Aural Rehab exam 2 Flashcards
Prefitting Testing includes
Estimate of hearing from Auditory brain response (ABR)
Auditory steady-state response (ASSR)
Audiologic Testing is ongoing
Estimate LDL based on thresholds
Fit with hearing aids that have wide fitting range
What are fitting considerations for the pediatric patient:
- Choose BTE over custom products
- Hearing aids should have direct audio input (DAI) and telecoils for use with FM systems
- Prescriptive methods - Desired sensational level (DSL) for children and NAL for adults
- Binaural amplification
Most reliable method for verification?
Probe microphone
Why is the probe microphone the most reliable tool for verification?
Assists audiologists in making sure the child has appropriate amount of gain for soft and average speech and that loud sounds are loud but not uncomfortable.
Post fitting procedures
- parental counseling orientation and expectation
- follow-up visits more frequent for children
- monitor hearing to determine need for adjustment of hearing aids.
- monitor earmold fit-replace earmolds once a year
How often should earmolds be replaced?
once a year
How often should hearing aids and hearing be checked?
at least once a year
Troubleshooting hearing aids, why is it important?
To maximize the patient’s hearing especially if they are in treatment.
Hearing aid troubleshooting guide includes:
- visual inspection of hearing aid while individual is wearing it
- inspection of hearing aid tubing, earmold, and battery after removal
- listening check of hearing aid with listening tube or stethescope
Cause of feedback:
- earmold or hearing aid not positioned properly in ear, sticking out
- earmold tubing is torn or there is a hole in tubing
- cerumen impaction (in external auditory canal)
- volume turned up full on
Causes of no sound from hearing aid when turned on:
-hearing aid is dead
-battery is dead
-no battery
earmold or wax guard clogged with wax
Reasons hearing aid would need to be sent in for repair:
- intermittency
- distortion
- dead hearing aid
What does it mean to have an internal problem of the hearing aid?
-microphone
-receiver
amplifier
What is the primary application for FM systems?
For children in the classroom (however adults are also able to take advantage of the FM systems)
What are the four regular classroom acoustics like?
-children talking, coughing
-squeaky chairs
fan motors cycling on and off
-feet shuffling
What do the regular classroom acoustics mean for a hearing-impaired child wearing personal hearing aids?
- personal hearing aids amplify background noise
- Affecting speech perception (speech intelligibility)
- The further the hearing impaired child is from the teacher the softer the speech signal becomes
- lost opportunities for learning through the auditory channel.
What are the 3 basic conditions that negatively affect all aspects of listening for a hearing-impaired child who wears conventional hearing aids?
- Background noise
- distance from the speaker/teacher
- reverberation
____ __ ______ ratio is an important factor- it is defined as the relationship of the intensity of the signal of interest to that of background noise
signal to noise
The ____ the sound to noise ratio is the worse the listening condition
poorer
An example of sound to noise ratio: +10 dB S/N ration mean:
speech is 10 dB greater than the noise
-10 dB S/N ratio means:
noise is 10 dB greater than speech
+0 dB S/N ratio means:
speech and noise are at the same intensity level
Normal hearing children can cope with a ____ S/N ratio
+5dB
Hearing impaired children with hearing aids require a ____ to ____ dB S/N ratio
+15
20
In order for a teacher to achieve a +20 dB S/N ratio she would have to maintain a distance of ___ inches from the child’s______ and ______
9
hearing, microphone
As distance _____ between the teacher/speaker and the hearing impaired child, there is a _______ in the intensity of the teacher’s voice making it more difficult for the child to hear and understand speech.
increases, decrease
_______ ________ may help to avoid increasing the distance from the speaker/teacher
preferential seating
- echo affect of sounds reflecting off hard walls
- effects intelligibility of speech
- architects now taking this into consideration when building new schools
reverberation
What advantages does the Fm system provide:
- achieve an optimal s/n ratio without having the teacher 9 inches from the microphone
- the distance between the teacher and child remains constant
- eliminates problem with room reverberation
Wireless system (no connection between the speaker and listener)
FM system
FM
Frequency modulated
Federal Communications Commission (FCC) has authorized use of _______ MHz bandwidth also known as auditory assistance band primarily used for assisting hearing-impaired persons in their communication needs.
72-76
How does the FM system work?
- FM signal transmits sound via a radio frequency carrier wave at distance of 50 to 150 feet depending on the system. Must have a transmitter and receiver
- sound enters the microphone and acoustical energy is converted into an electrical signal and sent to the transmitter.
- signal is then sent through a frequency modulated carrier wave to the FM receiver where it is amplified
- FM receiver demodulates the signal changing it back to acoustical signal and delivers it to the listener’s ears. Excellent sound quality
What are the basic components of the FM System
- transmitter/microphone
- receiver
- methods of sound pickup from FM receiver
FM component that is worn by the speaker/teacher on the body clipped to a belt or hanging by cord
transmitter
component of FM system that is connected to the transmitter, plugged into mic/ant jack placed about 4-6 inches below the child
microphone
component of FM system worn by listener or child
receiver
Methods of sound pickup from FM receiver-ways to configure:
- FM receiver is attached to a personal hearing aids
- FM receiver is built into the hearing aid (phonak link)
- FM receiver is used with earbuds
- FM receiver is used with a neckloop and personal ITE or BTE
- FM receiver is used with a DAI cord and audio shoe connected to their personal BTE
- FM receiver is worn with a BTE microphone
What are the three settings the receiver has?
- FM
- FM/HA
- HA
FM
hear only the teacher/speaker voice
FM/HA
hear the teacher and environmental sounds
HA
hear environmental sounds
Jack connects to DVD player or TV and located on receiver and transmitter. charge unit here
auxiliary
FM system placed in over night for re-charging nickel hydride batteries
charger
What are advantages of the FM system?
- Wireless transmission
- high-quality signal that provides access to intelligible speech
- flexible system
- choose from several types of receivers
- can be used indoors and outdoors
- no electromagnetic interference
- receiver does not have to be in line with the transmitter
- can be used in adjacent rooms without interference
- portable
What are the disadvantages of an FM system?
- 72-76MHz is allotted frequency band that has the potential of outside interference from fire call boxes and paging systems as well as radio stations
- it two transmitters are on the same frequency and are used in close proximity, there is potential for interference
- expensive and need care and maintenance, rechargeable batteries, repair costs are relatively high.
What are the populations that can be served by FM systems?
- minimal hearing loss
- mild hearing loss
- unilateral hearing loss
- auditory processing disorder-difficulty understanding speech in presence of background noise
- phonological disorders
Easy listener by phonic ear:
low gain, low output, wireless transmitter and reciever
microear by phonak
low gain, low output, wireless BTE receiver. same population as other FM systems. requires a transmitter: cannot change frequency
isense by phonak
behind the ear, also low gain receiver
ARC by phonak
low gain, low output, wireless receiver
The soundfield system is used for an individual or group?
group use
What population does the soundfield system use?
same as easy listener
What kind of system does the soudnfield system use?
Front row
What are the advantages of the soundfield system?
same as with other FM system but in this case the whole classroom benefits from the system
+10 dB signal to noise ratio-held constant regardless of where the teacher stands
What are the disadvantages of the soundfield system?
- not portable
- not strong enough to provide enough benefit for a child with severe or profound HL
- poor acoustics of the room may create reverberation
- teacher must be receptive to its use otherwise benefit is diminished
- wireless but not based on FM techonology
The induction loop system eliminates ________
reverberation
The induction loop system is ________ but not based on _____ technology
wireless, FM
What are the basic components of the induction loop system?
- microphone
- amplifier
- wire
- hearing aid-set to “T” and receives the signal
The microphone from the induction loop system is connected to an_____
amplifier
The amplifier from the induction loop system is connected to a ______ _______ that makes the signal ______
wire loop
louder
The induction loop system consists of a wire that loops around the _____ or _____ _____
room
listening area
How does the induction loop system work?
- electric current is amplified and passes through a loop of wire, and electromagnetic field is created around the wire.
- listener receives the signal via use of telecoil in the hearing aid. (needs to be sitting by the wire in a room)
What areas utilize induction loop systems?
- large areas
- conference rooms
- auditorium
- classrooms
What are the advantages of the induction loop system?
- Doesn’t require hardwired connection to listener
- inexpensive
- works with an individual’s hearing aid telecoil
What are the disadvantages of the iduction loop system?
- must stay in close proximity of wire loop
- interference from electrical source such as fluorescent lighting, 60Hz hum.
- not portable
Where are infrared (wireless) systems used?
group or large area applications: movie theaters, lecture halls, places of worship, courtrooms, majestic theater
The receiver in infrared (wireless) systems can be worn by _____ or _____ more individuals.
one
more
Method by which audio signal is transmitted by infrared light through a ________ ________ carrier light frequency _____ kHz.
frequency modulated
95
Parts of the infrared system include:
transmitter
receiver
How does the transmitter in the infrared (wireless) system work?
sends the signal thru frequency modulated infrared light to one or more receivers.
How does the receiver in the infrared (wireless) system work?
has one photodiode. Photodiode has a convex lens has a black filter/optical filter that is transparent only to IR light (prevents regular light from hitting photodiode)
What is one of the hardest listening conditions?
TV
What are the advantages of the infrared (wireless) system?
- wireless transmission
- can be used simultaneously in adjacent rooms without interference.
- inexpensive
what are the disadvantages of the infrared (wireless) system?
- have to be in direct line of sight
- doesn’t function outdoors in direct sunlight
- person confined to a specific seating area for listening
- portability - IR transmitters can’t be powered by batteries, have high power needs….plug into wall outlet
Infrared (wired) system device is a direct connection between speaker and listener that can be used in:
nursing homes with adults or children with minial, mild, or unilateral hearing loss, and those with APD.
Television amplification devices designed to improve speech intelligibility for hearing loss up to _________ - _________
moderately-severe
What is the most common television amplification device?
infrared technology
What are other types of assistive devices used for television amplification?
- direct wired connection
- induction loop-audio loop
- FM
- Bluetooth
______ ______ benefits those who cannot benefit from TV amplified listening devices. all televisions size 13 inches or greater must have _______ _______
closed captioning
what are the assitive devices for the telephone?
- amplified telephones
- seperate amplifier to connect to telephone
- captel
- hearing aid telecoil
- auto telecoil
You can control the ______ and _______ with the devices that amplifies telephone
volume
tone
CapTel is a _______ ________
captioned telephone that an operator works
The hearing Aid Telecoild is used to hear on phone without ________
feedback
Automatic telecoul sensor that detect the telephone and turn on the auto t coil _____ that detects the telephone and turns on
sensor
Assistive devices for cellphones:
- volume controls. neckloops also available
- T-coil
- M3 and M4 rating indicate hearing aid compatible
- Bluetooth used with cell phones.
- texting
How does a telecommunication device for the deaf (TDD) work?
It’s part of a Texas relay system in which the TDD user sends a message to a central relay operator, who then calls the landline user with the message, the operator then types a message to the person with a hearing impairment.
What population used the telecommunication device for the deaf?
severe-profound hearing loss population
people with normal hearing
Alerting/signaling devices allows hard of hearing and deaf individuals the same ability as normal hearing individuals to become aware of ______ in their _______
signals, environment
What are the three alerting/signaling devices?
- vibratory: alarm clocks (wake shake)
- visual: flashing lights can be connected to doorbell, telephone ringing, smoke alarms, alarm clocks
- auditory: very loud smoke alarms (90dB), doorbells that ring louder and at lower frequency, alarm clocks ring louder (sonic boom)
A cochlear is not a _______ _____
hearing aid
A cochlear implant does not restore _______ to _______ .
hearing
normal
cochlear implant destroys all _____ _____
hair cells
What is a cochlear implant?
An electronic devices that is designed to stimulate the auditory nerve to provide sound information for adults and children with severe to profound sensorineural hearing loss bilaterally who demonstrate little or not benefit using traditional hearing aids.
how is the cochlear implant surgically implanted?
an incision is made behind the ear on the mastoid and the surgeon drills through it. The receiver is placed under the skin and electrodes are inserted through the scala tympani via the round window to a distance of about 30 mm.
auditory nerve fibers are at the base of the _____ _____
hair cells
What are the five basic components of the cochlear implant?
- microphone
- speech processor
- external transmitter coil
- the receiver
- electrodes
who performs the cochlear implant surgery?
otologyst
how does the cochlear implant work?
- The microphone picks up the acoustical signal and changes it into an electrical signal
- the signal is sent to the speech processor which codes the information using a specific strategy.
- The information is then sent to the external transmitter coil. The transmitter coil send the information through the skin via Fm signal to the receiver.
- The receiver then sends the signal to the implanted electrodes.
- The electrical stimulation of the remaining auditory nerve fiber occurs. the auditory nerve then sends the information to the brain where it is perceived as sound.
Pre-operative considerations of the surgeon:
either otologist or neurologist provides medical evaluation and surgery
Pre-operative considerations of the audiologist:
evaluation of hearing abilities and hearing aid use general counseling about cochlear implants, fitting and programming the device, follow-up
Pre-operative considerations from speech language pathologist
evaluation of speech and language provides therapy or training to help patients learns to use hte device to the fullest extent possible
Pre-operative considerations from educators/teachers of the hearing impaired
evaluation of educational setting or rehabilitation needs. may provide therapy or training
pre-operative considerations from psychologist:
evaluates psychological status if necessary provides counseling to assist patients in adjusting to the hearing world, if necessary
What qualifies a child to be a candidate for cochlear implants?
- hearing loss greater than or equal to 90dB
- the child has had a consistent use of amplification during a 6-month trial while receiving auditory training
- lack of progress in the development of auditory skills over a 3-6 month period.
- children older than 5 years must also score a 20% less on sentence recognition tests under the best aided conditions
- no medical contraindications
- high motivation and appropriate expectations (child and family)
- placement in an educational program that emphasizes development of auditory skills after the implant has been fitted.
What are the different companies that implant a cochlear and what are the age groups?
- Cochlear corporation: 12-18 months (remote controls to access programs for noise reduction, volume control and check function of speech processor, autophone.
- advanced bionics corporation: 18 mo-18 years
- med-el: 18 months-18 yrs
what qualifies an adult to be a candidate for cochlear implants?
- amount of hearing loss += 70dB
- has tried hearing aids for 3-6 months and receive little or no benefit from hearing aids
- score 50% or less on sentence recognition tests in the ear to be implanted under the best aided condition
- no medical contraindications
- high motivation and desire to be a part of the hearing world
- appropriate expectations
What is the cost of the cochlear implant surgery and how long does it last?
40-60 K
1.5 hrs
What are the risks of a cochlear implant surgery to the ear?
- infection of the surgical flap
- numbness or stiffness aroudn the ear
- injury to the facial nerve inlcluding taste disturbance
- dizziness
- increased tinnitus
- neck pain
If a person with a cochlear implant is in need of an MRI what can the Cochlear corporation do?
can surgically remove receiver (magnet)
If a person is in need of an MRI what can advanced bionics do
can surgically remove receiver (magnet)
If a person is in need of an MRI what will Med El do?
no need to remove the receiver (magnet)
Parents can petition for cochlear implants prior to 12 months if they have a case for the ______ ______
cochlear ossifying
Speech coding strategy
techniques that the speech processor uses to translate pitch, loudness and timing of sound into electrical impulses that implant sends to the cochlea
________ deafened adults with a shorter duration of deafness tend to achieve the highest speech perception scores. They may be able to understand speech very well and communicate on the telephone as well as in other difficult hearing environments. Voice control-pitch, intonation, stress
postlingually
People with cochlear implants also have a reduced sense of _______, increased sense of _____ and _____.
isolation
safety
confidence
people with a cochlear implant are more _____
active
adults with _______, long term deafness that receive a cochlear implant typically do not develop ______ ______ word recognition abilities, although they do recognize environmental sounds and may develop enhanced __________ abilities.
prelingual
open-set
speechreading
Children generally demonstrate significant improvement in ______ _____ word recognition but obtain limited ____ ___ word recogniziton abilities.
closet-set
open-set
Unlike adults, children’s speech perception abilities improve with ________ and _______ with the device.
maturation
experience
Congenitally or prelingually deafened children appear to experience the greatest benefit when they are implanted prior to age _____.
2
What is a bimodal hearing?
when there is a hearing aid in one ear and a cochlear implant in the other ear.
Bimodal hearing can provide patients with prosody information including:
rhythm
stress
intonation
What is MAP?
a cochlear implant program that encodes the acoustic signal and translates it into electrical stimulation levels based on the measured T and C levels
c level
level of current that is comfortably loud that can be heard for a long period of time
T level
minimum stimulation level is the softest electrical current that produces an auditory sensation by the patient 100% of the time
How often are children seen after the cochlear implant?
once a week for the first 2 months. Then at 3, 6, 9 months, and every 6 months after that.
How often are adults seen after the cochlear implant?
once a week for the first two months, then at 3, 6 months and once a year.
When adults have bilateral cochlear implants they show ______ in _______ ability and ability to understand _____ in noise.
improvement
localization
speech
is implantation in unilateral hearing loss allowed?
No, it does not meet FDA criteria
Why do children have less of a benefit with bilateral cochlear implants?
because localization comes with maturation over time.
What treatment plan is recommended for adults with cochlear implants?
speechreading training is recommended before and after implantation.
ex. learning to hear again: trains to learn communication strategies
Cochlear implantation has a cd rom called sound and way which contains:
self paced modules to improve understanding of vowels consonants sentences
What is the rehabilitation manual designed for?
tests are used to determine entry point in treatment
What is recommended for children as treatment?
discrete skill training
What is an example of discrete skill training for children?
Erber’s Hierarchy of auditory skills
- Detection- awareness of sound
- discrimination- perception of same or different
- identification - labeling or naming what has been heard
- comprehension- understanding the meaning of an auditory message
DASL
developmental approach to successful listening: hierarchical
Auditory verbal therapy is a language that integrates auditory learning experiences that integrates _______ learning experiences into activities that target _______ development and ______.
auditory
language
communication
How does the Deaf community define deafness?
Deafness with a capital “D”
Deafness community states that Deafness is a _____ not a _____
culture
handicap
Deaf activist resent those trying to _____ a Deaf child
fix
Deaf activist liken CI to Deaf ______
holocaust
Position of the National Association of Deaf position?
Recognize the rights of parents to make the informed decision and respects the decisions and support the development of language and literacy skills
What can be done by doctors and audiologist
-provide parents of Deaf children with the chance to explore all options in a non-biased manner so they can make informed decisions
.-involves receiving information about cochlear implants as well as the deaf culture with the option of using sign language.
-respecting the decision made by parents for the individual.
