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AUDE 6140 > final exam new info > Flashcards

final exam new info Flashcards

1
Q

what is the clinical value of acoustic immittance

A

objective measure of TM mobility, measures middle ear pressure, identifies TM perforations, differentiates ME fixation from ossicular disarticulation, aids in the differential diagnosis of conductive HL, validates functional HL and provides objective inference of hearing sensitivity/pathology

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2
Q

process of acoustic immittance

A

muscle contracts, stiffens bones, pulls TM and some of the energy coming in will bounce back and won’t go in

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3
Q

what are some ways to promote the child’s cooperation during immittance testing

A

animated toys, hand puppets, pendulum, mirror, sticky tape, cotton ball or tissues
-children that are older than 3, generally will not need special distractions

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4
Q

compensated vs. not compensated tympanograms

A

compensated: the tymp begins at 0 admittance on the y ; removes the volume and the effect of the ear canal from the whole value
non compensated: the tymp begins above the 0 admittance on the y

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5
Q

how can we make a tymp compensated

A

we need to get the tails at the 0 line, so we can subtract the difference to ensure all correct values are mesaured

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6
Q

tymapnometric peak pressure (TPP)

A

provides indirect estimate of the air pressure in the ME space at which energy flows best into the conductive mechanism
-pay attention to if this is compensated or not

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7
Q

tympanometric width (TW)

A

halfway up the graph and then the distance between the peaks
-the wider it is, the more correlated it becomes with the potential of a ME pathology

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8
Q

ear canal volume

A

estimation of the volume that exists between the probe tip and the TM
-can be used to monitor the courser of ME disease after the placement of tubes

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9
Q

usage of 226 Hz tymp and how it correlates to infants

A

226 Hz is because it is sensitive to the stiffness dominated middle ear however with infants, their middle ear system is mass dominated
-therefore it is not suggested to infants

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10
Q

limitations of 226 Hz tymp in infants

A

low sensitivity to the presence of MEE, flat tymps are observed in some neonates with normal MEE, normal tymps were obtained in infants with diagnosed MEE and a notched 226 tymps in infants with confirmed OME
-low sensitivity to middle ear pathologies

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11
Q

226 Hz tymps are poor for infants under ___ months

A

6

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12
Q

anatomical differences between infants and adults

A

compliant EAC, small ear canal, horizontal orientation of the tympanic membrane, underosssified ossicular chain, small ME space, ET is more horizontal and shorter

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13
Q

how are immittance measurements altered within infants

A

the 226 Hz tymp may not provide accurate immittance results for children less than 6 to 9 months as this will result in lower static admittance, broader tympanometric width and appearance of notching at low frequencies

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14
Q

infant middle ear is a ____ dominated system with a ________ resonant frequency

A

mass ; higher

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15
Q

adult middle ear is a ______ dominated system with a ________ resonant frequency

A

stiffness ; lower

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16
Q

advantages of using 1000 Hz tymps in infants

A

is a more sensitive measure to changes within the ME status
-tend to be either a single peak or flat
-we are mainly looking to see if there is that single peak which means it is normal and without a peak it is abnormal

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17
Q

a _______________ during the first week after birth and is indicated when acoustic admittance decreased towards 0 mmho

A

collapsed canal

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18
Q

for infants (birth to around 6-9 months), explain the overview of the tymps

A

226 Hz is good for ear canal volume, 1000 Hz is good for the shape of the tymp BUT with wideband it is efficient to get both at the same time

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19
Q

why is there needing to be used caution when assessing ARTs at a higher level in infants

A

threshold shift is at a higher risk in infants due to smaller canal volumes than in adults and there is at least a 10 dB increase than what is delivered into an adult ear
-would not want to exceed 100 dB for infants

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20
Q

advantages of using WB tympanometry in pediatric populations

A

gives a broad frequency range, more sensitive/specific, less affected by ear canal volume/probe position, measured at ambient pressure, the air tight seal in not required

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21
Q

list some factors that affect OAE recording success

A

probe fit, conductive elements, restlessness and loud environment

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22
Q

what are OAEs used for within a pediatric assessment

A

NBHS, school screening, site of lesion testing, monitoring ototixc drugs on cochlear functions, estimates hearing sensitivity within a limited range and can be used as a cross check principal

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23
Q

benefits of recording both TEOAEs and DPOAEs

A

they do not provide the same information and therefore they may target different cochlear mechanisms
-by including both types it can provide a more comprehensive assessment of cochlear health and HL

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24
Q

how can a middle ear pathology effect OAEs

A

-OM or negative pressure can disrupt sound transmission to/from the cochlea, altering the OAE measurement
-severe OM can affect mobility of the TM and OAEs are likely to be absent
-negative pressure reduced OAE levels but does not eliminate them always unless there is a mild SNHL

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25
Q

advantages of OAEs

A

evaluate OHC function, quick/objective, ear specific, frequency specific, can predict future HL and not booth is required

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26
Q

limitations of OAEs

A

susceptible to noise, site specific, cannot quantify the degree of HL and cannot rule out minimal/mild HL

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27
Q

explain the challenges of conducting audiological evaluations in children with special needs

A

children may have problems with speech, responding to sound or understanding the task, may have a longer time to focus, longer latency time, may need to consider other responses, may fatigue quicker and there may be unexpected reactions

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28
Q

modifications needed for children with severe to profound loss

A

may take longer to respond to conditioning
-since they are visually alert, make sure there are no visual cues
-begin with low frequency stimuli
-if not responding to auditory stimulus, use a tactile stimulus

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29
Q

modifications needed for developmental delayed children

A

positioning, timing of test stimulus presentations and response reliability and interpretation

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30
Q

modifications needed for intellectual delayed children

A

the important factor is that we need to use a technique that will bridge the difference between the chronologic and developmental age of individuals
-VRA is an effective test!
-can use tactile conditioning procedure
-demonstrate the task
-include control trials
-monitor ME status

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31
Q

modifications needed for physical disabilitied children

A

child should be positioned to keep upper body steady and allowing for a head turn or the use of arms
-CPA can be used is toy that is selected is easy to manipulate
-hand raising or nod for older children can be accepted
-limit the speech to closed set

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32
Q

modifications needed for children with autism spectrum disorder

A

seat the child in a position that does not permit walking away, minimize physical contact, identify cognitive age prior to test protocol, avoid speech stimuli, presented stimuli at low levels and increase gradually, use loud stimulus for children who ignore the sound, behavioral testing that is appropriate for cognitive level, weighted blanket

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33
Q

modifications needed for children with ADHD

A

may take longer than expected, seat child in a high chair or at a table, reinstruct more often, change toys frequently, take small breaks, weighted blanket, visual schedule

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34
Q

modifications needed for children with a visual impairment

A

let the patient explore the test environment, allow the patient to examine the equipment, move reinforcer closer to the patient, if the child does not have sufficient vision to see bright light you can pair the stimulus with vibrotactile

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35
Q

modifications needed for pediatric nonorganic HL

A

reinstruct the child and if still not successful, use a portable audiometer and have the child seated next to you so that you can make eye contact
-if still not successful, have the child count the beeps or use a yes/no response

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36
Q

what is the purpose of a screening

A

identifying individuals at risk for specific disorders
-separating those with a high or low probability of a disease or disorder

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37
Q

prevalence

A

total number of cases within a time period
-proportion of the population that has the condition at a point in time

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38
Q

incidence

A

total number of new cases
-fraction of the population at risk of developing the disease or condition

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39
Q

equation for sensitivity

A

(true positive / true positives + false negatives) x 100

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40
Q

equation for specificity

A

(true negative / true negative + false positive) x 100

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41
Q

1-3-6 principle

A

1 month : children should be screened
3 month : receive comprehensive evaluation
6 month : receive appropriate intervention

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42
Q

why is there a push to move to a 1-2-3 principle

A

earliest age of identification is encouraged because the infant can then receive earlier intervention for auditory and/or verbal access to langue and objective audiologic testing can be completed without sedation

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43
Q

early hearing detection and intervention (EHDI)

A

programs ensure that infants and children with hearing loss are detect and receive intervention as early as possible
-they offer comprehensive hearing evaluations !

44
Q

medical home

A

provides health care that is acceptable, family centered, continuous, comprehensive, coordinated, compassionate and culturally competence

45
Q

what is the difference when it comes to when an ABR is needed in the JCIH 2007 and 2019

A

2007 : ABR is required by the age of 3 if you are trying to confirm HL or if you have found a child with HL, even if ear specific information is needed
2019: ABR is only required when ear specific information cannot be obtained

46
Q

explain what need to occur for a full pass

A

both ears must have a pass result in the same screening session to be considered an overall pass
-rescreening should comprise of a single valid rescreen of both ears in the SAME session

47
Q

loss to follow up (LTF)

A

not returning for necessary outpatient testing and therefore they do not receive a recommended follow up appointment service after a failed NBHS
-can be caused by inconsistent screening, parental refusal to follow up, lack of access, inconsistent quality, lack of communication, false negatives

48
Q

how can we reduce LTF

A

use an interpreter, provide written materials in parents language, verify contact information and verify the PCP

49
Q

loss to documentation (LTD)

A

those who have received services but results have not been reported to the EHDI program and therefore cannot be documented
-can be caused by name changes, data mismatched, incomplete data, unknown PCP

50
Q

common behaviors in school age children due to hearing impairment

A

difficulty attending to spoken or other auditory information, frequently requests repetition, fatigues easily when listening, gives inappropriate answers to simple questions and appears isolated from peers

51
Q

importance of screening beyond the newborn period

A

HL can go undetected after the NBHS
-HL can be late onset or progressive

52
Q

kids tend to become sicker in the wintertime which can impact the ME with fluid, therefore it is important that screenings occurs in the __________

A

fall
-less risk for URT infections so we are able to identify those people who truly have some abnormality in their hearing

53
Q

what is the pure tone screening protocol

A

pure tone sweep at 1000, 2000 and 4000 Hz at 20 dB HL
-lack of response at any requires a rescreen immediately

54
Q

neural development within infants

A

they are borns with billions of connections that are awaiting stimulation to become strengthened
-the developing brain depends on external stimulation to form meaningful neural connections and a functional network

55
Q

in order for connections to form, __________ behavior needs to occur

A

repetitive

56
Q

what is a consequence if there is no stimulation

A

cross modal reorganization

57
Q

cross modal reorganization

A

new tasks are given to an area of the brain when there is so stimulation
-somatosensory and visual processing may take place within the auditory cortical areas in long term deafened adults

58
Q

bottom up maturation process

A

matures in stages from the bottom up to the top
-the previous stage needs to occur as all stages depend on the completion of stage 1

59
Q

neuroplasticity

A

the brain organizes itself and develops neural connections with repeated stimulation
-the brains ability to create new connections/pathways or to modify existing ones

60
Q

what are three means by which plasticity occurs

A

synaptic plasticity (create new connections through learning and practice), neurogenesis (birth of new neurons) and functional compensatory plasticity (sensory reassignment)

61
Q

pruning

A

recognizing some areas are not being used and will get rid of those areas
-monitoring to see which parts of the brain get stimulated and those that do not

62
Q

sensitive period

A

how long a child can go without stimulation but will still be treated effectively

63
Q

critical period

A

a rigid age, once you pass this it will not happen

64
Q

how do critical and sensitive periods play a role in amplification in infants

A

the earlier a child can be amplified the better the outcomes
-with CI’s the critical period is 7 years of age so their positive outcomes will decrease
-3.5 is the sensitive period so positive outcomes can still occur however it may take more effort and more sessions to gain those

65
Q

three overarching reasons for why special considerations need to occur for children with amplification

A

rapidly changing ear canal acoustics, limited ability to provide reliable behavioral/verbal responses and the need for better SNR/sound access for speech and learning

66
Q

ASSR

A

measuring electric activity from the scalp
-not as reliable as ABR however they still can test multiple frequencies
-both ears can be tested, faster than an ABR
-artifacts can be present more often
-ANSD cannot be detected

67
Q

ABR assessment protocol

A

AC ABR thresholds using toneburst at 500, 2000 and 4000 (including 1000 when indicated) with BC ABR thresholds using toneburst at 500 and 2000

68
Q

explain ABR and how it is needing conversion factors

A

results are reported in dB nHL which does not equal dB HL so in order to use for fittings, we need to make the conversion
-we convert nHL into a eHL (behaviorally equivalent measure)

69
Q

what can happen if we do not indicate the proper results

A

-if we indicate in the software that it is nHL but it has already been converted then there can be under amplification as there will be an additional conversion

70
Q

RECD

A

objective verification that is essential for preverbal children
-measuring the difference between a child’s ear canal size and the standard coupler

71
Q

how does the RECD vary in children from adults

A

it is greatest with younger children as the residual volume is smaller for infants
-meaning there is more change between the coupler and the ear canal

72
Q

RECD’s should be measured …..

A

each time there is a new earmold

73
Q

what are the 2 considerations needed when selecting HA’s for children

A

non-electroacoustic considerations and electroacoustic considerations

74
Q

3 important components for HA selection and fitting process

A

be attentive to the auditory input that is received by the child so that the speech and language development can occur in a natural way, basic premise of the initial HA selection is that all initial electroacoustic characteristics are tentative and HA selection must be viewed as an ongoing process

75
Q

non-electroacoustic characteristics that are important

A

hearing aid style, ear mold impressions, ear molds, ear hook, retention options, tamper resistant battery doors, volume control lock, appearance of them (such as color) and is using two or one

76
Q

what style is recommended for children and why

A

BTE
-can grow with them as the ears grow, will just require new molds
-more durable and less risk for injury
-addressed feedback issues by creating a bigger distance between microphone and where sound is coming out of
-good for a wide range of hearing losses
-direct audio input capabilities

77
Q

what is the recommended earmold material and why

A

vinyl because it is soft but rigid enough to keep the sound bore open when inserted
-can be modified easily
-addresses safety concerns

78
Q

for very young children, what is the concern with using the standard #13 tube

A

the ear canal may not be large enough to accommodate the length so it may not go all the way to the sound bore leading to it impacting the acoustic dimensions

79
Q

how often do earmolds need to be replaced

A

every 3 months for children under 1 year of age
-every 6 to 12 months for children one year and older (up to around 5 years)

80
Q

why is having feedback a sign that an earmold needs to be replaced

A

the ear mold is loose within the canal allowing for amplified signal to leak out

81
Q

explain how binaural summation is essential for neural development

A

helps with localization and can impact the SNR through the usage of the head shadow, binaural summation will allow the sound to be perceived as louder, and an improved SNR when both ears are used due to binaural squelch

82
Q

when compared to adults, what are the different characteristics based on

A

having a higher resonance, by needing a higher SNR and because children need amplification to develop speech and language skills

83
Q

at what levels can higher gain be beneficial for children

A

-medium sounds because it may provide more speech intelligibility as well as it may reduce listening effort
-low sounds because it appears that child will be able to hear from a distance better as well as since this level is soft they will have a benefit from additional gain

84
Q

why do children not benefit from more gain within the high level sounds

A

from research we know that children can have the same LDL as adults so by increasing this, the level can then become uncomfortable

85
Q

what is the only feature that improves SNR

A

directional microphone

86
Q

selection of directional microphones in infants/children

A

benefit is only reliant based on the child’s ability to turn towards the talker
-full time usage is not recommended due to them not being likely to turn to the target
-can be activated for school aged children with certain situations

87
Q

selection of feedback cancellation in infants an children

A

this allows for the gain that is needed to be provided without the concern of feedback occurring
-however, with younger children as they grow the ear molds will create feedback so it could be altering the signals that they are getting that are important for speech
-we should not use FC as a way to prolong the life of an earmold

88
Q

given what we know about earmolds and feedback, when there is any feedback within children that is typically a sign of what

A

the child needs a new ear mold
-with the feedback they are losing the higher frequencies

89
Q

selection of digital noise reduction in infants and children

A

anything that has noise associated with it will be reduced so this does not improve the SNR but it is expected to reduce the cognitive load of the patient
-should increase listening comfort, listening effort and speech intelligibility should left unchanged

90
Q

selection of frequency lowering in infants and children

A

sending the HF signals into an area where there is no HL to become audible and to be perceived
-if children have HF loss we need to think about this to help with speech recognition and phonological development

91
Q

what are some candidacy factors for frequency lowering

A

hearing instrument details, does the child have access to the female /s/, depending on the developmental status do they response to the /s/
-FL is more likely with a HF or severe to profound loss

92
Q

what are some topics that need to be covered during counseling with parents

A

hearing milestones, care/use of HAs, troubleshooting, safety issues, help parents understand that the more consistent they are the better outcomes there are and ensure that parents are aware of the milestones that they can expect from their child

93
Q

what are some care and use of the HA that needs to be covered

A

cleaning the earmold/HA, changing batteries or charging schedule’s, performing listening checks, putting the HAs on, setting controls and avoiding hazards such as moistures

94
Q

hearing should be re-evaluated ….

A

-1 month following the fitting
-2 to 3 month intervals for the first year of amplification
-every 4 to 6 months until age 5
-yearly for children over the age of 5

95
Q

what is the importance of early intervention

A

early diagnosis of a HL is vital to help promote brain development
-the failure to detect congenital or acquired HL in children may result in lifelong deficits

96
Q

cross check principle

A

achieved through a test battery approach, where multiple tests can check each other to ensure accuracy
-behavioral and electrophysiological tests must be used to determine the extent of a child’s auditory function

97
Q

3 stages for selecting a test protocol

A

determine the child’s cognitive age, evaluate the child’s physical status and then choose the test room setup

98
Q

closed vs. open set

A

want to attempt an open set by the age of 5 years old
-if child is developmentally delayed, you may want to use closed set
-if child has a speech or language delay would not want to attempt an open list

99
Q

how does a tymp become compensated

A

the volume and the effect of the ear canal from the whole value

100
Q

typically we will want to accomplish a full audio by the age of _______

A

5
-at this time they should be able to be tested through conventional audiometry

101
Q

what testing requires cooperation? what testing does not require cooperation?

A

behavioral testing ; electrophysiological testing

102
Q

between 6 months and 5 years, what is important to do for testing?

A

needing to select a developmentally appropriate assessment
-selecting between VRA and CPA based on the child’s cognitive age

103
Q

ABR testing is indicated when ______________

A

behavioral responses are not reliable enough to provide ear specific information and if there is any evidence of HL

104
Q

6 months to 24 months with speech testing

A

can so SDT/SAT with MLV including their name or other phrases to get them to turn OR if the older children do know some body parts you can do body part pointing for SRT

105
Q

2 to 5 years with speech testing

A

should do SRT based on age accordance, is younger children known body parts do this, otherwise you can do SAT/SDT

AUDE 6140 (2 decks)

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