aural rehabilitation
professional efforts designed to help a person with hearing loss
- aimed at minimizing and alleviating the communication difficulties associated with hearing loss
goals of aural rehabilitation
- get adequate expressive and receptive communication
- enhance activities and participation to improve quality of life
- overcome the interpersonal, psychosocial educational and vocational difficulties resulting from hearing loss
- involve family, signif
red O's
right ear
blue X's
left ear
3 acoustic challenges
- distance
- noise
- reverberation
consequences of untreated hearing loss
in addition to sensory-perceptual deficit
- parental and societal reactions
- linguistic and cognitive deficit
- educational deficit
- vocational limitations
- social deficit
- emotional deficit
the two forms of visual communication:
- visual characteristics of oral communication
- manual communication
speechreading
the process of identifying articulator gestures and other visual cues to aid in speech understanding
- facial expressions
- hand gestures
- body language
amplification
makes sounds louder so that they are audible for someone with hearing loss
types of transmission
- air conduction
- bone conduction
- electrical stimulation
what happens with hearing loss
-loss of audibility
- loss of intelligibility
hearing aids
amplify auditory signals to make sounds audible
- may provide more intensity for signals of different frequency
programming in hearing aids include:
- directionality
- compression
- noise reduction
- frequency lowering
- connectivity
prescriptive fitting
- fitting for a hearing aid is an algorithm that makes the decisions about how the hearing aid processes sound
- includes compression, noise reduction, directionality etc
noise reduction
this may not make speech more intelligible but it may make noisy situations easier to tolerate
omnidirectional
hearing aids that have a microphone that picks up sounds from all the directions
directional
hearing aids that have microphones that only pick up sounds from in front of the person
purpose of electroacoustic measurements
- quality control --> manufacturer specifications
- appropriate functioning
specific electroacoustic measures
- hearing aid gain by frequency
- maximum power output (MPO)
- noise/distortion
who is a candidate for amplification
someone with:
- measurable hearing loss
- speech perception difficulty
- real-life communication difficulties
- desire/ the motivation to receive amplification
evaluation prior to HA selection
first, you have to:
- find pure tone air and bone conduction threshold measurements
- loudness discomfort levels
- self-assessments
real-ear measurements
this is when the patient is seated near a loudspeaker with a probe microphone and hearing aid turned on and placed in the ear
- the output is measured and observed on the screen
functional gain measures
- compares unaided and aided thresholds
- completed in the soundfield
external parts of a CI
- microphone
- speech processor
- transmitting coil
internal parts of a CI
- receiver
- electrode array
CI's are coded by:
- frequency (this is at the site of stimulation)
- amplitude (encoded by the current level)
- temporal ( rate and pattern of stimulation)
factors that affect performance with CI
- etiology of hearing loss
- age of onset
- duration of deafness
- residual hearing
intial stimulation / hook up of CI
- individual fit with external equipment
- telemetry -checking the integrity of the internal device
- creating the map programming
- informal assessment of child's initial responses to sound
- counseling
T- level
threshold level for mapping of audible sounds using CI
C level
comfort level of electric stimulation in those with CI
assistive listening device
hearing technology that contains a microphone for others to use and a receiver built into a persons HA or Ci
FM system
this employs frequency modulated radio waves to transmit a signal from the person speaking to the listener
- microphone
- transmitter
- receiver
alerting device
sounds are converted into visual or vibratory stimuli so they can benefit the deaf or hearing-impaired individual
- door bell
- smoke alarm
-alarms
- baby cry
how to learn more about your adult patient
ask them about
- their hearing loss
- their auditory processing capability
- physical and mental health
- personal factors
- environmental factors
- economic status
presbycusis
a type of hearing loss usually brought on by old age
- SNHL
- deterioration of high frequency audibility
- implies that deficits may not exist only in pure tone thresholds
but in auditory perception as well
aging and hearing
- dual sensory impairments in hearing and vision
- dementia
- comorbidities (physical ailments, diseases that affect the brain, cardiovascular, medications with adverse side effects)
stages of adjustment
- shock/disbelief
- anger and guilt
- depression
- acceptance
AR counseling
- providing information to the client
- receiving information from the client
- allowing the client TO SET GOALS FOR THEMSELVES
- counseling should always be interactive
aural rehab groups offer:
- review of hearing loss, hearing aids, ALDs and communication problems
- training in good communication strategies and speech readings
- support
tinnitus
the perception of sound when no actual external noise is present
- may be perceived as unilateral or bilateral
- originating in the ears and around the head
- buzzing whistling ringing
- first or only symptom of a disease
primary tinnitus
- tinnitus that is idiopathic (no known cause) and may or may not be associated with Sensorineural hearing loss
secondary tinnitus
tinnitus that is associated with a specific underlying cause (other than SNHL)
objective tinnitus
head/ear noises that can be heard by another person
- this might be caused by vascular abnormalities, TMJ, repetitive muscle contractions
- SUPER RARE (less than 5% of tinnitus cases)
- pulsations on tympanometry
subjective tinnitus
tinnitus for which the cause may occur anywhere from the ear to the brain
- much less well understood
- hearing loss and balance problems may or may not be present in conjunction with subjective tinnitus
- some have it constantly, others have it about 5 m
evaluation of a person with tinnitus
team approach
- medical evaluation by an ENT
- mental health evaluation by a psychologist
- audiological evaluation by audiologist
tinnitus rehabilitation
the goal is often to change the persons response to the tinnitus --> we cannot change the tinnitus itself
how many children are born with a HL
3 / 1000
how many children under the age 3 are identified each year
16,000 - 18,000
early hearing detection and intervention (EHDI)
refers to the practice of screenign every newborn for hearing loss
- reffering appropriately
- providing intervention as needed
all within a relatively short timeframe
1,3,6 PLAN
EDHI'S NATIONAL GOALS
- screening by
1 month
- diagnosis by
3 months
- intervention by
6 months
early intervention
a system of coordinated services that promotes the childs age appropriate growth and development and supports families during the critical early years
CT B23
this system strengthens the capacity of CT families to meet the developmental and health-related needs of their infants and toddlers who have delays or disabilities
CT B23 are based on the following practices
1) natural learning envrionment practices
2) coaching as a style of interaction with families and team members
3) primary service provider approach to teaming
Individual family service plan (IFSP)
this is a formal document for early intervention that states the goals of the rehabilitation
- guides interventions
- identifies specific services
- who will pay for services
- records progress
role of audiologist in early intervention
- complete diagnostic evaluation and make recommendations for treatment
- write up comprehensive report
- refer for EI services
- participated in ER
otoscopy
visually inspect the outer ear, ear canal and tympanic membrane
- verify presence or lack of drainage, foreign objects, cerumen or other things
reflexive responses to sound
- startle
- limb jerks
- eye blinks
attentive responses to sound
- quieting or increased activity
- change in breaking rate
- onset or cessation of vocalizations
- onset or cessation of crying
- eye widening, brow forrowing or expectant look
- smiling
- head turning
pediatric behavioral assessments
- behavioral observation (BOA)
- visual reinforcement (VRA)
- tangible reinforcement operant conditioning (TROCA)
- conditioned play (CPA)
- speech perception (SRT / SAT)
- word recognition
the goals of child audiological assessment
- to get ear specific information
- to get frequency specific information (minimum of 500 & 2000 hz)
- degree information
early interventionist as a
information resource
- adapt to the learning needs of individual families
- provide information in an objective manner to different families
- share information gathering responsiblities
- provide information to guide in decision making process
- pace the information sharing
early interventionist as
coach/partner
they shift the parent away from expert-driven to learner-driven
- they are in the driver's seat
- being observant, offering advice
early interventionist as
joint discoverer
any question can be addressed as an experiment
- pose a question rather than giving an answer
-let the parent have the success
early interventionist as
news commentator
- provide objective, descriptive feedback about key behaviors
- tell them what they're doing right, help build confidence
early interventionist as
partner in play
the clinician demonstrates new skills for parents and then shift s the role to the parents to try
early interventionist as
joint reflector and planner
helps parents by
- listing key observations
- highlighting successes
- planning for the remainder of the week and next sessions
- ask collaborative questions
educational audiologist
Provide hearing screenings
Make recommendations
Classroom acoustics
FM or assistive technology
Monitor equipment status
Personal & school equipment
In-services
Classroom observations
SLP in education
they evaluate and manage childs language
- assess and monitor their performance with technology
- then they help the parents and school make the choice of who provides service and what is needed
educational consequences of hearing loss
- children learn language through the auditory system (unless signers)
- if the auditory input is distorted or inconsistent due to Hearing loss the child can experience
- reduced vocab, delayed syntax, inappropriate use of morph. markers
hearing loss and learning
- most academic success depends on a competent use of language, defecits in a childs language development can have a direct effect on cognitive development
- no relationship between degree of loss and educational performance (
even a mild loss puts a chil
individualized education program
TWO PURPOSES
- establish measurable annual goals for the child
- state the special education and related services and supplementary aids and services that the public agency will provide to, or on behalf of, the child
placement options for school-aged children
- mainstream
- private schools
- schools for the deaf
what are the most frequently used services in mainstream schools:
1) SLP services (75%)
2) FM systems (65%)
3) Deaf education services (54%)
reverberation time
this is defined at the length of time required for sound to decay 60 dB from its initial level
what is the ideal reverberation time in classrooms
0.4 - 0.6 seconds
but many classrooms exceed this goal and have times of 1 second or more
SNR importance
- adults need a +6 SNR
- children need MUCH HIGHER THAN THIS
- children with hearing loss need
15-20 dB SNR
why are we concerned about children's hearing in the classroom
- difficulty following multiple talkers
- drops in educational performance
- changes in learning pace
- increased listening effort
key components in classroom acoustics
- sound isolation (room to room, exterior noise)
- reverberation
- background noise
classroom evaluation for noise
- look at the surfaces (wall, floor, ceiling, windows)
- noise sources (both external and internal)
- Noise levels (quiet vs background, speech levels , teachers voice)