SLHS 460 Final Exam 5 Study Guide

Why can't we just "pump up" the volume?

Hearing loss is not a problem of volume instead its...

1) A dynamic range problem

2) Signal-to-noise (SNR) problem

How do we categorize hearing loss as a dynamic range problem?

- Threshold = floor

- LDL (loudness discomfort level) = ceiling

What are the consequences of the reduced dynamic range?

1) Soft speech is really hard to hear and needs a lot of volume

2) Loud speech is much easier to hear and may need little or no volume at all

- Reduced dynamic range means that hearing impaired listeners are highly susceptible to variations in speech level

3) The appropriate volume setting for soft speech is too intense for loud speech

4) The appropriate volume setting for loud speech os too quiet for soft speech

Describe what the SNR problem is

As background noise level increases, people speak louder, but not at level that equals tha increase in background noise. Therefore in typical conversations, as noise increases the SNR becomes more adverse

How do we solve the SNR problem?

The key is to separate the speech from the noise before they reach the impaired ear

- Very difficult to do with single microphone strategies (e.g. noise reduction)

- Directional microphones are the only hearing aid technology in hearing aids that have been shown to overcome SNR loss in certain conditions

- As SNR loss increases so does the need for higher levels of technology

What is binaural beamfoaming?

True binaural processing

- More selective beam shapes and steering

- Higher SNR improvement, loss of binaural cues

What are the environmental consequences of SNR?

Classification of incoming signals is based on the acoustic analysis from one or both hearing aids

What do classifiers do?

They sample the listening environment and generate probabilities for each of the options in the automatic program

- The hearing aid switches to the option with the highest probabilities; updates as the listening environment changes

Classifiers are often trained using ____

Artificial intelligence

Classifiers may use ________ and _______ based features

Acoustic and location

Ex) level, SNR, modulation characteristics

What are some limitations of classifiers

Different engineers = different philosophies on what aspects of the signal should be prioritized

How can and how do acoustic classifiers fail?

Failure to accurately capture

1) Listening environment

2) Users needs

3) Users intent(s)

Describe how users needs depend on roles in listening environment

Motion sensors detect whether a user is stationary or moving if they change from one to the other

- This information can contribute to the hearing aid's decision-making process for selecting directional features

- Help balance needs: directional focus on a communication target

- Environmental awareness (safety, changes in communication targets)

What is machine learning

2 individuals can be exposed to the same acoustics in the same listening environment but require different signal processing solutions if they have different listening intents

Some fundamental problems include the assumption that hearing aids are designed for...

1) Average ear

2) Average user

3) Assumptions of what is typically given in environmentally between individuals

- Preferred gain levels vary substantially between individuals

- Prescriptions are really ranges not exact levels

- Even a perfect hearing aid fitting in the clinic cannot account for every real life situation

In machine learning fine tuning you have to ____________

Convert the degree of preference for a given listening environment into 13 gain adjustments in 3 bands

Describe edge computing

1) User-initiating action causes the hearing aid to capture an acoustic snapshot of the listening environment which is then analyzed by an onboard AI model trained with machine-learning technology

2) Uses a form of processing known as edge computing whereby input is efficiently analyzed in real time within a smart phone

3) No data transfer to another computing device or network is required so automatic decisions or actions can be made with minimal delay

What are the benefits of connectivity

Improved SNR and added convenience

- The ability to better meet patients' needs can significantly increase the value of and improve the satisfaction of the original hearing aid purchase

- Nearly all hearing aids sold today have wireless technology

Describe connectivity to smart phones

1) Remote control

- Volume, fixed programs, adaptive algorithims

2) Streaming options

3) Remote microphone

4) GPS enabled programs

5) Hearing aid finder

Describe connectivity to "internet of things"

Helps automatic routine tasks foster independence for those who have restricted mobility

Describe how connectivity to sensors improves overall health

Biosensors feed information to a smart device

1) In the future we will be able to provide health stats = blood pressure, glucose and 02 levels, sympathetic neural activity (stress levels), skin temperature

2) Inertial sensors: track physical activity and detect falls, which are a major cause of death for seniors

3) The sensors, along with the hearing aid's microphone and digital signal processor also allow users to top the hearing aid to awaken a smart assistant and nod or shake their head to respond to inquiries

Describe the broadcast sharing for assistive learning

Compared to hearing aid loop systems, audio quality will also be much better and it will be so much easier and cheaper to deploy -----> public assistive learning will become ubiquitous

- No prior pairing

- Hearing aids should be hardware ready by 2023

- Break out year for this technology will be 2024 when most when most smartphone and computer platforms will have adopted the technology

- May be mandated in public spaces, such as classrooms, government buildings, and public transportations

- Will see in sports venues, theaters, museums, places of worship, anywhere news and TV entertainment TVs are deployed

The average delay in adopting hearing aids after hearing aid candidacy is about _______ years

9

Who has to wait longer for hearing aids?

1) People of non white ethnicities

2) Those with better speech recognition for low context sentences presented in background babble

Who has a shorter wait time for hearing aids?

1) Those with poorer hearing

2) Those with a greater self-assessed hearing handicap in social situations

Name the consequences of untreated hearing loss

1) Greater fatigue

2) Greater emotional distress

3) Less involvement in social activities

4) Smaller social networks

5) Less availability of social support

6) Greater loneliness

What are examples of unsupportive and supportive compensatory behaviors of significant others for those with untreated hearing loss

Unsupportive: ignoring requests for repeats or excluding the hearing-impaired individual from complex conversations

- Less intimate spousal relationships

- Greater unemployment and less income

- Miscommunication during medical care

Supportive: speaking behavior, becoming the messenger

- Can become effortful and fatiguing to significant other, may lead to resentment

What are the benefits of hearing aid use

May slow the progression of cognitive decline

May have less frequent doctors visits

Hearing aid use is associated with high life-space mobility inconsistent hearing aid use and hearing aid non use is associated with less space

Hearing aid use improves _________ __________ illnesses and _________ ________ of life

Disease specific

General quality

Benefits with hearing aids and type A tympanograms

A = moderate loss

- Greater benefit for soft and moderate speech in quiet

- Much less benefit for loud speech (too easy) or speech in noisy, reverberant environments (too hard)

- Hearing aid will amplify noise along with speech

- With less noise (especially in low frequency noise) some benefit since the hearing aid amplify the high frequency parts of speech that are limited by audibility rather than noise

Benefits with hearing aids and type B tympanograms

B = conductive hearing loss

- Attenuation component without distortion component

Benefits with hearing aids and type C tympanograms

C = severe to profound HL

- A lot fo benefit for soft to loud speech in favorable listening conditions

Benefits with hearing aids and type D tympanograms

D = mild hearing loss

- Benefit for soft speech in quiet, not for moderate or loud speech (too easy)

- Some benefit for speech in noise because noise tends to be low frequency weighted, so amplifying high frequency's may help with understanding speech

What is the perceived benefit with mild hearing losses?

Assess goals and expectations --- are they realistic?

- May need to counsel on setting up the communication situation, advice to protect hearing, repeat testing in 1 year or sooner if they notive a change in their hearing

Why are mild hearing loss cases considered "very difficult"?

Because the overall deficit is low, so the amount of potential benefit is as well

How does assessing candidacy using the pure tone audiogram work?

Lower limits from the PTA

- Different suggestions based on 3 frequency averages 500, 1000, and 2000 Hz (ex greater than or equal to 25, 30, or 35 dB HL)

- Assumes bilateral HL

- While the audiogram might be one of the first criterion for determining candidacy, beyond the extremes (normal hearing and severe HL) it is a poor predictor of benefit and use

What are the components of assessing candidacy using PTA

1) Auditory assessment

2) Auditory needs assessment

3) Non-auditory needs

What is an auditory assessment? What does it consist of?

Comprehensive case history

1) Otoscopic inspection and cerumen management

2) Determine need for treatment/referral to physician or further testing for adults

3) Obtain medical clearance for children

4) Pure tone, speech, and immittance audiometry

5) Measurement of LDL for tones

6) Quantifcation of unaided speech intelligivbility in background noise using a standard test

7) Counsel patient, family, and caregivers on the results and recommendations

8) Assess candidacy and motivation for amplification

Name the red flags of inner ear pathology

*refer to ENT*

1) Sudden or rapidly progressive HL

2) Unilateral tinnitus or tinnitus of sudden/recent onset

3) Acute/chronic dizziness

4) Unilateral or asymmetrical HL of sudden/recent onset

5) Asymmetrical or unusually poor word recognition score that cannot be explained by the audiogram

Name the red flags of middle/outer ear pathology

*refer to ENT*

1) Significant air-bone-gap of greater than or equal to 15 dB (500, 1000, and 2000 Hz average)

2) Active drainage from the ear or a history of active drainage from the ear

3) Otitis externa/otitis media

4) Visible congenital or traumatic deformity of the car

5) Otalgia (pain in the ear)

6) Cerumen blockage (> 25%)

______ ______ ______________ identifies the patient-specific communication needs to determine specific amplification features

Auditory needs assessment

____________ is defined as the abnormality of a structure or function (audibility, frequency selectivity and temporal processing) and broadly assessed by audiogram

Impairment

Define disability (medicalized terminology)

Activity limitation

Functional consequences (inability to hear innoisy, reverberant environments)

"Handicap" indicates _____________ restriction and social ____________

Participant

Consequences

What can being hearing handicap result in?

Isolation, loss of job, or having to make career changes as a result of communication difficulties --- assessed by surveys and patients report

What are the factors that influence perceived benefit?

The amount of handicap is correlated with the amount of perceived benefit

- Handicap/benefit depends on a lot of social context

Amount of handicap is NOT correlated with the amount of _________ or ______

Disability or severity of impairment

What does the non-auditory needs assessment determine?

Patient expectations, motivation, assertiveness, manual dexterity, visual acuity, general health, tinnitus condition, occupational demands, and presence of a support system

What is the largest factor that influences perceived benefit?

Patient motivation

Benefit is much more strongly determined by ___________ than by __________

Need, hearing loss

What are the 7 actors that influence motivation?

1) Amount of impairment

2) Acknowledgement of the hearing impairment

3) Amount of disability and patient's acknowledge of this amount

4) Amount of handicap and patient's acknowledgment of this amount

5) Real or perceived loss

6) Psychological variables account for 30% of the variation of hearing aid satisfatction ratings

7) Personality traits

Name some of the psychological variables that account for 30% of the variation of hearing aid satisfaction ratings

1) Self image

2) Expected benefit

3) Influence of others (50% cite family as a reason)

4) Fear/uncertainty

Explain what locus of control is (LOC)

External (life outcomes due to luck or fate) less motivated vs internal (life outcomes due to individual choices)

What is the importance of assessing the "degree of hurt"?

- A person's decision to get hearing aids Is never based on the degree of HL but the degree of hurt: socially, emotionally, psychologically, and economically

It's important to counsel all hearing aid users on ____________

Proper expectations

What are some ways to increase motivation and expectation?

1) Involve a family member

2) Demonstrate using recordings of common, every day listening sound samples presented at an unaided (no gain) LDL and amplified level

3) Involve the patient (greater patient involvement during decision-making processing ---> higher use rates)

The __________ system is responsible for helping maintain balance

Vestibular

What are the three things we use to help keep our balance?

1) Visual system

2) Somatosensory system

3) Vestibular system

^^^^^ all are coordinated by the cerebellum ^^^^^

If one balance system is disordered, the other two must __________

Compensate

True or false: compensation relies on the neuroplasticity of the cerebellum

True

What is the goal of VOR?

To ensure stable gaze during head movements to minimize blurring of visual targets during head movements

The VOR is responsible for ________ _______

Gaze stability

Explain how the VOR is responsible and important for gaze stability

Maintains visual target on the most sensitive part of the retina (fovea) during head movement by moving eyes equal and opposite of the head movement

Inaccurate vestibular information leads to ___________ as visual target slips from fovea

Blurred vision

Many diagnostic tests infer the state of the vestibular system by _____________

Observing the movement of the eyes

A reflection where activation of the vestibular system of the inner ear causes movement is the ___________

VOR

________ detect angular acceleration and change in velocity (speed and or direction)

Semicircular canals

Why are there 3 semicircular canals?

One for each dimension of our 3D world

Anterior = _________

Superior

Posterior = ___________

Along x & y dimensions

Tilt forward and to the left

Horizontal = ___________

Lateral

Along z direction

Describe the ampulla

Sensory hair cells embedded in crust ampullaris, the sensory receptor responsible for detecting angular acceleration

What happened with semicircular canals and angular velocity when you turn your head?

Endolymph pushes on the gelatinous cupula and causes a shearing if the vestibular sensory cells due to inertia

- Excitatory on one side, inhibitory on the other

What does the velocity of fluid movement provide information about?

The strength of rotation

When you turn your head, excitatory shearing goes toward the _______ and inhibitory shearing goes ________

Kinocilium

Away

What are the 3 semicircular canal teams?

1) Right anterior and left posterior (RALP)

2) Left anterior and right posterior (LARP)

3) Horizontal pair

Explain the semicircular canal teams & how the structure and function of the canals makes sense & is possible

The pairs/teams (anterior canal) on one side and the opposite posterior canal lie in the same place, meaning they will both have the same excitatory/inhibitory response

- This makes sense if you think about how the eyes move when the head is turned --- one eye is pulled toward the inner acanthi and the other pulled toward the outer canthi

- This is possible because one pair receives an excitatory response that causes the inner and outer eye muscles to contract while the other receives an inhibitory response that causes the inner/outer eye muscles to relax

Utricle which connects to the semicircular canals and the saccule which connects to the cochlear duct is the __________

Otolith organ

Both otolith organs contain _________ which is an analog to the ampullae that detect linear acceleration (no directional change)

Macula

What is the utricle composed of and what is the function?

Macula are on the floor

- Senses motion on horizontal plane (example moving in a car)

- Responds to head tilting (y-dimension)

What is the saccule composed of and what is the function?

Macula are on the wall

- Senses motion on vertical plane (example moving in an elevator)

- Can respond to low frequency sound

The sensory cells in the utricle and saccule are stimulated by ____________

Otoconia

Another term for otoconia are _________

Calcium carbonate crystals

Where is the otoconia located?

The gelatinous structure above the sterocilia

___________ Are pulled by gravity, inertia increases the displacement of the stereo cilia to enhance vestibular function

Otoconia

What are the two branches of the vestibular nerve?

Superior and inferior

What are the differences between the superior and inferior branches of the vestibular nerve?

Superior: innervated utricle, lateral canal, and superior canal

Inferior: branch innervates saccule and posterior canal

Important vestibular centers are mostly located in the ___________ and the ________ for auditory centers

Brainstem

Cortex

True or false: there are connections to the visual system to coordinate eye movement with head rotation (VOR) & there are connections to postural centers

True

Connections to the cerebellum coordinate _______

Balance

What does vestibular compensation rely on?

The neuroplasticity of the cerebellum

Define vertigo

False sensation of self or environmental motion (room or self feels like its spinning)

Define the dizziness sensation of being lightheaded

An altered state of being where one feels that if this sensation worsened they may pass out or lose consciousness

Define the dizziness sensation of being imbalance

Unsteadiness while walking, but fine since lying down

Define the dizziness sensation of being disorientation

Loss of orientation to one's surroundings or confusion

Define the dizziness sensation of motion intolerance

Either physical (self) or visual (environmental) motion produces symptoms of nausea or a dizziness sensation

What are associate symptoms with dizziness/vertigo

Changes in hearing tinnitus pressure or fullness in ear(s), ear pain, sensitivity to lights or sounds, headache, nausea, vomiting, sweating, heart racing

_____________ is the sensation of movement

Vertigo

_________ & ________ from vertigo is common

Nausea and vomiting

Up to ______ Americans have experienced symptoms of a vestibular disorder

69 million