CSDS 131 - Final Exam

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What are the different methods for presenting speech material to the client and their advantages/disadvantages?

- CD
- Digital speech
- Monitored Live Voice with Volume Units (VU) meter (young children and elderly adults)
i. a and b give consistency
ii. c gives flexibility; preferred by Audiogists
iii. b and c allow control of presentation speed
iv. Recorded speech

What are the different methods that clients can respond during speech audiometry and their advantages/disadvantages?

Verbal response: risk misinterpretation by listener, poor, but helps with rapport and less time consuming; most common method used
Written: eliminates listening errors, but may be illegible, poor spelling, more time consuming
Identify pictures: Limited to

Part of the reason speech audiometry is performed is due to limitations of pure tone audiometry. Be familiar with those limitations.

Verbal response: risk misinterpretation by listener, poor, but helps with rapport and less time consuming; most common method used
Written: eliminates listening errors, but may be illegible, poor spelling, more time consuming
Identify pictures: Limited to

Define monaural, binaural and spondee.

- Monaural = one ear
- Binaural = both ears simultaneously
- Spondee = two syllable word with equal stress and effort on both syllables
i. E.g., hot dog, baseball, cupcake, airplane

Differentiate among speech awareness thresholds and speech recognition threshold testing. Know key points for each test.

- Speech Detection Threshold (SDT) aka Speech Awareness Threshold (SAT)
i. SDT is preferred terminology
- Speech Recognition Threshold (SRT)
i. more common test
ii. Lowest level in dB at which a subject can barely understand speech with a 50% criteria
iii

Be familiar with the relationship of SRT/ SAT/ PTA

- SDT should be lower dB value than SRT on same person
- Egan (1948) showed difference of SRT and SDT should not be more than 12 dB
- Chaiklin (1959) study suggests SDT between 6 to 10 dB better than SRT
- Relatively flat audiogram SRT and PTA within 10 d

What is the clinical value of SRT?

- Useful as a comparative measure with puretone results to signal test validity
- May be used in counseling patients in regard to the degree of hearing loss
- Use of BC SRT may provide information not able to be obtained with puretone thresholds
- Compari

Define MCL, UCL and know how to calculate the dynamic range of speech. What is the most common use of this information?

- MCL = Most Comfortable Loudness Level
i. Level at which listening to speech is comfortable; not too loud nor too soft
ii. Typically 40-55 dB above threshold for those with normal hearing (so 40 to 55 dB SL)
iii. Should be done with continuous discourse

Explain word recognition testing (aka speech discrimination scores). What valuable information is gathered by this test?

- Formerly speech discrimination testing
- AKA speech recognition testing
- Def: tests performed to determine an individual's understanding of speech stimuli that are presented at hearing levels above threshold
- Establish a word recognition score
- Monos

What is the purpose of the different intensity levels used for word recognition testing? What information is gathered at these various intensity levels? What level is considered to be conversation speech?

- If done at one level, don't know if we've found the client's maximum performance (unless it's 100%). Recommend two levels.
- 5 to 10 dB above patient's MCL provides an approximation of maximum performance
- Second level at 90 dB HL, used to reveal a pos

Know the chart of WRT scores (%) from the Martin reference.

90 to 100 Normal limits
75 to 90 Slight difficulty, comparable to listening over a telephone
60 to 75 Moderate difficulty
50 to 60 Poor recognition; marked difficulty in following conversation
Below 50 Very poor recognition: probably unable to follow runn

Differentiate among closed- versus open-set tests for speech audiometry.

- Nonsense syllables, digits, monosyllabic words, sentences
- Closed format - show list or pictures for young children or limited speech production
- Open format - don't show list or tell them about categories (no idea) - used for adults
- Increase number

What is signal-to-noise ratio? Can you calculate if given the needed information?

- Signal-to-noise ratio (SNR) is just the difference in intensity between the signal and the noise
- Speech at 50 dB HL and noise at 40 dB HL, then SNR is +10 dB
- Speech at 45 dB HL and noise at 45 dB HL, what is the SNR? 0 dB
- Speech at 45 dB HL and no

Can you name the various objective audiological tests we've covered and a brief description of what the test measures?

...

What is evoked otoacoustic emissions? What information is gathered when a response is present or absent? What inner ear structure is it believed to be measuring? What finding would be expected with a conductive or a sensorineural hearing loss? How about a

- Measures response of the OHC of the cochlea in response to auditory stimuli
- Should be present in normal hearing population
- Not present in those with moderate or greater degree of hearing loss
- Yet, need clear OE and ME pathway
- Does not tell us ab

What does a REFER or PASS suggest with EOAE? What if test findings coupled with immittance audiometry?

- Absent vs Present?
i. Analyzing each frequency (>6dB)
- Pass vs Refer?
i. Pass rules out serious degrees of hearing loss
ii. Refer indicates risk for hearing loss that could affect communication

What is ABR? What information can be gathered? Purpose for the use of the test.

What is it?
i. Client relaxed or asleep
ii. 3-4 electrodes placed after cleaning area
iii. Low impedance values
iv. Headphones or inserts
v. Present clicks (HF stimuli)
vi. Select number of sweeps
vii. Select rate of clicks
viii. Select intensity
ix. Very

Define minimal response levels - Pediatric?

- May be just the lowest level which a behavioral response to sound is exhibited, and not truly "threshold"
- Birth to 4 months, measures "responsiveness"
- Beyond 4 - 6 months, behavioral response to speech similar to adult levels; FM tones may stay elev

Describe how infant's general response to auditory stimuli changes during the first two years. - pediatric audiology chart birth - 2 ages

- Show a preference for their native language
- Initial response to sound include eye widening, smiling, crying, or change in breathing pattern
- Will startle to sounds
- As young as 4 months infants can discriminate their mother's voice from a stranger
-

Be able to describe BOA, VRA, and CPA. Know the appropriate age ranges

BOA - Behavioral Observation Audiometry
i. Diagnostic procedure
ii. May use two testers for judgement
iii. Sound presented from side or back, observe child's behavioral changes
iv. Eye blinking, change in sucking activity, startle response, orienting beha

In general, be familiar with how localization develops.

- Begins at 6 to 8 months of age
- Hearing in both ears need to be similar
- Initially, eye/head movement horizontally
- Then vertically
- Then on an arc
- Then in a direct line
- 8 months no localization means????

Explain the following disorders:

Microtia
i. Abnormally small pinna; often seen in atresia
ii. Congenital, outer ear
iii. HL
iv. Plastic surgery, plastic auricles
Anotia
i. Absent pinna
ii. Congenital, outer ear
iii. HL
iv. Plastic surgery, plastic auricles
Atresia
i. Absence of the norm

Explain how otitis media develops.

- Often caused by faulty Eustachian Tube function
- Pressure equalization prevented
- Negative pressure develops
- Fluid from membranous lining of ME is pulled into the ME cavity or infection may travel from opening of ET
- Fluid accumulates and may becom

What are common causes of congenital SNHL

- Hereditary
- Syndrome
- Anoxia
- Bacterial Meningitis
- German measles (Rubella)
- Mumps
- Syphilis
- Cytomegalovirus (CMV)
- Zika virus
i. All more of an impact during first trimester

Identify the inner ear disorders:

Noise-induced hearing loss
i. Typically occurs gradually
ii. Progressive
iii. Initially Impacts basal portion (HF)
iv. Noise Notch = greatest HL found at 3 to 6K Hz, often recovery at 8K Hz
v. More common in men than women
1. Temporary Threshold Shift
2.

Be familiar with Semicircular Canal Dehiscence Syndrome.

- AKA superior canal dehiscence syndrome
- Superior semicircular canal most often affected than posterior
- Symptoms: dizziness, vertigo, disequilibrium
- May report "echo" sensation when talking (known as autophony)
- Caused by thinning or weakening of t

What is auditory neuropathy and audiometric findings on pure tones, ABR and OAE tests?

- Condition where patient displays auditory characteristics that support normal OHC function and abnormal (dys-synchronous) responses from the VIII CN and brainstem
- Site of dysfunction may be with synapse of IHC and auditory nerve, and/or auditory nerve

Give a brief explanation of APD. What are the characteristics of an APD? - slide 10 common patterns

- What we do with our hearing
- Characteristics/Difficulties in one or more skill areas:
i. Sound localization
ii. Auditory discrimination
iii. Auditory pattern recognition
iv. Auditory performance in competing acoustic signals
v. Auditory performance wit

What is meant by the plasticity of the central auditory system?

- Refers to the central auditory systems ability to adapt to internal and external events
- Compared to adults, children have more rapid and more pronounced recovery because able to reorganize
- Lack of auditory input causes abnormalities in the shape, si

What are the candidacy requirements for testing for APD?

- Normal hearing sensitivity
- Minimum of 7 years of age
- Near-normal to normal IQ
- No greater than a moderate language impairment
- Sufficient attention abilities to perform the assessment tasks

Briefly explain the four areas that are evaluated as part of an auditory processing battery of tests.

Temporal Processing
i. Taps the listener's ability to correctly perceive order or sequence of auditory stimuli
ii. Often tones of varying frequency or duration
iii. If perform poorly, may miss suprasegmental/prosody cues
iv. Rx. Language therapy
Dichotic

Define aural rehabilitation and specify the six areas that comprise it

Treatment to improve communication ability of those with hearing loss acquired after the development of spoken language
Aural Habilitation is therapy provided when HL is acquired prior to the development of language
Infants, children, teenagers, young adu

What are the main components of a hearing aid?

- Microphone = Picks up the auditory signal and converts it into electrical signal
- Amplifier = increases the intensity
- Receiver = Converts it back to acoustic signal and sends it to the listener
- Supply Source = Provides the power
- MARS

What four factors need to be considered when selecting a hearing aid?

- Styles
- Features
- Warranties
- Bilateral versus unilateral

General information on styles of hearing aids

- Body hearing aid
- Behind-the-ear
- In-the-ear (half shell, low profile, in-the-canal, completely in-the-canal)
- Bone conduction hearing aid
- In general, the larger the HA the better fit for more severe hearing losses
- Today's styles are all digital

Explain the benefits of binaural amplification.

- Binaural summation = sound fuses together at brainstem resulting in 3 dB increase in gain
- Binaural squelch = brainstem more able to separate speech from background noise
- Localization = ability to locate a sound's source
- Head-shadow effect = attenu

Describe the criteria for cochlear implantation for adults and children.

- Bilateral, sensorineural hearing loss
- Children (12 to 24 months): profound
- Other children and adults: severe to profound
- Limited benefit from amplification
- Minimum 12 months of age
- No medical contraindications
- Appropriate expectations

Tell the purpose of hearing assistive technology.

Help overcome problems with:
i. Noise
ii. Distance
iii. Reverberation

Know the components that comprise speechreading.

More than lipreading......
i. Facial expressions
ii. Gestures
iii. Body language
iv. Context/Topic
v. Situation
vi. Speaker(s)

Describe the areas addressed when providing auditory training.

- Awareness
- Discrimination
- Identification
- Comprehension
- Analytic versus Synthetic
-Formal versus Informal
- Adjusting difficulty level

Be familiar with communication strategies

- Repair
- Elaborate
- Key word
- Rephrase

What topics may be covered in the educational component of aural rehabilitation

- Effect and impact of HL socially, educationally, vocationally, recreationally
- Amplification/Cochlear Implants
- Communication strategies
- Assistive Listening Devices
- Deafness and Deaf Culture
- Educational Options
- APD
- Hearing Conservation