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Amplification 2 > Other Study Cards > Flashcards

Other Study Cards Flashcards

1
Q

Describe how frequency resolution changes with SNHL. Why does reduced frequency resolution make it difficult to understand speech in noise?

A

Auditory filters (critical bandwidth) must be intact to efficiently process complex signals the cochlea needs
The cochlea analyzes signals using a bank of overlapping band-pass filters
These filters allow regions of the cochlea to “pay attention” to a specific frequency region while ignoring frequencies outside of the band
In normal hearing, sharp tuning curves allow for precise frequency discrimination & perception of sounds
w/ HL, the curve is broader and noise can easily affect perception of the desired signal
Noise energy peaks around 250 Hz but upward spread of masking impacts audibility up to about 1500 Hz

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2
Q

can amplification fix frequency resolution changes?

A

no
PT will face this problem and make them aware of this - do not give the impression that premium amp can make it all better
If you do not have a sharp tuning curve, the signal gets masked making it difficult to hear in noise

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3
Q

Define temporal resolution and the auditory processes which support it.

A

The ability of the auditory system to detect time related changes in the acoustic stimuli over time
Needed in order to understand speech in noise

Time related Cues

Phonemic duration - can vs cant

Gap detection - soon vs spoon
Can we hear the small brief pauses between words, syllables etc.

Temporal ordering (boots; boost)

Suprasegmentals
Provides us with meaning (is it a question, a demand, etc.)

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4
Q

If there is a temporal resolution hearing problem, can a standard hearing aid fix this? What is a non amplification method to improve understanding with temporal issues

A

It will not fix it
Talk slower, enunciate
Just as effective as amplification can be
If we cannot hear and distinguish timing differences, makes it hard to untangle speech in the sea of noise and makes the issue PT have with hearing in noise more prevalent

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5
Q

what cues allow us to localize where sound is coming from

A

ILD
ITD

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6
Q

Describe the benefits spatial hearing supplies

A

A
Spatial hearing allows us to
Determine location of a sound source
Unmask sounds otherwise masked by noise
Brain combines and analyzes info arriving from both ears for improved signal detection & identification of speech in noise
Shift our attention and focus on one sound source while ignoring another
Feel connected with the environment

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7
Q

what is spatial hearing

A

Localizing where sound is coming from by using ILD & ITD between ears

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8
Q

Explain binaural loudness summation. Its suprathreshold benefits and how this benefit supports hearing aid fitting strategies.

A

Results in PT perceiving greater loudness w/ bilateral devices
Less gain is needed to reach comfortable listening levels
Can fit a PT with less loudness in order for them to hear the words

@ threshold increase only around 2-3dB
@ suprathreshold increase around 6-8dB

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9
Q

Explain binaural squelch and the benefit this auditory process supplies

A

ability of the auditory system to combine the information from both ears centrally and segregate the speech from the noise by the differences in sound between both ears.

Leads to improved intelligibility in noise & ability to focus on 1 signal while ignoring others by taking advantage of these differing SNRs

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10
Q

Which frequencies supply the most information on interaural level differences?

A

High frequencies (>3 kHz) to identify ear to ear head shadow level differences

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11
Q

Which size receiver maximizes HF output

A

Small - because the aperture is able to move faster and quicker

HF signals need rapid diaphragm movements
This is done w/ smaller receiver because it makes the diaphragm smaller and stiffer

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12
Q

Severe HL that needs high frequency output needs what receiver?

A

Dual receiver - gives benefit of both & has a big receiver so you need a custom receiver (embedded) or a larger BTE that has the larger receiver

2 receiver system that sums both receivers before reaching the ™ where one is optimized for LF and the other HF which reduces battery drain, gives a good EHF output w/out compromising a lot in LF and minimizes saturation distortion potential

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13
Q

Difference bw WDRC & FDRC

A

Initial TK is lower (10-15) in FD than in WD

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14
Q

Which needs lower tk?

A

Consonants - HF, less energy, softer

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15
Q

expansion

A

Expansion is needed when someone complains about some of soft sounds they do not need to hear are too loud

Lower output with very very soft sounds

0-20 dB input

Really low CR (lower than linear; <.9:1);

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16
Q

WDRC

A

needed to get soft sounds louder & expand dynamic rang
manages incoming signals

Input compression (AGC-i: amp electric signal comes in & will )

-Engages BEFORE volume control

-activates at the pre-amplifier when TK is low input level & signal is louder than this (bw 20-50)

LOW tk

LOW CR - 1.1:1-4:1 (almost linear)

Slow AT & RT

-Slower AT = temporal fine structure preserved in speech signal

-Slower RT = reduces times of inaudibility to very soft consonant sounds after compressor releases

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17
Q

Slow or fast AT
temporal fine structure preserved in speech signal

A

Slower AT

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18
Q

reduces times of inaudibility to very soft consonant sounds after compressor releases

A

slower RT

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19
Q

OLC

A

Output compression (AGC-o)

-LOUD SOUNDS
need this to protect the ear
Engages AFTER VC

Hight TK: >/= 80dB SPL

High CR: >/= 5:1

Attack time is fast to protect ear from loud sounds

-Release time is variable
-Sudden noises = fast
-Sustained loud noises = slow

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20
Q

Differentiate those services Medicare will and will not reimburse

A

No= Anything that relates to HA’s

Yes= Anything medically necessary

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21
Q

what are 3 methods used to reduce external feedback

A

Increase snugness of mold to reduces side of slit leak & Decrease vent size to stop feedback path

digital notch filtering

digital feedback cancellation

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22
Q

Describe 3 methods used to reduce external feedback

A

Reduce external feedback loop
Increase snugness of mold to reduce size of slit leaks
Or decrease vent size to stop feedback path
Limitation: both increases OE

Digital notch filtering
Removes frequencies around the noise - reduces gain around 2-4 kHz where feedback occurs
HA between this range with notch creates a notch in frequency response so we don’t amplify sound in those regions -
reduction in gain from 2-4 kHz and if you don’t turn the volume up it won’t cause feedback
Limitation 35% of intelligibility comes from this range alone so you stop feedback but stopped audibility of important speech sounds so reduced speech intelligibility

Digital feedback cancellation
When HA detects feedback (identified due to steady state noise bw 2-4 kHz) an algorithm creates an out of phase clone of the signal (duplicate of the feedback) and this causes the clone to be subtracted from the amp path and in turn attenuates the feedback

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23
Q

what is the purpose of frequency lowering

A

tries to improve HF audibility by shifting it down to LF
used with someone that has residual hearing and loss in HF makes it impossible to reach hf amplification (cannot get them to ever hear these sounds again)

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24
Q

Frequency lowering: describe the 3 types, their uses and limitations

A

Linear Frequency Transposition
Improves HF audibility by moving HF band one octave down to LF region
CUT AND PASTE into LF, takes the highs and shoves it into the lows

Nonlinear Frequency Compression
HF range is compressed into a LF range; squishes it down into the audible region
maintain tonotopic order more, lowered all the frequencies, squished into lower frequency space, close to each frequencies close to their original spot

Spectral Envelope Warping
Leave the HF where it is but also COPY and PASTE into LF

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25
Q

what is a review of systems (ROS)

A

series of questions that healthcare providers ask patients to help identify signs and symptoms of potential health issues.

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26
Q

Describe how inclusion of a case history review of systems assists clinical decision-making

A

comorbidity can lead to HL in many cases
Identifying comorbidities leads to improved outcomes.

Certain medical conditions such as diabetes, cardiovascular disease, or autoimmune disorders can affect hearing. A thorough case history can help audiologists identify these conditions and understand their potential impact on auditory health.

By reviewing symptoms across different systems, audiologists can differentiate between primary auditory disorders and those secondary to other health issues. For instance, dizziness may be related to vestibular problems rather than purely auditory ones.

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27
Q

Create a list of comorbidities linked to hearing loss.

A

Gastrointestinal: Crohn’s disease
Musculoskeletal: Rheumatoid arthritis, Fibromyalgia
Respiratory: Asthma
Cardiac: Congenital heart disease
Lymphatic: autoimmune disorders
Hematology: anemia, Leukemia
Integumentary: Shingles, Herpes zoster, Ramsay Hunt syndrome
Nervous system: Parkinson’s disease

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28
Q

gastrointestinal comorbidity related to HL

A

Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis

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29
Q

musculoskeletal comorbidity related to HL

A

Rheumatoid & Psoriatic arthritis, Gout, Fibromyalgia

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30
Q

respiratory comorbidity related to HL

A

COPD, Asthma

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31
Q

lymphatic comorbidity related to HL

A

Hodgkin’s/ non-Hodgkin’s lymphoma, autoimmune disorders

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32
Q

cardiac comorbidity related to HL

A

poor circulation, coronary artery disease, Congenital heart disease

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33
Q

hematology comorbidity related to HL

A

anemia, B12 deficiency, Lyme Disease, Leukemia

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34
Q

integumentary comorbidity related to HL

A

Shingles, Herpes zoster, Ramsay Hunt syndrome

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35
Q

nervous system comorbidity related to HL

A

Parkinson’s disease, Cognition

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36
Q

endocrine system comorbidity related to HL

A

THYROID, GRAVE’S DISEASE, DIABETES, PANCREATIC DISORDERS, KIDNEY DISEASE

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37
Q

Highlight the most common comorbidities prevalent in older populations

A

ASK

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38
Q

Visual impairment (frequency 68%) and Reduced manual dexterity (frequency 42%) and impact on rehabilitation

A

Vision or manual dexterity limitations may affect a client’s ability to handle and operate a hearing aid.

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39
Q

Cognitive issues (frequency 50%) and impact on rehabilitaiton

A

Reduce the client’s ability to recall information such as appointment times or understand device handling instructions.

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40
Q

Depression (depression (16%) and impact on rehabilitation

A

Diminish a client’s motivation to seek or adhere to rehabilitation

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41
Q

describe a Puretone threshold loss is
good indicator of functional impairment

A

This is our diagnosis
Does the person have or not have hearing loss
Do they have “normal” thresholds or does the signal need to be louder for the PT to hear the signal
Purely diagnostic

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41
Q

Hypertension (frequency 43%) and Diabetes (frequency 13%) and impact on rehabilitation

A

Hearing loss progression; blood thinning medications or diabetes may warrant caution when removing cerumen or taking impressions

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42
Q

Explain this statement- “The audiogram is not and indicator of the degree of communication deficit”

A

Audio is a measure of individual’s ability to detect quiet tones when using headphones
Audio thresholds ONLY diagnoses functional sensory deficits
Not an indicator of degree of communication deficit

Puretone threshold loss is
good indicator of functional impairment
moderate indicator of activity limitation
poor indicator of participation restriction

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43
Q

Falls (frequency 33%) and impact on rehabilitation

A

Restrict a client’s opportunities for communication and social participation and create barriers to attending appointments with their audiologist

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44
Q

describe a Puretone threshold loss is
moderate indicator of “activity limitation

A

Our ability to execute a task
Can i hear in noise? Or does noise mask my hearing making it harder to understand?
Degree of hl cannot tell if we have HIN issues or not
Can i hear a plural s sound and tell whether or not a person is talking about multiple or a singular issue?

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45
Q

describe a Puretone threshold loss is
poor indicator of “participation restriction”

A

If i have a hl does it mean that i can participate in something i want to or does the hl stop me

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46
Q

an audiogram tells us in quiet at what intensity you can hear a pure tone T/F

A

True

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47
Q

research has proven that the predictability of an audio to a PT’s degree of difficulty wth communication is very weak T/F

A

True

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48
Q

T/F Audiograms are predictive of communication abilities and difficulties

A

False

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49
Q

Describe all the factors which limit an audiologist’s ability to use word recognition scores to predict communication difficulties.

A

Overreliance on speech audio scores leads to inaccurate assumptions of intelligibility, disconnected counseling and less ideal recommendations

if we do not follow the test instructions then we have to recognize the results are invalid and no statements can be diagnostically made from that data

just because they could repeat words 100% in quiet doesn’t mean they will do the same in the real world

OVER-RELIANCE ON AUDIOMETRIC DATA & THE TERMINOLOGY WE USE RESULTS IN

TRADITIONAL SPEECH AUDIOMETRY IDENTIFIES THE PERCENT OF TIME A SINGLE-SYLLABLE WORD SPOKEN OUT OF CONTEXT. IS REPEATED CORRECTLY

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50
Q

T/F Single syllable words out of context does not simulate how we communicate

A

true

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51
Q

PB words presented in quiet do not supply information related to:

A

An individual’s ability to use lip-reading and facial expression cues
An individual’s ability to use contextual cues
An individual’s performance in complex listening environments
The #1 patient concern relates to their ability to understand speech in noise!
Other disabilities which compound communication difficulties:
Visual loss
Cognitive decline

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52
Q

Describe test techniques offering a more realistic assessment method of speech understanding for improved identification of patient concerns.

A

In addition to WRS
Add binaural speech assessments to your test battery
Present the list in both ears and see what happens

Use sentences-based test stimuli
Because PB words ONLY predicts speech intelligibility w/o contextual cues
Sentence provides grammatical cues & contextual cues that helps them use auditory closure skills

Assess performance with and without visual cues
Go through speech test traditionally, then have them turn head and look at you and do the test again to see if they improve

Assess speech intelligibility in the soundfield at 50-60 dB HL to simulate normal conversational speech levels.

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53
Q

The World Health Organization (WHO) developed the International Classification of Functioning, Disability, and Health (ICF) nomenclature (language) to

A

focus on health and functioning and get away from the perspective that “disability” is always the result of failing health.

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54
Q

ICF provides a universal standard language and framework for the description of health and health-related states

A

Body/structure and Function
Activity Limitations
Participation Restrictions
labels things differently so that it is more positive

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55
Q

what is a functional limitation

A

a problem in body function or structure
an actual diagnosis (but do not know how it will impact the patient)

moderate SNHL

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56
Q

what is an activity limitation

A

relates to difficulties experienced when executing a task or action
looks at can they do a task or can they not

ex:poor frequency and temporal resolution reduces intelligibility in noise (have trouble understanding speech in noise)

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57
Q

COMMONLY ASSOCIATED ACTIVITY LIMITATIONS

A

Detection of sounds
Distinction (discrimination) of sounds
i.e., frequency resolution
Intelligibility in quiet
Intelligibility in noise
Auditory localization
Temporal resolution abilities
Spatial hearing abilities

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58
Q

what is a participation restriction

A

refers to involvement in activities an individual would like to participate in
desire to do something but avoid it because they do not communicate well
relates to a persons choice

ex: I avoid restaurants because I cannot hear in noise

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59
Q

Create a list of common activity limitations and participation restrictions hearing impaired individuals face

A

OTSC - reduced mobility (BSF), speaks softer, difficulty hearing in noise (AL), avoid conversations because people say they mumble, keep tv volume up high (PR)

HF SNHL - ohc damage in cochlea (BSF), difficulty hearing consonants & hearing in noise (AL), avoids social gatherings, misunderstands many communications & family thinks they are not paying attention (PR)

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60
Q

Explain the ICF “backward synergy” concept

A

FUNCTIONAL LIMITATIONS CAN NOT DETERMINE HOW THRESHOLD LOSS IMPACTS COMMUNICATION;
BUT, INCREASED PARTICIPATION CAN IMPROVE ACTIVITY LIMITATIONS

treatment resulting in increased participation supplies communication practice and experiences which may result in neural changes to improve activity limitations

backwards synergy results in
Increased participation results in improved auditory processing
Increased participation results in improved lip-reading skills
Increased participation results in improved auditory closure skills

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61
Q

give an example of backward synergy

A

Increased participation results in improved auditory processing
Increased participation results in improved lip-reading skills
Increased participation results in improved auditory closure skills

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62
Q

Describe ways to avoid communication mismatch in professional reports to improve understanding of hearing loss impact

A

making clearer statements that are related to the identified concerns and using quantifiable data to assist interpretation of the findings
Referring to objective SII percentages in a report helps healthcare professionals better understand threshold loss impact

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63
Q

CLINICAL STRATEGIES TO IDENTIFY COMORBIDITIES

A

Regular use of standardized case history questionnaires designed to complete a review of systems
Use screening tools to identify visual, dexterity, and cognitive issues

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64
Q

T/F OVER-RELIANCE ON SPEECH AUDIOMETRY SCORES LEADS TO INACCURATE ASSUMPTIONS OF INTELLIGIBILITY, DISCONNECTED COUNSELING AND LESS THAN IDEAL RECOMMENDATIONS

A

True

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65
Q

2kHZ audibility supports ___% speech intelligibility

A

35%

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66
Q

what is the speech intelligibility index SII

A

SII calculates the percentage of speech information that is audible and usable to the listener.

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67
Q

What does and SII of .50 mean?

A

Means that 50% of speech cues supporting intelligibility are audible in quiet setting.

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68
Q

What gives an idea of what is audible and what is not audible.

A

SII

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69
Q

WHAT SII PERCENTAGE IS NEEDED FOR 96% AUDIBILITY OF DIGITS? OF SENTENCEs? OF NU6 WORDS?

A

Digits- 15% SII
Sentences- 50% SII
NU6 - 90% SII

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70
Q

T/F THE DEGREE OF INTELLIGIBILITY ACHIEVED IS PREDICTABLE BASED ON THE TEST SIGNAL

A

True

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71
Q

What is predictive of speech intelligibility

A

SII

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72
Q

Describe all the clinical uses for SII

A
  • Helps audiologist determine amplification candidacy
  • Reduces counseling mismatch b/w audiologists and patient
  • SII scores show objective audibility improvements with amplification- Aided SII comparisons allows you to see if one style or brand of device supplies more audibility.
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73
Q

What is the goal of real ear?

A

When we do real ear, the goal is to see what % of audibility we can provide to out patients

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74
Q

what is the biopsychosocial test battery approach

A

assesses ALL relevant physical, social, and psychological contexts of the patient when designing a treatment plan.

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75
Q

what is the functional & communication needs assessment (F&CNA)

A

1.Diagnostic functional assessment
Comprehensive case history including an assessment of comorbidities (review of systems)

-A comprehensive audiometric evaluation, including TEN test
  1. Communication Needs Assessment

Objective assessments:
Speech in noise assessment, Acceptable noise level assessment, puretone LDL

Subjective assessments:
Standardized self-report questionnaires assessing communication needs and patient specific treatment goals

Non-auditory needs assessments
Assesses other factors impacting the rehabilitation process: Cognitive decline, general health, and other otologic conditions (tinnitus), additional sensory impairments (manual dexterity, visual acuity), environmental factors: occupational demands, recreational habits, and patient support systems, personality characteristics (expectations, motivation, willingness to take a risk, assertiveness).

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76
Q

what does a diagnostic functional assessment include

A

Comprehensive case history including an assessment of comorbidities (review of systems)
A comprehensive audiometric evaluation, including TEN test

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77
Q

what is incuded in the communication needs assessment

A

objective assessments

subjective assessments

non-auditory needs assessments

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78
Q

what is included in the objective assessments

A

Speech in noise assessment, Acceptable noise level assessment, puretone LDL

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79
Q

what is included in a subjective assessment

A

Standardized self-report questionnaires assessing communication needs and patient specific treatment goals

80
Q

what is included in non-auditory needs assessments

A

Assesses other factors impacting the rehabilitation process: Cognitive decline, general health, and other otologic conditions (tinnitus), additional sensory impairments (manual dexterity, visual acuity), environmental factors: occupational demands, recreational habits, and patient support systems, personality characteristics (expectations, motivation, willingness to take a risk, assertiveness).

81
Q

T/F If we don’t fully investigate, we can’t know the individual’s needs

A

True

82
Q

what can be done to determine comorbidities and their effects on the patient?

A

do a checklist of common disorders (review of systems) and if they check it off, they are related to progressive HL and should be a red flag to us
Use screening tools to identify visual, dexterity, and cognitive issues

83
Q

why are needs assessments conducted

A

To determine candidacy in making individualized amplification recommendations

84
Q

what is included in a needs assessment

A

Audiological, physical, communication, listening, self assessment and other pertinent factors affecting patient outcomes

85
Q

objective assessments supply additional information regarding

A

Activity limitations

86
Q

Objective Assessments of Body Structure & Function

A

TEN test
Purpose: Identifies cochlear dead regions

Puretone loudness discomfort levels (LDL)
Purpose: obtain objective data identifying the frequency-specific dynamic range to ensure output across frequencies does not exceed levels of comfort

87
Q

what is the purpose of a ten test

A

Identify cochlear dead regions

88
Q

what is the purpose of LDLs

A

obtain objective data identifying the frequency-specific dynamic range to ensure output across frequencies does not exceed levels of comfort.

89
Q

what is the purpose of QuickSIN

A

Quantifies degree of SNR loss and identifies potential of binaural interference

89
Q

Objective Assessments of Activity Limitation

A

QuickSIN
Purpose: Quantifies degree of SNR loss and identifies potential of binaural interference

Acceptable Noise Level
Purpose: Quantifies a patient’s tolerance of background noise

90
Q

what is the purpose of ANL

A

Quantifies a patient’s tolerance of background noise

91
Q

why are LDLs needed?

A

to ensure amplified output doesn’t exceed Patients loudness tolerance, UCL

92
Q

what are LDLs used for

A

Data is used to program output and verify OSPL 90/MPO limits of the devices

93
Q

T/F Individual tolerance levels vary significantly despite similar threshold loss.

A

True

93
Q

T/F When MPO settings remains below LDL acceptance of high input levels & overall satisfaction with amplification decreases

A

False,
Overall satisfaction improves

94
Q

what is the LDL test protocol

A

PT refers to loudness categories
signal is pulsed pure tone
1. present at MCL (wherever speech is presented)
2. Ascend 5dB & PT ranks loudness after each presentation (narrow DR ascend in 2dB as you near LDL threshold)
3. Stop ascending when reach #7 on category list
4. Run 2-3 trials, repeating the above steps starting at MCL again

Assessment Protocol
always assess 2&3 kHz
normal sensitivity - skip
LF >40 - test 500 Hz
Precipitous inter-octave change (>20 dB) - test inter-octaves
HA output supplies extended frequency range - assess above 3 kHz

95
Q

what symbols are used for LDL

A

forward L for the right ear and backward L for the L ear
upside down E’s are used in NOAH

96
Q

LDL purpose

A

LDL purpose is to find your judgment of the loudness of different sounds. we want to ensure that the amplified output of a hearing aid device does not exceed your loudness tolerance.

97
Q

LDL results meaning

A

Your results show that there is some consistency in the different frequencies tested, or pitches presented, meaning loudness is perceived consistently to you. Average patient LDL is 100-105 dB HL and your results were basically going to the limits of the equipment which just means you tolerate loudness more than the average patient.

98
Q

purpose & use of ANL

A

Quantifies a listener’s willingness to listen to speech in the presence of background noise.

Predictive of hearing aid satisfaction with 85% accuracy
Identifies those who will have more difficulty adapting to amplification

99
Q

what is the test protocol for ANL

A

ANL test protocol
Calibrate both external channels
ANL CD
Track 2
External A speech passage
Speaker
Same Side (L or R)
Channel 1
External B Noise/babble
Speaker
Same Side (L or R)
Channel 2
Binaurally through soundfield speakers
Patient positioned at 0° azimuth
Speech & noise are mixed within the same transducer (speaker)
Audiometer
Requires test tone calibration of both audiometer channels
Calibration tone on track 2
Both channels are routed to same transducer (speaker)
Channel 1- presents the speech signal
Channel 2- presents the competing noise

Step one, establish MCL
You do this in 5db steps to identify when speech is too loud
Follow ANL Speech MCL protocol on channel 1 (CH1)
Use 5 dB steps to identify speech is too loud
Use 5 dB steps to identify when speech is too soft
Change to 2 dB steps and ascend to MCL
This is often missed remember to change db steps
2db step until you identfy MCL (comfortable)
Document MCL intensity
(switch back to 5 db steps)

Step 2
Establish background noise level (BNL) value:
Add noise/Babble
Turn on External B (External A & B are both on)
Increase the competing noise (CH2) in 5 dB steps until the story is incomprehensible.
Decrease CH2 in 5 dB steps until story is very clear
Increase CH2 in 2 dB steps to the “greatest volume that they would want to put up with while listening to the story for a long period of time”.
Switch to 2 db steps.
Document CH2 intensity as “BNL”

Your BNL is the greatest volume that they would want to put up with while listening to the story for a long period of time”.

MCL-BNL = ANL

100
Q

how to score ANL

A

MCL value – BNL value = ANL score

101
Q

low ANL score

A

(difference < 7 dB)
Indicates the patient ACCEPTS a lot of noise background noise w/o issues
This patient is likely to wear hearing aids on a regular basis
no problems tolerating background noise, no management in fittings needed
study in noise example & can focus and not get distracted

102
Q

High ANL score

A

(difference > 13 dB)

Indicates the patient LACKS TOLERANCE for background noise
This patient is less likely to wear hearing aids regularly
very quickly bothered by the background noise
early research - lacks tolerance for amp, not amp candidates

103
Q

ANL scores b/w 8-12 dB are equivocal

A

May require extra post-fitting counselling or adjustment period
not amp candidate (early research)
These need extra counseling that they may need more time to adjust to amplification or they may never adjust to them or like them

104
Q

what is the rationale for SNR loss measurement

A
  1. Speech intelligibility in noise remains the #1 improvement patients seek with hearing aids
  2. To enhance satisfaction with amplification, it is essential to improve hearing in noisy environments. Each patient will need tailored technological recommendations based on their individual “signal-to-noise loss.” Measuring the extent of signal-to-noise ratio loss enables the selection of suitable technological options and validates the improvement provided by those choices.
  3. Quantifying the degree of signal to noise ratio loss allows you to elect appropriate technological options and validate the selection provided improvement
105
Q

what is the clinical usefullness with SNR tests

A

Completion of the test instills patient confidence in your skills

good for our knowledge and validating for PT complaints

Results supply quantifiable data:
Supporting use of evidence-based recommendations for technology for improved hearing in noise
Helping patients understand improved communication requires more than restoration of threshold loss

Quantifying the degree of signal to noise ratio loss allows you to elect appropriate technological options and validate the selection provided improvement

106
Q

Define the terms SNR-50 and SNR Loss

A

SNR Loss - is when a patients SNR-50 is greater than 2db they have an SNR Loss (2db os normal)

SNR 50 - is the signal to noise ratio that allows an individual to understand 50% of the test signal

When a patient’s SNR 50 is greater than 2 dB they have a signal-to-noise ration LOSS
SNR LOSS is calculated by subtracting 2 dB from the SNR-50 score

107
Q

What is a normal SNR-50

A

Normal SNR-50 = +2db SNR - 50

SNR - 50 above +2db is SNR loss

(signal needs to be 2 dB louder than the noise in order to understand 50% of what was said)

108
Q

what is the quicksin protocol

A

Presentation level is calculated based on PTA
If PTA <45 dB present word lists at 70 dB HL
When PTA >45 dB present sentence lists at an intensity perceived as “Loud but OK”

Present one practice list
Proceed with 3 test lists for each test condition
SNR Loss Scoring- Add each word list score and divide by the number of lists presented to one ear (3)
Avoid use of Lists 3, 4, 5, 7, 13, and 16

109
Q

how to score SNR Loss

A

Add each word list score and divide by the number of lists presented to one ear (3)

Each list has 6 sentences presented with varying SNR’s
5 key words in each sentence are scored as correct/ incorrect.
Cross out incorrect or missed and subtract one for each

110
Q

T/F THERE’S NO NEED TO DEDUCT AN ADDITIONAL 2DB FROM THE FINAL CALCULATION WHEN SCORING THE QUICKSIN. ITS SCORING CALCULATION OF SNR LOSS FACTORS THIS DIFFERENTIAL IN.

A

True

111
Q

T/F patient’s signal-to-noise ratio loss can be predicted by degree of threshold loss

A

False

112
Q

0-2 SNR

A

Normal;
Omni or May benefit from direction mics

113
Q

2-7 SNR

A

Mild;
Recommend Standard directional mics

114
Q

> 15 SNR

A

Severe;
Requires remote mics, in addition to above recommendations
( standard directional mics & beamforming)

115
Q

7-15 SNR

A

Moderate;
Requires beam forming mics &
Standard directional Mics

116
Q

alternative quicksin test protocols

A

Monaural presentation via headphones

Binaural presentation via headphones

Soundfield presentation via speakers

117
Q

QuickSIN Monaural presentation via headphones does what

A

Allows you to detect asymmetric SNR loss

118
Q

QuickSIN Binaural presentation via headphones does what

A

Quantifies functional SNR loss by supplying binaural benefit

119
Q

QuickSIN Soundfield presentation via speakers does what

A

Used to determine if aided speech in noise performance improved or degraded presentation level

120
Q

what is the most significant benefit for ANL is when what…

A

ANL improves what BOTH directional mics & DNR are enabled

121
Q

Acceptance of noise level improves when

A

BOTH directional mics & DNR are enabled.
Directional microphones alone only supported partial acceptance
DNR alone only showed minimal improvement

122
Q

what does DNR do?

A

reduces steady state noises (HF or LF as long as they are steady in frequency & intensity)

123
Q

what is another option instead of Quciksin

A

BKB-SIN test

QuickSIN is more stressful so you may want to move to BKB-SIN if you are concerned about cognitive or other abilities.

At times, the length of sentences is problematic for elderly with auditory memory deficits
QuickSIN sentences too difficult for young children

124
Q

What happens with elderly population about ⅙ individuals

A

Binaural Interference

125
Q

what is the binaural interference assessment

A

Binaural QuickSIN measurement to quickly identify potential for binaural interference

You presented & score QuickSIN monaural
Then present & score QuickSIN binaurally
compare Monaural to binaural.
if binaural degrades = red flag for Binaural interference

126
Q

what is binaural interference

A

Age related atrophy of the corpus callosum reduces speech intelligibility with binaural input

Each side has a different function and sometimes a signal can meet in the middle and get stuck and not make it all the way to the brain

127
Q

The functional & communication needs assessment must

A

Identify activity limitations & participation restrictions
Identify environmental factors which may impact plan of care
Identify personal factors which may impact plan of care

128
Q

STANDARDIZED SELF-REPORT QUESTIONNAIRES QUANTIFY _____, _____ & _____ OF THE HEARING-IMPAIRED PATIENT

A

ACTIVITY LIMITATIONS, THE SOCIAL AND PSYCHOLOGICAL NEEDS

129
Q

benefits of a standardized self-report questionnaire

A

Standardization allows comparison to normative data
Questionnaires are completed independently, prior to the scheduled appointment

130
Q

standardized self report questionnaires assist with comprehensive identification of all technology needs:

A

Selection of hearing instrument style
Features needs
Hearing assistive devices
Counseling on realistic expectations

130
Q

screening tests examples

A

HHIA/E screening; Hearing Disabilities and Handicap Scale, Hearing-Dependent Daily Activities Scale (HDDA has high highest sensitivity rating- 80%)

131
Q

what has the highest sensitivity rating for screenings

A

Hearing-Dependent Daily Activities Scale (HDDA)

131
Q

which questionnaire is for patient centered goals

A

COSI

132
Q

Communication abilities (activity/participation) questionnaires

A

APHAB, SAC/SOAC, CCP-confidence rating

133
Q

Patient Expectations of amplification

A

ECHO

134
Q

Related Non-auditory questionnaires

A

HASP, Social Network Inventory, WHO-DAS, Geriatric Depression Questionnaire

135
Q

experienced HA user questionnaire

A

SADL

136
Q

Describe the clinical usefulness of the Social Network Index

A

Describes the social relationships
Looks at how often the patient communicates with others, as well as the communication methods used (face-to-face, or telephone)

Correlations between the relationship of loneliness and cognitive decline are beginning to emerge

136
Q

Describe the clinical usefulness of the ECHO

A

expected consequences of hearing aid ownership

designed to assess 4 subscales related to patient expectations of amplification

usefulness: Knowing it in advance allows us to use other strategies to promote success or let PT wait because they are not ready for amplification

137
Q

Describe the clinical usefulness of the communication profile hearing impaired (CPHI)

A

used to find out how hearing loss affects daily life and what problems, if any, a patient is having

138
Q

Recent research finds the ECHO and CPHI are highly predictive of adherence vs. nonadherence
True or false

A

True

138
Q

Describe the clinical usefulness of the hearing aid selection profile (HASP)

A

Looks at self-perceptions outside of amplification to evaluate core beliefs

Type of HA to suggest or certain tech to recommend to a PT based on their lifestyle

Certain scores predict if PT will do well or not do well with amplification

139
Q

Patients were more likely to return devices for credit when expectations of hearing aid benefit scores were ___

A

Low

140
Q

Describe the clinical usefulness of the Client Orientated Scale of Improvement (COSI)

A

Prioritizes patient-centered treatment goals

Actively involves patients in plan of care
focuses on individual needs when planning rehabilitation
assists with counseling’s

141
Q

In General what do Standardized self report questionnaires do/assits with?

A

They are helpful with

  • Gathering information fast and efficient because you do not need to be present
  • To understand an individual needs
  • identity appropriate amplification levels, styles & features.
  • Recognize with Hearing assistive technology (HAT) needs to be considered

-Communication strategy recommendations

  • Allows for comparison to normative data
  • Assists with counseling
142
Q

activity limitation vs participation restriction

A

activity limitation relates to the difficulties experienced when executing a task or action
Focus on specific tasks and activities & occur at the individual level relating to specific actions

participation restriction refers to problems an individual experiences in involvement in activities an individual would like to participate in (involvement in life situations)
Encompasses broader life roles and social participation & often involves interactions with society and environment (highlighting societal barriers)

143
Q

activity limitation or participation restriction
Trouble hearing soft sounds or whispers

A

activity limitation
difficulty with detection of sounds

144
Q

activity limitation or participation restriction
Inability to hear HF sounds like birds or alarms

A

activity limitation
detection of sounds

145
Q

activity limitation or participation restriction
Problems distinguishing between similar sounding words

A

activity lmitation

146
Q

activity limitation or participation restriction
Difficulty understanding speech in noisy environments, such as restaurants or social gatherings.

A

Activity Limitation

147
Q

activity limitation or participation restriction
Trouble hearing in reverberant or echo-prone spaces, such as large halls or gyms.

A

activity limitation

148
Q

activity limitation or participation restriction
Avoiding social gatherings or events due to difficulties in following conversations.

A

participation restriction

149
Q

activity limitation or participation restriction
Reduced involvement in group activities, clubs, or community events.

A

participation restriction

150
Q

activity limitation or participation restriction
Difficulty performing job duties that require effective communication, such as customer service or teamwork.

A

participation restriction

151
Q

activity limitation or participation restriction
Reduced opportunities for career advancement due to communication barriers.

A

participation restriction

152
Q

activity limitation or participation restriction
Difficulties in understanding lectures or instructions, leading to academic challenges

A

participation restriction

153
Q

activity limitation or participation restriction
Difficulty hearing household sounds, such as doorbells, alarms, or children calling.

A

participation restriction

154
Q

activity limitation or participation restriction
Reduced enjoyment of hobbies that involve listening, like music or audio books.

A

participation restriction

155
Q

describe the difference between cognitive and affective goals

A

Cognitive: Defines difficult environments that require improvement to reduce the impact of the impairment (focus on improving PT’s ability to process, understand, and remember auditory information

affective: Defines desired improvements as they relate to feelings/ emotional needs (relates to the emotional and psychological aspects of HL and its management)

91

156
Q

Affective or Cognitive Goal
Feeling less embarrassment during communication

A

affective COSI goal

157
Q

Affective or Cognitive Goal
Reduced stress during workday

A

affective COSI goal

158
Q

Affective or Cognitive Goal
Alleviating feelings of anxiety or stress related to hearing difficulties

A

affective COSI goal

159
Q

Affective or Cognitive Goal
Building confidence in social interactions and communication situations.

A

affective COSI goal

160
Q

Affective or Cognitive Goal
Increasing participation in social activities and gatherings.

A

affective COSI goal

161
Q

Affective or Cognitive Goal
Enhancing the ability to comprehend speech in quiet or noisy environments.

A

cognitive cosi goal

162
Q

Affective or Cognitive Goal

A

cognitive cosi goal

163
Q

Affective or Cognitive Goal
Improving clarity and comprehension of conversations, particularly in challenging listening situations.

A

cognitive cosi goal

164
Q

Affective or Cognitive Goal
Improved conversation with a spouse in a quiet environment”

A

cognitive cosi goal

165
Q

Affective or Cognitive Goal
Improved communication with unfamiliar speakers on the telephone without removal of the hearing aid

A

cognitive cosi goal

166
Q

Affective or Cognitive Goal
Developing better listening strategies to focus on important sounds while filtering out background noise.

A

cognitive cosi goal

167
Q

what is the usefulness of cosi goals clinically

A

Actively involves patient in plan of care

Focuses on the individual’s needs when planning rehabilitation

Assists with counseling

Opens discussions related to advanced technology needs
Identifies unrealistic expectations for discussion
I want better hearing in noise using using a CIC style
I want improved localization when using one device
I want low-cost amplification, but poor dexterity requires automatic features

168
Q

non-auditory personal factors

A

General health
Chronic disorders, depression, anxiety
Dexterity, visual acuity, etc.
Cognitive decline (covered in AUDE 6310)
Prior experience with amplification
Personality characteristics
Expectations, motivation, willingness to take a risk, assertiveness

169
Q

what is a generic health-status instrument that gathers data about general health from a comprehensive case history

A

The World Health Organization’s Disability Assessment Scale II (WHO-DAS II)

170
Q

how does general health screening assist audiologic recommendations

A

General health - comes from primarily comprehensive case history
WHO-DAS II
Identify any underlying health conditions that might affect hearing health or the use of hearing aids
Ex: Detects conditions such as diabetes, cardiovascular disease, or ear infections that can impact hearing. Ensures that hearing aid recommendations consider any comorbidities or medications that might interfere with hearing health.

171
Q

how does depression screening assist audiologic recommendations

A

Identify symptoms of depression that could affect a PT’s motivation and engagement in hearing rehabilitation
Ex: Recognizes the need for additional support or counseling to improve treatment adherence. Adjusts communication strategies to accommodate the patient’s emotional state, ensuring a more patient-centered approach.

172
Q

how does anxiety screening assist audiologic recommendations

A

GAD-7
Identify symptoms of anxity that could impact PT’s ability to cope with HL and use hearing aids effectively
Ex: addresses anxiety related concerns like fear of using new tech or social anxiety in communication situations.

173
Q

how does manual dexterity screening assist audiologic recommendations

A

Purdue Pegboard Test
To assess PTs fine motor skills and ability to handle small objects like HA’s
Ex: Determines the need for hearing aids with easier handling features, such as larger controls or rechargeable batteries. Suggests assistive devices or alternative solutions if dexterity issues are significant.

174
Q

how does visual screening assist audiologic recommendations

A

Identify whether they can see small things on HA or not
Ex: Considers the need for additional visual aids or support for hearing aid maintenance.

175
Q

Motivation, and prior experience with amplification and how it can assist with audiologic recommendations

A

Was it positive? Negative? What did you like with HA or dislike?
Avoids creating the same mistakes

176
Q

what is the dexterity screening used and how is it run

A

Purdue Pegboard Test
4 tests
Right
Left
Both
assembly – uses both hands to make separate things? – how well the l and r hand can do things together
First 3 are 30 s and last is a min
Chair, table, stopwatch & pegboard

177
Q

T/F Chronic visual conditions in combination with hearing loss increase in prevalence as we age

A

True

178
Q

T/F The problems encountered by individuals with “dual sensory” loss are considerably greater than the effects of vision impairment or hearing impairment alone

A

True

179
Q

Visual & auditory-vestibular comorbidities examples

A

Audio-visual disorders
Visual-vestibular disorders

180
Q

why are we worried about dual sensory loss

A

one impact from one sensory deficit and another and combining two deficits, it exacerbates and may even triple the issue the PT encounters

181
Q

Dual-sensory loss commonly occurs in the presence of these comorbidities

A

Hypertension
Heart disease
Stroke
Diabetes
Cancer
Arthritis

182
Q

Comorbidities Including ________, ___________,___________ and __________, & ______________
_____________ = ___________
_____________ = ___________
_____________ = ___________

A

Comorbidities Including chronic systemic diseases, declining cognition and motor function, & reduced social engagement.
Systemic disease= progressive loss
Cognition/motor function= clinical decision-making
Reduced social engagements= progressive cognitive decline, depression, etc.

183
Q

Systemic disease=

A

Systemic disease= progressive loss

184
Q

Cognition/motor function=

A

Cognition/motor function= clinical decision-making

185
Q

Reduced social engagements=

A

Reduced social engagements= progressive cognitive decline, depression, etc.

186
Q
A
187
Q

List the Multidimensional factors audiologists should include in their functional & communication needs protocols

A

Biopsychosocial
- Auditory Assessment diagnosis
- Objective Functional Communication Needs Assessment

Psychological &Social
- Subjective functional Communication Needs assessment

Social
- Non-Auditory Needs Assessment

Functional & communication needs assessment must
- identify activity limitation and participation restriction
- identify environment factors that could impact plan of care
- identify personal factors that could impact plan of care

188
Q

Biopsychosocial Portion of Multidimensional factors audiologists should include in their functional & communication needs protocols

A

Biosychosocial
- Auditory Assessment Diagnosis
-Comprehensive Case history and Audiometric evaluation
- Objective Functional Communication Needs Assessment
-TEN test, Speech in noise, ANL, LDL

Functional & communication needs assessment must
- identify activity limitation and participation restriction
- identify environment factors that could impact plan of care
- identify personal factors that could impact plan of care

189
Q

Psychological &Social Portion of Multidimensional factors audiologists should include in their functional & communication needs protocols

A

Psychological &Social
- Subjective functional communication needs assessment
-Analysis of patients perception & communication needs; identify treatment goals
-ex: standardized questionnaires

Functional & communication needs assessment must
- identify activity limitation and participation restriction
- identify environment factors that could impact plan of care
- identify personal factors that could impact plan of care

190
Q

Social portions of Multidimensional factors audiologists should include in their functional & communication needs protocols

A

Social
Non-Auditory needs assessment
-Other factors that impact rehabilitation process. General health, cognitive decline, enviormnetal factors etc.

Functional & communication needs assessment must
- identify activity limitation and participation restriction
- identify environment factors that could impact plan of care
- identify personal factors that could impact plan of care

191
Q

Audiograms are not….

A

Audiograms are not predictive of communication abilities

192
Q
A

Amplification 2 (5 decks)

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