midterm 1 with review topics Flashcards
how does frequency resolution changes with SNHL
when the OHCs can no longer amplify soft signals, the BM can no longer produce the sharp tuning curve which results in the loss of these and there is difficulty hearing in noise
-not fixable with HA’s
frequency resoltution
the auditory system ability to detect discrete frequencies in the cochlea
how does a reduced frequency resolution make it difficult to understand speech in noise
the primary signal is no longer enhanced so the brain cannot untangle the speech signal from the noise
temporal resolution
the auditory systems ability to detect small time related changes within the acoustic stimuli over time
-not fixable with HA’s
-you can have people talk slower and produce clearer sounds
what are auditory processes that support temporal resolution
gap detection, phonemic duration, temporal ordering and suprasegmentals
what are some benefits of spatial hearing
localization, allows us to focus on one sound and suppress another, inter aural level differences (binaural squelch and summation) and inter aural timing differences
which frequencies supply the most information on interaural level differences
higher frequencies
how are receivers designed to achieve the greatest high frequency output for severe HL
we can use dual receivers with a severe HL that needs higher access to high frequencies
smaller receivers give more _________ frequencies due to having a smaller diaphragm
higher
WDRC
aims to expand the dynamic range where more gain is added to soft signals and less is added to louder signals
-lower TK
-low CR
-slower AT and slower RT
OLC
compression is applied to protect from over amplified sounds
-bigger TK
-high CR
what is the general rule for what Medicare will and will not reimburse
they will not reimburse anything that relates to HA’s, but they will reimburse anything medically necessary
what are 3 methods used to reduce external feedback
reduce feedback loop (increasing snugness of mold and decreasing vent size), digital notch filtering (notch in the 2-4 kHz range) and digital feedback cancellation
what are the 3 types of frequency lowering
linear frequency transposition, nonlinear frequency compression and spectral envelope warping
what is the main importance of having a review of systems and how can it support clinical decision making
the anticipation of the progression of loss can occur by :
-highlighting correlation between systemic disease and HL progression in medical reports
-using the presence of systemic disease to justify the medical necessity of future diagnostic monitoring
-considering potential for progression when recommending audiological rehabilitation
what are some common comorbidities that are linked to HL
gastrointestinal, musculoskeletal, respiratory, cardiac, lymphatic, hematology, integumentary, nervous system and the endocrine system can all be associated with HL
what are some common comorbidities seen within the older populations
visual impairments, cognitive issues, depression, falls and hypertension
what does it mean when we say ‘the audiogram is not an indicator of the degree of communication deficit’
the audiogram is simply a sign of if the patient can hear it or not
-measuring how loud a sound needs to be for audibility
-does not tell us anything about frequency or temporal resolution
puretone threshold loss is …..
-a good indicator of overall degree of functional impairment
-moderate indicator of activity limitation
-poor indicator of participation restriction
what limits the ability to use WRS
in general calculation errors and wrong presentation levels used
what can inaccurate WRS lead to
inaccurate assumptions of intelligibility, disconnected counseling and less than ideal recommendations
explain the calculation errors that occur with WRS
calculation is based on the whole 50 word phonetically balanced list
-when these are cut in half or even shorter, it can lead to not presenting a list that is phonetically balanced
-leading to us not being able to make any diagnostic statement off of the data based on not following the instructions of the test
explain the general rules to ensure that proper presentation levels are used
using the frequency at 2,000 Hz :
-if below 50, add 25 dB
-if between 50 and 55, add 20 dB
-if between 60 and 65, add 15 dB
-if between 70 and 75, add 10 dB
what are some techniques that offer a more realistic method of speech understand
add bianural speech assessments, use sentence based test stimuli, assess performance with and without visual cues, and assess speech intelligibility within the sound field
functional limitations
problem within the body function or structure
-the diagnosis
activity limitations
difficulties experienced when executing a task or action
-immediate results, not the patient’s choice
participation restrictions
involvement in activities an individual would like to participate in
-it is what you do once you are given the disorder, the patient’s choice in a way
what does backward synergy mean
treatment or rehabilitation that results in increased participation supplies communication practice and experiences that may result in neural changes to improve activity limitations
-in other words, when we improve participation, we start improving some of the earlier areas
how to avoid communication mismatch in professional reports
improve interdisciplinary communications (report writing to assist interpretation of the impact of HL), reduce communication mismatch and conduct communication assessments
how to properly make clearer statement related to identified concerns
include statement of purpose, what test signal was used, the test condition and discuss audibility
speech intelligibility index (SII)
tells us what is audible to the patient and what is not audible to the patient
-it is based on the importance of frequencies
-the % of speech signals that are audible to the patient
what does it mean to be based on the importance of frequencies
it correlates to speech meaning and there are less in the low frequencies and more within the high frequencies
-more importance is held within the highs within speech
what can be viewed within the SII chart
the SII along with the prediction of how many digits, sentences and NU6 words they will understand
what are clinical uses for the SII
helps other professionals better understand threshold loss impact, helps patients better understand their diagnostic findings, reduced counseling mismatch and helps audiologist determine amplification candidacy
loudness discomfort levels (LDL)
level that is too loud for the patient
-used to measure the MPO
-measured as levels vary, helps with amplification and it can be used to program and verify the output is within the limits
what frequencies to test for LDL
always measure at 2 or 3 kHz and for additional frequencies :
-skip measurement for any frequency with normal sensitivity
-are the LF thresholds greater than or equal to 40 dB HL
-is there a precipitous inter-octave change
-does the device supply output in an extended frequency range
QuickSIN
a test of speech with varying levels of background noise, testing SNR and SNR loss
-can lead to recommendations for technology
what level do we use to present the QuickSIN at
it is based on the PTA
-if PTA is less than or equal to 45 dB, present the list at 70 dB HL
-if PTA is greater than 45 dB, present sentence lists at an intensity perceived as loud by okay
SNR-50
SNR that allows an individual to understand 50% of the test signal
SNR loss
this is the amount of SNR differences between the patient than the normal listener
ANL
measuring a persons tolerance for background noise
-this is using the sound field option with both channels
-supports the recommendations for specific settings or technology
how is the ANL calculated
subtracting BNL from MCL
what do small ANL scores mean? high ANL scores mean?
small (less than 7) : tolerates background noise
large (greater than 13) : cannot tolerate background noise
what are the 4 steps of the developed multidimensional plan of care
-auditory assessment and diagnosis
-objective functional communication needs assessments
-subjective functional communication needs assessment
-non auditory needs assessment
what must a FCNA do
identify activity limitations/participation restrictions, identify environmental factors which may impact plan of care, and identify personal factors which may impact plan of care
what are benefits of questionnaires
standardization allows comparison to normative data and questionnaires are completed independently/prior to the scheduled appointment
social network index
shows how often the patient communicates with others as well as the communications methods use
-asks about social relationships
ECHO
designed to assess 4 sub-scales related to patient expectations of amplification
what are the sub-scales of the ECHO
expected acoustic and psychological benefits, expectations of service and cost, estimates factors that often detract from satisfactory outcomes and perceptions of self image
HASP
self perceptions outside of amplification to evaluate core beliefs
COSI
prioritizes patient centered goals
-ranks perceived importance of up to 5 situations
-either cognitive or affective goals
cognitive goals
difficult environments that require improvement to reduce the impact of the impairment
-factors within the environment
affective goals
desired improvements as they relate to feelings/emotional needs
CPHI
used to find out how hearing loss affects daily life and what problems the patient is having, if any
-can correlate to information on those who are more likely to keep or return the devices
what is the importance of including these assessments
-involves the patient within plan of care
-focuses on the individuals needs when planning rehabilitation
-assists with counseling by opens discussions related to technology needs and identifies unrealistic expectations
importance of dexterity screening
it can give us a insight of their dexterity abilities and can help our device recommendations
-as they may not be successful with smaller devices
importance of visual screening
can impact the ability to see small buttons
what is the audiologist’s role to ensure best practices are met
begin with a comprehensive investigative assessment followed by functional and communication needs assessment to give proper rehabilitation options
hearing loss and related communication difficulties increase with age due to several comorbidities, including …..
chronic systemic disease, declining cognition/motor function and reduced social engagement
importance of identifying systemic diseases
these can result in a progressive HL
over reliance of the audiogram results in ….
counseling miscommunications that reduce post treatment satisfaction
what are some common activity limitations
detection of sounds, intelligibility in quiet, intelligibility in noise, auditory localization
is LDL a test of body structure/function or activity limitation? what about QuickSIN?
LDL : body structure and function
QuickSIN : activity limitation
what is used to calculate the SNR loss?
SNR 50
-we deduct 2 dB from this
presentation level for ANL
based on the PTA
-less than or equal to 45, present at 70 dB HL
-greater than 45, present at a level that is loud but okay
what is the data that can be derived from the social network index
correlations between relationship of loneliness and cognitive decline are beginning to emerge with results from this test
what is the data that can be derived from both the ECHO and CPHI
correlations are shown between who is more likely to keep their devices or return the devices
