Module 1-3 aural

What can have a major impact of a child's development

Atypical hearing

Another name for aural rehabilitation

also known as audiologic rehabilitation, auditory, hearing, and/or rehabilitative audiology.

Services provided by the audiologist

Audiologic rehabilitation

Services provided by audiologists and SLP's

Aural rehabilitation

role for the SLP

- evaluating receptive & expressive language skills
- comprehension of language; oral, signed or written modalities
- treatment of speech and voice disorders

Role of audiologist

- fitting and dispensing hearing aids
- mapping cochlear implants
- evaluating and dispensing hearing assistive technology
- treatment of balance disorders

Main Areas of Aural (Re)habilitation

- Sensory Aids/Hearing Technology
- Instruction, demonstration and coaching
- Perceptual training
- Counseling

Coverage of AR (aural rehab)

- speechreading & training
- development of communication strategies

Roles of the disciplines in AR

- complimentary
- interrelated
- overlapping

Habilitation

working with children because the skills are being taught for the first time.

Rehabilitation

more appropriate for adults as it focuses on restoring a skill that has been lost.

What services are provided for atypical hearing

1. age of child and onset
2. age when child was identified as deaf or hard of hearing
3. degree and type of atypical hearing
4. age when child was first introduced to hearing aids (HA) or amplification

What do we hear with

Brain

Auditory Rehabilitation for Adults

1. adjusting to current hearing status
2. making the best use of hearing technology
3. exploring assistive devices
4. managing conversations
5. minimizing the impact of the hearing loss on the individual

How are services for aural rehabilitation for adults

Services can be individual, groups, or a combination of both

3 types of hearing loss

1. conductive
2. sensorineural
3. mixed

Common causes of hearing loss for sensorineural

Loud sounds, drugs and medication, aging

Common causes of mixed hearing loss

head trauma, virus or infection, genetic disease

Common causes of conductive hearing loss

foreign objects, ear wax accumulation, bone growth

Tympanometry is a test for what

individual's middle ear function

What does tympanometry measure?

the flexibility (compliance) of the eardrum to changing air pressures, indicating how effectively sound is transmitted into the middle ear.

Type A

normal

Type B

flat

Type C

negative

Type As

shallow/stiff

Type Ad

deep/disarticulated

What does Speech Reception Threshold assess?

minimum hearing level at which an individual can REPEAT two-syllable words 50% of the time the speech is presented.

What does the Speech Awareness Threshold assess?

softest intensity level at which an individual is aware and/or can detect the presence of speech, 50% of the time the speech is presented.

What does Word Recognition Scores assess?

uses monosyllabic words to assess one's ability to accurately identify different words presented to each ear at the comfortable listening level.

What does Pure Tone Average refer to?

average of hearing threshold levels at a set of specified frequencies: typically 500, 1000, and 2000 Hz.

What does a PTA do?

It gives a snapshot of an individual's hearing level in each ear.

What happens when speech sounds are more densely represented in the mid frequencies

the outlying frequencies are not included in the PTA calculation to allow for more consistent comparisons.

What is the basis of speech recognition testing?

Whole word basis

How is correctness judged in speech recognition testing?

The word must be absolutely correct

What are the traditional categorizations in speech recognition testing?

Excellent, good, fair, poor, and very poor

What percentage range corresponds to 'Excellent' in speech recognition testing?

90 - 100%

What percentage range corresponds to 'Good' in speech recognition testing?

78 - 88%

What percentage range corresponds to 'Fair' in speech recognition testing?

66 - 76%

What percentage range corresponds to 'Poor' in speech recognition testing?

54 - 64%

What percentage range corresponds to 'Very poor' in speech recognition testing?

< 52%

How is hearing loss measured?

in decibels (dB)

normal hearing

0-25 dB HL

mild hearing loss

26-40 dB HL

moderate hearing loss

41-55 dB HL

moderate to severe hearing loss

56-70 dB HL

severe hearing loss

71-90 dB HL

profound hearing loss

91+ dB HL

Individuals may receive an assistive listening device or hearing system to

- make speech audible
- restore a range of loudness experience
- augment communication
- improve QOL
- enhance personal safety of environmental awareness

hearing aids have three fundamental components which are

microphone, amplifier, and receiver

hearing aid has developed

since the mid 1800s continuing to improve technology

directional microphone

more sensitive to sound in the front of the user

omnidirectional microphone

respond to sounds from all directions

automatic directional

switch between modes

2 types of earmolds are

conventional & open fit

other features of hearing aids

on/off control
remote control
volume control
telecoil
audio input
multiple memories
batteries - disposable or rechargeable

What are the different types of hearing aids that are worn outside the ear?

1. Body aids
2. Behind the ear aids - BTE

What are the types of hearing aids that are worn inside the ear?

3. Receiver in the ear - RITE
4. In the ear aids - ITE
5. In the canal - ITC
6. Completely in the canal - CIC

What is the type of hearing aid that is surgically implanted?

7. Implantable hearing aids

Body aids are used for

- severe and profound hearing loss
- bulky and visible
- worn on body, with cord to earmold
- powerful amplication and easy control
- not heavily used in U.S. and Europe
- low cost

A cochlear implant is an

opportunity, NOT A REPLACEMENT

Components of a cochlear implant

1. Internal components are implanted in the skull.
2. External components (microphone, processor, transmitter, etc.) are worn behind the ear or directly on individual's head.
3. Most U.S. models are multichannel and have multiple microphones

When did the FDA approve the first cochlear implant

in 1984

When did modern research began for cochlear implants

In France in the 1950s

Behind the Ear - BTE

1. For mild-to-profound hearing loss
2. Components fit in shell placed behind the pinna
3. Very flexible style of hearing aid, can be fitted with many customizable options
4. Fewer problems with feedback, and easy maintenance
5. Highly visible, making it impractical for some
6. Appropriate for children

Receiver in the ear - RITE

1. For mild-to-severe hearing loss
2. Comprised of a small casing that sits behind the ear
3. Casing holds all components, short of receiver which sits in the ear
4. Appropriate for adults; now some manufacturers make for children

In the ear

1. generally for mild to severe loss
2. fit completely inside the external ear
3. must be custom-fit, have cosmetic appeal
4. may distort sound of user's voice

in the canal

1. generally for mild to moderately severe
2. fit completely inside the external ear
3. ITC fills less of the concha than the ITE
4. must be custom-fit, have cosmetic appeal
5. may distort sound of user's voice

completely in the canal

1. Worn completely inside the ear canal
2. Requires a remote control (when available) for adjustment
3. Reduces feedback and improves sound localization
4. Virtually invisible
5. High maintenance

Implantable Hearing Aid

1. For patients who cannot wear an external hearing aid or who choose not to do so
2. transmits micromechanical vibration directly to the ossicular chain
3. not very common

Bone Anchored Hearing Aid (BAHA)

1. type of implantable hearing aid
2. appropriate for conductive or mixed hearing loss
3. transmits sound through skull to directly vibrate cochlea and stimulate hair cells.

How is a hearing aid style selected?

Depends upon:
•Degree of hearing loss
•Patient's preference
•Cost/Insurance coverage
•User's age and lifestyle
•User's physical status

most common hearing aid manufacturers

1. phonak
2. oticon
3. widex
4. starkey
5. resound
6. signia/siemens
7. Over the counter hearing aids are available now.

Cochlear Implants - CI

1. virtually unheard of 40 years ago
2. used for individuals who cannot benefit from a hearing aid
3. CI provide sound sensation by means of directly stimulating the auditory nerve, bypassing damaged/missing hair cells.

Candidacy for Adults

•The presence of irreversible sensorineural hearing loss and good general health.
•Patients most likely to benefit:
1. Those who used aural/oral communication in childhood
2. Those who used a hearing aid in the to-be-implanted ear up until the time of implantation
3. Those who experienced a progressive hearing loss

Candidacy for Children

1. 12 months of age (Advanced Bionics and MED-EL), with some exception (e.g., meningitis)
2. Beginning in early 2020, 9 mo. of age.
3. Trial period with hearing aids (typically 3 mo.)
4.Limited or no benefit from hearing aids
5. Family seeking LSL.

CI manufacturers

- Cochlear Americas
- Advanced Bionics
-MED-EL
- Oticon Medical - not FDA approved yet for U.S.

What does the FDA monitor and regulate

manufacturers for cochlear implants NOT the cochlear implant centers.

In the U.S. in 2020 there were

38 million for total hearing loss - and 1.2-1.3 million potential CI candidacy for severe to profound HL

Bilateral vs. Unilateral

Surgery can be simultaneous or sequential; Depends on the individual's need and age;
Binaural Cochlear Implants
- Implants in both ears
- Can enhance sound localization

Receiving implants in a multi-stage process

1. extensive audiological eval
2. trial period w/ amplification
3. patient undergoes surgery for implants
4. approx 4 weeks later, the external components are added
5. patient engages in extensive aural rehab program

Wireless systems

1. sound is transported from the source to individual via radio waves or infrared signals
2. individual can be far from the sound source.
3. signal is delivered either via earphones or through hearing aid.
- ex: FM systems

FM system

Speaker wears a wireless mic and the speech is frequency modulated on radio waves transmitted through the room to the listener who wears a receiver and headphones or a BTE hearing aid with an audio boot.
- can be personally owned or for group setting - classroom
- great option for children and adults.

hard wired options

- connect sound source to the listener by wire
- sound is delivered to hearing aid, headphones, or neck loop
- most often used for television, radio, or music
- wired reality makes it unattractive to some patients

other options of hearing assistance tech systems

- facilitates info that is not speech
EX: flashing doorbell, flashing smoke or fire alarm, baby cry alert system, telephone ring causing lamp to flash

computer- based tech

1. members of the deaf community have quickly picked up texting
2. allows communication with those lacking knowledge of sign language
3. twitter and fb have enhanced communication
4. sign language via video chat are options

what do manufacturers offer

research, trainings, resources, and support for hearing technology

What are the principles and guidelines for early intervention?

• access to timely & coordinated entry into early intervention programs

• access to service coordinators who have specialized knowledge and skills related to working with individuals who are DHH.

• access to have early intervention providers who have professional qualifications.

• consider culture of child and family

• consistent monitoring of progress

• families will be active participants

• family will have access to other families who have children who are DHH for support, mentorship with guidance.

What are the two types of screening for Universal Newborn Hearing Screening (UNHS)

Otoacoustic Emissions OAE

Auditory Brainstem Response ABR

What is OAE

a small earphone or probe is placed in the ear. The probe puts sounds into the ear and measures the sounds into the ear and measures the sounds that come back.

What are the results for OAE?

Pass or Non-pass/refer

What is ABR?

This test is used with children or others who cannot complete a typical hearing screening and/or following a non-pass results on OAEs. Electrodes are placed on the head. The electrodes are connected to a computer. They record brain wave activity in response to sounds presented through earphones. The person completing the test interprets the results.

Early Hearing Detection and Intervention (EHDI) program’s staff are responsible for what?

creating, operating, and continuously improving a system or services which assures that

• every child born with a permanent hearing loss is identified before 3 mo. of age and provided with appropriate intervention services before 6 mo. of age.

• Every family of an infant with hearing loss receives culturally-competent family support as desired.

• effective newborn hearing screening tracking and data management systems are linked with other relevant public health info systems.

What is a medical home?

A medical home is NOT a building. It goes beyond the walls of a clinical practice. A medical home refers to the partnership with clinical specialists, families, and community resources.

Who should have a medical home?

All newborns who are DHH.

Why is the medical home so important?

It recognizes the family as a constant in a child’s life and emphasizes partnership between health care professionals and families.

Joint Committee on Infant Hearing (JCIH) 1-3-6.

1 month: hearing of all infants should be SCREENED at no later than 1 month of age.

3 month: Those who do not pass screening should have a COMPREHENSIVE AUDIOLOGICAL AND MEDICAL EVALUATION before 3 mo. of age.

• Goal is to get a diagnosis.

• Should be fit with amplification (if appropriate) within 1 mo. of diagnosis.

6 months: Infants with confirmed hearing loss should receive APPROPRIATE INTERVENTION at no later than 6 mo. of age from health care and education professional who expertise in hearing loss and deafness in infants and children.

Explain the EHDI process overview

Newborn Hearing Screening: not passed, refer to audiology

Confirm Hearing Status/Medial Eval: refer to early intervention, pursue amplification

Services: Direct therapy, counseling, support, transition to school once 3 years old.

Hearing loss is

one of the most common congenital conditions

Screening programs are typically

cost-effective

what population is hearing loss more common with?

infants admitted to intensive care units at birth