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Hearing > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

Name 5 areas of language/speech that are adversely affected by a paediatric sensorineural hearing loss

A
  • Vocabulary
  • Comprehension
  • PA
  • Phonology
  • Syntax
  • Voice
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2
Q

How is a developing vocabulary impacted by hearing loss?

A

More concrete/early-learnt words (nouns) are retained better than function/abstract words (conjunctions, feelings, prepositions)

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3
Q

How is comprehension impacted by hearing loss?

A

Children have a difficulty understanding words with multiple meanings (matching these words to particular contexts)

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4
Q

How is PA impacted by hearing loss?

A

Unstressed prefixes and suffixes are missed out

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5
Q

How is phonology impacted by hearing loss?

A

Children with hearing loss cannot hear the quieter sounds and therefore do not include them in their speech

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6
Q

How is syntax impacted by hearing loss?

A

Tense - the morphological markers that specify tense e.g. /ed/, /s/ may not be heard by the child with hearing loss (and therefore not included in their own speech).

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7
Q

How is voice impacted by hearing loss?

A

Children with hearing loss may not hear their own voice when they speak – and therefore may speak too loudly/softly, at an inappropriate pitch, or may mumble (because of a lack of self-monitoring).

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8
Q

Name two other domains that are affected by a childhood sensorineural hearing loss

A
  • Academic performance and educational outcomes are adversely affected. This gap widens if the hearing loss is not addressed
  • Social effects – children with hearing loss may miss out on social interactions, have a co-occurring disability, and feel left out.
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9
Q

Name the two general categories for causes of sensorineural hearing loss in children

A
  1. Genetic

2. Environmental

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10
Q

Discuss the hereditary (genetic component) of hearing loss.

Is hearing loss always associated with a syndrome? Is it dominant or recessive?

A

Hereditary hearing loss may occur as part of a syndrome (e.g. Down’s syndrome, Waldenburg syndrome, Usher syndrome) OR without associated abnormalities.

Most hereditary hearing loss is RECESSIVE. Therefore, while both parents are carriers of the trait, neither may necessarily have the syndrome.

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11
Q

Name the three phases of environmental causes of sensorineural hearing loss, and provide examples for each.

A
  1. Prenatal: rubella, viral infections, foetal alcohol syndrome, anoxia, measles, drug use (i.e. maternal).
  2. Perinatal: anoxia/asphyxia, severe jaundice, head trauma during birth, low birth weight.
  3. Postnatal: head trauma, jaundice, flu, meningitis, measles, antibiotics.
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12
Q

Name 6 indicators that a child may have a hearing loss

A
  • Absent/impaired babbling and speech
  • Not following sounds with eye contact, turning head
  • Reacting to voice/noises only occurs in line of sight
  • Later talkers – if child doesn’t have approx. 50 words by age 2, could indicate hearing loss
  • Behaviour issues – lack of interest, motivation, attention
  • Only repeat the lower frequency/louder sounds/stressed syllables in words
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13
Q

Social and Environmental Implications of Hearing Loss

A
  1. Parents:
    - May feel a sense of “guilt” for the genetic component.
    - Process of grief - therefore Ax and Ix needs to be conducted HOLISTICALLY.
  2. Sibling/s:
    - Must live up to being the “perfect” sibling
    - Feel left out because their sibling has much more attention (medically).
    - Can also be a positive thing – perhaps influence vocation
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14
Q

Name three stages of intervention in which a SLP is likely to be involved.

A
  1. Family counselling (most likely a referral to a psych)
  2. Provision of the amplification device (hearing aid, cochlear implant etc. Lot of parent training involved).
  3. Selection of appropriate assistive technologies – communication board, speech perception training, voice recognition training.
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15
Q

At what age are hearing difficulties usually detected? Why?

A

In Australia, the average age of detection of sensorineural hearing loss remains beyond two years
(Coates & Gifkins, 2003).

Because this is the age at which child should begin talking, producing 2-3 word utterances etc.

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16
Q

Why is it beneficial to detect a hearing loss before the child begins to speak?

A

Hearing loss has a negative effect on developing neural pathways (even before vocabulary is developed – there are critical periods for language learning i.e. Locke’s phase 1 & 2 rely heavily on adequate hearing).

17
Q

What is the critical age for intervention?

A

May be as early as six months

18
Q

Why is early intervention important?

A
  1. Early identification and amplification results in better speech / language outcomes for children. (Yoshinaga-Itano and Gravel, 2001).
  2. Given what we know about the development of speech from Locke’s theory, early Ix is extremely important for the acquisition of vocabulary AND grammar.
  3. It is also suggested that their socio-emotional outcomes are better.
  4. Given long wait lists in Australia - early Ix affects time at which amplification is provided.
19
Q

How does the pattern of a child’s hearing loss affect his or her speech?

A

Hearing loss is often more severe in higher frequencies. This affects the type of sounds that the child can hear (and therefore say).
High frequency sounds = f, sh, s, th

20
Q

What constitutes a “mild” hearing loss in a child?

A

HL 25 – 50dB

21
Q

What constitutes a “moderate” hearing loss in a child?

A

HL 50 - 70dB

22
Q

What constitutes a “severe” hearing loss in a child?

A

HL 70 - 95dB

23
Q

What constitutes a “profound” hearing loss in a child?

A

Threshold higher than 95dB

24
Q

Name the four choices made by parents

A 
The type of amplification 
•	Cochlear implant vs. hearing aid
The mode of communication
•	Manual vs. auditory verbal
How communication is to be fostered / habilitation
•	Involvement of family members
The best school placement
•	Is academic performance or social inclusion a priority?
25
Q

Outline factors involved around choosing the type of amplification (for both hearing aid and cochlear implant).

A

Hearing Aid:
• BUDGET - does the family have private health cover?
• Child’s personality - what activities will they participate in? Are they very active?
• Size of pinna (for fitting).
• Because of rapid GROWTH in childhood, new ear moulds will need to be made often (infancy = 6-8 weeks, preschool = 4 - 6 months, school-age = 12 months). → large cost involved. Therefore children are always fitted with behind the ear (BTE) hearing aids.
• Must ensure that sound isn’t too LOUD – i.e. does sound need to be amplified across all frequencies? Or is it only a high-frequency loss?
• High degree of MAINTENANCE required – risk of infection if hearing aid gets dirty.
• Need to ensure that the hearing aid works consistently (i.e. always has fully CHARGED batteries).

Cochlear Implant:
• Replaces the cochlear by acting as a nerve transmitter
• Risk inherent with any surgery – particularly with coexisting syndromes etc.

26
Q

Mode of communication

A

Sign vs. auditory-verbal
• Severity – does the child need to learn sign/lip-reading? Or can they be integrated into a mixed method of communication/speech?
• How much motivation/resources/time do the parents have? Are there other children - will all children learn to sign?

27
Q

Name one advantage and one disadvantage for learning sign language as opposed to using a hearing aid

A

o Advantages: not as invasive as hearing aid insertion; involvement in the deaf community – support groups, living arrangements,
o Disadvantages: not many people know sign language; need to get attention through visual means

28
Q

What decision do parents need to make for how will communication be fostered?

A

Total communication vs. auditory-verbal.

29
Q

Outline total communication (sim-com)

A
  1. Uses many means of communication - sign language, voice, fingerspelling, lipreading, amplification, writing, gesture, visual imagery (pictures).
  2. Philosophy of total communication is that the method should be fitted to the child, instead of the other way around. Another commonly used term for total communication is simultaneous communication, known as sim-com.
  3. Problems = some people feel that the effort to sign and speak at the same time results in a poorer quality of sign language. Some people believe it results in failing to develop fluency in either English or sign - use both imperfectly.
  4. Positives: Others favor it as a catch-all that ensures that a child has access to SOME means of communication. For example, a child who can’t communicate well orally gets the additional support of sign language, and vice versa.
30
Q

What does auditory verbal training involve? (3 steps)

A
  1. Provide an amplification device to return hearing to as normal as possible
  2. Teach child to speak and hear as a person of normal-hearing – majority of SP work
  3. Provide an individualised developmental intervention program in collaboration with audiologist, parents, teachers, to ensure full social and educational integration
31
Q

What are the 10 principles of auditory-verbal training?

A
  1. Promote the use of spoken language
  2. Early identification and early intervention
  3. Technology - appropriate amplification
  4. Parent Guidance - family-centred approach requires active participation of the family – parent is expected to take home “homework” and carry out program during the week with the child & rest of family
  5. Auditory Learning Environment - improving listening skills to make sound meaningful
  6. One-to-one Teaching - individual therapy sessions
  7. Hearing One’s Own Voice - teach children to talk by hearing their own voices and imitating the speech of others
  8. Sequential Learning - follow normal child development patterns and expectations
  9. Ongoing Evaluation - monitor and assess the child’s development as a regular part of the therapy program
  10. Mainstream Education - promote educational and social integration in mainstream education classes.
32
Q

Why must parents demonstrate flexibility in the decision of the four choices?

A

Parents may decide on an auditory-verbal approach, but the child’s progress may not be good. Manual (or total communication) may provide the child with more communicative success.

33
Q

What are some causes of sensorineural hearing loss in adults?

A
  • Stroke
  • Head injury
  • Noise induced
  • Infection i.e. meningitis, flu virus
  • Ototoxic drugs e.g. some antibiotics
  • Age related
34
Q

Why are higher frequency sounds more frequently implicated in sensorineural hearing loss?

A

Because the the hair cells that detect high frequency are at the base of the cochlear and are therefore bombarded frequently.

35
Q

What is presbycusis? Will air conduction and bone conduction be the same or different? Why?

A

An age-related, bilateral sensorineural hearing loss.
This means that there is a problem related to the elicitation of normal neural impulses by the inner ear hair cells.

Because this type of loss involves pathology/hindrance to the hair cells, the patient’s bone conduction thresholds will also exhibit evidence of a hearing loss and should agree closely in threshold level as with air conduction

36
Q

What does a “high” hearing threshold represent?

A

That the patient requires sounds of certain frequencies to be presented very loudly before he/she is able to hear them.

37
Q

What kind of impact does a sensorineural hearing loss have upon speech discrimination in adults?

A

Sensorineural loss is generally characterised by better hearing for the lower frequencies than higher frequencies.

Human speech ranges in frequency from approximately 250 – 4000Hz.

Therefore, patients with a sensorineural loss will have better hearing for vowels and low frequency consonants (e.g. /m/, /l/).

However - many consonant of the English language are characterized by high frequencies and weak intensities e.g. f, k, s.

SNHL affecting high frequencies would result in the inability of the patient to differentiate among words that sound similar but contain different high frequency e.g. fake, cake and sake (on the basis of hearing alone - must use lip reading etc.)

38
Q

What characterises a noise induced hearing loss? What is a way of managing NIHL?

A
  • Air conduction and bone conduction both decrease at the same rate (because the loss is sensorineural)
  • Shows a sharp decline at 4000Hz
  • Management can be achieved (generally, depending on severity) through the use of a hearing aid.

Hearing (4 decks)

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