CSD 433 EXAM 1 PSU

issues that could occur with the ear canal

-swimmer's ear -wax (cerumen) -foreign bodies

what are the disadvantages of "completely-in-the-canal" (CIC) hearing aids

-requires considerable manipulation for a comfortable and consistent fit in the ear canal -repair problems are very likely (caused by cerumen)

what are some solutions to cerumen and moisture problems of the hearing aid

-some modern hearing aids are making waterproof options -there are "dehumidifiers" that take the moisture of the devices

is one or two hearing aids better?

**binaural amplification of hearing will result in a more natural listening experience -two hearing aids will help with the patient determine the sources and enhance hearing in noisy environments

what is the amplifier of the hearing aid?

**considered the HEART OF THE HEARING AID -found within the enclosed circuit of the hearing aid case -the electrical signals passing through the hearing aid are amplified by a specific amount

recharger options to hearing aids

-are easy to power -fast charging -are reliable with charging -are easy to insert

what is the receiver of the hearing aid?

-area of the hearing aid that takes the electrical signals and CONVERTS THEM BACK TO SOUND

what are the electrode arrays?

-arrays of electrodes that are implanted into the cochlea (base to apex) -electrical pulse signals will be sent from the internal receiving device & stimulator to these arrays ** modern cochlear implants have between 16-24 electrodes

advantage of open-fit BTE hearing aids?

-availability of RIC hearing aids can be provided as well to extend range of hearing loss -RIC can be used with those with severe hearing loss in the high frequencies and low-frequency hearing loss

wireless connectivity for hearing aids benefits which areas of everyday life?

-communication between two hearing aids for persons with bilateral hearing loss -helps with better sound quality that improves speech understanding -will have fewer technical problems when using telephones and TV

what is "behind-the-ear" hearing aid?

-concave-shaped hearing aid that rests behind the ear -available in different colors -plastic tube leads downwards from the front of the case to the external auditory canal (amplified sound is delivered to the ear)

Captions

-could be applied to the TV -also could get app that will place captions onto the phone or ipad (phone is like a microphone) -movie theaters will provide captioning glasses or reading device

what do the bone conduction hearing devices do?

-delivers energy to the inner ear via bone conduction -will cause the cochlea to vibrate, leading for the patient to hear the sounds **known as BAHA devices

what are "open-fit BTE" hearing aids?

-discrete appearance, small size and lightweight hearing aids can provide comfortable, low-frequency sounds in the environment

what are things that you SHOULD NOT do with the otoscope?

-do not perform otoscopy on ear with visible drainage -continue process of ear pain is reported -take time with the test, you can always come back and do the test later

issues that could occur with the pinna

-ear pit -lack of pinna (ear microtia)

what is the importance for middle ear test evaluations?

-evaluates the physical properties of the ear -rules in/out middle ear pathologies that could be causing hearing loss

advantage of having rechargeable hearing aids

-good for dexterity issues -no worries about spending money on batteries -patients find this to the modern option for hearing aids

what do the bluetooth access to hearing aids help with?

-helps facilitate communication between a hearing aids and a wireless device (cell phone or telephone)

microphone component of cochlear implants

-located in the external sound processor -detects sounds and converts them into digital electrical signals that are amplified

parietal area with auditory perception

-makes associations of sounds with past experiences -will compare and match them with input from other senses

what is the microphone of the hearing aid useful for?

-necessary for detecting sound and converting them to electrical signals **some modern hearing aids have MULTIPLE MICROPHONES **location of the microphone depends on the type of the hearing aid

what is the post-surgery care look for a patient after receiving cochlear implant?

-patients do not stay overnight -have minimal pain -head is wrapped to keep incision clean -patient will wait four weeks before the cochlear implant is turned on

what is the process of converting sounds from the external pieces to the internal pieces of the cochlear implant?

-the coded electrical signal (represent outside sounds) are sent to the external sound processor -these signals are then sent to the external transmitting device

what are the advantages of "completely-in-the-canal" (CIC) hearing aids

-there are no external controls on it -able to wear this device and use telephone and determine the source of environmental sounds well

what are some downsides to cochlear implants?

-they CAN AND DO FAIL **they have a 10 year warranty on the internal devices -usually could be completely "dead" **will require explant and re-implant surgery

what is important about service needs for older persons?

-want to be able to continue their careers, communicate with friends and family, and participate in community activities

techniques for friends/family members of hearing loss

-will work to optimize communication with those with hearing loss -some will get support from speech/hearing professionals to better manage relationship with affected members

disadvantage of having rechargeable hearing aids

-you always need to remember to place them on the charger -is another part of the hearing that could easily break

characteristics of hearing aids

1. acoustically amplifies sounds 2. relies on the responsiveness of the hair cells 3. needs to have enough hair cells still available to transport sound to the brain

what are qualifications for a bone conduction device?

1. conductive hearing loss in one or both ears 2. severe outer or middle ear malfunctioning 3. single sided deafness 4. mixed loss

what are the 5 main types of hearing aids?

1. conventional behind-the-ear (BTE) 2. open-fit behind the ear (BTE) 3. in-the-ear (ITE) 4. in-the-canal (ITC) 5. completely-in-the-canal (CIC)

what groups are most likely to receive ear molds?

1. elders (this group may not realize that their hearing aid is falling out and sound is not going into the ear) **which is where we could hear the echo of our voice 2. infants (since there ears are continuously growing)

what are the guidelines that allow an adult to become a candidate for cochlear implants?

1. have NO BENEFITS from hearing aids 2. sensorineural hearing loss 3. moderate to profound hearing loss in BOTH EARS 5. need to have LESS THAT 50% with speech recognition in the implanted ear and LESS THAN 60% in opposite ear

why are behind-the-ear hearing aids the best fit for young children?

1. offers the most powerful amplification option **appropriate choice for those with a severe degree fo hearing loss 2. offers max flexibility, adjustments can be made when new info about child's hearing comes in 3. could wear the same hearing aid for long periods of time, adjustments with the ear mold piece can be made 4. could provide "loaner" hearing aids if ever lost

what are the different auditory testing that audiologist do with cochlear implant patients?

1. pre-, peri-, post-lingual needs 2. communication strategies (ex: looking at someone's face) 3. home-based programs 4. computer-based programs (helpful with bring therapy to the home)

what are the guidelines that allow ages (9-24 months) to become a candidate for cochlear implants?

1. profound sensorineural hearing loss 2. limited benefits from binaural amplification 3. most likely failed newborn hearing screening 4. utilized hearing aid and had minimal benefits

how do you properly hold otoscope?

1. secure the patients head (saves them from turning and puncturing their ear canal) 2. use you free hand to gently pull on pinna

what are the guidelines that allow children (2-17) to become a candidate for cochlear implants?

1. severe to profound sensorineural hearing loss 2. have limited benefits from binaural amplification 3. consistent use of amplification 4. multisyllabic lexical neighborhood test (MLNT) or lexical neighborhood test (LNT) wills score LESS THAN 30%

what is the central mechanism of transferring sounds from the outer ear--> brain

1. sound transferred from the cochlea to 3,000 neurons in the auditory nerve 2. sounds traveled to the auditory nerve is then processed by 200 million neurons in the brain 3. brain understands sound from the process of plasticity 4. the right ear processes sounds in the left side of the brain (language area of the brain) 5. left side processes via the corpus callosum

characteristics of cochlear implants

1. the candidates need to NOT HAVE ENOUGH HAIR CELLS PRESENT 2. transmits sounds to the brain 3. stimulates the auditory pathway directly through the application of electrical current 4. bypasses the damaged/dead hair cells

post cochlear implant surgery program

1. work with threshold and comfort levels for electrical stimulation 2. speech perception of the 6 linguistic sounds 3. sound field audiogram for verification is used **the brain takes a while to become adjusted to the sounds/speech being produced

what are the pure tones that should be presented during hearing screenings?

1000, 2000, and 4000 in each ear at 20 dB -failure to detect these pure tones will lead to failure of the screening

how many years does it take for the auditory cortex to fully develop?

15-20 years

What percentage of people under the age of 40 have hearing loss?

25%

What percentage of people under the age of 60 have hearing loss?

70%

medical questions for adult case history

Family History of Hearing Loss? Do you have any Ringing or Tinnitus? Do you have any dizziness or Vertigo? Do you work around noise? Have you had surgery on your ears? What medications do you take?

Type B tympanogram

Flat. Fluid or perforation conductive hearing loss

Type C tympanogram

Negative pressure (Eustachian tube dysfunction) **also could come from allergies or congestion

Other Hearing Screening Tests

OAE and ABR

word discrimination testing

Procedure by which phonemically balanced word lists are used to estimate how well a person is able to understand speech once it has been made comfortably loud enough for them.

Vestibular weaknesses

The three channels attached to the cochlea give the brain information about movement

What is a cochlear implant?

a device for converting sounds into electrical signals and stimulating the auditory nerve through electrodes threaded into the cochlea

phone apps with hearing aids

app with allows hearing aid users to: 1. adjust volume 2. switch programs 3. check battery status 4. "find my hearing aid" 5. digital patient manuals

how many children in the US are part of speech therapy?

approximately 40 million school-age children **7 million will have hearing loss -largest population of school children in needs of special services

lyric hearing device

are device that: -stays in for 2 months at a time -invisible -can sleep with it in -could somewhat swim with it -not digital **will need subscription plan and are pricey

phone adaptors (CONNECTCLIP)

are devices that connect the landline phone to the hearing aids -also used to connect to TV

TV headphones

are headphone that are connected to the TV and patient could wear them and place sound to any volume **no one else will hear the TV

What are in-the-ear hearing aids?

are hearing aids that are used by patients with hearing loss ranging from mild to severe in degree -the microphone is at the entrance of the ear canal -easy to control

What are assistive devices?

are hearing devices that are accessibility available to anyone

tele-coil loops

are the magnetic field that is applied to several devices, and the hearing aid also had this loop within the device. -this application will connect to another device

what are "completely-in-the-canal" (CIC) hearing aids?

are the smallest and most deeply located hearing aid in the external ear canal -made for those who want hearing aids that are "out of sight" -are removed my small fishing-line string on outer edge

What is ABR?

automated auditory brainstem response -used for early intervention that will be used to help child reach normal milestones

what are the benefits that adults get from cochlear implants?

better sound awareness speech understanding without having to lipread could use the telephone have better understanding in noise

what testing is done for patient with no pinna?

bone conduction -we are able to measure their hearing since this will be using the cochlea

what are common hearing aid problems?

cerumen and moisture -cerumen could block the tiny openings or ports of the hearing and ear molds

what is important about service needs for newborns?

children are testing right when they are born to see if there are any signs of hearing loss -if so, they will continue to get tested at 3-6 months to keep on tract with milestones

Clinical Decisions for patients care should be based on:

clinical expertise patients values best research evidence not "this is what we've always done" **use well-documented research of outcomes

anatomical parts of the inner ear

cochlea semi-circular canals vestibule

what are some of the surgical options for amplification of sound

cochlear implants middle ear implants bone conduction hearing devices

what is the internal receiving device?

component of the cochlear implant that is located underneath the external transmitting device (connected my magnet) -designed to keep/seal out bodily fluids and minimize rejection by the body (since the body will see this as a foreign object in the body)

remote microphones

connects with the hearing aid within 6 feet distance **are available in several versions, including the "tabletop mic"

why are hearing test important for audibility of patients that received a cochlear implant?

could indicate whether or not the patient could hear normal speech sound within the "speech banana" **if you unable to do this test, they could determine which frequencies they could hear by placing a piece of paper over the mouth and see what words could be recited back to the audiologist

alerting devices

devices that change auditory alerting signals that are inaudible for individuals with hearing losses into audible-acoustic, visual, or vibro-tactile stimuli

what are some case history questions to ask in pediatrics?

do you have concerns about their hearing? have they had any ear infections? any speech or language delays? family history of hearing loss? how are they doing in school?

what is wax (cerumen) problems in the outer ear?

excessive amounts of ear wax production in the ear

how are the eyes connected to the balance system?

eyes are connected to the vestibular system, which gives the balance system information

what happens if the patient fails the hearing screening?

follow-up will occur -comprehensive audiological test will happen asap -child will also be referred to educational services to bring more help into the classroom

What are in-the-canal (ITC) hearing aids?

hearing aids that are located completely in the ear canal -is a smaller version of the ITE hearing aid -all components of the hearing aid are squeezed into a more compact space -is an option for people with mild-to-moderate heating loss

what areas of the ear will be affected to have SENSORINEURAL HEARING LOSS?

inner ear -could be caused by noise exposure, family history, aging, ototoxicity

What is otosclerosis?

is an abnormal spongy (boney) growth over the middle ear (incus, malleus, stapes)

insular area with auditory perception

is the temporal aspects of sound

frontal area with auditory perception

is where sound memory is held

cortical and sub-cortical areas with auditory perception

is where sounds discrimination occurs

what are the new task that cochlear implant patients need to do?

learning to hear connection with visual cues role of auditory memory continuum of auditory learning brain plasticity **patient's ability to be patient and accepting of something new

what is otitis media (ear infection)?

liquids in the middle ear is not getting drained through the eustachian tube -liquids become funky **treatment will be to have tubes inserted or replaced to allow drainage

where is the external electromagnetic transmitting device located?

located behind the ear (rests upon the skin)

where are the ear molds created?

made/ manufactured at a commercial lab from a ear mold impression that an audiologist makes in a clinic or office **impressions ate made before hearing aid fitting

anatomical parts of the middle ear

malleus stapes incus eustachian tube ear drum (tympanic membrane)

parts of the cochlear implant

microphone external electromagnetic transmitting device internal receiving device and stimulator electrode array

Type A tympanogram

normal middle ear function sensorineural hearing loss

What is swimmer's ear?

otitis externa -caused by water stays in the ear canal to long periods of time (will lead to inflammation) **treated with steroid drops (deals with the swelling)

issue that could occur in the middle ear

otitis media (ear infection) otosclerosis eustachian tube dysfunction

what areas of the ear will be affected to have CONDUCTIVE HEARING LOSS?

outer and middle ear -could be caused by ear infection, wax, otosclerosis, no ear, foreign body in the ear

what group is more prone to get ear infections?

people with down syndrome (have NARROW eustachian tubes)

anatomical parts of the outer ear

pinna external auditory canal (ear canal)

what are some of the assistive device on the market?

recharger options to hearing aids phone apps (connection to the hearing aids) remote microphones phone adaptor TV headsets

what are some post-implant speech changes?

self-monitoring of articulation self-monitoring of voice quality pronunciation of words **this is where a SLP can step into play!

problems that can occur in the inner ear?

sensorineural hearing loss vestibular deficits

what type of hearing loss do patients with cochlear implants have?

severe to profound hearing loss in BOTH EARS

Speech Discrimination Testing Word Recognition Testing

special testing that helps identify if the child "perceives" or "discriminates" the difference between the target and error production

where do you start with hearing screenings?

start at 1000 Hz presented at 50 dB to see if THEY UNDERSTAND THE TASK **IF NOT, re-instruct or go louder -once done and understand, go down to 20-25 dB at 1000Hz

temporal lobe with auditory perception

takes the frequency characteristics of sound

what are the areas of the brain involved in the auditory perception?

temporal lobe insular area parietal area frontal area cortical and sub-cortical areas

what is the organization of the cochlea?

the frequencies are organized with the higher frequencies being heard first --> goes down the spiral to low frequencies

What is eustachian tube dysfunction?

the inability to equalize middle ear and atmospheric pressure

what is important about bone conduction audiometry?

the instruction and responses are the same as air conduction -works with patient that may have no pinna (cochlea is the main sources that is responding to the sounds)

how are cost managed for hearing aids?

there is resources, such as different medical coverages (Private (HMOS), State (Blue Cross & Blue Shield), Federal (Medicare), State and Federal (Medicaid))

What are ear molds used for?

they are custom fit to the patient's ear that are usually connected to the hearing aid

what is important about the hair cells on the cochlea?

they pick up the sounds that we are listening to -loud sound exposure, excessive alcohol consumption, etc will damage/kill the hair cells (are not able to return back to healthy cells)

what is important about pure-tone air conduction audiometry?

this determines the loudness or intensity threshold in dB to which a person begins to hear sound

what is important about air conduction audiometry?

this is conducting a test to determine the sound transmissions of day-to-day situations

what are hearing aids made for?

to make sounds louder (depends on patient's audiogram) **process is known as amplification

what are some case history questions to ask adults?

what brings you in? what kind of problems are you having? **have adults fill out questionnaires before coming to have a guide to look for any issues (BIG TIME SAVER)

what is important about service needs for adults?

with aural rehab, adult could continue contributing in the workplace and community -we could see this in Americans with Disabilities Acts (ADA)

what group is more prone to otosclerosis?

women (hormones may have an affect on this)

what is important about service needs for school age kids?

works with children with hearing loss get services that: -educational planning -accommodations in the classroom with assistive tech -helps with the transition from one school to the next