Audiology Course Notes – Quick Reference (ICF, SNAGs, SII, and Rehabilitative Practice)

Page 1: Course overview

  • Notetaking recommendations and CCP due dates cover 2 weekends for completion

  • Grading: missed assignments reduce final grade; no option for failed exam remediation

  • Expectations: focus on technical skills; real world clinical experience needed for integration of knowledge and clinical reasoning

Page 2: Critical concept review AMPI

  • Understand physiologic mechanisms driving occlusion complaints

  • TKs and CRs associated with wide dynamic range compression (WDRC)

  • Medicare coverage: diagnosis vs treatment

  • Front end distortion detected via situational analysis and patient complaints

  • Differentiation of frequency lowering algorithms

Page 3: Audiologic rehabilitation overview

  • Topic: audiologic rehabilitation of hearing loss and communication disorders

  • Amplification and related rehabilitation components form part of the overall strategy

Page 5: Audiologist vs hearing aid dispenser

  • Two types of providers share space in hearing healthcare

  • Audiologist: requires state licensure, master or doctoral degree in audiology

  • Hearing aid dispenser: may require high school diploma or associate degree

  • Training: audiology includes 1800+ hours of clinical education; dispensers focus on adult hearing aid fitting

  • Services: audiologists provide diagnostic testing, medical referrals, ototoxicity monitoring, balance and tinnitus management, cochlear implants, etc.

  • Billing: both can bill depending on setting; audiologists participate in medical team activities

Page 6: Best practices in audiology

  • Focused, whole patient approach using evidence based, patient centered care

  • Role starts with comprehensive investigative assessments and review of systems

  • Identify type and magnitude of hearing loss and its impact

  • Consider multiple treatment options and medical referrals when needed

  • Functional and communication needs assessments replace traditional hearing aid evaluations to identify biopsychosocial needs

  • Best practices differentiate clinicians from OTC providers

Page 7–8: APSO standards for hearing aid fitting (S2.1)

  • Fitting based on comprehensive, valid audiological assessment

  • Clear patient communication aligned with health literacy and preferences

  • Involve family and communication partners for support

  • Needs assessment covers audiologic, physical, communication, listening, self assessment factors

  • Pre fitting testing includes speech recognition in noise when appropriate

  • Bilateral fitting recommended for suitable candidates

  • Style and ear coupling match degree and configuration of loss; patient input considered

Page 9: Functional and communication needs assessments

  • Audiologic rehabilitation options:

    • Prescription hearing aids

    • Over the counter hearing aids

    • Speech and visual perception training

    • Communication strategy training

    • Personal adjustment counseling

    • Group or individual support resources

  • Goal: tailor options to the patient’s functional and communication needs

Page 10–11: Impact of comorbidities

  • Hearing loss and related communication difficulties increase with age due to comorbidities

  • Key links: systemic diseases, cognition decline, motor function changes, reduced social engagement

  • Implications: comorbidities influence clinical decisions and prognosis

Page 12–13: Systemic chronic health conditions linked to progressive hearing loss

  • Gastrointestinal: inflammatory bowel disease, Crohn’s disease, ulcerative colitis

  • Musculoskeletal: rheumatoid Psoriatic arthritis, gout, fibromyalgia

  • Respiratory: COPD, asthma

  • Cardiac: poor circulation, coronary artery disease

  • Lymphatic: Hodgkin and non Hodgkin lymphoma, autoimmune disorders

  • Hematology: anemia, B12 deficiency, Lyme disease, leukemia

  • Integumentary: shingles, herpes zoster, Ramsay Hunt syndrome

  • Nervous system: Parkinson disease, cognitive decline

Page 14: Endocrine system and common endocrine disorders

  • Structures: thyroid, thymus, pancreas, adrenal glands

  • Examples: Grave disease, diabetes, pancreatic disorders, kidney disease

Page 15: Common comorbidities in older adults (>65)

  • Visual impairment: 68%; reduced manual dexterity: 42%

  • Cognitive issues: 50%

  • Depression: 16%

  • Falls: 33%

  • Hypertension: 43%

  • Diabetes13%

  • Circle of care for older adults with hearing loss and comorbidities

Page 16: Clinical strategies to identify comorbidities

  • Use standardized case history questionnaires to review systems

  • Employ screening tools for visual, dexterity, and cognitive issues

Page 17: Diagnostic interpretation SNAG

  • A patient’s perceived communication abilities not always align with audiometric data

Page 18: What information does an audiogram supply

  • Pure tone audiogram measures ability to detect quiet tones with headphones

Page 19: SNAG 1 – counseling miscommunications

  • Overreliance on audiogram can mislead about communication difficulties

  • Pure tone threshold reflects functional impairment but not necessarily participation restriction

Page 20–23: SNAG 2 – test result interpretation challenges

  • Discrepancies between audiometric severity and self reported difficulty exist

  • Presentation level matters for speech understanding; audibility at key frequencies is essential

  • Example: low WR scores require nuanced interpretation of test parameters

  • Common issues: calculation errors, incorrect presentation levels, and lack of audibility at 2 kHz

Page 24–26: Word recognition and presentation level considerations

  • SRT and testing level influence WR results

  • Audibility at 2 kHz is critical for accurate WR interpretation

  • Example words list used in testing demonstrates the impact of inaudible items on scores

Page 27: Predictive value of speech recognition testing

  • Using word recognition tests to predict hearing aid benefit has limited or no predictive value

  • Systematic review findings cited

Page 28: Traditional speech audiometry limitations

  • PB words in quiet do not reflect real life communication

  • Visual cues, contextual cues, and noisy environments are not captured by PB words

  • Speech understanding in noise is a primary patient concern

Page 29: Realistic listening environment testing

  • Sentence based assessments better predict aided performance

  • Include binaural, real life noise and visual cues when possible

  • Use soundfield testing at conversational levels (around 50–60 dB) to simulate normal speech

Page 30–31: Counseling and data presentation pitfalls

  • Overreliance on audiogram leads to counseling mismatches with patients

  • Present data in patient friendly terms to reduce confusion

Page 32–34: ICF overview

  • WHO International Classification of Functioning, Disability and Health (ICF) standard framework

  • Shifts focus from disease to function across life domains: body functions and structures, activities, participation

  • Considers environmental and personal factors in health and disability

  • ICF provides universal language for health descriptions

  • Levels: Body/structure and function; Activities; Participation

Page 33: ICF classifications specifics

  • Body Functions and Structures: physiological functions and anatomical parts; impairments are problems in these functions

  • Activities: execution of tasks; activity limitations are difficulties performing tasks

  • Participation: involvement in life situations; participation restrictions are problems in life roles

Page 34: Distinguishing function, activity, and participation

  • Visual example shows how body structure, activity, and participation relate and differ

Page 35: Activity limitations with hearing loss

  • Difficulties in understanding speech, especially in noise or group settings

  • Repeated requests for repetitions, phone communication issues

  • Work communication challenges; social interaction barriers; difficulty localizing sounds

  • Question: which factors are assessed in the comprehensive audiometric evaluation

Page 36: Participation restrictions with hearing loss

  • Avoidance of challenging situations, noisy environments, group discussions

  • Difficulty with telephone use, self advocacy, relationships, and education participation

  • Example quote illustrating social withdrawal due to communication concerns

Page 37: Backward synergistic effects of comprehensive rehabilitation

  • Body function and structure improvements do not guarantee reduced participation restrictions alone

  • Comprehensive treatment can reduce participation restrictions and may improve activity limitations through neural and cognitive benefits

  • Increased participation enhances lip reading, auditory closure, cognition, and communication strategies in noise

Page 38: ICF perspective to improve care

  • Use ICF to avoid snags and improve care quality

  • Improve interdisciplinary communication and report writing for interprofessional interpretation

  • Conduct realistic communication assessments and use objective assessments in real life simulations

Page 39: Improving reporting for interdisciplinary understanding

  • Audiograms are hard for non specialists to interpret

  • Studies show physicians struggle to interpret audiograms

  • Simplify test conditions and concerns in reports

Page 40: Solution for clear reporting

  • Document purpose of speech assessment and test conditions

  • Distinguish test signals (PB words vs sentences) and quiet vs noise

  • Include audibility statements and signal-to-noise considerations

  • Provide an improved SOAP section with explicit findings and implications for rehabilitation

Page 41–42: Relating findings to patient symptoms and data use

  • Many patients do not recall discussion of hearing loss degree

  • Clinicians tend to overwhelm with data; tailor explanations to patient

  • Use quantifiable data to aid interpretation and recall

  • Introduce SII as a measurable index of speech audibility

  • SII equals the portion of speech cues audible to the listener

  • Example: SII of 0.50 means 50 percent of speech cues are audible in quiet

Page 43–44: Interpreting SII and test stimuli

  • Different stimuli have different predictability given SII

  • Digits, sentences, NU 6 words yield different intelligibility relationships

  • SII helps translate audiometric data into understandable terms

Page 45: Clinical use of SII

  • SII quantifies audibility to inform candidacy for amplification

  • Compare unaided vs aided SII (pre and post amplification) to show potential benefit

  • Use REM data to verify that amplification provides the intended audibility

Page 46–47: SII in treatment planning

  • SII values guide amplification candidacy and device selection

  • Use SII alongside REM to verify target audibility

  • Example: SII of 0.47 at 65 dB SPL input

Page 48: Aided SII and device selection

  • Compare SII across device styles/brands to optimize audibility

  • Visualize SII across input levels to assess device performance

Page 49: Critical concepts recap

  • Review overcoming snags via case history review, comorbidity lists, and ICF framework

  • Distinguish functional, activity, and participation concepts

  • Discuss test techniques for realistic speech understanding beyond pure tone thresholds

  • Define ICF classifications and backward synergy

  • Explain communication mismatch and the role of SII in documentation and counseling

  • Analyze and interpret SII results for clinical decisions

Page 50: Closing emphasis

  • Emphasis on patient-centered interpretation and involvement

  • Avoid overreliance on a single metric; integrate functional outcomes and patient experience

  • Always tailor communication to the patient and provide actionable next steps