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Advanced Diagnostic Audiology > w5 - assessments > Flashcards

w5 - assessments Flashcards

1
Q

What are the 3 binaural interaction tests?

A

1) the masking level difference test (MLD)
2) the listening in spatialized noise sentences test (LiSN-S)
3) binaural fusion/interaction test

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2
Q

What are the 2 auditory discrimination tests?

A

1) phoneme discrimination tasks
2) frequency, intensity, or duration discrimination tasks or difference limen tests

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3
Q

What is the aim of binaural interaction tests?

A

to assess binaural intensity and timing perception at the brainstem level

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4
Q

binaural vs monaural processing

A

Our ability to detect and interpret intensity, frequency, and timing is going to be different processing binaural vs monaural (assessing if the lower part of the auditory brainstem is able to combine the information coming from both side and come up with a unified idea based on all of the things above)

We are testing binaural advantage

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5
Q

binaural interaction test sensitivity

A

brainstem lesions (very high sensitivity)

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6
Q

What results are we expecting with MLD?

A

an improvement in signal detection in noise when the phase of the signal or noise is reversed by 180 degrees

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7
Q

What is being assessed with MLD?

A
  • assess binaural integration under a masked condition
  • assess interaural phase relationships at the brainstem level
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8
Q

What is the MLD sensitive to?

A

brainstem lesions

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9
Q

What are the 2 binaural stimulus presentations in MLD?

A

1) signal (nonverbal or verbal)
- a LF tone (250-500 Hz); better option
- or spondaic words (stairway, oatmeal)
2) noise
- the corresponding narrow band noise with the tone (for LF)
- or speech spectrum noise (for spondaic)

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10
Q

With MLD, are there better results with the nonverbal signal or the verbal signal?

A
  • better results with nonverbal tasks (LF) than verbal tasks (spondaic)
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11
Q

What is the task of the MLD test (what is the audiologist doing)?

A

thresholding the signal with 2 dB steps, while the test begins at 60/65 dBHL

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12
Q

What are the 3 MLD test conditions?

A

1) S0N0: signal and noise are presented in phase (homophasic)
2) SπN0: signal is out of phase and noise is in phase (antiphasic)
3) S0Nπ: signal is in phase and noise is out of phase (antiphasic)

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13
Q

In an antiphasic condition, the signal and noise are ____ degrees out of phase

A

180

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14
Q

When signal is out of phase, results are ____ than when noise is out of phase

A

better

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15
Q

MLD test instructions

A

you will now hear a tone and noise through the headphones. you should only focus on the tones and press the respond button whenever it is audible.

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16
Q

Explain the 4 steps of the MLD test

A

1) obtain masked hearing threshold for the tone in the S0N0 condition
2) obtain masked hearing threshold for the tone in the SπN0 condition
3) MLD = P1 - P2
4) expectation: improvement in SπN0 vs S0N0 if the brainstem is functioning normally

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17
Q

For the MLD test, when the brainstem is working normally, the person is able to identify the signal at ____ frequencies

A

lower

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18
Q

Where can you access the MLD test?

A

1) some audiometers such as interacoustics AC40 audiometer
2) CD or USC format through auditec

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19
Q

MLD test example and interpretation

A

Example
- in S0N0 the masked hearing threshold for a tone = 60 dB
- in SπN0 the masked hearing threshold for tone at the same noise level = 44 dB (improved signal threshold)
- MLD = P1 - P2 = 16 dB

Interpretation
- MLD is lower for spondaic words (4-10 dB)
- normal MLD with tone is around 12 dB
- MLD with tone < 7 dB suggests a problem with the brainstem and binaural interaction
- this case is suspected of APD

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20
Q

MLD is NOT recommended in ____

A

peripheral hearing loss

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21
Q

What is the aim of the LiSN-S test?

A

to identify a specific subtype of APD, spatial processing disorders, or to assess auditory stream segregation skills (those who have difficulty with binaural advantage)

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22
Q

What is the structure of LiSN-?

A

using the software under headphones, the person experiences a three dimensional auditory environment

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23
Q

What is the 2 stimuli in the LiSN-S?

A
  • target sentences (TS)
  • competing sentences (CS)
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24
Q

Simply, what does the LiSN-S consits of?

A

4 binaural conditions created by presenting TS and CS with:
- the same or different speakers
- the same or different phase/direction of presentation

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25
Q

What is the age for the LiSN-S?

A

6-11 years

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26
Q

what is the LiSN-S test sensitive to?

A

low brainstem lesions

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27
Q

What are the 4 LiSN-S test conditions?

A

1) Same voice, same direction (very difficult; low cue SRT)
2) same voice, different directions (spatial advantage)
3) different voices, same direction (talker advantage)
4) different voices, different directions (easiest; total advantage)

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28
Q

Which LiSN-S test conditions have improved SRT due to release from masking?

A

phases 2, 3, 4 (3 conditions lead to binaural advantage)

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29
Q

Which phase has the highest binaural advantage?

A

phase 4

30
Q

Overall, the LiSN-S uses ____ difficult test condition and ____ advantage test conditions

A

1, 2-4

31
Q

LiSN-S - ____ always come from the ____

A

TS, front

32
Q

LiSN-S - ____ always come from ____ or ____

A

CS, front (1, 3), sides (2, 4)

33
Q

How is the LiSN-S scored and interpreted?

A
  • the percentage of correctly identified TSs
  • the results are compared with age-appropriate normative data
34
Q

What framework is the LiSN-S in support of?

A
  • This study is in support of the auditory driven framework
  • If you are equipped with sensitive, reliable, and valid tests for APD, we might be able to differentiate between AP and other generalized disorders
35
Q

Children with APD have deficits in ____ or using ____

A
  • spatial stream segregation (SSS)
  • release from masking
36
Q

What is SSS?

A

a brain mechanism uses the spatial distribution of sound sources to suppress unwanted signals

37
Q

What is the aim of the binaural fusion/interaction test (BFIT)?

A

to test the ability to create a unified auditory perception from auditory information presented to the 2 ears (the 2 ears receive different information dichotically, then unify it together)

38
Q

The BFIT test is presented ____

A

dichotically

39
Q

What is the age for BFIT

A

children and adults

40
Q

what is BFIT sensitive to?

A

brainstem lesions

41
Q

What is the BFIT stimuli?

A

monosyllabic or spondaic words
- speech stimuli get bandpass-filtered using:
- a LF BP filter between 420-570 Hz
- a HF BP filter between 1950-2100 Hz
- HP and LP stimuli are dichotically presented to:
- 1) the LE (LP) and RE (HP)
- 2) the LE (HP) and RE (LP)

42
Q

How does the brainstem handle the BFIT?

A

These different frequencies get combined at the lower brainstem and come up with a final idea of what has been said (one ear gets LF BPF and the other gets HF BPF)

43
Q

How is the BFIT scored and interpreted?

A
  • the percentage of correctly identified words
  • it is compared with age appropriate normative data
44
Q

What is the aim of auditory and phonemic discrimination tests (PDT)

A

to test the ability to detect subtle changes in auditory stimuli

45
Q

What is the PDT stimuli?

A

verbal tasks: such as subtle changes in phonemes as phonemic disrimination tasks

nonverbal tasks: such as subtle changes in frequency, duration, or intensity, known as difference limens for frequency, duration, or intensity tests

46
Q

What is a difference limen?

A
  • Difference limen = minimum difference between two different stimuli (seeing if the person can differentiate between 1000 Hz and 1005 Hz)
  • Need a 2 channel audiometer, present 1000 Hz to the LE and 1005 Hz to the RE, ask if same or different, if they cannot identify the difference you go higher (1007, 1009, 1111), if they identify 1111 Hz as different than 1000 Hz, their threshold is 11
  • use 2-5 dB steps
47
Q

Usually get better results with ____ presentation than ____ presentation

A

descending, ascending

48
Q

What are the limitations of the PDT?

A
  • lack of commercially available tests meeting psychometric standards (we are able to complete the test, but cannot compare to norms)
  • but at least give you an idea of their discrimination
49
Q

What is the stimulus presentation for FDT?

A

monaural or dichotic

50
Q

what age is PDT for?

A

children and adults

51
Q

What is the stimuli for PDT?

A
  • list of pairs of nonsense syllables
  • with distinctive phoneme differences or similar phonems
52
Q

How is FDT scored and interpreted?

A
  • the percentage of correctly identified pairs
  • the results are compared with age appropriate normative data
53
Q

Why is the FDT difficult when presented dichotically?

A

Task is “the same or different” - when presented dichotically this is quite difficult because 1) such short stimulation, and 2) presented dichotically

54
Q

What is the bergen nonsense syllable test?

A
  • CV list
  • This is a way to help people with APD (most audiologists don’t use this)
  • Why use something like this? Looking at components of spoken language at a fundamental level, this leads to training of the auditory system (whereas FM system modifies environment), leads to brain plasticity
  • Not a device based test (that we are used to in audiology)
55
Q

What are the 2 ways to diagnose APD?

A

1) performance more than 2 SDs below the mean on 2 or more APD diagnostic tests
2) performance more than 3 SDs below the mean on 1 APD test, combined with significant functional difficulty in auditory processing, may also lead to a diagnosis of APD (not as recommended)

56
Q

Why is the second criteria of APD diagnosis not as recommended?

A

If using the 2nd criteria, we have less of an idea of what to include in a training program (if you only have 1 test BNL vs 3 tests BNL; with 3, have more info)

57
Q

What should a final APD report include (6)?

A

1) behavioural/functional difficulties (reported in everyday communication by parents/teachers)
2) audiologic, health, and medical case Hx
3) results of each APD test in the TB
- should have validity and reliability for APD Ax
- should be language appropriate and age appropriate
- should have normative values
4) findings reported by the multidisciplinary team (SLP, psych)
5) the potential impact of confounding factors in cases with poor performance, such as:
- difficulty understanding directions/instructions
- lack of motivation
- fatigue
- attention difficulties
- cognitive or language problems
6) treatment protocol

58
Q

What are 3 likely conditions that suggest the impact of confounding factors or difficulties?

A

1) inconsistency across test results (LE deficit on one dichotic speech test and RE deficit on another dichotic speech test)
2) poor performance on all test measures
3) low test-retest reliability

59
Q

Confounding factors could be suggestive of:

A

1) lack of motivation/fatigue
2) difficulties other than APD (a more global cognitive difficulty, attention deficit, and language difficulty)

if they are the case, they must be reported in the report

60
Q

What should be done after APD diagnosis?

A
  • listing the specific auditory processes affected
  • outlining appropriate management options
    • acoustic modifications to improve SNR
    • offering the use of FM systems or remote mics
    • auditory training activities (leading to brain plasticity)
61
Q

What are 3 examples of auditory training activities?

A

1) phoneme discrimination training for poor phoneme discrimination
2) temporal processing training for temporal resolution difficulties
3) dichotic listening training for binaural separation or integration difficulties

62
Q

left-hemisphere dysfunction is an ____ deficit

A

auditory decoding

63
Q

What are 4 difficulties with left-hemisphere dysfunction?

A
  • speech sound discrimination
  • SIN tasks
  • reading and spelling, specifically related to decoding phonological information
  • speech production errors by substituting similar sounding sounds
64
Q

What are 4 training activities for left-hemisphere dysfunction?

A
  • developing auditory closure tasks
  • creating speech sound discrimination and temporal processing tasks
  • enhancing the acoustic signal using ALDs, FMs, remote mics
  • the use of visual or multimodal aids
65
Q

Right hemisphere dysfunction is a ____ deficit

A

prosodic

66
Q

What are 4 difficulties with right-hemisphere dysfunction?

A
  • dichotic speech tasks
  • temporal patterning tests
  • discrimination of nonspeech sounds
  • prosodic elements of speech
67
Q

What are 2 training activities for right-hemisphere dysfunction?

A
  • nonspeech discrimination, prosody, and temporal patterning
  • improving the acoustic signal clarity
68
Q

Interhemispheric dysfunction (CC) is an ____ deficit

A

integration

69
Q

What are some difficulties with an interhemispheric deficit

A
  • dichotic speech tests
  • temporal patterning tests in the linguistic labelling condition
  • SIN tasks
  • localization tests
  • tasks requiring interhemispheric cooperation (binaural skills)
  • sound symbol association for reading and spelling
  • understanding prosodic and linguistic elements of speech
70
Q

What are some training activities for an interhemispheric dysfunction?

A
  • improving acoustic signal clarity
  • dichotic listening training
  • interhemispheric exercises
71
Q

Recommendations for the APD intervention plan should include (4):

A

1) environmental modifications
to improve SNR
2) offering personalized devices (FM, remote mic)
3) auditory training
4) compensatory strategies (visual or multimodal aids)
- last resource

72
Q

If we have tests with good sensitive and specific, maybe the ____ can be supported more

A

auditory-driven framework

Advanced Diagnostic Audiology (10 decks)

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