Candidacy Exam 2022 (Instrumentation, Amp, AR)

T/F: AR services are able to be reimbursed by the centers for medicare and medicaid services as well as by 3rd party insurers
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T/F: AR services are able to be reimbursed by the centers for medicare and medicaid services as well as by 3rd party insurers
False
T/F: Within the definition I provided in the course concerning the the definition of AR, someone who provides only diagnostic services would not be considered as providing AR services
False
T/F: the four military hospital centers established at the end of WWII were primarily focusing on diagnosing the servicemen's hearing as well as fitting hearing aids for those individuals who exhibited hearing loss
False
T/F: Even before commercial HAs were developed, there were centers providing AR services such as lipreading classes
True
Which of the following sentences is not correct as it pertains to the medical model?
the medical model is most effective when applied with individuals with chronic disorders
Which organizations are responsible for some portion of the regulations regarding hearing aids? What are their roles?
The Federal Trade Commission (FTC): monitors anticompetitive practices and ensures that there aren't hearing aid monopolies. They also monitor online or over the counter hearing aid sales.

Food and Drug Administration (FDA): monitors dispensers, vendors, and audiologists. The FDA can also monitor claims that are said about hearing aid benefits and success.

Federal Communications Commission (FCC): monitors batteries and wires, telecoil, phones, and frequencies that hearing aids can operate at, as well as Bluetooth. The FCC can ensure that phones have the appropriate electromagnetic field for t-coil to operate at.
Test-box measures are critical to ensure the proper function of hearing aids even before fitting a client. Name and describe 2 of the test-box measures we discussed in class.
OSPL90: makes sure the hearing aid works by doing a saturated output sound pressure level test.
--goal: put in an input so loud that the hearing aid is no longer applying amplitude to the signal.
--don't want to exceed it and damage the client's device or hearing.

frequency response test: shows how much gain is being applied across the frequency spectrum.
Couplers are used to estimate what? Why are they not necessarily accurate but still a reasonable tool to use?
Used to estimate how sound interacts in the ear.
--reasonable tool to use because a 2cc coupler is used, but every ear is still different!
--norms for couplers were developed in the 1940s and 50s based on the above average American man (WWII soldiers).
-----Not necessarily accurate.
Though not a governmental organization, why are ANSI standards used for many hearing aid related measures?
In the 90s, hearing aid companies and audiologists voted to regulate themselves, and because ANSI has standards relating to acoustics, microphones, and so on, ANSI standards are written and then can be applied by the regulatory bodies. Also, organizations, like ASHA, can develop standards and submit them to ANSI committees. They are voluntary, but not required.
Discuss the big three parts of a hearing aid, what do they each do?
The microphone picks up sounds, the processor manipulates that signal (adds gain or manipulates frequencies, etc.), and the receiver/speaker sends the signal to the ear.
What are the benefits and drawbacks of body-worn hearing amplification devices compared to behind the ear hearing aids? (assuming technological equivalence)Benefits: accessible for the time, produced little to no feedback, provided the easiest to use and see user controls. Drawbacks: bulky and heavy, prone to noises from clothes rustling, worn under layers of clothes, and people don't normally talk to your stomach. Also, they were hard to hide cosmetically and the wires were prone to breakage.How is amplification different in an analog device compared to a digital device?Analog device: input is amplified and we get the output. Also, the amplification is the same across all frequencies. Digital device: signal enters as an analog signal, is converted to a digital signal, and is then converted back to analog again. Analog is more fixed and continuous, while digital is more discrete and has to have A/D and D/A conversions.Detail the benefits and drawbacks of softer material ear molds compared to harder (acrylic) ear mold materials.Silicone and softer material ear molds are better for kids. --a bit tackier or stickier and tend to stay in the ear a little better. --can cause an occlusion effect (although it is subjective and there is no evident pattern of this). --typically used with profoundly Deaf people to get a very tight seal. Acrylic earmolds: useful for older people who have thin ear skin and lower dexterity because acrylic is better for retention purposes. --least allergenically reactant, --easiest to modify via dremmel --easier to clean --potential to give the user more feedbackHow are analog signals represented digitally?Analog signals: represented digitally through binary code. When intensities come in, they are changed to long strings of 1s and 0s, which is binary code. HAs= 64-bit systems Nyquist frequency= the sampling rate has to be at least double the frequency of the sampled sound in order to accurately reproduce it (and not end up with a line or a square wave).What methods can we use to alleviate concerns with the occlusion effect?To try to alleviate concerns with the occlusion effect, users could try out domes or other earmold styles other than full shell. Another tool to try to combat the occlusion effect is adding venting to earmolds. They can help the ear breathe and assist with pressure equalization, but unfortunately, they can also cause feedback or whistling.What is digital delay, why is it important to consider in hearing aid design?Digital delay is the amount of time it take for the signal to be converted to from analog to digital, processed, and then converted back into analog. If digital delay is 15ms or more, the hearing aid user can notice this difference and will become disoriented. Therefore, hearing aid designs and companies try to ensure that sound will be processed and reach the user as fast as possible. No one wants disorienting and seemingly slow processed sound as it's happening in real time! It would be like buffering in real life.Case Study: A 65 year old women with the audiogram below comes in, will you fit a hearing aid? What sort of information do you want from you client? Will you use an earmold? What style? Is a dome suitable? A bit of background: she lives a fairly active lifestyle (dinners, seeing friends), and works in a quiet office. She had moderate rheumatoid arthritis, and does express concerns that hearing aids appear quite small.I would fit the client with a hearing aid if she were concerned about her ability to communicate and continue living her active lifestyle. I also would like to know if she wants the ability to stream on a hearing aid (perhaps music or audiobooks), if she has worn hearing aids or used devices before, and what her goals for amplification are. Based on her moderate to severe loss, I think bilateral hearing aids would be a good tool. Also because of her moderate rheumatoid arthritis, I would first show her a RIC and a dome but keep in mind that with her physical limitations and hearing loss, a dome may not be the best fit. Depending on her ability to physically manipulate the dome, I would then probably recommend her either a skeleton acrylic ear mold or a device that goes into the canal. I wouldn't recommend a full shell earmold since she works in a quiet office; this may cause her to be occluded quite often. Also, with her level of hearing, I don't think a full shell earmold is necessary.impairmentrefers to dysfunction at the organ leveldisabilityrefers to the impact on one's daily ability to do an activityhandicaprefers to the effect on one's role in societyAR encompasses all of the following exceptmedical interventionT/F: There is a direct relationship between impairment, disability, and handicap; that is, an impairment predicts the extent of one's disability, and in turn, one's disability in a modality predicts how much of a handicap one will haveFalseT/F: One reason that the WHO moved from the international classification of impairment, disability, and handicap (ICIDH) model to the international classification of function and health (ICFDH) is that environmental influences and personal characteristics weren't accounted for in the earlier ICIDH model.TrueWhich of the following does not pertain to quality of life as discussed in my lecture and your readings?economic well-beinglabeling theory best refers togroups in power have a tendency to assign negative labels on groups of individuals who have less influence and who demonstrate deviance from cultural normsT/F: Labeling of members of society varies from place to placetrueT/F: Labels remain constant over timefalseas it pertains to concealability as it applies to acquired hearing loss, please list a potential advantage as well as a disadvantage of this attributeAdvantage: if a person can conceal their hearing loss, either by hiding their HAs with their hair or by simply not disclosing it, they have the ability to tell their communication partner that they have a HL specifically when thy choose to Disadvantage: if a person's hearing loss is concealed, they might lose access to communication opportunities and risk having no visual cues, good lighting, or other communication techniques employed by their friends and family. In this case, the family/friends simply don't know the person has a HL and is thus unable to support their access to communicationPlease describe why the psychosocial consequences of hearing loss may differ between individuals with a congenital hearing loss and those with a late onset hearing lossthose with a congenital hearing loss may experience isolation, anxiety, and frustration, the same way that those with late onset hearing losses do, but they have also been born with and grown up with a hearing loss. This means that they have become more accustomed to living their life with a hearing loss and what it means socially , emotionally, in communication. For people with late onset hearing loss, they may experience grief or a sense of loss. because they once had an entire life shaped around being hearing and now they do not. They may not know how to move forward socially, emotionally, and with communication, as well as with employmentT/F: adults with acquired, untreated hearing loss report higher levels of anxiety and depressiontrueT/F: older adults with acquired , untreated hearing loss self report poorer health at three times the rate of their hearing peerstrueT/F: research shows that the prevalence of peer victimization (bullying-such as teasing, rumors, exclusion) is not higher than that of hearing peersfalseT/F: the possible effects on siblings when there is a hearing loss in their brother or sister often depends on how the parents address the situationtruelist two possible secondary psychosocial consequences that can arise from the communication difficulties experienced by children with hearing life1. isolation 2. bullying from peersT/F: a culture of any group tends to be static, changing little over timefalseT/F: how one perceives one's identity is shaped greatly by just a few variables/traitsfalseT/F: prejudice is characterized by judging someone negatively without adequate knowledge or reason, but on predisposed beliefs that one cultural group is superior to anothertrueT/F: audism is based on the notion that one is superior based on one's ability to hear or behave in the manner of one who hearstrueTwo reasons why members of a culturally linguistically diverse group may not follow up on a referral (serve as a barrier) for a medical/audiology appointment1. lack of insurance 2. mistrust/distrust of healthcare as an institutionWhen assessing whether a person is a candidate for hearing aids:D. The patient's listening needs and expectations are the major factors.Which FREQUENCIES are impacted by LARGER vent sizes? How are they impacted by larger vent sizes?lower frequencies (below 2000 Hz) lose energy when you add a larger vent - as the sound leaks out of the ventWhich of the following is the most viable option to reduce the occurrence of feedback when fittingB. Create a better seal in the ear using a tighter earmold or a material with better retentionpatient arrives to clinic complaining that their ITE hearing aid is "weak", what should be completed first as part of the troubleshooting processlistening checkTo restore normal loudness growth for a moderate SNHL, a hearing aid should amplifyA. soft sounds by a lot, and loud sounds by little or nothing at allRECD is:A. The difference between the hearing aid gain in the 2-cc coupler and the REUG.REAR, REIG, REUR, and REUGREAR, real ear aided response: look at most often to see if the hearing aid is meeting its targets and if it's doing anything at all REIG, real ear insertion gain, is the REAR minus the REUR (real ear unaided response). In other words, REIG is the aided response minus the unaided response. If the REUR is equal to the REAR, we are able to see if the hearing aid is working or not. REUR is a REM that records the TM response without the hearing aid in and allows us to get a baseline for the person's "natural" hearing. REUG, real ear unaided gain, is a REM that takes an unaided measurement of the gain when the canal is unoccluded.AGCi, AGCo, and WDRC.AGCi, or automatic gain control inputs, allows us to alter or understand a signal before it's amplified, then let it go through processing. --goal is to shrink the overall window of where sounds are to ensure that the sounds will always fall below the client's loudness discomfort level. .AGCo, or automatic gain control outputs, allows a sound to be processed, then lets us understand or alter it. This allows that as the sound goes into the ear during the final step, it's not too loud. WDRC, wide dynamic range compression, is an implementation of AGCi with a relatively low compression threshold. For example, every 4 dB increase in input, there's only a 1 dB increase for output gain. WDRC is best for people with mild to moderate hearing loss, though it can be used across all degrees. It ensures that little to no gain is applied for loud inputs, while applying a lot of gain for soft inputs. Goal is to ensure soft sound audibilityDefine compression and expansion,Compression: nonlinear amplification, in which certain soft sounds can be made louder without loud sounds being made uncomfortable (for example). Not a 1:1 input/output function Compression and gain are essentially two sides of the same coin. AS gain decreases, input level increases. Compression can also either cap gain as sound comes in and is set it at a level, or sound can come in ad then be smooshed into a capped constraint. Expansion makes softer sounds amplified less than louder sounds, delivering different amounts of gain depending on the input level. In expansion, however, gain increases as input level increases.A client with the hearing loss configuration displayed below has just completed your standard audiometric evaluation. Everything points to SNHL, and the client is interested in pursuing amplification. Detail how you would assess the needs/desires of the client, any programs you might suggest to assist this client (based on your assessment of needs, feel free to be creative! Maybe your client goes to meetings, loves bars/clubs, etc), and then how you confirm the hearing aid is functioning.To first assess the needs and desires of my client, I would perform a hearing needs assessment and walk through everything with them. First, I would ask about face to face communication, then media, then the phone, and then alerting. Each category would be evaluated within the spheres of home, work, and recreational activities. Based on the needs assessment, it was determined that my client really wants to hear her daughter when she comes home from college and her wife more. She also has constant bilateral tinnitus and wants to see if amplification could help that. In terms of media, she needs better access to her phone and computer and work, as well as at home, so it doesn't affect her work performance. She feels okay about alert systems when her wife is home, but when she is alone, she worries about hearing emergencies and the smoke detector. Recreationally, she'spart of a bowling league but can only understand her teammates' scores by looking at the screen. She misses out on a lot of the side conversations and group activities. I would suggest a tinnitus program on the hearing aid with sound therapy to help the client with her tinnitus. I would also start with domes but potentially change to earmoldsdepending on how the client feels and how the seal seems to be. Lastly, I would run REM and speech mapping with ISTS, particularly REAR, REUR, REIG, and REUG to determine if the hearing aid is functioning. If the REUR and REAR are equal, that would let me know that the hearing aid is not working rightIf you wanted to shorten the reverberation time in that room, what would you do?Decrease room volume (find a smaller classroom, for example)increase sound absorption (lay down carpet, put curtains up)If a signal decays 20dB in .7 sec., what is the RT60?2.1 secWhich populations are most vulnerable to the effects of a prolonged reverberation time when listening to speech? Why are these groups the most vulnerable?Children, people with hearing loss, elderly adults, and people with auditory processing difficulties are the most vulnerable when it comes to prolonged reverberation time and listening to speech. For people with hearing loss, the auditory access they're getting is further damaged by a lack of clarity in the signal. For children, they don't have the ability to fill in the gaps when trying to understand speech with a prolonged reverberation time; this is especially difficult for children with hearing loss.What is the function of bandpass filtering for hearing devices?Filters are designed to remove specific frequencies from a signal, and bandpass frequencies allow the established bandwidth frequencies through. Therefore, a bandpass filter in a hearing aid provides control over frequency characteristics of hearing devices by allowing only the established bandwidth frequencies through.What is the function of a band stop filter?A band stop filter is the opposite of a band pass filter, in the sense that specific frequencies are screened out of the signal, and everything else is allowed to pass through.What is happening in an open circuit? What could be a cause?An open circuit could be caused by a break in the circuit wires and occurs when the circuit can no longer be completed (due to a problem with the power source, path, or resistors).What is the difference between a condenser and a dynamic microphone?Condenser mics are more capable of recording crisper and clearer sounds, while dynamic mics are often more durable and can record sounds with greater intensity without distortion. Condenser microphones are also electret microphones with a backplate. Dynamic microphones are made from wire coils in a magnetic field.Which is the most commonly used dB scale?dB AWhat is the purpose of the interrupt switch on an audiometer?he interrupt switch on the audiometer cuts out all other sounds and allows the client to hear only the presentation tone/signal.Which room in your home is likely the most reverberant? Why?My bathroom is likely the most reverberant because there is only tile, no carpet. It also has high ceilings and large open spaces. Also, the shower is open, has a metal bar and is tiledWhat is the utility of perforated interior walls in a sound booth?The perforated interior walls aid in sound absorption inside the sound booth.What are at least two benefits of not having extra equipment or furniture in a sound booth during testing?Having no extra equipment or furniture in sound booth testing reduces the amount of surfaces that the sound signals are bouncing off of. Having less equipment in the room also allows for continuity of testing. If one booth has equipment in it, but the next doesn't, how do we know if the audiometric results are accurate.What is needed to form an electrical circuit?path power source resistorsWhy is a shorter reverberation time preferred in a classroom environmentA shorter reverberation time is preferred in a classroom environment because it allows for children, specifically children with hearing loss, to have access to clearer auditory signals and have better comprehension, versus when there is interference. Also, most instruction in a classroom is verbal, so it is imperative that the child in the class can both hear and understand what's going on in order to learn. A longer reverberation time can disrupt temporal cues and may mask the original sound.Please describe at least two advantages of digital signals, as compared to analog.Digital signals are easier to manipulate in terms of frequency isolation. Digital signals also have power efficiency.What does a remote microphone mixing ratio indicate?A remote mic mixing ratio indicates how much of the sound is coming into the ear level mic on the hearing aid, versus how much sound is coming through the remote mic. For example, 1:1 or 50/50 means it's a completely even split between remote mic sounds and ear level mic sounds.what was the first step that was recommended if clinicians want to develop heir cross cultural competence skillsclinicians engage self reflection whereby the individual examines his or her own culture, biases and views, thus, realizing the influences of culture on themselvesthe health beliefs model is characterized by four major assumptions that either predict or explain a health related action. which of the following is not one of these assumptions?the degree of cultural competence of the physician can greatly influence whether the patient moves forward with a recommended treatment planASHA defines evidence based practice as an approach whereby three of the following aspects are included but which one is notstate licensing governancecarl rogers maintained which aspect is the most powerful ingredient in solidifying the therapeutic relationship?empathythe problem solving framework includes which 3 components1. identifying the problem 2. formulating a plan 3. taking actioninformational counselingact of explaining or conveying content to clients and/or family memberspersonal adjustment counselingassists clients to confront a range of psychological and emotional reactions as it relates to the clinician's own specialty areanarrative story tellingprimary goal is to help clients externalize problems so they can consider their relationship to the problem rather than feeling defined by the problemrational-emotive behavior therapypredominantly a cognitive approach that describes an ABC framework of emotional functioningDescribe what it means to be listening with a third earpersonal adjustment counseling with parents of a child wwith hearing loss encompasses that an audiologist enages in all of the following exceptconveying all of the options that are available to addres the child's needsunconditional positive regar encompasses all of the following exceptmaintaining a professional distance from the clientcounselor congruence refers toaudiologist's verbal expressions matching his or her body languagein working with a toddler with a hearing loss, the following approach is recommendedfamily centered approach, focusing on working with the child, parents, and any siblingsselling (counseling strategy with parental readiness)high level of knowledge but low level of motivation/readinessdelegating (counseling strategy with parental readiness)high level of motivation and high readinesscollaborating (counseling strategy with parental readiness)high readiness level but low level of knowledgetelling (counseling strategy with parental readiness)low level of involevemnt and low readinesssequential stage model of grieving1. Shock and Disbelief 2. Guilt 3. Bargaining 4. Anger 5. Depression or Detachment 6. Acceptancelist two behaviors that an audiologist might engage in that would serve as barriers to creating trust with a client1. being on their phone/checking their phone throughout the appointment 2. not making eye contact, not smiling, having too much of a professional distanceplease list two possible benefits for those who participate in group AR1. being able to relate to other people's experiences and feel less alone 2. get communication strategies and tips from people who have gone through what you haveT/F: in the assigned reading and in my lecture, it was indicated that when conducting Group AR, it is best if the clinician takes the lead by presenting critical content that will be of interest to all of the attendeesfalseT/F: research has shown that outcomes for people with HL improve when their communication partners are activetruelist two possible benefits of a significant other of an adult with HL participating in the AR process1. the SO gets info on what HL is truly like for their partner, as well as relevant communication strategies and info 2. the person with HL feels supported by their SO and knows they aren't going through the transition alonespeechreading refers to a person attending toboth the visual and auditory signals emanating from the talker, as well as the talker's facial expression & gesturesT/F: when individuals engage in lipreading only, the auditory cortex is activatedtrueT/F: educational achievement appears to impact on lipreading performancefalseT/F: younger individuals are better lipreaders than older individualstrueT/F: talker familiarity can impact the ease to which words are lipreadtrueT/F: during an analytic training activity, the individual's attention is focused on deriving the meaning of an utterancefalsethe focus of the synthetic training is on the individual segments of the speech stimulus, so that the individual can ultimately recognize each wordfalsegroup AR has been shown to reduce HA return ratetruean important aspect of an individual being able to implement communication repair strategies is that they inform the other individual they have a HLtrueclear speech encompasses all exceptlarger mouth openings (allowing for easier lipreading)list two factors that can make the task of lipreading someone easier1. talker/speaker familiarity 2. decreased distance between the talker and the listener/lipreaderWhich is not correct: a client's audibility to various speech contrastsallows us to predict with great accuracy one's speech recognition ability for words and sentencesthe frequency of the first formant of a vowel is highest when thetongue blade (height) is low in the mouthin very HoH individuals, initial consonant voicing is more difficult to perceive than sustained or final consonant voicingtruein individuals with profound HL, perception of whether a final consonant is voiced depends onpreceding vowel duration