Test 1 Flashcards
What is Aural Rehab?
A rehab service that
- Identifies HL
- Manages medical issues
- Gives technological support
- Develops auditory skills
- Gives counseling to patient and family
What is a Rehabilitation Service?
A service the provides the most appropriate technological and medical support and helps build skill level to improve function.
What are the goals of Aural Rehab?
To alleviate HL difficulties and minimize consequence, to enhance conversational fluency, and promote personal adjustment
*How many people suffer from hearing loss?
31 million
What is the range of loss in which an individual would be considered to have a hearing impairment?
26dB - 70dB
What range of loss puts an individual in the deaf category?
70+ dB hearing loss
What is an Audiogram?
A graph representing hearing thresholds as a function of frequency
What is a threshold?
The level of sound detected 50% of the time
What does air conduction test?
Outer and Middle Ear
How is hearing tested through air conduction?
Headphones, Insert Earphones, or a Soundfield (speakers)
What does bone conduction test?
Inner ear
How is bone conduction tested?
By placing a vibrator on the forehead or the mastoid
What is affected in a conductive hearing loss? How do you know this?
The problem lies in the outer and/or middle ear..
I know this because air conduction shows a hearing loss but bone conduction is normal.
What is the major feature indicating conductive hearing loss on an audiogram?
An air bone gap
Where is the problem in a sensorineural hearing loss? How do you know this?
Inner ear or Auditory nerve.. I know this because there is no air bone gap yet there are abnormal thresholds for both air and bone conduction.
*What does a soundfield used for?
To test for hearing loss by Air Conduction
What is a mixed hearing loss?
Abnormal thresholds for both air and bone conduction but there IS an air bone gap.
In a Mixed HL, which test is worse? AC or BC?
Air conduction is worse than bone conduction but bone conduction is still below 25dB
What does PTA stand for? What does it tell us?
PTA is the Pure Tone Avg… It predicts the softest level at which speech can be detected
How do you find a 2 tone PTA?
You avg. the two best readings between 500Hz, 1K Hz, and 2000 Hz
How do you find a 3 tone PTA?
Avg. 500Hz, 1KHz, 2KHz together
What does Pure Tone Audiometry evaluate? And through what method?
Evaluates the degree of hearing loss by air conduction and bone conduction
What could effect accurate Pure Tone Audiometry readings?
- when it was last calibrated
- experience of the person giving the test
- test environment
- patient state
*What is Speech Recognition?
Word Discrimination
How is speech recognition accomplished?
Lip reading, Auditory info/Listening, or both
What does SRT stand for?
Speech Recognition Threshold
How is the SRT obtained?
Spondee words
*What are spondee words? What are they good for?
2 syllable words with equal stress and same audibility
SPEECH RECOGNITION
i.e. baseball, hotdog, ice cream, football, cowboy
Speech Detection vs. Speech Recognition
Speech detection happens at a lower level than Speech recognition… Speech detection in knowing that someone is talking where speech recognition is being able to discriminate the words being said
*List stimuli
Nonsense bisyllables (phonemes) Monosyllable words Bisyllabic words Spondee words Phrases Sentences
*What are the levels of hearing loss? What are their ranges?
Mild: 25-45dB Moderate: 45-60dB Moderate-Severe: 60-75dB Severe: 75-90dB Profound: 90+dB
*What range is most speech located in? What frequencies?
20dB-50dB
1K-3K Hz
*If a person has a 40dB hearing loss, how much speech do they miss?
50-75%
What is a bilateral HL?
HL in both ears
What is a unilateral HL?
HL in only one ear
What type of condition is HL considered?
HL is an INVISIBLE condition… but the effects are not
What are the three onsets of HL?
Prelingual
Interlingual
Postlingual
When can Post lingual onset of HL begin?
Age 5
*What powers hearing aids?
A battery (cell)
*True or False: All hearing aids run on batteries.
True
H*ow many parts does a hearing aid have? What are they?
Four: Microphone, Amplifier, Receiver/Speaker, Power Source
*What are the parts of the microphone?
Diaphragm
Metal back plate
*Explain the microphone.
It picks up the acoustic signal which moves the diaphragm. This generates a small (electrical) voltage between the diaphragm and the back metal plate which is passed along to the amplifier.
*What is the purpose of the Amplifier?
Amplifies the sound based on the degree of HL.
What is gain?
Gain is the amount of amplification applied to the signal.
What are the two types of amplification?
Analog Aid
Digital Aid
Analog Aid vs. Digital Aid
AA: signal stays in analog electrical waveform
DA: A/D converter changes the analog electrical signal to 1’s and 0’s for sound processing and then converts it back to analog
What does A/D converter stand for?
Analog to Digital converter
*What is the receiver’s job?
To receive the signal from the amplifier and convert the electrical signal back to an acoustic signal
*What is the receiver essentially?
A mini loudspeaker
*Name the features of a hearing aid.
On/Off switch
Volume control
Telecoil
Audio input
What is a telecoil? What does it do?
An inductive coil..It picks up the phone signal and amplifies it
What does audio input allow for?
Connection between the aid and a TV, Computer, or FM station
*What is the role of the earmold?
To connect the aid to the ear
*Name the different styles of hearing aids.
Body Aid Behind the Ear In the Ear In the Canal Completely in the Canal
Explain the body aid
The mic, amp and battery are all located in a “box” which attaches to a cord connected to the receiver which connects to the earmold
What is the BTE aid?
Behind the Ear aid: fits over the ear/ behind the pinna and connected to the aid with a short, clear tube in the earmold.
What is the ITE aid?
In the Ear aid: all components of the aid fit in the ear.
What is the ITC aid?
In the Canal aid: everything fits in the ear canal
What is the CIC aid?
Completely in the Canal aid
Which style hearing aid is most common?
The BTE aid
What range hearing loss is the BTE aid used for?
Mild to Profound
What range hearing loss is the ITE aid used for?
Mild to Severe
Why does the range of hearing loss shrink with the smaller aids?
The smaller the aid, the more restrictive and the fewer features available
What advantage does a ITE aid have over the BTE aid?
The mic of the ITE aid is closer to the canal opening and uses the pinna for better localization
What range of hearing loss do aids work best for?
Mild to Moderate hearing loss
What type of hearing loss are cochlear implants used to help?
Moderate-Severe to Profound Sensorineural HL
How is a cochlear implant arranged?
Tonotopically
How does a cochlear implant work?
Electrodes are inserted into the cochlea and directly stimulate the auditory nerve
*Name the external components of a cochlear implant.
Microphone
Speech Processor
External Transmitter
*Name the internal components of a cochlear implant.
Receiver
What is the job of the microphone in a cochlear implant?
To pick up sound
What is the job of the speech processor?
To convert and code acoustic sound into electrical pulses
What does the external transmitter do?
Transmits info across the skin to the receiver
Describe the job of the receiver.
It is placed under the skin and it’s electrode array is inserted into the cochlea
What does ALD stand for?
Assisted Listening Device
Name some ALDs.
Closed captioning on a TV
Texting
Email
Light flashing for the doorbell
*List the four design principles.
Auditory Skill Level
Stimulus Unit
Activity Type
Difficulty Level
*List and explain the four steps of Auditory Skill Level.
1) Sound Awareness- easiest/most basic level; the ability to recognize if a sound is present and begin to put meaning with a sound.
2) Sound Discrimination- the ability to tell if two sounds are the same or different
3) Identification- the ability to label and the awareness that objects have names
4) Comprehension- hardest level; the ability to understand the meaning of a spoken message
What is the ultimate goal in the Auditory Skill Level design principle?
Comprehension
Do you always start with sound awareness?
NO! This varies based on the individual’s auditory experience and language at the time of hearing loss
Typically, what kind of patient starts with the sound awareness level?
A patient who has severe to profound pre-lingual hearing loss and now has hearing aids or cochlear implant
When going through sound discrimination, what sounds do you start with?
Two very different sounds! /a/ and /s/
- > different voicing
- > high vs. low frequency
How does the Stimulus Unit design principle work? What are the two types?
All the programs are combined together.. Analytic Activities and Synthetic Training
Explain Analytic Activities
These focus on segments of the speech signal.. It is essentially training in isolation.
i.e. phonemes and syllables
Explain Synthetic Training
Train to recognize meaning even if you don’t recognize every word or sound.
What is the Activity Type design principle?
This is the optimal training program because it incorporates both formal and informal training.
Explain formal vs. informal training.
Formal training is highly structured, drill type activities in a small group or even 1-on-1. Informal training incorporates daily routine activities.
Explain the Difficultly Level design principle.
When an individual reaches 80% correct performance, the difficulty should be raised. If below 50%, the difficulty should be lowered.
How many ways are there to change difficulty?
Six
List the six ways to change difficulty. Explain them.
1- Stimulus Set: open ended vs. closed (choices)
2- Stimulus Unit: words vs. complete sentences
3- Stimulus Similarity: dissimilar vs. similar
4- Context: highly detailed vs. low/little detail
5- Task: structured vs. spontaneous
6- Alter listening environment: good Signal-to-Noise ratio vs. poor Signal-to-Noise ratio vs. distance
What is analytic training used for?
To help those with low auditory skills learn sound awareness and the sound has meaning.. Usually young or new cochlear implant users
In analytic training, what sounds should you start with and why?
Start with vowels because they are voiced and solely contrasted by the formants
How is formant 1 determined vs. formant 2?
1 = how far the mouth is open 2 = tongue position
When moving on to consonant training, what should one keep in mind?
Start with voiced and nasal sounds- easiest
Pick consonants that differ in manner and voice and even place
What are the most difficult consonants to pick up?
short, high frequency and unvoiced sounds
What is cycling?
When you return to an objective previously achieved to refresh, reinforce and give additional learning.
What does synthetic training focus on?
Prosodic speech aspects
Learning to discriminate between single words and sentences
Checking comprehension
Explain formal auditory training.
Stimuli are more challenging Vary the talkers More info over a short period of time combines analytic and synthetic levels Progress from closed to small open set
What is a reinforcement?
A quick activity immediately following a correctly finished training activity
What is informal training?
Auditory practice occurs in the context of the activity the child is interested in
What is Interweaving?
Auditory training with speech therapy and speech reading training.
What THREE benefits come with interweaving?
This builds an association between auditory and visual
Links speech perception to speech production Allows the client to feel the difference in production even if they do not hear it.
What does Auditory Training affect?
Brain Development
What is the purpose of auditory-oral training?
It enhances the speech recognition better than simultaneous communications
What degree of hearing loss is auditory-oral training appropriate for?
Mild to Moderate
What is simultaneous speech?
Speech with sign language at the same time
When is simultaneous speech best?
With a severe to profound hearing loss
True or False:
A child with hearing loss progresses through the same stages of hearing and speech development once amplification or implants are given to them.
True
What is the difference between an activity limitation and a participation limitation?
Activity= the inability to hear speech and noise
Participation= things you don’t do due to hearing loss
*What is avoiding restaurants an example of?
Participation limitation
Does Aural Rehab always include Speech and Language therapy?
No, it depends on the patient.
Hearing aids send what kind of signal?
Acoustic
Cochlear implants create what kind of signal?
Electrical
Pre-lingual is when?
birth
*When can a post lingual hearing deficit begin?
Age 5
What years are considered post lingual?
9-10 years
What are the three categories of hearing loss?
1- Degree
2- Onset
3- Progression
*Envelope means?
Duration
*A case study is…
Correlational
*What is a correlational case study?
subjects are exposed to a particular treatment and followed over time and compared to unexpected subjects
*What is pitch NOT a feature in?
Pitch is not a feature in a consonant phoneme confusion analysis
*Was Alexander Graham’s wife hearing impaired?
YES
*When are cochlear implants implanted?
4-6 weeks after surgery
What are the SIX levels of evidence from most credible to least credible?
1- Systematic meta-analysis of more than one randomized control trial
2- Well designed, randomized control trials
3- Well designed control trial without randomization
4- Well designed quasi-experimental studies
5- Well designed non-experimental studies
6- Expert committee report
What is EBP?
Evidence Based Practice
What should be considered in EBP?
- clinical expertise
- patient values
- current and the best scientific evidence
^ What is the purpose of the speech recognition test?
To dictate one’s choice of test
