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midterm Flashcards

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1
Q

when was the Ontario IHP amplification protocol was revised

A

2023

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2
Q

Define a guideline

A

Systematically developed statements to assist clinicians in: Pediatric hearing assessment, fitting hearing aids etc.,
- Summary & appraisal of the best available research evidence or expert consensus

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3
Q

T/F A guideline Doesn’t provide info about the exact clinical processes that would fulfill the guideline

A

True

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4
Q

Protocol definition

A

Specifics about how to execute a guideline, Tailored for use with specific equipment or test signals

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5
Q

ewing & ewing 1947

A

education act of 44 outlined rights and responsiblities of parents, if their child was 2 years old and had suspected handicap due to deafness or partial deafness parents can apply to local education authority which arranges for medical exam, diagnosis should be by otologist

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6
Q

ewing & ewing 1958

A

to ensure children whose hearing is defective have best chance of remedial treatment, hearing screening should occur by 9-12M

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7
Q

hearing screening originally was

A

a 90dB narrowband signal 1ft away from baby and check response

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8
Q

arousal test

A

high frequency signal with bell

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9
Q

1967 recommendations

A
  • National conference on education of the deaf
  • High-risk register to facilitate identification
  • Public information campaign
  • Testing of infants and children 5-12 months of age should be investigated
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10
Q

16th century

A

deafness was a barrier to communication & not an intellectual deficit

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11
Q

late 19th century and early 20th century

A

deafness viewed as a problem belonging to the field of education

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12
Q

1960s

A

acknowledged that there were significant delays if HL was not identified early
o Lack of assessment techniques for children meant ID occurred around 3-5 yrs old
o Significant delay in fitting hearing aids

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13
Q

Mid 1960s

A

focus on identifying HL in children
-Screened infants at high risk first
- Electrophysiological screening equipment was not portable and required a high level of expertise for administration and interpretation
-Assessment techniques were behavioural and typically done in the sound field

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14
Q

1970s

A

Joint committee on infant hearing (JCIH) was formed and first position statement
- JCIH addresses populations to be screened, methods and protocols to be used for screening and later guidelines for early ID and intervention (EHDI)

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15
Q

1980

A

development in prescriptive formulae occurred
- Appropriate hearing aid gain, output and frequency response was studied extensively
o First version of DSL was paper pencil
- Probe mic systems also became available
o This was used by Dr. Seewald and colleagues to develop RECD and incorporate it into verification procedures for children

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16
Q

1990

A

CI were approved for use with children

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17
Q

Goal of (re)habilitation and educational management of children with HL

A

Overcome or minimize the barriers to communication imposed by HL to enable learning & participation in society

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18
Q

Historically children with HL fell into 2 categories

A
  1. Those with considerable access to acoustic speech signals
  2. Those who had limited or no access to speech despite the best technology (at the time)
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19
Q

2 parallel (re)habilitation and educational management philosophies evolved

A

o Manual approach: visual-based system; natural for those who are deaf
o Oral approach: spoken communication

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20
Q

T/F screening alone supports infant hearing health

A

false need other support services like technology -HA and language development (ASL/SLP)
most provinces lack the necessary follow-up services

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21
Q

why early detection & intervention

A

saves resources on more intense remediation (need to catch up if not supported early)
- supports language and cognitive development, psychosocial wellbeing, behaviour & academic success

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22
Q

PEACH plus: Format changes

A

1) addition of fatigue scale: “how easy or hard do you think this is for your child” (2) Questions exploring performance in quiet vs noise grouped together (3) Q12 phone use has been removed

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23
Q

Advantages of subjective outcome measures

A
  • Families become good observers of childs auditory behaviours in real world
  • Families develop shared language with clinicians
  • Can be conducted w children who have complex needs and available in several langauges
  • No special equipment needed
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24
Q
A

a national group of leaders & experts in matters related to early hearing detection and intervention (EHDI) formed to promote, support, and advocate for comprehensive universal EHDI programs in all Canadian provinces and territories

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25
when were report cards administered
Developed report cards on the status of availability of EHDI programs in Canada (2014, 19, 24)
26
what do report cards do
- advocate for comprehensive universal EHDI program across Canada - Report cards can help improve care, build understanding about the pressures & successes facing a system & provide valuable data about areas of success and improvements
27
Availability
service or item is there
28
accessibility
individuals can get to/make use of the service or item
29
2024 report card design
(mixed design online survey) New: Section 1: availability of the 5 EHDI components province/territory-wide Section 2: expand on other elements of infant hearing health care such as legislation, training, funding, live birth rate, screening coverage etc.,
30
when was ontario IHP implemented
2001
31
what is age range of IHP services
Provides services for children from birth until eligibility to enter grade 1 who are identified with PHL and their families - children under 6
32
how many regional lead agencies are there in ontario
12
33
what are regional lead agencies responsible for
delivering the program in accordance with provincial guidelines in a way that reflects regional & local needs
34
risk indicator
identifiable characteristic of a child or medical procedure used with the child that is associated with increased likelihood of PHL in the child that is greater than the likelihood in the newborn or child population as a whole
35
UNHS performed using
automated distortion product otoacoustic emission (ADPOAE) and/or automated auditory brainstem response (AABR) technology, identifies the need for further hearing assessment by an IHP audiologist
36
CMV
herpes family virus causing mild/asymptomatic infection in health individuals 50-70% acquire infection by adult but potential for serious infection for immunocompromised or fetuses
37
what is the leading cause of non-genetic SNHL & 2nd leading cause of intellectual disability after down syndrome
CCMV
38
T/F Screening mothers for CMV has low sensitivity
T
39
Anticipated # of IHP-risk factor screen positives
700 cCMV babies, 100 genetic babies
40
predictive value of a screen
1. If result is positive; how likely is it that the baby really has the condition 2. If the test is negative; how likely is it that the baby really does not have the condition
41
What is audiological surveillance
- Proactive recall for an audiological appointment of young children who are at risk for developing late-onset or progressive HL; systematic process for early detection of PHL that is not detected by UNHS - Does not replace hearing screening or community audiology services - Basic (single point) or intensive (multi-point) surveillance sequences
42
role of family support worker
- Connecting with IHP audiologist to establish info sharing & consistent messaging - Reinforce info from audiologist: support understanding of PHL & impact - Help with financial applications - Support chosen language development pathway: link with relevant service providers - Facilitate parent-to-parent connection
43
language development option IHP
- Families are supported in choosing language development path (spoke or sign ASL/LSQ) - Aim for service to start no later than 6 months old - Services will be as close to home as possible: SLP (spoken) PSL service; ASL consult (Sign): Silent voice
44
clinical need for outcome measurement
pediatric audiologists who fit young infants with hearing aids need tools to measure the impact of the hearing aid on the child’s auditory development
45
program need for outcome measurement
EHDI programs need tools to assess the overall quality of the program Use of outcome measures - Program outcomes such as when the HA were fitted are often the focus of outcome reporting - Process outcomes such as how well the HA was fitted should be included as part of the focus: Quality of HA fitting can impact overall outcome of the child
46
Aided SII normative value study
- Collected through network of pediatric audiologists of Canada - Fittings from 161 ears of infants & children w wide range of HL (fit to targets assessed) - Main findings: as HL increases, SII values decrease, level distortion factor applied for speech inputs higher than 62 dB SPL
47
SII fit to target criteria
Fit to target criteria for losses < 70dB PTA: 5dB from 250-2000Hz and 5-7dB at 4KHz. Beyond 70 dB PTA insufficient data and recognize inherit limitations of this fit
48
when was boundary updated for SII, what boundary was updated
lower boundary switched from 2SD to 1 in 2016
49
Outcome measurement in CI care; Key finding (2014)
the adult MSTIB serves as clinical guideline or starting point for an ssesment batery, formal pediatric PMSTIB does not exist, survey identified variety of approaches in pediatric care, need systematic approach
50
Standardized approach to outcome measurment; working group (2017)
could help facilitate continuity of care, assist in clinical decision making allowing clinicians and researchers to define benchmarks, PMSTB embodies 3 cornerstones of EBP: research, clinical expertise & patient/familiy concerns
51
Ontario programs outcome measures process What tools are used:
early speech perception battery (ESP) 3 subtests (pattern, spondee, word) Glendonald auditory screening Multi-syllabic lexical neighborhood test (MLNT) Phonetically balanced kindergarden (PBK) words and sentences versions
52
Objective outcome measures
LING 6 detection, UWO plurals
53
Ling 6
Pre-recorded female utterances of each sound, norms for detection in dB HL soundfield. Normal hearing listeners detect sound b/w -10 to 10 dBHL, average test-retest reliablity of 1-2 dB and range of test re-test of 1-2 step sizes
54
UWO plurals test
Nouns in singular & plural form at high SNR, task to hear the word-final fricative, sensative to high frequency audibility, uses 15 nouns (e.,g ant, ballon book)
55
Advantages of objective outcome measures
- Direct measure of child’s hearing in aided & unaided conditions (demonstration to family) - Most clinics already have needed equipment - Useful to combine w subjective measures to give comprehensive description of outcome
56
HAO includes
going over the components of the HA, how to care for the hearing aid (cleaning, listening check, warranty), hearing aid use (basic function, insertion, rechargeable orientation), importance of consistent use
57
Cons of rechargable HA
child loses access to language when charging, using RM systems drain battery faster and may want easy way to replace instead of waiting for charge, earmolds may need to get removed to place into charger and close
58
what is eyes open, ears on”
Wear devices (“eyes open, ears on”) children who use devices more than 10 hrs/day show better language outcomes than children who use them less
59
Muñoz et al., 2015 parents were asked to estimate # of hours/day their child typically wears HA
34% reported child used HA during all waking hours, 23% most hours of day (8-10), 11% some of the day (5-7), 32% reported use during a portion of the day (<5 hours)
60
HAO challenges & strategies
- Retention - Lack of awareness of the effect of non-use on avg daily access to sound - Lack of perceived benefit of HA use - Multiple disabilities - Not clearly defined
61
2 items reported causing challenges for HA use for over ½ parents:
- Child’s behaviour & activities, such as playing outside or riding in car - fear of losing HA in public places or when they are in the care of alternative providers
62
Ideas to motivate parents to use from class discussion
- Use SII; look how much more access to speech your child has with the hearing aid (aided vs unaided SII) * Safety concerns localization of sound if unilateral hearing loss (Walking in parking lot, crossing road) * Discuss fatigue with them
63

Aural rehab (2 decks)

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