Chapter 1, 6, 7, 8, Case Studies, & ASHA

Question 1

Prevalence

Answer 1

Refers to the number of children with hearing loss at a particular period of time.

Question 2

Incidence

Answer 2

Number of new cases of children with hearing loss over a period of time.

Question 3

Functionally Deaf

Answer 3

Describes a person who learned language primarily through a visual modality and who receives environmental information visually.

Visual inputs may be “Speech reading, cued speech, manual communication, lip reading, and sign language”

Question 4

3-Pronged Approach to Pediatric Audiology

Answer 4

Diagnostician
Counselor
Audiologic Care Coordinator

Question 5

Hearing loss definition:

Answer 5

Defined as a loss or deficit in hearing sensitivity due to auditory dysfunction in the peripheral or central auditory system.

Hearing loss exceeding 15dB HL may be considered hearing loss in children compared to 25 dB in adults.

Question 6

Hearing handicap definition:

Answer 6

Impact of hearing loss on a person’s goals, responsibilities, and professional roles.

Question 7

Hearing disability definition:

Answer 7

Describes the impact of the hearing loss on a person’s social functions and activities.

Question 8

Hearing impairment:

Answer 8

Refers to any type or degree of hearing loss.

Question 9

Functionally hard of hearing:

Answer 9

Describes an individual who learned language primarily auditorally and who receive information from the environment through the auditory modality.

Question 10

Prevalence of congenital hearing impairment:

Answer 10

1 - 3 per 1,000 children are born with hearing loss, based on screening and/or medical records.

Question 11

Etiology now vs. back in the day

Answer 11

There are 10x the number of children with mild/moderate hearing impairments compared to two decades ago. There are less than one-half the number of children with severe to profound hearing loss today than two decades ago.

Question 12

What amt of infants are screened nationally?

Answer 12

97.7%

Question 13

What amt of infants are screened in Michigan?

Answer 13

99.8%

Question 14

Diagnostic Assessment Tools (Crumpton’s era vs. now)

Answer 14

*Crumptons Era
-BOA
-Calibrated noise makers
-Behavioral Threshold testing (VRA/CPA)
-Tympanometry using 226Hz and 660Hz probe tone
*Our Era
-Assessment protocols that are based on age and developmentally based.
-ABR, DPOAEs, and TEOAEs
-High Freq. Tympanometry
Auditory developmental check lists (LittlEars)

Question 15

Age of intervention Crumpton’s Era vs. Now

Answer 15

Crumpton’s Era
-Intervention date was linked to age of diagnosis
-Diagnosis age was typically after the critical period for language development.
Now
-69% of infants w/ HL enrolled in intervention by 6mo
-30% are not, by 6 mo :(

Question 16

Hearing Aid technology Then vs. Now

Answer 16

Then:
-HA technology was limited
-HA fitting was delayed because of late diagnosis
-When CI implants were first available (1990) it was limited to 2 year olds and up.
Now:
-Attempts should be made to fit HA w/in 1 mo of diagnosis.
-CI implants are allowed by 12 mo

Question 17

Education Then vs. Now

Answer 17

Then:
-Prevalence of self contained classrooms for children who were deaf and hard of hearing
-Significant bias regarding communication and educational options.
Now:
-HoH and typically developing children are put into the same classrooms
-Family centered philosophy in determining communication and educational options.
-Laws and regulations that address needs in special education and general education.

Question 18

How would you approach a counseling session?

Answer 18

Family Centered approach
Be culturally sensitive
Natural Environment
Offer comprehensive services (diagnose and treat)
Evidence based

Question 19

VRA specifics

Answer 19

Speakers at 90 or 45degree angle
Use instructions
-Don’t cue child
-Get their attention back to center
-Reinforce each time or intermittently
-Warble or Narrow band noise can be used (doesn’t matter)
-Reinforcer should be colorful and complex to keep attention
-Avoid habituation to be get most accurate results.
*Change stimulus and reinforcement

Question 20

WIPI stands for

Answer 20

Word Intelligibility by Picture Identification (Normed 5-6y/o)

Question 21

PBK stands for:

Answer 21

Phonetically balanced kindergarten (normed 5-7y/o)

Question 22

CPA (conditioned play) specifics

Answer 22

• 3-5 years

- Most important Freq = .5 and 2kHz

Question 23

Etiology

Answer 23

>5 days NICU
Genetics
Rubella
Measles
Meningitis
Hyperbilirubinemia
Intraventricular hemorrhage
Syndromic/non-syndromic 
Ototoxicity
Autosomal
Infection during pregnancy

Question 24

Genetics cause:

Answer 24

50-60% of all HL in children

Question 25

What percent of babies with genetic hearing loss have a syndrome?

Answer 25

20%

Question 26

CMV (Cytomegalovirus) infection is the second leading cause of hearing loss? T/F

Answer 26

False, it is the number one leading cause.

Question 27

1 in how many infants with low birth weight have HL?

Answer 27

1 in 4

Question 28

What % of children with HL have one or more other developmental disabilities?

Answer 28

25%

Question 29

Environmental Etiology

Answer 29

50% Environmental - CMV - Meningitis - Rubella - Prematurity - Ototoxicity - TORCHs

Question 30

Genetic/syndromic/non-syndromic Etiology

Answer 30

(Genetic - 50%)/(Environmental - 50%) Genetic: Syndromic - 30% Non-syndromic - 70%

Question 31

Audiologist as diagnostician:

Answer 31

The establishment of an accurate diagnosis of hearing status.

Question 32

Audiologist as counselor:

Answer 32

Effective family counseling conducted in parallel with the diagnostic process.

Question 33

Audiologist as case manager/audiologic care coordinator

Answer 33

Timely service coordination

Question 34

An Audiologist (and SLP) must:

Answer 34

Demonstrate interpersonal skills that promote effective communication with children, their families, and fellow professionals in healthcare, early intervention, and educational communities.

Question 35

1-3-6 Rule:

Answer 35

(EHDI) Screen by 1 month of age Diagnose by 3 months of age Intervention by 6 months of age

Question 36

EHDI background

Answer 36

Early Hearing Detection and Intervention Programs Since late 80's/early 90's Improved screening rates Screened with OAE or AABR If in NICU, ABR is recommended to rule out neural HL

Question 37

What should be included in a case history?

Answer 37

Observing the parent and child together Case History NBHS results Risk factors (Also include late-onset or progressive HL risk factors) Developmental observation of cognitive, vision & motor development Emerging communication milestones Parents impression of infant/child responsiveness to sound (Possibly interpreter)

Question 38

Comprehensive Aud Assessment Birth - 4mo

Answer 38

Case history Otoscopy ABR (click stimulus) (Tone burst only if behavioral pure tone approximation is needed *Frequency specific*) ASSR/Auditory Steady State Response DPOAEs/TEOAEs (DPOAEs filter out noise better than TEOAEs) Tympanometry (1000Hz) Acoustic reflexes **Cross check with behavioral assessment)

Question 39

Comprehensive Aud Assessment 6 - 36mo

Answer 39

``` Behavioral assessment -VRA or CPA (inserts, get MRL down to 20, alternating freq.) -Soundfield or ear specific Speech Aud -SDT or SAT -SRT for spondees or body part identification DPOAE/TEOAE Tymp @ 226 Hz Acoustic Reflexes ABR (IF VRA IS Abnormal!) ```

Question 40

What takes the place of word recognition testing for young child?

Answer 40

WIPI

Question 41

For children with limited hearing -problems with speech perception, we would use (severe - profound HL)

Answer 41

ESP (early speech perception test) and GASP (Glendonald auditory screening procedure)

Question 42

Purpose of OAEs

Answer 42

Assesses auditory function though the level of the cochlea but DOES NOT tell you degree of loss. - Sensitive to OHC damage - Helps find malingering - Can be used in well-child screenings (NOT NICU)

Question 43

ABR stimulus types and Polarity

Answer 43

Click: Broadband signal - Provides estimate of hearing sensitivity in the 2-4 kHz regions Tone Bursts: Frequency specific stimuli - Must be used to estimate hearing thresholds at specific frequencies. (Minimally 500 Hz- 4kHz) Stimulus Polarity: Rarefaction, condensation, or Alternating - Used to rule out neuropathology. **If clicks are abnormal, then use tone burst.**

Question 44

Pioneer of pediatric audiology:

Answer 44

Marion Downs

Question 45

Chronological age:

Answer 45

How old they are.

Question 46

Developmental age:

Answer 46

What age level they function at (regardless of chronological age)