Final Exam Review Flashcards
What is the Lybarger prescription?
“Half-gain” rule
1944
What is the POGO and POGO II prescription?
POGO (1983) POGO II (1988)
Half-gain + low-frequency correction factor
What is the Berger prescription?
More than half gain for middle frequencies
1979, 1988
What is the Libby prescription?
Gain about 1/3 of the hearing loss
1986
What is the NAL-R prescription?
LTASS placed @ MCL
Intelligibility is assumed to be maximized when all bands of speech are perceived to have the same loudness
1986
What is the NAL-RP prescription?
Change in slope from 46% to 31%
What is the DSL prescription?
Achieve audibility & comfort in each frequency region
What is the Cambridge prescritpion?
Essentially the same rationale as NAL
Which prescriptive method provides the most gain?
From greatest to least amount of gain:
- Berger
- DSL
- POGO
- NAL-R
- Libby
What is the IHAFF/Contour?
IHAFF- Independent Hearing Aid Fitting Form
- IHAFF protocol aims to normalize loudness at each frequency
- Recommends CT of 40-45 dB
What is the FIG6?
- Developed by Killon & Fikret-Pasa (1993)
- Use of average loudness data
- Loudness normalization
What is the DSL [i/o]?
Goal: restore amplification characteristics so all acoustic signals available to WNL listener available to HoH listener within auditory DR
Loudness equalization
What is the DSL 5.0?
Adjustment to gain: lows, mids, highs
- Correction for conductive hearing loss
- Correction for binaural amplification
What is the NAL-NL1 prescritpion?
- Underlying rationale = maximize speech intelligibility (not to restore normal loudness) but with overall loudness of speech at any level being no more than perceived by a listener with normal hearing
Two theoretical models used:
- Speech intelligibility index
- Method for calculating loudness
- Prescribed gain for 70 dB input similar to NAL-RP
What are difficult issues related to selecting a prescription method?
- Acclimatization & adaptation gain & frequency response
- Patients adapt to the tinny sound of the hearing aids and get more benefit
- The more the patient listens with amplification, the more they adapt - Preferred loudness
- Hearing aid users prefer 3-4 dB less than what’s prescribed - Dead regions
- Damage to the inner hair cells; no signal going to the brain
- Sending sound to dead regions results in distortion - Severe hearing loss, effective audibility, & high-frequency amplification
How can you verify hearing aid performance?
- Probe microphone measurements
- Real ear measurements with speakers in front and in back of the patient
Why do you need to verify hearing aid performance?
- For quality control, to make sure they are getting sufficient volume to hear speech
- Also used to counsel the patient
What is the primary goal of orientation?
PHAST (Desjardins & Doherty, 2009)
- Remove your hearing aid
- Open the battery door
- Change the hearing aid battery
- Demonstrate how you clean your hearing aid
- Put your hearing aids in
- Turn up the volume
- How do you use the telephone with your hearing aids
- How do you use the noise program/directional microphone
What are appropriate expectations for new hearing aid users?
Listening in quiet
- We expect patients will hear better in quiet situations
Background noise
- They should hear better in background noise with hearing aids (if it’s a moderate level)
- They will not hear better in an extremely noisy situation
- Their hearing in loud background noise should be no worse than listening without their hearing aids
- They should expect to hear soft speech, average speech should be comfortable, and loud speech should not be uncomfortable
Earmold/earshell comfort
- It should be comfortable to wear for the patient
Own Voice
- They should expect that their own voice is acceptable to them (counsel them on getting used to the occlusion effect)
Acoustic Feedback
- There should be no feedback during regular use
- Not unusual for older patients to put their hearing aids on upside down or on opposite ears
What is the bottom line of the hearing aid fitting?
- Patient understanding of hearing loss consequences and treatment options
- Acknowledgement and “ownership” of hearing loss
- Help to overcome obstacles to better hearing
- Orientation/instruction
- Help patient with other communication strategies
- Provide perceptual training in speech understanding
What does the acronym “BUS” stand for?
B- Benefit
- Make sure that we have decreased the disability
- Want the patients to be able to hear certain things again (speech & environmental sounds)
U- Use
- Want the patient to use their hearing aids in every possible situation where they have trouble hearing
S-Satisfaction
- Want the patient to be satisfied with the selection, fitting, and outcome of their hearing aids
Why is it necessary to validate the fitting?
- Demonstrate benefit
- We can’t determine from an audiogram, occupation, and age, how the patient will do with their hearing aids - Justify cost
- Especially with premium hearing aids
- Any hearing aid will provide measurable benefit (especially in quiet) - Help with patient management
- Reduce return rate
- Demonstrate benefit to the patient
How can the clinician validate the fitting?
Objective
- Limitations
- Doesn’t give a sense of listening in environmental sounds
- Doesn’t take into consideration the self-monitoring of the patient’s voice
- Can’t recreate all listening environments - Benefits
- Direct/objective way to determine how well the patient hears with their hearing aids and without
- Can quantify residual difficulty that they might have - Speech testing in quiet
- Only a moderate correlation between objective measurement of benefit and self-reported measurement of benefit (not 1:1 relationship)
- Fixed presentation level (55 dB)
- Normal low frequency and steeply sloping high frequency hearing loss (40 dB)
- To compare aided to unaided; program 1 and 2; compare monaural to binaural fitting - Speech testing in noise
- HINT vs. Q-SIN
Subjective
- Informal assessment
- Evaluation of self-perceived benefit
- Evaluation of use time
- Evaluation of satisfaction
What is the SSQ?
Speech, Spatial, and Qualities of Hearing
- Short version (12 questions)
- Localization ability
- Spatial awareness