Other Study Cards Flashcards
Describe how frequency resolution changes with SNHL. Why does reduced frequency resolution make it difficult to understand speech in noise?
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
can amplification fix frequency resolution changes?
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
Define temporal resolution and the auditory processes which support it.
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.)
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
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
what cues allow us to localize where sound is coming from
ILD
ITD
Describe the benefits spatial hearing supplies
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
what is spatial hearing
Localizing where sound is coming from by using ILD & ITD between ears
Explain binaural loudness summation. Its suprathreshold benefits and how this benefit supports hearing aid fitting strategies.
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
Explain binaural squelch and the benefit this auditory process supplies
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
Which frequencies supply the most information on interaural level differences?
High frequencies (>3 kHz) to identify ear to ear head shadow level differences
Which size receiver maximizes HF output
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
Severe HL that needs high frequency output needs what receiver?
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
Difference bw WDRC & FDRC
Initial TK is lower (10-15) in FD than in WD
Which needs lower tk?
Consonants - HF, less energy, softer
expansion
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);
WDRC
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
Slow or fast AT
temporal fine structure preserved in speech signal
Slower AT
reduces times of inaudibility to very soft consonant sounds after compressor releases
slower RT
OLC
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
Differentiate those services Medicare will and will not reimburse
No= Anything that relates to HA’s
Yes= Anything medically necessary
what are 3 methods used to reduce external feedback
Increase snugness of mold to reduces side of slit leak & Decrease vent size to stop feedback path
digital notch filtering
digital feedback cancellation
Describe 3 methods used to reduce external feedback
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
what is the purpose of frequency lowering
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)
Frequency lowering: describe the 3 types, their uses and limitations
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
what is a review of systems (ROS)
series of questions that healthcare providers ask patients to help identify signs and symptoms of potential health issues.
Describe how inclusion of a case history review of systems assists clinical decision-making
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.
Create a list of comorbidities linked to hearing loss.
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
gastrointestinal comorbidity related to HL
Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis
musculoskeletal comorbidity related to HL
Rheumatoid & Psoriatic arthritis, Gout, Fibromyalgia
respiratory comorbidity related to HL
COPD, Asthma
lymphatic comorbidity related to HL
Hodgkin’s/ non-Hodgkin’s lymphoma, autoimmune disorders
cardiac comorbidity related to HL
poor circulation, coronary artery disease, Congenital heart disease
hematology comorbidity related to HL
anemia, B12 deficiency, Lyme Disease, Leukemia
integumentary comorbidity related to HL
Shingles, Herpes zoster, Ramsay Hunt syndrome
nervous system comorbidity related to HL
Parkinson’s disease, Cognition
endocrine system comorbidity related to HL
THYROID, GRAVE’S DISEASE, DIABETES, PANCREATIC DISORDERS, KIDNEY DISEASE
Highlight the most common comorbidities prevalent in older populations
ASK
Visual impairment (frequency 68%) and Reduced manual dexterity (frequency 42%) and impact on rehabilitation
Vision or manual dexterity limitations may affect a client’s ability to handle and operate a hearing aid.
Cognitive issues (frequency 50%) and impact on rehabilitaiton
Reduce the client’s ability to recall information such as appointment times or understand device handling instructions.
Depression (depression (16%) and impact on rehabilitation
Diminish a client’s motivation to seek or adhere to rehabilitation
describe a Puretone threshold loss is
good indicator of functional impairment
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
Hypertension (frequency 43%) and Diabetes (frequency 13%) and impact on rehabilitation
Hearing loss progression; blood thinning medications or diabetes may warrant caution when removing cerumen or taking impressions
Explain this statement- “The audiogram is not and indicator of the degree of communication deficit”
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
Falls (frequency 33%) and impact on rehabilitation
Restrict a client’s opportunities for communication and social participation and create barriers to attending appointments with their audiologist
describe a Puretone threshold loss is
moderate indicator of “activity limitation
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?
describe a Puretone threshold loss is
poor indicator of “participation restriction”
If i have a hl does it mean that i can participate in something i want to or does the hl stop me
an audiogram tells us in quiet at what intensity you can hear a pure tone T/F
True
research has proven that the predictability of an audio to a PT’s degree of difficulty wth communication is very weak T/F
True
T/F Audiograms are predictive of communication abilities and difficulties
False
Describe all the factors which limit an audiologist’s ability to use word recognition scores to predict communication difficulties.
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
T/F Single syllable words out of context does not simulate how we communicate
true
PB words presented in quiet do not supply information related to:
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
Describe test techniques offering a more realistic assessment method of speech understanding for improved identification of patient concerns.
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.
The World Health Organization (WHO) developed the International Classification of Functioning, Disability, and Health (ICF) nomenclature (language) to
focus on health and functioning and get away from the perspective that “disability” is always the result of failing health.
ICF provides a universal standard language and framework for the description of health and health-related states
Body/structure and Function
Activity Limitations
Participation Restrictions
labels things differently so that it is more positive
what is a functional limitation
a problem in body function or structure
an actual diagnosis (but do not know how it will impact the patient)
moderate SNHL
what is an activity limitation
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)
COMMONLY ASSOCIATED ACTIVITY LIMITATIONS
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
what is a participation restriction
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
Create a list of common activity limitations and participation restrictions hearing impaired individuals face
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)
Explain the ICF “backward synergy” concept
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
give an example of backward synergy
Increased participation results in improved auditory processing
Increased participation results in improved lip-reading skills
Increased participation results in improved auditory closure skills
Describe ways to avoid communication mismatch in professional reports to improve understanding of hearing loss impact
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
CLINICAL STRATEGIES TO IDENTIFY COMORBIDITIES
Regular use of standardized case history questionnaires designed to complete a review of systems
Use screening tools to identify visual, dexterity, and cognitive issues
T/F OVER-RELIANCE ON SPEECH AUDIOMETRY SCORES LEADS TO INACCURATE ASSUMPTIONS OF INTELLIGIBILITY, DISCONNECTED COUNSELING AND LESS THAN IDEAL RECOMMENDATIONS
True
2kHZ audibility supports ___% speech intelligibility
35%
what is the speech intelligibility index SII
SII calculates the percentage of speech information that is audible and usable to the listener.
What does and SII of .50 mean?
Means that 50% of speech cues supporting intelligibility are audible in quiet setting.
What gives an idea of what is audible and what is not audible.
SII
WHAT SII PERCENTAGE IS NEEDED FOR 96% AUDIBILITY OF DIGITS? OF SENTENCEs? OF NU6 WORDS?
Digits- 15% SII
Sentences- 50% SII
NU6 - 90% SII
T/F THE DEGREE OF INTELLIGIBILITY ACHIEVED IS PREDICTABLE BASED ON THE TEST SIGNAL
True
What is predictive of speech intelligibility
SII
Describe all the clinical uses for SII
- 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.
What is the goal of real ear?
When we do real ear, the goal is to see what % of audibility we can provide to out patients
what is the biopsychosocial test battery approach
assesses ALL relevant physical, social, and psychological contexts of the patient when designing a treatment plan.
what is the functional & communication needs assessment (F&CNA)
1.Diagnostic functional assessment
Comprehensive case history including an assessment of comorbidities (review of systems)
-A comprehensive audiometric evaluation, including TEN test
- 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).
what does a diagnostic functional assessment include
Comprehensive case history including an assessment of comorbidities (review of systems)
A comprehensive audiometric evaluation, including TEN test
what is incuded in the communication needs assessment
objective assessments
subjective assessments
non-auditory needs assessments
what is included in the objective assessments
Speech in noise assessment, Acceptable noise level assessment, puretone LDL
what is included in a subjective assessment
Standardized self-report questionnaires assessing communication needs and patient specific treatment goals
what is included in 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).
T/F If we don’t fully investigate, we can’t know the individual’s needs
True
what can be done to determine comorbidities and their effects on the patient?
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
why are needs assessments conducted
To determine candidacy in making individualized amplification recommendations
what is included in a needs assessment
Audiological, physical, communication, listening, self assessment and other pertinent factors affecting patient outcomes
objective assessments supply additional information regarding
Activity limitations
Objective Assessments of Body Structure & Function
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
what is the purpose of a ten test
Identify cochlear dead regions
what is the purpose of LDLs
obtain objective data identifying the frequency-specific dynamic range to ensure output across frequencies does not exceed levels of comfort.
what is the purpose of QuickSIN
Quantifies degree of SNR loss and identifies potential of binaural interference
Objective Assessments of Activity Limitation
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
what is the purpose of ANL
Quantifies a patient’s tolerance of background noise
why are LDLs needed?
to ensure amplified output doesn’t exceed Patients loudness tolerance, UCL
what are LDLs used for
Data is used to program output and verify OSPL 90/MPO limits of the devices
T/F Individual tolerance levels vary significantly despite similar threshold loss.
True
T/F When MPO settings remains below LDL acceptance of high input levels & overall satisfaction with amplification decreases
False,
Overall satisfaction improves
what is the LDL test protocol
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
what symbols are used for LDL
forward L for the right ear and backward L for the L ear
upside down E’s are used in NOAH
LDL purpose
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.
LDL results meaning
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.
purpose & use of ANL
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
what is the test protocol for ANL
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
how to score ANL
MCL value – BNL value = ANL score
low ANL score
(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
High ANL score
(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
ANL scores b/w 8-12 dB are equivocal
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
what is the rationale for SNR loss measurement
- Speech intelligibility in noise remains the #1 improvement patients seek with hearing aids
- 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.
- Quantifying the degree of signal to noise ratio loss allows you to elect appropriate technological options and validate the selection provided improvement
what is the clinical usefullness with SNR tests
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
Define the terms SNR-50 and SNR Loss
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
What is a normal SNR-50
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)
what is the quicksin protocol
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
how to score SNR Loss
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
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.
True
T/F patient’s signal-to-noise ratio loss can be predicted by degree of threshold loss
False
0-2 SNR
Normal;
Omni or May benefit from direction mics
2-7 SNR
Mild;
Recommend Standard directional mics
> 15 SNR
Severe;
Requires remote mics, in addition to above recommendations
( standard directional mics & beamforming)
7-15 SNR
Moderate;
Requires beam forming mics &
Standard directional Mics
alternative quicksin test protocols
Monaural presentation via headphones
Binaural presentation via headphones
Soundfield presentation via speakers
QuickSIN Monaural presentation via headphones does what
Allows you to detect asymmetric SNR loss
QuickSIN Binaural presentation via headphones does what
Quantifies functional SNR loss by supplying binaural benefit
QuickSIN Soundfield presentation via speakers does what
Used to determine if aided speech in noise performance improved or degraded presentation level
what is the most significant benefit for ANL is when what…
ANL improves what BOTH directional mics & DNR are enabled
Acceptance of noise level improves when
BOTH directional mics & DNR are enabled.
Directional microphones alone only supported partial acceptance
DNR alone only showed minimal improvement
what does DNR do?
reduces steady state noises (HF or LF as long as they are steady in frequency & intensity)
what is another option instead of Quciksin
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
What happens with elderly population about ⅙ individuals
Binaural Interference
what is the binaural interference assessment
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
what is binaural interference
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
The functional & communication needs assessment must
Identify activity limitations & participation restrictions
Identify environmental factors which may impact plan of care
Identify personal factors which may impact plan of care
STANDARDIZED SELF-REPORT QUESTIONNAIRES QUANTIFY _____, _____ & _____ OF THE HEARING-IMPAIRED PATIENT
ACTIVITY LIMITATIONS, THE SOCIAL AND PSYCHOLOGICAL NEEDS
benefits of a standardized self-report questionnaire
Standardization allows comparison to normative data
Questionnaires are completed independently, prior to the scheduled appointment
standardized self report questionnaires assist with comprehensive identification of all technology needs:
Selection of hearing instrument style
Features needs
Hearing assistive devices
Counseling on realistic expectations
screening tests examples
HHIA/E screening; Hearing Disabilities and Handicap Scale, Hearing-Dependent Daily Activities Scale (HDDA has high highest sensitivity rating- 80%)
what has the highest sensitivity rating for screenings
Hearing-Dependent Daily Activities Scale (HDDA)
which questionnaire is for patient centered goals
COSI
Communication abilities (activity/participation) questionnaires
APHAB, SAC/SOAC, CCP-confidence rating
Patient Expectations of amplification
ECHO
Related Non-auditory questionnaires
HASP, Social Network Inventory, WHO-DAS, Geriatric Depression Questionnaire
experienced HA user questionnaire
SADL
Describe the clinical usefulness of the Social Network Index
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
Describe the clinical usefulness of the ECHO
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
Describe the clinical usefulness of the communication profile hearing impaired (CPHI)
used to find out how hearing loss affects daily life and what problems, if any, a patient is having
Recent research finds the ECHO and CPHI are highly predictive of adherence vs. nonadherence
True or false
True
Describe the clinical usefulness of the hearing aid selection profile (HASP)
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
Patients were more likely to return devices for credit when expectations of hearing aid benefit scores were ___
Low
Describe the clinical usefulness of the Client Orientated Scale of Improvement (COSI)
Prioritizes patient-centered treatment goals
Actively involves patients in plan of care
focuses on individual needs when planning rehabilitation
assists with counseling’s
In General what do Standardized self report questionnaires do/assits with?
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
activity limitation vs participation restriction
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)
activity limitation or participation restriction
Trouble hearing soft sounds or whispers
activity limitation
difficulty with detection of sounds
activity limitation or participation restriction
Inability to hear HF sounds like birds or alarms
activity limitation
detection of sounds
activity limitation or participation restriction
Problems distinguishing between similar sounding words
activity lmitation
activity limitation or participation restriction
Difficulty understanding speech in noisy environments, such as restaurants or social gatherings.
Activity Limitation
activity limitation or participation restriction
Trouble hearing in reverberant or echo-prone spaces, such as large halls or gyms.
activity limitation
activity limitation or participation restriction
Avoiding social gatherings or events due to difficulties in following conversations.
participation restriction
activity limitation or participation restriction
Reduced involvement in group activities, clubs, or community events.
participation restriction
activity limitation or participation restriction
Difficulty performing job duties that require effective communication, such as customer service or teamwork.
participation restriction
activity limitation or participation restriction
Reduced opportunities for career advancement due to communication barriers.
participation restriction
activity limitation or participation restriction
Difficulties in understanding lectures or instructions, leading to academic challenges
participation restriction
activity limitation or participation restriction
Difficulty hearing household sounds, such as doorbells, alarms, or children calling.
participation restriction
activity limitation or participation restriction
Reduced enjoyment of hobbies that involve listening, like music or audio books.
participation restriction
describe the difference between cognitive and affective goals
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
Affective or Cognitive Goal
Feeling less embarrassment during communication
affective COSI goal
Affective or Cognitive Goal
Reduced stress during workday
affective COSI goal
Affective or Cognitive Goal
Alleviating feelings of anxiety or stress related to hearing difficulties
affective COSI goal
Affective or Cognitive Goal
Building confidence in social interactions and communication situations.
affective COSI goal
Affective or Cognitive Goal
Increasing participation in social activities and gatherings.
affective COSI goal
Affective or Cognitive Goal
Enhancing the ability to comprehend speech in quiet or noisy environments.
cognitive cosi goal
Affective or Cognitive Goal
cognitive cosi goal
Affective or Cognitive Goal
Improving clarity and comprehension of conversations, particularly in challenging listening situations.
cognitive cosi goal
Affective or Cognitive Goal
Improved conversation with a spouse in a quiet environment”
cognitive cosi goal
Affective or Cognitive Goal
Improved communication with unfamiliar speakers on the telephone without removal of the hearing aid
cognitive cosi goal
Affective or Cognitive Goal
Developing better listening strategies to focus on important sounds while filtering out background noise.
cognitive cosi goal
what is the usefulness of cosi goals clinically
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
non-auditory personal factors
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
what is a generic health-status instrument that gathers data about general health from a comprehensive case history
The World Health Organization’s Disability Assessment Scale II (WHO-DAS II)
how does general health screening assist audiologic recommendations
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.
how does depression screening assist audiologic recommendations
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.
how does anxiety screening assist audiologic recommendations
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.
how does manual dexterity screening assist audiologic recommendations
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.
how does visual screening assist audiologic recommendations
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.
Motivation, and prior experience with amplification and how it can assist with audiologic recommendations
Was it positive? Negative? What did you like with HA or dislike?
Avoids creating the same mistakes
what is the dexterity screening used and how is it run
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
T/F Chronic visual conditions in combination with hearing loss increase in prevalence as we age
True
T/F The problems encountered by individuals with “dual sensory” loss are considerably greater than the effects of vision impairment or hearing impairment alone
True
Visual & auditory-vestibular comorbidities examples
Audio-visual disorders
Visual-vestibular disorders
why are we worried about dual sensory loss
one impact from one sensory deficit and another and combining two deficits, it exacerbates and may even triple the issue the PT encounters
Dual-sensory loss commonly occurs in the presence of these comorbidities
Hypertension
Heart disease
Stroke
Diabetes
Cancer
Arthritis
Comorbidities Including ________, ___________,___________ and __________, & ______________
_____________ = ___________
_____________ = ___________
_____________ = ___________
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.
Systemic disease=
Systemic disease= progressive loss
Cognition/motor function=
Cognition/motor function= clinical decision-making
Reduced social engagements=
Reduced social engagements= progressive cognitive decline, depression, etc.
List the Multidimensional factors audiologists should include in their functional & communication needs protocols
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
Biopsychosocial Portion of Multidimensional factors audiologists should include in their functional & communication needs protocols
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
Psychological &Social Portion of Multidimensional factors audiologists should include in their functional & communication needs protocols
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
Social portions of Multidimensional factors audiologists should include in their functional & communication needs protocols
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
Audiograms are not….
Audiograms are not predictive of communication abilities
