Unit 3 Flashcards
Joint Committee on Infant Hearing (JCIH)
has published guidelines for monitoring Universal Newborn Hearing Screenings.
Who performs the test?
Nurses but they actually prefer AuDs and SLPs
Early Hearing Detection and Intervention (EHDI)
1-3-6 Rule
Individuals 3 years and younger identified with HL should be evaluated every 3 months
Recommend that infants with risk factors for HL be reevaluated in 9 months
1-3-6 Rule
Evaluated by 1 month
Diagnosed by 3 months
Intervention by 6
UNHS Protocol
All states have universal newborn hearing screening but protocol
Varies by state
Otoscopy and tympanometry are not required
ABR, OAEs (or both)
-To have ideal specificity and sensitivity, BOTH tests should be performed.
Auditory Brainstem Response (ABR)
Measures brain waves in response to sound
for those that can not responds behaviorally
Any pathologies of the OE or ME can affect ABR
Just a screening
Great objective test for patients who cannot respond behaviorally
Does not assess all necessary frequencies and cannot determine degree of HL
Otoacoustic Emissions (OAEs)
Measure of outer hair cell function
Normal OAEs suggest no worse than a mild HL
Diagnostic protocol: 750-8000 Hz (likely shortened in the hospital)
-OAE screeners likely have a shortened protocol
Greatly objective test for patients who cannot respond behaviorally
Does present OAEs mean the patient has normal hearing?
NO!
Certain configurations of HL
ANSD
Absent auditory nerve
What are Cochlear Implants?
Prosthetic devices that is surgically implanted to electrically stimulate the cochlea
Multiple components
It does NOT restore acoustical hearing (it is now electrical hearing)
cochlear implants are devices that are surgically implanted into the cochlea, activate the auditory nerve, and provide sensitivity to sound.
Components of the CI
Microphone
Speech processor
Transmitter
Electrode array
process of CI
- microphone picks up the sounds from the surrounding environment.
- speech processor changes the sound from the microphone into electrical sound signals and sends them to the transmitter.
- transmitter is held in place with a magnet behind the ear and sends the sounds through the skin to the receiver. This receiver then transmits the signals into electrical impulses and sends them to the electrodes placed within the cochlea.
- These electrodes send the impulses to the nerves in the scala tympani and then to the brain through the auditory nervous system (Battey, 2013).
CI Manuracturers
Advanced Bionics
Cochlear
MED EL
Advanced Bionics
California
Waterproof
MRI compatible
Phonak
Cochlear
Australia
Wireless accessories
ReSound compatible
MED EL
Austria
Single unit processor (Rondo)
(not recommended for children)
CI Evaluation
Will have a HA trial -Must show minimal benefit from hearing aids -Must have a referral Type of evaluations to determine candidacy Determine brand and accessories Surgery Activate CI’s 2-4 weeks later Initial visit Follow-up visits & therapy
initial visit
Activation
Determine baseline
May not UNDERSTAND language
Type of evaluations to determine candidacy
- Medical evaluation
- Physical examination
- Audiometry
- Contra-indications vs. candidacy
- Absolute contraindications
medical evaluation
General health Age of onset of hearing loss Etiology of hearing loss Auditory memory (use of hearing aids, use of oral communication) Duration of deafness
Physical examination
Cochlea present? Surgical planning (Michel’s Aplasia, temporal bone fracture, Otosclerosis, Small IAC, EVA
Absolute contraindications
Ossification of the cochlea Absence of the cochlea and/or auditory nerve Active otitis media Radical mastoidectomy cavity CNS disease that prevenst benefits Medical contraindications for surgery
FDA Audiological Criteria for Adults
Moderate to profound SNHL bilaterally
Patient receives minimal benefit from appropriately fitted amplification
<50% sentence recognition in ear to be implanted (aided)
<60% in contralateral ear and binaurally (aided)
-Medicaid: <40% in aided communication
High motivation and appropriate expectations
Children CI Candidacy (12-24 months)
Profound SNHL
Limited benefit from binaural amplification based on the MAIS/IT-MAIS
Children CI Candidacy (2-17 years)
Severe to profound SNHL bilaterally
Limited benefit from binaural amplification trial
Speech discrimination scores <30%
Candidacy
See power point
Tests utilized for Pre & Post measures
Open set tests: CNC words, AZBio Sentences, BKB-SIN Test, HINT sentence test
Closed set-tests: 4 choice spondee, vowel identification. Consonant identification
WIPI
Speech reading abilities
Family education is critical!
open set
provides an unlimited number of stimulus alternatives. These are more difficult. Monosyllabic word lists are the most widely used materials in speech recognition testing
close set
limits the number of response alternatives to a fairly small set (usually between 4-10) Word Intelligibility by Picture Identification (WIPI) is commonly used as it requires only the picture pointing response and has a receptive language vocabulary that is as low as about 5 years
Two Ears are Better Than One
An individual who meets candidacy criteria in both ears should be considered for bilateral CI.
If not, consider fitting non-implanted ear with hearing aid.
CI Benefits for Children
Development of spoken language -Expressive and receptive Environmental awareness Classroom benefits -Awareness of sound -Hearing music -Better classroom participation -Better communication -Hearing the teacher more easily
Different variables affect S&L in children with CI
Age of implantation Length of time utilizing device Language abilities prior to implantation Bilateral vs. bimodal Social interactions
When does our critical language learning occur?
first year
Study done by Conner et. al.
“Burst of Growth”
According to a study performed by Conner et.al., “Children who had received their implants before the age of 2.5 years had exhibited early bursts of growth in consonant-production accuracy and vocabulary and also had significantly stronger outcomes compared with age peers who had received their implants at later age” (2006). This study goes on to explain that this “burst of growth” begins to diminish with increasing age of implantation.
Catching Up
Implanted prior to 24 months old (Szagun & Stumper, 2012).
-Some research has suggested that if a child receives a cochlear implant by 24 months old they are more likely to make linguistic process and can be expected to catch up to their normal hearing peers by preschool age
Sensitive period (when their brain is more like a sponge)
-First 2 years of a child’s life
The duration of time for heightened sensitivity for language learning in children (Szagun & Stumper, 2012)
-Begins to diminish around 4 years old
Why is age of implantation vital for language acquisition?
The maturation of our central auditory pathways is one explanation as to why age of implantation is vital for language acquisition but language skills prior to implantation as well as a child’s social environment also play a role in language learning after implantation.
Language & Cognition Major goals
Development of speech perception
Development of spoken word recognition
Development of language skills Being able to UNDERSTAND conversational speech is essential for children to produce language correctly.
Academic Success
Better phonemic awareness
Better phonological skills resulting in better reading abilities
-Later onset hearing loss = better reading abilities (Marschark, Rhoten & Fabich, 2007).
Prior language experience
Mainstream school/changing rooms
-Mainstream: allow child to experience spoken language from multiple speakers
Fatigue
-Treatment plans
Bimodal hearing
One ear utilizes CI, other ear utilizes hearing aid
Why would we use this type of hearing?
Only 1 ear is a candidate for CI
Resources
Surgery on one ear vs. two
Studies have been conducted to determine if children perform better with bimodal hearing or cochlear implants
having brief period of bimodal stimulation earlier in life increased the rate of language learning
phonologial processing
important for language acquisition
reduced oral language abilities that leads to problems in reading, writing, and vocabulary deficits
Prevalence
12,000 with significant permanent hearing loss born each year in the United states
impacts 17/1000 children under 18 years of age
97.4% passed the newborn hearing screening
1.6% did not pass (2009)
-8.9% of those had a hearing loss
68.4% with hearing loss were diagnosed before 3 months of age
