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AMP II > Exam 1 Part 2 > Flashcards

Exam 1 Part 2 Flashcards

1
Q

why are needs assessments conducted

A

to determine candidacy in making individualized amplification recommendations

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2
Q

what is included in a needs assessment

A

audiologic, physical, communication, listening, self-assessment, and other pertinent factors affecting patient outcomes.

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3
Q

objective assessments supply additional information regarding

A

activity limitations

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4
Q

Objective Assessments of Body Structure & Function

A

TEN test
Purpose: Identifies cochlear dead regions

Puretone loudness discomfort levels (LDL)
Purpose: obtain objective data identifying the frequency-specific dynamic range to ensure output across frequencies does not exceed levels of comfort

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5
Q

what is the purpose of a ten test

A

identify cochlear dead regions

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6
Q

what is the purpose of LDLs

A

obtain objective data identifying the frequency-specific dynamic range to ensure output across frequencies does not exceed levels of comfort

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7
Q

Objective Assessments of Activity Limitation

A

QuickSIN
Purpose: Quantifies degree of SNR loss and identifies potential of binaural interference

Acceptable Noise Level
Purpose: Quantifies a patient’s tolerance of background noise

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8
Q

what is the purpose of QuickSIN

A

Quantifies degree of SNR loss and identifies potential of binaural interference

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9
Q

what is the purpose of ANL

A

Quantifies a patient’s tolerance of background noise

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10
Q

why are LDLs needed?

A

to ensure amplified output doesn’t exceed PTs loudness tolerance

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11
Q

what are LDLs used for

A

Data is used to program output and verify OSPL90/MPO limits of the device

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12
Q

When MPO settings remains below LDL acceptance of high input levels & overall satisfaction with amplification decreases

A

false
it improves

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13
Q

Individual tolerance levels vary significantly despite similar threshold loss.

A

true

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14
Q

what is the LDL test protocol

A

PT refers to loudness categories
signal is pulsed pure tone
1. present at MCL (wherever speech is presented)
2. Ascend 5dB & PT ranks loudness after each presentation (narrow DR ascend in 2dB as you near LDL threshold)
3. Stop ascending when reach #7 on category list
4. Run 2-3 trials, repeating the above steps starting at MCL again

always assess 2&3 kHz
normal sensitivity - skip
LF >40 - test 500 Hz
Precipitous inter-octave change (>20 dB) - test inter-octaves
HA output supplies extended frequency range - assess above 3 kHz

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15
Q

what symbols are used for LDL

A

forward L for the right ear and backward L for the L ear
upside down E’s are used in NOAH

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16
Q

LDL purpose

A

to find your judgment of the loudness of different sounds. We want to ensure that the amplified output of a hearing aid device does not exceed your loudness tolerance.

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17
Q

LDL results meaning

A

The purpose of LDL test (loudness discomfort level test) is to find your judgment of the loudness of different sounds. We want to ensure that the amplified output of a hearing aid device does not exceed your loudness tolerance.

So looking at your results, we expect these to vary since loudness is perceived differently. Your results show that there is some consistency in the different frequencies tested, or pitches presented, meaning loudness is perceived consistently to you. Average patient LDL is 100-105 dB HL and your results were basically going to the limits of the equipment which just means you tolerate loudness more than the average patient.

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18
Q

purpose & use of ANL

A

Quantifies a listener’s willingness to listen to speech in the presence of background noise.

Predictive of hearing aid satisfaction with 85% accuracy
Identifies those who will have more difficulty adapting to amplification

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19
Q

what is the test protocol for ANL

A

Set up PT to 0 deg. Azimuth to the speaker
Set up Channel 1 to - Ext. A
speech
Set up Channel 2 to - Ext. B
noise
Calibrate both channels
Turn Channel 1 on (with Channel 2 OFF)
Establish MCL
Increase speech in 5 dB steps until it is described that speech is too loud (provide with categories)
Decrease speech in 5dB until speech is too soft
SWITCH TO 2 DB STEPS NOW - increase speech until you reach person’s MCL
Note the MCL intensity
Turn Channel 2 on (Keeping Channel 1 ON)
Establish BNL
*MAKE SURE MCL DOESN’T CHANGE (it is fine if it does until we end this step)
Increase noise in 5dB until the story is incomprehensible. (BNL masks speech signal)
Decrease noise in 5dB until story is very clear
SWITCH TO 2DB STEPS (adjust mcl if needed) - Increase noise until PT can hear passage but they do not want anymore noise - as much noise as they can tolerant and can still understand
Note BNL intensity

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20
Q

how to score ANL

A

MCL value – BNL value = ANL score

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21
Q

low ANL score

A

(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
no problems tolerating background noise, no management in fittings needed
study in noise example & can focus and not get distracted

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22
Q

High ANL score

A

(difference > 13 dB)

Indicates the patient LACKS TOLERANCE for background noise
This patient is less likely to wear hearing aids regularly
very quickly bothered by the background noise
early research - lacks tolerance for amp, not amp candidates

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23
Q

ANL scores b/w 8-12 dB are equivocal

A

May require extra post-fitting counselling or adjustment period
not amp candidate (early research)
These need extra counseling that they may need more time to adjust to amplification or they may never adjust to them or like them

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24
Q

what is the rationale for SNR loss measurement

A

Speech intelligibility in noise remains the #1 improvement patients seek with hearing aids
To enhance satisfaction with amplification, it is essential to improve hearing in noisy environments. Each patient will need tailored technological recommendations based on their individual “signal-to-noise loss.” Measuring the extent of signal-to-noise ratio loss enables the selection of suitable technological options and validates the improvement provided by those choices.

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25
Q

what is the clinical usefullness with SNR tests

A

Completion of the test instills patient confidence in your skills

good for our knowledge and validating for PT complaints

Results supply quantifiable data:
Supporting use of evidence-based recommendations for technology for improved hearing in noise
Helping patients understand improved communication requires more than restoration of threshold loss

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26
Q

Define the terms SNR-50 and SNR Loss

A

how much louder do you need speech than the noise in the room?
SNR loss = individuals activity limitations

SNR-50 is the signal-to-noise ratio that allows an individual to understand 50% of the test signal

When a patient’s SNR 50 is greater than 2 dB they have a signal-to-noise ration LOSS
SNR LOSS is calculated by subtracting 2 dB from the SNR-50 score

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27
Q

Normal SNR-50 function

A

+2 dB SNR-50 (signal needs to be 2 dB louder than the noise in order to understand 50% of what was said)

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28
Q

What is a normal SNR-50?

A

Normal SNR-50 function = +2 dB SNR-50 (signal needs to be 2 dB louder than the noise in order to understand 50% of what was said)

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29
Q

what is the quicksin protocol

A

Presentation level is calculated based on PTA
If PTA <45 dB present word lists at 70 dB HL
When PTA >45 dB present sentence lists at an intensity perceived as “Loud but OK”

Present one practice list
Proceed with 3 test lists for each test condition
SNR Loss Scoring- Add each word list score and divide by the number of lists presented to one ear (3)
Avoid use of Lists 3, 4, 5, 7, 13, and 16

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30
Q

how to score SNR Loss

A

Add each word list score and divide by the number of lists presented to one ear (3)

Each list has 6 sentences presented with varying SNR’s
5 key words in each sentence are scored as correct/ incorrect

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31
Q

THERE’S NO NEED TO DEDUCT AN ADDITIONAL 2DB FROM THE FINAL CALCULATION WHEN SCORING THE QUICKSIN. ITS SCORING CALCULATION OF SNR LOSS FACTORS THIS DIFFERENTIAL IN.

A

true

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32
Q

patient’s signal-to-noise ratio loss cannot be predicted by degree of threshold loss

A

true

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33
Q

0-2 SNR

A

may benefit from directional mics or omni

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34
Q

2-7 SNR

A

recommend standard directional mics

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35
Q

7-15 SNR

A

requires beamforming mics plus standard directinal mic

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36
Q

> 15 SNR

A

requires remote mic in addition to standard directional mics and beamforming

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37
Q

alternative quicksin test protocols

A

Monaural presentation via headphones

Binaural presentation via headphones

Soundfield presentation via speakers

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38
Q

allows you to detect asymmetric SNR loss

A

Monaural presentation via headphones

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39
Q

quantifies functional SNR loss by supplying binaural benefit

A

Binaural presentation via headphones

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40
Q

used to determine if aided speech in noise performance improved or degraded.
Presentation level is 55 dB to simulate normal conversation levels in noise

A

Soundfield presentation via speakers

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41
Q

what is the most significant benefit for low ANL score

A

supported directional mic and DNR enabled = best chance of success for PT’s with high ANL score

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42
Q

Acceptance of noise improves when

A

BOTH directional mics & DNR are enabled.
Directional microphones alone only supported partial acceptance
DNR alone only showed minimal improvement

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43
Q

what does DNR do?

A

reduces steady state noises (HF or LF as long as they are steady in frequency & intensity)

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44
Q

what is another option instead of Quciksin

A

At times, the length of sentences is problematic for elderly with auditory memory deficits
QuickSIN sentences too difficult for young children
Cochlear Implants candidates may not have the language skills or auditory ability for QuickSIN
Simpler assessment is more likely to obtain usable data

80+ patients that fall apart in the quicksin move to this test because they are simpler sentences and better for cognitive impairments

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45
Q

happens with elderly population about ⅙ individuals

A

binaural interference assessment

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46
Q

what is the binaural interference assessment

A

binaural quicksin identifies those with this

degrading performance in the binaural test suggests this

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47
Q

what is binaural interference

A

poorer speech recognition with both ears than with the better ear alone

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48
Q

Amplification candidacy includes assessments to assist our understanding of

A

patient-specific communication needs.

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49
Q

functional & communication needs assessment must

A

Identify activity limitations & participation restrictions
Identify environmental factors which may impact plan of care
Identify personal factors which may impact plan of care

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50
Q

STANDARDIZED SELF-REPORT QUESTIONNAIRES QUANTIFY _____, _____ & _____ OF THE HEARING-IMPAIRED PATIENT

A

ACTIVITY LIMITATIONS, THE SOCIAL AND PSYCHOLOGICAL NEEDS

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51
Q

benefits of a standardized self-report questionnaire

A

Standardization allows comparison to normative data
Questionnaires are completed independently, prior to the scheduled appointment

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52
Q

standardized self report questionnaires assist with comprehensive identification of all technology needs:

A

Selection of hearing instrument style
Features needs
Hearing assistive devices
Counseling on realistic expectations

53
Q

which questionnaire is for patient centered goals

A

COSI

54
Q

screening tests examples

A

HHIA/E screening; Hearing Disabilities and Handicap Scale, Hearing-Dependent Daily Activities Scale (HDDA has high highest sensitivity rating- 80%)

55
Q

what has the highest sensitivity rating for screenings

A

Hearing-Dependent Daily Activities Scale (HDDA)

56
Q

Communication abilities (activity/participation) questionnaires

A

APHAB, SAC/SOAC, CCP-confidence rating

57
Q

expectations questionnaire

A

ECHO

58
Q

experienced HA user questionnaire

A

SADL

59
Q

Related Non-auditory questionnaires

A

HASP, Social Network Inventory, WHO-DAS, Geriatric Depression Questionnaire

60
Q

a quick pre-audiometric intake measure to get an idea of participation restrictions
Assesses the social impact and emotional response that is the result of the loss of function

A

Hearing handicap inventory (HHI)

61
Q

hearing loss is not interfering substantially in life

A

0-9

62
Q

mild to moderate impact

A

10-24

63
Q

severe impact

A

25 and higher

64
Q

Describe the clinical usefulness of the Social Network Index

A

Describes the social relationships
Looks at how often the patient communicates with others, as well as the communication methods used (face-to-face, or telephone)

Correlations between the relationship of loneliness and cognitive decline are beginning to emerge

65
Q

Describe the clinical usefulness of the ECHO

A

expected consequences of hearing aid ownership

designed to assess 4 subscales related to patient expectations of amplification

usefulness: Knowing it in advance allows us to use other strategies to promote success or let PT wait because they are not ready for amplification

66
Q

Describe the clinical usefulness of the communication profile hearing impaired (CPHI)

A

used to find out how hearing loss affects daily life and what problems, if any, a patient is having

67
Q

Describe the clinical usefulness of the hearing aid selection profile (HASP)

A

Looks at self-perceptions outside of amplification to evaluate core beliefs

Type of HA to suggest or certain tech to recommend to a PT based on their lifestyle

Certain scores predict if PT will do well or not do well with amplification

68
Q

Recent research finds the ECHO and CPHI are highly predictive of adherence vs. nonadherence

A

true

69
Q

echo
Patients were more likely to return devices for credit when expectations of hearing aid benefit score were ________

A

low

70
Q

what findings on the CPHI correlate with nonadherence

A

Communication Performance- perceived they have better communication performance and better adjustment to hearing problems
Communication Strategies- poorer use of verbal and nonverbal communication strategies
Personal adjustment- more denial of communication difficulties

71
Q

PTs cosi goals may be classified as

A

cognitive or affective goals

72
Q

Describe the clinical usefulness of the Client Orientated Scale of Improvement (COSI)

A

Prioritizes patient-centered treatment goals

ranks perceived importance of up to 5 situations causing the greatest communication problems

73
Q

activity limitation vs participation restriction

A

activity limitation relates to the difficulties experienced when executing a task or action
Focus on specific tasks and activities & occur at the individual level relating to specific actions

participation restriction refers to problems an individual experiences in involvement in activities an individual would like to participate in (involvement in life situations)
Encompasses broader life roles and social participation & often involves interactions with society and environment (highlighting societal barriers)

74
Q

Trouble hearing soft sounds or whispers

A

activity limitation
detection of sounds

75
Q

Inability to hear HF sounds like birds or alarms

A

activity limitation
detection of sounds

76
Q

Problems distinguishing between similar sounding words

A

activity lmitation

77
Q

Difficulty understanding speech in noisy environments, such as restaurants or social gatherings.

A

activity limitation

78
Q

Trouble hearing in reverberant or echo-prone spaces, such as large halls or gyms.

A

activity limitation

79
Q

Difficulty determining the direction from which a sound is coming.

A

activity limitation

80
Q

Problems identifying the source of sounds in a crowded environment.

A

activity limitation

81
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

82
Q

Avoiding social gatherings or events due to difficulties in following conversations.

A

participation restriction

83
Q

Reduced involvement in group activities, clubs, or community events.

A

participation restriction

84
Q

Difficulty performing job duties that require effective communication, such as customer service or teamwork.

A

participation restriction

85
Q

Reduced opportunities for career advancement due to communication barriers.

A

particiption restriction

86
Q

Difficulties in understanding lectures or instructions, leading to academic challenges

A

participation restriction

87
Q

Difficulty hearing household sounds, such as doorbells, alarms, or children calling.

A

participation restriction

88
Q

Avoiding recreational activities that rely on hearing, such as attending concerts, theater performances, or playing certain sports.

A

participation restriction

89
Q

Reduced enjoyment of hobbies that involve listening, like music or audio books.

A

participation restriction

90
Q

describe the difference between cognitive and affective goals

A

Cognitive: Defines difficult environments that require improvement to reduce the impact of the impairment (focus on improving PT’s ability to process, understand, and remember auditory information

affective: Defines desired improvements as they relate to feelings/ emotional needs (relates to the emotional and psychological aspects of HL and its management)

91
Q

Feeling less embarrassment during communication

A

affective COSI goal

92
Q

Reduced stress during workday

A

affective cosi goal

93
Q

Alleviating feelings of anxiety or stress related to hearing difficulties

A

affective

94
Q

Building confidence in social interactions and communication situations.

A

affective

95
Q

Increasing participation in social activities and gatherings.

A

affectiv

96
Q

Reducing frustration or irritability related to hearing difficulties.

A

affective

97
Q

Enhancing overall quality of life by improving communication and reducing the emotional burden of hearing loss.

A

affective

98
Q

Building confidence in using hearing aids and other assistive devices

A

affective

99
Q

Encouraging a proactive attitude towards managing hearing loss and seeking help when needed.

A

affectiv

100
Q

Enhancing the ability to comprehend speech in quiet or noisy environments.

A

cognitive cosi goal

101
Q

Improving clarity and comprehension of conversations, particularly in challenging listening situations.

A

cognitive cosi goal

102
Q

Improved conversation with a spouse in a quiet environment”

A

cognitive cosi goal

103
Q

Improved communication with unfamiliar speakers on the telephone without removal of the hearing aid

A

cognitive cosi goal

104
Q

Developing better listening strategies to focus on important sounds while filtering out background noise.

A

cog cosi

105
Q

Improving the ability to follow complex or fast-paced conversations.

A

cog cosi

106
Q

Improving the retention and recall of verbal instructions or information.

A

cog cosi

107
Q

give two examples of cognitive goals and two examples of affective goals

A

cog: Improved conversation with a spouse in a quiet environment”
“Improved communication with unfamiliar speakers on the telephone without removal of the hearing aid”

affective: Feeling less embarrassment during communication”
“Reduced stress during workday

108
Q

what are interview questions to support cognitive goal developments

A

Let’s talk about the listening situations that you find most challenging?
Who are you trying to communicate with in noisy situations?
What kind of room are you in when you have difficulty hearing in noise?
How many people are typically in this environment?
Tell me more about what makes that situation difficult?
Let’s talk about how you feel when you’re in those environments?

109
Q

what are interview questions to support affective goal developments

A

Let’s talk about why you feel that way?
Who: do you feel this way around all the people or is this a concern with some more than others?
What: does this occur all the time or only in certain environments or situations?
Tell me more about what makes that situation difficult? What might make it better?

110
Q

what is the usefulness of cosi goals clinically

A

Actively involves patient in plan of care

Focuses on the individual’s needs when planning rehabilitation

Assists with counseling

Opens discussions related to advanced technology needs
Identifies unrealistic expectations for discussion
I want better hearing in noise using using a CIC style
I want improved localization when using one device
I want low-cost amplification, but poor dexterity requires automatic features

111
Q

B.B. is an 88-year-old female who resides in an Assisted Living Facility (ALF). Her health is generally good, and she is reasonably independent within the ALF setting. She admits to failing eyesight and she reports that she remembers events that occurred many years ago with great clarity but has trouble remembering what she ate for lunch an hour ago.
She does not have trouble during family visits but is particularly frustrated that her hearing is failing, and she reports trouble carrying on a conversation with her table mates at mealtime. In addition, the resident who lives next door to her has been complaining about the volume of B.B.’s television. If she turns the television down, however, she has trouble following the programs and TV is a primary source of entertainment for her. With respect to the telephone, she finds understanding depends on the speaker, noting that callers with foreign accents are particularly difficult

5 cosi goals for BB

A

COSI Goals: (collecting data, no recommendations)
Cognitive
Better conversations at meal times with table mates
Understand the TV at a lower volume
Effectively use visual cues
Better understanding talking on the phone
Afraid she will forget to wear her hearing aids

112
Q

non-auditory personal factors

A

General health
Chronic disorders, depression, anxiety
Dexterity, visual acuity, etc.
Cognitive decline (covered in AUDE 6310)
Prior experience with amplification
Personality characteristics
Expectations, motivation, willingness to take a risk, assertiveness

113
Q

non auditory environmental factors

A

Environmental characteristics
Occupational demands
Recreational habits
Patient support systems

114
Q

what is a generic health-status instrument that gathers data about general health from a comprehensive case history

A

The World Health Organization’s Disability Assessment Scale II (WHO-DAS II)

115
Q

items of WHO-DAS II that comprise communication and participation domains

A

D1s
D6s

116
Q

how does general health screening assist audiologic recommendations

A

General health - comes from primarily comprehensive case history
WHO-DAS II
Identify any underlying health conditions that might affect hearing health or the use of hearing aids
Ex: Detects conditions such as diabetes, cardiovascular disease, or ear infections that can impact hearing. Ensures that hearing aid recommendations consider any comorbidities or medications that might interfere with hearing health.

117
Q

how does depression screening assist audiologic recommendations

A

PHQ-2
Identify symptoms of depression that could affect a PT’s motivation and engagement in hearing rehabilitation
Ex: Recognizes the need for additional support or counseling to improve treatment adherence. Adjusts communication strategies to accommodate the patient’s emotional state, ensuring a more patient-centered approach.

118
Q

how does anxiety screening assist audiologic recommendations

A

GAD-7
Identify symptoms of anxity that could impact PT’s ability to cope with HL and use hearing aids effectively
Ex: addresses anxiety related concerns like fear of using new tech or social anxiety in communication situations.

119
Q

how does manual dexterity screening assist audiologic recommendations

A

Purdue Pegboard Test
To assess PTs fine motor skills and ability to handle small objects like HA’s
Ex: Determines the need for hearing aids with easier handling features, such as larger controls or rechargeable batteries. Suggests assistive devices or alternative solutions if dexterity issues are significant.

120
Q

how does visual screening assist audiologic recommendations

A

Identify whether they can see small things on HA or not
Ex: Considers the need for additional visual aids or support for hearing aid maintenance.

121
Q

how does cognitive abilities screening assist audiologic recommendations

A

To assess cognitive function and identify any cognitive impairments that might affect hearing aid use and communication strategies
How this influence communication abilities
Adapts hearing aid programming and counseling to the patient’s cognitive abilities, ensuring instructions are clear and easy to follow.
Identifies the need for more intensive support or family involvement in the rehabilitation process.

122
Q

Motivation, and prior experience with amplification and how it can assist with audiologic recommendations

A

Was it positive? Negative? What did you like with HA or dislike?
Avoids creating the same mistakes

123
Q

what is the dexterity screening used and how is it run

A

Purdue Pegboard Test
4 tests
Right
Left
Both
assembly – uses both hands to make separate things? – how well the l and r hand can do things together
First 3 are 30 s and last is a min
Chair, table, stopwatch & pegboard

124
Q

Chronic visual conditions in combination with hearing loss increase in prevalence as we age

A

true

125
Q

The problems encountered by individuals with “dual sensory” loss are considerably greater than the effects of vision impairment or hearing impairment alone

A

true

126
Q

Visual & auditory-vestibular comorbidities examples

A

Audio-visual disorders
Visual-vestibular disorders

127
Q

why are we worried about dual sensory loss

A

one impact from one sensory deficit and another and combining two deficits, it exacerbates and may even triple the issue the PT encounters

128
Q

Dual-sensory loss commonly occurs in the presence of these comorbidities

A

Hypertension
Heart disease
Stroke
Diabetes
Cancer
Arthritis

AMP II (7 decks)

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