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CSD 591 > Final > Flashcards

Final Flashcards

1
Q

How to qualify for HAs

A
  • “significant” HL (mostly mild HL or worse; CHL or SNHL)
  • medical clearance for CHILDREN not adults
  • data needed: PTA/B, speech reception threshold (softest level they can repeat words), speech recognition in quite & noise
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2
Q

Dynamic range

A
  • usable range; difference b/t dB(PTA) & threshold
  • larger range in people w/out HL
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3
Q

Recommended time frame for children getting HAs

A

screening by 1 month, HL identified by 3 months, intervention by 6 months

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4
Q

stages of change

A

process where people vary their readiness to change (get HAs)
1. pre-contemplation (denial)
2. contemplation
3. preparation
4. action (Auds work here)
5. maintenance

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5
Q

How do HAs work?

A
  1. mic (acoustic signal) is transduced into electrical signal
  2. amplifier increases strength/loudness of signal
  3. receiver/speaker (electrical signal) is transduced back to acoustic signal
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6
Q

HA Microphone

A
  • transducer
  • converts acoustic to electrical signal
  • sound waves move diaphragm & coil back & forth
  • coil is wrapped at magnet (creating a current)
  • electrical signal is sent to amp
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7
Q

HA Amplifier

A
  • electronic device that increases amplitude of voltage (current of signal)
  • generates a larger current electrical signal sent to receiver/speaker
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8
Q

HA Receiver/Speaker

A
  • converts electrical signal (from amp) to acoustic signal
  • considered a small loudspeaker
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9
Q

HA Batteries

A
  • +/- proper insertion
  • 3-22 day battery life
  • 13, 312, & 10A are most common
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10
Q

Most common HA

A

BTE - mild to severe

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11
Q

Common BTEs

A

Open fit - clear tubing
RITE & RIC - wire in tubing
- mild to moderate (mostly SNHL)

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12
Q

Which type of HA has a longer adjustment period

A

Digital (DSP)

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13
Q

Where does the mic & receiver go for HAs (CROS)

A

mic - bad ear
receiver - good ear

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14
Q

Standard BTE

A
  • mild to severe
  • good dexterity
  • larger controls
  • 2 components: unit + HA
  • less feedback
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15
Q

ITE/ITC

A
  • mild to moderate
  • okay dexterity
  • 1 unit
  • enhanced amp of high frequencies
  • wax can block speaker
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16
Q

CIC

A
  • mild to moderate
  • cosmetically appealing
  • reduction of occlusion effect (booming sound) & feedback
  • less gain needed
  • elimination of wind sound
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17
Q

Circuitry

A
  • guts of HA
  • Analog vs. Digital
  • depends on severity of HL
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18
Q

Digital Signal Processing (DSP)

A
  • compression features allow soft sounds to be amplified more than loud sounds
  • noise reduction circuits work better than analog
  • self adjusting
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19
Q

Analog Signal Processing (ASP)

A
  • make sound waves louder
  • amplifies all sound (speech & noise)
  • most are still programmable
  • less expensive
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20
Q

Binaural vs Monaural

A
  • 60% of people with HL are fit with 2 HAs
  • localization improved (eliminates head shadow effect)
  • loudness summation adds signal received to both (3dB benefit in both ears)
  • ears working together to suppress background noise
  • BUT binaural interference (info from 2 different inputs)
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21
Q

Who can’t use AC HAs?

A
  • people with congenital atresia, microtia, some otosclerosis, or single-sided deafness
  • people with BAHAs
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22
Q

Bone Anchored Hearing Aids (BAHA)

A
  • info sent via BC across skull to opposite ear canal to Aud. N.
  • goes opposite way through skull to stimulate cochlea
  • BAHA goes on bad ear (skull side)
  • titanium implants
  • skin penetrating abutment
  • sound processor
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23
Q

adjustable components of HAs

A
  • earmolds
  • microphone
  • electroacoustic parameters
  • real ear measurement
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24
Q

Earmolds

A
  • anchor HA to ear
  • deliver sound from receiver to ear canal
  • sized to accommodate HL degree
  • usually bigger HL=bigger earmold
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25
Q

Telecoil

A
  • aka: T
  • pick up telephone signal
  • HA will not work on “T” setting
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26
Q

Output limiting

A

prevents signal from becoming too loud for people with reduced dynamic range

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27
Q

Specifications for HAs electroacoustic properties

A
  • output level (SPL)
  • gain
  • frequency range
  • distortion
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28
Q

Gain

A

Concept: The amount of amplification a HA
provides when conversational
sounds enter the HA.
Greater the HL, the greater the
gain needed from a HA. The gain in
a HA can be adjusted

Effect for person with HL: If there is too little gain, person may not
perceive benefit from HL. If the gain is
too high, persons may reject HA

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29
Q

Frequency Response

A

Concept: Filters used to emphasize high vs
low frequency HL so that it
matches the shape of the
audiogram. Frequency response can be
adjusted

Effect for person with HL: If a person has a HF HL and has low
frequencies included in the signal
(meaning they are not filtered out), they
will most likely not like the sound of the
HA and could even reject it.

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30
Q

Output limiting

A

Concept: The maximum output of a HA
when a loud sound enters the HA
and the volume is turned all the
way up – especially important for
persons w SNHL who have limited
Dynamic range. Output can be
adjusted

Effect for person with HL: If a sound from a HA exceeds the
person’s tolerance for sound, then the
sound will be uncomfortable, potentially
damaging and may result in a person
rejecting the hearing aid.

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31
Q

Distortion

A

Concept: HAs can distort sound when
amplified, but the total distortion
should not exceed 4% . Distortion
can be adjusted

Effect for person with HL: If there is too much distortion, the
individual user will complain that the HA
is noisy and will not want to wear.

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32
Q

Cochlear Implants (CI)

A
  • electronic device that can provide a sense of sound to a person who is profoundly deaf or severely hard of hearing
  • bypasses a nonfunctional inner ear & stimulates nerve with electrical current
    -surgically placed under skin & behind the ear
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33
Q

Important dates of CI

A

1985: FDA approved CI for adults
1990: FDA approved CI for kids

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34
Q

external parts of CI

A
  • transmitter
  • external magnet
  • microphone
  • speech processor
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35
Q

internal parts of CI

A
  • receiving antenna
  • internal magnet
  • receiver
  • electrode array (enter via ST for access to BM & put through RW)
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36
Q

How does the external CI work?

A

Directional mic: picks up sound, changes acoustic to electrical, electrical signal sent to speech processor

Speech processor: receives electrical info, selects & arranges sounds into codes, coded signal sent to transmitting coil

Transmitting coil: receives coded signals from speech processor & sends as an FM radio signal across skin via antenna under the skin

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37
Q

How does internal CI work?

A

Antenna: receives code from across skin

Receiver stimulator: receives signal from antenna & sends signal to electrode array

electrode array: receives coded signal, stimulates the nerve fibers which sends message to the auditory cortex portion of brain

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38
Q

Take home about CI signal - why this matters to SLPs & Auds

A

CI signal is inferior to normal hearing, so they need training & therapy to use it

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39
Q

CI process

A
  • determine candidacy
  • surgery (3-4 hours)
  • Hook up (4 weeks in between hookup & mapping)
  • habilitation/ rehab
  • education
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40
Q

CI adult candidacy (18+)

A
  • moderate to profound SNHL in both ears
  • limited benefit from amp defined by pre-op test scores of <= 50% sentence recognition in ear being implanted & <=60% in opposite ear or binaurally
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41
Q

CI child candidacy (2-17 yrs)

A
  • severe to profound SNHL in both ears
  • limited benefit from binaural amp
  • Multisyllabic Lexical Neighborhood Test (MLNT - speech pereception) or Lexical Neighborhood Test (LNT) scores <=30%
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42
Q

CI child candidacy (9-24 months)

A
  • profound SNHL in both ears
  • no medical contraindications
  • limited benefit from binaural amp after a HA trial
  • monitor auditory milestones
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43
Q

Factors affecting CI outcomes

A
  • duration of deafness (one of biggest factors)
  • chronological age
  • other conditions (ex: meningitis - ossification of cochlea)
  • functional/residual hearing prior to CI
  • Speech & lang abilities (affects rehab, may want to use ASL+ CI)
  • Fam support/structure
  • expectations (parents may have higher expectations than CI can deliver)
  • educational environment (mainstream school vs. school for the deaf)
  • Cognitive learning style
44
Q

Medical considerations for CI

A

Absolute contraindications (NO WAY implant): cochlear nerve aplasia, complete agenesis of cochlea

Relative contraindications (case by case): ossification (caused by meningitis), congenital malformations of IE, active chronic OM

Anatomic considerations: must have cochlear nerve, changes of technique can be used if partial IE malformation

45
Q

Which ear to implant for CI?

A
  • typically better ear is implanted
  • ear free of OM
  • patient preference
  • if 1 ear can still benefit from HA, then worse ear can be implanted
  • strong evidence for bilateral CIs in adults
46
Q

CI surgery

A
  • 3 (sometimes 4) hour procedure
  • approval from 3rd party payer
  • scalp shaved (mastoidectomy approach)
  • Chochleostomy (electrode insertion in ST)
  • Intraoperative monitoring by Aud ( make sure good connection b/t CI & BM
47
Q

CI risks/complications

A
  • bleeding
  • infection
  • meningitis
  • facial paralysis
  • tinnitus, vertigo
  • ear numbness
  • device failure; migration (<1% to 3%)
  • magnet has to be surgically removed prior to any MRI
48
Q

After CI surgery

A
  • Hookup between external & interal parts takes 3 weeks
  • mapping is performed after (performing dynamic range)
49
Q

factors that affect CI outcomes - Adults

A

TIME: age at time of implant; pre-implant duration of deafness

HEARING: pre vs post lingual, etiology of HL, residual hearing prior to CI, appropriate device programming

BRAIN: neuroplasticity, medical radiological, cognitive ability, consistency of use

THERAPY: access to rehab facilities

OTHER: fam & vocational support, additional special needs

50
Q

factors that affect CI outcomes - Children

A
  • same as adults plus…
    THERAPY: quality of educational & habilitative environment, mode of communication
    OTHER: maternal education
51
Q

Downsides of CI

A
  • will likely hear sounds differently
  • lose residual hearing
  • may have unknown/uncertain effects
  • may not hear as well as others with CI
  • may have limited benefit of understanding speech & lang
52
Q

CI microphone

A
  • Picks up sound from
    environment
  • Mic converts acoustic sound to an electrical
    signal and sends to speech processor
53
Q

CI speech processor

A
  • Unit receives electrical signal
    from microphone and
    arranges the speech signal
    into a code
  • Analyzes the speech signal into its frequency
    components of speech (high, mid, low) using
    band pass filtering concepts. Sound is also
    compressed here based on individual
    need.The amount of current is controlled by
    the MAP that is derived from T and C levels
    of individual
54
Q

CI transmitter (coil & magnet)

A
  • Unit receives the coded
    electrical signal from the
    speech processor
  • Sends the signal across the skin via radio
    frequency waves and holds the coil in place
55
Q

Receiver/Stimulator
/Electrode array

A
  • Receives the coded electrical
    signal from the transmitter
    and sends signal to the
    electrode array in the
    cochlea.Electrode is implanted
    alongside the basilar
    membrane.
  • Electrical signals are allocated to each
    electrode based on their place in the cochlea.
    High frequency sounds get allocated to the
    basal end of the cochlea. Low frequency
    sounds get allocated to the apical end. Nerve
    fibers get stimulated based on the which
    electrode is activated
56
Q

Adult AR

A
  • sensory management
  • instruction
  • perceptual training
  • counseling
57
Q

Transtheoretical Model of Health Behavior Change

A
  • provides info about predicting client attitudes in relation to smoking cessation, weight loss, & exercise behavior
  • Stages of Change is a process where people vary n their “readiness to change”
58
Q

Speech reading

A
  • learn to use visual cues to supplement what is heard (especially in noise)
  • not an easy skill to develop because articulators move so fast
  • look at mouth movements, gestures, facial expressions, & physical environment
  • NOT lip reading
59
Q

Why do we look at speech reading?

A

predictor of who will benefit from CI

60
Q

Why do we move our articuators?

A

to produce acoustically distinct sounds NOT visually contrastive movements

61
Q

How much of spoken english is lip readable?

A

30-35%

62
Q

What does speech reading NOT account for

A

coarticulation & stress effects

63
Q

Stress

A

emphasis on words in a sentence or phonemes in a word
- ex: I didn’t say vs. i didn’t SAY

64
Q

Coarticulation

A

phonemes are influences by the sounds around it
- ex: I have (haf) to go in & I miss (mish) you

65
Q

signal code

A

place & visemes

66
Q

Visemes

A

represent the facial expression related to pronounciation of certain phonemes
- phonemes that look identical on the mouth
- ex: thy vs thigh, /l/ -hidden in mouth, etc

67
Q

Can speech reading be trained

A

Yes, & it’s an approach similar Auditory training

68
Q

Analytic

A
  • focus on the building blocks of spoken english
  • bottom-up training
69
Q

Synthetic

A
  • focus on getting the main idea
  • top-down training
70
Q

Clear Speech

A

saying “ the ship left on a cruise” instead of “the shiplef ona twoweecruise”

71
Q

Vocational Rehab Counseling

A

GOALS: enhance communication function, increased participation in community, increased participation in employment
- job coaches assist in securing needed therapies

72
Q

Vocational Rehab Eligibility

A
  • physical or cognitive impairment to impact employment
  • ability to benefit fro VR services in terms of employment
  • if they require VR services to prepare for, enter, engage in, or retain employment
  • lack of awareness of own rights to accommodations
73
Q

Assistive Technology

A

Hearing Assistive Tech (HAT) = Assistive Listening Devices (ALD) = Assistive devices (AD)

74
Q

Why use HAT?

A

1: HAs aren’t enough
2: help people hear better
3: legislation

75
Q

Why HAT? Physical factors affecting speech perception

A
  • amount & type of noise in a room
  • distance the listener is from the speaker & how close they are to the noise source
  • reverberation characteristics (want low)
76
Q

What signal to noise (S/N) ratio is needed for people with HL to hear as good as people without HL?

A

+15-25dB S/N (full boat) IDEAL
- half sunk: +6dB
- fully sunk: 0 dB - speech is fully competing with noise

77
Q

Inverse Square Law

A

sound attenuates (intensity decreases) with distance
- lose 6dB of sound with every doubling of distance

78
Q

Which sounds are heard from a farther distance

A

voiced>unvoiced

79
Q

What length of reverberation negatively affects speech perception?

A

longer reverberation

80
Q

HAT transmitter & receiver systems

A
  • FM
  • electromagnetic induction loop (t-coil)
  • bluetooth
  • Infrared (IR)
  • hardwired systems
81
Q

What do HAT transmitter & receiver systems do?

A

bring sound from a distance to listener’s ears

82
Q

Frequency Modulation (FM)

A

enables HAs to wirelessly connect w/ external mic to improve speech signal listener (longer distance)
- uses radio waves (allocated stations for education)
- transmitter: radio station
- receiver: a radio

83
Q

(FM) you can leave the room & still hear the presentation

A

true

84
Q

(FM) system can be used inside and outside

A

True

85
Q

(FM) must have a receiver to use this system

A

true

86
Q

(FM) must have an HA to use FM

A

false

87
Q

(FM) can use FM in multiple rooms in the building

A

true

88
Q

(FM) I can use my FM receiver with your FM transmitter

A

true - ONLY if you’r on the same channel

89
Q

Bluetooth

A

uses short range wireless tech (10m/30ft) & not suitable for long range listening venues
- enables HAs to wirelessly connect w/ cells, TV, computer, tablets w/ HAs & CIs or remote mics
- very high-frequency radio waves to transmit data
- creates binaural signal in HA or CI

90
Q

Remote mics

A

wireless system that helps people hear & understand speech in noisy situations & over distances
- some RMs work together w/ HAs & others are made for those w/ some normal hearing
- transmitter: includes mic
- receiver: universal, integrated, stand alone

91
Q

Infrared (IR)

A

uses invisible IR light (similar to TV remote controls)
- can be used w/ headphones or a neck loop to connect to HA or CI
- transmitter: emitter panel (like IR diode on remote; emits signal like a flashlight)
- receiver: lanyard

92
Q

(IR) you can leave the room & still hear the presentation

A

false

93
Q

(IR) can be used inside or outside

A

false (maybe at night)

94
Q

(IR) must have a receiver to use the system

A

true

95
Q

(IR) must have an HA to use IR

A

false

96
Q

(IR) can use IR in multiple rooms in a building

A

true

97
Q

(IR) I can use my IR receiver with your IR transmitter

A

true

98
Q

Electromagnetic Induction Loop (Hearing Loop)

A

uses electromagnetic fields of energy
- loop provides a magnetic wireless signal that’s picked up by the HA when it’s set to “T”
- mic: PA system
- transmitter: created by a loop of several wires
- receiver: T-coil in HA

99
Q

(Loop) can leave the room & still hear presentation

A

false

100
Q

(Loop) can be used inside & outside

A

false - mostly indoor

101
Q

(Loop) must have a receiver to use

A

false - just need a t-coil

102
Q

(Loop) can use induction loops in multiple rooms in a building

A

true

103
Q

(Loop) I can use my loop receiver with your loop transmitter

A

true

104
Q

General HAT troubleshooting

A
  • are batteries charged?
  • what sources of interference are close by?
  • Must have 1 free channel in between if 2 different stations are being used in rooms next door
105
Q

Hard wired

A

pocket talker
- pros: low cost, flexible uses, easy to use
- cons: generic amplification, wired, unable to hear others

CSD 591 (2 decks)

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