pediatric testing, why different types of protocols
protocols for kids who don't attend or respond due to age or handicap, loud environment (school)
Birth to age 1 Methods of pediatric testing:
1. hammer/cow bell noisemaker, 0 - 6 mo.
2. crib-o-gram, 90 dB loud noise, sensor under crib mattress for movement (non-functional: unilateral, heavy sleeper)
3. ABR Auditory Brainstem Response (EEG) noise with earphones
4. Otoacoustic Emissions: Otoacoustic emissions (OAEs) are sounds given off by the inner ear when the cochlea is stimulated by a sound. When sound stimulates the cochlea, the outer hair cells vibrate. The vibration produces a nearly inaudible sound that echoes back into the middle ear. The sound can be measured with a small probe inserted into the ear canal.Those with hearing loss greater than 25-30 decibels (dB) do not produce these very soft sounds. The OAE test is often part of a newborn hearing screening program. This test can detect blockage in the outer ear canal, as well as the presence of middle ear fluid and damage to the outer hair cells in the cochlea.
5. Observation Audiometry: baby looks at a toy. A noise in BACK is made. See if baby notices.
Birth to age 1, methods of pediatric testing:
1. Moro Reflex: startle, disappears at 6 mo.
2. Aural Palpebral: eyes blink, widen
3. Sound Field: (Conditioned Orientation Reflex)turn head
4. Response to questions: Where's Mommy?
age 5-6 mo testing AND OLDER
use Behavioral hearing methods. Short attn. span, decide which frequency is most impt. With otitis media ID low freq hearing loss, start 500Hz go to 2,000 Hz, and then fill in other Hz if time
age 1 year to 5+, methods of pediatric testing
1. Tangible Reinforcement Operant Conditioning Audiometry TROCA - present signal, kid pushes clown's nose
2. Play Audiometry - hear signal put peg in hole
3. Visual Reinforcement Audiometry - VRA turn head after tone, see stuffed bear Use a SOUND TESTING ROOM with speakers, 1 assistant, Audiologist hidden behind wall. CENTERING - direct kid to look at center wall in between noises
Which Hz when testing children?
2,000 Hz and 500 Hz in each ear, other frequencies back and forth until kid does not cooperate
Rules for screening in schools
1. state health dept mandate in TX
2. FIRST TIME enrollees in a school, 4 yr old, K, 1, 3, 5, 7, 9th grade
3. approved screeners
4. submitted to state 1/year
Considerations for screenings in schools:
1. noise - so use supra aural earphones with disposable covers and wipe head band with alcohol between kids
2. tester needs to be able to hear signal - check it out
3. WE ONLY USE 25 dB at: 1,000, 2, 000
4,000 and 500 Hz.
Group Conditioning for schools
1. instruct the whole group at one time how to be tested. Use 2,000 Hz at 110 dB for example (LOUD).
2. demo with machine and 1 student who responds the fastest.
Reminders for school screenings
1. not in presence of noise (wait for airplane to pass)
2. do not let kid see the audiometer dials
3. no clues, no rhythm
4. do not look at child
5. It's eith erPASS or FAIL (no response to 2 frequencies in same ear)
What is Speech Audiometry? Why?
Method used to eval how well PT can hear and understand specific types of speech stimuli (not just pure tone noise signals).
Determine how well an individual functions in his/her environment by ability to hear spoken word (as opposed to hearing mumbling.)
The lowest level a PT can produce a response to speech stimuli.
3,000 - 6,000 Hz.
Shows BEST hearing in SOME frequencies.
does the audiogram show a problem in 8th nerve or Central Pathway?
NO. Audiogram results not representative.
MLV Monitored Live Voice
presentation of speech stimuli, not a good idea, voices not steady, need microphone
VU Meter Volume Unit Meter
VU meter must have output set at 0dB (midpoint) for calibration for Live Voice
when is speech equivalent to Pure Tones?
0dB HL = 19.5 dB SPL in speech channel
0dB HL = The Norm for the population
Mode of Response
1. verbally repeat
2. point to pictures
3. point to objects
4. written response
Is the PT MR?
Doesn't speak much English?
Speech Testing: What are we looking for?
most comfortable level
uncomfortable loudness level
Speech Awareness Threshold SAT =
Speech Detection Threshold SDT
SAT: Lowest level individual detects as speech, but does not require recognition of specific words (I hear sounds, but can't tell what they are saying).
Good for a non-English speaker
Speech Recognition Threshold SRT
SRT lowest level at which speech (words) can be understood
Can use with sound field, ear specific headphones, B/C
Downs & Minard, ASHA, have 2 methods
p. 180, 184
use pictures, like a small lotto board
show me ice cream
should be within 10dB of pure tone
SRT and PTA agreement
need to be within 10 dB of pure tone
if SRT lower than PTA:
1. Auditory Processing Disorder
2. foreign language
If SRT better than PTA:
pseudohypacusis: false and exaggerated hearing loss
Ability tests to understand speech
WRS Word Recognition Score% of correctly identified items
WDS Word Discrimination Score
SRS Speech Recognition Score
PB Phonetically Balanced Word Lists
Contain all phonetic elements of connected speech
Use to test SRT
comfortable listening level
Carrier phrase: "say the word _____"
helps to ID: conductive, cochlear, retro-cochlear
Adults: Nu-6 CID W22
Children: Single syllable phonetically balanced words CVC
WIPI point to picture word list 6 choices
Nu-Chips point to picture word list 4 choices
Word discrimination scores: WDS
SRT threshold, start here to determine and present at comfortable sensation level: 3- - 40 dB
1 word at a time
82 - 91 good
72 - 81 fair
52 - 70 poor
22 - 50 very poor
20% extremely poor