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Audiology Quiz 5
Hearing aids, cochlear implants, BAHAs, ABR, OAE, otitis media, and noise induced hearing loss
Terms in this set (91)
Where can you get hearing aids?
from an audiologist or a hearing instrument specialist/hearing aid specialist
What is a good indicator of how well someone will do with hearing aids?
word recognition scores: measures how well a patient performs when sound is presented well above threshold
Why might patients with severe and profound hearing losses have poor word recognition scores?
-loss of outer hair cell function causes spectral (pitch) resolution to decrease
-there may be regions where inner hair cells are no longer working
What do hearing aids do?
-increase the intensity of sounds so that they become audible (amplification)
-microphone, amplifier (sound processing), receiver
How are hearing aids programmed?
-based on the patient's hearing loss using audiometric information
-when processed by the hearing aid, sounds are broken into channels (each channel represents a range of frequencies)
-the amount of gain applied to each channel may be adjusted to accommodate the hearing loss of the patient
-we have lots of control over how hearing aids operate - we can customize them for the listening needs of each patient
What are the two basic categories for hearing aid styles?
behind the ear (BTE) and custom
Behind the ear (BTE) hearing aids
-electronic rests behind the ear
-more durable than custom products
-can fit full range of hearing losses (mild to profound)
Custom hearing aids
-shell is made from an ear mold impression: fits exactly in the pinna or ear canal
-comes in a variety of sizes
-smaller custom devices have limitations: typically unable to fit severe and profound hearing losses, do not have directional microphones which help in processing noise, and use the smallest battery size
What are 5 current/emergent technologies that all hearing aid manufacturers have?
-automatic auditory scene analysis = hearing aids that monitor the sound environment and make adjustments to improve speech understanding
-wireless connectivity to phones and bluetooth devices (some will stream audio back using microphones, others require a separate device to pick up the speaker's voice)
-remote microphones = streams audio from a talker directly to the hearing aid (similar to an FM system)
What do directional microphones do? What has been their limitation?
-improves signal processing in noise
-slow to identify the target
What does wireless connectivity allow for?
a synergy in directional microphone processing: incoming signal from both hearing aids are compared, allowing for a more accurate/narrow identification of where the target speaker is located. this improves signal processing in noise
What do almost all hearing aids have an IP rating of? What does this mean? What is the exception?
-can be completely submerged in water
-NOT sweat proof: contains oils, salt, etc.
-exception = some smaller (CIC) custom products
What is remote programming?
utilizes the wireless connection with a patient's cell phone allowing the audiologist to connect and make programming changes to settings through the internet
What is artificial intelligence/machine learning with hearing aids?
-listeners can adjust settings using apps
-the device monitors the acoustic environment the patient is in when these changes are made and develops an algorithm based on these changes, automatically adjusting the settings in the future
-data can be uploaded to a central data base for analysis, and creation of a more refined signal processing algorithm for all wearers of that company's device
-tracks the number of steps you take
-used in addition to auditory scene analysis to improve speech recognition
How many different sizes of hearing aid batteries are there?
-4: specified by number/color
-most patients memorize the color rather than number
What are 2 easy things to check if a patient's hearing aids are not working?
-wax trap (RIC hearing aids only)
What does a cochlear implant do?
uses electrical currents to stimulate the auditory nerve fibers, bypassing absent or dysfunctional hair cells
What are the 5 parts of the cochlear implant?
-microphone = turns sound into digital signal
-speech processor = encodes sound for electrical info
-transmission coil = sends sound to the internal receiver/stimulator
-receiver/stimulator = receives encoded signal and routes it to the electrodes
-electrode array = uses electrical pulses to stimulate auditory nerve fibers
What is each electrode of CI associated with?
a range of frequencies
What does the cochlear implant speech processing strategy do?
-determines how the sound picked up by the microphone will be delivered electrically
-in current speech processing strategies, some of the speech information is removed from the signal
What happens to frequency (spectral) resolution in CI listeners?
-it is reduced: finite number of frequency channels
-variable spatial selectivity in individual users: some people may not be able to tell the difference between one electrode being stimulated or another
What happens to the tonotopic map in CI listeners?
-it is compressed
-it is shifted basalward (so there is a pitch mismatch between ears)
-it is warped due to "holes" in surviving spiral ganglion cells (SGCs)
Cochlear implants are an option for those with a hearing loss that is:
-severe to profound
-unable to benefit from amplification (word recognition scores must be poor enough to demonstrate this <50% in ear)
-recently approved for single sided deafness and moderate to profound losses: <60% word recognition
What is important for patients/parents to understand about cochlear implants?
-performance is highly variable and much poorer in noise
-hearing with the implant is not like hearing through acoustic stimulation
What should CI candidacy include?
-hearing aid trial
-for pediatrics: speech and language evaluation
What 3 things does imaging evaluation do?
-ensures adequate ascending neural pathway
-checks for cochleovestibular anomalies
-checks for aberrant facial nerve/vestibular anomalies that may influence the surgical approach
How long must a hearing aid trial last before cochlear implantation?
3-6 months to show limited benefit from amplification
Why is CI criteria much stricter in children than adults?
due to variability in pediatric performance
What is the purpose of a speech and language evaluation?
-determine whether factors in addition to audibility are affecting development
-screen children for developmental language and articulation disorders
-provide a description of the child's communication status relative to age related norms: helpful in setting appropriate aural habilitation goals
What are the 2 goals of CI counseling?
-summarize the findings of the CI evaluation: provide recommendations from the CI team, answer questions, and provide information
-establish expected outcomes: explain that aural habilitation is necessary and will take time
The majority of children with CI devices eventually obtain what level of open-set word recognition in quiet?
-moderate or better
-early implantation can lead to similar speech recognition as hearing peers
What 6 factors may predict CI performance?
-age of implantation
-previous use of amplification
-presence of established language system
-device use/family support
When are bone anchored hearing aids (BAHAs) used?
-for mixed and conductive hearing loss
-air-bone gap of at least 30 dB HL
How do BAHAs work?
-sound is delivered directly to the cochlea using bone conduction (bypasses conductive component and routes the signal to contralateral ear using bone conduction for single sided deafness)
-external sound processor detects and processes sound similarly to hearing aids (divided into channels, gain adjusted based on the individual's hearing loss)
What are the 3 parts of the BAHA?
-sound processor = captures sound via microphone and converts them into vibrations
-abutment: transfers sound into mechanical vibrations to the implant
-titanium implant = placed in the bone, behind the ear and transfers sound vibration through the bone directly to the cochlea, bypassing outer and middle ear
What is the older/more traditional BAHA device?
-BAHA: direct-drive, percutaneous
-titanium screws are implanted and osseointegrated over 4-6 weeks
-sound processor snaps on to the abutment, directly delivering vibrations from the sound processor to the skull
What are the pros and cons of the direct-drive BAHA?
-pros: no loss of energy/distorted signal, no skin irrigation from pressure on the skin
-cons: must be diligent to keep skin from growing onto the abutment and keep it clean/prevent it from becoming infected
What is the new BAHA from Cochlear Corp.?
-sound processor attaches with a magnet: solves problems of skin around abutment
-doesn't offer quite as much gain as the older BAHA
When is BAHA stimulation recommended for children?
before 6 months of age
What is a softband BAHA? When must it be used?
-sound is presented through processor held on child's forehead
-2-15 dB attenuation compared to osseointegrated implant
-once softband is tight enough to transmit sound, further tightening only increases the sound marginally
-must be used for children younger than 5: language rich environment is important
What is the Med-EL AdHear? Who is it approved for?
-BAHA that does not require surgery: sticks on for 3-7 days
-approved for any age
Is BAHA FDA approved to treat single sided deafness with normal hearing (20 dB) PTA in contralateral ear?
What does otoacoustic emissions (OAE) do?
-measures outer hair cell function
-works like sonar: sound is put out and reflected back in a specific way if outer hair cells are working together
What does auditory brainstem response (ABR) do?
measures the signal of the auditory nerve as it moves through the brainstem
What is otitis media?
fluid and inflammation in the middle ear space
Why is otitis media more common in children?
-due to the orientation of their eustachian tub
-their tensor palatini muscle works less effectively
What is the incidence of OME?
-approximately 90% of children will have OME before they are school age
-most often between 6 months and 4 years old
What are the 3 subtypes of otitis media?
-otitis media with effusion (serous otitis media) = fluid in the middle ear space, but not infected
-acute otitis media = infected fluid/pus in the middle ear space (what parents usually mean when they say their child has an ear infection)
-chronic otitis media = > 3 months
How does poor eustachian tube function cause serous otitis media/OME?
-prevents air in the middle ear from being ventilated
-stagnant air is absorbed by tissues in the middle ear, resulting in negative pressure
-negative pressure causes fluid to be drawn into the middle ear space from tissues
-serous fluid is clear and watery (low viscosity)
-usually not very painful
What happens if serous fluid remains in the middle ear space?
-fluid will thicken from white blood cells and other cellular material: called secretory otitis media
-as the fluid thickens, the condition may be termed mucoid otitis media, then adhesive otitis media/"glue ear"
What are 3 problems that can compromise the eustachian tube function and be associated with OME?
-enlarged adenoids that push against the eustachian tube
-cigarette smoke: inflames the mucous membranes and interferes with the eustachian tube function
What is the incidence of acute otitis media? What is the nature of it?
-up to 75% of children before age 5
-2/3 is bacterial, 1/3 is viral
-microbes enter the ear via the eustachian tube, usually during or right after an upper respiratory infection
-early stages begin with engorgement of tissues with blood: may cause the tympanic membrane to appear red and will typically be painful (otalgia)
What happens after several days of acute otitis media?
-exudation: fluid thickened with white blood cells, red blood cells, mucous, and other debris will fill the middle ear space
-pain will be worse
-eardrum reddens and bulges from pressure/fluid
What can happen if acute otitis media is left untreated?
-the eardrum can rupture
-purulent (infected) discharge called otorrhea may ooze out of the ear
Acute, sub acute, and chronic time frames:
acute = less than 3 weeks
sub acute = 3 weeks - 3 months
chronic = longer than 3 months
What are some ways to prevent otitis media?
-adenoidectomy and tonsillectomy
-avoid letting children drink while laying on their back
-children in daycare are more prone to get colds, which can lead to otitis media
What are 3 treatments for otitis media?
-wait and see approach
-antibiotics (for acute otitis media, it often resolves on its own without antibiotics/antibiotics only work for bacterial infections, not viral)
-P.E. tubes: allows fluid to drain out through the tympanic membrane; usually only recommended for chronic otitis media
follow up is important
What causes threshold shifts?
-exposure to loud sounds can damage your hearing, resulting in an increase in thresholds
-can be temporary or permanent
What are the two ways for sound to damage the cochlea
mechanical: physical pressure from sound
metabolic: overproduction of free radicals trigger apoptosis
What is the most vulnerable to noise induced hearing loss?
outer hair cells (most noise induced hearing loss is due to damage to the outer hair cells)
What causes mechanical damage to the cochlea? Which areas are commonly damaged?
-exposure to noise >115 dB SLP
-areas commonly damaged include: OHC stereocilia, rupture of cell membranes, cochlear membranes, and IHC nerve synapses
What causes overproduction of free radicals/metabolic damage in the cochlea?
-exposure to noise >85 dB
-free radicals are molecules with an unpaired electron: trigger apoptosis
What defends against free radicals?
antioxidants = molecules with an extra electron: they give an electron free radicals, making them stable/not harmful
What are the 2 ways for a cell to die?
-necrosis = due to severe stress or mechanical damage to the cell
-apoptosis = programmed cell death: a mechanism to rid the body of unwanted cells
There is a trade off between the level of a sound and ___
-how long you can be around it before it will begin to cause permanent hearing loss
-thought to begin around 85 dB
What happens to free radicals at higher levels?
they are created more quickly than your body can create antioxidants to neutralize them, causing permanent damage more quickly
What is the 5 dB trading rule?
for every 5 dB increase above 90 dBA, the amount of permissible time exposed to the noise is halved
Permissible Exposure Limit (PEL)
-max noise exposure level to which an employee may be exposed for a specific duration
-US = 90 dBA for 8 hours
Daily Noise Dose (DND)
-percentage of allowable noise exposure the worker has experienced
-TWA of 90 dBA = 100% DND
What is the noise notch?
noise induced hearing loss begins at 4,000 Hz and then spreads to surrounding frequencies
What do sound level meters do?
-measure sound intensity
-range from very expensive (more accurate) to cheap
What does a sound dosimeter do?
-monitors sound exposure over an extended period
-used in industrial settings
-results usually presented as a user friendly daily noise dose percentage
What are 3 preventative measures for noise induced hearing loss?
-administrative: schedule workers to rotate in and out of noise
-engineering: reduce the amount of noise emitted from the source
-hearing protectors: ear muffs, ear plugs, helmets
What demonstrates noise protector effectiveness?
noise reduction rating (NRR)
What has become a prevalent danger for noise induced hearing loss?
personal listening devices (phones)
Is there individual variability in noise induced hearing loss?
What is hidden hearing loss?
-temporary threshold shifts that do not appear to be so temporary: low spontaneous discharge rate fibers, which code higher level sounds, do not recover after TTS; permanent nerve fiber loss over weeks after noise
-thought to contribute to poorer understanding in noise
What are 5 important things to know as an SLP in the school system?
-the speech banana
-how to read an audiogram
-how to explain conductive vs sensorineural vs mixed hearing loss
-how to interpret a tympanogram
What are some of the impacts of hearing loss in school?
-poor academic performance (reading and math)
-achieve several grade levels lower than hearing peers, especially without intervention
What are 3 major areas that a hearing loss impacts?
-articulation: fricatives/high frequency sounds, centralized vowels, syllable reduction, resonance issues
-language: vocabulary (concrete words are easier to learn than abstract). sentence structure/complexity/length, word endings like -s and -ed
Why is it important for an SLP in the school to understand their students' hearing loss?
-so they can work with teachers/advocate for accommodations
-so they can help with hearing aid batteries and connectivity
What does EHDI stand for?
Early Hearing Detection and Intervention
What is EHDIs goals?
-1 month: screening and re-screening
3 months: diagnosis
6 months: intervention and amplification
What are the 5 things EHDI does?
-tracking and identification (from birth)
-support for families
-support for and collaboration with service providers
-education and training
What is the most common birth condition?
What are the 4 hearing screening techniques?
-Automated Auditory Brainstem Response (AABR) = analyzes the presence of waveforms at different loudness levels (pass/refer)
-Otoacoustic Emissions (OAE) = sounds echo back from inner ear if it is functioning properly (pass/refer)
-Pure Tone Screening = test children 4+ at 1000, 2000, and 4000 Hz at 20 dB
-Tympanometry = determines presence/absence of fluid by measuring movement of the eardrum (not a hearing test)
What is auditory neuropathy spectrum disorder?
sound enters the ear normally but transmission of signals from the inner ear to the brain is impaired
What are the causes of hearing loss?
-genetics (50%), may also have another syndrome/condition
What is a pediatric audiologist?
experienced with the assessment of infants and children with hearing loss and knowledge and equipment necessary
Why are pediatric hearing assessments and referrals necessary?
any amount of hearing loss can impact a child's speech, language, social, emotional, and educational development
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