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1. obtain behavioral audiogram for each ear
2. physiologic measurements
what are the 2 goals of behavioral assessment?
250-4000Hz in octave intervals and it may take multiple sessions
what Hz should you obtain for behavioral audiogram for each ear?
Estimate hearing sensitivity—not true tests of hearing
is physiologic measurements a true test of hearing?
Used to cross-check findings in pediatric cases
what is physiologic measurements used for?
Immittance measures and otoacoustic emissions
what are the two cross-check findings in pediatric cases?
1. Behavioral Observation Audiometry (BOA)
2. Visual Reinforcement Audiometry (VRA)
3. Conditioned Play Audiometry (CPA)
what are the three testing methods for pediatrics?
for what ages is behavioral observation audiometry used for?
for what ages is visual reinforcement audiometry used for?
for what ages is conditioned play audiometry used for?
in behavioral observation audiometry is reinforcement necessary?
Time efficient; no special equipment needed
why is BOA good?
Auditory stimulus is presented and infant's response to sound is observed
---Eyes shift, quieting, blink or widen, head turns, etc.
---Behavioral responses are time-locked to stimulus presentation
describe how a BOA is given?
newborns through 6 months
when is a BOA ideal for?
calm, borderline asleep
how should infants be in BOA?
Maintain quiet in booth to "set-the-stage"
---Begin with soft level and ascend (increase) in level
---Look for response and determine MRL
how should the booth be set up for BOA?
Rapid habituation of responses
Startle test is an option if responses to auditory stimuli are not consistent
what is the limitation in BOA for responses?
Difficult to obtain true thresholds
Short attention span, quiet sounds are not interesting enough
what is the limitation in BOA for thresholds?
Subjective response criteria
"Was that a response???"
what is the limitation for gathering a response
at what age can children be conditioned to turn their head in response to the presentation of an auditory stimulus?
what is the ideal age for VRA?
training trials first
Conditioning procedure for VRA, must implement ---
--Use audible level
--Direct child's attention towards stimulus at onset of trial and hold there until reinforcement is presented
------Repeat and gradually increase time lag between onset of stimulus and onset of reinforcement until conditioned
how is a VRA given?
Follows a stimulus-response-reinforcement paradigm
what kind of paradigm is VRA?
---Child sits in caregiver's lap facing forward
---Auditory stimulus is presented; if child hears it, usually they will turn their head toward stimulus, then reinforced by movie or puppet
---Avoid rhythm and never reinforce the undesired response
---Response is clearly defined and cued by the presentation of the stimulus
describe how VRA is given
in CPA Older children habituate to the ----
25-30 months through 5 yr
what is age for CPA?
what does CPA use in lieu of visual stimulation?
3 years: block in the bucket
what toy/task would you choose for a 3 yr?
Older: build blocks to make a tower, legos, puzzle, etc
for older children what toy/task would you choose?
hear the auditory stimulus
Children learn to engage in an activity each time they ---
Easier to implement with help of an assistant
Clinician performs testing and assistant works with child
why might you need an assistant when doing the CPA?
Assistant sits in the booth with the child and teaches them to wait, listen, and respond with the play activity only when the auditory signal is audible
Assistants must be very careful not to cue the child when the auditory stimulus is presented
describe what the assistant would do in CPA?
sufficient precision to establish valid auditory sensitivity thresholds
Behavioral and conditioning procedures with infants and young children may lack ---
MRL = lowest intensity of auditory stimulus that produces the desired response
what is minimum response level (MRL)?
may not be -- we could see the thresholds improve over time if they are MRLs?
is MRL the true threshold?
Question parents regarding chief concern that facilitated the visit.
What brings you in today?
Do you feel your child has problems hearing?
Does your child respond to the telephone, doorbell, vacuum?
Does your child respond if you call his/her name?
what are some common sequence of questions for a parent interview?
regarding age-appropriate auditory development skills
If loss appears evident, inquire ---
Did sudden noises awake the baby?
what is a auditory development skill for 0-4 months?
Did the baby begin to turn toward sounds that were out of sight?
Did the baby repetitively babble a large variety of sounds at 5 and 6 months?
Could the baby sit alone by 6 months?
what are some auditory development skills for 4-7 months?
Did the baby turn to find sounds out of direct sight?
Did the baby make sounds with rising and falling inflections?
what are some auditory development skills for 7-9 months?
Did the baby turn and find sounds behind them?
Did the baby start to imitate sounds?
what are some auditory development skills for 9-13 months?
Prenatal and/or neonatal conditions known to place infant at risk for hearing loss
when asking questions what can we find out from medical history?
Childhood deafness in family?
Birth defects in family?
when asking questions what can we find out from family history?
Never say the word "hurt"
Attitude will determine your success
Quickly establish a good, positive relationship with parents
Try to work with the child alone
Tell the child what you want them to do - do not ask
Be calm - children detect nervousness
Learn what "normal" behavior and ""normal" responses look like
what are some things to keep in mind when talking to the child and parent?
no -- Only make available materials you will be using for conditioning to increase interest in these toys
should you have a ton of toys sitting out?
Goal is to get ear-specific information from 250 to 4000 Hz but don't make this a negative experience
what should you avoid when doing these test?
Children are scared of the dark
If in one room, light
If in two rooms, dark room for examiner and light for the test room
describe the lights when doing testing
We want ear specific information so always try ---
resort to Sound field
If child will not accept them, ---
SF does not give ear specific information (only testing the better ear)
describe SF transducers
have child practice wearing earphones at home
what might we tell parents to practice before coming in for testing?
- Lowest level child can identify speech
what is speech reception threshold (SRT)?
Lowest level child responds to speech without ID
what is speech detection/awareness threshold?
SDT/SAT - child is immediately involved and anxiety is reduced
what is a good speech audiometry test to do first?
speech as opposed to tones or noise
Child is more familiar with ---
Live voice for VRA and/or CPA; present speech stimuli via microphone and adjust level per child's response
Picture board or repeat words for older kids
describe the stimuli presented for testing protocols
Start at 30 dB HL and use 15 dB steps until 1st response
describe the level adjustment for testing protocols
May have to test multiple times if hearing loss isn't ruled out
time is limited -- what does his mean?
different with children because of their likely short attention span...
Order of testing frequencies is ---
Get 4000 Hz, 1000 Hz, switch ears & repeat
2000, 500 and 250 Hz per ear as time allows
Bone conduction if possible (or necessary)
which frequencies should you get for pediatric pure tone audiometry?
250 to 4000 Hz
If all you can get is an SAT/SRT and thresholds at 4000 and 1000 Hz, then you already have a good idea of hearing sensitivity from---
Sets found in the same folder
Audiologic Assessment Lecture 1
Audiological Assessments Lecture 3 and 4
Standards in Audiometry and Calibration
Pure Tone Testing
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