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Ped. Aud > Finals (Weeks 6-9) > Flashcards

Finals (Weeks 6-9) Flashcards

1
Q

what are some challenges to testing children with special needs

A

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

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2
Q

Around 25-50% of newborns born deaf or HH have additional neurodevelopmental conditions (mostly cognitive, behavioral emotional, and motor)

A

true

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3
Q

what are general strategies used to adapt behavioral and physiological tests for assessing hearing in children with special needs.

A

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.

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4
Q

general strategies to adapt BOA for special needs

A

use parents to determine a response
use a 2nd assistance
remain unbiased when determining a response
use different stimuli to avoid habituation

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5
Q

general strategies to adapt VRA for special needs

A

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

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6
Q

general strategies to adapt CPA for special needs

A

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

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7
Q

general strategies to adapt conventional audiometry for special needs

A

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

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8
Q

general strategies to adapt speech for special needs

A

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.)

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9
Q

testing considerations for physiological measures

A

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

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10
Q

Etiology of congenital HL can be derived from 4 etiologic classifications

A

Chromosomal origin
Genetic origin
Environmental teratogens
Low birth weight

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11
Q

can you teach children with hl the same way with normal peers

A

yes as long as they are developing normally & with really loud sounds

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12
Q

severe to profound HL testing considerations

A

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

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13
Q

testing considerations for dev disabilities

A

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

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14
Q

testing considerations for physical disabilities

A

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

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15
Q

If no HL identified and their disorder is not progressive no follow up is needed

A

true

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16
Q

If disorder can be progressive (CMV, CNS dysfunction) or fluctuating (CHL in Down’s) children need to be monitored on a regular basis

A

true

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17
Q

special considerations for CP

A

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

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18
Q

what is cp

A

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

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19
Q

3 types of CP

A

spastic
athetoid
ataxic

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20
Q

what is spastic CP

A

high muscle tone (hypertonia), stiff & difficult to move

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21
Q

athetoid CP

A

produces involuntary & controlled movement

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22
Q

ataxic cp

A

low muscle tone (hypotonia), unbalanced, uncoordinated

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23
Q

intellectual disability test considerations

A

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

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24
Q

Behavioral thresholds in Downs are _____poorer than those typically developing

A

10-25dB

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25
Q

Signs of DD or ID

A

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.)

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26
Q

HL can exaggerate ID by impeding learning process

A

true
increased risk for visual or hearing impairment or both

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27
Q

ID is characterized by

A

Impaired cognitive functioning
Below-avg intelligence
Lack of skills needed for day to day living

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28
Q

Downs needs cognitive age of ____ mos in order to participate in VRA

A

10-12

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29
Q

high prevalence of hearing loss and middle ear issues in this population, early and accurate diagnosis is crucial for ensuring appropriate interventions.

A

downs

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30
Q

How to test individuals with Downs

A

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

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31
Q

Research shows that the avg age they can reliably complete behavioral testing is delayed by up to

A

30 month

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32
Q

ASD test considerations

A

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

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33
Q

why is sedated abr not recommended for abr

A

they are at a higher risk of seizures under sedation

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34
Q

what is TROCA

A

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.

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35
Q

what are the symptoms of ASD

A

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

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36
Q

girls are more affected (3:1)

A

false
boys

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37
Q

50-70% of ASD also have

A

ID

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38
Q

Does ASD incrase HL risk?

A

no

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39
Q

ADHD test consideratios

A

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.)

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40
Q

Increased risk of HL with

A

vp and lp

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41
Q

Most prominent risk factor of sensory disabilities is

A

intracranial hemorrhage and convulsions

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42
Q

testing considerations for visual impairment

A

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

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43
Q

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.

A

3-year-old

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44
Q

how can you condition a child with vision loss who is typically developing

A

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.

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45
Q

what ped pop demonstrates nonorganic HL

A

bw 8-12 yrs

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46
Q

what are testing considerations for nonorganic HL

A

reinstruct or count the beeps or yes/no response

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46
Q

when should you suspect ped nonorganic HL

A

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

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47
Q

explain how to reinstruct nonorganic

A

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

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48
Q

explain how to have the child count the beeps for nonorganic

A

have them count the beeps and tell you how many you hear

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49
Q

explain how to have the child say yes/no for nonorganic

A

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

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50
Q

autism considerations (chart)

A

weighted blanket
visual schedule

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51
Q

add/adhd considerations (chart)

A

weighted blanket
visual schedule
variety of games, frequent breaks
multiple sessions to complete testing

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52
Q

ID considerations (chart)

A

visual schedule
VRA

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53
Q

limited vision/blind considerations (chart)

A

simple motor task
large button

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54
Q

CP considerations (chart)

A

easy to manipulate tokens
large button

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55
Q

what is sensitivity

A

the % of people with a given disorder who screen + for the disorder

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56
Q

Rate of correct classification for affected individuals

A

sensitivity

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57
Q

calculation for sensitivity

A

true positives/true pos + false negatives (x100)

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58
Q

what is specificity

A

tests accuracy in correctly identifying those without the condition

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59
Q

rate of correct classifications for unaffected individuals

A

specificity

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60
Q

calculation for specificity

A

true negs / true negs + false pos (x100)

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61
Q

Proportion of the population that has the condition at a point in time

A

prevalence

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62
Q

prevalence of HL in nicu

A

HL is 10x grester for those in the NICU than WIN

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63
Q

what is prevalence

A

number of cases of a disease existing in a population during a specific time perido

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64
Q

what is incidence

A

number of new cases identified over a gvien period of time

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65
Q

Fraction of the population at risk of developing the disease or condition of interested (1 per 1000)

A

incidence

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66
Q

136 JCIH principle

A

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

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67
Q

123 principle

A

1 mo: screening, 2 mo: aud diagnosis, 3 mo: early invention

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68
Q

what is EHDI

A

Programs to ensure that infants and children with HL are found (detected) and receive help (intervention) as early as possible

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69
Q

what are the components and goals of EDHI

A

Universal NBHS - birth admission screening, f/u screen & diagnostic, early intervention
Diagnostic audiology
Specialty referrals
Early intervention
Family support
Care coordination
Tracking & data management

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70
Q

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

A

true

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71
Q

what is a medical home

A

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

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72
Q

elements of medical home

A

Accessible, family centered, culturally competent, compassionate, coordinated, comprehensive & continuous

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73
Q

potential members of medical home

A

ENT, audiology, deaf community, EI therapists, genetics

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74
Q

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.

A

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.

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75
Q

Differences between the 2007 and 2019 JCIH position statements.

A

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.

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76
Q

changes in testing protocol for 2019

A

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

77
Q

what is the passing rule for rescreening both ears

A

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

78
Q

objective of NBHS

A

find all babies with permanent HL & not ot have all babies pass the screening

79
Q

NBHS to be efficient

A

Diagnosis
Early intervention
Medical home
Data management
Program eval
Family support

80
Q

what is LTF

A

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

81
Q

what is LTD

A

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

82
Q

Factors that could result in some children LTF and strategies to reduce it?

A

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

83
Q

Undetected consequences in school age

A

S/L delay
Cognitive delay
Academic interference
Social & emotional adjustment
Economic impact

84
Q

Common school age behaviors with HL

A

Difficulty attending to spoken or auditory info
Requests repetition
Fatigues easy
Inappropriate responses
Isolation

85
Q

Why do we need to screen beyond the newborn period?

A

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).

86
Q

Risk factors of hL

A

Family hx of childhood snhl
In utero infection
Craniofacial anomalies
Low birth weight
Hyperbilirubinemia
Ototoxicity
Bacteral meningitis

87
Q

protocol for screenings

A

Pure tones: 1, 2, 4 @ 20dB
Tymps: following failure of tones or OAEs

88
Q

what is a pass

A

if child’s responses are judged to be clinically reliable in at least ⅔ times at the db level at each frequen

89
Q

what is a refer

A

doesn’t respond to ⅔ at any frequency in either ear or they cannot be conditioned

90
Q

Reasons why screening is recommended in the fall.

A

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.

91
Q

Parent education regarding normal auditory, speech, and language development should also be included in the hearing screening program.

A

true

92
Q

Roughly 1 in 1000 births is born with profound hearing loss

A

true

93
Q

Importance of EI

A

face academic struggles, communication challenges, hard to build close relationships with peers because they cannot participate in conversations

94
Q

Silent developmental hidden disability

A

hl in kids

95
Q

Infants are equipped for language even before birth

A

Due to brain readiness and auditory experiences in uterus
Newborns prefer speech over other sounds

96
Q

Infants are born with billions of neurons and trillions of connections that wait for auditory stimulation to strengthen them

A

true

97
Q

Auditory input is crucial for the development of neural pathways in the brain responsible for processing sound and language.

A

true

98
Q

what is auditory deprivation

A

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

99
Q

is cortex fully mature at birth

A

no, it is ready for language but it is still developing as the child is growing
depends on experience and something is bottom up

100
Q

waht is meant by bottom up approach

A

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

101
Q

Cortex matures in stages what are they

A

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

102
Q

if a child doesn;t have access to auditory input, will the other levels form properly

A

no

103
Q

what is neuroplasticity

A

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

104
Q

neuroplasticities impact on hearing

A

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

105
Q

neurplasticity can be either

A

structural or functional

106
Q

describe structural neurplasticity

A

physical changes
Brain recognizes that a group fires together and there are synapses connecting them together so it physically changes

107
Q

describe functional neuroplasticity

A

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

108
Q

3 means of plasticity in the brain

A

synaptic
neurogenesis
functional compensatory

109
Q

brain creates new interconnecting neurons through learning & practice

A

synaptic

110
Q

birth and proliferation of new neurons in the brain

A

neurogenesist

111
Q

situation which a region in the brain demonstrates sensory reassignment

A

functional compensatory

112
Q

what is pruning

A

brain is always laying down new pathways and rearranging existing ones
Ones being used are strengthened
Ones not being used are fade away

113
Q

what is synaptic pruning

A

aka apoptosis or programmed cell death
Eliminates weaker synaptic contacts while stronger connections are kept and strengthened

114
Q

when is neuroplasticity the greates

A

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

115
Q

Neuroplasticity is high during first few years of life due to major increase in synatpogenesis

A

true

116
Q

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

A

true

117
Q

formation of synapses

A

synaptogenesis

118
Q

what is the process of cortex maturation

A

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

119
Q

what is synaptic plasticity

A

brain’s ability to create new interconnecting neurons through learning and practice

120
Q

what is cross-modal reorganization

A

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.

121
Q

Functional compensatory plasticity

A

situation which a regioin of the brain demonstraites sensory reassignment

122
Q

deliberate and controlled process by which cells self-destruct in response to internal or external signals.

A

apoptosis

123
Q

specific time frame during development when an organism is particularly sensitive to certain environmental stimuli or experiences.

A

critical period

124
Q

especially receptive to specific types of input or experiences. This heightened sensitivity facilitates the acquisition or refinement of certain skills or abilities.

A

sensitive period

125
Q

Early intervention is critical to defining the outcome
Lack of this can lead to poor implant outcome

A

true

126
Q

Reasons for applying special considerations in pediatric hearing aid fitting.

A

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

127
Q

Goals for fitting

A

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

128
Q

Minimum requirements for fitting a child with hearing aids.

A

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

129
Q

adv os ASSR

A

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

130
Q

dis of ASSR

A

Lack of longitudinal data compared ot behavioral thresholds for HI kids
Artifact responses at high intensities
Lack of data on infants

131
Q

dB nHL ≠ dB HL; dB nHL < dB HL

A

true

132
Q

importance of verifying whether ABR thresholds are reported in dB nHL or dB eHL when fitting hearing aids

A

Not knowing which to use can lead to over amplification or under amplification

133
Q

Non-electroacoustic characteristics that are important when considering amplification for infants and young children.

A

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

134
Q

what HA choice is chosen for kids

A

BTE is the preferred style for infants and children

135
Q

what would you explain to a child’s parents as to why BTE is the only choice for them

A

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

136
Q

why should an ITE not be given to kids

A

Growth: Frequent replacement due to growth.
Safety: Potential for injury and connectivity issues.
Durability: Harder to make adjustments and maintain.

137
Q

why not a RIC for kids

A

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

138
Q

HA for older kids & teenagers

A

RICs can be suitable for older children (around 11-12 years old) who are responsible, but they may still need careful consideration.

139
Q

how often do we need to replace earmolds

A

every 3 mos for children under 1
every 6-12 for children 1-5 yrs

140
Q

ear canal length for dam placement

A

For 1-3 months old: Use 6mm and 8mm
For 6-12 months and older: Use 9mm and 12mm

141
Q

what eamold material is best and why

A

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.

142
Q

tubing

A

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

143
Q

what style of earold

A

Shell style is standard because of retention and feedback-prevention
Helix locks can improve retention

144
Q

dis adv to using slim tube

A

more discreet
lose gain output by 5-10 dB

145
Q

what are earmold concerns to keep in mind with kids

A

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

146
Q

Why lack of venting is less problematic for young children?

A

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

147
Q

Advantages of binaural stimulation in children

A

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

148
Q

central phenomenon in brain

A

binaural squelch

149
Q

dis of binaural amp

A

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

150
Q

Advantages of ALD use in children.

A

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

151
Q

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?

A

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?

152
Q

adds more gain & provides more audibility

A

DSL

153
Q

Provides higher SNR because it is improving the speech signal and making it louder

A

DSL

154
Q

less gain

A

nal

155
Q

Do children, and infants in particular, need amplification characteristics different from those needed by adults with the same degree of loss?

A

Yes because they are still learning language

156
Q

The reason an infant is getting a HA vs an adult HA

A

Adult wants to function or hear the conversation or do the job better
Infants want to develop s/l

157
Q

Electroacoustic characteristics are important when considering amplification for infants and young children.

A

true

158
Q

Electroacoustic characteristics are important when considering amplification for infants and young children.
what are they

A

gain
OSPL
frequency response
CR
AT/RT
distortion
noise reduction
directional mics
feedback manager

159
Q

should directional mics be on on the time

A

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

160
Q

Only tech and feature available to improve SNR

A

directional mic

161
Q

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

A

feedback cancellation

162
Q

when should feedback cancellation be used

A

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

163
Q

noise dominant band

A

reduces all of it regardless if there is some speech present

164
Q

speech dominant band

A

increases speech and reduces noise

165
Q

adv to DNR

A

Listening comfort should be increased
Listening effort should be decreased
Speech intelligibility should be left unchanged

166
Q

does dnr improve SI

A

no makes it easier to hear

167
Q

should we use DNR for kids

A

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

168
Q

should we use FL

A

with sev to profound HL
provides gain for HF sounds by sending it to areas with useable hearing

169
Q

two ways of FL

A

Compression - keeps tonotopic ordering and squeezing it into the lower range, sounds different (affects sound quality)
Transposition - sending it to the lower areas

170
Q

Should we use FL with children to help understand speech?

A

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

171
Q

Periodic audiological re-evaluations are essential; hearing should be re-evaluated:

A

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.

172
Q

how often should they follow up after the first fit

A

1 month following initial fit
then 2-3 mos after that for the first year (do earmolds at this time)

173
Q

how often should you follow up </= age five after fit

A

every 4-6 months

174
Q

how often should those >5 yrs follow up

A

yearly

175
Q

Information that needs to be covered when counseling parents about the care and use of hearing aids.

A

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

176
Q

Strategies audiologists can use to ensure and promote consistent device use in children.

A

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

177
Q

what is RECD

A

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)

178
Q

IMPORTANCE OF RECD

A

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

179
Q

At birth, the peak is approximately ______but, decreases to____ kHz by the age of 2 to 3 years.

A

5-6 kHz

3

180
Q

when should RECD be measured

A

everytime a new earmold is made

181
Q

Difference between measured and averaged RECD and which one we should use; justify your answer?

A

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

182
Q

probe depth for 0-6 mos

A

11 mm

183
Q

probe depth for 6-12 mos

A

15mmp

184
Q

probe depth for 1-5 yrs

A

20mm

185
Q

probe depth for >5 yrs

A

25mm

186
Q

adult probe depth

A

27mm

187
Q

negg recd in lfs

A

individual ear is larger than 2cc coupler

188
Q

> 10 difference from avg for RECD

A

blockage or shallow probe insertion

189
Q

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.

A

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)

Ped. Aud (14 decks)

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