W10: OME & APD & Apps Flashcards
What is OM?
OM or OME refers to fluid behind the eardrum, in the ME
OM has as ____ depending on the type of fluid present
spectrum
Define acute OM (AOM)
when the eardrum is red and bulging, often with pain and fever
Define glue ear
- often follows “acute OM”
- or may occur independently, without fever, and with an inflamed or bulging eardrum
In some instances, the eardrum is ____ to varying degrees
retracted inwards
What are 4 otoscopic signs of AOM?
1) air fluid level
2) full, bulging tympanic membrane
3) redness
4) perforation of tympanic membrane
Who gets OM more frequently?
It is more frequency or longer in certain conditions like cleft lip/palate, down syndrome, APD
The incidence of AOM ____ with age
declines
Occurrence of OM in infants and young children (0-3 years):
- one episode of AOM in around 80% of children
- 3 > episodes in about 40% of children
- the peak incidence occurs between 6 to 12 months
- duration varies from a few days to several weeks or even months (in some untreated cases it may persist for a year or more)
Occurrence of OM in preschool children (3-5 years):
- recurrent episodes in approximately 50-60% of children
- experience of OME can lead to temporary hearing loss in many children
Occurrence of OM in school age children (5-12 years):
- recurrent episodes in about 15-20% of children
- OM remains the leading cause of medical visits and antibiotic prescriptions
Occurrence of OM in adolescents and adults:
- OM is relatively rare
- May occur due to upper respiratory infections, allergies, or eustachian tube dysfunction
What are 7 factors influencing the effects of OM?
1) onset age (more common between 6-24 months)
2) number and duration of episodes/bouts
3) cumulative duration over the years
4) thickness of effusions
5) hearing loss severity, particularly at high frequencies
6) genetic factors
7) environmental factors that increase the risk of severity of recurrent OM (smoking exposure, ambient air pollution)
What are 7 factors contributing to the delay in OM diagnosis?
1) subtle initial symptoms, mild or non-specific, can be mistaken for other common issues (irritability or sleep disturbances)
2) young children’s difficulty in symptom expression
3) misdiagnosis with other respiratory or ear conditions (upper respiratory infections)
4) challenges in accurate diagnosis through otoscopy (uncooperative children, cerumen obstruction)
5) transient or fluctuating symptoms (with periods of relief which may seem resolved)
6) limited access to health services in some areas
7) parents or caregiver delay (parents or caregivers may wait to seek medical attention, especially in mild symptoms)
OM is generally considered a ____, especially when:
harmless disorders, when there is no infection and hearing loss
Early diagnosis of OM is important, long-lasting OM is associated with what 3 things:
1) bilateral or unilateral CHL
- often low tone loss
- greater CHL at high frequencies (likely due to weaker BC transmission of high frequencies)
- the loss of binaural hearing advantages
2) auditory deprivation during OM
3) OM is associated with APD
What are 5 adverse effects of early OM (what can OM negatively affect)?
1) auditory processing skills
2) sound localization
3) speech and language development (errors in speech articulation)
4) reading ability
5) overall intelligence
What are two articulation errors in children with early OM?
initial consonant change
nasal consonant change
What is epenthesis?
Refers to adding one or more sounds to a word, especially:
- in the beginning or ending of a syllable
- between two syllables
What are the 5 effects that unilateral hearing loss has on binaural hearing?
1) sound localization
2) binaural summation
3) binaural squelch (suppression/repression)
4) binaural fusion/integration
5) binaural redundancy
How does binaural sound localization work?
it occurs by identifying slight differences between the 2 ears
- arrival time (ITD)
- sound intensity (IID)
How does binaural summation work?
- the brain’s ability to combine the inputs of the same information received by 2 ears
- resulting in:
- an overall increased loudness perception
- improved ANR
How does the binaural squelch effect for?
- the brain’s ability to improve SNR when the signal received by each ear is different (speech to one ear, noise to the other)
- in this situation, brainstem nuclei compare different signals received at each ear and reproduce the signal with higher SNR (3 dB improvement):
- by processing timing
- amplitude
- spectral differences between the 2 ears
How does binaural fusion/integration work?
- the brains ability to integrate and fust information from both ears
- benefits:
- more complete and accurate representation of the auditory scene
- facilitating the perception of complex sounds (music and speech)
How does binaural redundancy work?
binaural hearing provides redundance in auditory information
What are the 3 subtypes of APD in OM according to the buffalo model?
1) tolerance fading memory (TFM) deficit
2) integration deficit (especially in unilateral OM)
3) organization deficit
Buffalo model - TFM subtype of APD is characterized by:
- inability to retain auditory information
- limited auditory STM/WM
- distraction by background noise and forgetting what was said
Buffalo model - integration deficit subtype of APD is characterized by:
- impaired transferring of interhemispheric information
- severe reading and spelling problems
Buffalo model - organization deficit subtype of APD is characterized by:
- disorganized behaviours
- difficulty following sequences/tasks in order
- a high incidence of reversals in the SSW test (change in the sequence of the spondaic words)
____ is a specific type of APD common in OM
amblyaudia
What is amblyaudia?
- coined by Dr. Deborah Moncrieff
- refers to larger than normal REA with normal performance in the dominant ear on dichotic listening tests
- it is a type of APD due to auditory deprivation secondary to OM during the early developmental period
What are 4 tests sensitive to amblyaudia?
1) dichotic words test (DWT)
2) randomized dichotic digit test (RDDT)
3) SCAN:3-C competing words and sentences
4) dichotic digit test (DDT)
Explain the 4 types of dichotic listening test results in OM
What are 8 recommended strategies and interventions for preventing APD in those with OM?
1) early identification (regular monitoring for early indication of OM)
2) regular hearing screening programs for children between 3-11 years
3) following a team approach for treatment
4) exploring emerging interventions/devices (ear popper)
5) home strategies (speaking closely, slowly, amply, and repetitiously to infants and children to stimulate the auditory system)
6) improving SNR (ALDs or remote mics)
7) treatment for APD (focusing on decoding, TFM, and integration tasks)
8) increasing public awareness and research
What are the issues with auditory training programs for APD?
- training sessions typically range from 15-45 min, 2-7 times a week, for 2-3 months
- ASHA and AAA recommend using both bottom up (stimulus driven) and top down (cognitive language processing, metacognitive) components
- clinicians often aim to improve auditory processing abilities, rather than language or reading skills
- the generalizability of trained tasks and abilities is questionable
What are the objectives of using apps for APD?
- to inform you about mobile devices and apps for APD and intervention that can expand the clinical toolbox AND offer practicality and portability
What are the pitfalls of using apps?
using apps without:
- collecting comprehensive background information
- considering individuals needs
- considering clinical indications and judgements
What are the best practice for using apps?
using apps that are supported or guided by quality evidence
