Final (Weeks 1-5) Flashcards
birth to 6 wks
crying
7wks to 3 mos
cooing
after 4 mos (up to 7)
babbling
8-10 mos
first understanding of language
around 12 mos
first words
18 mos
50 words
18-20 mos
vocab spurt
24 mos
two word sentences
after 30 mos
grammar dev
extended repetition of certain single syllables around 6-7 mos
babbling
risk factor of HL with apgar
Apgar scores below 5 at 1 min or less than 6 at 5 min
Human cochlea shows response to sounds after _____ week of gestation
20th
auditory system becomes functional around
25 weeks’ gestation
chronological age
age of actual day child was born
corrected ag
Only used with premature babies (born before 37 wks)
Baby’s actual age in weeks minus the number of weeks the baby was preterm
Corrected age (CA) = chronological age - # weeks or months premature
Baby J was born at 28 weeks gestation and is 6 mos chronological what is is corrected age
3 mos
Moro reflex, eye blinking or widening, sucking. Startle when there is a very loud noise.
0-4 mos
Lateral head turn towards sound source
4-7 mos
Good lateral localization skills & downwards
7-9 mos
Sound localization in all directions
9-13 mos
Excellent localization. Easily distracted
13+ mos
Identify the red flags indicating potential issues in speech and auditory development.
No babbling at 12 months
No gesturing (pointing, waving bye-bye) by 12 months
No single words by 16 months
No 2 words combination spontaneous phrases by 24 months
No 3 words combination by 3 years of age
Unintelligible speech at 3 years
Limited number of consonants at 2 years
Simplified grammar at 3 ½ years
Difficulty formulating ideas and using vocab at 4 years
Language not used communicatively
kid misses 10% of speech with distance
kid misses 10% of speech with distance
inaudible (voiceless stops & fricatives)
inattention
mild hl
miss most conversational speech
vowels heard better than consonants
(-s, -ed) are difficult
inattention
learning difficulties
moderate HL
Language and speech do not develop spontaneously without intervention.
can hear distorted self-vocalization, very loud environmental sounds, and only the most intense speech at close range.
severe hl
rely on vision than hearing, aware of vibrations than tonal patters, S/L will not develop spontaneously, severe language delays, speech problems, and potential learning dysfunction without intervention
Speech often includes issues with voice, articulation, resonance, and prosody. Vocal pitch may be higher, with a monotone quality due to lack of intonation and stress
profound hl
not direct tests of hearing & not always able to provide complete & accurate assessments of hearing in early infancy
physiological tests
objective, reliable, provide info about the status of the auditory status
physiological (ABR, ASSR, & DPOAEs)
goal of behavioral testing
determine if the child has sufficient hearing to develop S/L
provides direct measure of hearing
behavioral audio
Purposes of audiological assessments in infants and children
To determine the type, degree, and configuration of hearing loss in each ear.
To assess the impact of hearing loss on speech, language, communication, and education.
To identify risk factors for progressive or delayed-onset hearing loss for ongoing monitoring.
To evaluate candidacy for sensory devices (hearing aids, assistive devices, cochlear implants).
To refer for medical evaluation and early intervention services when appropriate
Indications for Comprehensive Audiological Evaluation
Referral from newborn hearing screens or risk factors for hearing loss.
Behaviors indicating hearing loss vary by age
Parental concerns about hearing or speech/language delays.
Advantages of test battery approach
Provides detailed information
Avoids drawing conclusions from a single test
Allows for the identification of multiple pathologies
Provides a comprehensive foundation for observing a child’s auditory behaviors
Appropriate behavioral procedures depends on their developmental, cognitive and linguistic level, visual and motor development, and ability to respond appropriately
true
how do you pick the appropriate testing protocol
determine cognitive age
evaluate physical status
test stimuli for behavioral audiology
Frequency specific
Warble tones (pure tones?)
Narrow band noise
Non-frequency specific
Music
Noise
speech (capture attention & determine SAT)
presentation of stimuli in behavioral audios
Begin at HFs because many infants respond better to these (usually 2000 Hz) (obtain one HF & one LF)
If SNHL suspected start at 500 Hz
If middle ear pathology/CHL , start at 2000 Hz because CHL affects LFs more
Significant difference between 5 and 2: test 1 next & if flat loss test 4 next
test 250, 500, & 2,000
chl
test 500, 2,000 & 4,000
snhl
Suprathreshold stimuli presented at a level at which the infant previously responded
Used to demonstrate understanding of the task before descending in level to determine threshold and through the test to determine if the infant is still on task
probe trials
Observation trials in which the examiner judges whether a head turn occurs in teh absence of sound stimulation
Primarily used to determine if the responses “head turn” being judged are truly responses to the test stimuli and not just random head turns
control trials
reasons for a follow up visit
Inconsistent responses
Inadequate cooperation: might be fussy, sleepy, uncooperative
If infant is unwell (cold, flu, ear infections)
Ototoxicity monitoring
Ear canal/tympanic membrane abnormalities
what does acoustic immittance test
middle ear (ME) function, the cochlea, auditory nerves, and the brainstem
In the middle ear, sound vibrations are transferred from the TM to the cochlea via the ossicles, specifically the stapes, contributing to about ______ of amplification. Loss of ME results in _____ HL loss
30 dB
60 dB
two mechanisms that aid in amplification in the ME (MEIM)
The area difference between the TM and the oval window increases the pressure on the stapes footplate.
The lever action of the malleus and incus boosts sound energy at the footplate.
Highest incidence of middle ear problems occurs in the first few years of life.
RRUE
strategies to increase a child’s cooperation during immittance testing.
Seat young children and infants on the parent’s lap; parents can help prevent them from grabbing their ears.
Comfort children with otoscopy by showing the flashlight or looking into the parent’s ears; distract them with a toy.
Ensure children are quiet and still during the test.
Greet the child with an enticing toy to distract from the unfamiliar room.
Have an experienced assistant, and sometimes involve the parent.
Children over 3 typically don’t need special distractions.
Children aged 1-3 years can have unpredictable behavior and often fear pain.
Let them place the piece to their ear or watch the process.
WHAT SHOULD YOU NOT DO DURING TSTING
Don’t ask for permission, as this may encourage them to say no.
Like can I look in your ears? Can I put this in your ears?
Avoid mentioning pain unless they bring it up.
don’t use this as encouragement to do the test unless they mention it first or ask
Don’t over-explain the procedure; keep instructions simple or say nothing.
It is sufficient to say something like, “Here, listen to this,” or “Hold still for me,” and then proceed with the test. Better yet, say nothing!
This is what will happen and this is what i am going to do
how are ARTs measured
During ART testing, the probe monitors changes in middle ear compliance. When a loud sound is perceived by the brain, it triggers the stapedius reflex, causing the ossicles to stiffen and the tympanic membrane (TM) to pull inward. This stiffening reduces the amount of sound energy that can enter the middle ear, and the probe detects this as a decrease in admittance (e.g., a .02 drop).
when should you use 226 hz probe tone
ages 7 mos to adulthood (226 becomes adultlike by around 6-8mos)
when should you use 1000 Hz probe tone
<7mos
infant ears are ____ dominant
mass
limitations of 226 Hz tone
ears are structurally and functionally different so it doesnt work
can cause collapsing
results in lower static admittance, broader tymp width, & appearance of notching at LF due to the tone not matching the property of the system we are testing
Key factors in immittance include:
Stiffness (fluid pressure from the inner ear)
Mass (weight of the ossicles & TM)
Friction (ligaments supporting the ossicles)
In infants, the ME is mass-dominated with a higher resonant frequency, whereas in adults, it is stiffness-dominated with a lower resonant frequency.
true
Changes in the first postnatal months of life (bw 6-8 mos) includes
Growth of bony portion of the ear canal wall resulting in decrease in the length of the cartilaginous portion of the canal
Increase in overall size of the ear canal
Decrease in density of ossicles over first 6 months of life due to ossification and absorption of residual mesenchyme
Changes in orientation of the ™ to be more vertical
Progressive stiffening of the ossicular joints
Infant ear canal is small, compliant, and flaccid, gradually increasing in size and rigidity within 2 years.
true
anatomical differences in infants
it is small, compliant and flaccid
higher resonance frequency
TM is horizontal and thick but thins and becomes perpendicular (due to loss of mesenchymal tissues)
ME space increases w/ aeration, ossicular joint tightening and pneumatization of air cells
ET is more horizontal and less rigid (higher ME infections)
anatomical differences
Acoustic properties of the infant ear changes drastically over the first 6 mos of life
Excessively compliant EAC
Small ear canal
Horizontal orientation of ™
Underossified ossicular chain
Small ME space
what is static acoustic admittance (Ytm)
measures max mobility of the ME system
what is middle ear pressure (TPP)
pressure at which peak admittance occurs
shows where air pressure in ME matches atmospheric pressure
what is width/gradient
measures sharpness or broadness of the tymp peak