Aural Rehab Exam 2

What is a hearing aid?

An amplification system that increases the intensity of auditory signals to make sounds more audible

Hearing aids contain both ____ and _____ components

Acoustic and electrical

Most hearing aids use ____ conduction

Air conduction

Modern hearing aids use _______

Digital signal processing

When hearing levels change, what 3 things can occur?

Loss of audibility

Loss of intelligibility

Change in dynamic range

What is loss of audibility?

Difficulty detecting sounds

What is loss of intelligibility?

Difficulty understanding speech clearly

Wjat is change in dynamic range?

Changes in the range between the softest audible sounds and sounds that become uncomfortably loud

What are the 5 major components of a hearing aid?

Microphpne

Amplifier

Receiver

Battery door

Volume control

Program button

What does the micrphone in a hearing aid do?

captures incoming acoustic signals and converts them into electrical signals

What does the amplifier in a hearing aid do?

increases the intensity of the sound signal

What does the receiver of a hearing aid do?

converts the amplified electrical signals back into an acoustic signal (sound)

What does the battery door in a hearing aid do?

Battery provides power, door holds or provides access to the battery in applicable models

What does the volume control in a hearing aid do?

Optional feature that allows the use to adjust volume

What does the program button in a hearing aid do/

allows the user to switch between different listening programs or settings based on their environment

What is the basic hearing aid pathway (parts)

microphone → amplifier → receiver

What is the basic hearing aid pathway (signals)

acoustic signal → electrical signal → amplified electrical signal → acoustic signal

What are the 8 types of hearing aids?

Body worn

Eyeglass

Behind the ear (BTE)

Receiver in Canal (RIC)

In the ear (ITE)

In the canal (ITC)

Completely in canal (CIC)

Invisible in canal (IIC)

What part(s) are located on the body worn device in a body worn hearing aid?

The microphone and receiver

Where is the receiver located on a body-worn hearing aid?

At ear level

Where is the microphone located in eyeglass hearing aids?

on the bow/temple of the glasses

In a _____ hearing aid, the device sits behind the ear

Behind the ear (BTE)

How does a BTE hearing aid work?

Tubing delivers sound from the receiver to the ear

In a receiver in canal (RIC) hearig aid, the main hearing aid is where"?

It sits behind the ear

How does a RIC hearing aid work?

Wire connects to the receiver located inside the ear

What is the key difference between a BTE and RIC?

The location of the receiver

What kind of hearing aid is this?

Behind the ear (BTE)

What type of hearimg aid is this?

Receiver in canal (RIC)

What kind of hearing aid is this?

In the ear (ITE)

What type of hearing aid is this?

Completely in canal (CIC)

What kind of hearing aid is this?

In the canal (ITC)

What kind of hearing aid is this?

Invisible in canal (IIC)

What are Nuance audio hearing glasses?

Glasses with built in open ear speakers and beamforming microphones

What are earmolds?

Custom-fitted molds of an individual’s ear

What is the purpose of earmolds?

To secure the hearing aid to the ear and modify incoming sound

How are earmolds fitted?

An audiologist takes an impression or scan of the outer ear

What are the 6 types of earmold designs?

Full shell

Half shell

Skeleton

Canal

Semi skeleton

Receiver mold

Which earmold design provides the greatest acoustic seal?

Full shell

What is a half shell earmold?

Fills less of the concha and provides less of a seal than full shell

Which 3 types of earmold designs fill less of the concha and provide less of a seal?

Half shell

Skeleton

Canal

What type of earmold is this?

Shell (full shell)

What type of earmold is this?

Skeleton

What type of earmold is this?

Canal

What type of ear mold is this

receier

What are the 2 purposes of earmold vents?

Pressure equalization

Effects on low frequency amplification

Who is eligible for OTC hearing aids?

Adults 18+ with perceived mild-to-moderate hearing loss

Who is eligible for prescription hearing aids?

Children and adults

How to OTC vs prescription hearing aids differ in cost and follow up care?

OTC: lower initial cost and self directed care

Prescription: Higher overall cost due to professional services, including counseling & follow up

How to OTC vs prescription hearing aids differ in fitting ans adjustment?

OTC: consumer selects, fits, and adjusts device

Prescription: professionally fitted, programmed, verified, and adjusted

What are the audiologist’s 3 responsibilities in the hearing aid fitting process?

Determine appropriate device based on hearing thresholds, patient characteristics, and needs

Fit the hearing aid

Provide follow-up care and counseling

What are the 3 patient considerations in the hearing aid fitting process?

Communication needs

Style preferences, including color and size when appropriate

Price point

How do cochlear implants work?

Cochlear implants use electrical stimulation to provide auditory information

What are the 6 major components of a cochlear implant?

Microphone

Speech processor

Transmitter coil

Internal receiver/implant

Electrode array

Auditory nerve

What does the microphone do in a cochlear implant?

Receives sound from the environment

What does the speech processor do in a cochlear implant?

Processes sound into digital information

What does the transmitter coil do in a cochlear implant?

Relays information to the internal implant

What does the receiver/internal implant do in a cochlear implant?

Receives information & sends patterns of electrical impulses through a wire

What does the electrode array do in a cochlear implant?

Stimulates auditory nerve cells inside the cochlea

What does the auditory nerve do in a cochlear implant?

Carries neural signals towards brain, where they’re interpreted as sound

What is the 6 step cochlear implant signal pathway?

Microphone receives sound→ Speech processor converts sound to digital info→ Transmitter sends info to implant→ Electrodes stimulare auditory nerve cells→ Auditory nerve carries signals to brain

What 3 important characteristics of speech do cochlear implants code?

Frequency (pitch)

Amplitude (intensity)

Temporal characteristics (how sound changes over time)

What event in cochlear implant history occured in 1800?

Volta placed metal rods in his ear canals and perceived sounds

What event in cochlear implant history occured in 1957?

Djourno and Eyroes placed a wire in the auditory nerve of a patient undergoing surgery

What event in cochlear implant history occured in 1961?

House and Doyle implanted electrodes through the round window into the scala tympani in 2 adults, producing auditory percepts

What event in cochlear implant history occured in 1964?

Simmons placed an electrode in the modiolus, producing an auditory percept

What event in cochlear implant history occured in 1972?

First single channel CI, over 1000 implanted

What event in cochlear implant history occured in 1984?

Cochlear has first multi channel implants (Nucleus 22)

When did Cochlear make the first multi channel implants & what were they called?

1984, Nucleus 22

What are the 3 major cochlear implant manufacturers?

Cochlear (Nucleus)

Advanced Bionics

MED-EL

Which cochlear implant manufacturer has Nucleus 8, Kanso 3?

Cochlear

Which cochlear implant manufacturer has naida CI Marvel, Sky CI Marvel?

Advanced Bionics

Which cochlear implant manufacturer has SONNET and RONDO?

MED-EL

What are the 3 overall general candidacy requirements for a cochlear implant?

Individuals with significant SNHL

Limited benefit from appropriately fitted hearing aids

Must meet medical and audiologic criteria

What are the 4 general candidacy requirements for young children to get a cochlear implant?

Age: 7-12 months

Bilateral profound SNHL

Limited benefit from hearing aids

Limited auditory/language development process

Wjat are the 3 general candidacy criteria for adults to get a cochlear implant?

Moderate to profound SNHL

Limited benefit from hearing aids

Poor aided speech recognition

What is the revised 60/60 guideline for adult CI referral?

Unaided pure tone average of ≥60 dB HL

Unaided word recognition of ≤60%

Applied to each ear individually

Can individuals who don’t meet the 60/60 guideline still get referred for a cochlear implant?

Yes, inidiviuals with limited aid benefit may still warrant an evaluatiob even when the 60/60 thresholds aren’t met

What is off label implanting?

Implanting individuals who don’t fall within standard candidacy guidelines

What are the 5 main exclusion criteria for cochlear implant candidacy?

Absence of cochlear nerve or 8th cranial nerve

Certain neural or central audutory differences

Active middle ear infections

Tympanic membrane perforation with active middle ear disease

Unrealistic expectations

Who makes up the cochlear implant team? (6)

Audiologist

Psychologist

Social worker

SLP

ENT physician/surgeon

teachers and parents, particularly for pediatric patients

What are the 3 steps in the process of receiving a cochlear implant?

Pre surgical evaluation

Surgery and recovery

Initial activation

What happens in the pre surgical evaluation for getting a cochlear implant?

Establish goals, complete CI evaluation, meet iwth surgeon, address insurance

What happens in surgery & recovery when getting a CI?

Ear is bandaged for 48 hours after surgery, following wound snd stitch care to prevent infection

What happens during the initial activation when getting a CI?

Approx. 2-4 weeks after surgery, the device is activated for the first time

Activation doesn’t mean the person will immediately hear or understand speech well

What are the 4 potential improvements from a CI?

Detection

Discrimination

Idrntification

Comprehension

What is detection in a CI?

awareness that sound is present

What is discrimination with a CI?

Recognizing that 2 sounds are different

What is identification with a CI?

recognizing or labeling a sound

What is comprehension with a CI?

Understanding the meaning of auditory information

What are the 8 factors affecting CI performance?

Etiology

age of onset

duration of deafness

residual hearing

wear time

services

goals

language foundation

What is etiology in hearimg loss?

Cause of hearing loss

What is duration of deafness?

How long the person has experiences deafness

What is wear time with a CI?

consistency of device use

what is residual hearing?

hearing ability rtemaining before implanting a CI

What are language soundations with CI?

language skills developed before or during CI use

What are the 5 counseling considerations when getting a CI?

Invasive surgery

general anesthesia

time, money, effort

cultural considerations

future implications and expectations

What is a hybrid cochlear implant?

Combines cochlear implantation with hearing aid amplification

who is eligible for a hybrid cochlear implant?

Individuals over 18 with high frequency SNHL

When considering devices for individual patients, the audiologiosty considers what 7 things?

hearing thresholds

patient characteristcs

communication needs

device limitations

price

style preferences

What are the 3 models of disability?

medical model

functional model

social model