Exam 1 Flashcards
After wearing the device for several weeks Varuka indicates voices lack clarity and she’d like to hear more soft consonants. Which adjustment will improve her concerns?
Decrease the input level of the first TK to increase the output of soft signals.
Standing waves in a thin tube change a hearing aid’s final output and frequency response by:
- Attenuating high frequency output.
- Attenuating low frequency output
- Reducing high frequency output and shifting the tubes resonance from 1k Hz to 800 Hz
- Shifting the tubes resonance from 1k Hz to 800 Hz
Reducing high frequency output and shifting the tubes resonance from 1k Hz to 800 Hz
Standing waves in an enclosed space can enhance or attenuate an output signal.
In this case, the standing waves attenuate high-frequency output, while shifting the tube resonance to the lower frequencies (it shifts from1k Hz down to around
800 Hz)
TRUE/FALSE Smaller receivers with stiffer diaphragms supply greater high-frequency output than larger receivers.
True
The Smaller the receivers the higher frequency you can produce. However the larger the receiver the more gain you will get. Or you can do dual receivers
Briefly describe TWO different ways to reduce complaints of the occlusion.
1) increased Vent
* OE can be reduces with an increased vent becuase it will help to release the trapped signals from
* and plugged, boomy, echoy from internal nosie and voise
° by giving re signals/energy some where to go and not be trapped
2) 2mm beyond second bend
* OE often occurs due to the vibrations that travel along the cartilagions portion of the canal.
* by exteding the ear mold 2mm beyond the second bend and you will be reaching the bony part of the canal= no more vibrations of cartilaginous portion because it is now on bone
Your patient is an engineer who’s bothered by the sound of her refrigerator. They downloaded an app and found the signal’s intensity is 24 dB. The first TK in the device is set to compress when the input reaches 30 dB SPL. Which features should be adiusted to reduce the complaint.
Expansion
Wide Dynamic Range Compression TK & CR
low threshold kneepoint and low compression ratio
Output Limiting Compression TK,CR
High threshold kneepoint and high compression ratio
What is DNR, Digital Noise Reduction
define, benefits & limitations
Lowers, minimizes, reduces any signal that remains steady over a long period of time. ( applied to steady state noise)
Benefits
- Improves listening Comfort
- reduces listening effort
-reduces cognitive load
Limitations
-The more Broadband noise, the greater the effect on speech
- Can attenuate some speech sounds if noise that being attenuated is also Within the same frequency range as the speech sounds
- cannot improve speech intelligibility
Describe how frequency resolution changes with SNHL. Why does reduced frequency resolution make it difficult to understand speech in noise?
- The sharp peak of the tuning curve supplies the frequency resolution needed for speech intelligibility in noise
- When the tuning cure is broad it is hitting more frequencies rather then just the one intended frequency - when Frequency resolution is decreased primary signal is no longer enhanced making it difficult to differentiate the desired signal (speech) from the undesired signal (noise) = understanding is diminished
- A decrease in frequency resolution is a decrease in a sharp tuning curve= broad tuning curve
Define temporal resolution and the auditory processes which support it.
Temporal resolution: Is the auditory systems ability to detect small time related changes in acoustic stimuli over time. This is needed to understand speech in noise.
Time Related Cues:
Gap Detection
Phonetic Duration
Temporal Ordering
Suprasegmentals
Gap Detection
Gap Detection- being able to detect the gap or break in a sound or speech. Example: beep being presented closer and closer together until you can no longer hear the break
Describe the benefits spatial hearing supplies
ILD & ITD
Interaural timing differences (ITD)
Timing is the amount of time difference that it take to reach one ear versus the other
Important frequencies: Low frequencies
Because you notice more change in the lows
Interaural level differences (ILD)
ILD is the difference of sound level (intensity) between the two ears if its localized or louder on one side (becuase it is of mass attenuation head)
Important frequencies: high frequency
Because you notice more change in the
Interaural timing differences (ITD)
Timing is the amount of time difference that it take to reach one ear versus the other
Important frequencies: Low frequencies
Because you notice more change in the lows
Interaural level differences (ILD)
ILD is the difference of sound level (intensity) between the two ears if its localized or louder on one side (becuase it is of mass attenuation head)
Important frequencies: high frequency
Because you notice more change in the
Which frequencies supply the most information on interaural level differences?
Important frequencies: high frequency
Which frequencies supply the most information on interaural Timing differences?
Important frequencies: low frequency
How are receivers designed differently to achieve the greatest high frequency output for severe hearing losses
The Smaller the receivers the higher frequency you can produce. However the larger the receiver the more gain you will get. Or you can do dual receivers
Solution: Two receiver system
- Two receivers in one HA
- One with a Stiff Armutre
-Optimized for high frequencies
-One with a Flexible Armature
-Optimized for low frequencies
-Signals combine before final output
-Benefit high frequency bandwidth
-Reduced battery drain
Minimizes saturation duration
Describe 3 methods used to reduce external feedback
-Increase snugness of mold to reduce size of slit leaks & Decrease vent size to stop feedback path
-Digital notch filtering
-Digital feedback cancellation – the best option
Digital notch filtering
what is it, what is it used for and cons?
- reduces external feedback
- Works by removing a narrow band of frequencies around the feedback
- Creates a notch in frequencies so we can not amplify to those frequencies
Potential Con:
-Stops the audibility of important speech sound- reduced speech intelligibility
Digital feedback cancellation
- reduces external feedback
-When a feedback path is detected, the phase cancellation algorithm mimics the feedback and creates a clone of this signal. Within the hearing aid, this clone is subtracted from the amplification path, therefore breaking the loop.
Cons:
Entrainment - environment sound mimics feedback makes clone; patient can hear clone.
Con: not all HA companies have accurate/good Digital Feedback cancellation
Increase snugness of mold to reduce size of slit leaks & Decrease vent size to stop feedback path
- reduces external feedback
- Essentially the same thing – decrease the vent size increases the snugness
Count as one on exam
Con:
-Occlusion Effect
What is Entrainment?
- Occurs during digital Feedback cancellation
- environmental sound mimics feedback, makes a clone; patient can hear clone
what is frequency lowering and name three types of FL
- frequency lowering attempts to improve high frequency audibility by shifting them to lower frequency
- Linear frequency transportation
- non-linear frequency compression
- Spectral envelope warping
Linear frequency transportation
Type of frequency lowering
- Moves a high frequency band one octave down to a lower frequency region
- the moved frequency components are mixed with any low frequencies present
non-linear frequency compression
Type of frequency lowering
- High frequencies are compressed into a lower frequency range
Spectral envelope warping
Type of frequency lowering
- Copy and keep approach
- High frequency signals are transported to a lower frequency band but simultaneously remains present in its original tonotopic position
Describe how inclusion of a case history review of systems assists clinical decision-making
IDENTIFYING COMORBIDITIES LEADS TO IMPROVED TREATMENT OUTCOMES
- Helps us to anticipate progression of loss
-Identification of comorbidities leads to improved treatment outcomes.
-Its best practices, you are able to distinguish yourself from hearing dispensers and other audiologist
-You will have better outcomes for OTC
Create a list of comorbidities linked to hearing loss. Highlight the most common comorbidities prevalent in older populations
Visual Impairment and Reduced manual dexterity
Cognitive Issues
Depression
Falls
Hypertension & Diabetes
What are some Systemic chronic health conditions linked to Progressive HL?
Gastrointestinal: Crohn’s disease
Musculoskeletal: Rheumatoid arthritis, Fibromyalgia
Respiratory: Asthma
Cardiac: Congenital heart disease
Lymphatic: autoimmune disorders
Hematology: anemia, Leukemia
Integumentary: Shingles, Herpes zoster, Ramsay Hunt syndrome
Nervous system: Parkinson’s disease
Explain this statement- “The audiogram is not and indicator of the degree of communication deficit”
Audiograms are NOT predictors of communication difficulties
Puretone threshold loss is:
-A good indicator of overall degree of functional impairment
-A moderate indicator of “activity limitation”
-A poor indicator of “participation restriction”
Describe all the factors which limit an audiologist’s ability to use word recognition scores to predict communication difficulties.
- Lack of adherence to standard protocols leads to inaccurate diagnostic interpretation.
- Presentation Level
- Lack of audibility will always result in a lower PB word recognition score even with HA
Describe test techniques offering a more realistic assessment method of speech understanding for improved identification of patient concerns.
- Add binaural speech assessments to your test battery
- Use sentence-based test stimuli
-Because PB words only predicts speech intelligibility without contextual; cues. - Assess performance with and without visual cues
- Assess speech intelligibility in the soundfield at 50-60 db HL to stimulate normal conversational speech level
Name the ICF Classification
Functional Limitation, Activity limitations & participation restriction.
WHO ICF Classifications- explain the meanings of the term’s
- functional limitations; Diagnosis, problem in body function or structure
- activity limitations; degree of impact; difficulties experienced when executing a task or action
- participation restrictions; refers to involvement in activities an individual would like to participate in but doesn’t due to activity limitations
Functional Limitation
functional limitations; Diagnosis
-A functional limitation is a problem in body function or structure
- i.e., moderate sensorineural hearing loss
Activity limitations
activity limitations; degree of impact;
-An activity limitation relates to the difficulties experienced when executing a task or action
i.e., poor frequency and temporal resolution reduces intelligibility in noise
Participation restriction.
participation restrictions; patients choices, are they involved in the activities they want to do instead of isolation.
-Only a participation restriction when they are not doing something they enjoy solely due to their activity limitation.
Ex: they love going to bars but haven’t gone because they are afraid they wone be able to communicate= a participation restriction.
Create a list of common activity limitations
common activity limitations;
Detection of sounds
Distinction (discrimination) of sounds
i.e., frequency resolution
Intelligibility in quiet
Intelligibility in noise
Auditory localization
Temporal resolution abilities
Spatial hearing abilities
Explain the ICF “backward synergy” concept
Backwards synergy is treatment resulting in increased participation supplies communication practice & experiences which may result in neural changes to improve activity limitations
- Increased participation results in improved auditory processing
- Increased participation results in improved lip-reading skills
- Increased participation results in improved auditory closure skills
Name Body structure & function, Activity limitation, Participation restriction for Ossicular chain stiffens reducing mobility
Otosclerosis;
AL: Difficulty hearing low frequency of soft signals, Speaks softer, Difficulty understanding in noise
PR: Keeps TV volume too loud, Avoids conversations because people say they mumble, fired from job due to misunderstanding coworkers in open workspace
Otosclerosis Function, Activity limitation and Participation Restrictions.
Ossicular Chain stiffens reducing mobility
AL: difficulty hearing LF or soft signals, Speaks softer, difficulty understanding in noise
PR: Keeps TV volume too Loud, avoids conversations because people say they mumble, fired from job due to misunderstanding coworkers in open workspace
Name Body structure & function, Activity limitation, Participation restriction for OHC damage in high frequencies of cochlea.
OHC damage, SNHL
AL: Difficulty hearing constants sounds, delayed response to high frequency warning sounds, difficulty hearing in noise.
PR: Misunderstanding many communications family thinks they don’t pay attention, stopped driving due to safety concerns, avoids gatherings with friends, isolates self
OHC damage, SNHL Function, Activity limitation and Participation Restrictions.
OHC damage in high frequencies of cochlea.
AL: Difficulty hearing constants sounds, delayed response to high frequency warning sounds, difficulty hearing in noise.
PR: Misunderstanding many communications family thinks they don’t pay attention, stopped driving due to safety concerns, avoids gatherings with friends, isolates self
Name Body structure & function, Activity limitation, Participation restriction for cochlea cannot effectively transmit signal though nervous system
Auditory processing disorder
AL: Hearing loss fluctuates, difficulty distinguishing sounds and rapid speech
PR: Cannot follow conversations easily aggressively insists others to repeats, drop out of school because it was too diffculty
Auditory processing disorder; Function, Activity limitation and Participation Restrictions.
Cochlea cannot effectively transmit signal through nervous system
AL: Hearing loss fluctuates, difficulty distinguishing sounds and rapid speech
PR: Cannot follow conversations easily aggressively insists others to repeats, drop out of school because it was too diffculty
What information does the speech intelligibility index (SII) supply?
Speech Intelligibility Index (SII)
Calculates the percentage of speech information that is audible and usable to the listener
- SII of 0.50 means 50% of speech cues supporting intelligibility are audible in a quiet setting
What SII percentage is needed for 96% audibility of digits? Of IEEE sentences? Of NU6 words?
Digits- 15 SII
IEEE Sentence- 50 SII
NU6- 90SII
Be prepared to interpret and use the objective data based on the SII graph reviewed in this presentation during counseling.
Define, read graph and clinical uses
SII Calculates the percentage of speech information that is audible and usable to the listener
It is used for…..
- Reduces counseling mismatch b/w Audiologist and patient, instead of:
- Helps audiologists determine amplification candidacy:
- SII scores show objective audibility improvements with amplification
- Aided SII comparisons allows you to see if one style, or brand of device supplies more audibility
Describe all the clinical uses for SII
- Reduces counseling mismatch b/w Audiologist and patient, instead of:
- Helps audiologists determine amplification candidacy:
- SII scores show objective audibility improvements with amplification
- Aided SII comparisons allows you to see if one style, or brand of device supplies more audibility.
LDL; Knowledge of rationale, test protocol, scoring method
LDL
Rationale;
- Individual tolerance levels vary significantly despite similar threshold loss.
- LDL measurement is needed to ensure amplified output doesn’t exceed the individual’s loudness tolerance
- Dynamic Range
- Help to make sure to monitor your MPO settings are below your LDL
- Data is used to program output and verify OSPL90/MPO limits of the device
test protocol;
- Allow patients to refer to “Loudness Categories” during the test
- Signal: pulsed pure-tone
- Present pure tone signal at MCL
- Ascend in 5 dB steps allowing the patient time to rank loudness after each presentation
- Stop ascending when patient indicates sound reached #7 “uncomfortably loud”
- Reduce signal intensity to MCL and repeat 2 to 3 trials to establish P-T LDL
Assessment Protocols:
- Always measure LDL at 2k & 3k Hz
-Skip measurement for any frequency with normal sensitivity.
- Are the LF threshold > 40 dB HL? Then test 500 Hz
- Is there a precipitous inter-octave change (>20 dB) ? Then test the inter-octave transition frequency
- Does the device supply output in an extended frequency range? Then assess frequencies above 3k Hz
LDL Assessment protocols
Assessment Protocols:
- Always measure LDL at 2k & 3k Hz
- align w/ ear canal resonant peaks
-Skip measurement for any frequency with normal sensitivity.
- Are the LF threshold > 40 dB HL? Then test 500 Hz
- Is there a precipitous inter-octave change (>20 dB) ? Then test the inter-octave transition frequency
- Does the device supply output in an extended frequency range? Then assess frequencies above 3k Hz
LDL; Knowledge of rationale
LDL
Rationale;
- Individual tolerance levels vary significantly despite similar threshold loss.
- LDL measurement is needed to ensure amplified output doesn’t exceed the individual’s loudness tolerance
- Dynamic Range
- Help to make sure to monitor your MPO settings are below your LDL
- Data is used to program output and verify OSPL90/MPO limits of the device
QuickSIN; Knowledge of rationale
QuickSIN Knowledge of rationale
- Speech intelligibility in noise remains the #1 improvement patients seek with hearing aids
- Quantifying the degree of signal to noise ratio loss allows you to select appropriate technological options and validate the selection provided improvement.
- improved hearing in noise is needed if we want to improve satisfaction with amplification.
QuickSIN; test protocol
-Presentation level is calculated based on PTA
- if PTA is below 45 db present word lists at 70db HL
- PTA is above 45db present at “loud but OK”
-Present one practice list
- proceed with 3 test lists for each test condition and each ear
- SNR loss scoring. add each word list score and divide by the number of lists presented to one ear (3)
QuickSIN; scoring method
- Each list has 6 sentences
- 5 key words in each sentence cross out incorrect
- subtract 1 for each incorrect word
- add correct up and subtract by 25.5 = SNR loss
- SNR loss + 3 other / divide by total = Quick SIN, SNR loss
QuickSIN; clinical use
Results supply quantifiable data:
- Supporting use of evidence-based recommendations for technology for improved hearing in noise
- Increases clinical efficiency by reducing unnecessary office visits
- Technology recommendations based on QuickSIN score
QuickSIN Score/recommendations
(technology recommendations)
0-2 db Normal Omni directional or benefit with directional microphones.
2-7db Mild ; recommend standard directional mics
7-15 db Moderate; require beam forming mics, in addition to standard directional mic
>15 db Severe; requires remote mic, + above recommendations
Define SNR-50
SNR-50 is the signal to noise ratio that allows an individual to understand 50% of the test signal.
What is a normal SNR-50?
Normal SNR-50 =+2db SNR - 50
SNR 50 above +2db is SNR loss
SNR Loss
SNR loss is when a patients SNR 50 is greater than 2db they have an SNR LOSS (2db is normal)
-SNR loss is calculated by subtracting 2 from the SNR 50 score.
-If a patient has an SNR -50 at +8db you subtract 2db (norm) from 8 equaling 6db for this patients SNR loss.
SNR-50= +8db, 8-2=6 =6 db SNR loss
BINAURAL INTERFERENCE ASSESSMENT Knowledge of rationale,
The addition of binaural QuickSIN measurements quickly identifies potential binaural interference.
BINAURAL INTERFERENCE ASSESSMENT test protocol
- You would begin presenting and scoring monaural (single ear) QuickSIN.
- Then you will conduct Binaural QuickSIN (Both ears at once) and score.
- Finally you would compare the monaural to the binaural results.
- If the binaural quick sin degrades, this is a red flag for binaural interference.
BINAURAL INTERFERENCE ASSESSMENT scoring method
- You will compare monaural and binaural results
- If the binaural quickSIN degrades, this is a red flag for binaural interference.
- (If they are equal this is not red flag)
BINAURAL INTERFERENCE ASSESSMENT clinical use
-The addition of binaural QuickSIN measurements quickly identifies potential binaural interference.
How common is BINAURAL INTERFERENCE
About 1 in 6 people (16.7% of listeners)
ANL Knowledge of rationale,
Quantifies a listener’s willingness to listen to speech in the presence of background noise.
ANL Test protocol
Presentation:
-Binaurally through soundfield speakers
-Patient positioned at 0° azimuth
-Speech & noise are mixed within the same transducer (speaker)
-Audiometer
-Requires test tone calibration of both audiometer channels
-Calibration tone on track 2
-Both channels are routed to same transducer (speaker)
-Channel 1- presents the speech signal
-Channel 2- presents the competing noise
Temporal Ordering
Suprasegmentals
ANL scoring method
- Scoring: MCL value – BNL value = ANL score
- Low ANL score (difference < 7 dB)
-Indicates the patient ACCEPTS a lot of noise background noise w/o issues
-This patient is likely to wear hearing aids on a regular basis - High ANL score (difference > 13 dB)
-Indicates the patient LACKS TOLERANCE for background noise
This patient is less likely to wear hearing aids regularly - ANL scores b/w 8-12 dB are equivocal
-May require extra post-fitting counselling or adjustment period
ANL Clinical use
- Predictive of hearing aid satisfaction with 85% accuracy
- Identifies those who will have more difficulty adapting to amplification
Phonetic Duration
Phonetic Duration- similar words are distinguished from one another by difference in duration.
Temporal Ordering
Temporal Ordering- Is the idea that we can retain the order in which the words or sounds are coming in or are they getting mixed up? Ex: Boost or Boots.
Suprasegmentals
Suprasegmentals- Patterns of stress, intonation, and rhythm. How you know if what your saying is a statement or question, the breaks at the end of a sentence or word and the flow of speech.
