Found. of AuD. — Super Deck (Ch 1, 2, + types of hearing loss)

interprofessional collaboration

conveys the idea of sharing and implies collective action oriented toward a common goal, in a spirit of harmony and trust, especially within the context of health professionals

audiologist

a person in the field of research and clinical practice devoted to the study of hearing disorders, assessment of hearing, hearing conservation, and aural rehabilitation

speech-language pathologist (SLP)

a person in the field of research and clinical practice who specializes in the evaluation and treatment of communication and swallowing disorders

scope of practice

an outline of the parameters of each of the professions

preferred practice patterns

the informational base for providing quality patient/client care, and a focus for professional preparation, continuing education, and research

guidelines

current best-practice procedures based on available evidence

position statements

public statements of ASHA's official stand on various issues

knowledge and skills

the knowledge and set of skills required for a particular area of practice

technical reports

supporting documentation and research for an ASHA position statement

relevant papers

supporting and related professional documents

standards/quality indicators

documents related to certification, accreditation, and professional standards

ethics (ASHA)

includes the Code of Ethics, by which all members and certificate holders are bound, and its supporting documents

bylaws (ASHA)

bylaws of ASHA, the ASHFoundation, and the ASHA PAC

SLP scope of practice: collaboration

shares responsibility with other professionals (e.g., AuD, PT, OT, ENT) for creating a collaborative culture; must determine whether their own knowledge and skill is adequate for comprehensive patient care

SLP scope of practice: counseling

providing education, guidance, and support to individuals, their families, and caregivers regarding acceptance, adaptation, and decision-making

SLP scope of practice: prevention and wellness

activities geared toward reducing the incidence of new disorders, identifying them at an early stage, and decreasing the severity of existing disorders

SLP scope of practice: screening

screening individuals for possible communication, hearing, and/or feeding and swallowing disorders in a cost-effective manner (planning/conducting programs, selecting instruments, developing procedures, analyzing results, making referrals); includes a role in managing disorders, including hearing loss

SLP scope of practice: assessment

differential diagnosis of disorders of communication and swallowing

SLP scope of practice: treatment

designed to optimize an individual's ability to communicate and swallow and improve quality of life, using evidence-based research and best-practice standards

SLP scope of practice: modalities, technology, and instrumentation

use of advanced instrumentation and technology in evaluation, management, and care (e.g., hearing screening instruments, hearing aids, hearing assistance technology); fitting hearing aids is out of scope, but maintaining aids/assistive devices is in scope

SLP scope of practice: population and systems

managing populations to improve overall health, education, and experience; ensuring intervention strategies and therapeutic goals align with the whole patient

SLP service delivery areas

fluency, speech production, language, cognition, voice, and resonance

areas outside the SLP's scope of practice

evaluating a hearing disorder or diagnosing hearing loss; fitting hearing aids

ASHA scope of practice for the audiologist: prevention

promoting hearing wellness, which may include occupational, school, and community programs

ASHA scope of practice for the audiologist: identification

identifying dysfunction of hearing, balance, and other auditory-related systems; supervising newborn and school hearing screening programs; screening for speech/language/cognitive factors affecting learning with referral to SLP; identifying populations at risk for hearing, balance, or tinnitus problems

ASHA scope of practice for the audiologist: assessment

• conducting and interpreting behavioral, electroacoustic, and electrophysiological methods to assess auditory, balance, and related systems

• evaluating and managing adults and children with auditory-related disorders; making medical referrals as needed

• preparing reports and collaborating with other professionals

ASHA scope of practice for the audiologist: rehabilitation

fitting and dispensing hearing assistive technology; assessing cochlear implant candidacy including fitting, mapping, and (re)habilitation; developing aural rehabilitation plans; assessing vestibular rehabilitation needs; participating in IEP/IFSP plans; managing classroom acoustic needs; selecting/installing/evaluating large-area amplification systems

ASHA scope of practice for the audiologist: advocacy, education, and practice settings

advocacy/consultation; education, research, and administration (supervision, functional outcomes, consumer satisfaction, scholarship, professional association participation); practice settings include hospitals, MD offices, university speech/hearing centers, schools, industry, home health, subacute rehab, and long-term care

aural rehabilitation

the process of helping those affected by acquired hearing loss who have already attained language and require restoration of these skills

• includes:

  • evaluating hearing

  • diagnosing the effect of the hearing loss

  • making recommendations

  • selecting amplification devices

  • considering the rehab setting

  • and counseling patients/families about the impact of hearing loss and the need for rehab

acquired hearing loss

a hearing loss that is the result of an illness, disease, or disorder that was not present at birth

universal precautions

CDC set of procedures and practices designed to protect healthcare workers and patients from a wide range of pathogens: hand hygiene, isolation precautions, personal protective equipment (PPE)

21st-century person-first terminology: what to use

"student with a hearing loss," "child on the autism spectrum," "individual with a disability" — emphasis is placed on the individual, not the disability

21st-century person-first terminology: what not to use

"stutterer," "hearing impaired," "autistic"

deaf (lowercase)

an individual whose hearing loss is so severe that audition cannot be the primary means of daily communication; not affiliated with the Deaf community; often uses amplification (hearing aids or cochlear implants)

Deaf (capital D)

an individual who is part of Deaf culture: shares common values, rules for behavior, traditions, and views of self and others; uses ASL and speechreading as the main form of communication

hard of hearing

an individual with a hearing loss who can derive benefit from a hearing aid and uses aural/oral speech as the primary means of communication (e.g., can use a standard telephone)

best practice

a management philosophy asserting that a given technique, method, process, or activity is more effective at delivering a particular outcome than any other technique, method, process, or activity

evidence-based practice

the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of the individual patient, integrating individual clinical expertise with the best available external clinical evidence from systematic research

electroacoustic calibration

an annual evaluation of audiometric equipment by a professional trained in such practices, ensuring compliance with national standards for accurate sound generation

biological calibration/listening check

a daily functional visual inspection, performance check, and bioacoustic listening measurement conducted to verify potential problems that could affect equipment function or the validity/reliability of test results

critical period for language development

birth to age 5

newborn hearing loss prevalence

about 1 in 1,000 children is born with a significant hearing loss

parent hearing status of children with hearing loss

over 90% of children born with a significant hearing loss are born to hearing parents

sound

a physical phenomenon that describes the movement or vibration of an elastic medium without permanent displacement of the particles; measured in pressure; requires a source of energy, a vibrating object that generates an audible pressure wave, and a medium of transmission (e.g., air)

mass

the quantity of matter present

force

a push or a pull on an object

elasticity

the tendency of an object's resistance to deformity and its return to the rest position

inertia

the tendency to resist any change in motion; per Newton's first law, an outside force must be applied to overcome inertia, and the greater an object's mass, the greater its inertia

4 properties of simple harmonic motion

frequency, amplitude, period, phase

frequency

the number of complete vibratory cycles per unit time (cycles per second/speed of vibration)

• one compression plus one rarefaction

• unit is Hz

• psychological equivalent is pitch

• more cycles per sec = higher pitch

amplitude

a derived unit of measurement describing an object's distance from rest to maximal displacement; psychological equivalent is volume

period

the amount of time needed to complete one cycle of vibration

• shorter period → higer frequency tone

• longer period → lower frequency

  • (e.g., shorter for an 800 Hz tone than a 400 Hz tone)

phase

the relative timing of compressions and rarefactions of waves (how cycles relate to each other); also described as any stage of a cycle

decibel (dB)

a ratio between a measured sound pressure and a reference sound pressure, expressed logarithmically, used to describe the range of human hearing intensity; 1/10 of a Bel; logarithmic, base 10

range of human hearing on the decibel scale

0 dB to 140 dB

3 decibel scales

sound pressure level (dB SPL), hearing level (dB HL), sensation level (dB SL)

process of hearing

1. pressure waves emanate from a source

2. propagate through a medium (usually air)

3. reach the tympanic membrane, are transformed into mechanical energy

4. are converted to hydraulic energy in the cochlear fluids

5. the movement of the cochlea releases neurotransmitters to the brain

what sound requires

a source of vibratory energy; the energy must be delivered to and cause a disturbance in a medium (air, liquid, etc.); the disturbance is propagated through the medium as sound waves carrying energy away from the source (condensation/rarefaction)

true or false: 0 dB means the absence of sound

false — 0 dB means the start of audible sound, not the absence of sound

what does 0 dB SL mean?

the tone is being presented exactly at that person's threshold — the softest level that particular person can just detect

what does 0 dB SPL mean?

right at the reference threshold used to define the whole scale

waveform

the shape of a wave, plotted by graphing the disturbance over time

cycle

equal to one compression and one rarefaction

intensity

the magnitude of a sound; changes in sound pressure level; psychological equivalent is loudness; unit is dynes/cm2

wavelength

the distance (in meters or centimeters) covered by one cycle; equals speed of sound divided by frequency

speed of sound

331 m/s at normal atmospheric pressure

SPL needed to produce a just-audible sound in normal, healthy ears

0.00002 Pa (20 micropascals)

reference pressure for dBSPL

• 0.00002 Pa

• 20 micropascals

reference power for dBIL

10^-12 watts/m²

formula for frequency

f = 1/T (period)

formula for period

T = 1/f

formula for dBIL

dBIL = 10log (P_o / P_R)

formula for dBSPL

dBSPL = 20log(P₁/P₂)

find dBSPL from dBHL

dBHL + dBSPL = dBSPL

find HL from SPL

dbSPL - dBSPL = dBHL

find dBHL from dBSL

dBHL + dBSL = dBHL

threshold for pain

200,000,000 micropascals — comparable to standing next to a jet engine

dB IL (intensity level)

expresses intensity level as a power measure; formula IL = 10 log (PO/PR), where PO is the measured/output pressure and PR is the reference pressure; power can be converted to pressure (SPL)

dB SPL (sound pressure level)

expresses a power level or sound pressure level; formula dB SPL = 20 log (P1/P2), where P1 is the measured pressure and P2 is the reference pressure

pure tone

a sound that has only one frequency of vibration

absolute sensitivity

the auditory system's capability of detecting that a sound exists

differential sensitivity

the auditory system's capability of determining distinct features of a sound (frequency, intensity, and timing cues), such as timbre/sound quality

audiometric zero

the decibel level denoted as a solid black line on the audiogram, corresponding to 0 dB HL and representing average normal hearing acuity; 0 dB HL may not be the lowest level a person with superior hearing can detect; in reality, absolute threshold varies as a function of frequency (the minimal audibility curve)

sensation level

a given number of dB above or below a certain threshold (e.g., 40 dB SL re: SRT means the presentation level is 40 dB above the patient's individual threshold for speech)

human hearing frequency range

20 Hz to 20,000 Hz

pediatric audibility requirement

children need 15 dB or more (of audible signal) to hear all phonemes

adult mild hearing loss threshold

adults need 20-25 dB to be classified with a mild hearing loss, but can typically still access language

3 parts of the human ear and the energy found there

outer ear = acoustic energy; middle ear = mechanical energy; inner ear = fluid (hydraulic) energy

outer ear structures

pinna (auricle), external auditory canal/meatus, and the tympanic membrane (ear drum) is considered by Dr. Kimball, and on exams, to belong to the middle ear

pinna/auricle

the outer, visible structure of the ear

external auditory canal/meatus

the ear canal; the opening at its lateral end is the external auditory meatus

tympanic membrane

the eardrum

functions of the outer ear

collects and resonates sound; assists in sound localization; provides the primary cue for determining sound source elevation; assists in distinguishing sounds arising from in front of versus behind the listener; functions as a protective mechanism for the middle and inner ears (via conveyor-belt shedding that moves out dirt/cerumen); protects the middle and inner ears from foreign bodies; boosts (amplifies) high-frequency sounds

outer ear amplification

the pinna and external auditory meatus provide a natural source of amplification, but only about a couple of dB

sound localization safety note (case for technology)

being able to localize/lateralize where a sound (like a car) is coming from is important for safety and sound awareness

vowels vs. consonants

• vowels are power phonemes with high volume of speech

• consonants are low-energy, high-frequency phonemes important for clarity of speech

structures of the middle ear

tympanic membrane, malleus, incus, stapes, oval window, round window, the air-filled middle ear cavity, and the Eustachian tube

ossicles

the ear bones; the smallest bones in the human body; together they make up about 30 dB of hearing

malleus

aka the hammer; the lateral-most bone of the ossicular chain; connected to the eardrum; the first middle ear bone

incus

aka the anvil; the center bone of the ossicular chain