SLHS 340 Unit 4 Test

What questions do you ask during case history for children?

-Were there any difficulties at birth?

-Any medications during pregnancy?

-Any physical trauma?

-Any Confirmed illness, disease, disorders, or disabilities?

-History of Ear Infections?

-Is there a family history of HL?

-When did the parent suspect a problem?

-What amount of HL do they suspect?

For Pediatrics are you more interested in finding out the DEGREE or TYPE of hearing loss?

Type-sensorineural, mixed, conductive

Physical Problems for Children w/ HL

Pain, drainage, dizziness, tinnitus, fullness

Perceptual Problems for Children w/ HL

Delayed speech development, child does not respond, slurred speech

What test is used during a Newborn Hearing Screening?

OAEs and ABRs

If a child needs further testing during newborn hearing screening, what is the first thing you do?

RETEST

Steps for testing Pediatrics:

1. Otoscopy

2. Tympanogram

3. Behavioral Testing

4. Speech Perception(if possible)

If a child has a type A tymp then that is confirmation that...

Air and Bone are overlapping

If behavioral testing is abnormal or inconclusive (with normal middle-ear function), then

-OAEs to evaluate inner ear function

-ABRs to determine degree of hearing loss

Testing Environment

-In the sound field - stimuli presented through speakers in a sound-treated room. Problems with this is you do not know what ear is responding

-Positive reinforcer (R+) - an illuminating animated toy.

Variability occurs with determining a minimum response level or threshold. Why?

Variability- is the head turn reliable?

Three types of Behavioral Testing

-Behavioral Observation Audiometry(BOA)

-Visual Reinforcement Audiometry (VRA)

-Conditioned Play Audiometry(CPA)

Behavioral Observation Audiometry(BOA)

-Used for infants up to 4-6 months.

-Relies on unconditioned responses.

-Careful observation of any change in the infant's behavior.

-Most likely use a second observer in the sound-treated room to see subtle changes in behavior.

Potential Problems with BOA

-Sound field does not provide earspecific information.

-Reliability and validity may be questionable.

-No threshold information.

-OAEs and ABRs can provide a more complete assessment.

Visual Reinforcement Audiometry(VRA)

-Used for children 5 months to 2 or 3 years.

-Relies on the child's ability to localize by turning toward the source of the sound.

Conditioning Phase for VRA

-Acoustic stimuli is presented at a level at which the child should be able to hear.

-Pair the presentation of the stimuli with positive reinforcement. Illuminating, moving toy

Testing Phase for VRA

-Present the acoustic stimuli alone.

-Child associates the sound with the positive reinforcement and looks in that direction.

-After a response is noted, decrease the level again in an attempt to determine threshold.

Potential problems with VRA

-May not be able to use earphones and obtain ear-specific information.

-Interference from the parent.

-May need more specific information from OAEs and/or ABRs.

Conditioned Play Audiometry(CPA)

-Used with children from 2 to 5 years.

-Conditioned motor response to acoustic stimuli.

-Dropping a block in a bucket, placing a ring onto a post with the assistance of a second audiologist.

Conditioning Phase for Conditioned Play

-With both the child and the second audiologist under earphones, the audiologist prompts the child to put a block in the bucket when a tone is presented through the earphones.

-This is done until the child puts the block in the bucket independently.

Testing phase for Conditioned Play

-Prompting by audiologist is removed.

-Thresholds are obtained.

Potential Problems with Conditioned Play

-Children are required to wear earphones.

-Child has to wait for the stimuli before responding.

-Motivation

From March 2020, what is the estimated amount of people who have a hearing loss?

466 million people(34 million kids)

True or False: If someone has a hearing loss that automatically means they need a hearing aid

False

What fraction of the world's population of people 65 and older are affected by hearing loss?

one third

How many young people (12-35 years) are at risk of avoidable hearing loss due to exposure to noise in recreational settings?

1.1 Billion

By 2050, what amount of people projected to have some degree of hearing loss?

2.5 Billion

Causes of hearing loss from in the womb to adulthood

-Prenatal period: Genetic factors

-Perinatal period: Lack of oxygen at birth, Low-birth weight

-Childhood and adolescence: Chronic middle ear infections, Meningitis

-Adulthood and older age: Chronic diseases, Smoking, Presbycusis

Impact of Unaddressed Hearing Loss

-Limitations in communication and speech language development

-Adversely affected cognition

-Social isolation, loneliness, and stigma

-Impact of society and economy

-Limitations in access to education and employment

Psychophysical Consequences of HL

-Recruitment - abnormal sensitivity to loudness and a reduced dynamic range.

Affects speech perception.

Has implications of the types of amplification used for intervention.

-Loss of frequency resolution - reduction in the ability of the cochlea to separate complex sounds into the individual components.

Listening in background noise is more difficult.

More difficult to differentiate between frequencies

-Loss of temporal resolution - reduction in the ability of the auditory system to detect changes in sound over time.

Problems with voice onset time (VOT) and other time characteristics of speech

Hearing loss with age(EHLS)

-14.6% of participants with hearing loss were current hearing aid users.

-A substantial majority of older adults with hearing loss are not using hearing aids.

-30% reduction in word rec scores(bottom half) because they added a background noise

Voice Onset time

the interval between the release of a stop consonant and the onset of vocal cord vibrations

Signal to noise ratio

it becomes harder to detect a signal as background noise increases

Hearing Aids definition

-Provide amplification for individuals with various degrees of hearing loss.

-Aural (re)habilitation: person had hearing, then they lost it, and they want to gain some back

-ALL for sensorineural hearing losses

Behind the ear(BTE) aids

-Used for mild to profound hearing losses.

-Bigger instruments so there is more room for the electroacoustic components, specifically more gain(amplification) to compensate for hearing loss.

-More beneficial for older individuals with dexterity problems.

-Microphone is on top of BTE, pinna does not help

In the Ear(ITE) aid

-Use for mild to profound hearing losses.

-Because of the placement of the aid, there is a greater opportunity to utilize the pinna characteristics.

-Not used as much because of advances in technology

-Microphone is on top of the concha and Fills entire concha

In the Canal (ITC) and Completely in the Canal (CIC)

-Used for mild to severe hearing losses. Lose some degree bc of size

-Slightly less power because of the SIZE of the instrument.

-Provides more gain(amplification) at higher frequencies because of the acoustic resonance of the ear canal.

-CIC-All pinna, concha, and some ear canal

Receiver in the canal (RIC) or Receiver in the ear (RITE) aids

-Used for all degrees of hearing loss.

-Discreet fitting.

-Reduced feedback(whistle sound) and occlusion effect.

-More comfortable than other hearing aids

Occlusion effect

plugged up and hear yourself via bone conduction

Bone Conduction or Bone-Anchored

-Oscillator placed directly on the mastoid to transmit stimuli to the cochlea.

-Snap surgically implanted into mastoid and the hearing aid clips into the snap.

-This is for conductive hearing loss when it cannot be fixed if referred out. Non repairable conductive loss

-Problem with this is sound localization difficulties. Because bone conduction stimulates both cochlea

Localization

the ability to determine the location of a sound source, including its direction and distance, based on the sound waves received by the ears

Hearing aid components

1. power supply

2. microphone

3. amplifier/processor

4. Receiver

5. Earmold

Power supply-hearing aid

usually zinc-air or mercury zinc batteries.

Microphone on hearing aid

converts the acoustic signal into an analog/digital electrical signal.

Amplifier/Processor for HA

increases the level of the electrical signal

Receiver for HA

converts the amplified electrical signal back to an acoustic (or vibratory for bone aids) signal.

Earmold for HA

relatively air-tight fit in the canal so as to not get any feedback.

Smartphone app for hearing aids

-The app allows you to choose the appropriate memory program and then make adjustments.

-Other options included restaurant, party, and outside.

-Volume control shown for when hearing aid is connected to the app

Wireless FM system

-Wireless FM system receiver that clips to shirt and connects directly to the hearing aid.

-The teacher/speaker wears a similar looking device, but is a microphone and transmitter.

-Volume control shown is used to control the volume of the FM signal received.

Earmold impression steps

First have to do otoscopy, want to make sure there is not occluding wax

Then, put a cotton block deep into the ear canal

Then do otoscopy for the second time, want to make sure the cotton block is completely occluding the ear canal

Put two solutions together and put in a plunger and put the impression as tight as you can into the ear canal and concha. Might go all the way up to the helix

Takes 4-5 mins to set

Take the impression out carefully

Do otoscopy for the last time to make sure nothing was leftover. There may be redness in ear canal

Otoscopy is very important for this

Programmable hearing aids

-Adjusted by a hand-held programmer or by computer software.

-Visualize changes to hearing aid characteristics on a display.

-Utilize pure-tone data, loudness discomfort levels, and other audiometric data to obtain target satisfaction with the hearing aid.

Multiple-Memory Hearing Aids

-The frequency response(what the hearing aid is putting out into the persons ear) and maximum output of the hearing aids can be changed by the individual depending on the listening environment.

-The first program can be used in a relatively quiet environment.

-And the second can be used in a moderately noisy environment.

What type of hearing aid is preferred for children?

behind the ear

Assistive listening devices

-Any non-hearing aid device designed to improve the ability of an individual with any hearing loss to communicate and to function more independently

-Done either by transmitting AMPLIFIED sound more directly from its source or by transforming it into a tactile or visual signal

Hardwire system

-This system provides a direct physical connection from the sound source to the listener

-Used in nursing homes, doctor's offices, or at home

Advantages of hardwire system

easier to operate because of larger controls

Disadvantages of hardwire system

physically connected to another unit

Infrared system

-Sound is converted to infrared light waves and transmitted throughout the listening environment. A receiver worn by the individual changes the light waves back into the amplified signal.

-Used in movie theaters, for TV, churches, and work environment

Advantages of Infrared system

more mobility

Disdvantages of Infrared system

can only be used in closed rooms

FM System

-Sound is converted into FM waves and transmitted to the listener using a microphone and receiver worn by the individual

-Used primarily in educational settings

Advantages of FM system

can be used outdoors or in any indoor facility

Disadvantages of FM system

can pick up interference from signals passed along the same FM wave

When do you know if someone needs intervention or not?

Example: if their word rec is high but they have a mild HL they do not need an intervention

Task of all assistive listening devices

Task for all of these is to improve SNR. With hardwire and infrared systems you can only adjust volume. With FM you can adjust volume and frequency components

How many cochlear implant users are there worldwide?

1 million

How many adults and children have cochlear implants in the US?

In the US, more than 118,100 adults and almost 65,000 children have one cochlear implant.

How many people worldwide have bilateral cochlear implants?

Over 8000 people worldwide are bilateral cochlear implant users, including almost 5000 children.

World's youngest recipient of Bilateral CI surgery

9 months old

Steps of Cochlear Implant Surgery

-Make incision behind ear to peel it open, need access to temporal bone

-Drill through temporal bone(generates heat) to cochlea, and flush with cool water

-Interoperative monitoring: audiologist monitors facial nerve

-Heat can fray nerve fibers and cause paralysis

-After drilling temporal bone, they gain access to right below basilar membrane, then puts electrode into cochlea, needs to lay flat

-Suture everything, needs to heal, then activation process

-This is done by otolaryngologists

-2 to 3 hour surgery

Cochlear Implant components

Microphone

Speech processor

Transmitter

receiver/stimulator

Electrode array

Cochlea

Auditory nerve

What do the electrodes in CI act as?

Organ of corti

How do cochlear implants work?

1. External speech processor captures sound and converts it into digital signals

2. Processor sends digital signals to internal implant

3. Internal implant turns signals into electrical energy, sending it to an array inside the cochlea

4. Electrodes stimulate hearing nerve, bypassing damaged hair cells, and the brain perceives signals; you hear sound

Internal components of cochlear implants

electrode array and internal receiver

Electrode array

lays adjacent to the basilar membrane and transmits the electrical signal to the auditory nerve fibers.

Evolved from 1 electrode/channel to 8- 22 electrodes.

Disadvantage - each channel is larger than the frequency region for which it is substituting.

Internal receiver for CI

placed in the mastoid of the skull.

Receives information from the external components and conveys that information to the electrode array

External components of Cochlear implants

microphone, speech processor, transmitter

Microphone-CI

collects auditory information and delivers it to the speech processor.

Speech processor-CI

computerized filtering system that converts sound wave information to electrical impulses to enhance speech perception.

Transmitter CI

sends coded information across the skin to the internal receiver

Speech processor

Worn at the ear level and it resembles a BTE.

Speech processor simulates speech, it does not replicate speech

Cochlear implant candidacy for children

<12 months: severe-profound bilateral sensorineural hearing loss.

>12 months: moderately-severe-to profound sensorineural bilateral hearing loss and gap in auditory/language skills.

-Little or no benefit from hearing aids.

-Educational setting that provides auditory skill development.

Cochlear implant candidacy for adults

-Referral for Cochlear Implant Evaluation: "60/60 Rule" ≥60dB PTA (500, 1000, 2000 Hz) ≤60% WRS

-Established to minimize confusion about when to refer patients for a cochlear implant evaluation

-Moderate hearing loss in the low frequencies and profound in the middle and high frequencies.

-Little or no benefit from hearing aids - < 60% correct in the best aided listening condition in the ear to be implanted for open-set sentence recognition (tested at ~50 dB HL).

-Desire to be a part of the hearing world.

Medical contraindications for cochlear implants

-No surgical problems placing the electrode in the cochlea and the receiver in the mastoid bone.

-X-rays performed to confirm placement of electrode.

-Malformations of the cochlea may prevent implantation or make it more difficult.

-Not performed during active infection of the middle ear.

-Cochlear implantation is not done when the hearing loss is due to lesions of the auditory nerve or the central auditory pathway

Factors affecting performance(cochlear implants)

-Large variability in cochlear implant patient outcomes (e.g., success using the device)

-Age of implantation (especially children)

-Duration of hearing loss

-Hearing aid use prior to implantation

-Motivation (aural rehabilitation)

-Etiology of hearing loss (pure cochlear etiology best)