Aural Rehab Exam 2 Flashcards
The principal aim of any hearing aid fitting or strategy is to….
ensure environmental sound, especially conversational speech, is audible without being excessively loud
How to troubleshoot a hearing aid
1, Check battery
- Check volume and programs
- Check tubing
- Check for excess wax
A hearing aid must
- Provide good sound quality
- Maximize speech recognition
- Provide comfortable amplification
The 5 steps in the HA selection and fitting process are:
- Candidacy
- Fitting protocol
- Fitting
- Hearing aid orientation (Counseling and follow up)
- Validation and outcome measures
What 3 things are important for HA candidacy?
Degree of HL
Degree of communication difficulty
Motivation of patient
Before getting a HA a child should always get
clearance from an ENT
To understand a persons degree of communication difficulty, they are given:
a self assessment questionnaire
In a self assessment questionnaire a person
lists their difficult situations or rates the difficulty of situations
For “motivation of a patient” you want someone who
is open to the process, open to recommendations and will follow them
Appropriate style is based on:
- degree/type of HL
- Shape of canal
- Dexterity & vision
- final say of patient
What are 4 reasons you should do binaural HAs?
- better sound quality
- no bad ear
- better sound localization
- do better in background noise
What does compression do?
Limits the amount of gain/output
Compression is…
Special circuitry built into the HA that doesn’t allow HA to produce too much amplification
Adjusted on a patient basis
Now common in all digital HAs
What do “multiple channels” do?
Divide frequency region into sections
Explain what “linked HAs” means
What you do to one HA happens to the other. Binaural HAs are “paired”
Explain “Quality control”
Want to make sure HAs are working correctly and working how the manufacturer said they would work
What are 4 electroacoustic characteristics?
OSPL90
gain
harmonic distortion
equivalent input noise
The 9 parts of HA protocol are:
- selection of style
- directional mic
- Binaural
- Compression
- Multiple channels
- Multiple memories
- Linked HAs
- Quality control
- Evidence based practice
HA fitting is a combination of:
Science & Art
Even the best HAs will fail the patient, without what?
HA orientation (counseling and follow up)
This is a written physical aid for HA instruction
HIOBASICS
What do you need to address during the HA fitting process?
Emotional reactions
3 Validation/ outcome measures are:
- Electroacoustic outcome measures
- Audiologic measures
- Self-report outcome measures
For pediatric HA fitting a ______ approach is necessary
Team
For pediatrics, as soon as HL is diagnosed
Intervention must begin immediately
On children, we need to use DSL fitting formulas because they
account for the smaller sized ear canal
calculate average ear canal resonance and dynamic range levels based on the child’s age
In children _______ is a must and _________ are recommended
compression; directional mics
What style of HA is recommended for a child and why?
Behind the ear because it can grow with the child
When should HAs not be worn?
Sports
Sleeping
Humidity
What is the goal of pediatric amplification?
Have the child wearing HAs as much as possible as soon as possible
Why are there more frequent follow-ups with children?
Because they are growing the fitting needs to be adjusted frequently
Because we would like to get as much diagnostic information as possible
For a child, who should dictate when the HAs are worn?
The parent
Audiologic follow up should occur every ________ during first ______ of hearing aid use
3 months; 2 years
Visits should include:
Behavioral hearing testing
Hearing aid adjustments/earmold checks
Electroacoustic evaluation of hearing aids
What problematic situations may remain even after amplification is provided?
Telephones, large meetings, school
What are ALDs?
Assistive listening devices
Refers to devices to help a person in a certain listening situation.
What are HATS?
Hearing Aid Assistive Technologies
Broader term that encompasses ALDs and devices for safety/alerting.
ALDs and HATS can be used
with or without HAs
What are ALDs designed to do?
reduce the effects of noise, distance and reverberation on hearing and improve the user’s ability to communicate.
By placing the mike close to the sound source and the receiver next to the patient’s ear
Signal to noise ratio is improved
8 categories of ALDs/HATS
- hardwire systems
- audio loop systems
- infrared systems
- FM systems
- Telephone devices
- Alert/Alarm devices
- Television assistive technologies
- Auditory trainers
PSAPs
Personal sound amplification products
“intended to amplify environmental sound for non-hearing impaired consumers.”
Need to stress the importance of including the family in the AR process to
help identify the needs of a child and better meet those needs
Factors to be considered for child AR
HL (congenital, prelingual, postlingual)
Age
Other disabling conditions
OAE/ABR are critical for
early identification
testing/retesting should occur within
1st 3 months of life
is needed to clarify medical aspects of HL
medical referral
Prior to start of AR program, child should have a complete
medical evaluation
Audio info needed for children includes these 7 things
- Otoscopic results
- Degree and configuration
- HL type and cause (if possible)
- Speech recognition ability
- MCL
- Threshold of discomfort
- HA performance and audibility measures
For children, with a HA recommendation you need..
medical clearance
Reevaluation should occur:
Infant:
Preschooler:
School-age:
Infant: every 3 months
Preschooler: Every 6 months
School-age: Annually
A child cannot be effectively evaluated outside
The family system
Best models for children are
Family centered early evaluation models
We have to empower the caregiver/ parent
with knowledge and skills to promote the infant’s development
Early intervention services should be performed in
the child’s natural environment
Why is ongoing assessment of a child necessary?
we need to determine priority intervention needs, determine outcomes and best approaches for child
What is the purpose of early intervention?
To support / assist families in providing learning opportunities for the infant within everyday activities, routines and occurrences.
3 things family centered focuses on:
Family centered needs
Partnering with parents
Empowering family in decision making process
2 things child centered focuses on
Provides direct service to child
Limited parent involvement in intervention
What is IFSP?
Individualized family service plan
road map for intervention—created by professionals and family members
What 3 things does IFSP do?
It describes the infant’s present levels
Identifies the family’s strengths/needs related to the infant’s development
Identifies what outcomes are expected for the family and child
Primary goal of early detection HL and intervention is to
maximize language development during the critical periods of language learning by promoting a responsive social and communicative environment and to support family adjustment to the diagnosis
Early intervention should be: (3)
Consistent
Strategic
Adaptive
6 tools of the trade in early intervention are:
- information resource
- coach/partner
- joint discoverer
- news commentator
- Partner in play
- Joint reflector and planner
No 1 person or profession…
will have all the answers so it should be transdisciplinary
5 step decision making process
- Get to know the infant
- Get to know what strategies work for communication
- Set clear goals
- Support systems
- Keep current with technology, etc.
What are the 4 basic options of communication methods?
- listening/spoken language
- Total communication
- Cued speech
- Sign only
Hearing aids will allow hard of hearing child to maximize
their residual hearing and develop speech and language skills
What is auditory feedback loop?
child can self monitor speech production.
What is SKI-HI?
deaf mentor program that teaches ASL to families, provides info on deaf culture.
Family needs to understand that deafness is…
a unique human experience instead of a pathology or problem.
Parents go through different stages when HL is diagnosed, what are they?
1) Shock: may react as if they lost a loved one. May be numb.
2) Denial: HL isn’t visible, so many parents try this. Parents might be confused, want to tell the family and them exactly what is going on with realistic expectations.
3) Anger: towards the family, parent doesent know how to help child. A good thing, since first step towards acceptance.
4) Bargaining: “I’ll do anything for my child’s disorder to disappear”
5) Depression and guilt: why did this happen? What did I do? How did I cause this?
6) Acceptance: Parent is supportive and involved and wants to do whatever they can to advocate for their child.
Auditory skill development model from Eber includes:
detection, discrimination, identification, comprehension
Listening/ Spoken language
Emphasizing the oral/aural part of communication
Use residual hearing to best of their abilities
Want child to speak
Will have speech therapy
Not focused on leaning sign
Most students with hearing loss are educated in this manor
“Auditory Verbal Approach”
Total Communication
Incorperating everything Sign Speech Speech reading Nonverbal communication (Body language/Facial expressions) ESL and pidgin used Using residual hearing
Cued speech
Visual support system to help someone learn to speech read
Handshapes made close to the face and neck that represent groups of phonemes.
Sign only
Very small percentage is told to sign only.
Usually taught ASL as 1st language and written English as 2nd
Speech production and listening skills are not heavily emphasized
Clinician as Information Resource
Provide information in an objective manner
Suggest a website
Clinician as Coach/ Partner
Parent is in the driver’s seat
Professional is on the sidelines giving guidance
Give guidance, provide input, but don’t tell them what to do
Clinician as Joint Discoverer
Key in the partnership process
Any question can be addressed as an experiment
Ideas can be expressed as an experiment
Clinician as News commentator
Promotes partnership
Providing objective, descriptive feedback about the child’s behaviors
Clinician comments on behavior and family gives their interpretation
Help understand what is best for the child
Clinician as Partner in Play
Clinician demonstrates a new strategy/skill
Parents practice it in playful interactions with child/baby
Makes parents more comfortable with the new activity/skill
Clinician as Joint reflector and planner
Review at the end of each session
Partners list key observations and successes
3 components of HAs
Microphone
Amplifier
Reciever
What is acoustic feedback?
High pitched squealing sound emitted from aid.
Acoustic feedback can result from:
Poorly fitting earmold
Crack in tubing
Volume set too high
Excessive wax in EAC
6 styles of HAs are
Body aid Eyeglass aid BTE Receiver in canal In the canal In the ear Completely in the Canal
