CSD 425 Midterm

What if the hearing loss is steeply sloping?

(I.e. hearing thresholds drop off quickly at higher frequencies) -Hybrid Devices: Incorporates acoustic and electric modes of hearing in the same ear. -Low frequencies are delivered through hearing aid. -High frequencies are delivered through the implant.

What is the World Health Organization's Model of functioning and disability?

*All of these factors interact to "decide" what limits a person with hearing loss have. 1. Health Condition 2. Body Function and Body Structure (hearing loss characteristics, I.e. mild SNHL) 3. Activity: Limits communication (primary consequences) 4. Participation: Restricts social, vocational participation (secondary consequences) 5. Environmental factors: Factors not in a person's control (work, laws, lack of access). 6. Personal Factors: Innate characteristics (gender, education, IQ, language, coping styles, etc.) *We want to focus on factors that can be changed.

What is a Cochlear Implant?

- A device that electrically stimulates the auditory nerve. (bypasses the hair cells) -NOT an amplifier -Surgically implanted device.

Why is word recognition important?

--Pure tone thresholds cannot always predict word discrimination. -Phonemic regression: for the same degree, type, and configuration ----older patients will typically do worse on a discrimination task (they can hear well, but cannot understand speech because their nerves cannot track quick changes in speech).

What are Middle Ear Implants

-A fully implantable device (you can't see anything on the outside) -An implant in the ossicular chain for those with SNHL with moderate to severe degree. (permanent) -disrupts the ossicular chain, takes the signals out, amplifies it, and then putting the signal back into the natural path.

What are AR services for school-age children?

-AR plans can assist with: classroom accommodation, transitioning between schools, and educational planning.

What are Hearing Assistive Technology Systems?

-Additional systems that a device user can use to function more optimally. -Useful in environments/situations where hearing aids/CIs become limited. AKA Assistive Listening Devices

What factors are likely to affect the outcomes of Auditory Training?

-Adherence -Motivation -Readiness -Expectations -Personality -Adaptability -Function in non-auditory areas like cognition, visual perception. -Relational support

What are Advantages/Disadvantages of an Induction Loop HATs device?

-Adv: Telecoil is available in many hearing aids without much additional cost. -Disadv: Loop needs to be installed, device user needs to be inside loop for telecom to pick up the signal.

What affects post CI outcomes?

-Age of onset -Length of deafness -Age of implantation -Length of implant use -Etiology -Consistency in implant use -Technology

What is the speech banana?

-An easy way to predict the effect of hearing loss on audibility of speech sounds. -Can place speech sounds on an audiogram (how they are distributed in terms of intensity and frequency) -The speech sounds spread out to look like a banana.

What are limitation fo bilateral cochlear implants?

-Bilateral CIs are not equivalent to using to ears. -Two CIs are not synchronized (I.e they don't talk to one another) -All the cues (ITD and ILD) are distorted.

Who is a CI candidate?

-Bilateral severe to profound SNHL -Medical/surgically cleared -Motivated, realistic expectations -No benefit from HA (< 50% word recognition score in best aided condition). -At least 12 months old -Family and educational support

What if the hearing loss is asymmetrical?

-Bimodal (acoustic and electric fittings) -Severe ear = CI -Less severe ear = Hearing Aid *They sound different and provide better cues, but having a CI and HA is still better than having just one CI.

What did the Phonetically Balanced Test for Kindergartners (PBK) demonstrate at children who were implanted with a CI at a younger age?

-Children implanted at younger ages perform better. -With equal listening experience, children implanted at younger ages have higher speech perception scores. -Children who were implanted later only achieve about 48% scores (even with same CI experience)

Word Recognition Testing

-Closed set task, open set task, -Mostly focus on identification/recognition -Stimuli can be: single syllables (CVC), phonetically balanced list (50 words/ 25 words). -Presented at 30- 40 dB SL wrt SRT (SL= sensation level (the dB above threshold, and SRT= speech recognition threshold). * < 50% = very poor

What does the CORE approach stand for?

-Communication Status (auditory, visual, manual, communication, etc.) -Overall Participation Variables (psychological, social life, vocational, educational) -Related Personal Factors (personality, attitude, IQ, age, race, gender) -Environmental Factors (services, barriers, acoustic conditions, etc.) *consider relevant factors before treatment.

Type of HL and are AC and BC thresholds elevated?

-Conductive: AC= elevated, BC= not elevated -SNHL: AC= elevated, BC= elevated -Mixed: AC= elevated, BC= elevated

What are disadvantages of FM systems?

-Cost -There may be multiple talkers in a room.

What does the CARE approach stand for?

-Counseling and psychological (modifying personal attitude - interpretation, expectations and goals) -Audibility and Amplification (hearing aid fitting, cochlear implants, assertive devices). -Remediate Communication Activities (tactics/strategies, personal skill-building). -Environment Improvement (situation improvement, education, social, communication partner).

What is mapping?

-Determination of stimulation levels to restore audibility for soft sounds, avoid discomfort for loud sounds. -Achieve loudness normalization for a large range of inputs (soft speech has to sound soft, loud sounds have to sound loud).

What are Limitations of Hearing AIds?

-Doesn't make speech any clearer, only louder (amplification) -Speech in noise is difficult -Have to take it out and put it back in every day -Only works for certain types of HL (not severe or profound) -Have to have normal outer ear anatomy -Need to have adequate fine motor control.

What type of FM receivers are there?

-Ear level receiver (connects directly to the hearing aid) -Streamer: Device that is handheld- has a chord that goes around the neck (HAs pick up the signal from the receiver around the neck). -Sound field speakers (loudspeakers) - everybody benefits.

What difficulties might a child with hearing loss face?

-Education (learning how to read, other academics) -Language (learning how to talk) -Personal relationships -Developing social skills -Safety -Social isolation -Difficulty expressing emotion -Self-confidence/self-esteem

What should parents monitor in daily behavior to decide if their CI needs a programming adjustment?

-Emergence of disruptive or withdrawn behavior -Diminished response to environmental sounds -Change in frequency of vocalization, voice quality, and/or vocal intensity -Gradual reduction in distance listening.

What difficulties might an adult with hearing loss face?

-Employment -More effort for relationships/ maintain communication -Social isolation -Safety -Entertainment -Cost -Lack of confidence

What is the Ling Six Sound Test?

-Evaluates auditory skill development. -Uses 6 phonemes spread in frequency (ah, sh, oo, etc.). -Child should repeat what was said. -Can be detection or identification

What are the parameters of a HA quality check?

-Gain -Frequency response curve -Output sound pressure level 90 -Harmonic distortion (new frequencies should be harmonics of the original signal) -Battery current -Equivalent Input Noise Level -Attack and Release Times (time it takes for compression to turn on and off when the signal increases in volume). -Telephone Magnetic Field Response

How do you calculate the Pure Tone Average (PTA)?

-Get the threshold of the lowest frequency the listener can hear. -Add up 500, 1000, 2000, and divide by 3 (average)

What should be included in the Hearing Aid Orientation?

-Hearing loss and device management: Describe all the hearing aid parts, advantages and limitations of HAs, show and practice HA insertion, cleaning and care, show and practice changing programs and volume, show and practice use of HA with telephone. -Environmental Issues: Address factors that are likely to interfere with audibility and speech understanding (background noise, room acoustics, lighting, etc.) -Communication Therapy: Assertiveness training, communication strategies (anticipatory strategies). -Assisted Listening Devices: Help a person with HL in tasks when HAs cannot help.

How can AR help?

-Identifying those who need amplification. -Improve acceptance of hearing loss (and then they can do something about it) -Working with the individual for maximum benefit. -Working on strategies to improve communication. -Help reduce the negative effects of hearing loss.

What are the benefits of using two over one CI when patients have bilateral hearing loss?

-Improved localization (play, safety) -Improved speech in noise in children and adults -Avoids abnormal neural plasticity, especially in children. (dominance of one ear- preferred ear) *Longer inter-implant delays lead to larger asymmetry in speech understanding between ears.

What are advantages of FM systems?

-Improves speech to noise ratio (not losing any quality in signal) -Lowers listening effort -Portable, can be used anywhere -No installation necessary for a particular venue.

What are AR services for older adults?

-Increasing comorbidities that affect communication and hearing aid use (dexterity, vision deterioration, cognitive function) -AR can help with: appropriate device accessories, training, communication strategies, etc.

In what scenarios would Hearing Assistive Technology Systems help to increase access to speech?

-Increasing distance from talker (when you double the distance, it gets quieter by 6 dB and continues to decrease by 6 dB when you go back further away from the speaker). -Increasing distance from talker in the presence of noise (The speech gets quieter the further back you are sitting from the speaker, but the noise is constant - word recognition gets poorer with poorer signal to noise ratio). -Reverberation/echoes (if a speaker and a listener were in an echoey room, it deteriorates the signal - HAs can't do much about this, they only amplify the distorted signal).

What are the main components of hearing aids?

-Input -Microphone: Converts acoustic energy to electrical energy -Amplifier: Boosts or increases the amplitude of the signal. -Receiver: Converts electrical energy to acoustic energy -Battery: Powers all the hearing aid components. -Output

What are the suprasegmentals of speech?

-Intonation -Stress -Rhythm -Superimposed on speech sounds. *Stress or intonation can change the meaning entirely of the sentence. *Can cue emotion or sarcasm.

What is an induction loop?

-Loop in room carries electrical signal (I.e. input from the microphone) - creates magnetic field throughout the room. -Telecoil in hearing aids can pick up signals from the loop. -That will get amplified and sent to the person who is wearing a HA.

What are the thresholds of hearing loss?

-Normal: -10 to 15 -Slight HL: 16 to 25 -Mild HL: 26 to 40 -Moderate HL: 41 to 55 -Moderately Severe Hearing Loss: 56 to 70 -Severe HL: 71 to 90 -Profound HL: > 91 dB

What is the unique problem of telephone use with HAs/CIs?

-Not all frequencies are transmitted through the telephone -No visual cues

Why is speech reading so difficult?

-Not all sounds are visible or sounds appear the same -Variability in talkers -Coarticulation, homophenes

What are Advantages of Hearing Aids?

-Not as invasive as CI -Awareness of sound for safety -Improve quality of life -Cheaper than CI -Good for all ages - can help provide early intervention -malleable (when the ear grows, you can replace the mold) -Easy to remove when dealing with electrical devices

What is the goal of the Speech Processor in a Cochlear Implant device?

-Provide electrical stimulation that is as similar as possible to that provided by an acoustic stimulus in a normal hearing ear.

What are Objective Techniques to Mapping (especially for children?)

-Record the responses from the auditory nerve by stimulating each electrode (estimate maximum current level that should not be exceeded) -Each person is different, so have to estimate -If the nerve is responding, it means it is going.

What are the AR services for infants?

-Reduce the impact of hearing loss -Early hearing and detection and intervention programs are implemented -Family centered approach to provide appropriate means of intervention (e.g. sign, oral-aural)

What are the goals of aural rehab?

-Restore/optimize a person's participation in activities. -Benefit communication partners WHILE minimizing the negative consequences of hearing loss.

How do you differentiate between SNHL and moderate?

-SNHL: BC and AC are the same (the Air Bone Gap is less than 0). -Mixed: The ABG is greater than 10.

How does a person Speech Read?

-Scan the talker's face -Focus most on eyes, nose, mouth -At the end of talker's statement, gaze focuses on talker's eyes. -In noise: focus mostly on talker's mouth. -When we see prosodic (stress) information, focus on upper face (e.g. forehead wrinkling)

How does the speech processor in a CI function?

-Signal is broken up into multiple channels (bands) -In each band, the envelope is extracted and the fine structure is removed. -Electric pulses replace the fine structure and is shaped by the envelope. *Basic functionality is the same but specific parameters differ by the individual. (e.g. how much current is needed for detection?) -Each processor has to be mapped for each person & each ear.

What is redundancy?

-The ease with which one can predict what is being said. *The more cues = the higher the predictability.

What is the Long Term Average Speech Spectrum (LTAS)?

-The frequency content of speech varies. -Tells us how energy in speech is distributed across frequencies. -Speech has the most energy at 500 - 1,000 Hz.

What is Auditory Training?

-Training to maximize the use of the auditory signal. -The primary goal is to improve an individual's listening skills to improve speech perception (improve their ability to use an oral/acoustic signal).

Outcome Measurement or Validation - Speech Tests

-Wait 4-6 weeks -Test in quiet or noise -Stimuli: Monosyllabic words, sentences in broadband noise, sentences in multitasker babble noise, words in multitasker babble noise

In what areas can HATs be used to help increase the safety of a HA/CI user?

-Wake-Up Alarms: Vibrotactile cues to wake up (e.g. a watch, device that vibrates pillow) -Smoke/Fire Alarms: Fire alarm with strobe light, vibrotactile fire alarm -Door Bell: Alarm light, hearing dogs -Telephone: Vibrotactile and connection to accessories like fitbit -More audio-visual systems that aid communication (google hangouts, Skype, FaceTime, glide)

Why is there a need for Auditory Training?

1. Appropriate fitting of HAs/CIs do not restore normal hearing. -Speech recognition remains a challenge particularly in difficult listening situations. -Needing more effort to understand what is being said due to a poor signal increases the cognitive load. 2. Does not suffice to fit the appropriate device -- need to look at central processing as well.

What are the stages in the hearing aid prescription?

1. Assessing Candidacy 2. Hearing Aid Selection 3. Fitting HA/ Verification/ Orientation 4. Evaluation Benefit (Validations)

What are the stages in Auditory Training?

1. Assessment: Is AT needed? What specific areas need training for each individual 2. Training: The lesson plan to tackle all the factors that needed to be worked on based on assessment. 3. Assessment: post-training to compare with pre-training for improvement.

What are Auditory Training Schemes in Adults?

1. Consonant Training: analytical approach. -discrimination of consonants in nonsense syllables 2. CAST: Computer-based -Consists of closed-set discrimination, identification tasks, in noise, telephone speech. -Adaptable: Set level of difficulty (e.g. number of choices). 3. LACE (Listening and Communication Enhancement): Computer-based and adaptive -Degraded Speech (speech in noise, competing single speaker, time compressed) -Cognitive skills (auditory memory) -Communication strategies (provides hints for successful communication).

What are the stages of speech perception?

1. Detection: do you hear a sound? 2. Discrimination: Are the sounds the same or different? 3. Identification: What is that sound? 4. Attention: Focusing on the speaker and the message. 5. Memory: Involves retention of verbal information. 6. Closure: Using experience/knowledge/context to fill in what is missing. 7. Comprehension: What does this mean?

What are Auditory Training Schemes for Children?

1. Erber Approach: Flexible in structure 2. DASL II: structured - preschool and school-age -focuses on 3 areas: sound awareness, phonetic listening, and comprehension -Each area has specific responses as a checklist. 3. SKI-HI: Home based intervention (family approach) -Infants -Intensive list on skill building objectives and associated activities -Pick a skill and give a goal for the parent and a goal for the child 4. CAST: Computer-based -Consists of closed-set discrimination, identification tasks, in noise, telephone speech. -Adaptable: Set level of difficulty (e.g. number of choices).

What does the Hookup/Activation visit entail?

1. Fit Magnet - appropriate strength? 2. Program (aka MAP) the device 3. Activation (may not always be all smiles) - gradual introduction to sensation (not all at once). 4. Orientation/Goals for new CI users (counsel- realistic expectations, increase wear time), care and maintenance, troubleshooting

What does it mean to have a Fixed SNR? Adaptive SNR?

1. Fixed: Noise varies, then play the speech at a certain dB and then take the signal to noise ration (e.g. speech is played at 65 dB and noise is played at 45, then the SNR is 20 dB) -Then the % correct is scored at every SNR 2. Adaptive: Alter the SNR to get 50% correct - instead of changing just the level, changing the SNR as well.

What are the properties of segmentals?

1. Intensity: vowels have higher power than consonants and therefore easier to hear (intensity varies with vocal effort) 2. Frequency: The vowels are low frequency dominated and carry more energy. 3. Duration: Speech sounds range between 20 to 400 ms ( vowels are longer than consonants)

What are common perception of speech errors in individuals with HL?

1. Least difficulty with vowel perception, however severe to profound HL affects vowel perception significantly. 2. Consonants are difficult to hear -Most frequently missed = /s/ /p/ /k/ /d/ /th/ because they are higher frequency sounds. -Place of articulation more prone to error than manner of articulation (you have to hear the frequency difference to know what sound they're saying --> not very obvious on the face).

What are the three main parts of an FM System?

1. Microphone (for the speaker to speak into) 2. Transmitter (the speech is imposed on an FM signal connected to a microphone). 3. Receiver: Contains an antenna that picks up FM signal and decodes it to send it to the hearing device. *No loss in signal, reduced effects of reverberation and noise.

What decisions must be made when deciding an Auditory Training treatment plan?

1. Nature of Task: Detection, discrimination, identification, or comprehension. 2. Response format: Open set or closed set task 3. Stimulus Type: The extent of context (how much redundancy is provided) 4. Signal to Noise Ratio: With or without noise, what type of noise, and how is the testing going to be conducted?

Who is hearing aid candidate?

1. Permanent hearing loss (irreversible by surgery or medication) 2. Most include evaluation of: -Activity limitations -Participant restriction (impact on QOL) -Motivation to use amplification

What goes into the hearing aid fitting process?

1. Quality Check: does the hearing aid meet specifications that the manufacturers claim -This is carried out in a test box (have to do because some people cannot tell you if something is going wrong). 2. Programming: Patient audiogram can be entered and HA gain settings can be set. 3. Fitting with Verification: Once a hearing aid is chosen, AuDs have to ensure that the HAs are doing what they must. -AuDs program the HAs until the HA meet output targets (want prescription targets and hearing aid outputs to be the same).

What are the five main components of a communication model?

1. Source (speaker): Initiate conversation 2. Message (Auditory and Visual): the thought 3. Feedback (to correct an error in articulation) 4. Environment: Where communication occurs (I.e. is there noise?) 5. Receiver (Listener): Understand what is being said.

What are some factors that may lead to an increase in noise that affects speech perception?

1. Speaker-Related: Poor syntax, mis-articulation, incorrect prosody/stress. 2. Environment-Related: Distracting auditory/visual stimuli, reverberation, poor lighting, distance. 3. Listener-Related: Unfamiliar with language, unfamiliar with topic, poor attention/listening skills.

What are some factors that affect redundancy?

1. Speaker-Related: Uses appropriate language rules so one can use linguistic constraints to fill in. 2. Message-Related: Depends on the context/meaning, intensity of the signal. 3. Environment-Related: Noise, reverberation, situational cues. 4. Listener- Related: Hearing abilities, familiarity with language rules, vocabulary, knowledge of conversation topic.

What are the types of noise used as a distractor?

1. Speech Babble: Multiple talkers in the background (if you're sitting in a cafeteria and there are multiple people talking). 2. Speech-Shaped Noise: Steady noise, but if you take the spectrum of it -- looks like the LTA spectrum of speech. 3. Competing talker

What are the steps in Cochlear Implantation?

1. Surgery 2. Activation/Hookup 3. Follow-Up with Outcome Measurement 4. Therapy

What are examples of redundancy arising from linguistic constraints?

1. Syntactic Constraints: Grammar rule (e.g. adjectives are followed by nouns). 2. Semantic Constraint: Meaning probability (if you thought you heard "The girl fell off the tree" you'd guess you thought right even if it wasn't what was said). 3. Situational Constraints: Context (more likely to use audiology terms in a class than church).

What are two HAT that can help to solve the issue with telephone use?

1. Telecoil with Telephone: Put the phone over the hearing aid 2. Bluetooth wireless system: Hearing aid user can use a streamer that can connect wirelessly to many devices (and other devices)

What are the Components of a Cochlear Implant?

1. Transmitter Coil (held in place by a magnet 2. Speech Processor (converts sound into digital information) 3. Microphone 4. Receiver/Stimulator (turns digital into electrical signal) 5. Electrode Array (directly stimulates the auditory nerve).

When does the hook-up/activation occur after a CI surgery?

2-4 weeks post-op time for healing. (have to wait for swelling to go down).

What is aural rehabilitation?

A professional processes performed in collaboration with a client who has hearing loss and the client's significant others to achieve better communication and minimize the resulting difficulties. -Focus on client who has hearing loss.

What if Cochlear Implants Cannot be Useful?

Auditory Brainstem Implants (used for those with no cochlea/cochlear nerve, severe ossification, bilateral nerve tumors - pathway beyond the cochlea is affected). -Electrode is placed in the cochlear nucleus (external components look like a CI).

What if the external ear is malformed?

Bone-Anchored Hearing Aids- directly vibrate the skull (by passes the air conduction pathway). -Hear only through bone conduction not air conduction. -For conductive losses- draining ears, ear malformations.

What is the Analytic approach to therapy?

Bottom-up approach -Training is based on speech segments -Phoneme or word based training

What is the cognitive-skill based auditory training?

Builds over phonetic, and context cues. -E.g. selective attention: ability to focus on the target signal while simultaneously ignoring distracting information.

What is the AR model of EBP?

CORE and CARE models. -CORE: Assessment of rehabilitation -CARE: Management

What is an example of a wired system HATs? How does it work?

Direct Audio Input -Connect the target sound source to the listener through a wire. -Signal is carried through an electrical wire. -Fairly cheap option, but most patients do not like the hardwired option because it requires you to be connected directly to the sound source (affects moving around).

What is the early speech perception test?

Evaluation of auditory skill development in children -Object/picture pointing -Closed set -Can be live or recorded speech

What is the Word Intelligibility by Picture identification (WIPI) evaluation?

Evaluation of auditory skill development in children (listening abilities) -4 lists with 25 monosyllabic words each. -Picture pointing (closed set) - point to whatever is being asked for. -Suitable for children with limited expressive/receptive abilities.

What is Evidence Based Practice? What is the clinician approach?

External Evidence Clinical Expertise Patient values *ask a question, find best evidence to answer question, critically assess and decide if the result applies, integrate evidence with clinical judgement, evaluate performance after implementing plan.

Outcome Measurement or Validation - Self Reported Measures

How is hearing user doing in real world? -Interview -Questionnaire -Measure: communication performance, select areas where they want to hear better (do they improve?) -

What are AR services for adults?

Individuals with HL are more likely to be in group discussions, telephone use, personal relationships. -AR can help with: appropriate technology, communication strategies, and workplace modification.

What is the ecletic approach to therapy?

Mixture of all approaches -Not structured - take it as it goes

What is the Synthetic approach to therapy (auditory training)?

More global -Uses, words, phrases, and sentences -Uses context (provide a location and repeat items, words, usually available in that location). -Ask questions

What is the California Consonant Test?

Tests for evaluation of listening abilities in adults. -Closed set task -Check the word you hear spoken out of a list -More sensitive to high frequency loss (they do worse on this test).

What is the Northwestern University Auditory Test?

Tests for evaluation of listening abilities in adults. -Meaningful monosyllabic words. -25 or 50 word lists -Open set (repeat what is heard)

What is the Speech in Noise Test?

Tests for evaluation of listening abilities in adults. -Sentences in speech babble -The task is to identify the last word in a sentence. -Difficulty varied by predictability in sentences (high predictability (redundancy) able to guess the word based on the sentence).

What is the QuickSIN test?

Tests for evaluation of listening abilities in adults. -Sentences in speech babble. -Tests at multiple fixed speech to babble ratio -Outcome: Compared to a normal hearing person, how much higher should the SNR be for a person with HL to identify 50% of target words in sentences.

What is the Hearing in Noise Test (HINT)?

Tests for evaluation of listening abilities in adults. -Sentences presented with and without speech-shaped noise. -Adaptive: Noise is held constant, speech changes in level to arrive at SNR at which 50% correct identification was achieved. -Noise can change in location (test effects of asymmetry)

What are vowel characteristics in terms of frequency?

The first two formant peaks are the main cue to identify a vowel. -Across vowels, combination of F1 and F2 varies - so have to hear both F1 and F2 to know which consonant is being spoken. -If a person cannot hear high frequencies, they may not be able to distinguish between two sounds.

What are hearing thresholds?

The lowest dB sound you can perceive. -Start at 30 dB, if yes then you go up 5 -if no then you go down 10 -need to get "yes" in 2/3 of ascending runs.

What is the pragmatic approach to auditory training?

Training an individual to use communication strategies -Uses a conversation-based approach. -Teach the person how to converse -E.g. clinician provides a context followed by a Q&A

Where is the electrode array of a CI inserted?

in the scala tympani of the cochlea.