Aural Rehab Exam 1 Flashcards
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Sales Orientation
Based on persuading patients to obtain hearing aids and services –> box stores/ dispensaries
Patient- Centered Orientation
takes into account patient preferences, values and needs. Each patient can experience problems at different degrees/ cope differently
Patient Journey (6 stages)
Pre-awareness, Awareness, Movement, Diagnosis, Rehabilitation, Resolution
Pre-awareness
Few people anticipate to suffer hearing loss. Family and friends notice hearing loss symptoms. Average 5-7 years between onset and diagnosis
Awareness
Happens gradually. Can take days to years. Patients start to notice signs
Movement
patient consult family doctor, friends, or research hearing loss online. Start to moving to consultation of professional
Diagnosis
audiologist will identify and quantify hearing loss. Many patients will expect a quick tx and complete cure before realizing it is permanent.
Rehabilitation
Receive counseling, hearing aids, cochlear implants, psychosocial support, assertiveness training and more
Resolution
adjusted to hearing loss. Either accept it or move back to rehab.
World Health Organization (WHO) model
Health Condition - sensorineural hearing loss
Body structure - loss of hair cells in the cochlea
Body function - inability to hear speech sounds
Activity - ability to understand speech in noise
Activity restriction - inability to understand speech in noise
Participation - meetings, parties and dinners
Participation restriction - avoidance of these social gatherings because of inability to understand speech in noise.
Personal - cost and feelings
Environmental - transportation, medical provider location
Profound HL
90+ dB
-hears very loud or no sound, may perceive sound as vibrations, rely on vision.
1) Diagnosis
permanent hearing loss (counseling) - only tx for SNHL is amplification and aural rehabilitation
2) Provision of Listening Devices
(counseling) Amplification - Hearing Aid Cochlear Implants Bone Anchored Hearing Aids Assistive Listening Devices (ALD) fitting
5 step approach to EBP
1) ask a straightforward question
2) find best evidence to answer the question
3) critically assess evidence, decide if it applies to patient
4) integrate evidence with clinical judgement and patient values
5) evaluate the performance of the plan
5 dimensions of Hearing Loss
1) Degree
2) Configuration
3) Type (etiology)
4) Onset
5) Time Course
Degree of HL
how much loss there is
mild, moderate, severe, profound
Mild HL
25-39 dB
-difficulty understanding speech with background noise or when it is soft/distant
Onset of HL
when it occured
-congenital (birth), pre-lingual, peri-lingual (3-5 years), post-lingual, acquired, presbycusis (age-related)
Severe HL
70-89 dB
- relies of face to face and known topic; hears loud/shouted speech.
- with amp: recognize some speech and detect environmental sounds
Profound HL
90+ dB
-hears very loud or no sound, may perceive sound as vibrations, rely on vision.
Configuration of HL
reflects extent of HL at each audiometric frequency tested.
-low/med/high frequency, flat HL, sloping, reverse or upward sloping, left corner, bilateral/unilateral, symmetrical/asymmertical
Type (etiology) of HL
conductive, sensorineural, mixed, central
Conductive HL
obstruction in outer or middle ear.
-usually acquired
If the ACT is outside normal limits and the BCT is outside normal limits but the BCT is better than the ACT by 10+dB, then the loss is…
Mixed
Mixed HL
combination of conductive and sensorineural loss
-congenital or acquired
Central HL
hearing loss with normal peripheral function
Onset of HL
when it occured
-congenital (birth), pre-lingual, peri-lingual (3-5 years), post-lingual, acquired, presbycusis (age-related)
Counseling
- Helps patients better understand and solve their hearing related problems. 2. Better self disclosure/ acceptance 3. Reduced stress and discouragement.
Informational (content) counseling
Info is given to patient about hearing loss; hearing disability and management. (Given examples of what can go wrong, Concrete instructions, recommendations, etc)
Personal adjustment counseling
focus of psychological; social and emotional acceptance of the hearing loss (target counseling). Based on the well patient model. focus on adjustment and acceptance
Cognitive Approach
Modify thought process Rational Emotive Behavior Therapy (REBT) * Solution orientated therapy * identify activating event or adversity * Evaluate event * Dispute negative feeling. Etc
patient response format: Closed Sets
provide limited set of response choices; easier than open sets. used for testing cochlear implants.
Affective Approach
Modify emotions; Focus on feelings and fostering emotional adjustment. Find congruence with self. Use unconditional; positive regard. Employ empathetic understanding
Time Course of HL
how does the loss change over time?
-stable, sudden, progressive or rapidly progressive
If ACT is within normal limits and BCT for that same frequency are within normal limits and don’t differ from one another by 10+ dB, then this individual has…
normal hearing
If ACT is in normal range and BCT is in normal range, but the BCT is better than ACT by 10+dB, then there is …
Conductive Dysfunction and referral is required
If ACT is outside normal limits and BCT is within normal limits, and BCT is 10+dB better than the ACT, then the loss is…
Conductive
Amplifier
Increases sound intensity. almost all are digital and replaced analog versions. 3 stages to amplification process: preamplifier, signal-processing and output stage
If the ACT is outside normal limits and the BCT is outside normal limits but the BCT is better than the ACT by 10+dB, then the loss is…
Mixed
Receiver
Is an output transducer that changes electrical voltage back into sound pressure. sounds are converted back into acoustic energy; can be described as a mini loudspeaker or a microphone in reverse
Spondee
2 syllable words with equal stress on each syllable
SDS
speech discrimination scores
WRS
word recognition scores
MCL
most comfortable loudness level
UCL
uncomfortable loudness level
patient response format: Open Sets
no response choices and no contextual cues are provided to patients
patient response format: Closed Sets
provide limited set of response choices; easier than open sets. used for testing cochlear implants.
Signal/Speech to noise ratio
the level of signal you want to listen to v. everything else that is just noise
- speech stimuli: 10 dB louder than noise = +10 SNR
- speech stimuli: 10 dB softer than noise = -10 SNR
Dynamic Range
the difference between threshold of discomfort and threshold of audibility
3 aspects of understanding
1) the loudness of things
2) tuning of things
3) processing of things
CROS
Contralateral Routing of Signal (AC or BC)
- used with unilateral and single sided deafness
- no useable hearing in bad ear
- normal or near normal hearing in good ear
BICROS
Bilateral Contralateral Routing of Signal
- No useable hearing in bad ear, but there is hearing in the better ear as well
BAHS
Bone Anchored Hearing System
- 2 uses: conductive/mixed HL when Air conduction hearing aid is contraindicated; and SSD
BAHS involves…
inserting a titanium screw into the mastoid area behind the ear
provides hearing by bone conduction
Psychosocial Support
Helps patient manage psychological and social difficulties associated with their hearing loss. Aimed to increase self-acceptance; self- confidence. Helps understand how hearing loss impacts life
Microphone
May be directional or omnidirectional. Can be switched between (some automatically according to environment)
Directional
more sensitive to sound originating front of the user rather than the back. These enhance the signal-to-noise ratio and are better in noisy environments
Omnidirectional
sensitive to sound from all directions
Amplifier
almost all are digital and replaced analog versions. 3 stages to amplification process: preamplifier, signal-processing and output stage
Peak- clipping
limits loud noises from passing through but may introduce distortion
Receiver
sounds are converted back into acoustic energy; can be described as a mini loudspeaker or a microphone in reverse
BTE
Behind the ear. Mild to profound. Flexible/ customizable. Fewer feedback problems, easy maintenance
RITE
Receiver in the ear. Mild to severe. Small casing behind the ear, short receiver sits in ear. Custom fit, cosmetic appeal and may distort sound of user’s voice
ITE
In the ear. Mild to Severe. fit in external ear
ITC
In the canla. Mild to moderately-severe. Fits in external ear. fill less of cochlea that ITE. Custom fit, cosmetic appeal and may distort sound of user’s voice
CIC
Completely in the canal. Inside ear canal, remote control for adjustment, reduces feedback and improves localization, virtually invisible, distort sound of user’s voice and high maintenance.
How to fit hearing aid GOAL
make soft sound audible, moderate sound clear and comfortable, and loud sound should be loud but not uncomfortable.
Monaural
One hearing aid
Binaural
2 hearing aids. eliminates head shadow, loudness summation
Linear processing
1 for 1 relationship for input vs output.
Output
what comes out of the receiver- linear processing happens in between
Processing Gain
consistent across intensities, up until saturation point
Peak clipping
clipping of peaks of signal that reaches saturation level (point where an amplifier no longer provides an increase in output compared to input)
Compression processing
varying output as a function of input. Louder inputs not given the same gain as softer inputs. Goal= decrease dynamic range of sound environment so that all sound can be placed in the REDUCED dynamic range
Transducer
anything that changes one form of energy into another
Microphone
input transducer that changes sound pressure (audio) into variations in electrical voltage (electronic signal)
Compression Threshold
the input sound pressure level (SPL) at which compression is activated
Compression Ratio
degree of gain reduction for signals above the kneepoint . Squeeze sounds in the environment into the restricted dynamic range of indivi.
Input Compression
reduced gain of the hearing aid based on input level (before the processing)
Output Compression
reduces gain to limit the output (after the processing)
