Finals (Weeks 6-9) Flashcards
what are some challenges to testing children with special needs
auditory behavior might be unpredictable like not orienting to the sound or being hypersensitivity to the sound, have issues understanding the task, may take longer to focus, fatigue faster or have unexpected reactions
Around 25-50% of newborns born deaf or HH have additional neurodevelopmental conditions (mostly cognitive, behavioral emotional, and motor)
true
what are general strategies used to adapt behavioral and physiological tests for assessing hearing in children with special needs.
perform electrophysiological tests, use cross check principles to confirm NH or HL in this population, take time to observe (cues on physical & dev status, alertness, shyness, fearfullness etc.), introduce yourself & talk with them about their fav things to reduce anxity & build rapport
for physiological tests, do while they are asleep or distract with their favorite toys etc.
general strategies to adapt BOA for special needs
use parents to determine a response
use a 2nd assistance
remain unbiased when determining a response
use different stimuli to avoid habituation
general strategies to adapt VRA for special needs
darken control room, keep them alert, minimize distractions, vary the stimulus, use longer presentation of reinforcer, use more reinforcers to reduce habituation, monitor with control trials
general strategies to adapt CPA for special needs
turn it into a game, let the child play with the toys and equipment to familiarze themselves
might use NBN or warbles becuase they are more interesting
practicing together several times
general strategies to adapt conventional audiometry for special needs
Small testing window due to stress, tolerance, distractibility, habituation or fatigue
Keep them motivated and attentive
Intermittent social reinforcement
Provide different response options
Raise hand, give thumbs up, high fibes, blinking, clap hands, push button, verbally say it, say bep, nod head
general strategies to adapt speech for special needs
SDT - Can use stimulus words or phrases to get their attention; signal can be repeated until a response is obtained
SRT - Consider their familiarity with the words and the ability to repeat the words
Use pointing tasks, game tasks, or repetition games
Ask child to point to body parts (show me your eyes, hair, fingers, toes, shoes, etc.)
testing considerations for physiological measures
tymps & ARTs: complete after behavioral due to insertion in ears, parent holds kid or restrains, use a second aud to distract or use their fav show
OAEs: parent holds them or in highchair, play with quiet toys or distractions
ABR & ASSR: can do without sedation with certain techniques; arrive sleepy, nurse or bottle feed so come hungry, reduce room stimulation, bring items that comforts the child
Etiology of congenital HL can be derived from 4 etiologic classifications
Chromosomal origin
Genetic origin
Environmental teratogens
Low birth weight
can you teach children with hl the same way with normal peers
yes as long as they are developing normally & with really loud sounds
severe to profound HL testing considerations
may be unfamiliar with sounds so it may take more presentatioms before they learn to respond to it
they are more visually alert so no visual cues during testing
start LF and if not responding try tactile
testing considerations for dev disabilities
abilities vary
need to get ear specific & frequency specific info becuase many dev have HL too (Down’s charge, cmv, premies)
responses might be delayed, start with HF due to possible CHL in this pop, positioning, timing of test stim
testing considerations for physical disabilities
consider their specific motor needs
position so upper body is steady and can either turn head or use their arms/hands, use eyes to localize sound instead of a head turn, partial hand raising or even saying they heard it
If no HL identified and their disorder is not progressive no follow up is needed
true
If disorder can be progressive (CMV, CNS dysfunction) or fluctuating (CHL in Down’s) children need to be monitored on a regular basis
true
special considerations for CP
select easy toys to manipulate (gross motor skills vs fine)
May need sedation with CP to relax their head and neck and remove muscle movements to reduce artifacts
Can be abnormal if they have a disability that has a neuromotor component
what is cp
Disorder of neuromotor fxn characterized by an inability to control motor fxn as a result of damage to or an anomaly of the developing brain
3 types of CP
spastic
athetoid
ataxic
what is spastic CP
high muscle tone (hypertonia), stiff & difficult to move
athetoid CP
produces involuntary & controlled movement
ataxic cp
low muscle tone (hypotonia), unbalanced, uncoordinated
intellectual disability test considerations
may habituate faster or fixate on the reinforcer, need an attentive assistant to keep them interested and alert, reinforcer might cause anxiety, some might not have developed auditory localization abilities yet
do demonstration of play tasks instead of verbal instructions
Behavioral thresholds in Downs are _____poorer than those typically developing
10-25dB
Signs of DD or ID
delayed in motor, delayed and speech, they are not able to figure out how to work things (if you do this it opens the cabinets, etc.)
HL can exaggerate ID by impeding learning process
true
increased risk for visual or hearing impairment or both
ID is characterized by
Impaired cognitive functioning
Below-avg intelligence
Lack of skills needed for day to day living
Downs needs cognitive age of ____ mos in order to participate in VRA
10-12
high prevalence of hearing loss and middle ear issues in this population, early and accurate diagnosis is crucial for ensuring appropriate interventions.
downs
How to test individuals with Downs
success relies on collaboration bw aud, parents and other progessionals to report behavioral responses, overall development and health concerns
might provide variable responses so use combo of behavioral, physiological and observational measures
reduce distractions, increase engagement, shorter test intervals & frequent breaks
Research shows that the avg age they can reliably complete behavioral testing is delayed by up to
30 month
ASD test considerations
either responds abnormally to sound ignores you or sensitive to sound
responses are elevated and less reliable
well controlled environment is needed so they cannot walk away, minimize phyisical contact, avoid speech, TROCA is effective
why is sedated abr not recommended for abr
they are at a higher risk of seizures under sedation
what is TROCA
child receives a tangible, physical reward (such as a small toy, candy, or token) for responding correctly to an auditory stimulus. This positive reinforcement motivates participation and helps maintain the child’s attention.
what are the symptoms of ASD
appear in early childhood & impaires day to day
Symptoms: qualitative impairments in social/communication interaction & repetitive and restricted behaviors
Lack of eye contact
Lack of expression
Lack of response to name
Prosody
Lack of interests
girls are more affected (3:1)
false
boys
50-70% of ASD also have
ID
Does ASD incrase HL risk?
no
ADHD test consideratios
Organize the room carefully and use a structured environment
Seat them in highchair or with chair at a table close to keep them seated with feet on the floor to reduce fidgeting
Reminders to attend often to the stimulus
Change toys frequently
Take breaks if they are bored (jumping jacks, water break etc.)
Increased risk of HL with
vp and lp
Most prominent risk factor of sensory disabilities is
intracranial hemorrhage and convulsions
testing considerations for visual impairment
Let them explore the environment & examine equipment tactiley
Approach them slowly
Auditory responsiveness might be compromised due to lack of curiosity; they might not turn toward the sound in VRA
Move reinforcement closer to the PT or darken the test room
Children who are blind and who function at the _______level and higher should be able to perform play audiometry tasks by selecting toys that do not require difficult manipulation.
3-year-old
how can you condition a child with vision loss who is typically developing
condition the child that the sound comes with the vibration of the bone conductor
introduce the stimulus, if they hear it they reach out to the bone and feel the vibration and if it is correct we vibrate it and if they do not respond correctly it doens’t vibrate
The bone oscillator can be removed from the headband and held in the child’s hand or rested against the child’s arm.
A 250-Hz signal is presented at the maximum output for the bone oscillator, and the vibratory stimulus is then paired with appropriate reinforcement following the desired response.
what ped pop demonstrates nonorganic HL
bw 8-12 yrs
what are testing considerations for nonorganic HL
reinstruct or count the beeps or yes/no response
when should you suspect ped nonorganic HL
Test results are not agreeing with their communication abilities
Tests have elevated thresholds w/ normal oAEs
SRT is better/worse than pure tones
Speech stimuli response is off
Results are not repeatable
Unmasked BC thresholds are poorer in one ear than the other
explain how to reinstruct nonorganic
There must be something wrong with the equipment. Lets go to a different room and try again
The first test we did (OAEs & reflexes) tesla me you can hear soft sounds so please make sure you are responding when I play the soft sounds too
explain how to have the child count the beeps for nonorganic
have them count the beeps and tell you how many you hear
explain how to have the child say yes/no for nonorganic
tell them if you hear the noise say yes and if you dont say no; treat the no as yes and go down until they no longer respond
autism considerations (chart)
weighted blanket
visual schedule
add/adhd considerations (chart)
weighted blanket
visual schedule
variety of games, frequent breaks
multiple sessions to complete testing
ID considerations (chart)
visual schedule
VRA
limited vision/blind considerations (chart)
simple motor task
large button
CP considerations (chart)
easy to manipulate tokens
large button
what is sensitivity
the % of people with a given disorder who screen + for the disorder
Rate of correct classification for affected individuals
sensitivity
calculation for sensitivity
true positives/true pos + false negatives (x100)
what is specificity
tests accuracy in correctly identifying those without the condition
rate of correct classifications for unaffected individuals
specificity
calculation for specificity
true negs / true negs + false pos (x100)
Proportion of the population that has the condition at a point in time
prevalence
prevalence of HL in nicu
HL is 10x grester for those in the NICU than WIN
what is prevalence
number of cases of a disease existing in a population during a specific time perido
what is incidence
number of new cases identified over a gvien period of time
Fraction of the population at risk of developing the disease or condition of interested (1 per 1000)
incidence
136 JCIH principle
1 month: children should be screened
3 months: receive comprehensive evaluation
6 months: receive appropriate intervention
The earlier the impairment is identified & treatment started the greater the likelihood of preventing or reducing the debilitating/disabling effects that can result
123 principle
1 mo: screening, 2 mo: aud diagnosis, 3 mo: early invention
what is EHDI
Programs to ensure that infants and children with HL are found (detected) and receive help (intervention) as early as possible
what are the components and goals of EDHI
Universal NBHS - birth admission screening, f/u screen & diagnostic, early intervention
Diagnostic audiology
Specialty referrals
Early intervention
Family support
Care coordination
Tracking & data management
All kids who are D/HH have access to resources to help maximize their linguistic competence & literacy development in order to reach their full potential
true
what is a medical home
Provides healthcare that is accessible, family centered, continuous, comprehensive, coordinated, compassionate and culturally competent
Infant’s pediatrician or PCP is responsible for monitoring the general health, development and well-being of the infant beginning in the newborn nersery
elements of medical home
Accessible, family centered, culturally competent, compassionate, coordinated, comprehensive & continuous
potential members of medical home
ENT, audiology, deaf community, EI therapists, genetics
The rationale for the 2019 JCIH position statement recommending that rescreening in well-baby nurseries can be accomplished using either OAE or AABR, compared to the 2007 statement.
2007: Recommends at least 1 abr is done as part of the diagnostic eval for children <3 yrs for confirmation of permanent HL - not in 2019
2019: In contrast to 2007, new rec is made that screening in well baby nursery can be accomplished with OAE or AABR with the second (re)screen (second in hospital screen) conducted using either technology
Re-screening with OAE after failing an AABR is acceptable (for well-born only) with the caveat that a baby with ANSD will be missed using this protocol.
Differences between the 2007 and 2019 JCIH position statements.
2007 Guidelines:
Risk Indicators: Focus on factors like family history of hearing loss, NICU care for more than five days, intrauterine infections (like CMV), craniofacial anomalies, and neurodegenerative disorders.
2019 Guidelines:
Literature and Expert Reviews: Emphasizes best practices through updated research and expert consensus to improve early identification and intervention for children who are Deaf/Hard of Hearing (D/HH).
For NICU babies, the 1-2-3 month timeline is not always practical. Preterm infants should have diagnostic evaluations before NICU discharge when possible.
changes in testing protocol for 2019
Well-baby rescreening can use either OAE (Otoacoustic Emissions) or AABR (Automated ABR).
Rescreening with OAE after failing an AABR is acceptable for well-born babies, but there’s a risk of missing auditory neuropathy spectrum disorder (ANSD) with this method.
Infants with congenital atresia or significant pinna/canal deformities are not screened but are referred directly for diagnostic evaluation after discharge
what is the passing rule for rescreening both ears
Both ears need a pass result in the SAME screening session to be an overall pass
If each ear has a separate pass per screening, it doesn’t constitute a pass outcome
Rescreening needs a single valid rescreen of BOTH ears in the SAME session regardless of initial screening results
An infant who doesn’t pass both ears in the same screening session even if each ear has passed separately doens’t constitute a pass outcome
They hae to pass both ears in the same screening session
objective of NBHS
find all babies with permanent HL & not ot have all babies pass the screening
NBHS to be efficient
Diagnosis
Early intervention
Medical home
Data management
Program eval
Family support
what is LTF
Those that don’t return for outpatient testing and do not receive follow up services needed after a failed nbhs
Can occur at any point in EDHI
what is LTD
Those receiving services but no results were reported to EDHI so they are not documented
Name change, data mismatch, incorrect parent contact info, unknown PCP
Factors that could result in some children LTF and strategies to reduce it?
Inconsistent screening techniques
Loss to follow up after screening
Parental refusal to follow up on screening
Lack of access to audiology after f/u
Inconsistent quality of diagnostic eval
Lack of communication with state EHDI programs
False neg for babies w/ mild losses
Lack of recognition of risk for progressive HL
Reduce by
Use of an interpreter
Written materials in laymens terms
Make sure a f/u is made before discharge
Where they have to go & scheduling
Verify contact info & get an alternative contact
Verify PCP & communicate with them
Undetected consequences in school age
S/L delay
Cognitive delay
Academic interference
Social & emotional adjustment
Economic impact
Common school age behaviors with HL
Difficulty attending to spoken or auditory info
Requests repetition
Fatigues easy
Inappropriate responses
Isolation
Why do we need to screen beyond the newborn period?
Hl can affect
Education
Health
Development
Communication
Continuous monitoring is needed because significant HL can be undetected
11.3% of children (8-15 yrs old) will have some type of hearing loss (including late-onset or progressive).
Risk factors of hL
Family hx of childhood snhl
In utero infection
Craniofacial anomalies
Low birth weight
Hyperbilirubinemia
Ototoxicity
Bacteral meningitis
protocol for screenings
Pure tones: 1, 2, 4 @ 20dB
Tymps: following failure of tones or OAEs
what is a pass
if child’s responses are judged to be clinically reliable in at least ⅔ times at the db level at each frequen
what is a refer
doesn’t respond to ⅔ at any frequency in either ear or they cannot be conditioned
Reasons why screening is recommended in the fall.
Fall is typically a time when respiratory illnesses and ear infections increase, especially in children. Screening in the fall helps identify any hearing loss that might be related to these seasonal health issues
ensures that any hearing issues are identified early in the school year, allowing interventions to be implemented before they impact learning.
Parent education regarding normal auditory, speech, and language development should also be included in the hearing screening program.
true
Roughly 1 in 1000 births is born with profound hearing loss
true
Importance of EI
face academic struggles, communication challenges, hard to build close relationships with peers because they cannot participate in conversations
Silent developmental hidden disability
hl in kids
Infants are equipped for language even before birth
Due to brain readiness and auditory experiences in uterus
Newborns prefer speech over other sounds
Infants are born with billions of neurons and trillions of connections that wait for auditory stimulation to strengthen them
true
Auditory input is crucial for the development of neural pathways in the brain responsible for processing sound and language.
true
what is auditory deprivation
When auditory stimulation is lacking, as in the case of hearing loss, the brain’s ability to develop these pathways can be compromised, leading to this condition
is cortex fully mature at birth
no, it is ready for language but it is still developing as the child is growing
depends on experience and something is bottom up
waht is meant by bottom up approach
Neural organization uses this maturation approach
Meaning that the lower level maturation, stimulation and practice influences the quality of higher-level maturation
starts at bottom and as it is built it goes up and develops i stages
quality of the stages effects the next one so make sure quality is good to hafe this maturation
Cortex matures in stages what are they
Level 1: cortex matures by the time infant is around a year old
early intervention
child is few months old and is at setup stage - need aud access because if not the rest wont develop as well
Level 2: brain controls its own plasticity (how things are formed and connected by experiences)
Subsequent stages continue maturation until around 17-19 years
if a child doesn;t have access to auditory input, will the other levels form properly
no
what is neuroplasticity
Brains ability to organize itself and develop neural connections with repeated stimulation
Process that creates new connections, neural pathways or modifies existing ones based on experiences
neuroplasticities impact on hearing
if neurons are involved in aud stim in cortex and if they continue to fire together the brain recognizes they should always fire together and realizes that since they work together they are doing a function and then they become wired together to facilitate the communication bw them
neurplasticity can be either
structural or functional
describe structural neurplasticity
physical changes
Brain recognizes that a group fires together and there are synapses connecting them together so it physically changes
describe functional neuroplasticity
what it is the area is exactly doing, the brain moves the damaged area to another area and another function - assigns it to do something else
3 means of plasticity in the brain
synaptic
neurogenesis
functional compensatory
brain creates new interconnecting neurons through learning & practice
synaptic
birth and proliferation of new neurons in the brain
neurogenesist
situation which a region in the brain demonstrates sensory reassignment
functional compensatory
what is pruning
brain is always laying down new pathways and rearranging existing ones
Ones being used are strengthened
Ones not being used are fade away
what is synaptic pruning
aka apoptosis or programmed cell death
Eliminates weaker synaptic contacts while stronger connections are kept and strengthened
when is neuroplasticity the greates
Greatest during the first 3 ½ years of life
Younger the greater the neuroplasticity
If these critical periods are past without exposure to language it will be more difficult to learn
Neuroplasticity is high during first few years of life due to major increase in synatpogenesis
true
found children receiving CI stim early had normal P1 latencies within 6 mos of implant use & those receiving CI stim late (>7yrs) showed abnormal cortical response latencies even after years of implant use
true
formation of synapses
synaptogenesis
what is the process of cortex maturation
Level 1: cortex matures by the time infant is around a year old
early intervention
child is few months old and is at setup stage - need aud access because if not the rest wont develop as well
Level 2: brain controls its own plasticity (how things are formed and connected by experiences)
Subsequent stages continue maturation until around 17-19 years
what is synaptic plasticity
brain’s ability to create new interconnecting neurons through learning and practice
what is cross-modal reorganization
brain’s ability to reassign a sensory processing region to handle input from another sensory modality when there is a loss or deprivation in one sense.
ex: in individuals with profound hearing loss, parts of the brain typically used for auditory processing may be repurposed to process visual or tactile information. This phenomenon is a result of the brain’s inherent plasticity, allowing it to adapt to sensory changes by maximizing its functional capacity.
Functional compensatory plasticity
situation which a regioin of the brain demonstraites sensory reassignment
deliberate and controlled process by which cells self-destruct in response to internal or external signals.
apoptosis
specific time frame during development when an organism is particularly sensitive to certain environmental stimuli or experiences.
critical period
especially receptive to specific types of input or experiences. This heightened sensitivity facilitates the acquisition or refinement of certain skills or abilities.
sensitive period
Early intervention is critical to defining the outcome
Lack of this can lead to poor implant outcome
true
Reasons for applying special considerations in pediatric hearing aid fitting.
Ear canal acoustics change rapidly
Limited ability to provide reliable behavioral and verbal responses
Need for better SNR and sound access for speech and learning
Goals for fitting
Provide amplified speech signal consistently audible across levels
Avoid distortion
Ensure signal is amplified in as broad of a frequency range as possible
Include sufficient electroacoustic flexibility ear growth or changes in auditory characteristics of the infant
Minimum requirements for fitting a child with hearing aids.
Amp for any HL that can interfere w/ normal development
Fitting should occur w/in one month of diagnosis
Medical clearance is REQUIRED before fit
Permanent HL shouldn’t delay amp fitting even with ongoing MEE treatment
adv os ASSR
Multiple frequencies tested at once in both ears
Faster than ABR
Objective response analysis
Stimuli are easier ot calibrate
Potential applications for objective HA eval
dis of ASSR
Lack of longitudinal data compared ot behavioral thresholds for HI kids
Artifact responses at high intensities
Lack of data on infants
dB nHL ≠ dB HL; dB nHL < dB HL
true
importance of verifying whether ABR thresholds are reported in dB nHL or dB eHL when fitting hearing aids
Not knowing which to use can lead to over amplification or under amplification
Non-electroacoustic characteristics that are important when considering amplification for infants and young children.
coupling options, specific features of the HA, one or two HA’s, styles of HA’s (BTE, RIC etc.), adv features (enable or disable them), compatible with fm system, accessories, specific safety features of the HA’s etc
what HA choice is chosen for kids
BTE is the preferred style for infants and children
what would you explain to a child’s parents as to why BTE is the only choice for them
they are rapidly growing which causes things to need to be replaced every 3-4 months and having a BTE to replace just an earmold is cheaper than replacing the entire HA
earmolds are safer for active children and less likely to cause damange if they fall or hit thier head
BTE will have less whistling due to the mic distance from the receiver
BTEs are beneficial for school settings due to the features they will need
they are more durable and cleaned easily and can give loaners if they lose or need to fix theirs
why should an ITE not be given to kids
Growth: Frequent replacement due to growth.
Safety: Potential for injury and connectivity issues.
Durability: Harder to make adjustments and maintain.
why not a RIC for kids
Power and Infection: Limited power and potential for more ear infections due to the design.
Damage: kids explore by their hands and their mouth so the small pieces can cause a hazard for the child
HA for older kids & teenagers
RICs can be suitable for older children (around 11-12 years old) who are responsible, but they may still need careful consideration.
how often do we need to replace earmolds
every 3 mos for children under 1
every 6-12 for children 1-5 yrs
ear canal length for dam placement
For 1-3 months old: Use 6mm and 8mm
For 6-12 months and older: Use 9mm and 12mm
what eamold material is best and why
Vinyl
Properties: Soft yet rigid enough to maintain an open sound bore in the ear canal.
Modifiability: Easy to modify and accepts adhesive well to secure tubing.
Safety: Less concern compared to harder acrylic, as vinyl grips to the skin and reduces leakage, especially for severe hearing losses.
tubing
Standard #13 tubing
Recommended if sound bore size is large enough
For infants, use vinyl molds with tubing partially inserted through the sound bore if the ear canal diameter is equal to or smaller than #13 tubing, especially in the early weeks or months.
Ear canals grow rapidly, so tubing may need replacement every few months. Full tubing accommodation might be temporary, and it can affect high-frequency output.
Might impact the HF output
what style of earold
Shell style is standard because of retention and feedback-prevention
Helix locks can improve retention
dis adv to using slim tube
more discreet
lose gain output by 5-10 dB
what are earmold concerns to keep in mind with kids
Angle of the Tube and Earmold Fit: angle causes earhook to pull HA away and kink tube; solution is to hollow out the concha
difficult to achieve 2mm sound bore: as they grow this resolves
difficult or impossible to use acoustic modifications: venting due to small ear canal
Why lack of venting is less problematic for young children?
OE is less problematic because their resonance is higher so they may not perceive it with their small ear canals
also because as they grow this fixes itself and we can add one
Advantages of binaural stimulation in children
helps with neural development to process sounds with both ears
gives head shadow - helps to localize and have a better SNR through intensity differences form ear to tear
binaural summation: improves sound to be louder by 2-3
binaural squelch: helps to focus on one sound and suppress the unwanted background noise
central phenomenon in brain
binaural squelch
dis of binaural amp
Consistent and prolonged rejection of one hearing aid by the child after the clinician has made every effort to fine-tune the fitting for earmold comfort and loudness comfort.
Reports from the parent that the child functions better with one hearing aid.
Poorer speech test results when fitted bilaterally than when fitted unilaterally.
If the child rejects the HA’s when giving two but if you give them one and they take it can indicate an issue
Advantages of ALD use in children.
helps with distance
helps with SNR
even if parents do not want HAs for kids, recommend this
helps in reverberant rooms
helps rate of language acquisition
Is higher gain required for fitting hearing aids in children? Justify your answer. If there are differences in gain requirements between adults and children, at what level(s) this can be beneficial?
High-level sounds: it seems unlikely that children will benefit from more gain for high-level sounds than that given to adults.
Medium-level sounds: children prefer more gain than do adults.
Low-level sounds: it seems very likely that the optimum low-level gain for children should be greater than for adults.
add 26 dB?
adds more gain & provides more audibility
DSL
Provides higher SNR because it is improving the speech signal and making it louder
DSL
less gain
nal
Do children, and infants in particular, need amplification characteristics different from those needed by adults with the same degree of loss?
Yes because they are still learning language
The reason an infant is getting a HA vs an adult HA
Adult wants to function or hear the conversation or do the job better
Infants want to develop s/l
Electroacoustic characteristics are important when considering amplification for infants and young children.
true
Electroacoustic characteristics are important when considering amplification for infants and young children.
what are they
gain
OSPL
frequency response
CR
AT/RT
distortion
noise reduction
directional mics
feedback manager
should directional mics be on on the time
Full time use is not recommended
Because they do not turn their head to the speaker as well as the reduction of sounds from the sides or back may impaire learning through overhearing
Potential benefits have led to the recommendation that they can be activated for school-age children in specific situations
Only tech and feature available to improve SNR
directional mic
do not use this feature to fix a bad fit in an earmold but helpful in having this feature otherwise
Can stop feedback when they are inserting the earmold
feedback cancellation
when should feedback cancellation be used
to prevent feedback loop when inserting hearing aids
Children’s ears grow quickly, meaning ear molds may not always fit perfectly, leading to feedback issues. Regular use of feedback cancellation helps manage these issues in between fittings.
monitor to make sure there is no distorted speech or reduced amplification in speech frequencies for development
noise dominant band
reduces all of it regardless if there is some speech present
speech dominant band
increases speech and reduces noise
adv to DNR
Listening comfort should be increased
Listening effort should be decreased
Speech intelligibility should be left unchanged
does dnr improve SI
no makes it easier to hear
should we use DNR for kids
Nothing saying you shouldn’t but nothing that says you should
Just improves the comfort without affecting speech intelligibility so there is no harm in using it
So recommended to leave it on
should we use FL
with sev to profound HL
provides gain for HF sounds by sending it to areas with useable hearing
two ways of FL
Compression - keeps tonotopic ordering and squeezing it into the lower range, sounds different (affects sound quality)
Transposition - sending it to the lower areas
Should we use FL with children to help understand speech?
Those with severe/profound HF SNHL do not have access to HF cues without FL or cochlear implants
HF sounds are important for speech recognition, word learning, and phonological development
Keep it on
Periodic audiological re-evaluations are essential; hearing should be re-evaluated:
1 month following initial fitting
2-3 month intervals there after for the first year of amplification
Do both earmold and this at the same time
Every 4-6 months until age 5
Yearly for ages >5 years.
how often should they follow up after the first fit
1 month following initial fit
then 2-3 mos after that for the first year (do earmolds at this time)
how often should you follow up </= age five after fit
every 4-6 months
how often should those >5 yrs follow up
yearly
Information that needs to be covered when counseling parents about the care and use of hearing aids.
emphasize how important the child has access to auditory information for development
Doesn’t just affect the hearing also affects the S/L and their academic performance
think about barriers (why the parents might not have them use it all time)
losing HA
doesn’t stay
data logging
Device Use for Development
Needs to be worn at all times to develop s/l
Essential for brain stimulation
Time when kids re growing
Organization of requiring of brain due to lack
How does HL effect development of child and how HA can reduce this impact
Understanding thismakes the parents want to use them more
Strategies audiologists can use to ensure and promote consistent device use in children.
if you educate and empower the child and parents and provide access to auditory input you can reach the target of reaching expressive & receptive language to develop
make sure they are fit well, they are used, they continue to operate effectively and the child receives stimulating auditory input
what is RECD
Serves as an objective tool to confirm that amp is achieving its intended purpose
Measures the difference between the ear canal size and the standard 2cc coupler used in electroacoustic testing (output in ear - output in coupler)
IMPORTANCE OF RECD
HA output is higher in infants than adults due to small ears and calibration issues
Children cannot stay quit or still for a period of time that is needed for REM
Its easier and quicker
Once obtained you can program the HA’s without their presence
Correctly convert HL to SPL format
Allows fitting in the test box
At birth, the peak is approximately ______but, decreases to____ kHz by the age of 2 to 3 years.
5-6 kHz
3
when should RECD be measured
everytime a new earmold is made
Difference between measured and averaged RECD and which one we should use; justify your answer?
Measured
RECD values obtained directly from an individual using a real-ear measurement procedure
Averaged
standard set of RECD values that are derived from measurements taken across a group of individual
Adv: using age predicted value is more desirable than avg adult value
Limitation: derived from those with normal ME status & doesn’t reflect acoustic changes by ME fluid or ™ perf & errors can be as large as 5-10 dB
probe depth for 0-6 mos
11 mm
probe depth for 6-12 mos
15mmp
probe depth for 1-5 yrs
20mm
probe depth for >5 yrs
25mm
adult probe depth
27mm
negg recd in lfs
individual ear is larger than 2cc coupler
> 10 difference from avg for RECD
blockage or shallow probe insertion
Know what functional auditory assessments are in general and when it is important to include them in pediatric evaluation. Be able to give some examples.
Questionnaires are useful in assessing very young children’s auditory development as an indication of their early speech perception performance
These assess effectiveness of HAs in real world environments
ex: IT-MAISE (parent used for .5-3 yrs), COSI (parent >0)
