SHS 5732 Exam 2

Vestibular Assessment importance

Between 5-8 million consults/year to MDs are due to dizziness This estimate increases with age 65% of patients over 60 experience dizziness Often discussed as an "inner ear problem" (refers to vestibular system close proximity to inner ear) Other systems involved Visual Proprioceptive (feeling of where we are in space)

Basic Rules for Beginning Speechreaders

Watch the speaker Check seating arrangement Learn the topic being discussed Learn to look for ideas rather than isolated words (synthetic) Use situational cues to derive meaning Stay aware of current events Keep informed of friends' interests Relax Don't be afraid to guess -- "intelligent guessing"; use all these cues to help

** Candidacy important to HELP the person, but...

also helps with insurance (very expensive surgery)

Absorption of sound

sound that gets "lost" or absorbed. The sound is normally turned into heat energy.

CI post-op

small scar behind the ear; isn't usually that bad

Adult candidacy - Speech recognition testing

(if we feel they would do better with CI, want them to do poorly) CI candidates generally rely on visual cues for communication little (if any) useable hearing for communication purposes Therefore, materials should be tested without giving visual cues Recorded tests should be used (can't control live voice as well as a recording) - recommended by all CI manufacturers Live-voice testing yields higher recognition scores - live voice testing will eliminate some good candidates; we want to get the TRUE score

Speechreading Components: Gestures

(not equal to ASL) Stylized movement of the arms, hands and head Common to all cultures But may vary from culture to culture Different from sign language Gestures are known within a broad culture, and understood across the culture Gestures only supplement speech—they illustrate, emphasize, point out, explain, interrupt, etc. Difficult to speechread an individual who Lacks natural body gestures Utilizes excessive gesturing (distracting)

Outcomes of CIs - In pre-lingually deafened

*2003 study (Geers, Nicholas & Seday)* - 181 kids implanted before age 5 - More than ½ scored similar to age-matched peers on a language battery *Hammes, et al., 2002* - 47 kids - If implanted before 18 mos had significantly better language development than those implanted after 18 mos - Also, those implanted before 18 mos made full transition to oral communication (TC started initially)

ALDs: Hardwired Systems - pros

*Strengths* Low cost Can have good sound quality (one-to-one) Simple to operate

ALDs: Hardwired Systems - cons

*Weaknesses* Must have a direct electrical connection between the sound source and the listener (confined movement) Often poor S/N, depending on how it's used

Alerting Devices can be purchased as

*individual units*, each devoted to alerting a person to one particular sound—or, there are a number of *"universal" systems* that monitor a variety of systems around the house Often, the degree of HL will dictate which type of system to buy—the more HL the more likely the system to buy—the more HL the more likely the need for a universal system Used for: Alarm clock, telephone, doorbell, smoke detector, etc.

Outcomes of CIs: Level of success depends on

- Age of Implantation - Type of learning environment (oral vs. TC) - Adults—length of time spent with profound SNHL *Multiple studies have shown that CI in profound HL patients significantly improve their QOL*

Other factors to consider for CI candidates

- Desire to be part of hearing world (controversy of D/deaf culture, want child to choose for themselves) - No medical contraindications - Appropriate expectations

Auditory Brainstem Implants

- Developed for NF2 patients -- Bilateral VIII nerve tumors - Implant placed on CN of brainstem - Results similar to early generation CIs -- Promising for these patients who are not CI candidates - One company with FDA approval -- Cochlear -- Med El - has a device, but not yet FDA approved

Adult candidacy - audiometric threshold

- Generally, bilateral HL: -- moderate-to-profound loss in the low frequencies -- severe-to-profound loss in the high frequencies --- people with sloping loss will not always obtain benefit for successful communication with hearing aids but possibily would with CIs ---- "Dead regions"; stimulate cells but they're too dead to provide anything

Auditory progress of pediatrics

- Infants and small children need to demonstrate improvements in auditory skills and language development -- over a period of three to six months - If a child wears hearing aids for three months -- she should show 3 months progress in auditory skill/language development

Outcomes of CIs: Early implantation is beneficial

-- (Houston, et al., 2003) Children implanted bet. 7-15 mos. performed similarly to normal hearing peers in 2-6 mos. when looking at pre-word learning skills -- Qualitative characteristics (c, v, cv combinations) of the babbling of kids implanted between 5-20 mos were similar to normal hearing infants (Schauwers, et al., 2008) -- Pre-lingually deafened kids implanted before age 2 are twice as likely to be mainstreamed

Normal progression of auditory skills

0-3 mos. = startles, quieted by mom, enjoys music or other aud. stimulation, listening to own vocalizations 3-6 mos. = localization emerging, vocalizations to music 6-9 mos. = good localization skills, responding to own name, attentive to conversations 9-12 mos. = beg. to discriminate words

Why are CIs desirable?

1 - 4 of every 100,000 births are children with severe to profound SNHL Recessive gene related to deafness 90% of deaf children have two normally hearing parents Disabilities, societal cost of deafness Educational delays and employment disadvantages no longer are absolutes with CI MUST consider cultural issues of CI (Deaf culture)

History of CI (1790s - 1978)

1790s - Volta - delivered electricity to areas of the head and to his own ear 1957 - a physiologist and an otolaryngologist implanted an induction coil in a deaf patient Electrodes were placed near the end of the cochlear nerve Patient perceived sound but couldn't understand speech Implant failed - electrode malfunction after a few months 1972 - William House - read the 1961 paper and started implanted his own CI in patients One electrode near the round window and one in the scala tympani Patients had speech perception and limited speech understanding FDA approval in 1984 1978 - Graham Clark of Austrailia Safe surgical procedure of multi-channel CI, multiple electrodes with longevity

History of the Cochlear Implant

1790s - Volta - delivered electricity to areas of the head and to his own ear 1957 - a physiologist and an otolaryngologist implanted an induction coil in a deaf patient Electrodes were placed near the end of the cochlear nerve Patient perceived sound but couldn't understand speech Implant failed - electrode malfunction after a few months 1972 - William House - read the 1961 paper and started implanted his own CI in patients One electrode near the round window and one in the scala tympani Patients had speech perception and limited speech understanding FDA approval in 1984 1978 - Graham Clark of Austrailia Safe surgical procedure of multi-channel CI, multiple electrodes with longevity 1981 - Clark's patients had open set speech recognition Clark's device became the Nucleus mulitchannel CI and got FDA approval in 1985 (Adults) FDA approval for > 2 y.o. children in 1990 1998 - FDA approval for adults with severe to profound HL and children 1 and up CIs now compact with multiple channels to stimulate the cochlear nerve

History of CIs (1981 - 1998)

1981 - Clark's patients had open set speech recognition Clark's device became the Nucleus mulitchannel CI and got FDA approval in 1985 (Adults) FDA approval for > 2 y.o. children in 1990 1998 - FDA approval for adults with severe to profound HL and children 1 and up CIs now compact with multiple channels to stimulate the cochlear nerve

Speech Recognition criteria with older children:

< 30% correct in the best aided condition Monosyllable or multi-syllabic word testing whichever is most appropriate developmentally Early Speech Perception Test - won't ask about specifics on the exam; just know these exist PBK word recognition test HINT sentences for children When appropriate

What recognition scores are required for candidacy?

< 50% aided speech recognition in the ear to be implanted (worse ear; implanted ear) < 60% aided speech recognition in the best aided condition (better ear; unimplanted ear) < 40% best aided condition - Medicare (strict criteria!!)

Pediatric Candidacy Criteria

>12 mos. Old Profound SNHL Lack of progress on developmental auditory skills 3-6 mos. HA trial High level of family support and motivation Placement of child in educational program that emphasizes auditory skills (post implant)

Electrode array

A group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve

Developing Analytic Training Objectives

A hierarchy of training objectives is specified in development of an AT program. This is based on the child's skill level (awareness, discrimination, etc.) In developing the hierarchy, you need to consider the specific sequence of training that will promote more advanced listening skills

ALDs: Group FM Systems (most group systems like this are still FM, not DM)

A microphone is placed close to the sound source The FM transmitter of the system uses the electrical signal from the microphone to modulate a designated carrier frequency The FM signal is broadcast over a broad area—usually several hundred feet The listener uses an FM receiver to pick up and demodulate the signal, and then delivered to the listener's ear via headsets or through a HA

Viseme = Visual phoneme

A speech sound that has been classified by its place of articulation or shape of the mouth Several phonemes create the same visemes

When do you use ALDs?

ALDs are used to help HI listeners understand speech when listening conditions are less than ideal - When the SNR is poor because of background noise (busy restaurant) - When the person is listening from a distance (church, lecture hall) - When reverberation is present (basketball game)

What do you use ALDs with?

ALDs can be used in conjunction with a hearing aid or can be used in place of a hearing aid (In the classroom; in place of a HA (child with attention deficit disorder))

Absorption and Reflection

Absorption is inversely proportional to reflection Thus, as absorption coefficient increases, reflection & reverberation time decrease Absorption coefficient, α, varies with frequency and with nature of materials Realize: the softer the material, the more absorption and better it is acoustically! However, harder surfaces are much easier to clean. Does it make sense to have carpet in an elementary classroom where kids are going to spill things?

BPPV - Benign Paroxysmal Positional Vertigo

Accounts for 20% of dizzy patients Easily treated with canalith repositioning Nystagmus is hallmark

Auditory Training

Activities that are employed to help a HI person develop the auditory channel to the maximum extent possible Technically, a candidate for auditory training is any person who is not utilizing their auditory skills to the fullest extent possible Therefore, almost everyone with HL is a potential candidate for auditory training - often under-utilized in our field

Alternative therapies that have been used for treating tinnitus:

Acupuncture Hypnosis The herb ginkgo Zinc supplements Little/no evidence of effectiveness, but some patients report anecdotal improvement

Binaural advantages (room acoustics)

Advantages of having two ears/two HAs improvement in hearing of 3-6 dB in quiet improved word recognition due to summation enhanced localization of sound source (head shadow effect) Sound on right side hits right ear first and will be louder in right ear because by the time the signal hits the left, it has decreased in intensity (loudness) slightly enhanced ability to hear speech in noise Binaural Squelch; because of two normally hearing ears we're able to hear better, especially when there is background noise or competing signals

Computerized Speech Reading Instruction

Advantages: Can view a variety of stimuli in a short time frame Patient responses are recorded and tracked; adaptive Patient can view numerous types of talkers Pace is patient-dependent Convenient

Informal methods

Allows selection of stimuli that are appropriate for each individual; make it super easy at first and work up to difficulty to avoid making them quit or feel discouraged - What are they interested in? "Loose" format

Methods for Speechreading

Analytic and synthetic

Sound-Treated Rooms

Anechoic rooms have high absorption coefficient - Fiberglass wedges are absorbing material Sound isolated rooms (sound treated rooms) Ex: hearing booths - Designed to reduce sound transmission through walls - High absorption coefficient (not as high as anechoic rooms, but still high)

DASL II

Another AT approach developed by Stout & Windle (1994) Developmental Approach to Successful Listening II Appropriate for any age, but mainly utilized with preschoolers and school-age kids with HAs or CIs Focuses on: Sound Awareness Phonetic Listening (duration, intensity, rate of speech, discriminating vowel and consonants) Auditory Comprehension (basic comprehension of simple to complex speech) Placement test to see where a child falls and needs help.

Questions for conversation

Answer the questions rather than translate Would you like to order now?How would you like your steak cooked?What kind of dressing would you like on your salad?Would you like some more water?Where's the restroom?Do you want to see the breakfast menu?Would you care for dessert?Do you want coffee with your meal?Where is the waiter?

Auditory Training: What to expect in terms of the client's auditory capacity

Auditory Capacity X Learning Opportunity = Auditory Performance

Noise

Anything that reduces the amount of information present for the listener Includes factors relating to the talker (abnormal articulation, improper stress), the listener (poor listening skills) and the environment (acoustics of an environment, visual distractions, bad/poor lighting)

Evluation of tinnitus

Audiologic evaluation ABR CT Scan / MRI (especially if we think the problem is from beyond the auditory system)

Take Home Message:

Audiologists and School SLPs will need to evaluate classrooms Be prepared to make suggestions, both big and small (ie: ones that cost more, like FM systems; and ones that cost less, like rugs, curtains, tennis balls, etc.)

Important to consider functional hearing when determining candidacy

Audiograms are not good predictors of speech recognition performance - two people with similar audiograms may have very different speech recognition scores Can the client talk on the phone? No longer taking part in social situations?

Audiologic Assessment of Dizziness

Audiologic Evaluation Possibly ABRPossibly ABR Videonystagmography Tracking eye movements Vestibular Ocular Reflex (projection of images on fovea, optimal visual performance for us, look at how it adjusts and changes as targets move) Nystagmus Rotary Chair Posturography

Erber

Authored a widely used AT approach (primarily used for children) Uses GASP (Glendonald Auditory Screening Procedure-pg. 110 in your book) to determine starting point for therapy Sessions conducted that are similar to the synthetic and analytic activities we have covered AT therapy should not be performed in isolation; should be integrated with speech and language therapy

Suggestions for lessening tinnitus...

Avoid exposure to loud sounds and noises. Control blood pressure. Decrease salt intake. Avoid stimulants:coffee, colas (caffeine) and tobacco (nicotine). Reduce anxiety. Relaxation therapy. Adaptation. Tinnitus Retraining therapy. Get adequate rest , avoid fatigue. Exercise. (Good cardiovascular health, plus improved general health & well-being) Utilize masking noise. Tinnitus is usually more bothersome when the surroundings are quiet. A competing sound such as a ticking clock, a radio, a fan or white noise machine may help mask tinnitus. Avoid aspirin or aspirin products in large quantities (don't tell them to stop taking meds recommended by physician!) Review list of medications with physicians, especially ones that were started near the onset of tinnitus. Reduce alcohol intake. Alcohol increases the force of your blood by dilating your blood vessels, causing greater blood flow, especially in the inner ear area.

Bilateral CIs

Multiple studies show improved: Localization & SIN Intelligibility

Developing Synthetic Training Objectives (more global, bigger units)

Based on the child's skill level, synthetic training may begin with suprasegmentals: long/short (moving an object) go-go-go; goooo fast/slow (moving an object) loud/soft (calling names)

Vowel training

Begin with words that vary only in F1 (low frequency information) Later work on contrasts involving F2

Surgical risks

Bleeding Infection Taste disturbance Dizziness Tinnitus Facial nerve injury Implant extrusion Skin flap problems*

Anatomy of the Inner Ear

Bony Labyrinth Membranous Labyrinth Microanatomy of the Cochlea Innervation of the Cochlea Fluid Systems of the Cochlea

Analytic

Break speech into smaller components; phoneme or syllable level Emphasis is on auditory cue recognition (voicing, nasality, formant patterns, etc.)

Electric and Acoustic Stimulation

Can be done with Hybrid EAS CIs *Combined acoustic and electric binaural hearing* short electrodes to preserve low frequency hearings; only part of basal/low frequencies Normal hearing 60/70 dB HL through 750 Hz Higher frequencies no better than 70 dB HL no better > 1500 Hz

ALDs: FM/DM Systems - weaknesses

Can be expensive (personal systems cost almost as much as HAs) If FM, subject to interference (check carrier Hz or HA paired with mic) Privacy is not guaranteed—eavesdropping can occur if you're not careful

Settings and set up for infrared systems

Can be used as a large group system in theaters and concert halls A single transmitter or several transmitters are strategically placed around the listening area to bathe the area with the modulated light waves Listeners with hearing loss obtain headset receivers and sit anywhere in the audience that there is a direct "line of sight" between the photodiode on the receiver and the LEDs on a transmitter

Vestibular Assessment

Cause of dizziness not always able to be identified Regardless of cause, many patients are candidates for vestibular rehabilitation therapy (VRT) Goal is to develop changes in muscle response and reduce the action of reflexive responses

Candidates for CI

Children or adults with moderate to profound HL (something that is changing as surgeons and AuDs get more experience with CIs; more experience, wider range for candidacy) Generally not successful with HAs >> tried HAs but didn't help them as much Poor word recognition, Highly motivated (this is a process!) Good support system (frustrating experience), Realistic Expectations No medical contraindications (significant procedure because drilling into someone's head)

SKI-HI

Clark & Watkins (1985); Watkins (2004) Comprehensive identification and home intervention treatment for HI infants and their families (in home treatment guided by a professional) Consists of 4 phases broken down into ages (although movement from one phase to another may not be sequential, and doesn't need to be limited to those ages) Structure and completeness make it user-friendly for parents-guided by professionals Tables 4.10, 4.11

Three CIs with FDA approval

Cochlear Corporation Advanced Bionics, CA Med-El, Austria

What do cochlear implants do?

Converts sound into electrical impulses. Electrical stimulation is delivered via electrodes (implanted near the modiolus) through the cochlea stimulating the CN VIII The implant consists of an external portion which sits behind the ear and a second portion that is surgically placed under the skin

Recommendations for tinnitus patients

Counseling, support groups, education

Tinnitus: Counseling

Counseling. Can help with coping techniques to make tinnitus symptoms less bothersome. Counseling can also help with other problems often linked to tinnitus, including anxiety and depression.

CI surgical procedure

Curvilinear post-auricular incision Mastoidectomy (directly behind the EAC) Drill (in several surgical steps) to view the entire basal turn of the cochlea Each CI has a slightly different insertion technique, but want the electrode array inserted (as atraumatically as possible) so electrodes lie close to the modiolus Average surgical time ~ 2-3 hours

In a study looking at several disabilities:

Deafness had lowest rating for educational level Lowest percentage of working adults Lowest self-assessment of well-being

Detection: Awareness

Depends on HL and the speech signal

Important Components of Speech Perception

Detection, discrimination, identification, attention, memory, closure, comprehension

EX: someone is at the door. Child with HL may not hear the doorbell/knock and understand how someone just knows there's someone at the door.

Detection: can they hear the doorbell / knock at the door? Discrimination: Gross: difference between doorbell and knock Finer: is someone angry and really wants to get in very badly? Bang really loud and hard on the door. Identification: oh, that's a knock. It's an urgent knock. That means I need to get up and run to get the door.

Telecommunication Devices

Devices designed to assist a person with hearing loss to communicate on the telephone and to follow television programs are broadly classified as "telecommunication devices" Personal hearing aids can be used on the phone using either acoustic coupling (use mic of hearing aid) or inductive coupling (use telecoil)

Homophonous Words

Differentiated by context Words that sound alike to, two, too read, red

After a child is capable of sound awareness, move on to:

Discrimination - Loudness - Pitch - Rate (fast versus slow) (use a piano, chord organ or xylophone)

The environment

Distance - 5 ft is optimal, significantly decreased beyond 20 ft Viewing angle (45 degree angle is the best) Competition (anything that would be an auditory or visual distracted) Lighting - Ideal if contrast between speaker and background Situational cues - Pictoral cues - Environmental cues - Auditory cues

Room Acoustics History

Early 1100's European church builders attempted to improve room acoustics Not practiced during the middle ages, and not considered again until the 19th century No interest in acoustic conditions of schools until after WW II Acoustic environment of hearing-impaired is more of a factor than it is for those with normal hearing National standards exist, but not mandatory New schools try to meet some of these standards but most likely not all because of the lack of them being required

Tinnitus: Education

Education. Learning as much as possible about tinnitus and ways to alleviate symptoms can help-understanding tinnitus better makes it less bothersome for some people.

Internal Components of CI

Electrode array (wound through cochlea) - Inserted into the scala tympani - Wraps around the modiolus - Stimulates CN VIII

Transcranial magnetic stimulation (tinnitus)

Electrodes all over surface of cortex; electric impulses all over it; neural reorganization for tinnitus areas of brain, especially temporal lobe. Success rate = 50%. Not done by AuD

Present the printed sentences without sound, asking for a "key word" to be identified.

Encourage client to tell as much of the idea of the sentence as possible...not exact translation If the client does not get the key word or the idea of the sentence after two presentations without sound, - Say some words or phrases aloud and the rest of the sentence without sound - Say the sentence in a soft voice - If neither works, say the sentence aloud, then without voice, then aloud, and again without voice

Erber's Approaches to AT Therapy

Erber recommends three AR approaches differ in specificity, rigidity, and direction natural conversational approach: teacher eliminates visual cues, speaks to child as naturally as possible moderately structured approach: basic identification task but also basic speech development an a related comprehension task practice on specific tasks: set of acoustic speech stimuli and child's range of responses determine how therapy is approaches ranging from synthetic (1) to analytic (2 & 3)

Speechreading Methods Use of Context

Erickson (1989) Ask participants to think of several words, phrases or sentences in anticipation of the topic Type words and have patients read the printed list (and additional words) to be aware of mouth movements (kinesthetic awareness)

Societal cost of deafness:

Estimated cost of $122 billion in lost earnings Estimated $18 billion lost from decreased work-place paid taxes Estimated $2 billion on equal access for the deaf Possible lifetime cost of $1 million per patient in educational and work force costs

ALDs: FM/DM Systems - strengths

Excellent sound quality Easy to use—no installation required for personal systems, but needed for SF systems Extremely versatile—can be used indoors or outdoors and can transmit through obstructions and around corners Several systems can be used in the same area as long (with FM, need different carrier Hz) Not subject to electrical interference Receiver doesn't need to be in direct line with transmitter Different coupling options - Personal HA -- DAI -- Telecoil - Neckloop - Other (Silhouette)

The Use of ALDs in the School System

FM sound field amplification can be found in many (especially newer) classrooms Designed not only with hearing impaired children in mind—instead, it is designed to provide an enhanced acoustic signal for all children in the classroom

ALDs: FM Systems

FM systems have been used in classrooms since the late 1960s In 1982, the FCC lifted the classroom-only restriction—this allowed FM systems to become available for personal and group use in public facilities, like places of worship and auditoriums Today, these systems—both group and personal—are very popular, in large part due to their versatility

Speaker factors

Familiarity of speaker Facial expressions (appropriate) Gestures/articulation/lip movement Want a natural, clear speech that's a little slower than normal. Not over enunciated Rate of speech (15 phonemes a second, eyes process 8 to 10 a second, can't visually pick up all the phonemes visually) Too fast, makes it worse Too slow, unnatural and difficult too Distractors Chewing Sunglasses Hand near mouth Gender Women easier to speech read than men; why? Don't know. Maybe because of facial hair or lipstick? Non-verbal cues Shoulder shrugs, eye rolls, head nod, jaw movement/sigh

Tinnitus: Effects on Quality of Life

Fatigue Stress Sleep problems Trouble concentrating Memory problems Depression Anxiety and irritability

Present all words

First with sound and then without sound Skipping around the list, say the word without sound and have the client guess If incorrect, say it again in the same manner If necessary, say it again in a soft voice If the person has not guessed, say the word aloud, then without sound, then aloud, and then without sound

Television Viewing

For individuals who have trouble understanding television programs, closed captioning (CC) can help The Television Decoder Act requires built-in decoders on all TVs with 13" or larger screens produced after 1993 Thus, TVs will include a built-in decoder Separate decoders can be purchased for older TVs or those with smaller screens—although these are or those becoming harder to find

Auditory Training: Type of Activity

Formal versus Informal Formal activities are designated to take place at certain times of the day one-on-one or group activity highly structured may involve the same drills being repeated reinforcers given Informal activities occur as part of the daily routine occurs during everyday activities Successful training involves both types of activities

Speechreading - Components of Speechreading:

Gestures, facial expressions

Settings and set up for Group FM Systems

Group systems found in classrooms and in many public facilities In the classroom, the teacher wears a mic - The mic can be wired into a small battery-powered transmitter that is also worn OR the mic can be wireless and send a signal to an AC-powered transmitter In public facilities, the electrical signal from the public address system is typically used as the input to the FM transmitter *The FM signal is broadcast through the listening area—so individuals can sit anywhere in the room* Listeners who wish to use the system use an FM receiver to demodulate the signal In a classroom, the child will have their own receiver that is adjusted for their HL In a public facility, the person can pick up a receiver that provides a broad frequency response and a manual volume control The output from the receiver is delivered to the listener using headset or the listener's HA

ALDs: Hardwire Systems

Hardwired systems typically consist of A microphone that is placed near the source of the sound An amplifier A receiver that is at the ear of the listener All the components are connected via hardwire

FM Soundfield Systems in the school system

Help improve the S/N, therefore these systems help all children hear better It is hypothesized that this will be especially beneficial to children with fluctuating hearing loss due to otitis media (esp. Recurring ear infections), children with ADD, children with unilateral hearing loss It is also hypothesized that this will help teachers fatigue—particularly vocal fatigue

Identification

Identify or label what's heard

Autonomic Nervous System

Impacted by above structures and can cause inappropriate reactions to sound Ex: her husband hates ticking clocks

When would you use a group (non-individual) hardwired system?

In a practitioner's office to help those who are having a very difficult time communicating.

Pediatric Candidacy

In addition to threshold and speech recognition performance: - Also need to consider auditory progress with hearing aids (traditional amplification) - No medical contraindications - Highly motivated parents (and child) >> take child to speech therapy appointments, lot of work involved to help child - Appropriate expectations

Using Personal Hearing Aids with the telephone

In the acoustic coupling method, the listener simply holds the telephone receiver up to the microphone of the hearing aid - Positioning is normal for custom instruments—it works particularly well for CIC instruments - Positioning is toward the top/back of pinna for BTE instruments Problems associated with acoustic coupling: - Feedback - Positioning can be awkward In the inductive coupling method, the person activates the telecoil in the HA For listeners who do not own HA, whose HA do not have a telecoil, or who have problems even using a HA compatible phone with a good telecoil, telephone amplifiers can be used

Induction loop systems for personal use

Individuals can also purchase induction loop systems for personal use. The most typical application is for TV viewing. The mic of the systems is placed near the TV (or the signal can be obtained from an output jack) The electrical signal from the mic is sent through a coiled wire that is looped around a viewing area The listener sits anywhere in the looped area and can pick up the signal using the HA telecoil

ALDs: Induction Loop Systems

Induction loop systems are wireless—they use an electromagnetic signal to transmit the signal between the speaker and the listener's ear (similar to telecoil) When an electrical current is passed through a loop of coiled, an electromagnetic field is generated in the vicinity of the loop—this electromagnetic field varies in proportion to the current When a second coil of wire is placed in the vicinity of the varying electromagnetic field, an electrical current—identical to the one flowing through the original loop—is induced in the to the coil

ALDs: Infrared Systems - advantages

Infrared systems typically provide exceptional sound quality Infrared systems are the system of choice when confidentiality or copyright restrictions are a consideration—infrared light waves cannot penetrate walls or thick curtains

Computer Assisted AR Training for Adults

LACE (Sweetow and Henderson Sabes) - Listening and Communication Enhancement Home-based Interactive and adaptive Provides: better comprehension of degraded speech improvement of communication strategies enhancement of cognitive skills 20, 30 minute sessions (5 days/week for 4 weeks) http://www.neurotone.com/lace-interactive-listening-program

Induction loop system disadvantages

Lack of portability (system is only where it's installed!) Strength of magnetic field decreases with distance - If system installation isn't handled well, there are "dead" spots Subject to electromagnetic interference (lots of computers/equipment that can affect) Fidelity affected by telecoil strength and orientation

ALDs: Infrared Systems - disadvantages

Lack of portability, confined to certain listening area Cannot be used outside due to interference from sunlight The LEDs and photodiode must be "line of sight" - If something is blocking the pathway, it won't work Reflected signal from solid surfaces may degrade sound quality Large area systems need professional installation

Semicircular canals

Lateral, anterior and posterior Functionally paired canals bilaterally Canals are oriented in a mutually perpendicular arrangement Comprise sensory system for angular acceleration Any angular movement stimulates at least one pair (two total, one on each side)

Auditory Training: Goals For Adults

Learning to maximize auditory (and other) cues for speech perception Adjustment and orientation to hearing aids or CIs to get optimum use Often thought of as maximizing listening skills

Without a HA, can use different transducer styles:

Lightweight earphones (with headband) Earbuds (which fit into concha area) Under the chin style headsets—often used with infrared systems Small body aid-style hearing aid receivers (which snap into the standard-style earmold)

Other Suggested Activities

List and practice speechreading the names of some local restaurants Act out eating at a restaurant from the time you are seated until the time you receive your check. Use some speech out loud and some without voice. List vocabulary and practice conversations associated with specialty restaurants (e.g., Thai, Italian, Mexican, Lebanese) with speech aloud and some without voice.

Vestibule

Located adjacent medial wall of tympanic cavity Utricle: detects linear accelerations and head-tilts in linear accelerations and head-tilts in the horizontal plane Saccule: detects linear accelerations and head-tilts in the the vertical vertical plane Saccule/Utricle contain macula; sensory organ for linear acceleration; has HCHC Any relationship of head vs. gravity is included due to curvature of striolato curvature of striola

Homophenous Words

Look alike on the lips (about 50% of words in conversational speech) pat, bat, mat (same place of articulation, visually they look indistinguishable)

Which materials should be used (to test CI candidacy)?

Manufacturers differ in specific tests, but all recommend tests of: words in quiet sentences in quiets sentences in noise

Using TTYs in lieu of an amplifier

Many HI people cannot converse on a telephone even with HA or telephone amplifiers Some have severe to profound hearing loss Some have severe speech understanding problems Some have severe speech production problems

Audiologic Rehabilitation for CIs

Mapping / Coding Strategies Speech Therapy Auditory -Verbal Therapy Family!!!!

Auditory Training: Goals - very similar to goals for AR

Maximize receptive communication Acquisition of more proficient S/L skills Educational/vocational advancement Psychosocial adjustment

Assessment of Dizziness

Medical Evaluation Most common cause of disequilibrium is medications Systemic problems Cardiovascular Respiratory Endocrine system Neurologic disorders Vestibular pathologies

Evaluation of Candidacy for CI

Medical evaluation (ruling out medical contraindications) - Rule out cardiac issues - Other medical issues - CT scan of temporal bones, MRI

AR Groups - speech reading training is usually part of these groups

Meet once a week for 4-6 weeks Point is to enhance overall communication skills Common topics: - Understanding hearing loss - Use of ALDs - Using communication strategies and speechreading - Effective use of HAs

Components of a CI

Microphone, speech processor, transmitter and receiver/stimulator, electrode array

Room Acoustics: Acoustic Climate

Mixture of background noise and useful sounds in the environment in which we find ourselves A good acoustic climate is one in which the noise is suppressed as much as possible, and useful sounds stand out clearly and easily distinguishable Determined by 3 factors: Noise (Internal and External noise) Distance between speaker and listener Reverberation time of the room Room Acoustics and Acoustic Climate are considered by audiologists and other communication professionals Schools Workplace Industrial noise issues (OSHA)

SPICE

Moog, Biedenstein & Davidson (1995) Speech Perception Instructional Curriculum and Evaluation 4 levels Detection Suprasegmental Vowel & Consonant Perception Connected Speech Activities done with combined Aud/Vis and Aud only in short, structured therapy sessions; used a lot with CI kids

Tinnitus treatment options

More effective than medical, surgical or pharmacological treatments Hearing Aids (most common) Noise Generators Neuromonics - looks like HA but it's a 6 month treatment device; hopes to promote neuroplastic changes so brains can filter out sounds from attention; reduce tinnitus distractions; for those with NO HA but horrible tinnitus Tinnitus Retraining Therapy Cognitive Behavioral Therapy Objective Transcranial Magnetic Stimulation

Synthetic

More global approach; words, phrases, sentences The meaning of an utterance is learned without recognition of every sound or word

ALDs: Delivering the Signal from the Device to the Listener

Most ALDs can deliver the signal to the listener in two different ways By coupling the signal from the receiver to special headphones, which are worn by the listener By delivering the signal from the receiver (physical receiver or built-in) to the listener's personal hearing aid

Situation/conditions causing need for ALDs:

Most common HA user problem: Listening in conditions that are less than ideal—at a distance, noise, reverberant conditions These situations are difficult because: Signal arriving at HA microphone is reduced in intensity (because of the distance it has traveled) Signal is mixed with background noise present in the environment Signal is degraded by reverberation A HA alone (even advanced digital HA) cannot completely resolve these problems

DM (Digital Modulation) Systems (replacement of FM systems; she still calls them FM systems)

Most systems use digital signal modulation today Carrier frequency isn't an issue; each kid needed their own carrier frequency, but this is no longer an issue now >> Kids and their systems are "paired" to a teacher's mic When going to a different group, pair with a new microphone Direct DM systems have been developed - Some practical problems still need addressed; like pairing can be difficult or not work sometimes Digital sound transmission and digital sound processing - Leads to fewer transmission dropouts and security in the transmission itself, since it is an encrypted digital signal. - Digitally modulated sound utilizes w wider system bandwidths ~100 to 7000 HZ, compared to analog FM

Can auditory performance always be predicted by degree of hearing loss?

No - because there are so many factors involved! What else is going on in the brain?

Induction loop system advantages

No special receiver is needed if the listener has a HA telecoil Smaller systems are not overly expensive, although professional installations are required for large systems = expensive

Tinnitus is linked to...

Noise exposure Ototoxic medications Sensorineural hearing loss / presbycusis Acoustic neuroma Meniere's disease (build up of endolymph; low-pitch roaring type tinnitus) Stress & depression

If a child has little perceptual ability, begin with auditory (sound) awareness activities:

Non-Speech Stimuli used Teaches the relationship between sound and action toy drum--noise makers--piano--telephone We do not want to stay at this level too long

Cognitive Behavioral Therapy (Tinnitus)

Objective: Develop new thought processes and new reactions, to affect the way pt's think about tinnitus Some people have it so bad that they think about killing themselves; get them the help they need

Tinnitus Retraining Therapy

Objective: Don't respond to tinnitus in an emotional way

Auditory Training Methods

Once we know the patient's current level, activities are designed that are appropriate. For children: Detection: dropping blocks, peek-a-boo, musical chairs, etc. Discrimination: same props, different game Identification/Recognition: point to picture; repeat words Comprehension: answer questions about a story; play I-spy

Post-op recovery

Outpatient or overnight (very old, very young) Minimal activity for 1 week 2-3 week post-op check Implant "hook-up" / mapping at ~1 month

Personal hardwire systems are often referred to as

PASs (Personal Amplification Systems)

Rotary chair

Patient is strapped into a specialized chair in a darkened chamber Infrared goggles are worn Checking for nystagmus through rotation

Auditory Stimulation in Communication

Perception Abilities - Auditory Response Area Acoustics of Speech - Lecture 3 Redundancy of Speech - improves speech perception and makes it easier; all of these factors can add to the redundancy or take away (and make it more difficult to understand!)

ALDs: Personal DM Systems

Personal DM systems are very versatile, so they can be used for a variety of applications - By a child mainstreamed into classes of children with normal hearing - By adults who need an improved S/N

ALDs: personal FM/DM Systems

Personal FM/DM systems can also be used as a more expensive (and slightly more complicated) version of the hardwired PAS—e.g, - As a substitute for a body style hearing aid for individuals who are bedridden or who have vision and dexterity problems - As a tool in health care facilities to be loaned to individuals who don't own a personal HA to facilitate communication

What is a hardwired system?

Personal hardwire systems work in much the same way—just on a smaller scale The mic of the system is placed near the sound source (the talker, TV, etc.) The signal is sent to the amplifier, where the volume can be varied using a volume control wheel Amplified signal is delivered to the listener's ear—typically using a lightweight headset or earpiece

Bony labyrinth

Petrous portion of the temporal bone; projects auditory and vestibular systems Contains the membranous labyrinth Three parts of memb. lab./aka otic capsule: - Semicircular Canals - Vestibule - Cochlea - Plus all the fluid contained in these structures

ALDs help in adverse listening environments by:

Placing the microphone of the system close to the signal of interest (e.g., the speaker's mouth, the public address system) Signal is then transmitted directly to the ear of the listener The signal can be transmitted using a variety of technologies (hardwire, induction, infrared, FM, or Bluetooth) The ALD can be used with or without a HA

Induction loop system settings

Popular in classrooms, churches, auditoriums, theater before the advent of FM systems, currently a resurgence in popularity

Auditory Training: For Children

Professionals who implement AT help HI children acquire many of the auditory perception abilities that normally hearing children acquire naturally without intervention Limit to incidental hearing

Pediatric Candidacy for 12 months - 3 years

Profound bilateral SN loss (> 90 dB HL) - Children with better hearing still may be good candidates -- With infants and small children, often it is difficult to obtain accurate thresholds, so it's better to err on the side of profound hearing loss (don't want to implant if you can't even get the child's thresholds)

Transmitter and receiver/stimulator (CI)

Receive signals from the speech processor and convert them into electric impulses (acoustic to electric energy)

Example: Eating Out

Recognition of key words Sentences containing key words Questions for conversation Other suggested activities

Sentences Containing Key Words

Recognize each key word and look for meaning; avoid translating This is my favorite restaurant. The banquet room holds 50 people. I prefer to eat in the cafeteria. It's a good idea to make a reservation. Would you like wine with your meal? We have a choice of three entrees for dinner. I'd like some clean silverware. Our luncheon menu is a al carte. Please put this on separate checks.

Posturography

Recording of force plate information and electromyograms from postural muscles during postural tests.

Syntactic constraints

Refer to the fact that every language is governed by a set of grammatical rules that specifies the relationship between words used to communicate. For example, adjectives may be used to qualify nouns (as in "the blue shoes"); adjectives are not used to qualify verbs (as in "he blue ran").

Situational constraints

Refer to the fact that language usually takes place within a physical and social context. Generally, the use of language bears some relationship with the context in which it is used. For example, in a stadium, during a football game, it is more likely that the topic of discussion will center around sports-related activities than around religious beliefs and values.

Semantic constraints

Refer to the fact that the words used in a sentence are usually related to each other in a meaningful way. For example, although the sentence "Put the salt on the cloud" is syntactically correct, semantically it is highly improbable.

Limbic system

Regulates our emotions - Song (auditory signal) triggers emotions linked to it Can alter perception of internal and external stimuli Portions of cortex Hippocampus (temporal lobe, long-term memory and spatial navigation) Amygdala Hypothalamus

Speechreader/listener

Residual hearing (more HL, more reliance on visual cues. Deaf individuals are at a disadvantage to be good speech readers. Can't fill in the gaps of what's being said because haven't mastered English cues) Age of onset of HL Perceptual abilities (visually and auditorily) Age Young adults are best at speech reading Experience with language No phonemic regression Visual Acuity Must be at least 20/80 Visual closure skills (know what's important) - many people, in addition to HL, have vision issues!! Makes things difficult Gender Females do better than males when speech reading. No hard evidence on this yet. Attention, Attitude and Motivation The more motivated the speechreader, the more guesses that will be attempted Good speechreaders appear to have a more positive attitude towards others and themselves Speechreaders often report fatigue due to concentration/high focus IQ - it's not smarter = better speech reading. Huge variability in ability to speechread. Normal IQ, no significant difference in potential to learn to speech read

Reticular formation

Responsible for our state of arousal and readiness Heart rate Blood pressure "Fight or Flight"

Speech processor (CI)

Selects and arranges sounds picked up by the microphone

Pediatric Candidacy for 3 - 18 years

Severe-to-profound bilateral SN loss in low frequencies (>70 dB); profound in mid to high frequencies (70 dB); profound in mid to high frequencies (> 90 dB HL)

Factors that affect Speechreading

Speaker factors, signal/code factors, the environment,

Speechreading components: Facial expressions

Special class of gestures Less specific linguistic information than gestures They give a clue to the speaker's physiological state and opinions of the subject matter Situational Cues (non-verbal contextual cues) Physical location of conversation: where are you? Participants in conversation: who is involved? Objects in the environment: what's (what things) around you? All of these help to increase redundancies of language

Table 4.4

Syntactic constraints, semantic constraints, situational constraints These things add redundancy and therefore make speech perception easier

Tinnitus: Support Groups

Support groups. Sharing experiences with others who have tinnitus may be helpful. Some tinnitus groups meet in person, there are also Internet forums--best to make sure the group is facilitated by a physician, audiologist or other qualified health professional.

Using TDDs

TDD stands for Telecommunication Device for the Deaf (aka TTY "teletype" machines) - Some prefer the term Text Telephone (TT) since individuals other than those who are "deaf" often make use of the device TDDs typically consist of three parts - A keyboard for typing the outgoing message - A coupler (or modem) in which the handset is placed to send and receive the message - A display where the incoming message is shown

Using Telephone Amplifiers in lieu of inductive and acoustic coupling

Telephones can be amplified in a variety of ways The amplifier can be built into the telephone itself The amplifier can be built into a replacement handset (simply replace the original handset with one that amplifies the signal) The amplifier can be placed "in-line" between the telephone and handset

Advantage of personal HA delivery

The advantage to using a personal hearing aid is that it allows the signal from the ALD receiver to be amplified and shaped to meet the individual's needs Using the hearing aid telecoil Using a direct electrical connection between the ALD receiver and the HA

Personal infrared systems - situation and set up

The most common application of personal infrared systems is for TV viewing The microphone of the system can be attached with Velcro fasteners to the speaker of the television (or can be obtained from the audio output jack if available) The transmitter is placed on top of the TV—facing the viewing area The listener wears the receiver and headset—or couples the output of the receiver to their HA

Auditory Training: Auditory Skill Level

The selection of an appropriate auditory skill level (what do we need to work on and at what level?) is based on the client's auditory abilities: sound awareness (ability to detect sound) sound discrimination identification (recognition) Comprehension These four levels are not discrete, but represent a continuum of skill levels.

Recall that DAI is a means of delivering an electrical signal directly to a hearing aid

The signal from the ALD receiver is sent via cord to the hearing aid An audio "shoe" or "boot" is snapped on to the bottom of a BTE HA and is wireless Receivers are built in to the HA Receivers are downloaded into the HA

A sample hierarchy of vowel training objectives

The student (notice that it gets progressively harder) 1. Will discriminate vowels that differ in 1st formant information, using a 2-item response set; for example, meat from mat 2. Will discriminate vowels that differ in 2nd formant info., using a 2-item response set; bee vs. boo 3. Will discriminate words that have vowels with similar 1st and 2nd formant info.; using a 2-item response set; met vs. mit 4. Will identify words with different vowels, using a 4-item response set; for example, beet, from the response set of beet, boot, bat, bet 5. Will identify words with different vowels, from an open set of vocabulary

How do ALDs in the school system work?

The teacher wears a wireless mic that sends the signal to an AC-powered FM transmitter The FM transmitter sends an FM signal throughout the room FM receivers (attached to soundfield speakers) are located strategically around the room The soundfield speakers broadcast the teacher's voice throughout the room

Outcomes of CIs - In post-lingually deafened

Therapy focuses on reception s/l On average ~80% of sentences can be understood without visual cues Proficient in use of implant within 6-12 months Results usually age-independent Still working on improved music perception

Signal/Code factors

There are approximately 40 phonemes in English (different auditory signals) Number of distinctive visual features depends on: - Shape of the mouth - vowels - Place of articulation - consonants

assistive listening device (ALD)

There is a broad range of assistive devices Three categories (though prof calls all of them "ALDs") - Assistive listening devices (ALDs) - Telecommunication devices - Alerting Devices

What are PASs?

These devices can be used as an alternative to hearing aids - They are relatively low cost - They can have good sound quality - They are easy to operate and have large, accessible controls PASs can be a good alternative for people who are bedridden or physically or mentally unable to operate a conventional hearing aid Also useful for professionals who interact with HI individuals who may not own a HA They are "over the counter" devices

Assessment of Ability

To determine if visual communication training (speech reading training/class) is warranted; auditory + visual info is really powerful and helpful! Formal methods Informal methods

Home exercises

To improve balance and gait Retrain muscle responses to varying conditions 85% of patients report improvement

Reduction of Noise and Sound Treatment

Total absorption of sound in a room depends on: Absorption coefficients of materials in the room different materials absorb differently at different frequencies Size of the room The reverberation time of a room can be improved by using more absorbent materials

Adult candidacy - speech presentation level

Traditionally, 70 dB SPL Problems: Not conversation speech level (60 dB SPL) 40 dB HL Pre-implant performance at 70 dB SPL is better than at 60 dB SPL (inflating scores) - eliminating some good candidates

Pragmatic

Trains the listener to control communication variables like level of speech, S/N and context Use of repair strategies; what do they do when they don't understand?

Visual Stimuli in Communication: Manual Communication; rely on visuals only

Types—See Table 5.6 in your book ASL Pidgin Signed English Signed English Linguistics of Visual English Signing Exact English Seeing Essential English Fingerspelling Cued Speech

Visual information

Used by everyone More important for HI - The greater the HL, the greater the reliance on vision for receptive language Distinction between HI and Deaf and way visual information is utilized - Oral Communication -- Observation of mouth, facial expressions, gestures - Manual Communication -- Signing

Alerting Devices

Used to alert people with hearing loss to sounds that they might otherwise miss Although these devices are used primarily by individuals who are deaf, others with mild to moderate hearing loss can make use of them as well—if they are having particular difficulties

The Signal - ideally they get 33% of speech cues, but usually it's 11 - 25%; she argues that any little bit helps

Viseme, homophenous words, homophonous words

Using Visual Information (ways to say you're using visual info)

Visual Hearing Visual Communication Visual Listening Lipreading - Too limiting Speechreading - Includes use of facial exp., gestures, situational cues

ABSORPTION

When sound waves strike an object (wall, ceiling, floor, window, door, desk, drapes) Some sound will be reflected Some sound will be absorbed by the object

Reflection of sound

When sound waves bounce back to you ("echo"). The harder the surface, the stronger the reflection. Soft materials can absorb the sound and reduce the reflection.

Auditory Training: Stimuli

Which stimulus units are to be utilized in therapy? Most auditory training programs use a combination of analytic, synthetic and pragmatic training activities (eclectic) There is a continuum among these training activities Clients may be required to may be required to perform all types of activities during the same therapy session

Room Acoustics: impacts on listeners

With reverberation, how can normal listeners pinpoint sound source? Precedence Effect = binaural psychoacoustic effect, when a sound is followed by another sound with a short time delay, listeners will perceive a single, fused auditory "image" perceived sound is fixed by time and intensity cues at the listener's ears (two, normal ears) allows for suppression of background noise & focus on the primary signal What about hearing-impaired listeners? Room acoustics even more important consideration Problems with localization and speech intelligibility inherent speech intelligibility problems, i.e., reduced word recognition abilities even with amplification, two ears may not be equally balanced

How are auditory skills evaluated to determine the child is making progress?

With very young children, cannot determine speech recognition abilities Parental history; parents are the main way we figure out how a child is hearing and what a child is getting. Done with: Validated questionnaires Meaningful Auditory Integration Scale (MAIS) IT-MAIS for infants and toddlers Parents' Evaluation of Aural/Oral Performance in Children (PEACH)

Include in treatment program: activities should include this variety

With/without visual cues Close/far Noisy/quiet (vary S/N) Spontaneous/prompted Closed set/open set Familiar/unfamiliar Words/sentences Active listening/engaged in other activities

Room Acoustics: Internal Noise

Within the building but outside the classroom Cafeteria, gym, hallways

Table 4.3

Within the speaker Compliance with the rules of the language Use of appropriate articulation, intonation, stress Size and appropriateness of the vocabulary used to convey the message (jargon) Within the message Number of syllables, words, etc. Amount of context Frequency composition of the speech signal Intensity of the speech signal Within the communication environment Amount of acoustic noise Degree of reverberation Number of situational cues present that are related to the message Within the listener Familiarity with the rules of the language Familiarity with the vocabulary of the message Knowledge of the topic of conversation Hearing abilities (if individual has HL, effects speech perception)

Closure

ability to recognize speech even when some cues are absent (like with a HL) Bringing speech elements together into a meaningful whole

Sound is not only processed by auditory centers of the brain

all of these are connected and impact tinnitus Interactions between auditory messages and other brain centers involved with emotion and metabolic function

Eclectic

all of these combined in some way

optimal reverberation time

amount of reverberation is acceptable

Auditory Training: Four conditions must be met before auditory management is begun:

appropriate amplification amplification is functioning properly auditory cues are available for client to use, based on their audiogram the client has the potential to make better use of his/her amplified residual hearing

Personal systems

are "owned" by an individual and are portable and move with the individual *Prof provided example of one personal system that is not owned by the individual—when a school purchases the system for the individual. The school owns it, so as soon as that person moves on, they can't take that ALD with them, even though they used it.*

Group systems

are designed to be used by multiple individuals at once: Classroom An audience

Alerting devices

are used to alert individuals to acoustic stimuli they might otherwise miss ie: alarm clock, smoke detector, crying baby, or a ringing telephone Most commonly used by individuals with a severe to profound hearing loss

Telecommunication devices

are used to improve communication over the phone or to aid in understanding the signal coming from the TV Some telecommunication devices provide an enhanced auditory signal (like a telephone amplifier) Others provide a visual signal in addition to or in place of the auditory signal (like a TDD for the telephone or a closed caption system for the TV)

Methods for Speechreading: Analytic

basic approach, better when they have difficulty with one specific thing over and over Before an entire word, phrase or sentence can be identified, necessary to visually perceive the basic "parts" Identification of every lip movement of vowels and consonants Phoneme and syllable are the key units for visual perception

Methods for Speechreading: Synthetic

big picture Perception of the "whole" is most important, regardless of which of the parts are perceived visually Use of predictions and contextual cues Key words, phrases, sentences are the backbone of visual perception

Discrimination

can they tell the difference between and among sounds? Gross discrimination Difference between/among sounds (ie: noisemakers versus fog horn) Finer discrimination Variations in frequency, intensity, duration Gross discrimination of speech sounds (ex: vowels vs consonants) Fine discrimination of speech stimuli (ex: discriminate one consonant from another)

A typical induction loop system

consists of a microphone which is placed close to the sound source The electrical signal from the microphone is boosted by an amplifier and sent through a coil of wire placed around the floor (or ceiling) of a room, producing an electromagnetic signal in the area that is looped *Listeners with a hearing aid equipped with a telecoil can simply activate the telecoil in their hearing aid to pick up the signal*

Attention

degree and quality of the listener's attention will influence how speech is perceived (this is an important aspect to review with adults) Can be really exhausted when they get home, because they have to spend time being attentive and looking for potential speech/signals

Room Acoustics: Speaker to Listener Distance

distance from teacher's mouth to student's ear at distances close to the teacher, direct sound field predominates as the child moves away from the teacher, the indirect or reverberant sound field predominates How do we know if we're in the direct or indirect sound field? Indirect sound field originates at the critical distance of the room.

Room Acoustics: The Inverse Square Law

for every doubling of distance from the sound source, the intensity decreases 6 dB this law only holds for sound that is unobstructed. once the sound is obstructed (when the sound hits a wall, ceiling or floor), the Inverse Square Law no longer holds true beyond the critical distance, perception ability remains fairly constant, but degraded

Comprehension

full perception and understanding of an auditory message

mild-to-moderate losses (PTA = 60 dB HL or less)

good auditory capacity; have the potential to develop auditory skills with intervention deficits may exist in some areas

severe losses (PTA = 60 - 90 dB HL)

good auditory capacity; will gain the most from good, consistent auditory management, and will lose the most if poor auditory management

profound losses (90 - 115/120 dB HL)

greatest variation in auditory capacity pure-tone thresholds least satisfactory as a predictor of performance some children with profound losses do well with good management other issues can affect success: - intolerance to loud sound - tinnitus - poor word recognition scores - poor time and frequency discrimination

ALDs can have two types of "ownership"

group systems and personal systems

Room Acoustics: Room Noise

happens within the classroom/other space chair movement, feet shuffling, desk clatter, heating and AC, lighting

Two broad categories of ALDs

hardwired and wireless

Hearing Assistive Technology (HAT)

help people in a broad hearing situations, more general; whereas ALD is for more specific hearing situations (and ALDs fall under the category of HATs)

some reverberation is good

increase in 3 dB of sound intensity for early reflections (up to 30 msec) reverberation can act as masking noise with delays longer than 30 msec - speech patterns become smeared >>> speech perception decreases

Tinnituse

is a ringing, hissing, whistling or other type of noise that seems to originate in the ear or head. It can be constant, intermittent, monaural, binaural, pulsating. Often not a symptom of a severe problem, or single disease, but a symptom of an underlying condition (damage in some part of the auditory system or a circulatory disorder) Over 40 million Americans suffer from tinnitus.

The dB A scale

is roughly the inverse of the equal loudness contour of the human ear. The dB B and C scales, are used with very high SPLs (more linear)

Room Acoustics: How to improve classroom acoustics in older building (increase absorption)

line door frames with felt or rubber carpet corridors or rooms treat walls and ceiling with acoustic tiles (pieces of covered board) Drapery felt or rubber stoppers on bottoms of chairs or desks (helps with scraping of chairs on floors); tennis balls on the ends of chairs use FM systems (personal or group)

Room Acoustics: ANSI Standard S12.60-2010 on Classroom Acoustics

maximum reverberation time - unoccupied, furnished classroom: -- volume < 10,000 cubic feet = 0.6 sec (600 msec) -- volume between 10,000 and 20,000 cubic feet = 0.7 sec (700 msec) maximum level of background noise - 35 dBA >> dBA most commonly used

Room Acoustics: S/N ratio

more important in determining speech intelligibility than overall noise levels from external or internal sources (!!!) studies examining S/N ratios in many public schools is quite unfavorable (even in normal hearing classes)

Room Acoustics: External Noise

most common source (e.g. traffic noise; airplanes) important to think about external noise sources when planning new schools classrooms should not face playgrounds more noisy rooms (cafeterias, gyms, etc.) should face external noise sources

Once sound discrimination tasks are mastered

move on to vowel and consonant training Vowel training objectives are based on vowel formant patterns Children need to have awareness of vowels before vowel discrimination activities are begun use farm animal toys that make sound...not pictures Moooooo /u/ Baaaaaah /a/ Cheeeeeep /i/

Lecture based on classrooms

not because it's the only environment we care about, but it's the most common for SLPs/AUDs to work with and are concerned about due to the importance of education and the learning environment

Subjective tinnitus

only you can hear. Most common type often often caused by problems in the outer, middle, inner ear or auditory nerves

Objective tinnituse

others can hear. Rare. May be caused by a blood vessel problem, an inner ear bone condition or a muscular issue.

Microphone (CI)

picks up acoustic signals

Room Acoustics: Reverberation Time (T60)

potentially, the most important of the 3 factors determining acoustic climate of a room period in time it takes for a to decrease 60 dB SPL once the source has the source has stopped >> the longer this is, the worse the environment because there is more echo/mixture of competing signals = "smearing" reverberation - the prolongation of sound in a room after the sound source has stopped vibrating concrete, plaster, glass - nearly perfect sound reflectors acoustic tile, carpet, drapes - good sound absorbers

Hardwired systems

require a direct electrical connection (a wire) between the microphone of the of the system (at the signal of interest) and the receiver of the system (at the ear of the listener)

Recognition of Key Words (while eating out)

restaurant medium main course cafeteria seafood lunch(eon) soup fish meal banquet hostessappetizerdinnerwinerestroomorderkids' menumenuentrée(s)check(s)billwaitressmaitre d'potatoesdessertsilverwaretipcoffeesalad (dressing)winea la cartereservationsteakwaiter (waitress)breakfast

Optimal T60: for hearing impaired children

speech in a classroom for HI = 400 - 600 ms speech in a conference room = 400 - 800 ms chamber music = 900 - 1400 ms organ music = 1500 - 2400 ms

Two types of tinnitus

subjective and objective

VRT

success rates are very high! Even without knowing the cause (85%). Physical therapist may be the best option for these patients.

Formal methods

table 5.3

What are ALDs?

technologies (other than hearing aids and cochlear implants) that are *designed to improve the communication abilities of individuals with hearing loss*; anyone could benefit with these if it helps them communicate

If a child is outside the critical distance,

the direct sound arrives at the student's ear but so do reverberant sounds (original wave plus reverberations) The sound reaching the student's ear is has a different acoustic structure than the original signal - different frequency, intensity, and temporal characteristics, impacting speech perception In a classroom, speech perception can be improved by: decreasing the distance between the speaker and listener sometimes called the microphone-ear distance keeping the listener within the critical distance (direct sound field) a group amplification system: FM, infrared

Room Acoustics: Critical Distance

the point in the room where the level of the direct sound and the indirect (reverberant) sound are essentially equal the critical distance is approximately 12 ft. from the teacher in an average-sized classroom sounds within the critical distance are in the direct sound field; sounds beyond the critical distance, the indirect sound field predominates Kids outside this critical distance are in the indirect sound field and receive signals that are dominated by reverberation AND the signal intensity decreases (see Inverse Square Law).

Incidental hearing and learning

things that you hear that aren't necessarily directed at you or you happen to hear and learn from and store Less incidental hearing means less incidental learning (in any environment/situation, could be rich with learning experiences that children need to learn speech/language skills). Limited experiences. Ex: child learns to introduce people to each other through watching parents.

Memory

to retain/store verbal information Enables us to combine individual speech units in order to derive meaning from the entire message

Live room

too long a reverberation time

Dead rooms

too short a reverberation time; unnatural (anechoic chamber at Pressey hall)

Consonant Training

training will contrast differences in features of manner, place and voicing (voicing and manner would be trained before place)

Wireless technologies

transmit the signal from the microphone to the receiver without a direct electrical connection Include: Induction loop, Infrared, FM, Bluetooth (most common)

ALDs: Infrared Systems

use harmless light waves outside the boundaries of visible light to transmit sound An AC-powered transmitter (called an emitter) uses the electrical signal from the microphone to modulate an invisible light wave (95MHz) The light wave is transmitted throughout the listening area by special light-emitting diodes (LEDs) located on the front of the transmitter The receiver for the system is typically a battery-powered headset—it uses a photodiode to pick up the infrared signal, which is demodulated and heard via headset (or via coupling to a HA) >> DAI of BTE; Neckloop

SLPs need to be aware of

vestibular assessments and tinnitus to make referrals to AuDs

VNG

videonystagmography is the recording of nystagmus, a specific type of eye movement.