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Chapters one through five


are two syllable words spoken with equal stress on each syllable

parameters of hearing loss (4)

1. what is the severity
2. when did the loss begin
3. what is the cause
4. how quickly has the loss progressed

types of configurations

1. flat
2. high frequency
3. low frequency
4. saucer shaped

flat configuration

thresholds are within a 20 db range of each other across the span of frequencies. Looks like a flat line.


high frequency hearing loss. often called sloping. reduced hearing at 4000-8000Hz

low frequency hearing loss

cannot hear sounds in frequencies 2000 Hz and below. Also known as a "reverse slope".

saucer shaped configuration

cannot hear frequencies in the midrange.


Refers to a hearing loss acquired during the stage of acquired language


small external ear


closure of the external ear canal

aural rehab goal is to

minimizing and alleviating the communication difficulties associated with hearing loss

hearing related disability

loss of function because of an impairment (hearing loss), for example the inability to understand conversation at the office


structural or functional damage to the auditory system


social or vocational consequences of the disability

audiologic rehabilitation

Is a term most often used synonymously with aural rehabilitation; it entails greater emphasis on the provision and follow-up listening devices and less emphasis on communication strategies and auditory and speechreading training.

pure tone average

is the average of the thresholds at 500, 1,000 and 2,000 Hz


for older people, 65


for poor people

level of evidence 1a

systematic meta-analysis

level of evidence 1b

randomized controlled

level of evidence 2a

controlled without randomization

level of evidence 2b

quasi-experimental, cohort, pre/post measures

level of evidence 3

non-exeperimental, correlational and case studies

level of evidence 4

expert, consensus, authority

5 steps to EBP decision making

1. generate question
2. find current best evidence
3. evaluates evidence
4. makes a recommendation
5. follows up

11 knowledge and skills; SLP's who provide AR services

1. general knowledge
2. basic communication processes
3. auditory system function/disorders
4. developmental status, cognition, and sensory perception
5. audiologic assessment procedures
6. assessment of communication performance
7. devices and tech for those with hearing loss
8. effects of HL on psychosocial, edu, and vocational functioning
9. intervention/case management
10. interdisciplinary/advocacy
11. acoustic environments


the level at which sound can be detected 50% of the time

Normal hearing dB

0-15 dB especially in children

mild hearing loss dB

26 - 40 dB. in the presence of noise, speech recognition may decrease by 50%

moderate hearing loss dB

41-55 dB. dose well only face to face and/or in quiet environments

borderline normal hearing dB

15-25 dB.

moderate-to-severe hearing loss dB

56-70 dB. difficulty conversing face to face and in groups. may miss all or most of the message

severe hearing loss dB

71-90 dB. cannot hear voices, unless speech is loud

profound hearing loss dB

90 or greater. perceives sounds as vibrations

speech recognition threshold

The lowest level at which spondee words can be recognized accurately 50% of the time

speech discrimination score

a term that is not used very often anymore, refers to the percentage of monosyllabic words presented at a comfortable listening level that can be correctly repeated.

most comfortable loudness

(MCL) level sound is comfortable

uncomfortable loudness level

(UCL) level at which sound becomes uncomfortable

dynamic range

the difference in dB between SRT and UCL. this will often influence selection and programming of a hearing aid

loudspeaker azimuth

the position of the loudspeaker relative to the listener. If it's directly in front of the patient it is 0 degrees, if it is behind the patient its 180 degrees.

sound field testing

Often, speech recognition tests are presented in a sound field as opposed to under headphones. If the patient wears a hearing aid, they should wear it during testing. The clinician will indicate the loudspeaker azimuth. This helps us know how the patient hears speech in a normal everyday environment.

dead air space

unventilated air spaces. This is where audiological testing should be done to obtain the patients best performance. The room should be sound proof, insulated, and have a tight sealing door. If this is not available, you should use the quietest room you can.

purpose of speech recognition testing (9)

1. determine the need for amplification.
2. compare performance w/ and w/o hearing
3. compare different listening devices.
4. demonstrate that their ability to recognize speech is diminished. They may be unaware because they use compensatory visual cues
5. demonstrate the need or benefits of visual speech performance and speechreading training.
6. obtain info that might clarify environment related listening issues. e.g., do testing w/ and w/o background noise
7. determine placement within a training curriculum.
8. evaluate the appropriateness of an educational placement setting.
9. determine if expected benefit has been achieved. To see if the hearing aid is working.

communication mode

how a sender shares info with a receiver. e.g., speech, writing, ASL

Information transmission analysis

a statistical procedure that analyzes speech features by scoring confusion between test stimuli that are group based on features. For example, if the patient confuses eepee for eetee, they will receive credit for correctly utilizing the voicing but not the place feature.

Multidimensional scaling

a statistical procedure whereby data points are represented in a geometric space, for example, two phonemes that sound similar to a patient will be plotted near each other and two that don't will be plotted far from each other.

Cluster analysis

a statistical approach to information in a database that aims to determine which data points fall into groups or clusters; for example, it is common for, b, d, g, to be cluster together because they often sound similar to people with hearing loss

Six simple questions that may indicate a hearing loss.

1. Can you hear on the phone?
2. Do people tell you that you set the TV volume too high?
3. Do you often ask people to repeat?
4. Do you have problems in noisy rooms?
5. Do people seem to mumble?
6. Are women and children especially difficult to hear?

phonetically balanced word list

presents a set of words that contain speech sounds with the same frequency in which they occur in everyday conversations

acoustic lexical neighborhood

comprised of a set of words that are acoustically similar and have approximately the same frequency of occurrence.

Frequency of occurrence

refers to the frequency in which a word is likely to occur in everyday conversation.

A dense neighborhood

refers to words that share acoustic characteristics with a lot of other words, or rhythms with many other words. For example, fat, cat, mat and many more.

A sparse neighborhood

refers to words that don't rhythm with many other words. For example, the words lost and cost.

Advantages and Disadvantages of nonsense syllables stimuli

Advantages; performance is unaffected by vocabulary and a feature analysis can be performed.
Disadvantages; not appropriate for some children and they have poor face validity.
Face validity means it "looks like" it is going to measure what it is supposed to measure. When you are asking the client to repeat nonsense they may look at you like your crazy and think, how is this going to help me hear speech better?

Advantages and Disadvantages of word stimuli

Advantages; they have higher face validity, easy to score, and permit fine grained scoring, which mean comparing word score to phoneme score.
Disadvantages; it may not index everyday listening, because we typically listen to connected discourse, and it may not be appropriate for some who have limited vocabulary.

Advantages and Disadvantages of sentence stimuli

Advantages; it has high face validity and it's likely to reflect the real world.
Disadvantages; performance may be influenced by linguistic knowledge and by familiarity with the topic.

Test of speech recognition can be administered in one of three conditions.

Audition only;
Vision only;
Audition plus vision;

Audition only condition

only one auditory signal is presented, usually at a normal or moderately loud conversation level, 60 to 70 decibels. Alternatively, the level might be set at 30 to 40 decibels about their speech recognition threshold.

vision only condition

only the visual signal is presented, usually showing the head and neck of the test talker, this is lipreading condition.

Audition plus vision condition

both auditory and visual signals are presented, this is speechreading condition.

sensational level (SL)

is the level of a sound in dB above a person's threshold. For example, setting the audiometer 30 to 40 dB about their speech recognition threshold.

white noise

is broadband noise that has equal energy at all frequencies.

Signal to noise ratio

is the level of a signal relative to a background of noise. For example, if the signal is presented at 40 dB, and the noise is presented at 30 dB, the SNR is 10.

speechreading enhancement

the advantage afforded by adding hearing to a vision only condition.

open set task

no choices

closed set task

multiple choice, easier than open.

Disadvantages of live testing

variability from one test to another, different clinicians have different speaking styles, e.g., they may have different frequency, male or female, intonation, rate, and clarity. Also, during vision conditions, clinicians may have different physical characteristics, e.g., bigger lips, pronounced jaw, facial hair or no facial hair, expressive facial movements or Botox.

Time-compressed speech

is one way is could be altered. Speech has been accelerated by removing segments and then compressing the remaining segments together without changing its frequency.

Expanded speech

is altered by duplicating small segments so that is sounds like a slow speaking rate.
Filtered speech removes or amplifies frequency bands in the signal. This may help determine how their hearing aid should be programmed.

Low pass filtered speech

removes all high frequencies.

High pass filtered speech

removes all low frequencies.

Learning effect

occur when performance on a test improves as a function of familiarity with the test, not a change in ability.

Equivalent list

contain items that are presumed to be equally difficult to recognize. This is one way to address the learning effect problem.

Test retest variability

is a measure of the consistency of a test from one presentation to the next. this may be low because people, especially children, have different moods, motivation levels, energy, and interest, from day to day.


is the degree to which a group of test takers will achieve the same score with repeated administrations of a test. Changes in these things can also shift test scores; live versus recording, change location, change clinician, or repeating the test item more times versus last time.


is the extent to which a test measures what it is assumed to measure.

Synthetic sentences

are syntactically correct buy meaningless, and usually include a noun, verb, and object.

Two major trends are evident in modern hearing aid design;

miniaturization and enhanced signal processing.

Signal processing

involves manipulation of various parameters of a signal.

multiple memories

that allow the speech signal to be processed in more than one way.

Noise reduction

is the difference in the sound pressure level (SPL) of a noise measured at two different locations.

Acoustic feedback cancellation

is a feature that avoids the annoying squeal produced by hearing aid when the microphone picks up the amplified sound from the hearing aid and re-amplifies it.

Programmability in a hearing aid means

that several parameters of the instrument, such as gain, are controlled by a computer.

A hearing aid that uses digital processing

converts the signal from analog to digital form, processes the signal to achieve target, and then converts the signal back to an analog form.

Analog means

what the acoustic signal turns into after going into a microphone.

A hearing aid with multiple channels

filters the signal into frequency bands so that some bands, usually the high frequency ones, can receive more gain than others.

Directional microphones

are more sensitive to sound originating from in front of the user than to sound coming from behind them.

Omni directional microphones

are sensitive to sound coming from all directions.

Automatic directional microphones (ADM)

automatically switch between an Omni directional and directional mode according to environmental conditions.


the difference in decibels between the input and output level.

the preamplifier stage

the signal from the microphone is amplified.

In the signal processing stage

the signal is manipulated to enhance or extract component information.

In the output stage

the process signal is boosted.

Maximum power output (MPO)

is the maximum intensity level that a hearing aid can produce.

Peak clipping

is a method of limiting hearing aid output in which a constant or linear amount of gain is provided across a range of input levels until it reaches a saturation level, at which time the amplifier begins to, clip, off the peaks of the signal.

Saturation level

is the point at which an amplifier can no longer increase output compared to input. The hearing aid can't make the sound any louder because it has reached its (MPO).


is a nonlinear form of amplifier gain used to determine and limit output gain as a function of input gain. This helps limit the max sound so it's not uncomfortable to the client. This also helps soft sounds become more amplified than loud sounds.


is the point on an input-output function when compression is activated.

Compression ratio

is the dB ratio of acoustic input to amplifier output. For example, if a sound enters the amplifier and increase to 20 dB, but leaves at 10 dB, because 20 is uncomfortable for the client. That compression ratio is 2 to 1.

attack time

The amount of time that it takes a compression amplifier to react to a loud sound and compress it

The release time

is the time it takes for the compression amplifier to increase its gain again once the really loud sound has stopped.

Multiband compression

is a method to maximize speech recognition. It permits different degrees of compression for different frequencies.

An audio boot

also called a shoe, is a device that is used with a behind the ear hearing aid for coupling to a direct audio input cord, such as a TV or radio. they can block out surrounding environment noise and strictly listen to the TV.

A telecoil

sometimes called a t-coil or an audiocoil, in an inductive coil, which is a coil of wire wrapped around a magnetized metal rod, within a hearing aid. It enhances telephone communication. The phone emits electromagnetic signals, which are picked up and the hearing aid is bypassed.

T and M stand for...

The hearing aid may include a T for telecoil and M for microphone by the on off switch.

Body hearing aids

include a box worn on the torso and a cord connecting it to an ear-level receiver. It is the size of a deck of cards. It provides much more powerful amplification and use for those who have severe hearing loss. Despite the amplification advantage, body aids are not used often today, unless the client has a pinna that cannot support a behind the ear hearing aid, atresia, microtia, or chronic otitis media. The body aid may be attached to a bone conductor.

A bone conductor

is a vibrator or oscillator used to transmit sound to the bone of the skull. This bypasses the middle ear and is used for those with obstruction of the middle ear. Clients with atresia, microtia, or chronic otitis media can also benefit from this type of hearing aid.

A behind the ear (BTE) hearing aid

is worn over the pinna and coupled to the ear by means of an earmold, which must be custom made, or a tube, which fits anyone. The tube option reduces the annoying occlusion effect.

In the occlusion effect

low frequency sounds in bone conducted signals are enhanced as a result of closing of the ear canal. For example, you can hear your heart beat and hear yourself chew.

In the ear (ITE) hearing aid

fits into the concha of the ear.

In the canal (ITC) hearing aid

fits in the external ear canal.

most popular hearing aids in todays market

ITE and ITC hearing aids must be custom fit. They are less susceptible to wind noise. They are somewhat hidden and more cosmetically appealing.

Completely in the canal (CIC) hearing aid

are completely hidden. They are so small that they do not have on off switches on them and require the use of a remote control.

Disadvantages to CIC

they are high maintenance, ear was builds up, needs cleaned often, do not have directional microphones.

Middle ear implants

convert sound into a micro-mechanical vibration and transmits it directly to the ossicular chain. This device has not been widely used.

Binaural versus monaural fitting

Often the clinician will recommend that the client will need two hearing aids instead of just one, even though its more expensive

Why you should have 2 hearing aids (4)

1. It will eliminate the head shadow effect. If you only have one hearing aid and the sound is coming from the unaided side, you still can't hear well enough.
2. Loudness summation; when sound is received by both ears a summing of the two signals results. Thresholds for sound may improve by 3 dB or more.
3. Binaural squelch is an improvement in listening in noisy environments. This improvement in signal to noise ratio may be 2 or 3 dB.
4. Localization; the ability to perceive the direction and location of sound when using both ears.

When selecting a hearing aid you want to consider (5)

1. degree of loss; eg. those with profound hearing loss would benefit from a body aid
2. user preference; eg. some are too self conscious to wear BTE
3. cost; eg. CIC may be too expensive
4. lifestyle; eg. A nurse who uses a stethoscope everyday may need a CIC
5. physical status; eg. gross and fine motor skill may determine how well they can manipulate the controls and change the batteries

The output sound pressure level (OSPL)

once called the saturation sound pressure level, refers to the max level of sound that can be delivered to the ear when the volume is turned full on and the input signal is 90 dB. This value is determine to make sure that the hearing aids max power does not exceed the user's loudness discomfort level.

Loudness discomfort level (LDL)

is the level at which sound is perceived to be uncomfortable loud. AKA, uncomfortable loudness levels (UCLs), but Others prefer threshold of discomfort (TDs). Regardless of what you call it, LDLs, UCLs, and TDs all refer to the same thing. Something a little different, however, are ULCs, which stands for the upper level of comfort. This is the level right before uncomfortable.

OSPL 90 curve

is an assessment of a hearing aid's maximum level of output signal with volume set to full on. This assessment is done in a hearing aid test box.

A hearing aid test box

is a chamber that simulates the human external ear canal volume.

Total harmonic distortion (THD)

is unwanted signals created by the hearing aid.

Prescription procedures

are strategies for fitting hearing aid by using a formula to calculate the desired gain and frequency response. The audiogram will indicate the degree of hearing loss and how the hearing aid needs to be configured.


means to determine that the hearing aid meets a set of standards, including standards of basic electroacoustics, real ear performance, and comfortable fit. You can administer a speech recognition test with and without the new hearing aid. You can also use a probe microphone.

A probe microphone

is a microphone transducer that is connected to a flexible tube and inserted in the external ear canal for the purpose of measuring sound near the tympanic membrane. The test is done with and without the hearing aid.

Real ear measures

uses a probe microphone to measure hearing aid gain and frequency response delivered. If this test reveals we have reach our prescribed gain, we have reached are target gain.

Target gain

is the prescribe gain we wanted to achieve with the hearing aid.
A clinician can also subjectively assess the hearing aid by using a questionnaire or inventory.

Hearing aid orientation (HAO)

is the process of instructing a patient and or family member, to handle, use, and maintain a new hearing aid.


refers to a series of steps to follow when the hearing aid will not turn on, if the sound if faint or distorted, or feedback occurs, to correct the malfunction. Steps to try first; change the battery and clean off wax.

A cochlear implant is effective because

it replaces the hair cell transducer system by stimulating the auditory nerve directly, bypassing the damaged or missing hair cells.

Tonotopic organization

high frequency bands are delivered to the basilar end of the cochlea and low frequencies are delivered to the apical end.

basal end

the base

apical end

the tip

parts of the cochlear implant

comprised of internal and external parts, although soon manufactures are offering completely implantable. The internal components are in the skull by the inner ear. The receiver is on the mastoid bone, and an electrode array, which is inserted into the cochlea through the round window. The external parts include a microphone, connecting cables, a speech processor, and transmitter. The microphone and transmitter are typically worn behind the ear. The speech processor attaches to the mastoid bone magnetically.

The term multichannel is used to describe a cochlear implant because

it presents different channels of information to different parts of the cochlea. These channels help the implant to act like a normal cochlea would with Tonotopic organization.

Interleaved pulsatile stimulation

is an algorithm that many current cochlear implants use. It is a processing strategy. This is the newest one that represents different frequency bands tonotopicly like a normal cochlea would.

Candidacy for cochlear implant

the presence of bilateral, irreversible, severe or profound hearing loss, and good general health.

is there an age limit for cochlear implants

There is no upper age limit, however the younger the client is, the better the success. The lower age limit is at least 12 months, although children as young as 6 have been implanted. The cochlea is adult size at birth so implantation in babies is feasible in the future.

what must children do before getting a cochlear implant

Children must demonstrate that they receive no benefits from hearing aids and they must try for 6 months.


is a term used to describe the process of programming the speech processor of a cochlear implant. Mapping includes programming dynamic range, loudness balancing, and pitch ranking.

Dynamic range for a cochlear implant

is determined by finding the clients electrical threshold, (T-Level) and Maximum comfort level, (C-Level). The difference between these two ranges is the dynamic range. These levels will vary depending on the clients neuronal survival in the auditory nerve.

cochlear implants; the T level

is the amount of current that must be passed through an electrode so the client is just aware of a sound sensation.

The C level

is the maximum current level that can be introduced before the client experiences discomfort.

If the electrodes are not balanced in the cochlear implant

the client may hear popping sounds or may not hear some speech information.

Pitch ranking for cochlear implants

determines the ability to discriminate pitch from the basal to the apical electrodes. During pitch ranking, two electrodes are stimulated, one right after the other. The clients task is to determine which has a higher or lower pitch.

Assistive listening devices, (ALD)

are usually only used in specific situations, as opposed to hearing aid that are used during all waking hours. They basically collect sound from the talkers mouth and deliver it to the users ear, no matter how big the room is.

Assistive listening devices can be more useful than hearing aids

when you need to hear a distant speaker, TV, church services, or in a classroom. This is because in hearing aids the microphone is in the ear and can only pick up sounds close by.
Assistive listening devices also come in handy when you experience ambient noise, reverberation, and background noise.

Ambient noise

is present in a room when it is unoccupied. This may emanate from open windows, vents, computers, or lights buzzing.

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