Final Exam Flashcards
Determining medical clearance as determined by FDA
-visible congenital or traumatic deformity of the ear
-history of active drainage from the ear within the previous 90 days history of sudden or rapidly progressing hearing loss within the previous 90 days
-acute or chronic dizziness
-unilateral HL of sudden or recent onset within the previous 90 days
-audiometric ABG equal to or greater than 15 dB at 500, 1000, 2000 (or one frequency at 20)
-visible evidence of significant cerumen accumulation or a foreign body in the ear canal
-pain or discomfort in the ear
-child under 18 years old
Three different types of approaches to hearing aid selection
-physical factors of cosmetics, anatomical and dexterity issues and selection by needs assessment
-measurement, circuitry and components and expert fitting techniques (usually the preferred method)
-perception and paired comparisons
Subjective FCA measures (6)
-characteristic of amplification tool (COAT)
-the client oriented scale of improvement (COSI)
-expected consequences of hearing aid ownership (ECHO)
-hearing handicap inventory for the elderly- screening (HHIE-S)
-the hearing handicap inventory for adults (HHIA)
-communication scale for older adults (CSOA)
Objective FCA procedures (5)
-QuikSIN
-Hearing in noise test (HINT), now its AzBio
-acceptable noise levels (ANL)
-test of binaural interference
-listening span
Transactional sale
-simple, short-term sale in which the customer already knows what he needs so little product knowledge is required on the sales side
-buying criteria usually hinges on price or ease of acquisition
-usually only focused on todays transaction, fear of paying more than they had to
Consultative selling
-a more complex, long-term involving collaboration of both buyer and seller in which the latter must first develop an understanding of the customers business, industry and needs and then craft a solution to help the customer achieve their objectives
-usually service or solution based
Relational shopper
-todays transaction is one in a long series of future purchases, fear making the wrong choice
Consultant
-works with client
-have expertise to apply tools and techniques to resolve process problems and can advice and facilitate an organizations improvement efforts
Difference between a customer and a client
-selling to a customer is a transaction relationship involving an exchange of good of money
-selling to a client for whom the salesperson takes responsibility for guiding and advising by taking on a stewardship
Multiple channel of WDRC
-allows for flexibility to fit to target, can be moved individually to make comfortable
-helps to repackage sound into the users residual dynamic range
-for patients: help patient hear important soft sounds
Expansion
-makes softer sounds softer
-makes soft non-speech sound inaudible and less annoying
-for the patient: the HA will minimize annoying soft non-speech sounds
Automatic feedback reduction
-will automatically detect and reduce feedback
-for patients: automatically take care of annoying whistling sounds associated with HA use
Digital noise reduction
-based on time and frequency analysis of input sound, it reduced gain in bands with noise
-for the patients: dramatically improve listening comfort in noise while maintaining speech
Impulse detection and reduction
-sometimes called anti-shock it reduced peak gain of impulse and transient sounds
-for the patients: detects sharp uncomfortable sounds and reduced them
Directional mics
-improves SNR when speech and noise are spatially separated
-for the patient- significantly improve speech understanding in many noisy listening situations
Automatic directional mics
-polar plots automatically change based on input levels of noise
-for patients: the HA will be easier to use and no buttons to push activate it
MCL
-tells us that the same patient can prefer highly variable loudness level to the same stimuli over the course of minutes, hours, days, weeks and months
PB Max
-maximum score can get in speech tests with no rollover
-not the same level as MCL necessarily
MPO
-maximum power output of the hearing aids
OSPL90
-MPO of a HA measured in a 2cc coupler
RESR
-real ear saturation response
-MPO measured in the real ear using probe-mic equipment
RETSPL
-reference equivalent thresholds in SPL
-values used to convert HL LDL to 2cc coupler
RECD
-real ear coupler difference
-values used to convert from 2cc coupler to ear canal SPL
REDD
-real ear dial difference
-this is the addition of the RETSPL and RECD
-suing this you can convert from HL LDL to ear canal SPL
-provides the output targets you see on the probe mic fitting screen
AGCI
-input compression often referred to as WDRC which can be used to control the maximum output if kneepoints are low enough and the ratios are big enough
AGCo
-output compression or compression limiting- the most common method to control the MPO
Why do people not measure LDLs?
-believe it may take too much time
-believe everyones LDL are the same
-believe LDL measures are not reliable/valid
-believe you can predict LDLs from persons HL
-believe the manufacturers fitting software can get it right
-believe clinical LDLs have no benefit to the real world
What stimulus works best for LDLs?
pure tones
Why are speech in noise tests not used more often?
-clinicians are more familiar with word recognition scores obtained in quiet
-speech in noise tests are scored differently (more work)
-adds time to test battery
-audiologists lack information about SIN tests
-less normative data for SIN tests
Why do SIN tests?
-helps to guide treatment plan
-appropriate expectations during counseling
What options are there for SIN?
-QuikSIN
-HINT
-AzBio + noise
-words in noise (WIN)
-acceptable noise level (ANL)
-BKB-SIN
-SPRINT
-audible contrast threshold (ACT)
Two test methods for SIN
-adaptive: presentation of target or background noise changes in real time depending on the patients response; results can be plotted as psychometric function, not a single score
-fixed: presentation level of target stays the same, but background noise can change in level; present different SNRs; often scored as percent correct, there will be a ceiling
QuikSIN
-comprised of sentences recorded recorded in four-talker babble at various SNRs
-provides a one minute estimate of a patients SNR loss
-simulated a social gathering in which the listener must time in the target talker while tuning out the background talker
-there is a total of 18 lists with 6 sentences each
-womens voice will remain the same but SNR of the background noise is decreased
-a single list takes approximately 1 minute to administer
What is SNR loss?
-the dB increase in SNR ratio required by a hearing impaired individual to understand speech in noise
-SNR loss = 25.5 - number of words correct
HINT
-no longer available
-has three different protocols: adaptive, alternate and percentage
Adaptive protocol for HINT
-speech is located directly in front of the subject at 0 degrees azimuth
-four test conditions: sentences with no competing noise, sentences with competing noise presented directly in front of the patient (sentence should be played 4dB below noise), noise presented at 90 degrees to the right of the patient (sentence should be played 10 dB below the noise), noise presented at 90 degrees to the left of the patient
-in all conditions the competing noise is presented at a steady loudness of 65 dBA
-loudness of the sentences is varied throughout the test depending on whether the patient repeats it correctly or not
-for the sentence to be correct, all words must be repeated correctly
-presentation level of the sentence is increased and decreased to find the reception threshold of sentence (RTS)
Alternate HINT scoring
-sentences and noise are at a fixed level
-score the number of words correct
HINT percentage protocol
-60 dB SPL sentence presentation level (if in noise, the noise will be 50 dB SPL)
-used for pre and post operative CI testing
-faster and easier to administer but has a ceiling effect
AzBio
-created to limit ceiling effects
-has a lot of sentences (15 for clinical use) with both male and female talkers
-used for pre and post operative CI testing
Words in noise (WIN)
-35 monosyllabic words presented at 7 different SNRs
-assign one point for each word repeated correctly
-add the total number and compare the threshold to the descriptor on the score sheet
Audible contrast threshold (ACT)
-new
-uses test results to customize hearing aid noise settings and assist counseling
-takes into account: audibility loss (thresholds as measured by the audio), contrast loss (amount of contrast need between the desired speech and the undesired background noise)
-adaptive test procedure: patient responds to tones in specuali noise, standard threshold search to measure their ACT value
-can enter the ACT value into Oticon software
When to conduct SIN tests
-initial hearing evaluation
-hearing aid selection/FCA
-demonstrate aided audibility in noise
-assess directional benefit
Acceptable noise level (ANL)
-measures the willingness to accept and listen to speech in the presence of background noise
-can be used to predict how people will utilize their hearing aids
-need a 2-channel setup for a recording of a story in one channel and background noise
-establish range using 5dB step size to find the upper and lower limit then repeat in 2 dB step sizes
-want to establish background noise level using 5 dB step size
-establish a BNL using 2 step size
-ANL = MCL - BNL
What does a low ANL value mean?
greater HA use
Clinical uses of ANL
-requires approximately 2-3 minutes to conduct one test
-test-retest is low with about 2 dB differences across several studies
-can be measured using the actual ANL CD or other material already available in the clinic like running speech sample for MCL or multi-talker babble for BNL
OHC function
-mechanically amplify low-level sound that enters the cochlea
-reduced acuity in low, mid, high or all frequencies
-reduced dynamic range across frequencies
-distortion of sound
-reduced frequency resolution
IHC function
-transform the sound vibrations in the fluid of the cochlea into electrical signals that are then relayed via the auditory nerve to the auditory brainstem to the auditory cortex
-reduced efficiency = much worse hearing thresholds
-noisy transmission of info to the auditory nerve
Cochlear dead region
-a region on the cochlea where the IHCs and/or neurons are functioning so poorly that a tone producing peak vibration in that region is detected by off-place or off-frequency listening
Why measure cochlear dead regions?
-clinical counseling
-amplification recommendation
-fitting of amplification
-assessing candidacy for CI/EAS
Prevalence of dead regions when there are threshold values greater than 70
> 50%
Threshold equalizing in noise test (TEN)
-relatively fast and simple to use in clinic
-based on the detection of a pure tone in the presence of a formulated broadband masking noise
-presenting masking to the same ear to prevent cross over to neighboring hair cells
-the noise is producing at least 10 dB of masking and the signal threshold in the noise is at least another 10 dB above the TEN level
-limitations: other pathologies can result in elevated thresholds in TEN, requires behavioral response
-looking for a masked threshold that is at least 10 dB above the absolute threshold/10 dB above the TEN
Why is it hard to test above 4000 Hz for SIN tests?
-more inconclusive results
-not as reliable
-more false positives
At the HCC, what is a hearing evaluation coded as
92557; tymps only is 92567, reflexes is 92568, tymps AND reflexes is 92550, reduced services is 52
To bill for reflexes, what and how many frequencies need to be tested?
4: 500, 1000, 2000, 4000
Billing for FCA/hearing aid selection
-92590/1 where 0 is unilateral and 1 is bilateral
-earmold impressions V5275, mold is V5264 individually for both of these codes
What are some things the COAT asks about?
-developed by Cleveland Clinic
-asks about: motivation, budget, priorities in terms of tech, price range
-total of 10 questions
Hear aid fitting billing
-visual inspection and listening check 92592/3
-quality assurance V5011
-office visit V5299
-conformity evaluation (probe mic measures) V5020
-HA programming V5014
-orientation V5011
What things should be verified prior to HA fit?
-earmold, dome, shell style
-correct RIC tubing length
-ordered vent size
-proper color
-model number
special features and mechanical
Roger systems
-can improve SNR
-successful use going to depend on users ability to handle all different components
-integrated DM perhaps device of choice
-consider pocket talker if losing HAs is an issue
