Final Flashcards
COUNSELING remember to be:
Sensitive
Empathetic
Humanistic (i.e. different cultures)
In charge, but pt should feel comfortable to ask questions
Well-Patient Model
No psychological problems
Helping them deal w physiological issues
Acceptance & (Re)Habilitation
If deeper issues, must refer out to approp professional
Goals of counseling
Help those we treat Achieve independence Learn how to solve or strategize problems associated w HL i.e. Background noise, classroom, etc. Improve Quality of Life (QOL)
types of counseling
Diagnostic
Emotional Response
Personal Adjustment
Counseling: Diagnostic
Provide and follow…
Results and impressions are imparted to pt and families
Provide basic understanding of audiogram, degree &
nature of HL, and implications to follow
Speech-language development
Trouble in background noise
Classroom acoustics
Tests serve merely as instruments to help explain, provide
advice and counsel
Counseling Diagnostic explaining:
Appropriate Jargon Knowing your scope practice If you need to refer out and why Elicit questions from the patient/parents/family, so they feel their concerns are being addressed
Counseling Diagnostic: Amount of Info
Do not provide more than they can take it
Initial diagnosis w a child – emotions are raw and
processing info is limited
Provide patient/family w written info they can refer
back to
Encourage them to call back w any q’s
Schedule a f/u call once emotional response has settled
Counseling: Diagnostic provide info on
Coming back for an appointment to discuss hearing aids or assistive listening devices Strategies (Re)Habilitation Choices Technological Devices, etc. Arrangements to be made at school
Counseling Diagnostic children
Include them when they old enough to understand
You want them to feel as of they have “a say” in process
Counseling Diagnostics Geriatrics
Don’t just address spouse/caregiver/family member
Although they may be severely hearing impaired or present w cognitive decline, try to include them so they are motivated towards address their issues
They should have “a say” in their healthcare
COUNSELING: EMOTIONAL
Various responses to diagnosis
Sorrow Shock Fear Denial Anger Helplessness Blame Internalized or Externalized
Counseling: Emotional: Parents
Just told them there is something wrong with their child, whom they see perfect in their eyes
Dreams are shattered
Roller coaster of Emotions
Counseling: Emotional: Adults/Geriatrics
Cannot gauge reaction based on affect alone
Helpful to have 3rd Party present
Provide support
Give insight as to how pt is struggling
Acknowledges there is a problem, even though pt may deny it
HL is invisible – not as easily observed in adults vs. children
Can fill in blanks when parts of message is missing, read lips
Counseling: Emotional: Children
parents can see that their child is not responding during testing
Speech & Language fails to develop
Counseling: Stages of Emotion
Denial
Mourning
Anger
Guilt
COUNSELING:
PERSONAL ADJUSTMENT
Help pts and families to make practical changes
in their lives
Assist in developing a positive approach to their hearing loss
Identify technology and strategies
Review realistic expectations and limitations
Provide a supportive base
COUNSELING:
PERSONAL ADJUSTMENT
Nonprofessional Counselor
Provide counseling directly related to primary services
How can we improve their quality of life, which related to a
physiological issue
Present information in an unbiased fashion
COUNSELING:
PERSONAL ADJUSTMENT
Teach them how to cope
Strategies
Continue to live as you would, and include whole family in normal activities and those that are geared towards hearing loss
COUNSELING:
PERSONAL ADJUSTMENT
Questionnaires – subjective information
Provides info beyond audiogram
Gives insight to how pt/parent feels and where they
think they are struggling most
Informs us of daily activities we need to improve for
success
COUNSELING:
PERSONAL ADJUSTMENT
Questionnaires & Students
Elicits counseling opportunities, as it will identify where the
individuals are struggling socially, educationally, and
psychologically
If a student divulges information out of our scoop of
practice, acknowledge it and refer out if needed
COUNSELING:
PERSONAL ADJUSTMENT
Self Advocacy
Individuals need to be able to describe their loss and what accommodations they need to succeed
School: FM, Preferential Seating, etc.
Home: Reducing background noise, facial cues for
communication, etc.
Public Settings: i.e. Restaurant, putting noise behind you
and speaker in front of you
Support Groups
Lets patient/parent know that they are not alone
Learn from others
Lean on one another
May open new opportunities for success, activates, or life
changes
Provides an outlet
Gives them a voice to be heard
Support Groups: parents
Will learn from other parents and it will give them insight on what’s
to come and what to expect
Support Groups: Teens and Adults
You are not alone
Open up about feelings, difficulties, and experiences others without
hearing loss may not understand
Support Groups are found…
Online Regional/State Family Counseling Communities Be sure to provide information in writing for all groups and organizations available
Support Group Names:
Hearing Loss Association of America
Listening & Spoken Language Knowledge Center (Alexander
Graham Bell)
Social Media – Facebook Pages
Hear Ya Now (18-40 years)
International Federation of Hard of Hearing Young People (IFHOHYP)
Hearing Impaired Singles
Inner Ear and Balance
In order for our body to maintain balance there are many systems wn our body that must communicate
These systems coordinate or work togetherby way of cerebellum
3 Main systems of inner ear and balance
Visual
Proprioceptive
Vestibular
Balance systems: visual
Provides direct info from our surroundings and body’s orientation in relation to them
Balance systems: Proprioceptive – Somatosensory
Stimuli received from the muscles and tendons of
body, which allow body-part positioning
Knowing where you are in space
Balance systems: vestibular system
Gravity & Inertia
Vestibular-Ocular Reflex (VOR)
Coordination of your head and eye movements to maintain a stable image, even as your body moves
Eyes move in an equal but opposite direction of head
Work in a push-pull manner damage to vestibular sense organs, patients will complain of dizziness, lightheadedness, or spinning
Vestibule
Oval Window – entry way to inner ear
Vestibule
Chamber/space that connects membranous labyrinths of cochlea and vestibular system
Filled with perilymph
5 Sensory Organs
Utricle
Saccule
3 Semicircular Canals
Utricle and Saccule
Responsible for Linear Acceleration Forward and backwards Up and Down Membranous sacs located w/n vestibule Filled w endolymph
Utricle
oriented horizontally
Back & Forth
Saccule
oriented vertically
Up & Down
Macula
Sensory structure
Contains hair cells
Utricle & Saccule:
Macula
Sensory portion
Hair cells – cilia that project into a gelatinous layer
Otoconia
Calcium carbonate crystals that rest on top of gelatinous layer
Crystals are heavier than endolymph
Force of gravity always acting on cilia of hair cells
Physiology of the Macula
Otoconia weighing on hair cells
Thus when we move otoconia lag behind due to inertia
Due to this lag, it causes hair cells to bend in opposite direction of movement
Bending/Shearing of hair cells – sends a signal to nerve
Semicircular Canals
Arise from membranous labyrinth of utricle
Responsible for rotational acceleration
Horizontal – shaking head “no”
Anterior – shaking head “yes”
Posterior – tilting head from shoulder to shoulder
Filled w endolymph
Semicircular Canals:
Ampulla
Sensory organ of canals
Located at base of each canal
Crista – sensory cells of ampula
Cilia of cells project into a gelatinous mass, cupula (hangs from a stalk on top of ampulla)
Physiology of the Ampulla
Like macula of utricle and saccule
As head rotates, the cupula lags behind
Crista bend in opposite direction
Shearing action sends signal to nerve
Vertigo
symptom of feeling like room or you is spinning
Because the vestibular system is impaired, signals to brain are incorrect which may cause eyes to move when they
shouldn’t
Nystagmus
rapid rocking or snapping movement of the eyes
Spontaneous
Provoked
Can be natural/normal at times
Vestibular System Assessment
Videonystagmography (VNG) Computerized Dynamic posturography (CDP) Vestibular-Evoked Myogenic Potential (VEMP)
Videonystagmography (VNG)
Assessment of vestibular system and central motor function
Measures movement of eyes through infrared cameras
Battery of tests to document a patient’s ability to track an object, and how eyes respond when vestibular system
is excited
Computerized Dynamic
Posturography (CDP)
Aka Sensory Organization Test
Looks at how the body coordinates movements to maintain balance
Provides more of functional assessment of daily life activities
-measure how the pt’s weight is distributed in specific testing conditions
Stable or Unstable Floor
Vision or Perturbed Vision
Any combination of conditions can be put together to see where pt falls apart
Vestibular-Evoked Myogenic
Potential (VEMP)
Sound-evoked muscle reflex
Believed to be generated from utricle and saccule via acoustical stimulation
Tells us more about linear acceleration abnormalities
Controversial test
FDA has not really approved
Vestibular Tests:
VNG Semicircular Canals/Rotational Movement Central Nervous System Peripheral vs. CNS CDP/SOT Functional abilities VEMP Utricle & Saccule/Linear Movement
BENIGN PAROXYSMAL POSITIONAL
VERTIGO (BPPV)
Most common vestibular disorder
Otoconia of utricle dislodge and float around in semicircular canals
Usually affecting posterior canal
BENIGN PAROXYSMAL POSITIONAL
VERTIGO (BPPV) symptoms
Brief vertigo w head movements
Head movement causes the otoconia to stimulate semicircular canals, sending a false signal to brain
Unequal input, induces nystagmus
Nausea and/or vomiting
BPPV causes
Head Injury
Idiopathic
BPPV treatment
Maneuver patient to place otoconia back in correct anatomical position (Epley Manuever)
BPPV prognosis
High success rate 95%
Limited movement post-maneuver to ensure proper placement of otoconia
May reoccur
BPPV:
AUDIOLOGICAL FINDINGS
Tympaometry Type A Acoustic Reflexes Present Air Conduction Normal Bone Conduction Normal Speech Recognition Scores Excellent
BPPV:
DIX HALLPIKE
- Performed as part of the VNG
- Considered to be a positioning test
- Essentially trying to move suspected lose otoconia
- Positive response when nystagmus is present
MENIERE’S DISEASE symptoms
Disorder of inner ear 4 Main Symptoms Vertigo (longer duration) Tinnitus Aural Fullness Fluctuating Hearing Loss Usually unilateral in nature Associated w nausea and vomiting
MENIERE’S DISEASE
causes
Believed to be caused by improper regulation of fluids
of inner ear
Specifically endolymph
Too much is produced, causing pressure in inner ear
aka Endolymphatic Hydrops
MENIERE’S DISEASE: prognosis
Different for everyone
Symptoms usually fluctuate/intermittent over time
Can cause permanent hearing loss on affected side
MENIERE’S DISEASE: treatment
Medication: Meclizine, anti-anxiety, sedatives
Reduced sodium diet
Vestibular Therapy
MENIERE’S DISEASE:
AUDIOLOGICAL FINDINGS
Tympanometry
Type A
Acoustic Reflexes
Present, elevated or absent – dependent the amnt of
hearing loss
Air Conduction
Reduced in low frequencies of affected ear
Bone Conduction
Equally reduced as air
Speech Recognition Scores
Dependent on amount of hearing loss
• May have normal hearing in btwn episodes
•Hearing loss is sensorineural in nature
•Hearing loss may affect remaining frequencies over
time – more of a flat hearing loss
•Total loss of hearing is not very common
VESTIBULAR NEURITIS &
LABYRINTHITIS
Disorder of inner ear
Results from infection of inner ear, causing inflammation
Disrupting transmission of the nerve signals
Typically unilateral in presentation
Viral in nature
Symptoms
Vertigo, off-balance/light headed, changes in hearing and/or tinnitus
VESTIBULAR NEURITIS
Inflammation of nerve Off-balance → Severe Vertigo Nausea and/or vomiting Difficulty with vision Impaired concentration
Vestibular Labyrinthitis
Inflammation of labyrinth
Same as neuritis, but may also experience tinnitus and changes in hearing acuity
VESTIBULAR NEURITIS &
LABYRINTHITIS symptoms
Symptoms are usually acute in onset
Episodes last from several minutes to hours
May occur in clusters for a few days
Usually have one episode and then are symptom free or
experience a residual off-balance sensation
Unlike Meniere’s disease, episodes typically do not reoccur over time
VESTIBULAR NEURITIS &
LABYRINTHITIS treatment
Meclizine, anti-depressant/anxiety, steroids
Vestibular Therapy
VESTIBULAR NEURITIS &
LABYRINTHITIS prognosis
Full recovery
Possible Hearing Loss – sensorineural in nature
Impaired vestibular system
VESTIBULAR NEURITIS & LABYRINTHITIS:
AUDIOLOGICAL FINDINGS
VESTIBULAR NEURITIS & LABYRINTHITIS:
AUDIOLOGICAL FINDINGS
Tympanometry Type A Acoustic Reflexes Present, Elevated or Absent – dependent upon hearing acuity in affected ear Air Conduction Normal or Reduced in affected ear Bone Conduction Normal or Equally reduced as air in affected ear Word Recognition Scores Dependent on hearing sensitivity
Rehabilitation
To restore or return to usual life through therapy
Restoring a skill that was acquired previously
Habilitation
Assisting a child to achieve developmental skills when
impairments have caused a delay of initial acquisition of
skills
Acoustic Neuroma
Benign tumor of auditory nerve
Arise from the myelin sheaths that cover nerve
United States: 100,000/year
Typically seen in adults
Usually a unilateral lesion
Early Symptoms: Tinnitus & Asymmetrical Hearing
Acoustic Neuroma:
Other Signs & Symptoms
Discrepancy between amnt of hearing loss and word
rec scores
Dizziness
Facial Weakness or Numbness
Abnormal sense of taste and smell
Damage/symptoms occur by growth of tumor, causing
there to be pressure on brain and other cranial nerves
Acoustic Neuroma:
Audiological Findings
Tympanometry
Type A
Acoustic Reflexes
Ipsilateral: Absent
Contralateral: Present
Air Conduction
Reduced high frequencies in affected ear
Bone Conduction
Equally reduced as air in the affected ear
Word Recognition Scores
Depending on the stage of tumor growth, results can range from normal to significantly reduced
Acoustic Neuroma:
Diagnosis & Treatment
Diagnosis MRI of Internal Auditory Canal Treatment – dependent on size & location of tumor Monitor Gamma Knife Beams of gamma radiation Arrest growth of tumor Surgery Removal of tumor
Other Causes of VIII Nerve Hearing Loss
Acoustic Neuritis
Inflammation of vestibular or cochlear portion of nerve
Multiple Sclerosis
Auto-immune disease affecting central nervous system
Immune system attacks myelin sheaths that protect nerves, resulting in scar tissue, which alters transmission of electrical impulse along nerve
Other neurological conditions
Cerebral Vascular Accident (CVA)
Parkinson’s
Brain Injury, etc.
Auditory Neuropathy/Dys-synchrony
AN/AD
Otologic Disorder where sounds enter ear normally, but
transmission from cochlea to brain is impaired
Normal outer hair cell function
Transmission of electrical impulses fail to occur in synchrony
Level of dys-synchrony varies from person to person
Site of lesion along the CANS may also vary from patient to pt
Auditory Neuropathy/Dys-synchrony
(AN/AD) signs and symptoms
Hearing can range from normal to profound and can
fluctuate
1/3 with AN/AD will display a severe to profound hearing
loss
Hearing progressively worsens in time
Deaf speech/behavior when normal hearing thresholds
are obtained on audiogram
May present with other peripheral neuropathies
AN/AD:
Audiological Findings
Tympanometry Type A Acoustic Reflexes Elevated and/or absent Air Conduction Range from normal to profound Bone Condition Same as air Word Recognition Scores Disproportionate with amount of hearing loss present
AN/AD:
Site of Lesion Testing
OAE
Normal – since outer hair cells are healthy
ECoG
Present response (measurement of cochlea)
ABR
Absent – no identifiable wave
Absent/abnormal ABR reveals that there is no synchronous neural activity of cochlear nerve
Present OAEs & Absent ABR – Hallmark for the disorder
AN/AD:
Diagnosis & Treatment
Diagnosis Rely solely on ABR & OAE findings MRI fails to display any lesions along VIII CN Treatment Hearing Aids Success varies Cochlear Implants Typically most beneficial outcome Electrical stimulation of nerve may be lead to a more synchronous firing of nerve impulses Cued Speech Speech reading
primary effect of hearing loss
Ability to communicate with others
secondary effect of hearing loss
Impact/influences on education, vocational,
psychological, and social functions
prelingually deaf
congenital or before language was acquired
postlingually deaf
after speech and language has been fully or partially acquired
deafened
– after education is complete (teens/twenties)
hard of hearing
partial hearing loss either at birth or acquired
auditory deprivation
Reduced, or lack of stimulation, in the auditory areas of brain
Atrophy of VIII CN and the association areas in brain
Leads to reduced word recognition ability
World Health Organization – 2 Models
CORE
CARE
AURAL REHABILITATION:
ADULTS - CORE
Communication Status
Overall Participation Variables
Related Factors
Environmental Factors
AURAL REHABILITATION:
ADULTS - CARE
Counseling & Psychological Aspects
Audibility/Amplification Aspects
Remediation of Communication Activity
Environmental Participation
AURAL REHABILITATION:
ADULTS/GERIATRICS
Hearing loss signifies aging Depressing for most Provide with strategies for everyday life and communications situations Self advocating Using visual cues Dealing with background noise Making changes at home
AURAL (RE)HABILITATION:
CHILDREN factors
Age of child at onset of HL
Degree and nature of HL
Age at which amplification was introduced
AURAL (RE)HABILITATION:
CHILDREN
Most debilitating consequence
disruption of speech and lang development, which then affects reading writing, learning, etc.
Early Detection is best!
AURAL (RE)HABILITATION:
CHILDREN
Communication Options – 7 Approaches
Auditory-Oral Auditory-Verbal Listening & Spoken Language Cued Speech Manually Coded English Total Communication American Sign Language
AURAL (RE)HABILITATION: CHILDREN
COMMUNICATION OPTIONS
Auditory-Oral
Spoken language concept that leads to language development
No ASL or finger spelling
Emphasizes consistent use of amplification everyday
Visual cues can be used (i.e. lip reading)
AURAL (RE)HABILITATION: CHILDREN
COMMUNICATION OPTIONS
Auditory-Verbal
Similar to Auditory-Oral, but NO visual cues
During therapy the SLP will cover their mouth to ensure
auditory only input
AURAL (RE)HABILITATION: CHILDREN
COMMUNICATION OPTIONS
Listening & Spoken Language (LSL)
Combination of Auditory-Oral and Auditory-Verbal
Stresses Early Intervention
Emphasizes more of an auditory-verbal approach
Special Certification through Alexander Graham Bell
Association
AURAL (RE)HABILITATION: CHILDREN
COMMUNICATION OPTIONS
Cued Speech
Uses spoken language and 8 visual hand cues around
speakers face
Helps to discriminate between sounds that look similar when produced
Amplification is encouraged
Family needs training
Benefit – child verbally misses a word, can use visual cues to fill in gaps
AURAL (RE)HABILITATION: CHILDREN
COMMUNICATION OPTIONS
Total Communication
Incorporates multiple modalities
ASL, finger spelling, lip-reading, auditory input, etc.
Amplification is encouraged
Similar benefits of Cued Speech – can fill in blanks if misses something
AURAL (RE)HABILITATION: CHILDREN
COMMUNICATION OPTIONS
Manually Coded English
Visual mode of communication
Finger spelling and signing
Follows the same rules of English syntax
Amplification does not always need to be used
AURAL (RE)HABILITATION: CHILDREN
COMMUNICATION OPTIONS
American Sign Language (ASL)
Visual/Manual communication
No amplification
Does not follow the rules of English syntax
AURAL (RE)HABILITATION:
SCHOOL SETTING
Educational Environment
Regardless of who delivers services, an educational
audiologist should be involved w development of
habilitation activities
Both the SLP and educational audiologist should be present at all IEP meetings to support and advocate approp technology and accommodations for both academic and
extracurricular activates
Speech Perception &
Production
Input
Auditory Perception: ability to hear
Auditory Processing: ability of brain to understand
Speech Perception &
Production output
Speech & Spoken Language Organization: ability
of the brain to organize speech and spoken
language
Speech & Spoken Language Production: ability
to produce meaningful speech and language
speech and language is…
Redundant Communication context & intent Semantic content & noun-verb meanings Stress-time information Intonation Patterns Word order regularity Visual cues What is secondary to normal hearing individuals, is pertinent to those with HL Compromised input = poor output
4 Levels of Auditory Skill
Development
Detection
Discrimination
Identification
Comprehension
Auditory Skill Development: detection
Ability to hear
Be aware of a sound, but a verbal response is not required
Auditory Skill Development: Discrimination
Perceive difference between 2 similar sounds
Phonemes, words, phrases, sentences, environmental sounds
Auditory Skill Development: Identification
Identify what has been
labeled or named
Aka recognition
Auditory Skill Development: Comprehension
Highest level of processing
What the brain does w what we hear
Understanding the meaning of auditory input and
application to known info, experiences and language
Key goal for auditory development
ensure family follows through w recommendations and strategies to achieve success
6 strategies for auditory development
Auditory Access Daily Listening Check & Discrimination Acoustic Cues for Prosody & Redundancy in Speech Signal Auditory Environment & Input Overhearing or Incidental Learning Talk Time
Auditory Access
Consistent wearing and appropriate device
Monitoring of the child’s auditory learning w device
Ongoing audiological management
Sufficient auditory input of language
Daily Listening Check &
Discrimination
Monitoring device daily to ensure device is functioning well (parent & SLP)
Perform Ling Six
/u/, /m/, /a/, /i/, /sh/, /s/
Represents all the speech sounds across frequency range
Be sure child can repeat back accurately
Acoustic Cues for Prosody &
Redundancy in the Speech Signal
Early Stages of Auditory Development Melody of message Suprasegmentals Intonation, stress, etc. Changes meaning
Auditory Environment & Input
Ensuring child ALWAYS has access (be sure parents follow through at home)
Reducing background noise
Moving closer to child
Sitting close and being on same level
Overhearing or
Incidental Learning
Goal: teach child how to develop spoken language through listening Learn cues for redundancy Prosodic patterns Phonotactic probability Context of convo Word and knowledge Rules of syntax Distance listening & overhearing – desirable goal
Talk Time
basically how frequently you talk to your child
Amount & Quality of Input
Children who hear more, develop more
Better vocabulary & IQ scores
Encourage parents to speak often and become
confident w what they talk about with their child
Don’t be afraid to expose them
Hearing Age
Calculated from when child consistently begins to wear hearing instrument(s)
Helps put into perspective child’s length of
listening and how they are progressing
Helps to determine what is appropriate for the
child
Functional Auditory Assessment: intrinsic factors
cognitive ability, presence of other disabilities, learning style, auditory processing skills
Functional Auditory Assessment: extrinsic factors
age of identification & intervention, appropriateness of hearing device(s), type & amnt of intervention, parental support
Closed-Set Auditory Assessment
Fixed number of stimuli from which child chooses correct answer (i.e. picture pointing)
Open-Set Auditory Assessment
Items on test are unknown
Use words w/in child’s vocabulary/age-appropriate
Hearing devices available
Hearing Aids Traditional CROS Bone conduction – surgical and non-surgical Cochlear Implants Assistive Listening Devices
history of hearing aids
First electronic hearing aid was introduced in the
late 1800’s
Around 1947 – first commercial use of hearing
aids
Now all newly manufactured hearing aids are
digital
hearing aids: 3 primary components
Microphone(s)
Amplifier
Receiver
hearing aids: microphones
Main Purpose: convert acoustical energy in environment into electrical energy
2 Types
Omnidirectional – microphone response is equal from all directions
Directional – more sensitive to where sound is coming
from by way of a 2nd port
Front and Back ports
hearing aids: amplifier
Takes electrical signal, using a binary
system, and breaks down incoming signal into its components
Then, based on the HL, it will amplify frequencies and sounds accordingly
i.e. soft, moderate, or loud input
hearing aids: receiver
Converts the electrical signal back into an
acoustic signal
aka Speaker
hearing aid styles
Essentially 4 Different Classes
Behind-the-Ear (BTE)
Receiver-in-the-Ear/Receiver-in-Canal (RITE/RIC)
In-the-Ear (ITE)
Completely-in-canal (CIC) or Invisible-in-canal (IIC)
hearing aid style: BTE
Worn over the ear, or behind the ear, w a tube and ear
mold that is worn in ear
All 3 components (microphone, amplifier & receiver) are housed within casing
hearing aid style: RITE/RIC
Similar to a BTE, but the receiver/speaker is in the canal
Much smaller than a traditional BTE
hearing aid style: ITC
3 Types of ITE Full Shell (largest) Half Shell (smaller) In-the-Canal (smallest) All 3 components are housed within a custom shell that is shape of the patient’s ear (like an ear mold)
hearing aid style CIC or IIC
Custom mold that sits much deeper in the canal
Lose features (i.e. directionality)
Hearing aid power source
Battery Operated
Different Sizes
Battery life, battery strength, manipulation
Battery door – opens and closes into casing of either BTE or custom aid
Rechargeable –not as common
hearing aid features
Volume Control Programs Telecoil (T-coil) Direct Audio-Input (DAI) Bluetooth
Hearing aid features: volume control
Ability to raise or lower the volume
Mute Option
Not always enabled, or not available on all styles
Hearing Aid features: Program button
Allows the user to manually change setting of instrument
i.e. omnidirectional, split directionality, mute, TV program
-much more common than volume control
Hearing aid features: T-coil
Magnetic coil housed w/in casing to pick up and connect wirelessly to an external magnetic signal
Initial Purpose – telephone
Induction Loop System – meeting rooms, theatres,
schools, etc. are becoming more and more common
Can be automatic or a manual program
Hearing aid features: Direct Audio Input DAI
Hardwire capability w aids
Direct input from a sound source (i.e. TV, computer, ipod)
Usually seen w BTEs
Hearing aid features: bluetooth
Wireless options
Works with cell phones, computers, ipods, etc.
Can be used w FM-like systems too
Hearing aids: selection factors
Degree of hearing loss Age Cognitive Ability Dexterity Surgical/Draining Ear
Hearing aids selection factors: degree of hearing loss
The more profound the loss, the stronger and usually bigger the device
High frequency hearing loss vs. Flat Hearing Loss
Open Fit vs. Custom mold
Hearing Aids: selection factors: age
Infants/Children
Ears are still growing
BTE with ear molds that can be changed out as they grow
hearing aids selection factors: cognitive ability/geriatrics
Easier to manipulate the better / Ease of insertion
ITE
Battery size
May take away features like volume control or program push button
No extra accessories (i.e. blue tooth capabilities)
hearing aids selection factors: dexterity
How easily can they manipulate device
Battery size
Ease of insertion (BTEs vs. ITEs)
Options like raised push button or volume wheel are available
Magnetic tool to help inset/remove battery
hearing aids selection factors: surgical/draining ear
Stay away from instruments where receiver is in ear (RITE/RIC & ITEs)
Use BTEs where the receiver is not ear, this way if ear drains, moisture is not going inreceiver, but rather just the ear mold that can be cleaned
Moisture in the receiver = damage
Hearing aids: maintenance and care
Instruments should be cleaned on a somewhat daily basis
Cleaning and maintenance tools can include:
Wax pick
Tubing blower
Listening stethoscope
Battery tester
Dri-Aid Kit
3 typical issues that may arise with hearing aids
Dead Hearing Aid
Feedback
Signal is Distorted or Intermittent
Dead Hearing Aids
Change the battery
Make sure tubing/ear mold and/or receiver is not occluded w debris
Hearing Aids: Feedback
Volume is too high
Aid was not inserted properly into ear
Ear mold is too small for the child – ears grow quickly, may need a new mold every 3 months
Make sure there are no cracks in the casing or tubing
Make sure the ear canal is not occluded w cerumen
Hearing Aids: Signal is Distorted or Intermittent
Inspect the instrument for any moisture
Listening check with stethoscope
Problem during humid months of the year – suggest
a dri-aid kit
Hearing Aids: CROS style
CROS – contralateral routing of offside signals
Utilized for unilateral hearing loss/single sided deafness
A microphone is worn on side of worse ear, which picks up sound patient otherwise wouldn’t hear and routes it to a device in good ear
Providing patients w info from their nonfunctioning ear
CROS
Normal hearing in good ear
Device worn on good side will not provide amplification
BiCROS
Hearing loss in good ear
Device worn in good ear will amplify sounds in addition to providing missing info from worse ear
Hearing Aids: Bone Conduction Styles
Instead of using air conduction in traditional hearing aids, utilize bone conduction to transmit signal
Useful for patients who have…
Constantly draining ear
Malformed pinna and/or ear canal
Hearing Aids: Bone Conduction Styles: Non-surgical
Head band with a bone oscillator attached
Can also provide stimulation via the teeth
Hearing Aids: Bone Conduction Styles: Surgical/Implanted
Titanium screw is surgically placed in the mastoid bone
Oscillator attaches to abutment
Sends signals via bone conduction
Cochlear Implants
Electronic device that allows for direct stimulation of auditory nerve
Internal Components
External Components
Cochlear Implants: External Components
Behind the ear piece – picks up the acoustic signal
and processes sound into a digital signal
Transmitter – receives input from the processor and
sends it the receiver under skin
Cochlear Implants: Internal Components
Receiver – takes input from transmitter and sends signal to electrode array
Electrode Array – thin wire coil with several electrode channels that will stimulate the auditory nerve
Cochlear Implants: Team Approach
Otologist Audiologist Speech Pathologist Social Workers Primary Care Physician Early Intervention Teacher of the Deaf
Cochlear Implants: Trouble Shooting
One difficulty is that you cannot listening to device to see if it is working
Check function light on processor
If it is not flashing, the battery may need to be changed
Usually rechargeable
Do not last as long as HA batteries
Check wires and magnet
Looking for an fraying or disconnections
Assisstive Listening Devices
FM Systems Induction Loop Infrared Systems Environmental Adaptations Personal Listening Devices
FM Systems
Utilizes radio frequencies to carry the desired signal Speaker wears microphone Signal is delivered via… Speaker/Sound Field Ear Level device Desk Top Speaker Coupled to hearing aid
Main purpose of FM systems
Increase the signal-to-noise ratio (SNR)
Direct comparison of the desired signal, i.e. teacher’s voice, to level of background noise
Multiple studies have revealed significant benefits to
device and increase in educational performance
Induction Loop System
Electromagnetic field is created by a loop of wire around
a room
Microphone transmits signal to induction loop
Hearing aids or personal system picks up signal
Hearing aid users can use a manual program, or they can automatically switch into this mode as soon as it recognizes magnetic field (T-coil)
Induction Loop system can be used as
a personal device
Speaker wears microphone
Receiver wears a wired loop around their neck, which can send a wireless signal to their hearing aids, or it can be hardwired to headphones
Seen mostly in auditoriums, theatres, boardrooms, etc.
Starting to grow in popularity
Infrared Systems
Uses light frequencies that are invisible to human eye
to carry signal
Drawback – objects will interfere with signal transmission
Best for smaller spaces, or open areas
Home use with TV
Can be seen in cinemas, theatres, etc.
Environmental Adaptations
Amplified phone speaker and ringer
Alarm systems that utilize flashing lights or vibrations
Emergency Signals – fire alarm, carbon monoxide
Other: crying babies, door bells, alarm clocks, etc.
TDD – telecommunication devices for deaf
Closed Captioning for the TV
Personal Listening Systems
Hardwired devices
Composed of a microphone, amplifier, and speaker/headphones
Good for patients in nursing homes, with dexterity issues,
cognitive decline, visual impairments, etc.
Easy to use and manipulate
ASSISTIVE LISTENING DEVICES IN
SCHOOL
Educational Audiologist
Determines, fits, and manages/monitors the device(s)
Absence of Educational Audiologist
SLP – work w student’s private audiologists, who will determine appropriate device for child
SLP & TOD – manage and monitor device and child’s progress
Schools may want to contract a private audiologist to help w selection, fitting and management
ASSISTIVE LISTENING DEVICES IN
SCHOOL: MANAGEMENT
IDEA (2004) strengthened responsibility of device
management
Students’ IEPs should include a monitoring plan and who is
responsible
ALD: MEASURING PERFORMANCE
Objective & Subjective Measures
Observe the classroom environment
Seating arrangements, classroom design, acoustics
Observe child’s performance & behaviors
What is expected on the students, i.e. participation level
Questionnaires – students, teachers, and parents
Function Assessments – measures performance
Use these tools pre- and post-modifications to validate
and set goals
SCHOOL SERVICES & HEARING LOSS
Children w HL are not automatically eligible for special
ed and related services
IDEA – eligibility requires an “educational manifestation”
of disability
Section 504 – impact on education would be “substantially limiting one or more major life function(s)
School services and deafness
a hearing impairment that is so severe that child is
impaired in processing linguistic information through hearing, with or without amplification, that adversely affects a child’s educational performance
school services and hearing impairments
an impairment in hearing, whether permanent
or fluctuating, that adversely affects a child’s educational
performance but that is not included under definition of deafness
ASSISTIVE LISTENING DEVICES IN THE
SCHOOL
Remember that no 2 children are same
2 Children may present with the same degree and nature
of HL, but their educational consequences may be very
different
Auditory Processing, learning style, and behaviors will
have a large impact
