and continuous auditory stimuli
Frequency and amplitude can be modulated
Gives frequency specific information (objective algorithm)
Not ideal for younger than 2 years old
Frequency specific responses
What is auditory brainstem response (ABR)?
Electrophysiologic response to brief sounds with low repetition
Responses are generated from the auditory nerve to the lateral lemniscus
Examiner subjectively reviewing the waveforms and deciding whether a response is present
Does not differentiate between levels of profoundness of deafness
Not a true test of hearing–predictive only
What is otoacoustic emission?
Ideal for newborns and young infants
OAE: sounds generated by cochlea that travel back to the middle ear. Sound produced by the shearing of the outer hair cells.
Measure sound produced by hair cells in the cochlea
Present OAE: suggest normal cochlear function in the presence of normal middle ear function
Absent OAE suggest: some degree of hearing loss in the level of the cochlea if middle ear is functioning normally
D/dx of cochlea vs neural hearing loss
0-6 months (what objective and subjective assessment should you use)
ABR/ASSR
6-2 years old
BOA and VRA
Assess auditory and listening skills
2-5 years
Conditioned Play Audiometry
SRT if language supports ling six sounds
5 years and above
Standard audiometry
Speech reception
Speech and word recognition
Cochlear implants
External sound processor – sound filter, converter (minicomputer)
Internal unit - converts digital signal to electric signal
Electrode array - surgically inserted into scala tympani: stimulates CN VIII and auditory pathways
Candidacy for CI
12 - 24 months - Profound SNHL; No medical lack of progression in auditory skill dev
2-18 years - Severe to profound SNHL ; Lexical neighborhood test score of 30% or less
Adult - moderate to profound SNHL
What is Bone anchored auditory implant (BAI)
Conductive/mixed hear loss: patients with incomplete, blocked, or damaged OE, EAM
Sound processor placed on ear with profound loss stimulates contralateral (normal hearing) ear via bone conduction
To select familiar speech sounds that would broadly represent the speech spectrum from 250-8000 Hz. Implies that amplification is working
Ling 6 sound test [m], [ah], [oo], [ee], [sh], [s]
Provide are the speech perception assessments
ELTL (Early learning to listen sounds)
Represents suprasegmental and segmental features of speech. Introduced in play. Clinician introduction, opportunities for imitation, spontaneous production.
ELTL
ASCO. What does this assess?
Discrimination
Auditory memory
Auditory feedback
Figure ground
What does Glendonald’s Auditory Screening Procedure assess?
Assesses the auditory lip reading, detection, and identification skills
What does an early speech perception test assess?
Assesses pattern perception for both low verbal and verbal
Pattern perception: Discriminates between 3 SS, 2 spondee, 3 trochee, 3 ps
