Lecture 1 Flashcards
What is adult aural rehabilitation?
The reduction of hearing-loss induced deficits of function, activity, participation, and quality of life through sensory management, instruction, perceptual training, and counselling
What are some of the impacts on QOL resulting from acquired hearing loss?
Deficits in activities of speech perception and communication
Limitations on participation in social interactions, employment, leisure pursuits, and enjoyment of sound
What is the goal of rehabilitation?
Restore quality of life by eliminating, reducing, or circumventing these deficits and limitations
restore to pre-loss state as much as possible
What are the original core components of adult aural rehab?
Sensory management
Instruction
Counselling
Perceptual Training
What are the updated core components of adult aural rehab?
Hearing aids & other listening devices
- optimize auditory function
Knowledge & skill
- use of technology and control of environment
Motivational engagement
- enhance participation, deal with residual limitation
Auditory and cognitive training
- improve speech perception and communication
What is the “Life with Hearing” hierarchy?
trajectory of therapy process
Anatomy and physiology
- physical and functional integrity of ear and pathways
Function
- basic perceptual capacity
Activity
- use of capacity in real world
Participation
- contribution of activities to daily life (ex. social interactions, leisure, learning)
Quality of life
- self assessment
What 2 factors are core to all interventions to promote patient-centered approaches?
self-management and behaviour change
have to understand where they are coming from and meet them where they are to support them in this
What is the COM-B system of behaviour change?
psychological model of human behaviour
framework developed to characterize behaviour change interventions and link them to the analysis of target behaviour
- can be used to understand health behaviour change
Describe the behaviour change wheel.
3 rings
- inner = sources of behaviour
- middle = intervention functions
- outside = policy categories
3 sources of behaviour
- capability = psychological and physical capacity to participate in activity
- opportunity = opportunities outside the individual that make the behaviour possible or prompted
- motivation = what energizes someone to engage in a behaviour
What did Ferguson et al (2019) find about hearing aids and QOL?
use of hearing aids supports listening ability, health related QOL, and hearing specific QOL
significant positive effects
What is the main hearing-loss related concern?
cochlear damage
has direct and immediate impact on most aspects of auditory functioning
- sensitivity, discrimination ability, etc.
- different from conductive hearing loss which mainly reduces volume
How do we address deficits of function?
sensory management
- hearing aids and cochlear implants
- smartphone apps and personal amp devices
goal is to provide audibility of sound (give access) while preserving comfort and perceived quality
- improving auditory function should improve speech perception but it may not carry over to participation or QOL
What is the biggest challenge for people with hearing loss, even when they use devices?
hearing speech in noisy background
How do we address deficits of auditory perception?
perceptual training
- enhance auditory and/or auditory-visual perceptual skills (AST)
supported in becoming accustomed to new auditory sensations provided through their devices
increased perceptual abilities expected to translate into increased participation and improved quality of life
How do we address deficits in participation and quality of life?
counseling
discuss and come to terms with HL impact on their daily life
- explore ways to address practical, social, emotional consequences
- use motivational tools
Describe a relevant tool created by the Ida institute.
tool to help patient gauge how motivated they are to do something, how important a certain listening situation is
What audiological services are covered by OHIP?
audiology not covered by OHIP since 1999, other than initial infant hearing screening
What are some individual factors contributing to AR success?
motivation
readiness
expectations
sense of entitlement
personality
adaptability
perceived locus of control
lifestyle
support from others
Who shares the scope of practice of AR?
SLPs and audiologists
will collaborate in AR process (ideally - usually only AUD)
What are some of the appropriate roles for SLP in the AR scope?
educating others on communication needs of patients
advocating for patient needs
conducting speech/language screening
defining speech/language goals
collaborating on developing AR plan of care
providing referrals/resources
counselling
providing info and training on listening and the environment, communication strategies
What are the core values of person and family centered care?
dignity and respect
information sharing
participation
collaboration
Why are air conduction hearing aids inappropriate for those with outer ear damage/malformed pinnas?
air conduction hearing aids fit over the pinna, will not be able to sit on a malformed pinna
need to use bone conduction hearing aids
How are bone conduction devices worn?
either surgically implanted or worn on a headband
What is oteosclerosis?
arthritis in the malleus/incus/stapes
causes conductive hearing loss
What types of hearing aids can people with middle ear infections use?
potentially make use of air conduction/conventional hearing aid
- audiologist would look at hearing situation
What are the hearing effects of those prone to fluid in the middle ear space?
like listening under water
can cause decay of the bones
more difficult to hear as liquid becomes less clear (ex. infection)
What are some descriptors we use to describe someone’s hearing loss?
left vs right
masked vs unmasked
air conduction levels
bone conduction levels
What is the threshold above which hearing is considered normal?
25 dB+
Why do we mask during audiograms?
make sure the other ear isn’t over-compensating and responding
bone oscillator naturally stimulates both sides, have to play a masking sound in the other ear to isolate one side
What does it mean if there is a large discrepancy between masked and unmasked stimuli?
means cochlea is functioning properly but conduction of sound to the cochlea is impaired (conductive loss)
bone conduction directly stimulates cochlea (bypasses outer and middle ear) so if hearing is good when using masking but bad when not, must be conductive issue
What does it mean if there is no difference between masked and unmasked stimuli?
sensorineural loss
even with masking/bone conduction stimulation bypassing outer/middle ear (conductive loss area), still having issues, must be sensorineural
What do we believe if tympanometry results were normal?
no conduction difficulties
