lecture 13: pediatrics - exam 3 Flashcards
birth - 3 mos auditory milestone
startle/cry/awaken over loud noises
smile when spoken to
listens to someone talking
begins to coo
4-6 mos
looks for sound sources
notices toys that make noise
babbling begins
7mos - 1 yr
recognizes common words
turns when name is called
listens when spoken to
imitates some sounds
1 -2 yrs
follows simple commands
listens on the phone
begins to use 1-2 word sentences
2-3 yrs
may ask simple questions
says names of familiar people
can follow 2 step commands
uses 2-3 word sentences
3-4 yrs
talks using 2-3 sentences at a time
can be understood by family
understand terms like in, on, & under
electrophysiological measures
show maturation of the central auditory system into early adulthood
psychophysics
show development until late childhood/teenage years
how many babies born annually in the US have some degree of hearing loss
3 in every 1000
how many children under 18 have hearing loss
17 in 1000
how many children experience at least 1 episode of otitis media by their 3rd bday
75%
non specific risks for childhood hearing loss
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
congential risk factors for childhood hearing loss
neurodegenerative disorders
syndromic
congenital infection
postnatal risk factors for childhood hearing loss
congenital CMV
syndromic
craniofacial anomalies
early hearing detection & intervention (EHDI)
1st committee to make nation guidelines for risk factors
1-3-6 guidelines started in 1994 & became widespread in 2000
1-3-6
screen by 1 month
diagnose hearing loss by 3 months
services implanted by 6 months for children w/ permanent hearing loss
purpose of EHDI
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
adult vs childhood hearing loss
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
audiological procedures in children
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
minimum response level (MRL)
best response obtained to stimulus, not a treshold
cross-check measure critical in determining likelihood of hearing loss
behavioral testing for up to 6 mos
behavioral observation audiometry
BOA
behavioral testing for 6 mos - 3 yrs
visual reinforcement audiometry
VRA
behavioral testing for 3 -5 yrs
conditioned play audiometry
CPA
BOA
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
VRA
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
VRA threshold search
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
CPA
oberant conditioning – toy/game
prioritize insert earphones, will fit a kid better
CPA threshold search
typical step size
lowest level = 15 dB because it wont change any of the clinical decisions
children w/ hearing loss have greater risk of deficits in:
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
why is not helpful for hearing aid recs for children to be based on degree of HL
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
intervention for HL in children
cochlear implants increasingly recommended - early & bilaterally
speech input & practice critical for success
many recommend total communication (CI & ASL)
major factors affecting outcomes for children w/ hearing loss
time of intervention
audibility
hearing aid use tie
socioeconomics/maternal education
