lecture 13: pediatrics - exam 3

Question 1

birth - 3 mos auditory milestone

Answer 1

startle/cry/awaken over loud noises

smile when spoken to

listens to someone talking

begins to coo

Question 2

4-6 mos

Answer 2

looks for sound sources

notices toys that make noise

babbling begins

Question 3

7mos - 1 yr

Answer 3

recognizes common words

turns when name is called

listens when spoken to

imitates some sounds

Question 4

1 -2 yrs

Answer 4

follows simple commands

listens on the phone

begins to use 1-2 word sentences

Question 5

2-3 yrs

Answer 5

may ask simple questions

says names of familiar people

can follow 2 step commands

uses 2-3 word sentences

Question 6

3-4 yrs

Answer 6

talks using 2-3 sentences at a time

can be understood by family

understand terms like in, on, & under

Question 7

electrophysiological measures

Answer 7

show maturation of the central auditory system into early adulthood

Question 8

psychophysics

Answer 8

show development until late childhood/teenage years

Question 9

how many babies born annually in the US have some degree of hearing loss

Answer 9

3 in every 1000

Question 10

how many children under 18 have hearing loss

Answer 10

17 in 1000

Question 11

how many children experience at least 1 episode of otitis media by their 3rd bday

Answer 11

75%

Question 12

non specific risks for childhood hearing loss

Answer 12

family history of childhood hearing loss

babies in NICU

ototoxic meds

mechanical ventilation

supplemental oxygen

low APGAR (color, heart rate, reflexes, muscle tone, respiration)

low birthweight

Question 13

congential risk factors for childhood hearing loss

Answer 13

neurodegenerative disorders

syndromic

congenital infection

Question 14

postnatal risk factors for childhood hearing loss

Answer 14

congenital CMV

syndromic

craniofacial anomalies

Question 15

early hearing detection & intervention (EHDI)

Answer 15

1st committee to make nation guidelines for risk factors

1-3-6 guidelines started in 1994 & became widespread in 2000

Question 16

1-3-6

Answer 16

screen by 1 month

diagnose hearing loss by 3 months

services implanted by 6 months for children w/ permanent hearing loss

Question 17

purpose of EHDI

Answer 17

identify children w/ HL before they reach 3 mos

if not identified at birth, children can go until 3 yrs before HL identified

much more success if put into intervention programs by 6 mos

Question 18

adult vs childhood hearing loss

Answer 18

configuration much more varied in children

adult - less hearing loss, mostly high freq sloping, shorter air bars

child - no patterns, longer air bars, asymmetry more common

Question 19

audiological procedures in children

Answer 19

case history

otoscopy

tymps & acoustic reflexes
otoacoustic emissions
(more common in kids than adults, harder to do behavioral tests)

ABR

behavioral testing – depends on abilities of child

Question 20

minimum response level (MRL)

Answer 20

best response obtained to stimulus, not a treshold

cross-check measure critical in determining likelihood of hearing loss

Question 21

behavioral testing for up to 6 mos

Answer 21

behavioral observation audiometry

BOA

Question 22

behavioral testing for 6 mos - 3 yrs

Answer 22

visual reinforcement audiometry

VRA

Question 23

behavioral testing for 3 -5 yrs

Answer 23

conditioned play audiometry

CPA

Question 24

BOA

Answer 24

measure infant’s response to an acoustic stimuli

behavior can be anything stimuli can be anything

not very reliable - lean more on tymps, OAEs, & ABRs

no way to tell for sure they are responding to the stimuli you presented

Question 25

VRA

Answer 25

based on operant conditioning

2 clinicians - one presenting, one centering child

child turns head in sync w/ stimulus (offset or onset)

only sound field info, no ear specificity

sometimes children respond better to speech than sound
often times a warble tone is used

has 2 phases - condition & testing

Question 26

VRA threshold search

Answer 26

larger step sizes
20 down, 10 up – to go faster, shorter attention span

don’t need as precise of info, just need to know if they have HL or not

lowest level = 15 dB

Question 27

CPA

Answer 27

oberant conditioning – toy/game

prioritize insert earphones, will fit a kid better

Question 28

CPA threshold search

Answer 28

typical step size

lowest level = 15 dB because it wont change any of the clinical decisions

Question 29

children w/ hearing loss have greater risk of deficits in:

Answer 29

speech & language

academic performance

social skills

generally cognition (controversial)

audibility plays crucial role in how you perceive & interact w/ the world in typical speech & hearing families

Question 30

why is not helpful for hearing aid recs for children to be based on degree of HL

Answer 30

audiograms worse predictor of audibility in children than adults

audiometer calibrated for adults so kid hearing can look normal but pressure may be diff & actually have a mild hearing loss

use audibility based criteria instead

Question 31

intervention for HL in children

Answer 31

cochlear implants increasingly recommended - early & bilaterally

speech input & practice critical for success

many recommend total communication (CI & ASL)

Question 32

major factors affecting outcomes for children w/ hearing loss

Answer 32

time of intervention

audibility

hearing aid use tie

socioeconomics/maternal education