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Ped. Aud > Practical > Flashcards

Practical Flashcards

1
Q

goal of behavioral testing

A

determine if the child has sufficient hearing to develop S/L

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2
Q

protocol that provides a direct measure of hearing

A

behavioral audiologic testing

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3
Q

Purposes of audiological assessments in infants and children:

A

To determine the type, degree, and configuration of hearing loss in each ear.
To assess the impact of hearing loss on speech, language, communication, and education.
To identify risk factors for progressive or delayed-onset hearing loss for ongoing monitoring.
To evaluate candidacy for sensory devices (hearing aids, assistive devices, cochlear implants).
To refer for medical evaluation and early intervention services when appropriate

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4
Q

Indications for Comprehensive Audiological Evaluation

A

Referral from newborn hearing screens or risk factors for hearing loss.
Behaviors indicating hearing loss vary by age:
Infants: No response to loud sounds or not turning to sudden sounds.
Toddlers: Not responding to verbal instructions, talking too softly or loudly, or speech misarticulations.
School-aged children: Frequently asking for repetition, turning up TV volume, difficulty following directions, inattention, or social isolation.
Parental concerns about hearing or speech/language delays.

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5
Q

what is the cross check principle

A

achieved through a test battery approach, where multiple tests cross-check each other to ensure accuracy, especially in infants and young children.

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6
Q

adv of test battery approach

A

Provides detailed information
Avoids drawing conclusions from a single test
Allows for the identification of multiple pathologies
Provides a comprehensive foundation for observing a child’s auditory behaviors

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7
Q

behavioral test protocon needs to include

A

ross-check principle (ensures valid & comprehensive eval) & developmentally appropriate for assessing hearing in infants and children

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8
Q

how do you choose the appropriate testing

A

Determine child’s cognitive age - determined from case hx, reports from other evals & infant developmental screening scales
Evaluate their physical status - used to determine his/her ability to perform the test task, evaluating their ability to control head, neck & upper torso, see objects (vision) and ability to manipulate toys
Choose the test room setup

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9
Q

for behaviorally testing if there is significant physical limitations but cognitively they are there what should you do

A

can verbally say they heard it
can use eye movement
physiological measures

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10
Q

what factors affect behavioral assessment

A

state of the child during the assessment

audiologists skills

clinican assistance

testing environment & setup

past experience

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11
Q

describe the stimuli used for behavioral audiometry

A

Frequency specific
Warble tones (pure tones?)
Narrow band noise

Non-frequency specific
Music
Noise
Speech - used to capture their attention & determine SAT

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12
Q

Speech can be used to confirm

A

warble/NBN threshold levels
Used to condition during audiometry to gain their attention more?
Ba - close to 500 (low)
Sh - close to 2000 (mid high)
S - close to 3-4000 (high)

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13
Q

ba

A

close to 500 (low)

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14
Q

sh

A

close to 2000 (mid high)

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15
Q

s

A

close to 3-4 (high)

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16
Q

presentation procedure for behavioral audiometry

A

Start at 30dB(improves probability of starting close to threshold) & increase in 20 dB if no response happens
Completed from 500-4000 Hz: most critical for S/L development
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

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17
Q

how is stimuli presented for behavioral audios

A

Inserts, supras, SF, BC, HA’s CIs

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18
Q

adv/dis of headphones & SF

A

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.

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19
Q

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

A

probe trials

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20
Q

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

A

control trials

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21
Q

what to do with no responses

A

Stimulus might not be audible or engaging enough (increase PL or change stim type or frequency)
Use VT stimulus w/ bone oscillator (~ 40 dB HL at 250 Hz)

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22
Q

what are some reasons a child might have to return for a follow up

A

Inconsistent responses
Inadequate cooperation: might be fussy, sleepy, uncooperative
If infant is unwell (cold, flu, ear infections)
Ototoxicity monitoring
Ear canal/tympanic membrane abnormalities

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23
Q

what can you do to test behavioral audio in severe to profound

A

May need test adaptations
The probe from the insert earphones can be attached directly to their personal earmolds.
If the child does not respond at the audiometric limits, it may be possible to obtain a response using a bone vibrator held either in the child’s hand, on the knee, or on the mastoid.
Once the child responds consistently to the tactile stimulus, begin testing with earphones at 250 or 500 Hz

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24
Q

what are ped audiology tools

A

case hx

speech audiometry (SAT, SRT, WRS)

behavioral audiometry (BOA, VRA, CPA, Conventional

physiologic tests (TYMPS, OAEs, reflexes)

electrophysiologic tests (ABR, ASSR)

dev measures (ASQ, IDA, CDL etc.)

fxnal measures (ITMAIS, LITTLEARS, CHAPS, ETC.)

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25
Q

what is the importance of case hx

A

Accurate diagnosis of hearing loss relies on interpretation of a test battery within the context of the child‘s medical and/or developmental history.
Understanding the Child: Provides essential information about the child’s development and health, offering insights into their cognitive and developmental status and helping estimate their auditory skills.

Understanding the Family: Enables the audiologist to understand the parents’ concerns, needs, and assessment expectations, and helps build rapport with family and caregivers, which is crucial for effective counseling.
Observational Opportunities: Allows the audiologist to observe the child’s behavior and note interactions with family members and others.

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26
Q

Accurate diagnosis of hearing loss relies on interpretation of a test battery within the context of the child‘s medical and/or developmental history.

A

true

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27
Q

describe behavioral audiometry

A

measures the whole system
requires cooperation
direct measure of hearing
parents can observe and understand the results

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28
Q

when is boa performed

A

Birth to 6 mos

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29
Q

what are we looking at with BOA

A

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

Cessation or initiation of sucking rate is a reliable response for observing auditory behavior in younger than 6 mos within 2s of the stimulus presentation

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30
Q

how do you detect a response in BOA

A

TIMING - responses need to be within 2 s of sond presentation
Some respond to the ON and some respond to the OFF
Infants are consistent in their pattern of response
Response time is slightly shorter for louder stimulus

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31
Q

testers needed for BOA

A

Minimum of 2
Audiologist - control room
Audiologist or assistant next to infant - monitoring child making sure the head and torso are comfortably balanced
Both need good visualization

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32
Q

when should you get ear specific information with headphones

A

Ear specific info might not be required at initial visit unless medical condition warants it or HL detected
Hearing is normal in general - can wait to get it
Evidence of HL - this info is needed and need to test under earphones

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33
Q

when do you see startle responses

A

when the sound is suprathreshold

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34
Q

can you change the response criteria durig testing

A

no

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35
Q

can you get minimum response levels (MRLs) in BOA

A

yes

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36
Q

what is the dis of using Auro Palpebral & moro reflexes in BOA

A

Using auro-palpebral, moro reflexes, changes in limb movement or respiration are not elicited responses to threshold stimuli but suprathreshold stimuli instead

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37
Q

how do you maximize sucking responses in BOA

A

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

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38
Q

describe the protocol for BOA

A

infant comes in hungry state

seat them so torso is supported and they are not fidgety and so the tester can easily see the infant’s mouth

monitor their state during testing to test stimuli or responses from the child

instruct parents to not respond to stimuli or their child

assistant keeps infant visible, centered and monitors the parents behavior

begin testing in SF & w/ stimulus slightly above estimated threshold

test one low and one high then do the procedure next for which one

reduce thresholds in 10 dB and increae in 5-10 to bracket threshold. record response after 3

take breaks as need3d & calm infnant to increase test time

if SF indicates hL, test bc

if infant is still responding or at next session test with inserts

test with tech as needed

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39
Q

when should you use VRA

A

developmental ages 6-36 mos

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40
Q

what is VRA and what does it entail

A

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.
Correct response is rewarded by activation of a light or lighted toy
The best reinforcers are novel and interesting

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41
Q

reinforcers for VRA

A

Speakers/reinforcers at 45 or 90 degrees

Best placed at the child’s ear level & 90 degrees to the side of the child
One or two?
They can perform with one side
Even if sound is presented to one side and they look to the other it still counts as a + response because they only have to detect the sound; NOT dependent on localization
Plexiglass boxes
Lighted toys htat can be lighted or animated
Monitors
Animated images
Cartoon video reinforcer
Older children or those not interested in the VRA toys
No sound

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42
Q
A
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43
Q

What distractors in VRA should be used

A

Quiet and simple but less interesting than the reinforcer toy
Colorful toys, puppets, finger toys, pieces that connect, magnets on a magnet board
Examiner can also make funny face
Let the child play with distractor only as a last resort!!

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44
Q

positioning for vra

A

High chair is preferred
Parent - do not react to any stimulus

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45
Q

what is the role of the in room examiner

A

Keep child in a listening posture and environment
Keep child busy with visual stimuli at midline
Do not talk or smile at infant unless a + response has been provided
Keep a quiet environment
Keep a rapport with parent
Parents
Don’t look at the reinforcement toy until the child does
Don’t change your body language when the sound is presented
Don’t alter the way you play with the toys when the sound is presented
Act deaf to the sound!

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46
Q

describe the training/conditioning phase

A

Start 100% reinforcement then slowly decrease to less frequent reinforcement

pairing phase is either simultaneous stimulus reinforcer pairing approach or response observation and shaping approach

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47
Q

what is the Simultaneous stimulus-reinforcer pairing approach

A

Tone and visual are presented together

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

48
Q

what is the Response observation and shaping approach

A

Tone is presented and the reinforced with visual when turn

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

49
Q

testing phase (threshold procedure)

A

Larger step sizes can be used (20 down 10 up instead) to get to the thresholds faster so we do not lose the attention of the child
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

50
Q

what are minimum response levels (MRL)

A

Describes the lowest intensity of auditory stimulus that produces the desired response
Not adut like thresholds but they are repeatable and reliable and close to true threshold
Referring to these responses as MRLs rather than thresholds emphasizes that we should anticipate further improvement in response behavior as the child grows.

51
Q

If the child responds to the combined stimulus/reward but fails to demonstrate a response to the stimulus alone

A

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.

52
Q

If the child is not responding to the stimulus/reward combination

A

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.

53
Q

protocol for VRA

A

seat child in high chair, child chair or parents lap

test assistant or parent keeps their attention centered using quiet toys

stim presented at a comfy level loud above expected threshold & conditioning/reinforcement toy turned on and if child doesnt turn, test assistant calls their attention to it. stim and toy are kept together for 3-4s

when child is conditioned to respond, stim is presented without the reinforcement and if they turn to the sound, the reinforcing toy is turned on and conditioning is done

testing begins with one lf and one hf with stim decreased until they stop responding

add other frequencies determined by the responses

testing then needs to be done with headphones bc and technology

reinforcing toy is now only turned on when they make a conditioned head turn in response to the sound

when in doubt do not reinforce

54
Q

describe the conditioning phase

A

2 kHz is presented supra (60-70 HL) unless HL then use judgement or another frequency (like if there is HF loss use LF instead)

if they turn head witin 2-3s of stim presenteion then visual reinforcement is provided in combo with the sound for another 2-3s. if they repeat then conditioning is established and begin testing

if child doesn’t respond spontaneously with head turn then a more formal conditioning phase occurs - initally stim and reward is presented together and a number of this might be required. when head turn is reliably elicited with this combined method check with just presentation of tone alone and the visual as a reinforcer and once they respond to sound alone testing can begin

if they respond to combined stim/reward but not the stim alone, stim may not be interesting enough or not audible. Increase PL by 10dB & if no response at a higher level assess stim type

if they are not responding to stim/reward combo, reward may not be interesting or visible. Lower room lighting, change the reward, use 2 or more rewards in combo or move the visual reward closer to the child.

child may also not be developmentally ready for procedure or sufficiently motivated by the reward so other test procedures are required

55
Q

when should CPA be used

A

Developmental age 30 months to 5 years (2.5-3 yrs to 5 yrs?)

56
Q

what is cpa

A

Method of testing toddlers and preschoolers hearing through conditioned motor responses to sound with game activities
Train the child to react to a sound in a specific way
The response must be deliberate, consistent with the child’s motor skill, and time efficient.

57
Q

in CPA you want to start with the most difficult task first

A

false

58
Q

when do you test bone

A

when there is concern of CHL or HL

59
Q

AC & BC thresholds from 250-8 in each ear
procedure

A

Start at 2 in one ear, move to 2 in the other ear then repeat at 500
If thresholds at both 5 and 2 are normal get 4
If thresholds are worse at 2 then get 1

60
Q

what level should you condition in CPA

A

Condition around 40-50 dB if hearing is assumed to be normal
Pre play comforts the child in their new environment and can see which toys draw their attention
Process: Auditory stimulus to behavioral response to reinforcement

61
Q

what is the first step in conditioning CPA

A

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

62
Q

what is the second step in conditioning CPA

A

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

63
Q

waht is the third conditioning step in CPA

A

child attempts alone (if they are hesitant, guide them by saying “you heard it, you can put it in”)

64
Q

if the child is successfully conditioned for CPA what do you do? if they are not conditioned what do you do?

A

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

65
Q

what is considered a response in CPA

A

Performance of the desired motor behavior within 3s after the stimulus onset of the signal

66
Q

what are reinforcements that can be used in CPA

A

Positive reinforcement
Verbal praise (that’s good, good listening)
Social (pat on the back, smile & nod, applause)
Tokens - traded in for stickers or small toys
Food
Changing computer display screen

67
Q

what are toys that can be used in CPA

A

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

68
Q

CPA Protocol

A

set child in high chair or at a children’s table so they are comfy

select a toy that is enjoyable and within their skills

begin using test stimuli child will be able to hear

begin demonstrating the task. assistant holds toy to ear & when she hears the sound she says “I hear that” and drops it into the bucktet

after a few presentations the child is given the toy and assistant holds the toy to the child’s ear. when sound is heard the assistant helps the child drop it into the bucket

repeated until child can perform the task without assistance & performing reliably test can begin

if child gets bored change toys

testing can be accomplished by ac bc has cis baha & fm systems

69
Q

procedure for birth to 6

A

BOA

70
Q

procedure for 5-36 mos

A

VRA

71
Q

procedure for 30 mos to 5 yrs

A

CPA

72
Q

challenges of BOA

A

requires careful observation of infant sucking by the audiologist

can’t be used in infants who do not suck

only performed when they are calm and in a light sleep state

not generally accepted in audiology community due to lack of training

73
Q

benefits of BOA

A

audiologists can get valuable behavorial responses in infants; part of the cross check principle

can be done in SF, earphones, BC, HAs, or CIs

ensures accurate fitting of tech becuase we can obtain MRLs

74
Q

challenges to VRA

A

getting ear specific data when child won’t wear earphones

75
Q

benefits of VRA

A

audiologists can get valuable behavorial responses in infants; part of the cross check principle

can be done in SF, earphones, BC, HAs, or CIs

ensures accurate fitting of tech becuase we can obtain MRLs

76
Q

challenges to CPA

A

keeping child entertained and involved long enough to obtain all the necessary info

77
Q

benefits to CPA

A

accurate responses possible at threshold level

can be done in SF, earphones, BC, HAs, or CIs

78
Q

change in sucking in response to auditory stimulus
other behavioral changes are not accepted because they are suprathreshold responses

A

boa

79
Q

conditioned head turn to a visual reinforcer usually a lighted animated toy

A

vra

80
Q

motor act by a child in response to hearing a sound
listen & drop task

A

cpa

81
Q

when can conventional audiometry be used

A

children >/=5yrs

82
Q

only part of the audiology test battery that assess functional auditory performance

A

speech perception testing

83
Q

what is the point in speech perception testing

A

provides information about how a child can be expected to function in daily listening situations.

84
Q

Speech audiometry principles

A

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

85
Q

use words familiar to the child & that are within their vocabulary; incorporate pictures or objects to represent words or sounds being tested

A

true

86
Q

articulatioin problems in kids

A

make it difficult to score speech tests
instead do picture pointing, perform speech awareness

87
Q

what is the procedure for presenting WRS

A

NH - present 30 dB SL
HL - present 40 dB SL
sloping - make sure it is audible at 2 kHz & in HFs

88
Q

when should you do SRT vs SDT

A

SDT - dev age of 5 mos to 24 mos

SRT - receptive language skills >/= 2 yrs

89
Q

when should you consider normal spondee words for SRT

A

around 5 yrs

90
Q

when should you rely on picture boards, body parts, etc

A

below 5 yrs

91
Q

what are tests that can be used with SRT

A

pointing to body parts or familiar objects

point to spondee pictures

CRISP

92
Q

what are ways to test SDT

A

stimuli can be child’s name, nonsense words (bababa) , short phrases (hi, hey can you hear me, hi johnny)

usually MLV in SF or headphones

ling 6 sounds

93
Q

Use when they are too young, delayed, have limited vocab or significant HL

A

sat/sdt

94
Q

what is considered a response in SAT/SDT

A

Can be eye widening, head turn, facial change, etc.

95
Q

what are the ling 6 sounds

A

Provides frequency specific information telling us how a person can be expected to perceive speech stimuli across the frequency range needed for speech
Can be compared directly to pure tone thresholds

96
Q

indicates useable hearing through 1000 Hz (low frequency)

A

Audibility of /a/, /u/, /i/

97
Q

hearing through 2000 Hz (mid-high frequency)

A

Audibility of /∫/

98
Q

hearing through 4000 Hz (high frequency)

A

Audibility of /s/

99
Q

assessing low-frequency information

A

ba

100
Q

assessing mid- to high-frequency information

A

sh

101
Q

assessing high-frequency information.

A

s

102
Q

how to perform SRT

A

start around 30dB
if no response, go to 50 etc (like adults)

present with carrier phrase (show me, point to the, say the word)

carrier phrase is presented 10-15dB above the spondee level presentation

103
Q

if your threshold for srt for snowman is 20 dB what do you present the carrier phrase at and the next srt presentation

A

present show me at 35 dB and immediately decrease to 20 and say “snowman”
carrier has to be audible for them to be attentive

104
Q

when is a closed WRS appropriate

A

< 5 yrs or S/L delay

105
Q

when is an open list appropriate

A

> /= 5 yrs

106
Q

when should you use NU CHIPS

A

language age 3-5 yrs
Scored as %
Closed set of picture pointing word recognition test

107
Q

how do you set up for NU CHIPS

A

just like adult WRS
ext A channel 1 track 3 for cd
or mic channel 1 for MLV

108
Q

when should you use WIPI

A

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.

109
Q

how to set up for WIPI

A

just like adult WRS
cd: ext a channel 1 track #3
mlv: mic channel 1

110
Q

when should you use PBK-50

A

language ages 5-8 yrs
Cannot be used younger than kindergarten due to vocab too hard
only an open set
requires a verbal response

111
Q

when do you use bkbsin

A

language age 5-8
Pre recorded signal to noise ratios, noise increasing with each sentence, used to est snr in kids 5+ or adults which quicksin is too hard

112
Q

how to set up for bkbsin

A

channel 1
ext b
#19&20 are calibration
#13 is the list

113
Q

when can you use NU-6

A

older children
12??

114
Q

what can be used to test sev to profound HL for WRS

A

AND
used when they cannot perform standard tests

Determines whether child w/ HL can perceive spectral aspects of speech or only gross temporal acoustic patterns

115
Q

how is ANT performed

A

Examiner calls out numbers w/ mouth covered, child points to the correct card or says the number
Scoring: 1 point for each one identified correctly & can range from 0-5
High Score = 3 to 5: Child capable of perceiving some spectral qualities of words
Low score = 1 to 2: Child tentatively considered having a profound hearing loss, requiring appropriate intervention

116
Q

when should we use ABR ASSR

A

under 6 mos

Ped. Aud (14 decks)

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