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audiology 4

Terms in this set (54)

Joint Committee on Infant Hearing
-recommended screening for all new borns
-identify HL before 3mths
National institute of health
-all new borns have hearing screening before leaving hospital
methods for newborn hearing screening
-ABR
-OAE
costs for newborn hearing screening
ranges between 25-40$
Benefits of early detection
-more likely to develop on par if can hear
-minimizes need for rehab in school years
-better lang skills with amplification which can be put on at 4weeks of age
screening
-not diagnostic
-rapid, simple tests to generally large numbers of those with high probability of disorder to those who dont
-criterion measurement cutoff point is always present
-indicates that hearing loss MAY be present
-leads to further testing
NIH Consensus Statement 1993
-infants in NICU be screened before discharge
-all new borns screened within 3 mnths of birth, preferably before discharge
-screening be rapid, reliable, highly sensitive, specific, easy to administer
two stage process of NIH Consensus statement
1. OAE
2. if failed OAE, rescreened with ABR
-if fail ABR, further testing to verify HL
sensitivity
-ability to correctly identify patients with disease (HL)
-if test has 90% sensitivity rate, 9 out of 10 with HL are correctly identified
specificity
-ability of test to correctly identify those without the disease (normal hearing)
sensitivity, false negatives
not properly classified to have HL when they do have HL
specificity False positive
told they have HL when they don't
who can screen birth to 18 yrs
-audiologist
-SLP
-support personnel with supervision of audiologist
clinical process for birth to 18
1. guardian permission
2. infection control
3. case history
4. inspect ear visually
5. use lighted otoscope/video-scope to look at ear canal and TM
6. perform tympanometry
who can screen neonates birth to 6mths
-audiologists
-support personnel with supervision of Aud
clinical process for birth to 6mths
-parent permission
-infection control
-ABR or EOAE
-educate parents
who can screen 7mths to 2 years
audiologist only
clinical process for 7mths to 2 years
1. parent permission
2. infection control
3. visual reinforcement audiometry at 1000, 2000, 4000 HZ at 30dB hl
4. conditioned for play audiometry at 1000, 2000, 4000 Hz at 20 dBHL
who can screen 3-5 years
-audiologist
-SLP
-support personnel with supervision of Aud
clinical process for 3-5 years
1. parent permission
2. infection control
3. two trial at suprathreshold to ensure child understands task
4. screen at 1000, 2000, 4000 Hz at 20 dB HL
5. at least 2 presentations of each stimulus for reliability
6. educate parents
who can screen 5-18 years
-audiologist
-SLP
-support personnel with Aud supervision
clinical process of 5-18 years
1. parent permission
2. infection control
3. conditioned play audiometry or conventional audiometry
4. screen under 1000, 2000, 4000 Hz at 20 dB HL
5. educate parents
who can screen birth through 18 for disability
-audiologist
-SLP
-physicians, nurses, educators, other personnel
further testing must be done if these risk factors are present
-family history of HL in childhood
-maternal infections (pregnancy or delivery)
-physical problems of head, face, ears, neck
-ototoxic meds given in neonatal period
-syndrome associated with HL
-in neonatal intensive care unit more than 5 days
-prematurity (<37 weeks)
-hyperbilirubinemia
-parent concern regarding hearing
-delay in speech/lang development
-recurrent middle ear infections
-head trauma with loss of consciousness/skull fracture
-bacterial meningitis and other infections
-exposure to damaging noise levels
behavioral observation audiometry (BOA)
observing behavior
-unconditioned response procedure
-startle to loud noise
-eyes blink
conditioned response audiometry
VRA
CPA
BOA (behavioral observation audiometry)
-observation of child's response to sound
-may be reflexive or attentive response
-2 clinicians must agree
the younger the child
the louder the noise must be for the child to respond
reflexive behaviors
-startle response
-head or limb reflex
-APR (auropalpabral reflex), eye blink
-change in sucking behavior
-facial twitches
attentive (orienting) response
-quieting responses
-increase in activity
-onset of vocalizing/crying
-sudden stopping of vocalization/crying
-eye widening
-localization attempts
-change in facial expression
-looks at parent
habituation
-response becomes extinguished due to familiarity
-need to change stimuli
-conserve responses
VRA (visual reinforcement audiometry)
-conditioned response
-pair stimulus w/ animated toy
-conditioned child to think tone and toy go together
-separate stim from toy so child responds to tone then reinforce with toy
where can VRA be done
in soundfield or under phones, starting around 5mths
if child fails to condition in VRA
it is due to hearing loss or developmental delay
how to differentiate hearing loss or developmental delay
repeat test with tactile stim (vibration)
-if no response must look into developmental delay
CPA (Conditioned Play Audiometry)
starting around 2-5 yrs
-in sound field, or under earphones
-play response to stimulus
CPA example
drop block in bucket when you hear the beep
conventional audiometry
age five and above
how to establish rapport
-clothing
-sneakers
-girl things
-boy things
-what kids like
pediatric protocol: birth-4mths
1. freq. specific ABR
2. EOAE
3. Immittance
4. behavioral observation (as cross check)
pediatric protocol: 5 to 24 mths
1. VRA
2. EOAE
3. Immittance
4. Freq. specific ABR (as necessary)
pediatric protocol: 24mths- 4 years
1. CPA
2. EOAE
3. Immittance
4. Freq. specific ABR (as necessary)
Toxoplasmosis
bacteria from kitty litter, can cause deafness
rubella
German measles
CMV
cytomegalovirus, very common virus stays dormant in body normally, may present itself
atresia
born with no ear canal or very thin ear canal
hyperbelirubinemia
poor liver function, yellow skin, jaundice
speech audiometry: performance intensity function
1. sponde words
2. phonetically balanced words
3. phonetically balanced monosylabic words
4.. phonetically balanced words
1. sponde words
-2 syllables (hotdog)
-used for speech recognition threshold
-line 1
2. phonetically balanced words
-40 dB above threshold
-house, boat
-takes greater dB to recognize
3. phonetically balanced monosylabic words
-for those with sensorineural hearing loss
-rarely reaches 100%
4. Phonetically balanced words: w/ sensorineural hearing loss
-as intensity increases, performance increases, but only to a certain point
-PB max.
-roll over
-retrocochlear pathology may be present
signs of retrocochlear pathology and acoustic neuroma
-unilateral hearing loss, ringing in ear, dizziness
PIPB roll over
Performance Intensity Phonetically Balanced Roll over
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