W11 Flashcards
What are the 3 management strategies for APD?
- Compensatory Strategies
- Environmental Modifications (EMs)
- Assistive Technologies and Hearing Aids
like a hierarchy
What are compensatory strategies?
− Strategies to improve the learning environment without making physical alterations.
Examples of compensatory strategies:
– Improving self-advocacy and speaking up about communication difficulties
‒ Practicing in mock settings
‒ Using visual aids and lip-reading to enhance understanding.
‒ Providing notes ahead of the class to help the child prepare and reduce reliance on auditory information.
‒ Using recording devices, reduced-speed playback, captions, and note-taking aids
‒ Using alternative methods to take exams.
What are EMs?
They refer to physical changes in the environment
What 4 thing do EMs overcome?
̶ Low SNR
̶ High reverberation
̶ Poor insulation
̶ A low teacher voice level
Classroom ANSI standards: The maximum allowed noise is ____ dB with ____ dB SNR.
35, +15
Classroom ANSI standards: ̶ The speaker-to-listener distance should ideally be less than ____ feet.
3
Classroom ANSI standards: RT (reverberation time) should not exceed ____ sec at frequencies of 500 Hz, 1000 Hz, and 2000 Hz
0.6
Classroom ANSI standards: RT (reverberation time) should not exceed no more than ____ sec for classrooms between 10,000 and 20,000 cubic feet
0.7
Classroom ANSI standards: RT (reverberation time) should be as short as ____ sec for primary schools
0.3
̶Overall, an RT of ____sec for hearing-impaired children/APD and ____sec for hearing peers is recommended.
0.3, 0.6
What is reverberation?
Reverberation is the persistence of sound in a room after the sound source has stopped. Reverberation can interfere
with speech intelligibility.
What 4 reasons is Improving the SNR Important?
̶ Children’s ability to hear in noise doesn’t reach adult-like levels until adolescence.
̶ Children with normal hearing require higher SNR than adults (+10dB vs. +6dB).
̶ Children with hearing loss and APD require higher SNRs than hearing peers (+12 to +20dB vs. +10dB).
̶ While current classrooms often have SNRs ranging from -7 to +5dB, which is concerning.
What are 3 Negative Consequences of Poor Classroom Acoustics (long RTs and low SNRS):
̶ Reduced speech perception, leading to mishearing and spelling errors.
̶ Reduced reading ability
̶ Poor academic achievements
When are the ALDs recommended?
Once EMs can not meet the SNR needs of children with APD,
hearing loss, or learning disability.
4 Types of ALDs:
̶ Personal FM or ear-level FM systems
̶ Sound-field FM systems (placing speakers in the classroom)
̶ Infrared induction loops
̶ Hardwired systems
- The ideal SNR in a classroom is ≥ ____
+15dB.
- FM systems provide an average SNR advantage of ____ dB.
8.3
To determine if a child needs an FM unit for sound enhancement, the following factors should be
considered:
̶ Poor speech-in-noise discrimination
̶ Ability to wear and adapt to the unit
̶ Support of the school or district
̶ Compatibility with the child’s personal aids or other FM units in the classroom
̶ Child‘s willingness to wear without feeling stigmatized
̶ Teacher’s willingness to wear the microphone and transmitter and learn how to troubleshoot
̶ Teacher’s acceptance and willingness to introduce the device to the class
̶ Having solutions for potential interferences from external sources: radio stations, computers, and pagers
̶ Costs for the family and/or the school
Should the FM Be Fitted for One or both Ears?
- Bilateral fitting is generally recommended to improve SNR and sound localization.
- The decision should be individualized, based on the child’s needs.
How can you use sound field amplification systems to improve SNR?
Involving a microphone to capture the teacher’s voice and speakers to amplify and project it throughout the classroom.
What are the benefits of sound field amplification?
− Improved speech perception
− Improved academic achievement
− Enhanced eye contact, attending skills, reduced listening difficulties, and listener fatigue.
− They are not expensive, almost equal to the price of 1 personal amplification system
What are the limitations of sound field amplification?
− They can not overcome the effects of excessive reverberation.
− They increase the overall classroom sound levels, causing distractions for neighboring rooms
The following 5 Hearing aid features can be used to improve SNRs:
̶ Using a hearing aid with a mild gain
̶ Directional microphones
̶ Noise reduction algorithms
̶ Conservative nonlinear processing options (NPO)
̶ Wide dynamic range compression (WDRC) circuits
Define stroke
A neurological deficit caused by vascular damage in the CNS.
What are the 2 types of strokes?
hemorrhagic
ischemic
What is a hemorrhagic stroke?
When bleeding in the brain damages nearby cells.
What is an ischemic stroke?
Blockage of a blood vessel supplying the brain by a blood clot. It is called:
̶ Thrombotic stroke/atherosclerotic stroke, when the clot forms in an artery supplying the brain.
̶ Embolic stroke, when the clot forms somewhere else in the body and travels through the bloodstream to the brain.
What is a Mini-stroke/TIA (transient ischemic attack)?
̶ Due to a temporary blockage
̶ Symptoms usually last for just a few minutes or < 24 hours.
stroke symptoms vary based on the what?
place and extent of brain damage
What are the 3 common symptoms of stroke?
̶ Sudden weakness or numbness on one side of the body
̶ Confusion
̶ Headache
How do you differentiate between a hemorrhagic and ischemic stroke?
To differentiate between the 2 you need imaging
Are there hearing deficits associated with stroke?
– Hearing thresholds are mostly preserved.
‒ HL may occur by disrupted vascular supply to the inner ear or nerve.
Are there auditory processing deficits with stroke?
̶APD reported: Depending on the lesion site and time elapsed since stroke onset:
‒ Deficits in sound localization
‒ Deficits in sound recognition
o Auditory agnosia: Deficits in word, music, or environmental sound recognition (refer to session 7)
o Temporal and spectral perceptual disorders
̶Central deafness is rare.
̶ It may occur due to bilateral impaired auditory cortices or extensive brainstem damage
When does central deafness occur?
Severe head injury affecting the brainstem
OR is both auditory cortices are involved
What were the 4 deficits observed in a 10-year-old child with acquired APD due to severe left hemorrhagic
stroke at 13 months of age?
̶ Sound localization
̶ Speech perception, particularly in background noise.
̶ Speech and language development
̶ Short-term memory and attention (visual and auditory)
- Acceptable performance at school using special education needs strategies.
How does sound get to the brain?
The majority of the
auditory nerve fibers take
a contralateral pathway
from each ear, which
assists in sound
localization and speech
perception
Why were most issues with this child in the right ear?
Most issues are in the right ear, but a stroke on the left side (why? Crossing to the contralateral side)
- If the deficit is in the LEFT ear, the damage is in the RIGHT hemisphere
Not limited to stroke
What test did Jafari et al. (2017) use in their study?
The Musical Emotional Bursts (MEB) Test
was used to assess basic emotions in music
(happiness, sadness, and fear) and neutrality
What were the results of the Jafari et al. (2017) study?
̶ MEB total scores were significantly lower in the stroke groups than in the NC group (p < 0.001).
̶ The RBD group showed lower scores than the LBD group in recognizing sadness (p = 0.047) and neutrality (p = 0.015).
̶ In support of the “valence hypothesis” of right hemisphere dominance in processing negative emotions
What was the conclusion of the Jafari et al. (2017) study?
Conclusion: The stroke affecting the auditory cerebrum can cause acquired amusia with greater severity in RBD than in LBD.
Define TBI
̶ TBI is a disturbance of brain function caused by a bump, blow, or jolt to the head, penetrating head injury, or
explosive blast.
̶ The Glasgow Coma Scale (GCS) is commonly used to classify TBI severity.
Glasgow Come Scale
What are the 2 types of TBI?
contusion
concussion
What is contusion TBI?
‒ When the brain collides with the skull due to direct trauma, leading to tissue damage and hemorrhage.
What is contussion TBI characterized by?
‒ Characterized by localized bruising or bleeding, & neurological deficits (brain structural damage).
what does a contusion TBI commonly affect?
‒ Characterized by localized bruising or bleeding, & neurological deficits (brain structural damage).
What problems are associated with a contusion TBI
‒ Impaired cognitive functions depending on the lesion site (brain functional disruption).
What is concussion TBI?
‒ Is the result of a sudden, jarring movement or blow to the head.
What does concussion TBI not involve?
‒ Does not involve visible structural brain damage or bleeding.
What is contusion TBI characterized by?
‒ It is characterized by a brain functional disruption.
What problems are associated with concussion TBI?
‒ Temporary alteration in brain function, leading to a range of symptoms, such as headache, dizziness, confusion,
memory problems, and changes in behavior or mood.
What is the prevalence of APD in TBI?
16 to 58 percent
What does prevalence of APD in TBI depend on?
Depends on parts of involvement, place of involvement, and which hemisphere of the brain is affected.
TBI APD has deficits in?
‒ SIN performance
‒ Temporal sequencing ability (e.g., DPT)
‒ Frequency pattern recognition ability (e.g., FPT)
These aren’t the only tests that can be used, but they have normative data and good psychometric properties
There are deficits in AEPs with TBI that are at different levels including:
Deficits in AEPs at different levels, including:
‒ The brainstem
‒ Auditory cortex
‒ Higher-order processing areas
Depending on place of involvement
What are the 2 types of abnormal cell masses (location?
̶ Primary brain tumors developed in the brain tissue itself.
̶ Secondary or metastatic brain tumors spread to the brain from other parts of the body.
What are the 2 BT types based on cell type?
̶ Malignant
̶ Benign
What is the incidence of BT?
Average estimate of 3.4 new cases per 100,000 individuals per year.
* Varies among different ethnic populations.
What is the clinical presentation of BT?
̶ Neurological Symptoms can be focal or general.
̶ Common presentations include:
̶ Seizures
̶ Loss of consciousness
̶ Symptoms reflecting increased pressure within the skull:
̶ Blurred vision, vomiting, headache, feeling less alert than usual, lack of energy, problems with moving or talking.
What is an acoustic neuroma?
- Acoustic neuroma/vestibular schwannoma, is usually a slow-growing tumor
that develops on the auditory-vestibular nerve
What are some common audiological signs and symptoms of acoustic neuroma?
̶ Facial numbness and weakness or loss of muscle movement
̶ Predominantly unilateral or asymmetrical hearing loss
̶ Rarely sudden hearing loss
̶ Tinnitus in the affected ear
̶ Unsteadiness or loss of balance
̶ Dizziness (vertigo)
̶ Changes in ABR (Hain, 2023)
̶ Impaired speech perception, dichotic listening
̶ Impaired sound localization
What are the main signs of acoustic neuroma that should be reported?
̶ Tinnitus in the affected ear
̶ Unsteadiness or loss of balance
̶ Dizziness (vertigo)
̶ Changes in ABR (Hain, 2023)
̶ Impaired speech perception, dichotic listening
̶ Impaired sound localization
What are the changes in ABR associated with acoustic neuroma?
- Increased IPI of waves I-III is common.
- Wave V delay (40-60%)
- Only wave I (10-20%)
- Sensitivity and specificity:
- Sensitivity: 37-91%
- Specificity: 57-97%
- 1/3 of patients with small tumors (on MRI) have normal ABR
Depending on the tumor size (acoustic neuroma), its removal can result in:
̶ Temporary or permanent hearing loss to severe to profound hearing loss.
What can help identify smaller tumours?
Stacked ABR can help identify smaller tumours
Define epilepsy
- Definition: Epileptic seizures can be classified as:
What are the 2 types of epilepsy?
̶ Generalized: Involving both brain hemispheres.
̶ Focal/partial: Arising within one hemisphere but potentially involving the other
Epilepsy patients vary in what 4 things:
̶ Age at onset
̶ Cognitive, developmental, motor, and sensory signs
̶ EEG characteristics
̶ Triggers
What are the 3 types of epilepsy with APD?
- Autosomal-Dominant Lateral Temporal Epilepsy (ADLTE):
- Temporal Lobe Epilepsy: APDs reported:
- Landau-Kleffner Syndrome (LKS)
What is Autosomal-Dominant Lateral Temporal Epilepsy (ADLTE) characterized by?
‒ Auditory auras, buzzing, ringing, humming sounds, and perception of voices.
‒ Stimulated by some environmental sounds (a ringing telephone) or speech in a few cases.
What are the deficits with temporal lobe epilepsy?
‒ Deficits in temporal processing:
‒ Temporal resolution (GIN test) and sequencing (DPT) deficits
‒ In individuals with mesial temporal sclerosis
‒ Deficits in IID (interaural intensity differences)
‒ Impaired dichotic listening & abnormal P3 latency and amplitude
‒ In the left temporal lobe epilepsy
Landau-Kleffner Syndrome (LKS) Involves the ____ and manifests as ____
temporoparietal cortices, childhood epileptic seizures.
Landau-Kleffner Syndrome (LKS) APD difficulties:
– Auditory verbal and nonverbal agnosia and language difficulties
‒ Impaired auditory working memory and attention in the chronic phase of LKS
Define MS
MS is a demyelinating disease characterized by:
* Chronic damage to the CNS
* Episodes of neurological dysfunction in different brain areas over time.
What is APD like in MS?
- Deficits primarily at the brainstem level:
‒ Impaired localization
‒ Reduced MLD (Masking Level Difference)
‒ Abnormal ABR and MLR results
‒ Reduced temporal resolution (e.g., GIN test)
‒ Impaired temporal ordering (e.g., DPT)
What is impaired in progressive MS?
- Impaired DL:
‒ In progressive MS due to the corpus callosum (CC) atrophy (isthmus(6)/splenium(7) involvement
People with MS have difficulties with all types of ____ tests
auditory fusion (MLD)
Where might the place of involvement for MS be?
The place of involvement might be in upper levels (like the CC)
If you see difficulties in dichotic test with MS, place of involvement = ____
corpus callosum
If you see difficulties in MLD with MS, place of involvement = ____
brainstem
If you see difficulties in MLD AND dichotic test with MS, place of involvement = ____
both CC and brainstem
What are other causes of APD?
- Long-term noise exposure can affect various levels of the auditory pathway (shipyard workers, in pilots)
- Solvent Exposure
̶ APD at the brainstem and midbrain levels - Infections
̶ E.g., bacterial meningitis: impaired auditory figure-ground skills, and localization - Neurodegenerative diseases
̶ Alzheimer’s disease and Parkinson’s disease: Deficits in speech processing
What are 3 ways to manage neurological disorders?
- Regular assessments to guide appropriate management:
- The use of FM systems/remote microphones
- Customized auditory training programs (deficit-specific)
Why are regular Ax important with the mgmt of neurological disorders?
̶ Because of the likely disease progression
̶ Patients may not spontaneously share information about their auditory difficulties.
SSNHL is a ____ emergency
medical
Define SSNHL
Is defined as a drop in hearing, 30 dB or greater SNHL, over at least three contiguous audiometric frequencies
within 72 hours.
SSNHL typically affects ____
only 1 ear
What is the peak incidence of SSNHL?
̶ The peak incidence between the fifth and sixth decades
Who does SSNHL affect?
̶ Equal incidence in men and women
SSNHL affects ____ to ____ per 100,000 people annually
5-27
What are the causes of SSNHL?
- 90% of cases are idiopathic.
̶ Idiopathic causes are mostly reversible (spontaneously or with medication) - It can result from a variety of identifiable causes, e.g.:
̶ SSNHL due to identifiable causes may be unreversible.
̶ Infections
̶ Head trauma
̶ Cochlear trauma with tearing or rupture of delicate inner ear membranes (Reissner’s membrane), an
explanation for a “pop” sound before hearing loss in some cases.
̶ Autoimmune diseases
̶ Exposure to certain drugs that treat cancer or severe infections
̶ Vascular etiology (a sudden issue in the blood supply to the cochlea)
̶ Disorders of the inner ear, such as Ménière’s disease (fluctuating HL)
̶ Neurological disorders, such as multiple sclerosis (MS)
- Necessity and options for treating idiopathic SSNHL are ____.
controversial
SSNHL Spontaneous recovery in ____ to ____ of cases.
45-65%
With SSNHL what impacts a lower prognosis for hearing recovery?
̶ The severity of hearing loss (greater hearing loss)
̶ With tinnitus
̶ Higher ages
̶ Presence of vertigo or imbalance
̶ Shape of the audiogram
SSNHL - Higher rates of recovery for ____
compared with ____
low-frequency or mid-frequency hearing losses, flat or down-sloping hearing losses
What is the treatment for idiopathic SSNHL?
̶ Corticosteroids
̶ Steroids can reduce inflammation, decrease swelling, and help the body fight illness.
What is the does of steroids for SSNHL?
Dose: Prednisone, 1 mg/kg/d, to a maximum of 60 mg, for 10 to 14 days (Kuhn et al. 2011).
What are the types of steroids for SSNHL?
- Using pills
- Or intratympanic injection into the middle ear in the ENT office.
̶ For those who cannot take oral steroids
̶ Or to avoid steroids’ side effects- Increased appetite leading to weight gain, acne, rapid mood changes, thin skin that bruises easily, and muscle weakness
Steroids should be used ____ for the best effect
ASAP
What is normal cognitive aging?
includes brain structural/ functional changes that are non-pathological, within
normative age limits
What is mild cognitive impairment (MCI)?
a syndrome characterized by cognitive decline greater than age-, sex, and education level-matched limits, but not notably interfering with daily activities
What is the prevalence of MCI?
The prevalence of MCI ranges between 3-19% over 65yr
What are the 2 subtypes of MCI?
amnestic (aMCI) and non-amnestic MCI
What is the primary distinction between aMCI and MCI?
the area of episodic memory, the ability to learn and retain new information
Amnestic refers to if it is associated with memory
Roughly ____% of MCI cases progress to developing dementia within ____ of diagnosis
60, 5yr
What is subjective cognitive decline?
(when an individual starts to feel the cognitive decline. We may tell them that their assessments are WNL, but they may still be concerned regarding their cognitive abilities)
If you are able to delay the ability of cognitive decline through cognitive training, this is called ____
“healthy aging”
What is dementia?
Dementia is a progressive neurodegenerative disorder characterized by cognitive impairment, neuropsychiatric
symptoms, sensory and physical disabilities, dependency, caregiver burden, substantial health care expenditures, and
premature death
Alzheimer’s disease (AD) dementia accounts for ____ of cases
60–80%
What are the subtypes of AD?
Familial (5-10%) & sporadic (90-95%) over 65yr
What are the neuropathological hallmarks of AD?
− Brain atrophy: Progressive neuronal and synaptic
loss in the limbic system, neocortical regions, and
the basal forebrain.
− Extracellular deposition of amyloid-beta (Aβ)
peptide
− Intracellular deposition of neurofibrillary tangles
(NFTs)
− Microgliosis and astrogliosis: an abnormal
increase in the number of activated microglia and
astrocytes at the site of neurodegeneration.
Why is there a gender disparity in dementia statistics?
The reasons for this disparity are multifaceted and involve biological, social, and demographic factors
What 8 reasons explain the gender disparity in dementia statistics?
− Longer Life Expectancy: Women generally live longer than men, and age is the most significant risk factor for
dementia. R36503
− Hormonal Differences: The decline in estrogen levels during menopause.
− Genetic Susceptibility: Higher risk of the APOE ε4 allele, a genetic risk factor for AD, in women.
− Gender Differences in Brain Structure and Function: Women may have distinct brain aging patterns.
− Diagnosis Bias: Women are more likely to look for assessment and diagnosis.
− Social and Lifestyle Factors: Historically, women in many societies have had less access to education and
cognitive engagement opportunities.
− Higher risk of Stroke and Cardiovascular in Women: e.g.: due to anemia, early menopause, and inactivity.
− Caregiving Burden: Caregiving roles may increase stress and reduce opportunities for cognitive and physical self-care.
____ precede the cognitive symptoms of AD by several years and can increase the risk of the disease
Sensory impairments
The prevalence of sensory impairments in dementia is higher than those who are ____
cognitively intact
What types of sensory impairments occur in older adults with AD?
− Olfactory Impairment
− Vision impairments
− Age-related hearing Loss (ARHL/presbycusis)
____ is a strong indicator of early dementia
olfactory impairment
Explain age related hearing loss (ARHL) as it preceded cognitive symptoms of AD?
- ARHL/presbycusis is a mild to moderate progressive
bilateral sensory-neural hearing loss (SNHL). - It has a prevalence of 50-75% at the age 70yr or
older - Its prevalence increases from 5–10% at age 40 to
about 80–90% at age 85 - ARHL is characterized by difficulty in speech
perception in adverse listening conditions such as
reverberant and noisy environments
Central vs. Peripheral HL and AD
- Central HL or APD is characterized by more difficulty understanding SIN that is not explained
by cochlear (peripheral) HL and may not improve with hearing amplification - Central HL is less frequent than peripheral HL.
- Thus, it may not have a noticeable contribution to dementia risk
Explain ARHL and dementia
- ARHL precedes the cognitive symptoms of dementia by several years (5-10yr) and can increase the risk of the disease
- The prevalence of ARHL in patients with dementia
is higher than those who are cognitively intact - For every 10 dB increase in ARHL over 25 dB, there
is a 20% increased risk of developing dementia - typically this is associated with more severe levels of HL
ARHL accounts for up to ____ of global dementia cases
9.1%
Why is the ARHL a significant contributor to
AD?
- The onset of ARHL may trigger a need for
increased cognitive resources during speech
comprehension, which can lead to auditory and cognitive-related cortical reorganization - This process leads to the reduction of
cognitive resources available for other cognitive functions and subsequently to the
decline of cognitive reserve
Explain using up your cognitive resources with ARHL and how that can lead to AD
- When you are struggling for information processing, you are using your cognitive resources more than you should be (this drains that part of the brain from cognitive resources)
- What should be used for challenging things is being used for simple tasks (maladaptive neuroplasticity)
- This isn’t just for ARHL; when you put any stress on the brain to process information this can happen
What are the 2 hypothesis underlying the Link between ARHL and AD?
sensory hypothesis
common cause hypothesis
Explain modifiable risk factors for dementia
____ Is Linked to Cognitive Decline and AD
Chronic Tinnitus
Why is tinnitus linked to cognitive decline and AD?
It is likely resulting from:
* Large-scale brain plasticity (pathological
plasticity) in various cortical and limbic
brain regions.
* Which is associated with behavioral
changes, such as:
̶ Frustration
̶ Inability to relax
̶ Difficulty in concentration
̶ Impaired executive control of attention
and working memory
____ can Prevent/Decrease the Risk for cognitive Decline
Hearing Aids
According to cohort studies, long-term hearing aid usage can lead to what 6 things:
− Auditory plasticity
− Improved cortical auditory evoked potentials (CAEPs)
− Improved working memory function
− Enhanced overall cognitive performance
− Improved mental health and quality of life
− Reduction self-perceived hearing handicap
Clinical effectiveness of CI in ARHL:
− Speech understanding
− Cognition
− Working memory and sustained attention
− Improved mental health and quality of life
Addressing modifiable risk factors of dementia
