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AMP II > Exam 1 Part 2 > Flashcards

Exam 1 Part 2 Flashcards

1
Q

why are needs assessments conducted

A

to determine candidacy in making individualized amplification recommendations

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2
Q

what is included in a needs assessment

A

audiologic, physical, communication, listening, self-assessment, and other pertinent factors affecting patient outcomes.

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3
Q

objective assessments supply additional information regarding

A

activity limitations

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4
Q

Objective Assessments of Body Structure & Function

A

TEN test
Purpose: Identifies cochlear dead regions

Puretone loudness discomfort levels (LDL)
Purpose: obtain objective data identifying the frequency-specific dynamic range to ensure output across frequencies does not exceed levels of comfort

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5
Q

what is the purpose of a ten test

A

identify cochlear dead regions

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6
Q

what is the purpose of LDLs

A

obtain objective data identifying the frequency-specific dynamic range to ensure output across frequencies does not exceed levels of comfort

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7
Q

Objective Assessments of Activity Limitation

A

QuickSIN
Purpose: Quantifies degree of SNR loss and identifies potential of binaural interference

Acceptable Noise Level
Purpose: Quantifies a patient’s tolerance of background noise

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8
Q

what is the purpose of QuickSIN

A

Quantifies degree of SNR loss and identifies potential of binaural interference

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9
Q

what is the purpose of ANL

A

Quantifies a patient’s tolerance of background noise

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10
Q

why are LDLs needed?

A

to ensure amplified output doesn’t exceed PTs loudness tolerance

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11
Q

what are LDLs used for

A

Data is used to program output and verify OSPL90/MPO limits of the device

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12
Q

When MPO settings remains below LDL acceptance of high input levels & overall satisfaction with amplification decreases

A

false
it improves

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13
Q

Individual tolerance levels vary significantly despite similar threshold loss.

A

true

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14
Q

what is the LDL test protocol

A

PT refers to loudness categories
signal is pulsed pure tone
1. present at MCL (wherever speech is presented)
2. Ascend 5dB & PT ranks loudness after each presentation (narrow DR ascend in 2dB as you near LDL threshold)
3. Stop ascending when reach #7 on category list
4. Run 2-3 trials, repeating the above steps starting at MCL again

always assess 2&3 kHz
normal sensitivity - skip
LF >40 - test 500 Hz
Precipitous inter-octave change (>20 dB) - test inter-octaves
HA output supplies extended frequency range - assess above 3 kHz

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15
Q

what symbols are used for LDL

A

forward L for the right ear and backward L for the L ear
upside down E’s are used in NOAH

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16
Q

LDL purpose

A

to find your judgment of the loudness of different sounds. We want to ensure that the amplified output of a hearing aid device does not exceed your loudness tolerance.

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17
Q

LDL results meaning

A

The purpose of LDL test (loudness discomfort level test) is to find your judgment of the loudness of different sounds. We want to ensure that the amplified output of a hearing aid device does not exceed your loudness tolerance.

So looking at your results, we expect these to vary since loudness is perceived differently. Your results show that there is some consistency in the different frequencies tested, or pitches presented, meaning loudness is perceived consistently to you. Average patient LDL is 100-105 dB HL and your results were basically going to the limits of the equipment which just means you tolerate loudness more than the average patient.

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18
Q

purpose & use of ANL

A

Quantifies a listener’s willingness to listen to speech in the presence of background noise.

Predictive of hearing aid satisfaction with 85% accuracy
Identifies those who will have more difficulty adapting to amplification

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19
Q

what is the test protocol for ANL

A

Set up PT to 0 deg. Azimuth to the speaker
Set up Channel 1 to - Ext. A
speech
Set up Channel 2 to - Ext. B
noise
Calibrate both channels
Turn Channel 1 on (with Channel 2 OFF)
Establish MCL
Increase speech in 5 dB steps until it is described that speech is too loud (provide with categories)
Decrease speech in 5dB until speech is too soft
SWITCH TO 2 DB STEPS NOW - increase speech until you reach person’s MCL
Note the MCL intensity
Turn Channel 2 on (Keeping Channel 1 ON)
Establish BNL
*MAKE SURE MCL DOESN’T CHANGE (it is fine if it does until we end this step)
Increase noise in 5dB until the story is incomprehensible. (BNL masks speech signal)
Decrease noise in 5dB until story is very clear
SWITCH TO 2DB STEPS (adjust mcl if needed) - Increase noise until PT can hear passage but they do not want anymore noise - as much noise as they can tolerant and can still understand
Note BNL intensity

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20
Q

how to score ANL

A

MCL value – BNL value = ANL score

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21
Q

low ANL score

A

(difference < 7 dB)
Indicates the patient ACCEPTS a lot of noise background noise w/o issues
This patient is likely to wear hearing aids on a regular basis
no problems tolerating background noise, no management in fittings needed
study in noise example & can focus and not get distracted

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22
Q

High ANL score

A

(difference > 13 dB)

Indicates the patient LACKS TOLERANCE for background noise
This patient is less likely to wear hearing aids regularly
very quickly bothered by the background noise
early research - lacks tolerance for amp, not amp candidates

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23
Q

ANL scores b/w 8-12 dB are equivocal

A

May require extra post-fitting counselling or adjustment period
not amp candidate (early research)
These need extra counseling that they may need more time to adjust to amplification or they may never adjust to them or like them

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24
Q

what is the rationale for SNR loss measurement

A

Speech intelligibility in noise remains the #1 improvement patients seek with hearing aids
To enhance satisfaction with amplification, it is essential to improve hearing in noisy environments. Each patient will need tailored technological recommendations based on their individual “signal-to-noise loss.” Measuring the extent of signal-to-noise ratio loss enables the selection of suitable technological options and validates the improvement provided by those choices.

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25
what is the clinical usefullness with SNR tests
Completion of the test instills patient confidence in your skills good for our knowledge and validating for PT complaints Results supply quantifiable data: Supporting use of evidence-based recommendations for technology for improved hearing in noise Helping patients understand improved communication requires more than restoration of threshold loss
26
Define the terms SNR-50 and SNR Loss
how much louder do you need speech than the noise in the room? SNR loss = individuals activity limitations SNR-50 is the signal-to-noise ratio that allows an individual to understand 50% of the test signal When a patient’s SNR 50 is greater than 2 dB they have a signal-to-noise ration LOSS SNR LOSS is calculated by subtracting 2 dB from the SNR-50 score
27
Normal SNR-50 function
+2 dB SNR-50 (signal needs to be 2 dB louder than the noise in order to understand 50% of what was said)
28
What is a normal SNR-50?
Normal SNR-50 function = +2 dB SNR-50 (signal needs to be 2 dB louder than the noise in order to understand 50% of what was said)
29
what is the quicksin protocol
Presentation level is calculated based on PTA If PTA <45 dB present word lists at 70 dB HL When PTA >45 dB present sentence lists at an intensity perceived as “Loud but OK” Present one practice list Proceed with 3 test lists for each test condition SNR Loss Scoring- Add each word list score and divide by the number of lists presented to one ear (3) Avoid use of Lists 3, 4, 5, 7, 13, and 16
30
how to score SNR Loss
Add each word list score and divide by the number of lists presented to one ear (3) Each list has 6 sentences presented with varying SNR’s 5 key words in each sentence are scored as correct/ incorrect
31
THERE’S NO NEED TO DEDUCT AN ADDITIONAL 2DB FROM THE FINAL CALCULATION WHEN SCORING THE QUICKSIN. ITS SCORING CALCULATION OF SNR LOSS FACTORS THIS DIFFERENTIAL IN.
true
32
patient’s signal-to-noise ratio loss cannot be predicted by degree of threshold loss
true
33
0-2 SNR
may benefit from directional mics or omni
34
2-7 SNR
recommend standard directional mics
35
7-15 SNR
requires beamforming mics plus standard directinal mic
36
>15 SNR
requires remote mic in addition to standard directional mics and beamforming
37
alternative quicksin test protocols
Monaural presentation via headphones Binaural presentation via headphones Soundfield presentation via speakers
38
allows you to detect asymmetric SNR loss
Monaural presentation via headphones
39
quantifies functional SNR loss by supplying binaural benefit
Binaural presentation via headphones
40
used to determine if aided speech in noise performance improved or degraded. Presentation level is 55 dB to simulate normal conversation levels in noise
Soundfield presentation via speakers
41
what is the most significant benefit for low ANL score
supported directional mic and DNR enabled = best chance of success for PT’s with high ANL score
42
Acceptance of noise improves when
BOTH directional mics & DNR are enabled. Directional microphones alone only supported partial acceptance DNR alone only showed minimal improvement
43
what does DNR do?
reduces steady state noises (HF or LF as long as they are steady in frequency & intensity)
44
what is another option instead of Quciksin
At times, the length of sentences is problematic for elderly with auditory memory deficits QuickSIN sentences too difficult for young children Cochlear Implants candidates may not have the language skills or auditory ability for QuickSIN Simpler assessment is more likely to obtain usable data 80+ patients that fall apart in the quicksin move to this test because they are simpler sentences and better for cognitive impairments
45
happens with elderly population about ⅙ individuals
binaural interference assessment
46
what is the binaural interference assessment
binaural quicksin identifies those with this degrading performance in the binaural test suggests this
47
what is binaural interference
poorer speech recognition with both ears than with the better ear alone
48
Amplification candidacy includes assessments to assist our understanding of
patient-specific communication needs.
49
functional & communication needs assessment must
Identify activity limitations & participation restrictions Identify environmental factors which may impact plan of care Identify personal factors which may impact plan of care
50
STANDARDIZED SELF-REPORT QUESTIONNAIRES QUANTIFY _____, _____ & _____ OF THE HEARING-IMPAIRED PATIENT
ACTIVITY LIMITATIONS, THE SOCIAL AND PSYCHOLOGICAL NEEDS
51
benefits of a standardized self-report questionnaire
Standardization allows comparison to normative data Questionnaires are completed independently, prior to the scheduled appointment
52
standardized self report questionnaires assist with comprehensive identification of all technology needs:
Selection of hearing instrument style Features needs Hearing assistive devices Counseling on realistic expectations
53
which questionnaire is for patient centered goals
COSI
54
screening tests examples
HHIA/E screening; Hearing Disabilities and Handicap Scale, Hearing-Dependent Daily Activities Scale (HDDA has high highest sensitivity rating- 80%)
55
what has the highest sensitivity rating for screenings
Hearing-Dependent Daily Activities Scale (HDDA)
56
Communication abilities (activity/participation) questionnaires
APHAB, SAC/SOAC, CCP-confidence rating
57
expectations questionnaire
ECHO
58
experienced HA user questionnaire
SADL
59
Related Non-auditory questionnaires
HASP, Social Network Inventory, WHO-DAS, Geriatric Depression Questionnaire
60
a quick pre-audiometric intake measure to get an idea of participation restrictions Assesses the social impact and emotional response that is the result of the loss of function
Hearing handicap inventory (HHI)
61
hearing loss is not interfering substantially in life
0-9
62
mild to moderate impact
10-24
63
severe impact
25 and higher
64
Describe the clinical usefulness of the Social Network Index
Describes the social relationships Looks at how often the patient communicates with others, as well as the communication methods used (face-to-face, or telephone) Correlations between the relationship of loneliness and cognitive decline are beginning to emerge
65
Describe the clinical usefulness of the ECHO
expected consequences of hearing aid ownership designed to assess 4 subscales related to patient expectations of amplification usefulness: Knowing it in advance allows us to use other strategies to promote success or let PT wait because they are not ready for amplification
66
Describe the clinical usefulness of the communication profile hearing impaired (CPHI)
used to find out how hearing loss affects daily life and what problems, if any, a patient is having
67
Describe the clinical usefulness of the hearing aid selection profile (HASP)
Looks at self-perceptions outside of amplification to evaluate core beliefs Type of HA to suggest or certain tech to recommend to a PT based on their lifestyle Certain scores predict if PT will do well or not do well with amplification
68
Recent research finds the ECHO and CPHI are highly predictive of adherence vs. nonadherence
true
69
echo Patients were more likely to return devices for credit when expectations of hearing aid benefit score were ________
low
70
what findings on the CPHI correlate with nonadherence
Communication Performance- perceived they have better communication performance and better adjustment to hearing problems Communication Strategies- poorer use of verbal and nonverbal communication strategies Personal adjustment- more denial of communication difficulties
71
PTs cosi goals may be classified as
cognitive or affective goals
72
Describe the clinical usefulness of the Client Orientated Scale of Improvement (COSI)
Prioritizes patient-centered treatment goals ranks perceived importance of up to 5 situations causing the greatest communication problems
73
activity limitation vs participation restriction
activity limitation relates to the difficulties experienced when executing a task or action Focus on specific tasks and activities & occur at the individual level relating to specific actions participation restriction refers to problems an individual experiences in involvement in activities an individual would like to participate in (involvement in life situations) Encompasses broader life roles and social participation & often involves interactions with society and environment (highlighting societal barriers)
74
Trouble hearing soft sounds or whispers
activity limitation detection of sounds
75
Inability to hear HF sounds like birds or alarms
activity limitation detection of sounds
76
Problems distinguishing between similar sounding words
activity lmitation
77
Difficulty understanding speech in noisy environments, such as restaurants or social gatherings.
activity limitation
78
Trouble hearing in reverberant or echo-prone spaces, such as large halls or gyms.
activity limitation
79
Difficulty determining the direction from which a sound is coming.
activity limitation
80
Problems identifying the source of sounds in a crowded environment.
activity limitation
81
Can our entry level assessments identify a patient’s activity limitations?
92550 Tympanometry/ART 92587/ 92588 DPOAE 92557 Comprehensive audiometric evaluation V5020 Conformity evaluation- verification of hearing aid performance including REM
82
Avoiding social gatherings or events due to difficulties in following conversations.
participation restriction
83
Reduced involvement in group activities, clubs, or community events.
participation restriction
84
Difficulty performing job duties that require effective communication, such as customer service or teamwork.
participation restriction
85
Reduced opportunities for career advancement due to communication barriers.
particiption restriction
86
Difficulties in understanding lectures or instructions, leading to academic challenges
participation restriction
87
Difficulty hearing household sounds, such as doorbells, alarms, or children calling.
participation restriction
88
Avoiding recreational activities that rely on hearing, such as attending concerts, theater performances, or playing certain sports.
participation restriction
89
Reduced enjoyment of hobbies that involve listening, like music or audio books.
participation restriction
90
describe the difference between cognitive and affective goals
Cognitive: Defines difficult environments that require improvement to reduce the impact of the impairment (focus on improving PT’s ability to process, understand, and remember auditory information affective: Defines desired improvements as they relate to feelings/ emotional needs (relates to the emotional and psychological aspects of HL and its management)
91
Feeling less embarrassment during communication
affective COSI goal
92
Reduced stress during workday
affective cosi goal
93
Alleviating feelings of anxiety or stress related to hearing difficulties
affective
94
Building confidence in social interactions and communication situations.
affective
95
Increasing participation in social activities and gatherings.
affectiv
96
Reducing frustration or irritability related to hearing difficulties.
affective
97
Enhancing overall quality of life by improving communication and reducing the emotional burden of hearing loss.
affective
98
Building confidence in using hearing aids and other assistive devices
affective
99
Encouraging a proactive attitude towards managing hearing loss and seeking help when needed.
affectiv
100
Enhancing the ability to comprehend speech in quiet or noisy environments.
cognitive cosi goal
101
Improving clarity and comprehension of conversations, particularly in challenging listening situations.
cognitive cosi goal
102
Improved conversation with a spouse in a quiet environment”
cognitive cosi goal
103
Improved communication with unfamiliar speakers on the telephone without removal of the hearing aid
cognitive cosi goal
104
Developing better listening strategies to focus on important sounds while filtering out background noise.
cog cosi
105
Improving the ability to follow complex or fast-paced conversations.
cog cosi
106
Improving the retention and recall of verbal instructions or information.
cog cosi
107
give two examples of cognitive goals and two examples of affective goals
cog: Improved conversation with a spouse in a quiet environment” “Improved communication with unfamiliar speakers on the telephone without removal of the hearing aid” affective: Feeling less embarrassment during communication” “Reduced stress during workday
108
what are interview questions to support cognitive goal developments
Let’s talk about the listening situations that you find most challenging? Who are you trying to communicate with in noisy situations? What kind of room are you in when you have difficulty hearing in noise? How many people are typically in this environment? Tell me more about what makes that situation difficult? Let’s talk about how you feel when you’re in those environments?
109
what are interview questions to support affective goal developments
Let’s talk about why you feel that way? Who: do you feel this way around all the people or is this a concern with some more than others? What: does this occur all the time or only in certain environments or situations? Tell me more about what makes that situation difficult? What might make it better?
110
what is the usefulness of cosi goals clinically
Actively involves patient in plan of care Focuses on the individual’s needs when planning rehabilitation Assists with counseling Opens discussions related to advanced technology needs Identifies unrealistic expectations for discussion I want better hearing in noise using using a CIC style I want improved localization when using one device I want low-cost amplification, but poor dexterity requires automatic features
111
B.B. is an 88-year-old female who resides in an Assisted Living Facility (ALF). Her health is generally good, and she is reasonably independent within the ALF setting. She admits to failing eyesight and she reports that she remembers events that occurred many years ago with great clarity but has trouble remembering what she ate for lunch an hour ago. She does not have trouble during family visits but is particularly frustrated that her hearing is failing, and she reports trouble carrying on a conversation with her table mates at mealtime. In addition, the resident who lives next door to her has been complaining about the volume of B.B.’s television. If she turns the television down, however, she has trouble following the programs and TV is a primary source of entertainment for her. With respect to the telephone, she finds understanding depends on the speaker, noting that callers with foreign accents are particularly difficult 5 cosi goals for BB
COSI Goals: (collecting data, no recommendations) Cognitive Better conversations at meal times with table mates Understand the TV at a lower volume Effectively use visual cues Better understanding talking on the phone Afraid she will forget to wear her hearing aids
112
non-auditory personal factors
General health Chronic disorders, depression, anxiety Dexterity, visual acuity, etc. Cognitive decline (covered in AUDE 6310) Prior experience with amplification Personality characteristics Expectations, motivation, willingness to take a risk, assertiveness
113
non auditory environmental factors
Environmental characteristics Occupational demands Recreational habits Patient support systems
114
what is a generic health-status instrument that gathers data about general health from a comprehensive case history
The World Health Organization’s Disability Assessment Scale II (WHO-DAS II)
115
items of WHO-DAS II that comprise communication and participation domains
D1s D6s
116
how does general health screening assist audiologic recommendations
General health - comes from primarily comprehensive case history WHO-DAS II Identify any underlying health conditions that might affect hearing health or the use of hearing aids Ex: Detects conditions such as diabetes, cardiovascular disease, or ear infections that can impact hearing. Ensures that hearing aid recommendations consider any comorbidities or medications that might interfere with hearing health.
117
how does depression screening assist audiologic recommendations
PHQ-2 Identify symptoms of depression that could affect a PT’s motivation and engagement in hearing rehabilitation Ex: Recognizes the need for additional support or counseling to improve treatment adherence. Adjusts communication strategies to accommodate the patient's emotional state, ensuring a more patient-centered approach.
118
how does anxiety screening assist audiologic recommendations
GAD-7 Identify symptoms of anxity that could impact PT’s ability to cope with HL and use hearing aids effectively Ex: addresses anxiety related concerns like fear of using new tech or social anxiety in communication situations.
119
how does manual dexterity screening assist audiologic recommendations
Purdue Pegboard Test To assess PTs fine motor skills and ability to handle small objects like HA’s Ex: Determines the need for hearing aids with easier handling features, such as larger controls or rechargeable batteries. Suggests assistive devices or alternative solutions if dexterity issues are significant.
120
how does visual screening assist audiologic recommendations
Identify whether they can see small things on HA or not Ex: Considers the need for additional visual aids or support for hearing aid maintenance.
121
how does cognitive abilities screening assist audiologic recommendations
To assess cognitive function and identify any cognitive impairments that might affect hearing aid use and communication strategies How this influence communication abilities Adapts hearing aid programming and counseling to the patient's cognitive abilities, ensuring instructions are clear and easy to follow. Identifies the need for more intensive support or family involvement in the rehabilitation process.
122
Motivation, and prior experience with amplification and how it can assist with audiologic recommendations
Was it positive? Negative? What did you like with HA or dislike? Avoids creating the same mistakes
123
what is the dexterity screening used and how is it run
Purdue Pegboard Test 4 tests Right Left Both assembly – uses both hands to make separate things? – how well the l and r hand can do things together First 3 are 30 s and last is a min Chair, table, stopwatch & pegboard
124
Chronic visual conditions in combination with hearing loss increase in prevalence as we age
true
125
The problems encountered by individuals with “dual sensory” loss are considerably greater than the effects of vision impairment or hearing impairment alone
true
126
Visual & auditory-vestibular comorbidities examples
Audio-visual disorders Visual-vestibular disorders
127
why are we worried about dual sensory loss
one impact from one sensory deficit and another and combining two deficits, it exacerbates and may even triple the issue the PT encounters
128
Dual-sensory loss commonly occurs in the presence of these comorbidities
Hypertension Heart disease Stroke Diabetes Cancer Arthritis

AMP II (7 decks)

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