Exam 3 Flashcards
What is the purpose of a hearing screening?
To determine if an individual needs further testing and/or to identify individuals who may have a hearing loss
What are the results of a screening?
Pass/fail
What are the target populations for a hearing screening?
- Newborns and young children (those who don’t know they have a problem)
- Elderly (those who are unable or reluctant to get the services they need)
- Employees at risk for NIHL (noise-induced hearing loss)
What are the criteria for effective screening programs?
- Should respond to a recognized need
- Should be a defined target population
- Should be scientific evidence of the screening program’s effectiveness
- Should integrate education, testing, clinical services, and program management
- Should be quality assurance
- Should ensure informed choice, confidentiality, and respect for autonomy
- Should promote equity and access to screening for the entire target population
- Should have planned program evaluation from the outset
- The overall benefits of screening should outweigh the harm
What is reliability?
Testing again gets the same results (the ability of a test to replicate results)
What is validity?
The test is capable of diagnosing hearing loss (and passing those who have normal hearing)
What are the three criteria for screening populations?
- They do not show or act upon symptoms of the disorder
- There is a good chance of finding those with the disorder
- The disorder is important enough to identify in the larger population
What is universal screening?
Screening for all members of a larger population
What is targeted screening?
Screening of a subgroup of a larger population
What does UNHS stand for?
Universal newborn hearing screening
What does EDHI stand for?
Early hearing detection and intervention (programs)
What two screening tools are used for newborns?
OAEs and ABRs
What are the advantages and disadvantages of using OAEs to test newborns?
Advantage: fast
Disadvantages
- Can’t see a conductive loss
- They’ll fail if there’s any fluid or stuff in the ear
If the child passes, when should a follow-up be done?
If the child passes, a follow-up hearing screening or diagnostic hearing evaluation should be completed between 24-30 months of age
What is the 1-3-6 rule?
Screened by 1 month, diagnosed by 3 months, and fit with a device and enrolled in intervention by 6 months
Tell me about the HRR.
- High-risk register
- Only identified 50% of children with hearing loss
Can still be useful for
- Later onset or progressive hearing loss
- Developing countries
What are risk factors for congenital and delayed onset hearing loss?
- Caregiver concern regarding speech, language, and/or hearing development
- Family history of permanent childhood hearing loss
- Time spent in the NICU (more than 5 days)
- Ototoxic medications/chemotherapy
- In-utero or postnatal infections associated with hearing loss
- Craniofacial anomalies
- Syndromes associated with congenital, progressive, or late-onset hearing loss
- Head trauma
When is screening recommended for school-aged children?
Recommended annually for preschool through 3rd grade, 7th grade, and 11th grade
What equipment is used during school-age screening?
- Otoscope (otoscopy)
- Tympanometer (tympanometry)
- Portable audiometer (pure-tone testing)
- Test 1k, 2k, and 4k Hz
- If they can hear 20dB, they pass
What are the possible screening results of school-aged children?
- Pass
- Recommend cerumen removal by pediatrician
- Pass pure tone, fail tymps (one or both ears)
- Fail pure tone, pass tymps
- Fail pure tone and tymps
- CNT (could not test; due to behavioral issues or young age)
When should adults be screened?
Should be done about every 10 years for those younger than 50, and every 3 years for those who are older than 50
What does hearing screening for an adult include?
- Case history questionnaire
- Otoscopy, tympanometry, and pure tone screening (1k, 2k, and 4k, passing at 25 dB)
- Self-assessment questionnaires (HHIE-S; hearing handicap inventory for the elderly- screening)
- Assumes a “gold standard” exists
What are the four outcomes of a screening test?
- True positive
- True negative
- False positive
- False negative
What is sensitivity?
How well a test correctly identifies those with a disorder; the proportion of true positives to the total of those who actually have hearing loss
- TP/TP + FN (true positives divided by those who actually have the disorder)
What is specificity?
How well a test correctly identifies those without a disorder; the proportion of true negatives to the total of those who actually do not have hearing loss
- TN/TN + FP (true negatives divided by those who actually don’t have the disorder)
What is a positive predictive value (PPV)?
The level of confidence you have in the true positive
- TP/TP + FP (true positives divided by those who failed the test)
What is a negative predictive value (NPV)?
The level of confidence you have in the true negative
- TN/TN + FN (true negatives divided by those who passed the test)
What are the six steps in hearing aid selection and fitting?
Assessment, treatment planning, selection, verification, orientation, and validation
Name three hearing aid manufacturers.
Phonak, Signia, and Starkey
What happens in the assessment step?
Look at the audiogram (pure tones and word rec)
- For sloping: hearing loss at 2k Hz and up (HA advised)
- For rising: hearing loss at 1k Hz and below (HA advised)
- Word rec scores (any score 30% and below, HA won’t be helpful)
Questionnaires/self-assessment tools
Patient needs/wants
What happens in the treatment planning step?
- Share the test results
- Ask them if they feel the need for treatment or feel like the hearing loss is a problem
- Needs assessment
What’s your environment?
Do you need to be able to hear and communicate a lot?
What happens in the selection step?
- Finances/insurance
- Style/size
- Technology level
What happens in the verification step?
- Perform sound quality check (is the HA functioning according to manufacturer specifics?)
Fitting
- Enter audio into manufacturer software and program with prescriptive procedures
NAL-NL2
DSLv5.0
NOAH: a universal computer software program
- Check HA fit; is patient okay with how the hearing aid looks
- Perform real-ear measures and aided WRS
What happens in the orientation step?
- Explain the use, care, and maintenance of HAs
- Discuss realistic expectations
- See if there is a need for an aural rehabilitation program
When does the orientation step happen?
During HA fitting
What happens in the validation step?
- Evaluate the benefits and satisfaction
Can use questionnaires
- IOI-HA (international outcome inventory - hearing aids)
- COSI (client-oriented scale of improvement)
- APHAB
What are the basic hearing aid components?
Microphone, analog-to-digital converter, amplifier, digital-to analog converter, and receiver
What does the microphone do?
It collects acoustic signals from the environment and converts them into electrical signals that are sent to the amplifier
What does the amplifier do?
It amplifies and filters the signal
What does the receiver do?
It sends the amplified signal into the ear canal
Tell me about hearing aid batteries.
- Powers the HA
- May be rechargeable
- Size 10 (yellow), 312 (brown), 13 (orange), and 675 (blue)
What is multiple memory programs?
Specific settings are saved into “programs”
Manual vs. automatic
Signal classification system
Continually measures the input signal to control which program the HA should be in
Controls gain, output, and the HA’s various features
What is multiple channels?
- Frequency-specific channels
- Gain can be adjusted independently in each channel
What is automatic gain control for output (AGCo)?
- Need to limit maximum output of sound
- A type of compression (compression: compression of the sound; doesn’t amplify all the input at the same time)
What is automatic gain control for input (AGCi)?
- Used when soft sounds need to be amplified more than loud sounds
- Type of compression; often called WDRC
What is automatic digital noise reduction?
- Analyses sounds coming into the hearing aid (steady state sounds), finds the channels where they are, and turns them down
- Helps listening comfort and decreases listener fatigue
What is adaptive feedback reduction?
- What is feedback? - leaked amplified sound getting re-amplified
- Phase cancellation
What is directional microphone technology?
- Allows the listener to hear sounds from the front and reduces the output of sound coming from the back and sides of the listener
- Improves S/N (signal-to-noise ratio)
Automatic vs. automatic and adaptive
- Automatic: switches automatically between omnidirectional and directional depending on the listening environment
- Adaptive: while in directional mode, will “adapt” to the changing environment
What is data logging?
A hearing aid log
What are linked hearing aids?
- When adjusting one aid, it automatically transmits that adjustment to the other aid
- Benefit: the client only has to adjust one aid instead of two
What is frequency-lowering?
- Low to mid frequencies: mild to moderate
- High frequencies: severe to profound
- Goal: to “transpose” the high-frequency information into the low/mid frequencies
