Exam 2 (Part 1) Flashcards
List 8 warning signs of ear disease that should be referred for medical evaluation before proceeding with amplification?
Visible congenital or traumatic deformity of the ear.
History of active drainage from the ear within the previous 90 days.
History of sudden or rapidly progressive hearing loss within the previous 90 days.
Acute or chronic dizziness.
Unilateral hearing loss of sudden or recent onset within the previous 90 days.
Audiometric air-bone gap equal to or greater than 15 decibels at 500 hertz (Hz), 1,000 Hz, and 2,000 Hz.
Visible evidence of significant cerumen accumulation or a foreign body in the ear canal.
Pain or discomfort in the ear.
proceeding to a solution by trial & error or rules that are loosely defined
heuristic decision making
Gioia et al. (2015) found technology level recommendations were not based on outcome benefit, but instead on variables such as patient lifestyle as perceived by the hearing professional.
true
recommendations of premium technology dramatically increased when professions PERCIEVED patient as
active vs. non-active
Create a guide for the purpose of assisting your ability to recommend amplification based on patient preferences, degree of hearing loss and evidenced based research
recommendations of premium technology dramatically increased when professions PERCIEVED patient as active vs. non-active
Audiologists theorize more use equals more benefit from premium level technology
entry level or lower-level technology recommendations increases for patient’s over 70
active patients w/ poor speech discrimination only had a 17% chance of being recommended a premium technology while active patients with good speech discrimination increases to 68%.
Prem vs. Entry level Tech
No significant difference in sentence recognition scores is found b/w premium and entry-level hearing aids, if directional microphones were available.
No significant difference in aided loudness existed b/w the premium and entry-level hearing aids.
Sound quality ratings are similar for premium and entry level technology.
Premium technology was preferred when subjects desired user-controlled DSP, streaming, convenience, & connectivity.
when was prem tech preferred by subjects?
Premium technology was preferred when subjects desired user-controlled DSP, streaming, convenience, & connectivity.
Wu et al (2019) while premium technology appeared to improve intelligibility and localization in laboratories, these benefits did not translate to the real world.
true
2 individual factors that may impact performance, preference, and real-world outcomes of prem tech
individual’s ability to accept background noise AND the listening demands of an individual’s environment.
Pyler et al (2021) concluded premium technology offers the most benefit to:
Individuals with poor ANL scores (tolerance to noise)
Premium technology improved aided ANL score
Individuals regularly communicating in large group or demanding settings
what is the evidence based recommendation when recommending amplification
use of multi-level demonstration level technology during device trials allows patient to compare entry-level vs. premium level in realistic environments
How many frequency shaping bands are needed to optimize a hearing aid fitting for a flat or sloping HL
Flat or sloping hearing loss:
4 bands provides sufficient frequency-shaping flexibility
How many frequency shaping bands are needed to optimize a hearing aid fitting for a steeply sloping loss
Steeply sloping losses
Research suggests increasing to 7 bands allows output adjustments to narrower frequency ranges (2001)
act as a frequency specific volume “handle” to maximize audibility w/o changing compression
frequency shaping bands
adjust compression ratios to shape output into the individual’s dynamic range
compression shaping channels
How many compression shaping channels are needed to optimize a hearing aid fitting?
9 frequency shaping channels should accommodate majority of audiograms
Increasing the number of frequency shaping bands from 3 to 18 significantly improved speech audibility for a steeply sloping hearing loss BUT increasing frequency shaping channels from 3 to 18 supplied little benefit
true
An organizational tool designed to systematically review a set of treatment options
decision aid
List counseling strategies that improve retention and recall of recommendations
presentation needs to include concrete advice
explain in easy to understand terms
present most important info first
stress importance of info you want the person to recall
dont present too much info
repeat most important things
understand what it is the person wants
provide written, graphical, and picture material for the information
what are the REM steps
- input audio, choose protocol and target info
- calibrate and position patient with equipment
- otoscopy and place probe in the ear
- unaided measurements
- occluded measurements
- calibrate open fit?
- aided measurements & matching targets
what does all systems have
external speaker that generates variety of input signals
what is the ear level probe module
connects PT to the REM system
has ref mic, probe mic, probe tube, & retenton cord
what is the ref mic
monitor and calibrate the soundfield speaker output, maintaining the desired signal intensity at the measurement point
makes sure the signal arriving to probe module is the intended intensity
what is the retention cord
stabilize and maintain the reference microphone’s position
Blue stretchy coard
probe tube
measure the intensity of the signal arriving to the TM
prob mic
collects and measures sound from the probe tube attached to it
Stem
Output requirements to achieve binaural benefit
Aided output must be 15dB
describe a type one signal
Brief puretone signal swept over a variety of frequencies
brief pure tone signal presented and they are used because they can measure highest output coming out of the HA (make sure max power output is not exceeding PT LDL)
waht is the benefit of type I signals
Type I signals drive a higher output than speech signals
They’re used to accurately measure maximum loudness when verifying MPO
what are type I signal limitations
Does not show affect of compression or channel interactions on the output signal
DFS signals attenuate Type I signals when its activated
how does DFS attenuate type 1 signals
if unit uses swept instead of pulsed, activates DFS and HA attenuates the signal and you dont see true output of the HA & with speech we are getting soft sounds adding gain and compressing loud sounds and the pure tone signal dones’t show us compression, doesn’t show if we put it into persons dynamic range (cannot see the compression weve added and the impact CR have )
describe type II signals
complex “speech-like” signals
Broadband signal consisting of random frequencies occurring at different intensities
(LF & HF very rapidly presented, soft and louder signals rapidly varying and changing as we speak), testing audiblity for soft, moderate and loud inputs (loud is different than MPO) of speech
benefit of type II signals
Its unpredictable moment-to-moment amplitude changes mimics speech
limitation to type II signals
Rapid gain changes may not truly show a device’s response to different spectral shapes in the succeeding sounds
might not see all of the spectral issues because we cannot capture every little detail
types of type II signals
standardized and non standardized
Calibrated speech signals providie
repeatable, consistent signals to verify a device’s ability to meet prescriptive targets for output & frequency response
what are standardized speech signals (type II)
contain all sounds within the speech spectrum within a 10 second passage
ex of standardized speech signals
Speechmap- speech signals filtered to provide the long-term average speech spectrum (LTASS)
ISTS- International Speech Test Signal: 6 female talkers reading the same passage in American English, Arabic, Chinese, French, German and Spanish
ICRA- International Collegium for Rehabilitative Audiology: distorted speech signal is a recording of an English-speaking talker that has been digitally modified to make the speech largely unintelligible
what is the speech map
speech signals filtered to provide the long-term average speech spectrum (LTASS)
standardized speech signal
not used for amplification programming
non standardized signals
what are non standardized signals (Type II)
Measures output of different signals
Good for counceling
The intensities, frequencies are less repeatable which is why we cannot use them to program
Noncalibrated signals are helpful in counseling, but cannot be used for prescriptive fittings
benefit to non standardized
signals lack standardized repeatabilitySpeech- female
Speech- child
Speech- live
Measures the LTASS and speech envelope of any audible signal over 10 seconds
Use: probe microphone acts as a spectrum analyzer and “test signal” is typically communication partner’s voice
Provide an excellent demonstration of output based on communication partners speech
what is the LTASS
Long-Term Average Speech Spectrum
frequency-dependent measure of time averaged sound pressure level of speech
change with varying vocal effort, microphone position, and language.
Vocal effort primarily influences
mid-frequency LTASS average.
Microphones azimuthal position strongly influences
high-frequency LTASS average.
Tonal languages influences
low frequency LTASS average
Explain how a signals LTASS is calculated
LTASS is calculated by averaging a measured signal for 10 seconds
Speech envelope has a crest factor of ______dB & valleys of_____ dB
+12
- 18
The Speech Intelligibility Index (SII) is maximized when
entire speech is above threshold.
Speech signals with different intensities will have a the same LTASS
false
different
An individual’s LTASS will be the same as the LTASS of a standardized speech signal
false
it will differ
changes depending on the intensity of the speech signal
LTASS
measured over a 10 s period of time
LTASS
measurement showing the dynamic range of the speech signal arriving to the tympanic membrane
measured speech envelope
The difference between the valleys (softest signal) and peaks (loudest signal) of speech is ______- SPL
~30dB
if PT SII is low, might look at lower part of speech envelope and see if you can raise just the soft sounds to make louder to get more audibility and max SII
true
what is the LTASS “SPEECH ENVELOPE”
Visual representation of modulated speech sounds
Speech envelope has a crest factor of +12 dB & valleys of - 18 dB
These two lines define the representative dynamic range of normal conversational speech over time (a 10 sec. measurement)
louder speech sounds re about 12 dB louder than LTASS
tru
valles of soft sounds rea bout 18 dB softer than LTASS
true
Difference bw threshold & LDL represents \
dynamic range
what is the substitution method calibration protocol
Done before the PT arrives, placed at where subject’s head would be, stored as a reference point, used to calibrate the reference mic and probe
Sound level measurement mic is placed at subject’s position
Calibration is stored & used as reference point
limitation to the substitution calibration method
Absence of subject’s head/body reduces precision
Changes in location/movment of subject impacts results
what are the modified pressure methods
Modified pressure “concurrent equalization
Modified pressure “stored equalization”
describe Modified pressure “concurrent equalization”
reference mic monitors test signal throughout test to equalize and adjust, calibration signal replays every 10 seconds (pink noise segment)
ref mic constantly monitors test signal throughout testing to equalize & adjust signal intensity
Recalibration happens automatically and calibrated signal replays every 10 s throughout measurement process
describe the Modified pressure “stored equalization”
probe is calibrated one time on PT’s ear & stored for fitting process
Used when amp sound can leak out of open domes & interact w/ ref mic
Used to avoid ref mic contamination (stops it)
happens when amp output escapes ear canal through open dome
reference mic contamination
Head movement during measurement can impact final recording
Modified pressure “stored equalization”
what is reference mic contamination
Ref mic measures and reacts to the intensity of HA output signal lowering the intensity of speaker’s input signal
Amp signal goes into the ear & leaks out of ear w/ open fit reaching the ref mic sitting outside of the ear tricking it into thinking the speaker intensity is louder than it is causing the speaker to turn down so now the signal arriving to the ™ is softer than the true response that is arriving to the mic
Why does the probe module calibration process result in an “acoustic transparency” b/w the reference mic and probe tube?
probe microphone module cannot be physically located in the ear canal; the probe tube serves as an extension to the probe microphone
Probe tube tip is placed directly over the reference microphone during calibration. This protocol accounts for the different intensities arriving to the probe microphone module’s reference mic and through the probe tube.
The unit mathematically adjusts the intensity differences removing the tube’s resonance effects.
This procedure makes the probe tube “acoustically invisible”
The modified pressure concurrent equalization calibration signal arrives simultaneously to the probe tip and reference mic during. Therefore, the “distance” b/w the reference mic and probe tube tip becomes acoustically invisible
describe the protocol for calibration
Place tip of probe directly over reference mic
Ref mic must face speakers during calibration
Hold probe module 6” to 36” away from the speaker
Keep your fingers and body out of the way!
Present calibration signal
Explain the concepts and ANSI recommendations surrounding effective measurement “working distances” for equipment, patient position and audiologist position
defines “working distance” as the allowable distance b/w the patient and the speaker (18”-36”).
The nearest reflective surfaces and the tester should be 2 times farther than the working distance during testing.
That means you stand 36” to 64” away!
Ambient room noise must be 10 dB lower than the REM signal to minimize effect on test results.
Horizontal plane: 0º azimuth: greatest reliability
45º: may be used by some
90º: results in significant variability/errors
Vertical plane: to accurately measure high frequency output, the speaker should be level with the patient’s ear.
0º azimuth
GREATEST RELIABILITY
45º
used by some
90º:
results in significant variability/errors
what are we looking for with otoscopy before probe tube placement
Watch direction/angle of EAC
Helps w/ probe tube insertion
Check for cerumen/debris
Can interfere/plug tube and interfere with placement
Insert at an angle to avoid cerume or remove it before
describe probe module placement
The reference mic must face the room (away from the patient’s neck)
Use the blue cord to stabilize the probe module under the earlobe
Clip the probe module cable to the opposite side to stabilize the location of the reference mic
Slip the probe behind the blue cord so the black marker lays in the inter-tragal notch
Add lubricant to the middle of probe tube and/or mold to reduce slit leaks
The black marker must be moved to the inter-tragal notch once depth of insertion is confirmed to ensure the tube doesn’t move after placement
what are the probe tube insertion methods
otoscopic method
constant depth method
acoustic method
geometric postition method
otoscopic method
lead to bump and pull, not pleasant for PT, other methods are more precise
constant depth method
measure black bead (tube marker) to premeasured position
Distance from intertragal notch to TM is about:
Male: ~30 mm
Female: ~28 mm
Pediatric: move marker to ~20-25 mm
Using these measurements the tube tip will be within 2-5 mm of TM for the average patient
Distance from intertragal notch to TM in
Male
~30 mm
Distance from intertragal notch to TM in
female
~28 mm
pediatric
~20-25 mm
acoustic method
Present a 65 dB SPL pink noise signal while inserting probe tube.
Gently insert the probe tube while keeping an eye on the high frequency notch
The probe is w/i 5mm of the TN when the notch is no longer dragging the gain curve down in the high-frequencies (no > 5 dB at 6k Hz)
Once the measurement is stabilized move the probe tube marker into position.
geometric position method
used for squirmy/uncooperative PTs, probe placed along outer ridge of intertragal notch of device
Probe tip extends 3- 5 mm beyond the tip of the earmold.
The extent to which this insertion depth is appropriate will also depend on the length of the earmold. For instance, shorter length canals (e.g., not beyond the second bend), it is likely that the probe tube will not be close enough to the eardrum to accurately assess the high frequencies.
Mark the probe tube length
RE
real ear measures acquired on a PT’s ear
U
unaided
how your ear resonates sound naturally
o
occluded
what happens to the resonance in your eaer qhen we block it
a
what happens in ear when HA is turned on
gain
HL
Difference bw input level arrive to eaer and output level arriving to ™
difference between the output intensity and the input intensity
How much gain did we add to each frequency in order to make it audible to the PT
Expect a low SPL value
low SPL value
gain
high SPL value >90
response
r
response (SPL)
Output arriving at the ™
Absolute measure of SPL output arriving at the ™
Expect a high SPL value >90 for acronyms ending in R
Intensity at the TM
reur
Gain differential
reug
the natural resonance resulting from the pinna and ear canal effect that the patient walked in the door with
REUR
the insertion loss that results from the mold/dome
REOR
