Interaural attenuation
the loss of intensity of a sound introduced to one ear and heard by the other
masking is required much less frequently with
insert ear phones
cross hearing is less likely to occur when insert earphones are used because the ________ is increased
interaural attenuation
during audiometry cross hearing occurs by
bone conduction
undermasking
threshold of the tone in the test ear has not been reached
plateau
there is no change in threshold or response level. -p. 140
during plateau seeking when the signal and masker are both heard in the test ear, _________ has taken place
overmasking
When masking for bone conduction, the patient's ________ must be added to the air conduction threshold of the masked ear
occlusion effect
a significant reason for using insert receivers during speech audiometry is that they
increase the interaural attenuation
calibration of effective masking for speech is typically carried out
psychoacoustically
Because tests of SRS are suprathreshold, they require masking (more/less) often than speech threshold tests
more
the three basic acoustic immitance tests are _____, _______, and __________
static acoustic compliance, tympanometry, acoustic reflexes
one dekapascal is equal to _____ Pascals
10
abnormally high static compliance suggests
flaccid tympanic membrane or interrupted ossicular chain
Type C tympanograms suggest
retracted tympanic membrane
the tympanograms of people with normal hearing may be identical to those of patients with _________- hearing loss
sensorineural
acoustic admittance
tympanometric height
2 small muscles involved in the operation of the middle ear mechanism
tensor tympani and stapedius muscle
intra- aural muscle reflex
most normal hearing individuals will demonstrate this bilaterally when pure tones are introduced to either ear at 85 to 100 dB SPL
acoustic reflex threshold ART
lowest level at which an acoustic reflex can be obtained
the cranial nerves involved with the acoustic reflex are _______- and _______________
VII and VIII
assuming normal hearing in both ears, a reflex- activating signal presented in the left ear will elicit a reflex in the right, left or both ears?
both
acoustic reflex thresholds of patients with cochlear hearing losses are expected to occur at ______ sensation levels.
low
extremely rapid acoustic reflex decay is expected of patients lesions of the
VIII cranial nerve
otoacoustic emissions may be either spontaneous or
evoked
T/F a normal TEOAE does not guarantee normal hearing, and an absent TEOAE does not tell whether the loss is conductive or sensorineural
true
a patient with a severe sensorineural hearing loss with normal otoacoustic emissions is expected to have a lesion of the
VIII Cranial nerve
latency
used to define the time period that elapses between the introduction of a stimulus and the occurence of the response
amplitude
strength or magnitude of a response
ECoG has been found to be useful during
neurosurgical procedures
a summing computer is used in ABR testing to help identify 7 small wavelets within the first _________msec of the stimulus
10
T/F the ABR is a direct test of auditory sensitivity
false
like the ABR, the ASSR is (affected or not affected) by the patient's state of consciousness
not affected
the P300 is an AEP thought to be related to the _______ of the stimuli
perception or processing
loudness recruitment is suggestive of lesion in the
cochlea
tone decay
when the level of a tone is increased, the tone may be heard again, only to disappear quickly to silence
patients with rapid tone decay often have lesions in/ on the
VIII cranial nerve
since many children do not respond at threshold during auditory tests, their responses are often called
minimum response levels
apgar is a procedure for evaluating
newborns in the hospital
theauropalpebral reflex is a ____________ of the muscles around the
contraction, eyes
the main purposes of infant hearing screenings are and .
early identification, treatment
major advantages of using OAE's for infant hearing screening is that they are ___________ and ____________
rapid, cost effective
if otoacoustic emissions are present, hearing loss is no greater than
mild
T/F a positive response to a broadband signal at essentially normal intensities indicates normal hearing
false
most BOA procedures rely on a child's ability
to localize sound
a child with hearing loss and no co- existing handicaps can often be tested using behavioral audiometric procedures before _________ years of age
three
nonverbal children may be tested using speech audiometry by having them
point to named pictures or objects
OCA works best when the reinforcement is
tangible
accurate threshold readings at only _______ and _______ can frequently give a good indication of degree and configuration of hearing loss
500 Hz, 2000 Hz
T/F when testing a child using ABR or ASSR, it is important that the child remain alert yet quiet
false
does the identification of one disorder increase or decrease the likelihood that a second disorder co- exists with the first?
increase
one intervention for children in school with APD is
enhancing signal- to- noise ratio
childhood hearing loss identification programs most frequently screen using _______ and _________
pure tone audiometry, acoustic immittance measures
an excellent means of checking the accuracy of a hearing screening program is the use of a
tetrachoric table
children who feign or exaggerate a hearing loss are said to have
erroneous hearing loss
infants under 3 months of age
-hearing loss interferes with the natural acquisition of speech and language by interrupting the imitative process
-hearing loss in infants is often undetected due to lack of parent follow up
-babbling occurs up to 6 months of age
-after 6th month childre
hearing is a _______________ event
1st order event
-a hearing loss will affect the acquisition of skills necessary to acquire spoken language, reading/ writing and other academic skills
purpose of early hearing detection and intervention
identify children with hearing loss before age of 3 months
criteria necessary for a justified screening program
-sufficient prevalence of the disorder
-evidence of early detection due to screenings
-availability of follow- up diagnostics
-treatment accssebility following diagnosis
-documented advantage of early identification
apgar test- dr. virginia apgar
evaluates newborns on a scale of 1- 10 at 1, 5, and 10 minutes after birth
-evaluated on appearance, pulse, grimace, activity, respiration
-children with low apgar scores should also be suspected of having SNHL
early detection of hearing loss may also aid in the detection of what other disorders:
SIDS-
possibly due to enzymes like biotin
may also help prevent disorders of the heart, eyes, and musculoskeletal system, as well as predisposition to infection
proper training in infant screening is necessary for identification and also counseling of parents why?
normal hearing children may refer on a screening due to not being settled down enough or interfering with the test results
-clinicians should be able to relay this information without traumatizing the parents
Joint Committee on Infant Hearing
created a high- risk registry containing list of risk factors
Universal Newborn Hearing Screenings (UNHS)
AABR
gold star of screenings
-disadvantages: lack of frequency specific information, dependence on chronological ages, and proper training/ placement of electrodes
-Automated AABR has decreased need for tester interpretation of results
neonatal OAE screening
- assumed that infants whose ears produce evoked emissions have normal peripheral hearing, or no worse than a 30 dB hearing loss
-presence of even a slight CHL eliminates measureable emissions
-only tests to the outer hair cells of the cochlea
-a lesion p
neonatal OAE screening
-auditory neuropathy/ dys- synchrony (AN/AD) is missed during OAE only screening
-does not reveal how the brain responds
patients with AN/AD have no ABR, no acoustic reflexes and normal OAE's
purpose of early identification
-provide the greatest opportunity possible for educational success
3 components to each EDHI program
-birth admission hearing screening
-follow- up diagnostic evaluations for referrals
-implementing intervention before 6 months of age
where may referrals come from
-hospital screening
-parental, cargiver, or pediatrician concerns
pre-test observations should include
-child's relationship with caregiver
-their gait
-standing positions
-general motor performance
-methods of communication
tympanometry can also be used to determine
abnormal middle ear pressure
-eustachian tube dysfunction
-presence of fluid
-ossicle mobility
-perforated TM
-patency of PE tubes
presence of OAEs and normal acoustic immittance finding rule out
middle ear pathology
anything worse than a mild hearing loss
objective testing in pediatrics
obtaining test results is over half the battle
experienced team of clinicians can test and get results before child objects
why is screening and early intervention so crucial
at 1 year of age child with hearing loss may begin to lose potential for normal spoken language development
-a child with normal hearing sensitivity is acquiring auditory information with the visual input they are receiving to increase imitative learning
when testing children
a broader frequency range will catch their attention sooner
-danger of using broad frequency range is that children with hearing loss may have normal hearing sensitivity in some frequency ranges
Behavioral Observation Audiometry BOA
-used during 6-8 months of age
-2 clinicians needed to direct/ test child
-observe head/ eye movements of child while responding to sound
Sound Field Audiometry
-child is placed in sound suite with 2 calibrated speakers
-childs responses vary from eye/ head movement to crying to change in expression
-use of BOA in sound field is advantageous due to the calibration of the sound source
Visual reinforcement audiometry (VRA)
uses sound field audiometry and visual reinforcement to get a response
-stimulus is played through one of the speakers and visual reinforcement is used to reinforce child's response
-lighted/ animated toy, picture, video, anything that gains child's inter
Sound field test stimuli
various stimuli are used
-no true consensus on what works best
-narrowband noise is often used to elicit response due to the child's frequent response levels
-it should be noted that a response to narrowband noise is not the same as a pure- tone response
Speech audiometry
-performed before pure tone audiometry in behavioral assessment
-may use spondaic words, point to picture tasks or pointing to body parts....make sure to ask the parent if the child has the vocabulary to comprehend the words
-demonstrate the behavior and
Ling 6 sound test
can provide frequency specific hearing loss info even when pure tones cannot be obtained
-/m/ /a/ /u/ and /i/ indicates useable hearing thru 1000 Hz
-audibility of sh thru 2000 Hz
-audibility of /s/ 4000 Hz
Ling 6 sound test
- how well a child responds to these phonemes may determine how well a hearing aid may meet their acoustic needs
-can also use simple questions to elicit responses during tasks
-whisper may cause 2 or 3 yr old to whisper back indicating good high frequenc
pure tone audiometry
-biggest hurdle is getting them to understand the task
-many are people pleasers and have a very, very high false positive rate for this age group
-make it fun, pulsed tones, and demonstrate the tasks
-reinforcement may be helpful in acquiring results
Operant condtiioning audiometry
-food often used as a reward and a switch may be employed as a push button response format to receive reward
-initial presentation must be well above threshold to ensure a response
-must vary the timing of the signal to prevent child from predicting inste
play audiometry
taught by demonstration of task
-needs to be positive child clinician interaction
-child must participate to obtain correct responses
-build an initial rapport with parent, especially if child is difficult to test
-having parent play first can decrease ch
Electrophysical tests
-involve use of ABR
-many children may sleep or be anesthized thru testing
-do not require behavioral responses
Language disorders
-detailed case history is essential to obtaining info that may be helpful to testing
-difficulties may arise in differentiating between the hard of hearing and language disordered child
-may co- exist or stand alone
-normal hearing sensitivity does not al
Auditory processing disorders
-difficulty in the development of language and other communication skills associated with disorders of the auditory centers of brain
-approx 2-3% of children
-twice as likely in males
-normal hearing sensitivity
-recognition/use of language not appropriat
Diagnosis of APD
-overdiagnosis is issue due to its similarities with mild autism and ADHD
-accurate diagnosis is dependent on multifaceted, comprehensive assessment
-team may include SLPs, audiologists, psychologists, medical drs and educators
Children with APD
-normal intelligence
-make social contacts with younger kids
-poor listening skills and short attention spans
-poor memories and reading comprehension
-difficulty in linguistic sequencing and learning to read and spell
_most common complaint speech recogn
Intervention of APD
objective: to improve listening skills and spoken language comprehension
-enhancement of signal to noise ratio
-preferential seating
-reducing background noise and reveerberation
-use of FM systems
auditory neuropathy in kids
-rare in children, prevalence is on rise due to recent research
-symptoms: mild to moderate SNHL, abnormal or absent ABR, absent or very elevated acoustic reflexes, normal OAE and MRI,
-amplification is usually met with mixed success
psychological disorders
congenital or acquisition of a hearing loss early in life can have effects on: social and intellectual skills, emotional development, inability to emphasize with others, rigidity, impulsivity, dependency, expression of feelings thru actions, instead of sy
developmental disabilities
includes mental disability, CP, epilepsy, autism, or a wide variety of physical or mental challenges
-many have normal to near normal intelligence
-hearing loss may go undetected due to auditory behaviors that may be attributed to the child's other handic
school screening programs
-exact number of school agers with hearing impairments is unknown
-use of properly calibrated screening equipment is essential to accurate results
-checks should be performed daily to ensure calibration
school screening programs
-children should comprehend task and clinician needs to be aware of what limits they are testing at
-screening is performed at 20 dB at 1000, 2000, 4000 Hz for both ears
-pulsed tones
-use of screening immittance meters allows for a more thorough screenin
reliability of screening measures
-sensitivity: determined by dividing the number of children with hearing loss who fail the screen by the number who actually have a hearing loss- yields percent of those correctly identified
-specificity: dividing # of kids who pass and do not have a hear
erroneous hearing loss in kids
-include kids who are malingering, misunderstanding the test, and psychogenic disorders
-awareness by clinician can prevent falsified testing results
-important to eliminate erroneous results early to prevent the need for further testing
-often used as cr