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AMP II > Exam 1 Part 1 > Flashcards

Exam 1 Part 1 Flashcards

1
Q

Describe how frequency resolution changes with SNHL. Why does reduced frequency resolution make it difficult to understand speech in noise?

A

Auditory filters (critical bandwidth) must be intact to efficiently process complex signals the cochlea needs
The cochlea analyzes signals using a bank of overlapping band-pass filters
These filters allow regions of the cochlea to “pay attention” to a specific frequency region while ignoring frequencies outside of the band
In normal hearing, sharp tuning curves allow for precise frequency discrimination & perception of sounds
w/ HL, the curve is broader and noise can easily affect perception of the desired signal
Noise energy peaks around 250 Hz but upward spread of masking impacts audibility up to about 1500 Hz

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2
Q

can amplification fix frequency resolution changes?

A

no
PT will face this problem and make them aware of this - do not give the impression that premium amp can make it all better
If you do not have a sharp tuning curve, the signal gets masked making it difficult to hear in noise

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3
Q

Define temporal resolution and the auditory processes which support it.

A

The ability of the auditory system to detect time related changes in the acoustic stimuli over time
Needed in order to understand speech in noise

Time related Cues

Phonemic duration - can vs cant

Gap detection - soon vs spoon
Can we hear the small brief pauses between words, syllables etc.

Temporal ordering (boots; boost)

Suprasegmentals
Provides us with meaning (is it a question, a demand, etc.)

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4
Q

If there is a temporal resolution hearing problem, can a standard hearing aid fix this? What is a non amplification method to improve understanding with temporal issues

A

It will not fix it
Talk slower, enunciate
Just as effective as amplification can be
If we cannot hear and distinguish timing differences, makes it hard to untangle speech in the sea of noise and makes the issue PT have with hearing in noise more prevalent

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5
Q

what cues allow us to localize where sound is coming from

A

ILD
ITD

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6
Q

Describe the benefits spatial hearing supplies

A

Spatial hearing allows us to
Determine location of a sound source
Unmask sounds otherwise masked by noise
Brain combines and analyzes info arriving from both ears for improved signal detection & identification of speech in noise
Shift our attention and focus on one sound source while ignoring another
Feel connected with the environment

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7
Q

what is spatial hearing

A

Localizing where sound is coming from by using ILD & ITD between ears

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8
Q

Explain binaural loudness summation. Its suprathreshold benefits and how this benefit supports hearing aid fitting strategies.

A

Results in PT perceiving greater loudness w/ bilateral devices
Less gain is needed to reach comfortable listening levels
Can fit a PT with less loudness in order for them to hear the words

@ threshold increase only around 2-3dB
@ suprathreshold increase around 6-8dB

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9
Q

Explain binaural squelch and the benefit this auditory process supplies

A

ability of the auditory system to combine the information from both ears centrally and segregate the speech from the noise by the differences in sound between both ears.

Leads to improved intelligibility in noise & ability to focus on 1 signal while ignoring others by taking advantage of these differing SNRs

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10
Q

Which frequencies supply the most information on interaural level differences?

A

High frequencies (>3 kHz) to identify ear to ear head shadow level differences

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11
Q

Which size receiver maximizes HF output

A

Small - because the aperture is able to move faster and quicker

HF signals need rapid diaphragm movements
This is done w/ smaller receiver because it makes the diaphragm smaller and stiffer

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12
Q

Severe HL that needs high frequency output

A

Dual receiver - gives benefit of both & has a big receiver so you need a custom receiver (embedded) or a larger BTE that has the larger receiver

2 receiver system that sums both receivers before reaching the ™ where one is optimized for LF and the other HF which reduces battery drain, gives a good EHF output w/out compromising a lot in LF and minimizes saturation distortion potential

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13
Q

Difference bw WDRC & FDRC

A

Initial TK is lower (10-15) in FD than in WD

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14
Q

Which needs lower tk?

A

Consonants - HF, less energy, softer

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15
Q

expansion

A

needed when someone complains about some of soft sounds they do not need to hear are too loud

Lower output with very very soft sounds

0-20 dB input

Really low CR (lower than linear; <.9:1);

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16
Q

WDRC

A

needed to get soft sounds louder & expand dynamic rang
manages incoming signals

Input compression (AGC-i: amp electric signal comes in & will )

-Engages BEFORE volume control

-activates at the pre-amplifier when TK is low input level & signal is louder than this (bw 20-50)

LOW tk

LOW CR - 1.1:1-4:1 (almost linear)

Slow AT & RT

-Slower AT = temporal fine structure preserved in speech signal

-Slower RT = reduces times of inaudibility to very soft consonant sounds after compressor releases

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17
Q

temporal fine structure preserved in speech signal

A

Slower AT

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18
Q

reduces times of inaudibility to very soft consonant sounds after compressor releases

A

slower RT

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19
Q

OLC

A

Output compression (AGC-o)

-LOUD SOUNDS
need this to protect the ear
Engages AFTER VC

Hight TK: >/= 80dB SPL

High CR: >/= 5:1

Attack time is fast to protect ear from loud sounds

-Release time is variable
-Sudden noises = fast
-Sustained loud noises = slow

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20
Q

Differentiate those services Medicare will and will not reimburse

A

No
Anything that relates to HA’s
Yes
Anything medically necessary

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21
Q

what are 3 methods used to reduce external feedback

A

Adaptive Digital Feedback Suppression (DFS)

reduce external loop

digital notch filtering

digital feedback cancellation

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22
Q

Describe 3 methods used to reduce external feedback

A

Reduce external feedback loop
Increase snugness of mold to reduce size of slit leaks
Or decrease vent size to stop feedback path
Limitation: both increases OE

Digital notch filtering
Removes frequencies around the noise - reduces gain around 2-4 kHz where feedback occurs
HA between this range with notch creates a notch in frequency response so we don’t amplify sound in those regions -
reduction in gain from 2-4 kHz and if you don’t turn the volume up it won’t cause feedback
Limitation 35% of intelligibility comes from this range alone so you stop feedback but stopped audibility of important speech sounds so reduced speech intelligibility

Digital feedback cancellation
When HA detects feedback (identified due to steady state noise bw 2-4 kHz) an algorithm creates an out of phase clone of the signal (duplicate of the feedback) and this causes the clone to be subtracted from the amp path and in turn attenuates the feedback

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23
Q

what is the purpose of frequency lowering

A

tries to improve HF audibility by shifting it down to LF
used with someone that has residual hearing and loss in HF makes it impossible to reach hf amplification (cannot get them to ever hear these sounds again)

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24
Q

Frequency lowering: describe the 3 types, their uses and limitations

A

Linear Frequency Transposition
Improves HF audibility by moving HF band one octave down to LF region
CUT AND PASTE into LF, takes the highs and shoves it into the lows

Nonlinear Frequency Compression
HF range is compressed into a LF range; squishes it down into the audible region
maintain tonotopic order more, lowered all the frequencies, squished into lower frequency space, close to each frequencies close to their original spot

Spectral Envelope Warping
Leave the HF where it is but also COPY and PASTE into LF

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25
Q

what is a review of systems (ROS)

A

series of questions that healthcare providers ask patients to help identify signs and symptoms of potential health issues.

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26
Q

Describe how inclusion of a case history review of systems assists clinical decision-making

A

comorbidity can lead to HL in many cases

Certain medical conditions such as diabetes, cardiovascular disease, or autoimmune disorders can affect hearing. A thorough case history can help audiologists identify these conditions and understand their potential impact on auditory health.

By reviewing symptoms across different systems, audiologists can differentiate between primary auditory disorders and those secondary to other health issues. For instance, dizziness may be related to vestibular problems rather than purely auditory ones.

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27
Q

Create a list of comorbidities linked to hearing loss.

A

Gastrointestinal: Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis
Musculoskeletal: Rheumatoid & Psoriatic arthritis, Gout, Fibromyalgia
Respiratory: COPD, Asthma
Cardiac: poor circulation, coronary artery disease, Congenital heart disease
Lymphatic: Hodgkin’s/ non-Hodgkin’s lymphoma, autoimmune disorders
Hematology: anemia, B12 deficiency, Lyme Disease, Leukemia
Integumentary: Shingles, Herpes zoster, Ramsay Hunt syndrome
Nervous system: Parkinson’s disease, Cognition
Endocrine system: THYROID, GRAVE’S DISEASE, DIABETES, PANCREATIC DISORDERS, KIDNEY DISEASE,

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28
Q

gastrointestinal comorbidity related to HL

A

Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis

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29
Q

musculoskeletal comorbidity related to HL

A

Rheumatoid & Psoriatic arthritis, Gout, Fibromyalgia

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30
Q

respiratory comorbidity related to HL

A

COPD, Asthma

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31
Q

cardiac comorbidity related to HL

A

poor circulation, coronary artery disease, Congenital heart disease

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32
Q

lymphatic comorbidity related to HL

A

Hodgkin’s/ non-Hodgkin’s lymphoma, autoimmune disorders

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33
Q

hematology comorbidity related to HL

A

anemia, B12 deficiency, Lyme Disease, Leukemia

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34
Q

integumentary comorbidity related to HL

A

Shingles, Herpes zoster, Ramsay Hunt syndrome

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35
Q

nervous system comorbidity related to HL

A

Parkinson’s disease, Cognition

36
Q

endocrine system comorbidity related to HL

A

THYROID, GRAVE’S DISEASE, DIABETES, PANCREATIC DISORDERS, KIDNEY DISEASE

37
Q

Highlight the most common comorbidities prevalent in older populations

A

Visual impairment (frequency 68%) and Reduced manual dexterity (frequency 42%)

Cognitive issues (frequency 50%)

Depression (depression (16%)

Falls (frequency 33%)

Hypertension (frequency 43%) and Diabetes (frequency 13%)

38
Q

Visual impairment (frequency 68%) and Reduced manual dexterity (frequency 42%) and impact on rehabilitation

A

Vision or manual dexterity limitations may affect a client’s ability to handle and operate a hearing aid.

39
Q

Cognitive issues (frequency 50%) and impact on rehabilitaiton

A

Reduce the client’s ability to recall information such as appointment times or understand device handling instructions.

40
Q

Depression (depression (16%)
and impact on rehabilitation

A

Diminish a client’s motivation to seek or adhere to rehabilitation

41
Q

Falls (frequency 33%) and impact on rehabilitation

A

Restrict a client’s opportunities for communication and social participation and create barriers to attending appointments with their audiologist

42
Q

Hypertension (frequency 43%) and Diabetes (frequency 13%) and impact on rehabilitation

A

Hearing loss progression; blood thinning medications or diabetes may warrant caution when removing cerumen or taking impressions

43
Q

Explain this statement- “The audiogram is not and indicator of the degree of communication deficit”

A

Audio is a measure of individual’s ability to detect quiet tones when using headphones
Audio thresholds ONLY diagnoses functional sensory deficits
Not an indicator of degree of communication deficit

Puretone threshold loss is
good indicator of functional impairment
moderate indicator of activity limitation
poor indicator of participation restriction

44
Q

describe a Puretone threshold loss is
good indicator of functional impairment

A

This is our diagnosis
Does the person have or not have hearing loss
Do they have “normal” thresholds or does the signal need to be louder for the PT to hear the signal
Purely diagnostic

45
Q

describe a Puretone threshold loss is
moderate indicator of “activity limitation

A

Our ability to execute a task
Can i hear in noise? Or does noise mask my hearing making it harder to understand?
Degree of hl cannot tell if we have HIN issues or not
Can i hear a plural s sound and tell whether or not a person is talking about multiple or a singular issue?

46
Q

describe a Puretone threshold loss is
poor indicator of “participation restriction”

A

If i have a hl does it mean that i can participate in something i want to or does the hl stop me

47
Q

an audiogram tells us in quiet at what intensity you can hear a pure tone

A

true

48
Q

research has proven that the predictability of an audio to a PT’s degree of difficulty wth communication is very weak

A

true

49
Q

Audiograms are predictive of communication abilities and difficulties

A

false
not

50
Q

Describe all the factors which limit an audiologist’s ability to use word recognition scores to predict communication difficulties.

A

Overreliance on speech audio scores leads to inaccurate assumptions of intelligibility, disconnected counseling and less ideal recommendations

if we do not follow the test instructions then we have to recognize the results are invalid and no statements can be diagnostically made from that data

just because they could repeat words 100% in quiet doesn’t mean they will do the same in the real world

OVER-RELIANCE ON AUDIOMETRIC DATA & THE TERMINOLOGY WE USE RESULTS IN

TRADITIONAL SPEECH AUDIOMETRY IDENTIFIES THE PERCENT OF TIME A SINGLE-SYLLABLE WORD SPOKEN OUT OF CONTEXT. IS REPEATED CORRECTLY

51
Q

Single syllable words out of context does not simulate how we communicate

A

true

52
Q

PB words presented in quiet do not supply information related to:

A

An individual’s ability to use lip-reading and facial expression cues
An individual’s ability to use contextual cues
An individual’s performance in complex listening environments
The #1 patient concern relates to their ability to understand speech in noise!
Other disabilities which compound communication difficulties:
Visual loss
Cognitive decline

53
Q

Describe test techniques offering a more realistic assessment method of speech understanding for improved identification of patient concerns.

A

In addition to WRS
Add binaural speech assessments to your test battery
Present the list in both ears and see what happens

Use sentences-based test stimuli
Because PB words ONLY predicts speech intelligibility w/o contextual cues
Sentence provides grammatical cues & contextual cues that helps them use auditory closure skills

Assess performance with and without visual cues
Go through speech test traditionally, then have them turn head and look at you and do the test again to see if they improve

Assess speech intelligibility in the soundfield at 50-60 dB HL to simulate normal conversational speech levels.

54
Q

The World Health Organization (WHO) developed the International Classification of Functioning, Disability, and Health (ICF) nomenclature (language) to

A

focus on health and functioning and get away from the perspective that “disability” is always the result of failing health.

55
Q

ICF provides a universal standard language and framework for the description of health and health-related states

A

Body/structure and Function
Activity Limitations
Participation Restrictions
labels things differently so that it is more positive

56
Q

what is a functional limitation

A

a problem in body function or structure
an actual diagnosis (but do not know how it will impact the patient)

moderate SNHL

57
Q

what is an activity limitation

A

relates to difficulties experienced when executing a task or action
looks at can they do a task or can they not

ex:poor frequency and temporal resolution reduces intelligibility in noise (have trouble understanding speech in noise)

58
Q

what is a participation restriction

A

refers to involvement in activities an individual would like to participate in
desire to do something but avoid it because they do not communicate well
relates to a persons choice

ex: I avoid restaurants because I cannot hear in noise

59
Q

Can our entry level assessments identify a patient’s activity limitations?

A

92550 Tympanometry/ART
92587/ 92588 DPOAE
92557 Comprehensive audiometric evaluation
V5020 Conformity evaluation- verification of hearing aid performance including REM

60
Q

Create a list of common activity limitations and participation restrictions hearing impaired individuals face

A

OTSC - reduced mobility (BSF), speaks softer, difficulty hearing in noise (AL), avoid conversations because people say they mumble, keep tv volume up high (PR)

HF SNHL - ohc damage in cochlea (BSF), difficulty hearing consonants & hearing in noise (AL), avoids social gatherings, misunderstands many communications & family thinks they are not paying attention (PR)

61
Q

COMMONLY ASSOCIATED ACTIVITY LIMITATIONS

A

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

62
Q

Explain the ICF “backward synergy” concept

A

FUNCTIONAL LIMITATIONS CAN NOT DETERMINE HOW THRESHOLD LOSS IMPACTS COMMUNICATION;
BUT, INCREASED PARTICIPATION CAN IMPROVE ACTIVITY LIMITATIONS

treatment resulting in increased participation supplies communication practice and experiences which may result in neural changes to improve activity limitations

63
Q

give an example of backward synergy

A

Increased participation results in improved auditory processing
Increased participation results in improved lip-reading skills
Increased participation results in improved auditory closure skills

64
Q

Describe ways to avoid communication mismatch in professional reports to improve understanding of hearing loss impact

A

making clearer statements that are related to the identified concerns and using quantifiable data to assist interpretation of the findings
Referring to objective SII percentages in a report helps healthcare professionals better understand threshold loss impact

65
Q

CLINICAL STRATEGIES TO IDENTIFY COMORBIDITIES

A

Regular use of standardized case history questionnaires designed to complete a review of systems
Use screening tools to identify visual, dexterity, and cognitive issues

66
Q

OVER-RELIANCE ON SPEECH AUDIOMETRY SCORES LEADS TO INACCURATE ASSUMPTIONS OF INTELLIGIBILITY, DISCONNECTED COUNSELING AND LESS THAN IDEAL RECOMMENDATIONS

A

trur

67
Q

2kHZ audibility supports ___% speech intelligibility

A

35

68
Q

what is the speech intelligibility index SII

A

Calculates the percentage of speech information that is audible and usable to the listener

69
Q

what is an SII of .50

A

means 50% of speech cues supporting intelligibility are audible in a quiet setting

70
Q

is the SII an intelligibility test

A

no

71
Q

gives an idea of what is audible and what is not audible

A

SII

72
Q

why are there more dots on the SII in the HF than LF

A

because hf audibility supports speech intelligibility more than lf and weighted more heavily

73
Q

WHAT SII PERCENTAGE IS NEEDED FOR 96% AUDIBILITY OF DIGITS? OF SENTENCEs? OF NU6 WORDS?

A

SII 15%
SII 50
SII 90

74
Q

THE DEGREE OF INTELLIGIBILITY ACHIEVED IS PREDICTABLE BASED ON THE TEST SIGNAL

A

true

75
Q

predictive of speech intelligibility

A

SII

76
Q

Describe all the clinical uses for SII

A

Helps audiologists determine amplification candidacy
Reduces counseling mismatch b/w Audiologist and patient
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.

77
Q

what is the goal of real ear

A

when we do real ear, the goal is to see what % of audibility we can provide to our pt

78
Q

what is the biopsychosocial test battery approach

A

assesses ALL relevant physical, social, and psychological contexts of the patient when designing a treatment plan.

79
Q

what is the functional & communication needs assessment (F&CNA)

A

1.Diagnostic functional assessment
Comprehensive case history including an assessment of comorbidities (review of systems)

A comprehensive audiometric evaluation, including TEN test

  1. Communication Needs Assessment
    Objective assessments:
    Speech in noise assessment, Acceptable noise level assessment, puretone LDL

Subjective assessments:
Standardized self-report questionnaires assessing communication needs and patient specific treatment goals

Non-auditory needs assessments
Assesses other factors impacting the rehabilitation process: Cognitive decline, general health, and other otologic conditions (tinnitus), additional sensory impairments (manual dexterity, visual acuity), environmental factors: occupational demands, recreational habits, and patient support systems, personality characteristics (expectations, motivation, willingness to take a risk, assertiveness).

80
Q

what does a diagnostic functional assessment include

A

Comprehensive case history including an assessment of comorbidities (review of systems)
A comprehensive audiometric evaluation, including TEN test

81
Q

what is incuded in the communication needs assessment

A

objective assessments

subjective assessments

non-auditory needs assessments

82
Q

what is included in the objective assessments

A

Speech in noise assessment, Acceptable noise level assessment, puretone LDL

83
Q

what is included in a subjective assessment

A

Standardized self-report questionnaires assessing communication needs and patient specific treatment goals

84
Q

what is included in non-auditory needs assessments

A

Assesses other factors impacting the rehabilitation process: Cognitive decline, general health, and other otologic conditions (tinnitus), additional sensory impairments (manual dexterity, visual acuity), environmental factors: occupational demands, recreational habits, and patient support systems, personality characteristics (expectations, motivation, willingness to take a risk, assertiveness).

85
Q

If we don’t fully investigate, we can’t know the individual’s needs

A

true

86
Q

what can be done to determine comorbidities and their effects on the pt?

A

do a checklist of common disorders (review of systems) and if they check it off, they are related to progressive HL and should be a red flag to us
Use screening tools to identify visual, dexterity, and cognitive issues

87
Q
A

AMP II (7 decks)

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