exam 1 Flashcards
what is aural rehabilitation
intervention aimed at minimizing and alleviating the communication difficulties associated with hearing loss
goal of ar
to restore (or establish) a patient’s ability to communicate; alleviate the difficulties related to hearing loss and minimize its consequences
two measures of successful AR
conversational fluency
reducing hearing related disability
conversational fluency
- ease of information exchange
- smooth flow of conversation
- topics of conversation aren’t limited
reducing hearing-related disability
- a hearing-related disability is a loss of function caused by hearing loss or an inability to perform an activity
- this tem denotes a multipdimensional phenomenon and may include pain, discomfort, physical dysfuntion, emotional distress, and the inability to carry out typical activities
what does icf stand for?
international classification of functional, disability, and health
international classificataion of function, disability and health model
ICF
developed a classification system that considers the consequences of a health-related condition within the context of a patient’s environment and circumstances
- uses a biopsychosocial framework
the domains of the international classification of function, disability and health (icf)
- body structure
- body function
- activity
- participation
- environmental factors
- personal factors
(baby bunnies always prank elderly persons)
1 & 2 are impairments; 3 is limitations; 4 is restrictions; 5 & 6 are contextual factors
body structure
icf
actual anatomical part of the body that is affected
ex. 8th nerve
body function
icf
what does that structure usually do, what problem does the issue with the structure cause
ex. sensorineural hearing loss
activity
icf
anything that the person wants to do
- ex. i want to hear in background noise (or on the phone etc.)
hl causes activity limitations
activity limitation
icf
the person can’t do the activity that they want to do
- ie; can’t hear a baby cry, can’t monitor the level of their voice
(can cause participation restriction)
participaton
icf
broader scope, more specific to their life
-ex. talk with family at dinner
participation restriction
icf
they decide not to participate in a larger aspect of their life
- not having kids; quitting choir
an acitvity limitation creates a participation restriciton that removes the person from an entire area of their life
environmental factors
icf
contextual factor that can make activities and participation worse
- how society views the disability
- ex. acoustics, lighting, background noise
personal factors
icf
cognitive, age, your attitude towards your health conditions, who is your frequent communication partner (are they helpful?)
frequent communication partners, 3rd party disability
frequent communication partners
FCPs are persons with whom another often converses such as a teacher, friend, or family member
- in AR we often treat the patient and their communication partners (often have them there when fitting a hearing aid)
(can have a 3rd party disability)
third party disability
the effects of hearing loss on the frequent communication partner’s perceived quality of life
- wife keeps turning up volume on television, and husband can’t deal with it so leaves
- patient doesn’t got to parties so their partner doesn’t
components of a typical AR plan
14
- diagnosis of hearing loss/wrs
- provisions of appropriate listening device
- provision of appropriate hearing assistance technology system (hats) and assistive listening devices (alds)
- tinnitus management
- hearing protection
- auditory training
- communication strategies training
- informational/educational counseling
- personal adjustment counseling
- psychosocial support
- frequent communication partner training
- speech-language therapy
- literacy instruction
- in-service training
this is important
a typical AR plan for adults
- diagnose and quantify hearing loss
- know and understand hearing loss
- device selection (aided thresholds and speech testing)
- communication strategies (including family & friends)
- counseling about emotions with hearing loss
- auditory training
- hearing conservation and protection
all ar plans will include smart goals
what extra things does a typical ar plan for children have
(in addition to the components an adult has)
- help them understand and accept (and re-accept) hearing loss
- speech and language training
- academic achievement skills
- in-service trainings
all ar plans will include smart goals
places where ar occurs
- private slp/aud office
- nursing home
- community center
- private hearing aid center
- school
- online
- hostpital/clinic
why is AR unserved and underserved?
- shortage of professional training programs = too few speech & hearing professionals
- poor professional and public awareness
- geographical barriers - lack of access
- poor suppot and reimbursement for services (insurance doesn’t always cover it)
what is the ratio of audiologists to general population in developed countries
1: 20,000
in developing countries its 1: 6.25 million
what is evidence-based practice (EBP)
the clinical decision making that is based on a review of the scientific evidence, of benefits and costs of alternative forms of diagnosis or treatment, on clinical experience, and on patient values
follow the 5 step approach
it incorporates 3 things: practioner’s expertise, best evidence, patient values
what is the 5 step approach to evidence based practice
(EBP)
- ask a straightforward question
- find best evidence to answer the question
- critically assess evidence, decide if it applies to patient
- integrate evidence with clinical judgement and patient values
- evaluate the performance of the plan
- aka generate question
- aka find the best available evidence
- aka evaluate the evidence
- aka make a recommendation
- aka follow up
what 3 things does EBP incorporate
- practioner’s expertise
- best evidence
- patient values
purposes for speech testing
- amplification needs
- aided vs unaided to build confidence (measure benefit) in HA
- demonstrate reduced speech recognition
- illuminate environmental listening issues
- assess performance longitudinally
- auditory training needs
- assess expected benefits
pros and cons of using phonemes as stimuli units for speech testing
used to determine placement in an auditory training curriculum
advantages:
- don’t need big vocab
- specifically what problems (feature analysis) [ex. if the problem is between voiced vs unvoiced phonemes]
disadvantages:
- poor face validity (we don’t typically use just single phonemes)
pros and cons of using words as stimuli units for speech testing
used in a SRT, spondee; and WRS, typically phonetically balanced
advantages:
- higher face validity than phonemes (we use words to communicate)
- small unit – don’t need to know lingusitic structure
- easy and fast to score
disadvantages:
- not refective of real world performance
- not appropriate for limited vocabulary
- not useful for some purposes (not long enough signal for hearing aid adjustment in background noise)
(most common stimuli)
pros and cons of using sentences as stimuli units for speech testing
- used for assessing benefits from a hearing aid; test in quiet noise and in background noise
- can be easier to undertand because there are contextual cues and prosodic cues
advantages: - more benficial for some purposes (ha)
- highest face validity (real world performance)
disadvantages:
- affected by patient viables (cognition, linguistic level, vocab, familiarity with the topic)
advantages and disadvantages of live vs recorded voice
- preferable for SRT: live-voice
- for everything else recorded is preferable (but still look at patient factors)
loudness levels (mcl, ucl, dynamic range)
mcl: what you would turn the tv volume to, or the level on your headphones etc
dynamic range: difference in db between threshold and ucl (person with hearing loss will have a small dynamic range)
hyperacusis
where ucl is even lower, so the dynamic range is even smaller
3 reasons why the advent of the audiometer was important in the 1800’s
- helped to find residual hearing in those thought to be completely deaf
- helped to identify slight hl to help with articulation and lip reading
- detected loss in children thought to be ‘stupid’ or ‘inattentive’
hearing loss severity levels
normal= -10–25
mild= 26–40
moderate= 41–55
moderate/severe= 56–70
severe= 71–90
profound= 91+
Congenital v Acquired (Prelingual v Perilingual v. Postlingual)
- congenital (born with it)
- genetics (recessive trait is most common)
- connexin-26 protein (throws balance of in the inner ear, too high potassium killing hair cells) —> congenital (born deaf)
- infection in utero (CMV most common)
- TORCH
- toxoplasmosis, other (syphilus), rubella, cmv, herpes
- TORCH
- genetics (recessive trait is most common)
- acquired (was obtained after birth)
- prelingual (up to age 2)
- meningitis, progressive hl
- perilingual (2 to 5 yrs)
- during formative language years
- postlingual (after age 5) —-[will generally do better with speech and language]
- prevocational 5-17 (school years)
- early working age 18-44
- later working age 45-65
- retirement age 65+
- prelingual (up to age 2)
- medical
- meningitis
- ototoxicity
- meniere’s
- otosclerosis
- acoustic neuroma
- otitis media
WRS, SRS, SRT, SDS
(know what each acronym stands for)
- wrs: word recognition score
- srs: speech recognition score
- sds: speech discrimination score
- SRT: speech recognition threshold
what is the purpose of speech recognition testing
- amplification needs
- aided vs unaided and build confidence
- demonstarte reduced speech recognition
- illuminate environmental listening issues
- assess performance longitudinally
- auditory training needs
- assess expected benefits
the primary objectives for fitting hearing aids
- making speech audible without distortion or discomfort (fit properly so you don’t introduce anymore distortion)
- restoring a range of loudness experience
basic components of an electronic HA
- microphone: transducer, acoustic signal to electrical signal
- processor/amplifier: something happens to the sound here (louder, reduces a certain frequency, lower background noise)
- receiver (aka speaker): electrical signal to acoustic signal to put back into the ear
- power source: connects to them all (battery, or charging)
Know what each part of the HA does and which parts are transducers
- mic: converts acoustic signal to electrical signal
- transducer
- processor/ amplifier: something happens to the sound- louder, reduces certain frequencies, or background noise
- receiver (speaker): converts electrical signal to acoustic signal and sends it back into the ear
- transducer
- power source: powers all parts of the hearing aid
2 major trends of the modern HA
- miniaturization
- signal processing: takes in the signal and analyzes it and does something and them puts it back out
·Analog v Digital HAs
- analog: takes signal and turns it up or down
- digital: basically where we are at, most things are digital
- advantages of digital hearing aids
- flexibility in programming—multiple frequency bands
- would give all signals a boost with analog, but digital can boost each frequency differently
advantages of a digital HA
- reduction of feedback (sound coming out of the receiver is coming back to the mic and it is looping around)
- connectivity (to phone, mic, tv)
- compression (& expansion)
- different levels of gain at different frequencies
- so many more advantages of digital hearing aids
- wind can be a big problem and digital hearing aids can eliminate this
digital hearing aids will recognize feedback and bring it back down
what is a transducer
converts one form of energy to another (receiver and microhpone)
Directional vs Omnidirectional Microphones
- omnidirectional ——capture noise from all directions
- important for sounds in the environment (cars), hearing nature, in class hearing people from all around the room comment
- directional——take in noise from specific locations/angles
- sitting across from people, talking with one person in a noisy environment, being pushed in a wheel chair, walking alongside someone
how to calculate gain
output - input= gain
(how much louder the output is than the original sound)
what is mpo
maximum power output (means that the hearing aid will never go louder than the ucl)
compression
- a way of making soft sounds louder while keeping loud sounds at a comfortable volume
- the compression ratio is the ratio of increase in input level to increase in output level
behind the ear ha
bte
- microphone, processor, and receiver are contained in a case worn behind the ear (ie all in the same unit)
- every bte needs an ear mold or a thin tube
- sound is delivered to ear via a tube connected to an earhook
- tube may be attached to an earmold
- until 2005, only the only type
- or tube may go directly into the ear canal (open fit, bte)
- tube may be attached to an earmold
- for kids BTEs are most often prescribed: you can make a new earmold for less money, because they will grow out of them quicker
- easier to find if dropped
- note: we want to start hearing aids as soon as possible with infants (so they can have language development)
receiver in canal
ric/rite
- a wire runs from the case (holding the microphone and processor) to a small receiver placed in the ear canal
- by far the most popular
- more variability in the dome
- with the receiver in the canal the sound doesn’t have to travel through a tube to the ear
in the ear
ite
- microphone, processor, and receiver all located in a case custom made to fit the user’s ear
- range in size from full shell to invisible in the canal
- full shell are easier to handle and larger for people with arthritis etc
· In the canal (ITC)
o Completely-in-canal (CIC)
- type of in the ear
o Invisible-in-canal (IIC)
- type of in the ear: the smaller the hearing aid the less capability it has
hearing aid candidacy- factors to consider
- motivation
- degree and configuration of loss, and word recognition abilities
- impact of hearing loss
- motivational counseling
motivation (factor for ha candidacy)
- do they want a hearing aid, are they in denial
- use motivational counseling tools to determine their level of motivation and help them become more motivated
- the line: how important is it for you to improve your hearing rn? and how much do you believe in your ability to use…? (scale of 1-10)
- the box: advantages and disadvantages of continuing without HA, and of taking action and getting them
benefits of binaural amplification
- sound quality
- localization
- volume (binaural summation–6db increase)
- decreased auditory deprevation and increased stimulation
- speech understanding in noise
results of delaying amplification
- untreated hl can cause up to a sugar cube size portion of brain matter to disappear per year
- for infants and children who haven’t developed language it can be detrimental to their language acquisition
when would we choose just one over 2 ha
- one ear with good word rec that could be helped with a hearing aid and a profound loss with terrible word rec in one ear so a ha wouldn’t help
- if they are worse than 60 on word rec, look at a cochlear implant
what factors to consider when choosing hearing aid type
- degree and config of loss
- physical limitation
- cosmetic concerns
- techonology
verification
making sure the hearing aid is perfectly fit to the patient’s hearing loss
validation
more subjective than verification, use the COSI questionnaire to see if it improves what they want
real ear measurements
REMs
- determining that the aid is providing appropriate gain and won’t exceed ucl
- measurements made while aid is in ear (an apparatus goes over the ear and a microphone is picking up the sound at the eardrum, so you can tell if the output of the ha is perfectly matched with the target gain)
why do rems
- improves hearing aid benefits
- improves patient perception of clinical services
- helps reduce return visits
- maximizes speech recognition
what happens during hearing aid orientation
- audiologist describes function of all the parts of the hearing aid
- patient practices inserting and removing hearing aids and manipulating controls (make sure the patient is comfortable with all the parts of the hearing aid)
- inserting and removing the battery
- aud reviews troubleshooting techniques (ie they are getting feedback-wax)
ling 6
- to ensure understanding of speech
- make sure they can repeat those sounds without seeing your mouth
- /a u i ʃ s m/
Troubleshooting techniques for a HA not working
- wax, batteries, setting, moisture, etc
basic ha skills an slp should know
- check if HAs are working (listening check)
- trouble shooting
- putting them on a patient
- refer for programming and/or repair
- turning them on/off
- tubing changes
- change batteries
- keeping them on a patient
differences between his and aud
- HIS (hearing instrument specialist):
- pass 2-3 tests (utah)
- some states have min age 18
- some states requires 2 yrs college education (any subject)
- 2000 supervised hours
- 10 CEUs per year
- board certification available
- audiologist
- 4 yr bachelor’s degree
- 4 yr doctoral degree (master’s prior to 2007)
- one year residency (typically included in doctoral degree time period; often 2000+ hrs)
- 10 CEUs per year
- board certification ASHA and ADA memberships available
pros and cons of an audiologist
- pros:
- do cool tests (balance, electrophysiology) and bill insurance for them
- prestige (dr)
- research opportunities
- can teach at university level
- more varied career options
- cons:
- more school ($)
- takes more time
- pay is *usually about the same as HIS (if they are selling a ton of ha)
pros and cons of a his
- pros:
- not student debt
- can start earning a good salary sooner
- often gets paid during their his training period
- a lot easier than being an aud
- pay can be the same as an aud*
- 50% restocking fee
- can create new his (bunnies)
- cons:
- stuck with hearing aids only, no access to the rest of the field
- no college degree
- can’t charge for hearing tests
- can’t diagnose hearing loss
otc hearing aids pros and cons
pros
- affordability
- accessibility
- convenience
cons
- no prescription-based fitting
- no REMs
- no follow up/support
- must be tech savvy
- may prevent people from seeking the help they need
- vulnerable population groups (children or people with profound losses) may not get the help they need
PSAPs (Personal Sound Amplification Products)
- amplifies sound (like headphones that do it), some can also protect your hearing by peak clipping (headphones for hunting)
- NOT designed for hearing loss
hearing conservation program
- noise measurements
- noise control
- hearing protection
- audiometric monitoring
- education and training
- recordkeeping
- program inspection/evaluation
sound level meter
very precise: used by industrial audiologists to measure the sound levels
NRR (Noise Reduction Rating)
- average attenuation in laboratory for a group of subjects (measures hearing protection)
- best fit in the perfect conditions
- misleading: in the workplace, most people get significantly less protection
- protectors not worn perfectly
- protectors not worn during all noise exposures
Dual Hearing Protection–how to calculate NRR
- add 5db to the higher NRR protection device number
- for example if you have earplugs with an nrr of 33 and earmuffs with an nrr of 29 the total maximum protection would be 38db
Human factors that determine the best hearing protection
- the best hearing protector is the one that is:
- worn correctly (fit)
- worn consistently (wear time)
CROS/BiCROS
- cros= contralateral routing of signal (only one hear is good)
- bicros= one ear has some hearing but with a loss
How cros/bicros work/when each is used
- cros: you have a dead ear on one side and a good ear (if the ear with hearing has hearing loss then it is bicros)
- the microphone is on the side of the dead ear and sends the sound to a receiver on the other ear
- inserted by an audiologist and is a long term ha, they can wear for 4-6 months until the battery dies (then take back to aud to get replaced)
- analog hearing aid
- can sleep in it
- don’t have to take it out
- deep in canal so you get natural resonance in the pinnacons:
- cerumen can build up
- you never really own it, subscription based, pay per year (3,000/yr)
- can trap moisture in the canal and cause infection (quite common)
- can start adhering to the canal wall
osseointegration
implantable hearing device
How osseointegrated HAs work (ex. BAHA)
- bone anchored hearing aid: put a little titanium abutment in the bone (surgery), sound processor connects to it, there is also one with a magnet that is implant so it attaches magnetically (less common bc it can get knocked off easier)
- soft/hard band for kids under five and to demo the ha
When to select osseointegrated over a traditional HA
(BAHA)
- bilateral conductive loss
- insurance will pay for 1 for adults and 2 for kids
- anotia/microtia/aural atresia
- single sided deafness
- if there is a significant sensorineural loss on either side a BAHA won’t be good
Advantages of osseointegrated devices
- bone conduction usually allows the recipient to hear sounds more clearly and naturally than with conventional ha as the conductive component of their hearing loss is eliminated
- potential recipients can easily test bone conduction, so that they can experience the benefits before they have surgery
- these procedures are reversible and do not damage or harm residual hearing
- these procedures do not prelude any benefits form future hearing technological advances as they don’t compromise the middle or inner ear
- many insurance companies pay for the surgical procedure and some pay for the processor
Auditory Brainstem Implants
and differentiation from CIs
- for someone born with no cochlea or auditory nerve
- works at the cochlear nucleus level, straight to the brainstem
- not as good as ci but gives some access to sound
- cochlear implant has an electrode array that goes to the hair cells while and abi goes straight to the brainstem and is capable of less sounds
- they look similar on the outside
What provisions are included in the Technology Related Assistance Act of 1988 and the Assistive Technology Act of 1998? (5 provisions)
- evaluation needs and skills for assistive technology
- acquiring assistive tech
- selecting, designing, repairing, and fabricationg assisstive tech systems
- coorddinating services with other therapies
- training both individuals with disabilities and those working with them to use the technologies effectively
what are hats
- listening, alerting, and/or signaling devices that helps a person to communicate with their environment or increase their safety through use of auditory, visual, or tactile modalities
- brings in a different modality (not sound)
- telephone relay, lights on fire alarms, light up baby monitor, vibrating watch
- cellphone is one of the most common hats: facetime, text, speech to text app
what is an ald
emphasis put on the listening aspect of hats devices (generally are already using a ci or ha but it is not enough for the current environment)
fm, infrared, induction loop systems
FM systems (personal and sound-field)
- personal receiver on the hearing aid connects to a microphone next to someones mouth
- good for: car passengers, lecture, watching tv, at home, group tour, education
- there are receivers you can check out at venues
- uses radio waves
- they have soundfield ones that broadcast to the whole room (benefits everyone)
Infrared systems
- need a good line of sight (travels through light waves)
- watching tv and movies (not outdoors)
Induction loop systems
Why are they preferred by most HA users?
- telecoil is in the hearing aid and activated with a switch (or automatic)
- room needs an induction loop system (lots of venues have them)
- sound can go directly from the telecoil to the ha and ear (but you can adjust how much you are hearing tc vs outside sound)
- it’s good to have one in the ha just in case you want to use it
- they can automatically connect and you don’t need an extra thing for your ha (convenient)
State telecommunication requirements
o Utah website for telecommunication resources
- utah: relay utah→ providing telecommunication access for deaf, hard of hearing, and speech challenged individuals
- includes things like volume and tone control (you need to advocate for this)
- [relay.utah.gov]
Hearing with a CI v Hearing with a HA v Normal Hearing
- when you hear with a hearing aid, it is the same way that you hear with normal hearing, but the sound is amplified
- we assume that there are enough (inner) hair cells to transfer the signal (if there aren’t then the ha can’t help with speech recognition)
- when you hear with a cochlear implant it bypasses the outer and middle ear and goes straight to the cochlea and auditory nerve
Cochlear Implant Components—>External components
- microphone
- traditional- behind ear, with the processor
- also have ones where they are all by the transmitting coil
- sound processor
- by the microphone
- transmitting coil
- on the skin, transmits sound through radio waves to the internal receiver
- held in place on the head with a magnet
cochlear implant components—> internal components
- receiver-stimulator
- receives signal from external transmitting coil and sends electrical current down to the electrode array
- electrode array
- inside the cochlea
5 steps of hearing with a CI
- microphone picks up sound from the environment and converts into an electrical signal
- the processor: digitizes and analyzes sound generates a coded (electrical) signal and sends it to the transmitting coil
- the transmitting coil uses radio frequencies to send the coded signal to the internal receiver-stimulator
- the receiver-stimulator (internal processor) sends electrical pulses to the electrode array, which is located in the cochlea
- the electricacl signal travels from the cochlea, to the auditory nerve, and to the brain for interpretation
4 steps of getting a ci
- determining candidacy
- surgery
- programming or mapping the processor
- aural rehab
4 indicators that someone will do well with a CI
- age of implantation
- length of deprivation
- communication mode
- cognitive factors: learning, attention, memory
post lingually deafened adults
- usually get ~90% on open-set sentences in quiet
- they have a much harder time in noise though (about 50% correct)
- music can be very challenging too (though they could have memories of songs)
- good speech intelligibility (maybe a little more nasally)
pre-lingually deafened adults
- gain access to environmental sounds
- usually won’t understand open-set speech
- note, there’s tremendous variability among all sub groups (not everyone does this well, some do better)
pre-lingually deaf children implanted early
- mnay catch up with normal-hearing peers by kindergarten
- have high expectation for them
bimodal hearing
- one implant and one hearing aid
- better hearing: 28% avr hearing performance with 2 hearing aids and 75% with one ci and one ha
