Exam 2 Aud Rehab

The ________ rate is the proportion of babies who have hearing loss who were missed during the screening.
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The ________ rate is the proportion of babies who have hearing loss who were missed during the screening.
false-negative
A _____ occurs when a baby does not have hearing loss but fails the screening test.
False-positive
A ______ occurs when a baby has hearing loss but passes the screening test.
False-negative
Risk factors for hearing loss
- Low birth weight (<3.3 lbs)
- Family history of hearing loss
- In utero infections (rubella, herpes, cytomegalovirus)
- Otoxic medications
- Low Apgar scores (test given at birth to determine health)
- Craniofacial anomalies
- Bacterial meningitis
- Severe jaundice
Risk factors
variables associated with an increased or decreased risk of disease or infection
Congenital hearing loss
presence of hearing loss established at birth,
Acquired hearing loss
hearing loss that occurs after birth
_____ are conditions that help define one`s life, such as relationships, family, education, and occupation.
Life factors
Examples of pertinent medical history
- Medications
- Chronic conditions
- Hearing-related history (ear-infections, pain, drainage, tinnitus, vertigo)
- Hearing aid history
Types of hearing and communicative behaviors
- What does the child do in the presence of different sounds?
- How does the child communicate?
- Is the child reaching hearing and communication milestones?
WHO-ICF - differential impact of environmental/social factorsAsk about the child`s - Home setting - Family members in the home - Language spoken in the home - School or daycare setting - Peer interactions - Social developmentMost adults with hearing loss have learned how to __________ and _______ because their life factors are in place.listen, communicateCase history for adult hearing difficulties:- What brings you in today? - What sort of hearing problems are you having? - Consider administering the Hearing Handicap Inventory for Adults (HHIA) questionnaire.What events trigger a hearing test for a child/infant?1. Failed hearing screening 2. Child is not responding to sound/speech/etc.Universal Newborn Hearing Screening (UNHS)Screening for hearing loss in all newborn infantsIf intervention is given by 6 months old, children will have normal language and literacy skills by age ____.3Objective pediatric hearing testthe child does not have to do anything to produce results (Ex. OAE, ABR)Behavioral pediatric hearing testthe child participates in some way to get the test results (Ex. CPA, VRA)Auditory Brainstem Response (ABR)For NBHS - Can estimate frequency-specific thresholds for purposes of hearing aid or cochlear implant fittingAuditory Steady State Response (ASSR)useful for estimating frequency-specific thresholds in profound hearing loss casesOtoacoustic Emissions (OAEs)most common objective test used in NBHSBehavioral Observation Audiometry (BOA)method of testing a child`s hearing in which the tester presents a sound stimulus and observes the child`s behavior for change - 0-6 months of age - Disadvantage: too variable; ABR and OAE preferredVisual Reinforcement Audiometry (VRA)method of testing young children in which presentation of the sound is coupled to lighting of a toy for reinforcement of the child`s response - 6 months - 2 yearsConditioned Play Audiometry (CPA)method of testing children 2.5 years and older in which the child is trained to perform a task in response to the presentation of a soundPrelingual hearing lossacquired after birth but before the child has developed language (3/1000)_______% of parents who have a child with hearing loss have normal hearing.90-95Causes of pre-lingual hearing loss- Cytomegalovirus - Maternal rubella - Anoxia - Microcephaly - Usher Syndrome Etc.Idiopathic hearing losshearing loss with unknown originGenetic hearing losscaused by the presence of an abnormal gene within one or more chromosomesNon-genetic hearing losscaused by inflammatory disease, toxicity, noise or injury that inflicts damage on any part of the auditory system.Non-syndromic hearing losshearing loss that has no other associated findingsSyndromic hearing lossHearing loss associated with a syndromeExternal CI componentsMicrophone, speech processor, transmitter coil, external magnetInternal CI componentsInternal magnet, receiver/stimulator, electrode arrayHearing aid features the improve ease of use- Volume control - On-off function - Direct audio input - Telecoil - Accessory compatibilityHearing aid features that improve sound quality- Advanced signal processing - Multiple memories - Noise reduction circuits - Feedback cancellation - Wireless programmingGlascow Hearing Aid Benefit Profile (GHABP)Assess individual`s concerns/expectations in a variety of difficult listening situations Ex. In x situation, what proportion of the time fo you wear your hearing aid?Hearing Aid Performance Inventory (HAPI)Assess the benefits of amplification in varying listening situations Ex. You are alone at home talking with a friend on the phone. (5 point scale: 1 = very helpful, 5 = hinders performance)Hearing Aid Users QuestionnaireTo detect problems that affect a patient`s ability to use hearing aids and receive benefit. Ex. How would you describe your satisfaction with your hearing aid? (4 point scale: 1 = very satisfied, 4 = very dissatisfied)Hearing Problem InventoryTo assess benefit of using a hearing aid and to identify some of the influences on a patient`s perception of his or her problems and hearing aid use. Ex. The telephone pickup on my hearing aid is good. (5 point scale: 1 = almost always, 5 = almost never)Profile of Aided Loudness (PAL)To determine whether amplification has restored loudness. Ex. You are chewing soft food: Loudness rating (Scale from - to 7: 0 = do not hear; 7 = uncomfortably loud); Satisfaction rating (scale from 5 to 1: 5 = just right; 1 = not good at all)Profile of Hearing Aid Benefit (PHAB)To generate a measure of hearing aid benefit computed from the difference between aided and unaided conditions Ex. Answered with and without hearing aid) Women`s voices sound shrill (7-point scale: A = always; G = never)Abbreviated Profile of Hearing Aid Benefit (APHAB)To generate a measure of hearing aid benefit in a clinically feasible amount of timeProfile of Hearing Aid Performance (PHAP)To generate a measure of performance rather than benefit Ex. When I am in a quiet restaurant, I can understand conversation (7-point scale: A = always; G = never)Satisfaction with Amplification in Daily Life (SADL)To quantify hearing aid satisfaction Ex. Are you convinced that obtaining your hearing aid was in your best interest? (7-point scale: A = not at all; G = tremendously)assistive deviceAny device that helps a person with hearing loss or a voice, speech, or language disorder communicateassistive listening device (ALD)help amplify the sounds you want to hear, especially where there`s a lot of background noise. Can be used with a hearing aid or CIAmbient noise levels are high in _______Classrooms, offices, hospitalsReverberation is high in ______Places of worship, theatres/auditoriums, courtroomsBackground noise is high in _____Restaurants, classroomsHardwired systems have _____connected by wires for direct audio inputType of wireless systemsFM Infrared Induction loop BluetoothFM systemsFrequency Modulated - utilize radio waves to transmit sound from the source to the user between 72 mHz and 216 mHzPersonal FM- speaker wears a wireless microphone and the speech is sent via FM radio waves transmitted through room to listener who wears receiverSound field FMsound from microphone to loud speakers --> the personal hearing aid microphone picks up the signalInfrared systemsinfrared light transmits the sound, worn like earbuds Most commonly used for TV listening devices Small theatersInduction loop systems- Use electromagnetic energy to transmit sound - Amplified sound travels through the loop and creates an electromagnetic field that is picked up directly by a telecoil - To pick up the signal, the person must be using their telecoil and be near the loop4 Parts of the Loop System1. A sound source 2. An amplifier 3. A thin loop of wire that encircles a room or branches out beneath carpeting 4. A receiver worn in the ear or as a headsetBluetooth systemsSimilar to FM systems, but use Bluetooth technology - Personal microphones - TV listening devices - Phone streamingBehind the Ear (BTE)All ages Mild to profound hearing loss Good for people with earwax buildupIn the Ear (ITE)Completely fits inside the outer ear Mild to severe hearing loss Adults onlyIn the Canal/Completely in CanalMild to moderately severe hearing loss Not for children or severe to profound hearing loss since smaller size leads to limited power/volumeAnalog hearing aidConvert sound waves into electrical signals, which are amplified, adjust for hearing environments, and are cheaper than digitalDigital hearing aidsConvert sound waves into numerical cods before amplifying them. Can amplify some frequencies more than others to adjust for hearing environments and sound from different directionsCochlear implanta device for converting sounds into electrical signals and stimulating the inner hair cells/auditory nerve through electrodes threaded into the cochleaCI microphonePicks up sounds from the environmentCI speech processorselects and arranges sounds picked up by the microphoneCI transmitter and receiver/stimulatorreceive signals from the speech processor and convert to electrical impulsesCI electrode arraySends impulses to the brain through auditory nerve stimulation.Who is eligible for a cochlear impant?Young children who are deaf or hard-of-hearing, adults who have lost all or most of their hearingTelecoilreceives an electromagnetic signal from the hearing loop and then turns it back into sound within the hearing aid or cochlear implantPatient OrientationSales Orientation______% of children with congenital hearing loss have risk factors at birth/.50%For children, we ask about these 3 factors when taking a case historyrisk, environmental, and socialFor adults, we ask about _____ factors.LifeWhat 2 events trigger a hearing test for an infant/child?1. Failed hearing screening 2. Child not responding to sound/speech/etcMore than ____% of babies born in US hospitals have a hearing screening before discharge.90Anoxiaabsence of oxygenCytomegalovirusherpes-type virus that usually causes disease when the immune system is compromisedMaternal rubellacauses deafness, CNS damageUsher syndromeSyndrome presenting deaf and blindness; caused by autosomal recessive inheritanceAuditory neuropathya hearing disorder in which sound enters the inner ear normally but the transmission of signals from the inner ear to the brain is impairedMicrocephalyabnormally small headHearing aid style depends on _______.Type, degree, configuration of HL User preferences Dexterity/Visual acuityData loggingHow many hours/day is the person wearing their hearing aids?Aided hearing aid benefitHow much better are a person`s hearing thresholds when tested with hearing aids?Self-reportlikely the most important outcome from an AR perspective, considering the WHO-ICF frameworkWhen were cochlear implants approved for adults?1980sWhen were cochlear implants approved for children?1990CI candidacy- 18 years of age and older - Moderate to profound, bilateral sensorineural hearing loss - Limited benefit from hearing aids - Defined by preoperative test scores of ≤ 50% sentence recognition in the ear to be implanted and ≤60% in the opposite ear or binaurallyCI Candidacy for PediatricsYounger than 18 years of age 12 - 24 months : - Profound, bilateral sensorineural hearing loss - Limited benefit from hearing aids : 2 - 17 years : - Severe to profound, bilateral sensorineural hearing loss Limited benefit from hearing aids - Multisyllabic Lexical Neighborhood Test (MLNT) or -Lexical Neighborhood Test (LNT) scores ≤ 30%Hybrid CI System is used for _______- Low-frequency residual hearing is in tact - Single-sided deafness - Auditory neuropathy/dys-synchrony - Enlarged vestibular aqueductCI Implant JourneyCandidacy evaluation: Hearing test Speech audiometry in quiet and in noise With vs. without hearing aids Consultation with surgeon (neuro-otologist): MRI/CT scan to determine if cochlea intact Rule out other surgical contraindications Device counseling and selection with audiologist Surgery: "23-hour procedure" Post-surgical healing time: 2-4 weeks Initial activation AR, device maintenanceOn the horizon for CI ______- Fully implantable implants - Candidacy expansion - Optical cochlear implantsPeak clippinga 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 signalHearing aid saturation levelHearing aid compressionGrief cycleshock, denial, anger, bargaining, depression, testing, acceptance