Ped. Aud Flashcards
Behavioral observational audiometry using the sucking response can be obtained from______.
Infant who use gastrointestinal feeding tube
Infants who are not visually alert
Infants with variable neurologic conditions
Infants who are hungry
infants who are hungry
Conditioning procedures must implement training trials first.
true
Of the following sounds, which one is most likely to be produced correctly by a child who has a profound hearing loss
/b/
/t/
/g/
/n/
b
VRA follows a stimulus-response-reinforcement paradigm.
True
False
true
Distractors are used in conditioned play audiometry to keep the child centered.
True
False
false
Which of the following is true about hearing loss in children?
Speech in children with moderate hearing loss can be characterized with excessive nasality
Hearing loss can result in delayed receptive but not expressive speech
Children with hearing loss can understand abstract words more easily than concrete words
Children with minimal hearing loss may have difficulty hearing soft speech or that at a distance greater than 3 feet
Children with minimal hearing loss may have difficulty hearing soft speech or that at a distance greater than 3 feet
Which of the following is false regarding electrophysiological testing
Does not require cooperation
Can be easily obtained in infants younger than 6 months without sedation
Is a direct measure of hearing
Cannot be used to monitor hearing aid or CI
direct measure of hearing
All of the following can result from mild hearing loss in children with the exception for:
Inattention in classroom setting
Language delay
Omission and distortion of speech sounds
Vowels can be heard clearly
Will benefit from FM system
omission and distortion
When testing very young children, a good protocol is to start at 2,000 Hz in one ear and then move to 2,000 Hz in the other ear. Then repeat at 500 Hz.
True
False
\
true
The use of two reinforcers in VRA improves conditioning success and maintains the child’s attention longer eliciting more responses.
True
False
true
Young infants attend closely to infant-directed speech because they:
Are likely to understand the words that are used
Remember hearing their mother’s voice prenatally
Are attracted to the exaggerated intonation pattern
Their hearing is better for lower-pitched sounds than higher-pitched sounds
Are attracted to the exaggerated intonation pattern
A child, as young as 5 or 6 months, may be conditioned to turn their head in response to the presentation of an auditory stimulus.
True
False
true
In conditioned audiometry, a response is defined as performance of the desired motor behavior within 3 to 4 s after the onset of the auditory stimulus.
True
False
true
Control trials are suprathreshold stimuli presented at a level at which the infant previously responded.
True
False
false
In VRA, it is recommended to start the test at an intensity level of 60 dB.
True
False
false
Infants are expected to localize in all directions by age
6 mos
12 mos
2 yrs
4 yrs
12 mos
The auditory system become functional around
15-18 wks
20-25 wks
30-34 wks
37-40 wks
20-25 wks
In VRA, no reinforcement is necessary
True
False
false
When one ear fails newborn hearing screening, screening needs to be repeated only for that ear and if a pass result is obtained, then it is considered an overall pass.
True
False
false
When testing air conduction (AC) thresholds in a child with PE tubes, which type of transducer should be used?
Insert earphones
Supra-aural earphones
Loudspeaker
Either insert or supra-aural earphones can be used
supras
Which of the following is an appropriate probe tone frequency for tympanometry in a 2-month-old infant?
226 Hz
250 Hz
500 Hz
1000 Hz
1 kHz
Testing protocol should always be selected based on child’s chronological age.
True
False
false
A weighted blanket can be used to make children with ADHD more comfortable during behavioral assessment.
Group of answer choices
True
False
true
Which of the following statements is not true regarding speech detection thresholds?
Can be used in children who are very young or those with cognitive or language delay
Useful in providing basic information about auditory status
Can results in higher threshold than SRT
Can results in lower thresholds than other types used for threshold assessment
Can results in higher threshold than SRT
Which of the following tests would you use for a 3-year-old child whose auditory language age is lower than 2 years and has severe to profound hearing loss?
ANT
NU-CHIP
PBK-50
WIPI
ant
Abnormal decrease in absorbance in the low frequencies indicates the possibility of a hypermobile eardrum.
Group of answer choices
True
False
false
Which of the following statements is incorrect about the BKB-SIN test?
Group of answer choices
Can be used in adults with memory impairment
Can be administered using MLV
Scores cannot be compared to the adult norms
Can be used on children ages 5 and older
Can be administered using MLV
What is the admittance for the tympanogram shown below?
0.4 mmho
1.2 mmho
1.9 mmho
2.4 mmho
(quiz 2)
.4
Presence of OAEs ensures that hearing is poorer than 40 dB on the tested frequencies.
True
False
false
You are performing tympanometry on a one-week-old infant and you obtained the below tympanogram. Results suggest that the infant has a _______.
Perforation
Collapse ear canal
Normal middle ear function
None of the above
(quiz 2)
collapse
Pure tone testing provides information about degree and type of hearing loss, but it does not provide information about a child’s ability to understand speech.
True
False
true
Loss to follow-up (LTF) may result from parental refusal to follow up on screening.
Group of answer choices
True
False
true
When evaluating hearing sensitivity in very young children, the testing protocol should include the cross-check principle to ensure a valid and comprehensive evaluation.
True
False
true
It is recommended that infants receive their hearing screening close to the time of hospital discharge, yet early enough to allow for a repeat screening if required.
True
False
true
According to the 2019 JCIH guidelines, ABR testing is not required in children younger than 3 years when_______.
Behavioral audiometric tests are reliable.
Ear-specific thresholds cannot be obtained.
Inconclusive test results are obtained.
Auditory neuropathy is suspected
Ear-specific thresholds cannot be obtained.
What could cause the ear canal of a young infant to collapse?
Negative pressure
Ambient pressure
It does not collapse
I will always collapse and that is why we use 1000 Hz probe tone
neg pressure
Why is wideband tympanometry often considered easier for children than traditional 226 Hz tympanometry? (Select all that apply)
Because it measures different frequencies simultaneously
Because we do not have to use pressure and young children really do not like that
Because it uses quieter probe tone which is less startling for them
Because it measures one single frequency, which can be completed in a shorter time
Because it measures different frequencies simultaneously
Because we do not have to use pressure and young children really do not like that
What differences exist in OAE levels between newborns and adults?
Levels are similar
DPOAEs are higher in newborns compared to adults.
DPOAEs are lower in newborns compared to adults.
DPOAEs are 20 dB or higher in newborns compared to adults.
DPOAEs are higher in newborns compared to adults.
How does middle ear affect OAEs?
ME conditions can affect OAEs
ME conditions do not affect OAEs
Negative pressure will not reduce OAEs
ME condition can affect OAEs in adults but not children
ME can affect OAEs
How do shorter ear canals in young children affect the volume and resonance frequency compared to adults?
Larger volume, higher resonance frequency
Smaller volume, lower resonance frequency
Larger volume, lower resonance frequency
Smaller volume, higher resonance frequency
Smaller volume, higher resonance frequency
The pediatric ear canal is more ________ than the adult ear canal.
Stiff
Rigid
Compliant
None of the above
compliant
A healthy middle ear system of an infant (< 6 months old) is____________.
Mass dominated
Stiffness dominated
Resistance dominated
None of the above
mass
What are the ME pressure and compliance indicated by this tympanogram?
-100 daPa, 0.7 cm3
0 daPa, 1.4 cm3
100 daPa, 2.0 cm3
0 daPa, 0.3 cm3
(lab quiz)
0; 1.4
What ECV would you expect to find in a clogged PE tube?
Large ECV
Normal ECV
Small ECV
Cannot be measured with clogged probe
normal ECV
What ECV would you expect to find in patent PE tube?
Large ECV
Normal ECV
Small ECV
Cannot be measured with PE tube
large
You have an uncooperative child with bilateral middle ear dysfunction. How can you shorten the testing time without compromising the diagnostic value of acoustic reflex testing? What would be your first choice of stimulus to use?
500 Hz
2000 Hz
4000 Hz
BBN
BBN
Wideband tympanometry cannot be used with infants?
True
False
false\
What should you consider when evaluating the quality of a WB measurement?
The 3D graph
The wideband average graph
The absorbance graph
All of the above
all
Having a variety of toys and methods to distract or engage children is very useful. How can the Wideband Tympanometry system be utilized to help keep the child engaged during the test?
Playing music through the system’s speakers
You can’t use the system to help you with this
Drawing a “rainbow” by showing the child the 3D graph developing on screen
By reading a story aloud
Drawing a “rainbow” by showing the child the 3D graph developing on screen
Wideband Tympanometry is particularly useful for children under 4-6 months old because ______________.
The stimulus is quieter in their ears
It takes measurements at multiple frequencies, avoiding the need to choose between 226Hz and 1000Hz probe tones
The results are easier for parents to understand
It automatically starts once a seal is detected
It takes measurements at multiple frequencies, avoiding the need to choose between 226Hz and 1000Hz probe tones
What does WB tympanometry absorbance measure?
The size of the ear canal
The amount of movement of the eardrum
The amount of energy that is absorbed by the middle ear
None of the above
The amount of energy that is absorbed by the middle ear
What type of stimulus does WB tympanometry use?
Click
Pure tone
Chirp
BBN
click
Wideband Tympanometry is exclusively used in specialist pediatric clinics.
True
False
false
Wideband Tympanometry provides all the typical information found in traditional tympanometry, including Ear Canal Volume and Tympanic Peak Pressure.
True
False
true
When using Wideband Tympanometry, you have to choose between 226 Hz or 1000 Hz probe tones.
True
False
flase
You began testing a toddler in the soundfield using VRA at 30 dB, but there was no response. Your next step is:
Switch to insert earphones
Increase level by 20 dB and try again
Increase level of reinforcement
Change test assistant
Increase level by 20 dB and try again
You are testing a 14-month-old baby using VRA. The child has been cooperative, and you have obtained the results listed below. Assuming that the next threshold will be the last one you can obtain from this baby, what would be your next step? (500 in L at 25, 2000 in L at 70) (500 in R 20 and 2000 in R 20)
Measure threshold at 4000 Hiz in the right ear
Measure threshold at 4000 Hz in the left ear
Measure threshold at 1000 Hz in the right ear
Measure threshold at 1000 Hz in the left ear
Recheck thresholds at 2000 Hz in the left ear
(exam 1)
Measure threshold at 1000 Hz in the left ear
Which of the following is a true advantage of the BOA procedure?
It allows the audiologist to obtain valuable behavioral responses in infants, supporting the cross-check principle.
It can be conducted in sound fields, with earphones, bone oscillators, hearing aids, or cochlear implants.
It can be used to verify access to speech sounds with amplification
All of the above.
all
To obtain a more realistic assessment of the child’s ability to perceive speech in everyday situations, which of the following speech tests would you select for a 6-year-old child with an auditory language age of 3.9 years?
WIPI, closed set
WIPI, open set
NU-CHIPS, open set
NU-CHIPS, closed set
nu closed
When testing a 13-month-old baby, which of the following stimuli would provide more frequency-specific information?
Speech
Music
Ling-6 sounds
BBN
ling
An infant with severe to profound hearing loss will exhibit less babbling as he/she grows older due to:
Weakness in aural musculature
Lack of auditory feedback
Birth order
None of the above
lack of aud feedback
Children with minimal to mild hearing loss may benefit from which of the following:
Preferential seating
Personal FM system
Hearing aid
All of the above
all
The first-time parents of a 2-month-old infant are concerned that their baby may have a hearing loss because she does not turn her head when they enter the room or call out her name. You should:
Counsel the parents that the baby is too young to be tested and besides she seems fine to you
Share the parents concern and refer to an otologist for an MRI to ensure that the baby is not deaf
Perform an audiologic assessment using soundfield behavioral observation audiometry at 65 dB HL demonstrating to the concerned parents that the baby startied to the sound and, theretore, all is well
Perform an audiologic assessment using OAEs and diagnostic ABR and let the parents know all is well
Perform an audiologic assessment using OAEs and diagnostic ABR; counsel the parents that children younger than 3-months generally are unable to localize but do not minimize the parents’ concerns
Perform an audiologic assessment using OAEs and diagnostic ABR; counsel the parents that children younger than 3-months generally are unable to localize but do not minimize the parents’ concerns
Your patient is a 9-month-old baby boy who is accompanied by his mother. In the case history, it was reported that he was born 8-weeks premature. All developmental milestones are delayed. What is his corrected age?
10-months
9-months
8-months
7-months
7 mos
You have identified a five-year-old as having severe unilateral sensorineural hearing loss. As you discuss the potential impact of this hearing loss on the child’s educational development, you would tell the parents:
With preferential seating, hearing loss will probably have no impact on the child’s educational development
A hearing aid for the affected ear would be the best strategy for alleviating problems that hearing loss may cause.
A much higher risk for educational difficulties exists for this child than for children with two normal hearing ears.
A binaural FM system would be the best strategy for alleviating problems that the hearing loss may cause.
A much higher risk for educational difficulties exists for this child than for children with two normal hearing ears.
Since many children do not respond at threshold during auditory tests, their responses are often referred to as …….
Conditioned responses
Unconditioned responses
Better ear responses
Minimum response levels
None of the above
minimum
Head lateral turn towards the sound source are expected in infants by:
0:4 months
4:7 months
9-13 months
13+ months
4:7
Language and speech will not develop spontaneously when very young children have ….
Mild SNHL
Moderate SNHL
Moderately severe SNHL
Severe SNHL
sev SNHL
KJ is an 18-month-old baby girl who was brought to the clinic by her mom, who is concerned about the possibility of hearing loss. Which of the following information in her case history is not considered a red flag?
Apiar score of 3 at 1 minutes and 5 at 5 minutes
KJ can only say 3 words: mama, baba, dada
KJ did not start babbling until she turned 7 months old
KJ consistently reacts to loud sounds but less often to softer levels
KJ did not start babbling until she turned 7 months old
When using the sucking response method as the primary procedure for behavioral observation audiometry, all of the following can be accepted as a response except:
Cessation of sucking
Increased sucking rate
Eye widening
Responding only at stimulus offset
eye widening
If a significant sensorineural hearing loss is suspected, behavioral testing in infants should begin with ..; otherwise, it is reasonable to start at
500 Hz; 2000 Hz
1000 Hz: 4000 Hz
2000 Hz; 500 Hz
4000 Hz; 500 Hz
500 Hz; 2000 Hz
A 4-week-old infant’s startle response or Moro reflex to a loud sound in the soundfield may indicate:
Normal hearing in both ears
normal or near normal in one ear
A unilateral moderate hearing loss in the better ear
A mild hearing loss in both ears
All of the above
all
Which of the following should not be included in the test protocol when evaluating infants younger than 6 months?
Case history
Visual reinforcement audiometry
OAES
ABR
vra
Which of the following is not recommended when counseling parents on strategies to encourage language development in children with hearing impairment?
Using infant-directed speech that incorporates high pitch, varied intonation, and simple, concrete words.
Regularly speaking and reading to the infant to promote language development.
Introducing the infant to multiple languages early to speed up language acquisition.
Providing consistent emotional and physical support to boost the infant’s motivation to communicate.
Frequently naming objects during interactions to aid vocabulary development.
Introducing the infant to multiple languages early to speed up language acquisition.
Jamie, an eight-year-old boy, has recently been diagnosed with mild hearing loss. His parents are hesitant about using hearing aids, concerned that such a mild loss may not warrant the use of these devices. Given Jamie’s condition and his parents’ concerns, which recommendation would you provide to best explain the impact of his hearing loss on his ability to participate in classroom activities?
Assure the parents that children with mild hearing loss do not require any form of hearing assistance and can manage well without any modifications.
Inform the parents that while Jamie may face some challenges, mild hearing loss generally does not significantly affect academic performance or peer interactions.
Explain to the parents that mild hearing loss can pose substantial challenges in noisy environments, and that hearing aids can help Jamie better follow classroom discussions and alleviate his frustration.
Suggest that the parents monitor Jamie’s academic and social progress for six months before deciding on any intervention, as children often adapt to mild hearing impairments naturally.
All of the above
Explain to the parents that mild hearing loss can pose substantial challenges in noisy environments, and that hearing aids can help Jamie better follow classroom discussions and alleviate his frustration.
You are reviewing the case history of a 3-month-old infant, Alex, brought in after failing the newborn hearing screening. Alex was born full-term via C-section after prolonged labor. The birth weight was 3.2 kg (7.05 lbs), and the Apgar scores were 7 at 1 minute and 8 at 5 minutes. Post-delivery, Alex developed mild respiratory distress and spent 48 hours in the NICU for observation but required no mechanical ventilation. The initial newborn hearing screening was inconclusive. Alex’s parents noted that they are concerned because Alex does not startle at loud noises and seems not to respond to their voices consistently. Which of the following is not a risk factor for hearing loss in this case?
Stay in the NICU
Lack of startling to noise
Apgar scores
Failing initial newborn hearing screening
None of the above
apgar
Which of the following speech tests would you use for a 6-year-old child with an auditory language age equivalent to 4 years?
PBK-50, open set
WIPI, open set
NU-CHIPS, open set
NU-CHIPS, closed set
NU-6
nu closed
When testing a 13-month-old baby, which of the following stimuli would provide the most frequency-specific information?
Speech
Music
Ling-6 sounds
Broadband noise (BBN)
None of the above
ling
Sylvia, a 5-year-old, is being evaluated. By case history report, Sylvia started kindergarten this year. She is in the process of having her speech and language evaluated by the school speech-language pathologist. According to her parent, they can understand approximately half of Sylvia’s speech.
The parents feel she understands them when they talk to her. You find a mild bilateral sensorineural hearing loss. You now want to test word recognition for Sylvia. Which of the following is the best option:
PBK words
WIPI, open set
BKB-SIN
WIPI, closed set
wipi closed
The auro-palpebral reflex and Moro reflex are unconditioned responses observed in infants younger than 6 months in response to sounds. Which of the following is a limitation of using the auro-palpebral reflex and Moro reflex for determining auditory thresholds in infants?
Responses are obtained at supra-thresholds
Responses are not repeatable
Infants can habituate to stimuli fast
They do not provide frequency specifc information
All of the above
all
Mia, a 4-year-old child, is undergoing a hearing assessment with play audiometry. The audiologist assistant trains Mia to place blocks in a basket whenever she hears a tone. Despite multiple training trials and attempts at reinforcement, Mia consistently hesitates and waits for visual prompts before completing the task. Instead of independently responding to the auditory stimulus, she frequently looks up at the audiologist for approval before proceeding. Which of the following statements best describes Mia’s response pattern?
Mia is a false responder.
Mia is a reluctant responder.
Mia is an off responder.
Mia is showing typical behavior for a 3-year-old.
Mia is a reluctant responder.
What strategy should the audiologist use to address Mia response pattern?
Place an open hand in front of Mia’s hand holding the block, requiring Mia to go around the audiologist’s hand to complete the task once a tone is heard.
Observe if Mia shows any facial response when the tone is presented and assist her in completing the task with the block while watching for her reaction to the next stimulus.
Use a continuous tone to help her feel more confident in responding.
Use a vibrotactile response to condition Mia
Observe if Mia shows any facial response when the tone is presented and assist her in completing the task with the block while watching for her reaction to the next stimulus.
Obtaining behavioral thresholds are not always possible in very young children. List three specific patient-related factors that would require the patient to return to the clinic for a follow-up/repeat session using VRA.
One factor that would cause a patient to need to return to the clinic for a follow up or repeat session would be that they habituate really fast and you are not able to continue to get the information you still need from them.
Another factor that would yield a repeat session with VRA is if you need to get ear specific information using headphones and despite multiple attempts and different strategies, you cannot get them on the child. It would be best then to have the parents work with the child to get headphones on them and come back at a different time to try again after the parents have gotten the child acclimated to the headphones.
A third factor that may cause a patient to need to return for a repeat session is if the child has a conductive loss and we need to do repeat testing once the middle ear pathology is resolved to compare the hearing results from before and after.
List three strategies that you can use to delay habituation when testing infants using VRA.
One strategy to delay habituation during testing with VRA is to use two reinforcers as opposed to one. Even though we can get results by using one reinforcer, it keeps their attention longer if we use two. Another strategy that could be used to delay habituation during VRA testing is to switch back and forth with speech or the Ling 6 sounds to keep their attention for longer in order to test what we need to test. A third strategy could be to change the reinforcement to keep their attention or even changing the test assistant. For example, instead of using the same light up toys, use a video without the sound as a reinforcer to change it up for them and with a new assistant, it could be enough to get their attention back on the task.
A 2.5-year-old child has been brought in for a hearing assessment. During VRA testing, you and your test assistant began conditioning the child to respond to sounds. The child turns his head toward the visual reinforcer only when the test assistant directs his attention to it during sound presentation, but he fails to demonstrate a response to the auditory stimulus alone.
Describe the two approaches that can be used to condition the child to pair the auditory stimulus with the visual reinforcer. (2 pt)
There are two possible scenarios that could explain why the child is not responding to the auditory stimulus alone. Discuss these two potential reasons and concisely outline the steps you would take to determine the underlying cause. (3 pt)
Young children are likely to produce a number of false responses during a clinical assessment. What test strategy can an audiologist use to ensure that responses are true responses and not false positive? (2 pt)
Simultaneous stimulus response procedur - presenting both the stimulus and the reinforcer at the same time. Response observation and shaping approach - preferred approach, present stimulus and watch their reaction to that because they turn towards sounds naturally.
Stimulus is not interesting enough so they are not reacting. Switch stimulus to make it more interesting like speech, NBN etc. It could also be that they cannot hear the stimulus. In this case, we need to increase the intensity and if this continues then attempt vibrotactile response. These help to rule out whether the child cannot be conditioned or because they cannot hear it so VT causes them to turn when they feel it it shows they can be conditioned and that they are not responding because they cannot hear it.
How do I know that it is a true response? Control trial is what we need. Do not do anything or present anything and see if they still respond. If not, you know it is still a true response and everything done so far is reliable. If they do respond even without stimulus presentation, this is a false positive and the results obtained might not be true. You need to then recondition this child.
Juan is a 3.5 - year-old child scheduled for an audiological evaluation. You have planned to test him using CPA. When seen for the appointment.
Juan’s parents report that he started walking 4 months ago and that he is just beginning to say his first words. He is scheduled for a comprehensive development evaluation by a developmental pediatrician next week. Would this information change your choice of testing procedure? Justify your
Yes, this information would change the procedure needed to test this child. His developmental age doesn’t match his chronological age. Therefore.
CPA would not be appropriate to choose to test this child and the results would not be indicative of his capabilities. If he just began walking not long ago, the chances of him being able to perform a motor task is very slim, which is required in CPA testing. Therefore, a different test, like VRA, is more appropiate for this child’s developmental age.
Your decision to switch from CPA to VRA is correct. However, you need to be more specific and explain why CPA is not appropriate to use in Juan’s case based on his reported developmental milestones that include delay in both speech and motor development that might impact his ability to understand instructions and make appropriate motor reaction in r
The ability of a test to correctly identify individuals who dont have a disease
Sensitivity
Specificity
Prevalence
False negative
spec
2 mo old infant referred after failing NBHS at birth. Which is the most appropriate diagnostic test?
BOA
VRA
OAE
ABR
ABR
When child’s PCP takes responsibility for coordinating comprehensive health care and collaborates as a team member with the family and other key professionals is referred to as
Monitoring and surveillance
Medical home
Family centered approach
EHDI
medical home
Process which the brain continuously forms new pathways and rearranges existing routes is called
Pruning
Bottom up maturation
Synaptic elasticity
Functional compensatory plasticity
can be either pruning or synaptic elasticity
Following passed NBHS. according to JCIH (2019) guidelines for risk factors, which of them should receive at least one audiologic assessment by 24-30 mos of age
Child with family hx of early and progressive HL
Full term typically developing child who spoke first words at 13 mos of age
Healthy 15 mos old who has not been immunized for childhood diseases like measles or mumps
3 mo old who was in neonatal intensive care unit for 7 days after birth
3 mo old who was in neonatal intensive care unit for 7 days after birth
Child with family hx of early and progressive HL
Which of the following explains why children and adults have different needs when it comes to HAs
Adults only need ITE HAs
Children only need FM systems
Children acquire language through aided sound
Adults require higher SNR
Children acquire language through aided sound
Neuroplasticity in brain can occur in various forms. Which is NOT true
Creating new interconnecting neurons in response to repeated learning experiences
Forming new maturation due to new life experiences
Moving functions from a damaged area of the brain to other undamaged areas
Connecting neurons that fire separately
Connecting neurons that fire separately
WB tymps offers the advantage of
Assessing entire frequency range with one stimulus
Examining absorbance, reflectance and impedance with one measurement
Wide frequency range as a function of air pressure
Increased sensitivity for some pathologies
All
all
3 physical features of infants HAs that are important for retention and safety are
Ped earhooks, tamper-resistant battery doors and a retention cord
Volume control covers, HA desiccant jar and listening tube
Colorful stickers, carrying case, and a storybook
Battery tester, listening tube, and user’s manual
Ped earhooks, tamper-resistant battery doors and a retention cord
One way which wideband acoustic immittance testing differs from conventional single frequency or multifrequency tymps
Probe seal in ear cana is not needed
Uncalibrated stimuli are used
Use of click or chirp stimuli
Measurements are made near the ™
click or chirp
Common earmold features in children’s hearing aids include:
The use of bright colors and decorations
Partial insertion of the earmold tubing through the mold to prevent crimping
Use of thick-walled tubing to prevent feedback in high power fittings
All of the above
all
A 3-year-old with CHARGE syndrome is fit with binaural amplification in the form of traditional BTEs coupled with half shell silicone earmolds. His parents report persistent feedback from the devices after the first 10 to 15 minutes of use each morning. The feedback stops when the earmolds are pushed back into the ear. What steps can be taken to reduce feedback for the patient?
Remake the earmolds with a larger vent.
Enable feedback cancellation.
Purchase a different hearing aid style. Instead of a BTE, the patient could try a RIC.
Remake the earmolds to be a full shell with a helix lock for better retention.
Remake the earmolds to be a full shell with a helix lock for better retention.
When conducting VRA testing, a head turn observed during a control trial is evidence of ….
A false response
A true response
Distraction
Auditory fatigue
false
An audiologist is testing a 2.5-year-old child using VRA in the soundfeld. After successfully conditioning the child, she begins assessing hearing. The child provides consistent responses at 500 Hz and 2000 z down to 20 dB HL. The audiologist begins testing at 4000 Hz, the child responds reliably at 45 dB HL, but as the intensity decreases, responses become inconsistent, and the child eventually stops responding. What should the audiologist do next?
Use a control trial.
Use a probe trial.
Attempt to obtain ear-specific information using insert earphones.
Conclude the test session due to the child’s lack of cooperation.
use probe trial
A 7-month-old baby is seen for a diagnostic ABR test. Parents report the baby failed the newborn hearing screening performed 7 days after birth and the rescreening performed 2 weeks later. A diagnostic ABR was recommended, but the family was unable to attend the appointment because the family moved to a different state for the father’s job. Due to challenges in establishing a new pediatrician and obtaining a referral to a local audiologist, the child is now being seen for his first diagnostic ABR. Results reveal a bilateral moderate flat sensorineural hearing loss. The child is subsequently fit with bilateral behind-the-ear hearing aids at 8 months of age. Based on the current JCIH guidelines, which of the following statements is true?
The initial newborn hearing screening should have been performed within 48 hours of the child’s birth.
The newborn hearing rescreening should have been performed within 7 days of the initial failed screening.
Because the child failed the newborn hearing screening and rescreening, the audiological evaluation to confirm his hearing should have been completed by 5 months of age.
Since a hearing loss was identified, early intervention services (including fitting with amplification) should have begun no later than 6 months of age.
Since a hearing loss was identified, early intervention services (including fitting with amplification) should have begun no later than 6 months of age.
A preschool child demonstrated a conditioned play response to a pure tone presented in the sound booth. What level of auditory skill development was demonstrated?
Identification
Comprehension
Discrimination
Detection
detection
A 6-month-old (George) is scheduled for a hearing evaluation. His mother noted that she was sick in the first trimester of her pregnancy with a fever, sore throat, and fatigue, but she did not seek medical care at that time. The mother reports that George was born at 27 weeks gestational age and was in the NICU for 9 weeks. During that time, George received oxygen due to underdeveloped lungs. His mother also noted that George did not show any other symptoms of sickness at birth and that George passed his ABR newborn hearing screening in the NICU. George has had approximately four ear infections in the past 3 months, which have been treated with antibiotics. His most recent ear infection was last month. At this time, George’s pediatrician is talking to his family about getting PE tubes for George. On the test date, George showed normal movement of the tympanic membranes and absent otoacoustic emissions. You are scheduling additional testing for this child to estimate hearing ability.
What is the likely probe frequency used in immittance testing for George?
1 000 Hz
What is the most appropriate procedure to estimate George’s hearing ability?
BOA in the soundfield
Soundfield VRA thresholds
VRA thresholds under headphones
Air- and bone-conduction ABR thresholds
Air- and bone-conduction ABR thresholds
A 4-year-old patient with moderate conductive hearing loss is seen for a hearing aid evaluation. Which is the best air-conduction HA and coupling option?
RIC with open-dome modular fitting
RIC with closed-dome modular fitting
BTE with open-dome modular fitting
BTE with traditional tube and custom earmold
BTE with traditional tube and custom earmold
A higher-frequency probe tone is used in acoustic immittance testing for young infants because:
Infants have a fully developed cochlea that responds better to higher frequencies.
Infant’s ear canal is highly rigid and ossified, requiring higher frequencies for accurate measurement.
Infant’s middle ear is more mass-dominated and less compliant, making higher-frequency probe tones more sensitive to middle-ear status changes.
Lower-frequency probe tones are ineffective due to the infant’s immature cochlea.
Infant’s middle ear is more mass-dominated and less compliant, making higher-frequency probe tones more sensitive to middle-ear status changes.
Baby’s actual age in weeks minus number of weeks the baby was preterm
corrected age
Measurement of acoustic immittance that accounts for the acoustic immittance of the EAC
compensated tynps
Term used to refer to an infant who has received recommended follow-up services after failing NBHS but their results haven’t been reported to EDHI leaving their status unknown in the program
ltd
Term used to refer to a specific and limited time in early childhood during which language acquisition must occur; if missed, it can lead to long term abnormalities and the brain’s wiring becomes harder to change
critical perod
Use of multiple, independent tests to confirm or verify diagnostic findings, reducing risk of misdiagnosis or inaccurate assessments
cross check principle
Your patient is a 12-month-old infant who was seen for an audiological assessment. The infant was previously diagnosed with bilateral moderate to moderately severe SNHL based on ABR testing. At 7 months of age, the child was fitted with bilateral hearing aids.
List two limitations of using ABR for assessing hearing sensitivity. (2 pts)
Which behavioral audiometry procedure would you use to determine her hearing thresholds? (1pt)
As you begin behavioral testing with this patient, at which initial frequency and intensity level would you start testing? Justify your choices. (2 pts)
One limitation to using ABR to assess hearing sensitivity is that with infants over 6 months of age it requires sedation which can be risky and parents are hesitant to have it performed. Another limitaton to using ABR is that it requires the infant to be completely still and to be asleep in order to avoid artifacts in the results.
The behavioral audiometric procedure I would use to determine her hearing thresholds is VRA because she is 12 months old with no other cognitive or physical limitations inhibiting her from performing this test. She is also at the age that I could attempt to determine speech detection thresholds by saying nonsense words, her name, or using the Ling-6 sounds to verify the PTA I got from the VRA procedure.
I would begin testing this child at 500 Hz because she has a sensorineural loss. In order to condition this child for the VRA procedure, I would begin presenting probe trials between 50-60 due to the severity of her loss. If she is not responding to the stimuli or stimuli and reinforcer presentations then I have to decide if she is either not entertained by the reinforcers used or if the stimuli presentation is not loud enough. If it is not loud enough, I would increase the intensity and retry the conditioning trials. If it is that the reinforcer is not entertaining enough, I would change it by either adding two reinforcers or using a mix of the light and motor function on one.
I would begin the actual testing and threshold search at 50B because she has a known moderate loss so if I started at the normal 30d she most likely will not respond due to her loss and the next step would be to increase by 20dB and present again at 50 dB. By starting with 50d 1 am reducing the testing time due to the fact that with her severity of loss she will most likely not respond at 30dB. Once I present if she responds I will do the down 10, up 5 procedure to obtain her thresholds.
Patient X is a 7-month-old infant with bilateral, moderately severe SNHL. She is fitted with traditional behind-the-ear hearing aids and a full-shell silicone earmold with #13 tubing.
What venting option would be most appropriate for this patient and why? (1pts)
Is this venting option likely to cause an occlusion in the infant? Explain (2 pts)
This patient’s ear canal size most likely would not be able to accomodate a vent if needed. But with her severity, she most likely doesn’t require a vent or the vent would be really small.
Due to not having a vent if it is needed, we would usually be worried about the occlusion effect due to lack of venting. However, with infants, due to their ear canal sizes being smaller and their ear canal resonances being higher they do not experience the occlusion effect at this age, as well as their ear canals are changing and growing rapidly so in a few months we would be able to place a vent if needed because her ear canal size could accomodate it then.
A 2.9-year-old boy with a diagnosis of autism is being evaluated for hearing loss due to parental concerns about speech delay. VRA is used for this assessment.
List two common behavioral reactions to auditory stimuli often observed in children with autism spectrum disorder. (2 pts)
Describe three modifications in the testing procedures that should be considered when conducting hearing tests for children with autism. (3 pts)
In children with ASD, in response to auditory stimuli they can be overly sensitive to it and have a negative reaction to the stimulus being presented.
They can also react by tuning it out, as seen in the case with speech stimuli the most.
One modification that could be done when testing a child with autism is to minimize the distractions in the room. Another modification to take is to make sure they are seated in a way that they are not able to get up and walk away from the testing area. A third modification is to avoid as much physical touch as possible, as this usually has adverse reactions in this population, so testing in the soundfield is the best to begin with.
K., a 4 year-old female, has returned for an audiological reevaluation. She was seen two weeks ago at this clinic following hospitalization for meningitis (see the results below). At that appointment, immittance testing indicated normal middle-ear function with absent ipsilateral acoustic reflexes, bilaterally. Up to the time of contracting meningitis, K. appeared to have normal hearing and had an age-appropriate speech and hearing milestones. She has no history of otitis media and no medical problems. At present, she is being seen by Occupational Therapy to assess her fine motor abilities, as they appear to have diminished since meningitis.
Write a short report describing the audiologic findings shown in the above audiogram using SOAP report format. (1 pt)
What behavioral procedure would you use to assess K’s hearing thresholds during this appointment? (1 pt)
Which behavioral audiological information would be the most important to obtain during this reevaluation? (1 pt)
Why are the ipsilateral reflexes absent in both ears? (1 pt)
Will you need to implement any procedural modifications to the testing method you selected in question 2 to accommodate K’s fine motor difficulties? Explain how you would adjust the testing process, providing examples of activities that would better match her abilities. (2 pts)
S:
K is a 4 year old female being seen today for an audiological re-evaluation. Two weeks ago she was seen at this clinic for an evaluation following hospitalization for meningitis. Before contracting meningitis, K appeared to have normal hearing sensitivity with age appropriate speech and hearing milestones. The rest of her medical history was unremarkable. Currently, she is being treated by occupational therapy for diminished fine motor skills.
O:
The previous appointment revealed tympanometry results with normal middle ear function and acoustic reflex thresholds that were absent for ipsilateral conditions bilaterally. Pure tone air conduction performed in the soundfield with warble tones revealed hearing thresholds at a slightly sloping, moderately severe to severe hearing loss in at least the better ear from 500-4000 Hz.
A:
K’s audiological evaluation results reveal that she has possible normal middle ear function and her ear canals are free of obstruction due to her normal tympanometric data. Her absent reflex thresholds are likely due to the severity of her hearing loss being below the expected thresholds for having present reflexes. Based on the results of the audiogram obtained in the soundfield, K has a significant hearing loss in at least the better ear.
This loss could potentially begin to impact her speech and langauge development and her academic performance in the future without rehabilitation measures and early intervention.
P:
K needs to return for a follow-up audiological evaluation to perform ear specific air and bone conduction testing under headphones to determine the site of lesion and severity for each ear. Speech testing also needs to be conducted at this follow-up appointment to assess how her hearing loss is affecting her speech and language acquisition. She also needs to have OEs performed at this follow-up appointment to determine the integrity of her outer hair cells. A referral is being sent to the EHDI program to provide the parents with assistance in understanding K’s potential hearing loss based off of the results obtained today.
2. Since there are no previous concerns for K’s cognitive ability, I would perform CPA to assess her ear specific hearing thresholds under headphones at this appoinment. I would also perform speech reception testing and word recognition score testing. See below for modifications
3. At this appointment, it would be important to get ear specific thresholds for both air conduction and bone conduction if possible. It would also be important to assess K’s speech understanding to see how her hearing loss is affecting her speech and language acquisition.
4. K’s ipsilateral reflexes are absent for both ears due to her thresholds being at the dB level that they are. We can expect to get no reflex responses once the hearing loss exceeds around 60 dB HL.
5. For SRT, I would have her attempt to point at the picture board for spondees. For word recognition, I would perform NU-CHIPS closed set. For both SRT and NU-CHIPS picture pointing, a modification I could do is to slow down my presentation stimuli to allow her time to use the motor skills she does have to point to the pictures. I will also have to do this for air and bone conduction testing. She could also use a larger button to manipulate and the toys used for CPA will need to be toys that are more gross motor skills related as opposed to fine motor skills.
JK, a 7-week-old male, presents for an audiologic assessment following a failed newborn hearing screening. His birth and medical history are unremarkable, and his mother does not suspect hearing loss, as she has noticed that he startles to loud sounds. JK has failed repeated ABR-based hearing screenings in his right ear. Immittance testing indicated normal middle ear system mobility (Type-A tympanogram), with ipsilateral acoustic reflexes present at expected levels in each ear. The audiologist also performed TEOAEs and DPOAEs at this appointment. Review the results below and answer the following questions.
In general, what constitutes a passing result in newborn hearing screening based on the current JCIH guidelines? (1 pt)
What type and severity of hearing loss are ruled out by the presence of normal-level acoustic reflexes? (1.5 pts)
How do the TEOAEs and DPOAEs results compare? If there are any differences in the findings, what could be the potential causes for these differences? (2 pts)
Explain concisely why it is recommended to include both TEOAEs and DPOAEs in the comprehensive audiologic assessment of pediatric patients. (1.5 pts)
A pass in newborn hearing screenings according to the current JCIH guidelines is that both ears have to be within the criteria of the test for both ears simulatenously (within the same test) in order to pass. For example, if a newborn passed in the right ear but referred in the left ear, they would need to be re-screened in both ears and have passing results in both ears in order to be an overall pass. If one ear fails, they are a refer.
Present normal-level acoustic reflexes rules out more severe hearing losses because in order to obtain them the hearing loss has to be better than around 60 dB HL. Normal reflexes can also rule out the possibility of a cochlear loss if the dB SL values are lower or a retrocochlear loss if the dB SL values are larger.
Based on the graphs above, the DPOAE results are showing a pass result where as the TEOAE results are showing a refer. Looking at the DPOAE. the stimulus was good and ended before 3 seconds, the response wave began around 4 seconds and is repeatable becuase the waves are very similar, the rejection was really low confirming that there was minimal noise to effect the results and the graph showing the signal versus the noise also confirms this because the noise was less than -10. In the TEOAE however, the stimulus was not good because there was no ringing present or the peaks present we look for, the response wave somewhat overlaps but not as well as the DPOAE wave, and the noise is below -10 and the rejection rate was low. Due to the rejection rate being low and the noise floor being below -10 where it is supposed to be, as well as the stimulus not being good, this leads me to believe that the potential causes for the difference in results from the DPOAE and TEOAE was that in the TEOAE the probe insertion was not correct leading to a leakage and a reduction in the responses we see in the graph.
It is important to include both TEOAEs and DPOAEs in a comprehensive audiologic assessment of patients because they each stimulate a different mechanism in the ear. Having both can give a better representation of what the hearing loss may look like, where the hearing loss could potentially be and maybe what caused it based on the mechanism effected and the test battery approach and cross-check principles combined.
birth to 6 wks
crying phase
7 wks to 3 mos
cooing
after 4 mos
babblinh
8-10 mos
first understanding of language
around 12 mos
first words
18 mos
50 words
18-20 mos
vocab spurt
24 mos
two word sentences
after 30 mos
development of gramar
extended repetition of certain single syllables around 6-7 mos
babbling
risk factors of apgar
Apgar scores below 5 at 1 min or less than 6 at 5 min
Apgar scores of 0–4 at 1 minute or 0–6 at 5 minutes
Moro reflex, eye blinking or widening, sucking. Startle when there is a very loud noise.
0-4 mos
Lateral head turn towards sound source
4-7 mos
Good lateral localization skills & downwards
7-9 mos
Sound localization in all directions
9-13 mos
13+ mos
Excellent localization. Easily distracted
Identify the red flags indicating potential issues in speech and auditory development.
No babbling at 12 months
No gesturing (pointing, waving bye-bye) by 12 months
No single words by 16 months
No 2 words combination spontaneous phrases by 24 months
No 3 words combination by 3 years of age
Unintelligible speech at 3 years
Limited number of consonants at 2 years
Simplified grammar at 3 ½ years
Difficulty formulating ideas and using vocab at 4 years
Language not used communicatively
mild HL
kid misses 10% of speech with distance
vowels are heard clearly, voiceless consonants might be missed
inaudible (voiceless stops & fricatives)
inattention
moderate HL
miss most conversational speech
vowels heard better than consonants
word endings (-s, -ed) are difficult
inattention, language delays, speech issues, and learning difficulties.
severe HL
Language and speech do not develop spontaneously without intervention.
can hear distorted self-vocalization, very loud environmental sounds, and only the most intense speech at close range.
Significant language problems speech problems and associated educational problems.
profoound HL
Speech often includes issues with voice, articulation, resonance, and prosody. Vocal pitch may be higher, with a monotone quality due to lack of intonation and stress.
rely on vision than hearing, aware of vibrations than tonal patters, S/L will not develop spontaneously, severe language delays, speech problems, and potential learning dysfunction without intervention
case hx of ped vs adults
ped: -Emphasizes developmental milestones - motor skills, language acquisition & social development
-Asking about prenatal and birth hx
Provided by parents/guardians & accuracy depends on their observations and knowledge of the child’s history
-Family hx looking for hereditary factors; social hx including child’s environment, school performance and interactions w/ peers
-Behavioral issues and emotional development; focus on conditions like ADHD, autism, anxiety disorders etc.
adult: -Focuses on PT’s medical hx, lifestyle factors, chronic conditions
-PT usually provides the information directly allowing firsthand reporting of symptoms and concerns
-Family hx is important; social hx includes lifestyle factors like smoking, alcohol use, occupation and living situation
-Behavioral and emotional health - focus on mental health conditions like depression
not direct tests of hearing
physiological testing
Influences on BOA
Spend time w/ infant to make sure they can perform the task = more reliable results
Gastrointestinal feeding tube
Infants neurologic status
Visually alert
Behavioral audiologic testing is the protocol that provides a direct measure of hearing
true
goal of behavioral testing
determine if the child has sufficient hearing to develop S/L
test stimuli for behavioral audios
Frequency specific
Warble tones (pure tones?)
Narrow band noise
Non-frequency specific
Music
Noise
Speech - used to capture their attention & determine SAT
SAT - MLV w/ “ba ba ba” or “shhhhh”
Frequency specific uses low mid and high stimuli corresponding to pure tone thresholds (ba, sh, s)
close to 500 (low
ba
close to 2000 (mid high)
sh
close to 3-4000 (high)
s
presentation of stimulus
Begin at HFs because many infants respond better to these (usually 2000 Hz) (obtain one HF & one LF)
If SNHL suspected start at 500 Hz
If middle ear pathology/CHL , start at 2000 Hz because CHL affects LFs more
After 500 and 2000 Hz, these answers determine the next most important piece of info
Significant difference between 5 and 2: test 1 next & if flat loss test 4 next
Ex: if thresholds are 500 and 2000 Hz are normal more useful to test 4000 Hz than 1000 Hz but if hearing at 500 Hz is 30 dB and 2000 is at 70 then testing 1000 Hz is more crucial
Attention concerns, test 2-3 frequencies
CHL - test 250, 500, & 2,000
SNHL - test 500, 2,000 & 4,000
If HL present, BC testing is next
Alternate bw ears
SF vs headpbones
Soundfield:
Global idea about hearing
Information reflects better hearing ear
Natural head turn seems more intuitive in this localization task than in lateralization task.
Headphones
Needed for ear specific information
Inserts are good options for infants
Soundfield testing yields more responses than for insert earphone
Using earphones first may upset the child; very little information is obtained.
Infant responses are better for localization in soundfield than lateralization under earphones.
what is a probe trial
Suprathreshold stimuli presented at a level at which the infant previously responded
Used to demonstrate understanding of the task before descending in level to determine threshold and through the test to determine if the infant is still on task
what is control trials
Observation trials in which the examiner judges whether a head turn occurs in teh absence of sound stimulation
Primarily used to determine if the responses “head turn” being judged are truly responses to the test stimuli and not just random head turns
reasons to return to the clinic
Inconsistent responses
Inadequate cooperation: might be fussy, sleepy, uncooperative
If infant is unwell (cold, flu, ear infections)
Ototoxicity monitoring
Ear canal/tympanic membrane abnormalities
BOA
Birth to 6 mos
Observation - sucking response
Looking for changes in sucking response to sounds (with bottle, nursing, pacifier (nonnutritive sucking); this change in sucking pattern is most likely to provide threshold responses
responses need to be within 2 s of sond presentation
minimum of 2 testers
Conducted in soundfield, earphones, bone oscillator, HAs or CIs
Enables accurate fitting of technology because minimal response levels (MRLs) can be obtained
Disadvantages using Auro Palpebral & moro reflexes in BOA
Using auro-palpebral, moro reflexes, changes in limb movement or respiration are not elicited responses to threshold stimuli but suprathreshold stimuli instead
how to max sucking response for BOA
Infant is in a quiet, alert state
Hungry enough to have a strong sucking reflex but not hungry enough to be upset to participate
Ensure they are in a comfortable position
VRA
developmental ages 5-36 mos
Involves training an infant to make a conditioned head turn response to a test stimulus
Infant make a head turn in response to sounds and receives reinforcement.
Reinforcers
Best placed at the child’s ear level & 90 degrees to the side of the child
Distractors
Quiet and simple but less interesting than the reinforcer toy
types of pairing phases
Simultaneous stimulus-reinforcer pairing approach
Response observation and shaping approach:
Simultaneous stimulus-reinforcer pairing approach
method that pairs an auditory stimulus with a visual reinforcer (toy) to teach them to turn towards the sound, they then learn to associate the sound with the toy & if they notice the sound but do not turn, audiologist/helper helps by pointing to the toy
Tone and visual are presented together
Response observation and shaping approach
preferred, method that the audiologist observes and reinforces a child’s natural response to sound, if they hear but do not turn, response is shaped by directing attention to the reinforcement during sound presentation, training continues until the child consistently responds to the sound without additional cues
Tone is presented and the reinforced with visual when turn
testing phase
Starting level: start close to the subjects threshold and not too loud (leads to greater false response rate)
Start at 30 dB (improves probability of starting close to threshold) & increase in 20 dB if no response happens
Describes the lowest intensity of auditory stimulus that produces the desired response
MRL
Discuss potential reasons when no response is obtained in VRA procedure.
Assess the stimulus: The stimulus might not be audible or engaging enough. Consider increasing the presentation level or changing the type of stimulus (e.g., NBN) or its frequency.
Use a vibrotactile stimulus generated from the bone vibrator (such as ~ 40 dB HL at 250 Hz) with reconditioning using the paired presentation should show a response even in a deaf child.
If the child is not responding to the stimulus/reward combination
Enhance the reward: The reward may not be sufficiently visible or interesting. Try dimming the room lighting or offering more attractive rewards.
Alternatively, possible the child is not developmentally ready for the test or is not motivated by the reward; consider other procedures.
CPA
Developmental age 2.5-3 yrs to 5 yrs
Method of testing toddlers and preschoolers hearing through conditioned motor responses to sound with game activities
Performance of the desired motor behavior within 3s after the stimulus onset of the signal
how to condition in cpa
Condition around 40-50 dB if hearing is assumed to be normal
First: start by showing the task (make eye contact, hold toy next to ear, say I hear that when sound is present & put toy into bucket)
Hold toy next to ear do give a clear indication of the motor act of dropping the toy i the bucket in response to the test stimuli
Lets you know that the child is ready to listen
Second: assistant performs it with the child (hold child hand with toy next to their ear, say we hear that when sound is presented moving the child’s hand & dropping it in), after a few trials, feel for the child to move their hand first
Third: child attempts alone (if they are hesitant, guide them by saying “you heard it, you can put it in”)
*if successful move to threshold exploration, if not increase intensity and present additional conditioning trials, still if not consider using another method (VRA) or switch to bone vibrotactile (place on their head or in their hand or on their knee) & after conditioning go back to air conduction
the audiologist can place an open hand just in front of or resting against the child’s hand holding the response peg or block. The child then has to go around or through the audiologist’s hand to complete the task once the sound is heard
fake responder
want to identify if there is a definite facial response or reaction when the tone is presented and can then assist the child in completing the play task and watch for the child’s reaction to the next stimulus.
These wait until they are visually prompted to do the task
reluctant responders
Using a continuous tone can often assist them in feeling more confident in responding because there is a definite “off” to the signal.
These ones wait until the stimulus stops before doing the task
off responders
toys for CPA
Toss a ball in a basket
Place puzzle piece together
Put ring on the cone
Place peg in pegboard
Give mom/dad a high five
Place block on a castle
How to engage uncooperative child
What we offer has to be realistic
Do not ask if they want to put on the headphones
But which game do they want to play is good
Dont switch test techniques
Instead try
Short breaks
New toys
Try a new assistant
Like a parent
New stimulus
Bribe
If you finish you can have ____
Allow them to sit on a parent’s lap
Or indication of how long the test will last
conventional audiometry
Can be used in children older than 5 yrs
Child raises their hand or presses the button in response to a stimuli rather than completing a play task
Speech perception testing is the only part of the audiology test battery that assess functional auditory performance
true
provides information about how a child can be expected to function in daily listening situations.
speech testin
Speech audiometry principles
Needs to match their capabilities (cognitive, motor, & attention)
Has to be interesting and motivating
Needs to match speech perception abilities in realistic scenarios
*if a child isn’t repeating or identifying, is it because they cannot hear or because they do not understand the words or langauge
procedure for speech testing
NH - present at 30 dB SL
If HL is 20, administer speech at 50
HL - minus 40 dB SL
Sloping - make sure it is audible at 2 kHz & in HFs
SAT/SDT
Developmental age of 5 mos to 24 mos
Stimuli can be the child’s name, nonsense words, or short phrases
nonsense words - bababa
name
short phrases - hi, hey can you hear me, hi johnny
vStimuli is presented typically via MLV and can be obtained in the SF (better ear response) or under headphone.
SDT is always better than PTA average.
ALWAYS LOWER THAN SRT
Ling 6 sounds
SRT
Receptive language skills >/=2 yrs
Around 5 yrs old - normal spondee words
Below 5 yrs old - picture board pointing, body parts pointing, CRISP
use carrier phrase
show me _____
show me snowman
present show me at 10-15 above what you ant to present the spondee
wrs
< 5 yrs or S/L delay - closed list
>/= 5 yrs - attempt open
speech scoring
excellent 90-100
good 80-89
fair 70-79
poor <70
NU-CHIPS
language age 3-5 yrs
Closed set of picture pointing word recognition test
closed set - using the booklet with pictures
open set - ask the child to repeat the words without the book and pictures
WIPI
Most common
Language age bw 5-8 yrs
Can be administered as an open-set measure by not using the picture book.
The test can be performed in an “auditory only” or “auditory and visual” (lip reading allowed) modality.
PBK-50
language ages 5-8 yrs
Cannot be used younger than kindergarten due to vocab too hard
50 phonemically balanced monosyllabic word list selected from spoken vocab of normal hearing kindergarten children
Only open set (no pictures)
BKB-SIN
language age 5-8 yrs
language age 5-8 yrs
how to score BKB SIN
BKB SIN NORMS
normal hearing adults -2.5
5-6yrs: 3.5
7-10yrs: .8
11-14yrs: -0.9
when can you use CNC or NU-6 lists for kids
older children
around 12 yrs
Used with severe to profound HL or those with low vocab levels
Examiner calls out numbers w/ mouth covered, child points to the correct card or says the number
ANT
under 6 mos of age
primarily electrophysiological tests (ABR, ASSR, etc.)
226 Hz probe tone
used to test ages 7 mos to adulthood (226 becomes adultlike by around 6-8mos)
1,000 Hz probe tonef
use for <7mos of age
Anatomical Differences of infant to adult EAC
Acoustic properties of the infant ear changes drastically over the first 6 mos of life
Excessively compliant EAC
Small ear canal
Horizontal orientation of ™
Underossified ossicular chain
Small ME space
Present TEOAEs
Absolute emission > -10 dB SPL
SNR (relative value) > 3-5 dB (varies)
Reproducibility of 70% or greater
present DPs
Absolute emission > -10 dB SPL
SNR (relative value) >6 dB (3-5 dB some)
Replicates
% of people with a given disorder who screen + for the disorder
sensitivity
test’s accuracy in correctly identifying those without the condition
f
specificit
number of cases of a disease existing in a population during a specific time period
Proportion of the population that has the condition at a point in time
prevalence
number of new cases identified over a given period of time (typically a year)
Fraction of the population at risk of developing the disease or condition of interested (
incidenc
The 1-3-6 principle and why JCIH is pushing to replace it with the 1-2-3 principle.
1 month: children should be screened
3 months: receive comprehensive evaluation
6 months: receive appropriate intervention
The earlier the impairment is identified & treatment started the greater the likelihood of preventing or reducing the debilitating/disabling effects that can result
1 mo: screening, 2 mo: aud diagnosis, 3 mo: early invention
Those that don’t return for outpatient testing and do not receive follow up services needed after a failed nbhs
LTF
Those receiving services but no results were reported to EDHI so they are not documented
LTD
Bottom up approach
Neural organization uses this maturation approach
Meaning that the lower level maturation, stimulation and practice influences the quality of higher-level maturation
starts at bottom and as it is built it goes up and develops i stages
quality of the stages effects the next one so make sure quality is good to hafe this maturation
brain is always laying down new pathways and rearranging existing ones
pruning
formation of synapses
synaptogenesis
brain’s ability to create new interconnecting neurons through learning and practice
Synaptic plasticity
brain’s ability to reassign a sensory processing region to handle input from another sensory modality when there is a loss or deprivation in one sense.
cross-modal reorganization
specific time frame during development when an organism is particularly sensitive to certain environmental stimuli or experiences.
\
critical period
During this period, the brain’s ability to acquire and refine certain skills or functions is at its peak.
critical period
especially receptive to specific types of input or experiences. This heightened sensitivity facilitates the acquisition or refinement of certain skills or abilities
sensitive period
why BTEs for children
Behind-the-ear (BTE) hearing aids use earmolds, which are cheaper to replace compared to customized HAs. Earmolds still need to be replaced often but are generally more cost-effective.
Earmolds are safer for active children as they are less likely to cause injury if the child falls or bumps their head. In-the-ear (ITE) hearing aids, being harder, can break and cause damage. Earmolds are softer and less likely to damage the ear.
Increasing the distance between the receiver and the microphone reduces feedback. BTE hearing aids have a larger distance compared to smaller ITEs, reducing feedback issues
Children’s hearing thresholds can change frequently, requiring hearing aids that can adjust to these changes.
BTE hearing aids often have direct audio input features beneficial for school settings, which many ITEs do not offer.
BTE hearing aids are generally more durable and can be cleaned more easily. If they need repair, loaners can be provided.
why do we not fit ITE for kids
Growth: Frequent replacement due to growth.
Safety: Potential for injury and connectivity issues.
Durability: Harder to make adjustments and maintain.
why do we not fit RICs for kids
Safety: Small pieces can be hazardous, and the receiver may get damaged.
Power and Infection: Limited power and potential for more ear infections due to the design.
Damage: kids explore by their hands and their mouth so the small pieces can cause a hazard for the child
how often should earmolds be replaced
every 3 mos for children under 1 yr
Every 6-12 mos for children 1-5 yrs
Advantages of binaural stimulation in children.
Head shadow - intensities are different from ear to ear and helps with localization and one ear has a better SNR
Binaural summation
improve sound as louder by 2-3 dB
Do not need to add as much gain with two HA’s as opposed to one
Binaural squelch
Central phenomenon in brain
*huge adv with two devices
Focuses on the desired sound and while suppressing the unwanted background noise
Advantages of ALD use in children.
helps with distance
helps with SNR
even if parents do not want HAs for kids, recommend this
helps in reverberant rooms
helps rate of language acquisition
