Exam 2 Flashcards
What is this?
- Uses operant conditioning
- warble tone, noise band, and speech
- Response - unidirectional head-turn
- Reinforcement - animated, lighted toy within a plexiglass box
Visual Reinforcement audiometry (VRA)
What is the VRA setup?
- infants sits in high chair or on parents lap
- 2 testers (in-booth tester “centering” tester, stimulus control, and watching infants response. the other is a control room tester who presents stimulus.
VRA Protocol -conditioning phase involves what?
auditory stimulus is presented at a comfortably loud level above expected threshold while conditioning/ reinforcing toy is turned on (pair together for 3-4 secs)
• repeat until child consistently turns towards the auditory stimulus
• condition with speech stimulus
call the baby by what the caregiver calls him/her
What are the 3 phases of VRA?
1) conditioning phase
2) probe phase
3) testing phase
Nonorganic hearing loss is another way of saying what?
a fake hearing loss, malingering
True or false? Infants are born with an innate ability to categorize perception of speech.
True
When testing infants, hearing perception, how do we know they hear something exciting?
increased sucking
True or false? Voice onset time is a category of all languages AND is a unique category in every language.
True
How do we know that sucking is related to increased interest in phonemic category difference?
/pa/ comes later that /ba/. In study, sucking increased when hearing /pa/, but decreased with repetition. Than increased when hearing /ba/
2 factors in speech perception need to be changed to spark interest with infants - what are they?
VOT changes by the same amount AND phonemic category changes.
True or false? There is not an innate ability to tie speech and visual sounds together.
False - there is an innate ability.
True or false: Re speech perception - interest was not sparked when 2 factors were not changed.
True
True or false: Re speech perception - interest was sparked when it was the same phonemic category but change VOT
False
True or false: Change of articulation sparked infant interest when hearing synthesized voice
True
True or false: infants show interest when change in place of articulation and phonemic category
true
True or false: re auditory-visual speech perception. Infants preferred to look at the face that matched the vowel utterance they were hearing.
True
Brain development during the ___ ___ is rapid and extensive
first year
The brain is not a rigid structure, but a malleable “plastic” organ with the ability to reorganize based on sensory and motor input. This is termed ______
neuroplasticity
The developing brain is very plastic and influenced by ______ activity from the periphery
auditory
All levels of the pathway from the _____ up can be stimulated by auditory input
brainstem
What are the 3 postnatal stages of auditory development and what are their age ranges?
1) Neural encoding of fundamental characteristics sound 0-6 months
2) Increasing Specificity & Selectivity - use information is sound in a specific way 6mths to 8-9 years
3) Flexibility in Sound Processing - approach sound in a more adult way
What postnatal stage of auditory development?
auditory system is less sensitive to sound than the adult auditory system (acuity and frequency resolution)
immature frequency discrimination immature frequency resolution poorer hearing thresholds than adults
Stage 1: neural encoding
True or false? For both animals and humans, behavioral thresholds are elevated, particularly at low frequencies, right after birth
False - particularly high frequencies
At __ months, thresholds are 15-30 dB greater than adults
3
At __ to__ months, thresholds are about 10 dB higher than adults
6-12
Low frequency hearing continues to develop until __ years of age
8
During Stage 1 Neural Encoding, Threshold improvement occurs in lower or higher frequencies?
higher
Stage1 aud development:
Higher frequencies are related to ___ ear maturation, whereas low and mid frequencies are related to ____ and ___ ear maturation
- inner
- outer and middle ear
In Stage 1 of auditory development is the auditory system less sensitive or more sensitive? More refined or less refined?
less sensitive and less refined
Stage 1 auditory development re ABR:
does amplitude increase or decrease? What about latency?
amplitude increases and latency decreases as we age
Stage 1 auditory development re ABR true or false:
Larger amplitude = larger waves = less defined
False = more defined
At __ months, thresholds are __-__ greater than adults
15-30 dB
At 6 to 12 months, thresholds are about _ dB higher than adults
10dB
Overall changes in neural processing occur in what auditory development stage?
Stage 1 neural encoding
Overall changes in listening strategies occur in what auditory development stage?
stage 1 neural encoding
For ABR and evoked cortex response, what happens as we age?
Improves as we age: more robust, happens sooner, and more defined
Auditory sensitivity: There is a large jump between 2-4 weeks, but the biggest improvement occurs between _ and _ months
3-6 months
If you see a child _ months and above, you expect their hearing to be much closer to adult-like hearing
6 months
Fine temporal tuning occurs - intensity and prosody of speech occurs during what stage of auditory development?
Stage 2 Increasing specificity and Selectivity (6 months to 8-10years)
Global cues: sounds that mean words. Undertone of speech that communicates a different meaning. What age and auditory stage does this occur?
8-10 years old; Stage 2
_____ ____ is the Ability to differentially process one component of a complex sound from another. Frequency selectivity.
frequency resolution
what stage does frequency resolution occur?
Stage 2
How to test frequency resolution in
- how well one sound masks another sound.
-infants have a much higher threshold of masker (same amount of noise does not impact their hearing than an adult’s hearing is affected) aka adults not as impacted by masker than infants
• Infant hears sound, when masked sound is added, it required a much higher volume for them to hear but when same sound and masked sound is added, only a small amount of increased volume is needed for them to hear
• Imp bc small amount of noise has a huge impact for child to attend to/hear desired signal
• Closer tone is to the masker, the more affected it is & further the tone is from the masker, the less affected it is look at masked thresholds in children compared to adults. We can see bands of frequency ranges that are affected when comparing child to adult hearing
Improvements in broadband listening occur in what stage?
stage 2
The shortest time period over which the ear can discriminate two
signals. What is this?
Auditory temporal resolution
Temporal resolution does not become adult-like until age __
6
Why is auditory temporal resolution relevant to speech perception?
✦ Speech is dynamic complex stimuli which rapidly change over time in terms of frequency and amplitude.
True or False? Gap detection and/or duration discrimination experiments show that infants have poorer temporal resolution than adults
True
Broadband listening:
True or False:Adults’ thresholds did not change significantly with the introduction of the noise regardless of its level.
True
Broadband listening:
True or False infants had significantly lower
thresholds in noise than in quiet.
False - higher
what are Broadband listening perceptual consequences.
- Sensitivity to the acoustic features that adults don’t “hear”
- More distracted by non-relevant stimuli (environmental noises)
- Higher thresholds for tone in noise and susceptibility to masking in everyday life
Improvements in broadband listening?
Bc not able to pick out certain noises as infant/adults can mask sounds that are not relevant to our target sound (usually speech); skill improves as you age
Imp bc so much learning that occurs as young children is through incidental learning
Summary of what stage of development? less dramatic of changes
stage 1
Summary of what stage of development? near adult aud sensitivity but less capable of how we control how to use (less fine-tuned)
stage 2
Summary of what stage of development?
now we have these sounds, how do we use these (more skilled in manner in which we listen)
Neural mechanisms of coding sound mature. This happens in what stage?
Stage 3: Flexibility in Sound Processing
How do neural mechanisms of coding sound mature?
- more specific in the way they listen to sound
- more able to use finer acoustic details in the identification of sound
- Flexibility in the use of acoustic information
What are the challenges to auditory development of children with HL?
- Early identification of hearing loss
- Early, consistent use of advanced hearing instruments
- Early access to auditory-based language learning in the home
- Access to knowledgeable and skilled professionals
What is the Ling Six-Sound Test?
-Daily perceptual check of detection and discrimination
-Six sounds representing the frequency range of the entire speech spectrum
/u/, /m/, /a/, /i/, “sh”, /s/
Why us the Ling Six-Sound Test?
May identify speech perception problems by noting any auditory confusions
Why teach language through audition?
•Typically developing children learn language through audition
-Link between speech perception and production: not just what comes in through HAs but what they do with information
o Manner in which child can use incidental learning is already diminished
o Child with HAs will be less able to use auditory information (bc all voices in a big room will amplified vs. typically developing hearing children who can pick out one voice in bug room)
-Most children with HL can benefit from hearing aid technology
- Majority of deaf and HoH children are using spoken language and are learning in regular education settings
- Most kids with HL are not candidates for CI and need HAs
What stage?
ability to distinguish speech from noise
Learning to use new information to distinguish sound, developing the ability to attend to finer details as opposed to global cues finer details as opposed to global cues
Fine temporal tuning
Stage 2: Increasing specificity and selectivity
Frequency resolution: auditory filter widths mature between _ and _ months. And, infants showed broader tuning curves than adults at _ and _ kHz
- 3 and 6
- 4 and 8 kHz
Broadband listening: True or False?Adults focus their listening to specific critical bands that are more relevant to speech
True
Broadband listening: True or False? Infants do selectively listen in the frequency domain
False - they do not
Broadband Listening:
Adults’ thresholds did or did not change significantly with the introduction of the noise regardless of its level?
Infants had significantly higher lower
thresholds in noise than in quiet.
- did not
- higher
What are the perceptual consequences of broadband listening?
Sensitivity to the acoustic features that adults don’t “hear”
More distracted by non-relevant stimuli (environmental noises)
Higher thresholds for tone in noise and susceptibility to masking in everyday life
Stage 3: Flexibility in Sound Processing. Neural mechanisms of coding sound mature. What are 3 characteristics of this stage?
- more specific in the way they listen to sound
- more able to use finer acoustic details in the identification of sound
- Flexibility in the use of acoustic information
What is the high risk register?
A set of conditions; if a child had any of these they got referred for a hearing eval.
-employed the ABCDs of high-risk deafness.‣ Asphyxia
‣ Bacterial meningitis
‣ Congenital perinatal infections – TORCH ‣ Defects of head and neck
‣ Elevated bilirubin
‣ Family history
‣ Gram birth weight < 1500 gm
Why didn’t the high risk register work?
failed to identify 50% of infants with hearing loss
What does the research by Yoshinaga-Itano say?
- Language outcomes are different depending on the age at intervention
- Poorer receptive language, expressive language, and total language skills
- These result held regardless of degree of hearing loss
What are the prerequisites for a population screening?
- Condition sufficiently frequent in screened population
- Condition serious or fatal without intervention
- Condition must be treatable or preventable
- Effective follow-up program possible
What are the characteristics of a good screening program?
Refer rate of 1.5-5.0% in well baby nursery and slightly lower in the NICU (resulting from 2-stage screening in the hospital)
‣ 5.0% = 400 babies per 8000 births
• Ongoing training and monitoring program for
personnel
• Structured plan for follow up
• Ability to track program performance
What are recommendations for counseling parents of children who fail a newborn hearing screening?
• Effective communication of results to families has an influence on follow up behaviors
• Balance between reassurance and importance of follow up testing • Parents want to know about hearing loss at birth
• Parents want audiologists to inform them about hearing loss
‣ Allow for questions
‣ Use parent-friendly language ‣ Trained to handle emotions
‣ Unbiased information
‣ Time to process information
What are the school age screening procedures per ASHA & AAA?
‣ use individual, pure-tone screening
‣ screening level or “fence” 20 dB HL
‣ Frequencies - 1000, 2000, 4000 Hz
• Failure -any one frequency in either ear
• Re-screen failures
• Refer two-time failures for follow up (audiological evaluation)
What are the school age immittance screening procedures per ASHA & AAA?
• Looks for middle ear dysfunction, not
hearing loss
• May be recommended on a regular basis for at risk populations
• Screening tympanometry
Failure: ‣ flat tympanogram in either ear ‣ negative pressure NOT a reason for failure Follow up: ‣ medical referral
When screening preschool and school aged children - the screening is NOT what?
1) not a threshold measure
2) not diagnostic
When screening preschool and school aged children - what are you screening for?
- presence of a hearing loss
- presence of middle ear dysfunction
What are the different hearing screening techniques?
1) Otoacoustic emissions (OAE)
2) Auditory brainstem response (ABR)
3) two stage screening (OAE + ABR)
Sounds are presented to the ear canal and a small microphone measures the response in the ear canal
• Average test time is 5-15 minutes/baby
What type of hearing screening?
OAE
Sounds are presented and surface electrodes measure brainstem activity
• Average test time 20 min/baby
What type of hearing screening?
ABR
All babies are screened using OAEs
• Those babies who fail the OAE screening receive an ABR screening prior to leaving the hospital
• Reduces refer rate; useful when follow up is likely to be difficult or costly
• Initial cost of equipment is higher than OAE or ABR screening alone, but follow-up costs are lessWhat type of hearing screening?
OAE + ABR
ABR: tests brainstem; different pathway, if just OAEs-would be missing all ___ ___
*A-ABR = Automated ABR
Neural paths
OAE: tests ___ __ __
Inner hair cells
What is the difference in recommendation for well baby nursery screening vs NICU?
Well-baby nursery: If they don’t pass, they get screened again
But in NICU, if they don’t pass = immediate referral to Aud.
All baby in NICU get ABR
True or False:
Lower rate of referral in NICU bc using more comprehensive eval (less false positives)
Higher rate of HL in NICU
True
Behavioral test recommended for birth to 6 months?
behavioral observation
Behavioral test recommended for 5 to 24 months?
Visual Reinforcement Audiometry (VRA)
Behavioral test recommended for 25 - 60 months
VRA and Conditioned Play Audiometry (CPA)
What are the components of a good pediatric case history? See powerpoint for details of the answer
- Birth and prenatal
- Health history
- Developmental history
- Communication history: hearing
- Communication history: speech and language
- Social history
- Other evaluations (audio logic, speech-language, OT/PT
- Special service (in or outside of school)
What are the key components of Behavioral Observation Audiometry (BOA)?
components: test one low frequency and one high frequency. reduce intensity by 10 dB. Look for arousal response, eye blinks, limb movements, and sucking response **
What are the key limitations of Behavioral Observation Audiometry (BOA)?
-Significant inter- and intra- subject
variability
-Observer bias
What is the Visual Reinforcement Audiometry (VRA) setup?
-Infant sits in highchair or on parent’s lap
-Two testers
in-booth tester: “centering” the infant, facilitating stimulus control, watching infant response
control room tester: presenting stimuli
What are the 3 phases of VRA?
1) Conditioning phase
2) Probe phase
3) Testing phase
What is involved in the Conditioning phase of VRA?
auditory stimulus is presented at a comfortably loud level above expected threshold while conditioning/ reinforcing toy is turned on (pair together for 3-4 secs)
• repeat until child consistently turns towards the auditory stimulus
• condition with speech stimulus
call the baby by what the caregiver calls him/her
What is involved in the Probe phase of VRA?
stimulus is presented with out reinforcement
at same level as in conditioning phase
child turns towards stimulus reinforce
conditioning is confirmed
What is involved in the Testing phase of VRA?
present stimulus and wait for child to turn for
reinforcement
• if ✔ response: reinforce, decrease level by 20 dB
- repeat until x NR
-if x NR: raise level by 10 dB and present until response
- Continue bracketing until 50% criterion response is obtained (2/4 or 3/6)
-Vary frequency or stimulus to keep child’s interest
-Obtain threshold for one low (500 Hz) and one high (2000 Hz)
-Then: 1000 Hz & 4000 Hz
-Sound field responses: better ear’s minimal response level (MRL)
-Continue testing using headphones/inserts to get
ear specific information
-500 Hz and 2000 Hz for the right and left ear
-Then: 1000 Hz & 4000 Hz for the right and left ear
-Use bone conduction vibrator and determine
presence of ABG
-test 500 Hz and 1000 Hz (why?)
What are normal results for VRA?
• Results- what is normal?
• Infants with normal hearing respond to sound at slightly
higher levels than adults
• Infants thresholds should be at approximately 15 to 20 dB HL
better thresholds for speech is expected
• Remember- these are MRLs
may not be the threshold, but should be repeatable and close to threshold
True or False?Test-retest reliability was good for VRA and very poor for BOA
True
VROCA is designed to be used with children __ to __ months old.
18-36
VROCA uses ___ conditioning. It’s discriminative stimulus is ____ ___. The operant is ___ ___. The reinforcement is ____.
- operant
- pure tone
- push button
- animated lighted toy
TROCA was originally designed for children with ___ ___ ___.
Designed for children __to__ months. Child uses a __ __ to respond to stimulus. Reinforcement is ___, __, or a ___.
- limited cognitive abilities
- 18-36 months
- cereal, candy, or a trinket
True or False? VRA and VROCA require more testing time then TROCA.
False, TROCA requires more testing time.
Conditioned Play Audiometry (CPA): Uses \_\_\_ conditioning. The operant is \_\_ \_\_. What is the reinforcement? Used with children with a cognitive age of \_\_ months.
- operant
- play response
- social reinforcement, tangibles such as stickers, chips, etc
- 30 months
What is th CPA protocol?
• Once the child is under stimulus control, proceed with a threshold measure
• Assume short time window for obtaining responses
• Get responses from each ear individually
• Test each ear at each frequency, rather than all frequencies in one ear
•Air-conduction thresholds first, then bone-conduction thresholds
• Examine the audiogram for air-bone gaps and whether masking is needed
-Masking is rarely used under age 5 years of age
What is the order of frequencies used for CPA?
- 1000 Hz in each ear (R&L)
- 4000 Hz in each ear (R&L)
- 500 Hz in each ear (R&L)
- 2000 Hz in each ear (R&L)
- 250 Hz in each ear (R&L)
Prerequisite skills for testing VRA:
Cognitive Skill Prerequisite is?
Motor Skill Prerequisite?
Time required?
- object permanence
- head turning
- 15 minutes
Prerequisite skills for testing TROCA/VROCA:Cognitive Skill Prerequisite is?
Motor Skill Prerequisite?
Time required?
- object permanence and cause/effect
- pushing/pulling and gross motor skills
- 15 minutes
Prerequisite skills for testing CPA:Cognitive Skill Prerequisite is?
Motor Skill Prerequisite?
Time required?
- object permanence cause/effect turn taking
- fine motor skills to manipulate toy
- 15 minutes
Warning signs of non-organic hearing loss/malingering?
-BIG clue: poor agreement between PTA and SRT
- verbosity
- brashness
- over withdrawal
- exaggerated straining to hear the test tones
- inconsistent intra-test results
How do you identify non-organic hearing loss/malingering?
Use Stenger test.
what is Stenger effect?
Do you use speech or pure tones?
sound presented to both ears is perceived only in the ear in which it is louder
-can use either
Explain the Stenger test?
• Simultaneously present:
Stimulus 10 dB above obtained threshold in better ear
Stimulus 10 dB below obtained threshold in poorer ear • If responds, Negative Stenger (not suggestive of malingering)
• If does not respond, Positive Stenger (suggestive of malingering)
How to manage malingering - what should DO?
-Calmly and firmly reinstruct the child: “I think you might have not understood what I wanted you to do. When you hear my voice or the beeps, please…”
-Attempt to get responses behaviorally
-use physiological tests: ABR, OAE, tympanograms,
acoustic reflexes
• Sometimes you can go back to behavioral tests after physiological ones and get more accurate results
• Allow the child to “save face”
• Remember, the goal isn’t to ID a malingerer; it is to get accurate information on hearing status
What should you NOT do when managing malingering?
Make threats to the child and/or family to cooperate Embarrass the child
Get angry or annoyed
