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AUDE 6150 > final exam with review > Flashcards

final exam with review Flashcards

1
Q

challenges of fitting a reverse slope loss

A

the addition of too much gain within the LF’s can lead to upward spread of masking as well as satisfaction may be limited due to increased likelihood of extensive dead regions

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2
Q

fitting strategies with a reverse slope loss

A

-add 15-20 dB gain to the low and mid frequencies
-add 10-15 dB at 2kHz and above for increased audibility
-allow time for habituation before any additional increases

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3
Q

what is important when we interact with patients that have a severe to profound hearing losses

A

we have to think of every patient individually, no two are the same
-residual hearing depends on individual factors
-be aware they may not be able to process speech due to the degree of loss

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4
Q

audibility objectives with severe to profound loss

A

need to consider communication style and patients may be more dependent on a specific signal processing type (i.e. some may prefer linear or nonlinear)

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5
Q

fitting strategies with a severe to profound loss

A

-raising up the TK may result in more access to the sounds that are more important to them
-lower compression ratios (closer to linear)
-slower acting compression to maintain longer non-compressed state
-using NAL-RP is recommended
-ensure to raise MPO as high as we can while staying under LDL

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6
Q

with severe to profound loss, these people tend to prefer _______

A

linear

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7
Q

fitting strategies needed for conductive loss

A

additional gain is needed to overcome the attenuation caused by the mechanical loss
-NAL formula is recommended

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8
Q

fitting with perforations

A

-losses that need LF energy will need ventilation
-BTEs are the only option for these patients to allow circulation
-NAL 2 is used

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9
Q

challenges with A/B gaps and fitting

A

these gaps attenuate the amplification prior to when it arrives to the cochlea
-additional gain will be needed to overcome these gaps

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10
Q

how to overcome the A/B gaps in fitting

A

calculate prescriptive gain that is recommended for the AC thresholds
-calculate 25% of the gaps
-increase the MPO by the same percentage allowing headroom for the extra gain
-use NAL as it calculates for this

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11
Q

two reasons as to why we measure RECD

A

it accurately converts an individuals HL audiometric thresholds into dB SPL values and it can allow for a prediction of real ear output when HA measurements are made within the test box

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12
Q

what is the importance of gaining personalized conversions from an RECD

A

the HL of two patients may be the same however the SPL can vary based on their individual ear factors
-if we use average data, this can lead to over or under amplification

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13
Q

how will slit leaks present on an RECD measurement

A

there will be a negative RECD within the LF
-can check the seal
-if that does not fix it, you can increase the tip size or use aquaphor

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14
Q

how will a blockage present on an RECD measurement

A

there will be a negative RECD within the HF

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15
Q

explain how ear canal volume can impact the SPL

A

-the smaller the volume, the higher the SPL (needing some more gain)
-the higher the volume, the lower the SPL (not needing as much gain)

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16
Q

why will we see changes in the RECD with patients that have perfs or PE tubes

A

with these two conditions, we have the additional of the ME cavity while measuring the volume
-we will see that LF energy is being released into the ME cavity o these lows are impacted more often
-therefore, the RECD will be decreased!!

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17
Q

why will we see changes in the RECD with fluid

A

the eardrum becomes stiffer and gets smaller, becoming a different system with different movements
-the RECD will be increased due to a smaller volume

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18
Q

why will we see changes in the RECD with a mastoidectomy

A

the ear canal space is impacted so therefore we will see a larger volume and therefore the RECD will be decreased

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19
Q

if there is a larger volume, the RECD will be _______. if there is a smaller volume, the RECD will be _______,

A

decreased ; increased

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20
Q

what are the steps that should be completed prior to the first fit appointment

A

conduct ANSI measurements, program the HA using RECD data and perform a listening check

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21
Q

frequency lowering is not recommended to be turned on at the first fit appointment however during the programming we can turn it on to observe. what are we doing to see how it functions?

A

we assess FL both with it off then with it on while playing a /s/ signal within the test box
-we are observing for the MAOF to become audible with their thresholds

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22
Q

day of delivery appointment notes

A

ensure a conformity evaluation is ran, perform speech map at 65 dB only, we can lower the volume if needed based on the perception from the patient and we are able to use speech map as a counseling aid to help show the patient what speech they hear and what they miss

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23
Q

functional gain (FG)

A

compares the patients unaided sound field audiogram to the aided audiogram
-this needs to be tested using soundfield for both the unaided and aided!!!

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24
Q

how is FG assessed

A

there is a pulsed or warble tone presented while masking is presented to the other ear using inserts
-the opposite ear is tested with the device through soundfield
-testing 500 to 4kHz

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25
Q

common reasons for measuring FG

A

REM equipment may not be available, cerumen may clog the probe microphone, pediatric fittings or uncooperative patients, CI/BAHA/lyric fitting and some federal government agencies may require it

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26
Q

with FG, we are not looking to achieve 0 dB for aided. what is a ballpark value we are looking for

A

around 20 dB

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27
Q

limitations of FG

A

test-retest is poor (could vary as much as 20 dB from day to day), testing only identified threshold of audibility, aided thresholds are invalid for near normal hearing, limited number of frequencies tested, HA features could suppress audibility of the tones, loss of HF aided functional gain is caused by AGC knee point

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28
Q

to ensure efficacy of aided function gain, when do these tests need to be performed?

A

after every modification to gain

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29
Q

what are the alternative conformity protocols

A

aided speech intelligibility measures, aided verification of adaptive speech in noise performance, aided loudness ratings and subjective soundfield ratings

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30
Q

aided speech intelligibility measures

A

checking to see if the audibility we added improved the ability to detect speech
-present speech through sound field

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31
Q

aided verification of adaptive speech in noise performance

A

ensures SNR loss did not degrade with amplification and functional verification of improved performance
-QuickSIN that is performed in the soundfield
-we need to adjust the signals manually, so after each sentence we increase the noise by 5 dB

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32
Q

what is the starting SNR for QuickSIN

A

+25 dB
-meaning the signal is 25 dB louder than the noise

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33
Q

aided loudness ratings

A

aided bilaterally and provide the patient with the loudness chart
-deliver a 45 dB signal (1-3 is acceptable)
-deliver a 65 dB signal (3-5 is acceptable)
-deliver a 85 dB signal (5 or 6 is acceptable)

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34
Q

subjective soundfield ratings

A

both subjective speech intelligibility and subjective speech quality judgements

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35
Q

3 considerations to determine if manual memories are warranted

A

how often they are in challenging environments, can the patient hear the difference and would the patient be able to understand/manage the programs

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36
Q

how often would a patient need to be in challenging environments to benefit from multiple memories

A

frequently!!
-with occasionally, you would need to determine with additional questions
-people that are rarely in challenging environments are not needing programs

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37
Q

what factors would impact the ability for a patient to hear the difference between programs

A

configuration does not require LF gain/output, feedback limits ability to add HF gain/output, receiver size limits the output and can’t increase the CR further

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38
Q

what factors would allow the patient to hear the difference between programs

A

threshold at 500 Hz is better than or equal to 40 dB and that the HF loss is not too severe

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39
Q

what factors decide if a patient could be able to understand/manage the programs

A

have the patient describe when they would use the programs, can the patient manipulate the control and can also screen for any mild cognitive impairment

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40
Q

what is the goal when creating a program for speech in low-frequency weighted background nosie

A

to eliminate the offending signal (within the lows) while increasing the high frequencies for clarity

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41
Q

changes that should happen for speech in low frequency background noise

A

-lower the low frequency band from 1kHz to 250 Hz (most at the very lowest)
-raise the high frequency band from 2kHz to 4 kHz (most at the very highest)

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42
Q

changes that should happen to improve comfort listening in low frequency weighted background noise

A

-raise the low frequency TK below 1.5 kHz to attenuate the soft LF signals
-increase the CR in the LF loud input channel (done by decreasing the gain)

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43
Q

changes that should happen for high frequency weighted background noise

A

increase the bands of LFs (the most at 250 Hz and the least at 1 kHz) and then decrease the bands of HFs (the most at 4 kHz and the least at 2 kHz)

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44
Q

what is the goal of programs for party noise

A

improving the comfort and striving for tolerance

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45
Q

what are the complexities with making a program for music

A

no long term average, intensity/frequency variations are significant and the intensity max/min are very different than speech (can be up to 16 to 18 above whereas speech is 12 above)

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46
Q

management of the amplifier origin

A

lower the LF band 4-6 dB
-if still present, try increasing it to overcome the mild occlusion and under amplification

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47
Q

how to assess the management for the shell origin

A

we can push the HAs further in then pull it out slightly, if the complain is better when it is deeper change the canal length but if the sound is better when it is pushed out change the vent

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48
Q

changes that should happen for party noise

A

-raise TK for HF up to 60 dB for attenuation of the soft HF signals
-increase the CR in the loud input channels (taking the edge off)

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49
Q

management of the shell origin

A

open vent or increased canal length

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50
Q

fitting suggestions for music

A

select a HA with a microphone that allows high front end input range or ….
-lower the volume on the stereo while increasing the volume on the aid
-use FM system as the input source instead of the device microphone
-place 3 layers of scotch tape over microphone to attenuate input by 10 to 12 dB

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51
Q

changes that should occur within a dedicated music memory

A

-disable DFS, DNR, adaptive directional microphone and frequency lowering
-reduce CR in the low frequencies by raising gain for loud input signals
-raise MPO to improve brightness/crispness

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52
Q

how can we tell if it is shell or amplifier origin

A

if the complaint is there with the device turned off, it is shell. if the complain stops when the HA is turned off, it is amplifier origin.

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53
Q

what are the two origins for the occlusion effect

A

shell and amplifier

54
Q

TK adjustments

A

best for adjusting the soft channels or any signal below the TK
-don’t forget about expansion below the TK

55
Q

MPO adjustments

A

best for adjusting the loud channel or any signal that is greater than 65 dB
-this can introduce more headroom

56
Q

what are some scenarios when we would change the TK

A

if the HA does not have expansion (raising the TK) or if you want the patient to hear more soft consonant sounds (lowering the TK)

57
Q

what does medicare reimburse

A

diagnostic procedures needed to diagnosis a patient
-annual or recurrent services are not covered
-audiologic treatment is not covered

58
Q

who can be reimbursed

A

the audiologist is the only one unless the state allows for a physician to be reimbursed

59
Q

medicare requires medical necessity, what are some examples of this

A

must be necessary based on diagnosis or symptoms, re-evaluation due to suspected change in hearing/tinnitus/balance or to investigate the cause of a disorder

60
Q

bundling billing practices

A

consumer prepays for all the current and future services at the time of the purchase ; one flat rate up front
-generally the HA cost + $1000

61
Q

benefits of bundling services

A

practice can estimate the revenue generation based on number of amplification units dispensed each month and billing protocols are less complicated

62
Q

bundling does not recognize everything we give away such as ….

A

time spent completing FCNA, time spent on quality control checks or programming, time spent programming or finetuning, time spent on HAC, in office repairs

63
Q

when we charge a single price for a HA with all of the services, it shows the patient ……

A

that the HA is costly but our time is free

64
Q

unbundling billing practices

A

separates the cost of technology from all other associated services
-the patient is in control of what they can pay

65
Q

benefits of unbundling services

A

allows consumer to differentiate the cost of the device from your services, provides the consumer with the opportunity to be selective in choosing the level of services, allows consumers to purchase devices through other platforms and then receive only the service component from the audiologist

66
Q

challenges with unbundling services

A

3rd party payers expect providers to unbundle billed services, knowledge of reimbursement fee schedules to determine the combination of codes needed to optimize payments is time consuming

67
Q

even though CROS and BiCROS devices technically have two devices, they are considered _________ when coding

A

one HA

68
Q

when billing for batteries or molds, how do we code

A

code as units
-we code for the amount given to the patient

69
Q

common comorbidities linked to HL

A

GI (crohn’s disease), musculoskeletal (RA), respiratory (COPD), cardiac (poor circulation), lymphatic (autoimmune disorders), hematology (anemia), integumentary (shingles), nervous system (parkinson’s) and endocrine system (kidneys diseases)

70
Q

what are common comorbidities in older adults

A

visual impairment, cognitive issues, depression, falls and hypertension

71
Q

functional limitation

A

problem within the body function/structure

72
Q

activity limitation

A

difficulties experienced when executing a task or action

73
Q

participation restrictions

A

involvement in activities an individual would like to participate in

74
Q

speech intelligibility index (SII)

A

what is audible to the patient and what is not audible
-helps the patient better understand their diagnostic findings
-clear understanding of their abilities

75
Q

root mean squared (RMSE)

A

considers how close the measured output is to the targets
-a difference between the probe output and targets

76
Q

loudness discomfort level (LDL)

A

objective measurement of the dynamic range
-used to measure the MPO

77
Q

the average LDL is around 100. if our patient has a lower LDL, what does this potentially mean for amplification

A

may need slower paths to technology and might need habituation into amplification

78
Q

frequencies to test for LDL

A

always measure at 2 and 3 kHz
-skip measurement for any frequency with normal sensitivity
-are the LF thresholds greater than or equal to 40 dB HL
-does the device supply output in an extended frequency range

79
Q

what can the QuickSIN tell us about the patients amplification

A

with a higher than typical score (over a +2 dB signal) these people would have more success with premium technology as this gives the best directionality

80
Q

how is the ANL found

A

subtracting the BNL from the MCL
-MCL from channel 1 and BNL is channel 2
-remember the BNL is played with the MCL on to see at which point it overwhelms them from audibility

81
Q

with ANL the small scores (below 7 dB) require no changes to the fitting. however if a patient has a high score (over 13 dB) this requires changes. what are these?

A

these patients are less likely to wear the HA’s so we need to counsel on habituation
-giving the patient realistic expectations
-premium technology would be beneficial
-directionality!!

82
Q

what must a functional and communication needs assessment identify

A

activity limitations and participation restrictions, environmental factors which may impact plan of care and personal factors which may impact plan of care

83
Q

when assessing patient factors, we often give out questionnaires. explain the benefits

A

questionnaires allow comparison to normative data and they are completed independently prior to the appointment

84
Q

what is the COSI

A

prioritizes patient centered goals
-cognitive goals (desired environments that require improvements)
-affective goals (desired improvements relating to feelings/emotional needs)

85
Q

8 warning signs that indicate medical evaluation should occur

A

deformity of the ear, active drainage within the previous 90 days, sudden or rapidly progressive HL within the previous 90 days, acute/chronic dizziness, unilateral HL within the previous 90 days, ABG at 500/1000/2000 Hz, significant cerumen accumulation and pain in the ear

86
Q

real ear unaided response (REUR)

A

measurement of SPL at the TM
-measured with an open canal

87
Q

real ear unaided gain (REUG)

A

calculation of the difference between the input arriving to the TM and the output leaving the TM

88
Q

real ear occluded response (REOR)

A

measuring the output arriving to the TM when the canal is occluded
-can tell us if the vent effect is releasing the lows as it should

89
Q

real ear occluded gain

A

looking at insertion loss

90
Q

real ear aided response (REAR)

A

the increase in gain arriving to the TM when the HA is turned on

91
Q

real ear insertion gain (REIG)

A

the difference between the aided and unaided response

92
Q

REAR 85/90 (MPO)

A

measures the intensity of the output signal arriving to the TM when the input is sufficiently intense to drive the device to its maximum power

93
Q

what are the output requirements to achieve binaural benefit

A

15 dB

94
Q

type 1 test signal vs. type 2 test signal

A

type 1 : pure tone swept over frequencies
type 2 : complex speech like signals with random frequencies

95
Q

long term average speech spectrum (LTASS)

A

a frequency dependent measure of time average sound pressure level of speech
-measuring sound over time through a looping passage

96
Q

what are the levels of the speech envelope? speech envelope peaks? speech envelope valleys?

A

30 dB ; +12 dB ; -18 dB

97
Q

why does probe module calibration result in an acoustic transparency between the reference microphone and probe tube

A

since probe tube is placed directly over reference microphone during calibration and this accounts for the different intensities arriving to the probe microphone modules reference microphone and through the probe tube
-the unit adjusts the intensity difference by removing the tubes resonance effects

98
Q

how does reference microphone contamination occur

A

reference microphone contamination occurs when the amplified output escapes the ear canal through open domes
-reference microphone measures and reacts to the intensity of the HAs output signal lowering the intensity of the speakers input signal

99
Q

loudness normalization approach

A

theorizes aided loudness perception should be the same as normal loudness perception
-looking at how much output is needed to arrive to the TM to be perceived as soft, moderate and loud
-utilizes REAR

100
Q

loudness equalization approach

A

recognizes audibility of mid and high frequency cues are critical for intelligibility
-based on threshold and audibility to determine how much gain to add
-utilizes REIG targets

101
Q

DSL formula

A

loudness normalization
-maximizes audibility to assist with language development
-TKs are based on degree of loss
-expansion is applied to the low input levels

102
Q

NAL formula

A

loudness equalization
-focusing on the higher frequencies as these support the most speech intelligibility
-based on the SII
-provides targets for both tonal and non-tonal languages
-calculates for A/B gaps
-good for people with severe to profound HL

103
Q

is it acceptable to apply gain that does not meet the +/- 5 dB criteria

A

it is good to use the +/- 5 dB rule when fitting patients however we can move away from that rule based on what our patients is experiencing
-based on patients loudness or sound quality perceptions as long as the output measurement follows the recommended prescriptive contours

104
Q

fitting strategies for dead regions

A

may be needed however we cannot assume that they need reduced HF output
-fitting is based around adding gain to the healthier areas of the cochlea

105
Q

when is frequency lowering good to use

A

steeply sloping HL or severe to profound losses
-this is not recommended at the initial fitting appointment

106
Q

challenges for fitting type 3 NIHL

A

OHC damage leads to recruitment, damaged/absent IHC can cause distortion, HF output is limited by feedback and full HF audibility is not a good goal due to comfort

107
Q

fitting strategy for type 3 NIHL

A

add gain to the thresholds below 85 dB
-strive for balance of audibility from 500 to 3000
-add 5 to 8 dB of gain to normal thresholds prior to precipitous drop
-enable expansion to reduce microphone noise
-if the threshold is near the LDL, apply no gain or .25 of the threshold

108
Q

frequency resolution

A

the auditory systems ability to detect discrete frequencies in the cochlea
-not fixable with HA’s

109
Q

what damage can impact frequency resolution

A

damage to the cochlear hair cells
-this impacts the sharpness of tuning curves
-detecting those changes in speech

110
Q

temporal resolution

A

auditory systems ability to detect small time related changes in the acoustic stimuli over time
-not fixable with HA’s

111
Q

what occurs when temporal resolution is impacted

A

there will be an impacted ability to detect small breaks between sounds and words
-they all blend together impacting ability to follow conversation

112
Q

benefits of spatial hearing

A

localization !!!
-can help with focusing on one signal and suppress the other signal

113
Q

how does spatial hearing function

A

it sorts out the signals and can assist in binaural summation or binaural squelch

114
Q

when you raise the TK, the output _________

A

the output becomes decreased

115
Q

when you lower the TK, the output ____________

A

the output becomes increased

116
Q

front end distortion

A

occurs when the collected/incoming signal exceed the microphones dynamic range
-exceeds the limit of the HA

117
Q

why do digital HAs have a lower dynamic range

A

digital HA’s use analog to digital converts which uses a 16 bit that supplies a 96 dB dynamic range
-leads to peak clipping and distortion

118
Q

how is front end distortion managed within digital HA’s

A

they have the ability to shift the dynamic range to fit the listening situation

119
Q

what is the only feature that can be added in order to improve speech intelligibility

A

directional microphone

120
Q

how are receivers designed to achieve the greatest high frequency output

A

smaller receivers give more higher frequencies due to having a smaller diaphragm

121
Q

3 methods to reduce external feedback

A

reduce external feedback loop, digital notch filtering and digital feedback cancellation

122
Q

3 types of frequency lowering

A

linear frequency transposition, nonlinear frequency compression and spectral envelope warping

123
Q

how is fitting changed for A/B gaps with normal bone thresholds compared to A/B gaps with abnormal bone thresholds

A

with normal bone thresholds: compression is not needed because the dynamic range is normal
with abnormal bone thresholds: compression is needed in addition with extra gain to reduce the dynamic range

124
Q

CROS vs. BiCROS device

A

CROS : a normal ear and a dead ear in which the dead ear transmits the signal to the normal ear for hearing
BiCROS : a better ear and a dead ear in which the dead ear sends the signal to the better ear which is amplified to hear

125
Q

what calibration method is used to prevent reference microphone contamination

A

stored equalization

126
Q

how does microphone contamination underestimate the output arriving to the TM

A

if the sound picked up by the reference microphone is louder than the speakers input, the algorithm will turn down the speaker
-this results in the aided response being lower than the actual output arriving to the TM

127
Q

what considerations should occur prior to modifying any programs

A

-is it a problem that can be fixed through counseling
-will fixing this problem create a new problem
-will the problem solve itself over time through acclimatization
-can it be solves through adaptation or are there changes that need to occur

128
Q

importance about systematic fine tuning

A

-establish a baseline setting for comparison (the original program)
-changes should be significant at first (larger steps then decrease)
-track the adjustments made so we can return to baseline

129
Q

complaints associated with own voice issues

A

voice is hollow, sounds like they’re talking in a barrel or its annoying to eat crunchy foods

130
Q

channel interaction

A

with the change of one channel, this can impact other channels as well
-we need to pay attention to the output change but also the output changes in additional channels

AUDE 6150 (4 decks)

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