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CSD 411 Midterm
Terms in this set (88)
Conductive Hearing Loss
results from an obstruction within the outer or middle ear; typically treatable
AC---> abnormal, outer ear, middle ear
BC---> normal, inner ear
Sensorineural Hearing Loss
results from an obstruction in the inner ear, eighth nerve, brainstem, midbrain, or auditory cortex.
(they are both going to be similar about 10dB of each other)
Mixed Hearing Loss
has both a conductive and sensorineural component; Occurs in outer, middle, and inner ear
BC--->abnormal (not as bad)
Degree of Severity Loss
-10-15 dBHL: normal (child) -10-20 dBHL: normal (adult)
30-45 dBHL: mild
50-65 dBHL: moderate
70-90 dBHL: severe
> 90 dBHL: profound
Tells us where in the ear problems occur and about the cochlea
unmasked right ear (red <); masked right ear ( red [ ); unmasked left ear (blue >); masked left ear (blue ] )
tells us about severity
unmasked right ear (red circle); masked right ear (red triangle) unmasked left ear (blue X); masked left ear (blue square)
Sloping (left to right and goes down)
Rising (left to right and goes up)
Bilaterally (in both ears)
Speech Recognition Testing
is performed in order to determine how well an individual can recognize speech sounds
is the ability to perceive a spoken message and make decisions about its lexical composition using auditory and sometimes visual information
What is the use of speech recognition testing?
1. determine the need for amplification
2. compare different listening devices
3. assess performance longitudinally
4. determine the need for auditory training
5. determine placement within a training curriculum
What factors affect speech recognition testing results?
learning effects and test-retest variability
occurs when performance on a test improves as a function of familiarity with the test procedures or items, not as a result of a change in ability
is a measure of the consistency of performance on a test from one presentation to the next. This factor can affect speech recognition testing because a patient may achieve a score on one day then take it again on another day and achieve a different score. Test conditions that can affect variability are the mode of presentation, location, the talker, and the number of times an item is repeated.
What are the considerations for hearing aid candidacy?
-Speech Recognition ability
What are the different types of hearing aids?
Behind the Ear
Receiver in the Ear
In the Ear
Completely in the canal
In the canal
amplifier physically amplifies the sound; set of diagrams that vibrate and they vibrate more if you turn up the volume
(operates like a car speaker)
amplifier is still analog (physical in there) but hearing aid connects to a computer to adjust the hearing aids, the programmability is the digital part
the amplifier itself is digital, there is a microchip in the hearing aid. First
sound comes in, then the hearing aid turns it into a digital signal and the microchip
converts it, the hearing aid makes it an acoustic signal and then it goes into the ear
How can the different types and styles of hearing aids be confusing to customers?
This can be confusing to a client because there are lots of options and they may
feel overwhelmed and they also may not be familiar with the differences.
What are the different parts of a hearing aid?
responds to sound, picks up acoustic signal from the environment and converts the acoustic signal into an electrical signal
increase the level of the signal (intensity of the sound)
processes the electrical signal and converts it back to acoustic energy
delivers sound from the receiver to the ear and help in holding the hearing aid in place
allows the user to adjust the level of amplification
audiologist use this to adjust the output of the hearing aid
What are the different aspects of hearing aid fitting?
a. earmold impression
b. dispenser instructions
An audiologist takes an ear mold impression of the ear and then sends the impression to the manufacturer for construction of the hearing aid. (CIC and ITE)
insertion/removal of the HA, cleaning the HA, insertion/removal of battery, volume control adjustment, and adjustment/expectations/tips
real ear measure and functional gain
Real Ear Measure
involves placing a small microphone in the ear canal to measure the output of the hearing aid. A way to assess how the hearing aid is functioning in the ear. Are we meeting those targets and are we amplifying the right amount, not too much. Making sure we are not over amplyfying
a hearing test with the hearing aids on, how much benefit they are receiving with the hearing aid
What are the FDA requirements for cochlear implants?
The primary candidacy requirements for implantation are the presence of irreversible hearing loss and good general health.
18 years or older
Moderate to profound sensorineural hearing loss in both ears
Limited benefit from amplification
Children (2-17 year olds):
Severe to profound sensorineural hearing loss in both ears
Limited benefit from binaural amplification
Multisyllabic lexical neighborhood test or lexical neighborhood test scores < 30%
Children (9-24 months):
Profound sensorineural hearing loss in both ears
Limited benefit from binaural amplification
What additional factors are considered in determining potential success with a cochlear implant?
-Age of onset
-Length of deafness
-Motivation and Commitment
Age of Onset w/h cochlear implants
For someone who has prelingual HL the best opportunity for success with a cochlear implant is to have it done earlier in life, but someone with post-lingual is a better candidate in general since their auditory system has been previously stimulated so there is much less learning involved and they can make a connection quicker
Prelingual Hearing Loss
have not developed speech and language yet
have spoken language in place and lost hearing later in life
Length of Deafness with cochlear implants
how long they have gone before cochlear implant; the longer the range of deafness, the harder it is for someone to adjust to a cochlear implant. Best candidate are individuals who have early onset of hearing loss and early implantation
Motivation and Commitment with cochlear implants
kids who receive cochlear implants the motivation is on the parents (need committed caregivers who bring kids to appointments, invest in therapy and be involved in therapy)
Adults: important in individuals who have poor prognosis. Have to talk to them about the long haul of being committed
Education/Rehab for children with cochlear implants
AURAL options for education (teaching spoken language rather than using an alternate form of communication). Rehab is life long
Education/Rehab for adults with cochlear implants
rehab may or may not be necessary. Some people benefit from coming to therapy and some do it at home, even if they can do a few visits working on listening skills they are likely to do better in the long term
Expectations with cochlear implants
make sure they have realistic time periods to stay motivated and committed
Neural Survival with cochlear implants
process by which the electrical stimulation gets to the brain and in some cases when people do not have good auditory stimulation they have much poorer outcomes
surgically implanted device that acts to replace damaged hair cells in the cochlea
What is the purpose of a cochlear implant?
to allow a person to hear the sounds of speech for the purpose of listening and development of spoken language
Assistive Listening Devices
used in conjunction with hearing aids/cochlear implants to improve listening in a certain environment.
What is the purpose of an assistive listening device?
to improve listening experience in a particular environment
Examples of ALD
allow people to communicate through typed messages
flashers in the home that dim and brighten when someone rings the doorbell
an alarm clock that vibrates
smoke detectors that dim and brighten to go off
classroom amplification (signal to noise ratio) teacher must be louder than background noise
used to help persons with hearing loss develop the ability to recognize and interpret auditory stimuli.
What are the principles of auditory training?
auditory skill level, stimulus unit, activity kind, difficulty level
Auditory Skill Level
detection, discrimination, identification, comprehension
ability to determine the presence or absence of a sound
ability to distinguish differences between sounds. Can include duration, intensity and frequency
Ability to recognize a sound and label it by repeating it, writing it, or pointing to it.
Ability to understand the meaning of an acoustic message by referencing it to the knowledge of language.
Can include: answering a question, following directions, paraphrasing a story.
Stimulus Unit (principle)
determine what stimulus are we going to use
analytic- segments of the speech signal (syllables/phonemes)
synthetic- meaning of utterances
writing skill, writing stimuli, and how you will elicit it. is it structured or unstructured.
structured- drills (listening on delivering of sounds and they know you want them to respond)
unstructured- daily routines (more difficulty closer to letting go of therapy)
starts with the level of the client and as they master things increase the level of difficulty
(stimuli set --> stimulus unit --> stimulus similarity --> context --> structured vs spontaneous tasks --> listening environment)
closed vs open
Closed: certain number of items in the set (2 picture cards so the stimulus set would be 2). They can be expanded into larger sets to increase difficulty and you can go to open sets
Open: I say a word and you say it back to me
sentence, phrase, word, phoneme
Where do you start? Language allows filling into gaps when they do not hear parts given to them
talks about the acoustics you are stimulating. Use words that differ in syllable length to make it easier on clients. The more sounds they have, the easier they are to discriminate. When they get closer together in acoustics the harder it is to discriminate.
linguistic and we can also provide context in the task
Structured vs spontaneous tasks
what kind of activity is occuring?
consider it the last step. Auditory training needs to be worked on in a quiet environment, as time goes on and you get closer to discharging people from therapy you need to start incorporating noise
What are the parameters of sound as they relate to speech acoustics?
Intensity: 45 dBSPL (soft speech) to 85 dBSPL (shout)
Magnitude of sound
Duration: how long a sound is
Long vs. short phonemes (/b/ vs. /sh/)
Syllable length: contrasting 1 vs 3 syllables
What factors affect speechreading?
, talker vs message, environment, speechreader,
How do we use parameters of sound in developing auditory training objectives?
TCW discriminates phonemes /k/ and /d/ with 75% over 3 sessions. To make it more difficult to adjust it but changing sounds, increasing accuracy, including noise in the session, or changing discrimiantion to identification.
any amount of residual hearing (ability to hear without hearing aids) can contribute positively to a person's ability to speech read
Talker vs. Message
mumbling, shouting, covering mouth, smiling, familiarity, gender of the talker all impact speechreading
Structure of the message affects the ability to speechread (more complex messages are harder to speechread) and how often a word or phrase is used is another factor (frequency of usage)
viewing angle (should be face to face), distance (close to one another), room conditions (well lite and no distractions), background noise
natural ability, appropriate amplification, eyeglasses, stress, fatigue, and attention
How can speechreading be incorporated into therapy?
1. Increasing difficulty starting with a simple set of commands (starting at phrase level and then have them do tasks)
2. Sentence recognition with pictures
3. Topic related sentence recognition
4. Paragraph- read from a book and answer questions for a higher level
What is conversation used for?
for expressing of needs and wants, to give information, influence other people, and establish intimacy
What are the impacts of hearing loss on conversation?
Disrupted turn-taking (missed cues for speaker, falling intonation/reduced rate of speech)
Modified speaking style (speaking louder, getting closer, exaggerated speech)
Inappropriate topic shifts (miss topic changes)
Superficial content (avoid in-depth topics)
Frequent clarification (affects flow/dynamic of convo)
What are the types of communication strategies?
facilitative and repair
before or during communication to promote success
How are facilitative techniques implemented?
participants: listener must turn hearing aids on, get closer, pay attention, face person they are talking to while the speaker must talker louder at a slower rate
environment: avoid noise, pay attention to lighting, reduce distractions
message: keep it simple, stay on topic and use common vocab
after communication breakdown
How are repair techniques implemented?
repeat (sometimes cannot understand even if repeated so ask what they heard)
request information (be specific, asks what they need)
keyword (oriente on topic of convo)
elaborate (description of words they do not understand)
Examples of Maladaptive Behaviors
Withdrawing from the conversation
pretend to understand you even if they do not.
Nodding, saying yes, uh-huh, yeah, agreeing
Withdrawing from conversation
sit in corner by themselves, limit small/short interactions
talking more so they do not have to listen
What are the different conversation types?
passive, aggressive, and assertive
Passive Conversation Type
Draw themselves out of the conversations, bluffing, skate by with as little interaction as possible, be quiet (enduring conversation)
Aggressive Conversation Type
Dominate the conversation, often the louder person in the conversation, blame other people for the problems they have hearing
Assertive Conversation Type
Goal for people to use effective and good communication strategies, they accept responsibility for their hearing loss, they convey that to their speaking partner so they know how to help them. Part of therapy is teaching them how to do this the right way and gain confidence.
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