final exam new info

Question 1

what is the clinical value of acoustic immittance

Answer 1

objective measure of TM mobility, measures middle ear pressure, identifies TM perforations, differentiates ME fixation from ossicular disarticulation, aids in the differential diagnosis of conductive HL, validates functional HL and provides objective inference of hearing sensitivity/pathology

Question 2

process of acoustic immittance

Answer 2

muscle contracts, stiffens bones, pulls TM and some of the energy coming in will bounce back and won’t go in

Question 3

what are some ways to promote the child’s cooperation during immittance testing

Answer 3

animated toys, hand puppets, pendulum, mirror, sticky tape, cotton ball or tissues
-children that are older than 3, generally will not need special distractions

Question 4

compensated vs. not compensated tympanograms

Answer 4

compensated: the tymp begins at 0 admittance on the y ; removes the volume and the effect of the ear canal from the whole value
non compensated: the tymp begins above the 0 admittance on the y

Question 5

how can we make a tymp compensated

Answer 5

we need to get the tails at the 0 line, so we can subtract the difference to ensure all correct values are mesaured

Question 6

tymapnometric peak pressure (TPP)

Answer 6

provides indirect estimate of the air pressure in the ME space at which energy flows best into the conductive mechanism
-pay attention to if this is compensated or not

Question 7

tympanometric width (TW)

Answer 7

halfway up the graph and then the distance between the peaks
-the wider it is, the more correlated it becomes with the potential of a ME pathology

Question 8

ear canal volume

Answer 8

estimation of the volume that exists between the probe tip and the TM
-can be used to monitor the courser of ME disease after the placement of tubes

Question 9

usage of 226 Hz tymp and how it correlates to infants

Answer 9

226 Hz is because it is sensitive to the stiffness dominated middle ear however with infants, their middle ear system is mass dominated
-therefore it is not suggested to infants

Question 10

limitations of 226 Hz tymp in infants

Answer 10

low sensitivity to the presence of MEE, flat tymps are observed in some neonates with normal MEE, normal tymps were obtained in infants with diagnosed MEE and a notched 226 tymps in infants with confirmed OME
-low sensitivity to middle ear pathologies

Question 11

226 Hz tymps are poor for infants under ___ months

Answer 11

6

Question 12

anatomical differences between infants and adults

Answer 12

compliant EAC, small ear canal, horizontal orientation of the tympanic membrane, underosssified ossicular chain, small ME space, ET is more horizontal and shorter

Question 13

how are immittance measurements altered within infants

Answer 13

the 226 Hz tymp may not provide accurate immittance results for children less than 6 to 9 months as this will result in lower static admittance, broader tympanometric width and appearance of notching at low frequencies

Question 14

infant middle ear is a ____ dominated system with a ________ resonant frequency

Answer 14

mass ; higher

Question 15

adult middle ear is a ______ dominated system with a ________ resonant frequency

Answer 15

stiffness ; lower

Question 16

advantages of using 1000 Hz tymps in infants

Answer 16

is a more sensitive measure to changes within the ME status
-tend to be either a single peak or flat
-we are mainly looking to see if there is that single peak which means it is normal and without a peak it is abnormal

Question 17

a _______________ during the first week after birth and is indicated when acoustic admittance decreased towards 0 mmho

Answer 17

collapsed canal

Question 18

for infants (birth to around 6-9 months), explain the overview of the tymps

Answer 18

226 Hz is good for ear canal volume, 1000 Hz is good for the shape of the tymp BUT with wideband it is efficient to get both at the same time

Question 19

why is there needing to be used caution when assessing ARTs at a higher level in infants

Answer 19

threshold shift is at a higher risk in infants due to smaller canal volumes than in adults and there is at least a 10 dB increase than what is delivered into an adult ear
-would not want to exceed 100 dB for infants

Question 20

advantages of using WB tympanometry in pediatric populations

Answer 20

gives a broad frequency range, more sensitive/specific, less affected by ear canal volume/probe position, measured at ambient pressure, the air tight seal in not required

Question 21

list some factors that affect OAE recording success

Answer 21

probe fit, conductive elements, restlessness and loud environment

Question 22

what are OAEs used for within a pediatric assessment

Answer 22

NBHS, school screening, site of lesion testing, monitoring ototixc drugs on cochlear functions, estimates hearing sensitivity within a limited range and can be used as a cross check principal

Question 23

benefits of recording both TEOAEs and DPOAEs

Answer 23

they do not provide the same information and therefore they may target different cochlear mechanisms
-by including both types it can provide a more comprehensive assessment of cochlear health and HL

Question 24

how can a middle ear pathology effect OAEs

Answer 24

-OM or negative pressure can disrupt sound transmission to/from the cochlea, altering the OAE measurement
-severe OM can affect mobility of the TM and OAEs are likely to be absent
-negative pressure reduced OAE levels but does not eliminate them always unless there is a mild SNHL

Question 25

advantages of OAEs

Answer 25

evaluate OHC function, quick/objective, ear specific, frequency specific, can predict future HL and not booth is required

Question 26

limitations of OAEs

Answer 26

susceptible to noise, site specific, cannot quantify the degree of HL and cannot rule out minimal/mild HL

Question 27

explain the challenges of conducting audiological evaluations in children with special needs

Answer 27

children may have problems with speech, responding to sound or understanding the task, may have a longer time to focus, longer latency time, may need to consider other responses, may fatigue quicker and there may be unexpected reactions

Question 28

modifications needed for children with severe to profound loss

Answer 28

may take longer to respond to conditioning -since they are visually alert, make sure there are no visual cues -begin with low frequency stimuli -if not responding to auditory stimulus, use a tactile stimulus

Question 29

modifications needed for developmental delayed children

Answer 29

positioning, timing of test stimulus presentations and response reliability and interpretation

Question 30

modifications needed for intellectual delayed children

Answer 30

the important factor is that we need to use a technique that will bridge the difference between the chronologic and developmental age of individuals -VRA is an effective test! -can use tactile conditioning procedure -demonstrate the task -include control trials -monitor ME status

Question 31

modifications needed for physical disabilitied children

Answer 31

child should be positioned to keep upper body steady and allowing for a head turn or the use of arms -CPA can be used is toy that is selected is easy to manipulate -hand raising or nod for older children can be accepted -limit the speech to closed set

Question 32

modifications needed for children with autism spectrum disorder

Answer 32

seat the child in a position that does not permit walking away, minimize physical contact, identify cognitive age prior to test protocol, avoid speech stimuli, presented stimuli at low levels and increase gradually, use loud stimulus for children who ignore the sound, behavioral testing that is appropriate for cognitive level, weighted blanket

Question 33

modifications needed for children with ADHD

Answer 33

may take longer than expected, seat child in a high chair or at a table, reinstruct more often, change toys frequently, take small breaks, weighted blanket, visual schedule

Question 34

modifications needed for children with a visual impairment

Answer 34

let the patient explore the test environment, allow the patient to examine the equipment, move reinforcer closer to the patient, if the child does not have sufficient vision to see bright light you can pair the stimulus with vibrotactile

Question 35

modifications needed for pediatric nonorganic HL

Answer 35

reinstruct the child and if still not successful, use a portable audiometer and have the child seated next to you so that you can make eye contact -if still not successful, have the child count the beeps or use a yes/no response

Question 36

what is the purpose of a screening

Answer 36

identifying individuals at risk for specific disorders -separating those with a high or low probability of a disease or disorder

Question 37

prevalence

Answer 37

total number of cases within a time period -proportion of the population that has the condition at a point in time

Question 38

incidence

Answer 38

total number of new cases -fraction of the population at risk of developing the disease or condition

Question 39

equation for sensitivity

Answer 39

(true positive / true positives + false negatives) x 100

Question 40

equation for specificity

Answer 40

(true negative / true negative + false positive) x 100

Question 41

1-3-6 principle

Answer 41

1 month : children should be screened 3 month : receive comprehensive evaluation 6 month : receive appropriate intervention

Question 42

why is there a push to move to a 1-2-3 principle

Answer 42

earliest age of identification is encouraged because the infant can then receive earlier intervention for auditory and/or verbal access to langue and objective audiologic testing can be completed without sedation

Question 43

early hearing detection and intervention (EHDI)

Answer 43

programs ensure that infants and children with hearing loss are detect and receive intervention as early as possible -they offer comprehensive hearing evaluations !

Question 44

medical home

Answer 44

provides health care that is acceptable, family centered, continuous, comprehensive, coordinated, compassionate and culturally competence

Question 45

what is the difference when it comes to when an ABR is needed in the JCIH 2007 and 2019

Answer 45

2007 : ABR is required by the age of 3 if you are trying to confirm HL or if you have found a child with HL, even if ear specific information is needed 2019: ABR is only required when ear specific information cannot be obtained

Question 46

explain what need to occur for a full pass

Answer 46

both ears must have a pass result in the same screening session to be considered an overall pass -rescreening should comprise of a single valid rescreen of both ears in the SAME session

Question 47

loss to follow up (LTF)

Answer 47

not returning for necessary outpatient testing and therefore they do not receive a recommended follow up appointment service after a failed NBHS -can be caused by inconsistent screening, parental refusal to follow up, lack of access, inconsistent quality, lack of communication, false negatives

Question 48

how can we reduce LTF

Answer 48

use an interpreter, provide written materials in parents language, verify contact information and verify the PCP

Question 49

loss to documentation (LTD)

Answer 49

those who have received services but results have not been reported to the EHDI program and therefore cannot be documented -can be caused by name changes, data mismatched, incomplete data, unknown PCP

Question 50

common behaviors in school age children due to hearing impairment

Answer 50

difficulty attending to spoken or other auditory information, frequently requests repetition, fatigues easily when listening, gives inappropriate answers to simple questions and appears isolated from peers

Question 51

importance of screening beyond the newborn period

Answer 51

HL can go undetected after the NBHS -HL can be late onset or progressive

Question 52

kids tend to become sicker in the wintertime which can impact the ME with fluid, therefore it is important that screenings occurs in the __________

Answer 52

fall -less risk for URT infections so we are able to identify those people who truly have some abnormality in their hearing

Question 53

what is the pure tone screening protocol

Answer 53

pure tone sweep at 1000, 2000 and 4000 Hz at 20 dB HL -lack of response at any requires a rescreen immediately

Question 54

neural development within infants

Answer 54

they are borns with billions of connections that are awaiting stimulation to become strengthened -the developing brain depends on external stimulation to form meaningful neural connections and a functional network

Question 55

in order for connections to form, __________ behavior needs to occur

Answer 55

repetitive

Question 56

what is a consequence if there is no stimulation

Answer 56

cross modal reorganization

Question 57

cross modal reorganization

Answer 57

new tasks are given to an area of the brain when there is so stimulation -somatosensory and visual processing may take place within the auditory cortical areas in long term deafened adults

Question 58

bottom up maturation process

Answer 58

matures in stages from the bottom up to the top -the previous stage needs to occur as all stages depend on the completion of stage 1

Question 59

neuroplasticity

Answer 59

the brain organizes itself and develops neural connections with repeated stimulation -the brains ability to create new connections/pathways or to modify existing ones

Question 60

what are three means by which plasticity occurs

Answer 60

synaptic plasticity (create new connections through learning and practice), neurogenesis (birth of new neurons) and functional compensatory plasticity (sensory reassignment)

Question 61

pruning

Answer 61

recognizing some areas are not being used and will get rid of those areas -monitoring to see which parts of the brain get stimulated and those that do not

Question 62

sensitive period

Answer 62

how long a child can go without stimulation but will still be treated effectively

Question 63

critical period

Answer 63

a rigid age, once you pass this it will not happen

Question 64

how do critical and sensitive periods play a role in amplification in infants

Answer 64

the earlier a child can be amplified the better the outcomes -with CI's the critical period is 7 years of age so their positive outcomes will decrease -3.5 is the sensitive period so positive outcomes can still occur however it may take more effort and more sessions to gain those

Question 65

three overarching reasons for why special considerations need to occur for children with amplification

Answer 65

rapidly changing ear canal acoustics, limited ability to provide reliable behavioral/verbal responses and the need for better SNR/sound access for speech and learning

Question 66

ASSR

Answer 66

measuring electric activity from the scalp -not as reliable as ABR however they still can test multiple frequencies -both ears can be tested, faster than an ABR -artifacts can be present more often -ANSD cannot be detected

Question 67

ABR assessment protocol

Answer 67

AC ABR thresholds using toneburst at 500, 2000 and 4000 (including 1000 when indicated) with BC ABR thresholds using toneburst at 500 and 2000

Question 68

explain ABR and how it is needing conversion factors

Answer 68

results are reported in dB nHL which does not equal dB HL so in order to use for fittings, we need to make the conversion -we convert nHL into a eHL (behaviorally equivalent measure)

Question 69

what can happen if we do not indicate the proper results

Answer 69

-if we indicate in the software that it is nHL but it has already been converted then there can be under amplification as there will be an additional conversion

Question 70

RECD

Answer 70

objective verification that is essential for preverbal children -measuring the difference between a child's ear canal size and the standard coupler

Question 71

how does the RECD vary in children from adults

Answer 71

it is greatest with younger children as the residual volume is smaller for infants -meaning there is more change between the coupler and the ear canal

Question 72

RECD's should be measured .....

Answer 72

each time there is a new earmold

Question 73

what are the 2 considerations needed when selecting HA's for children

Answer 73

non-electroacoustic considerations and electroacoustic considerations

Question 74

3 important components for HA selection and fitting process

Answer 74

be attentive to the auditory input that is received by the child so that the speech and language development can occur in a natural way, basic premise of the initial HA selection is that all initial electroacoustic characteristics are tentative and HA selection must be viewed as an ongoing process

Question 75

non-electroacoustic characteristics that are important

Answer 75

hearing aid style, ear mold impressions, ear molds, ear hook, retention options, tamper resistant battery doors, volume control lock, appearance of them (such as color) and is using two or one

Question 76

what style is recommended for children and why

Answer 76

BTE -can grow with them as the ears grow, will just require new molds -more durable and less risk for injury -addressed feedback issues by creating a bigger distance between microphone and where sound is coming out of -good for a wide range of hearing losses -direct audio input capabilities

Question 77

what is the recommended earmold material and why

Answer 77

vinyl because it is soft but rigid enough to keep the sound bore open when inserted -can be modified easily -addresses safety concerns

Question 78

for very young children, what is the concern with using the standard #13 tube

Answer 78

the ear canal may not be large enough to accommodate the length so it may not go all the way to the sound bore leading to it impacting the acoustic dimensions

Question 79

how often do earmolds need to be replaced

Answer 79

every 3 months for children under 1 year of age -every 6 to 12 months for children one year and older (up to around 5 years)

Question 80

why is having feedback a sign that an earmold needs to be replaced

Answer 80

the ear mold is loose within the canal allowing for amplified signal to leak out

Question 81

explain how binaural summation is essential for neural development

Answer 81

helps with localization and can impact the SNR through the usage of the head shadow, binaural summation will allow the sound to be perceived as louder, and an improved SNR when both ears are used due to binaural squelch

Question 82

when compared to adults, what are the different characteristics based on

Answer 82

having a higher resonance, by needing a higher SNR and because children need amplification to develop speech and language skills

Question 83

at what levels can higher gain be beneficial for children

Answer 83

-medium sounds because it may provide more speech intelligibility as well as it may reduce listening effort -low sounds because it appears that child will be able to hear from a distance better as well as since this level is soft they will have a benefit from additional gain

Question 84

why do children not benefit from more gain within the high level sounds

Answer 84

from research we know that children can have the same LDL as adults so by increasing this, the level can then become uncomfortable

Question 85

what is the only feature that improves SNR

Answer 85

directional microphone

Question 86

selection of directional microphones in infants/children

Answer 86

benefit is only reliant based on the child's ability to turn towards the talker -full time usage is not recommended due to them not being likely to turn to the target -can be activated for school aged children with certain situations

Question 87

selection of feedback cancellation in infants an children

Answer 87

this allows for the gain that is needed to be provided without the concern of feedback occurring -however, with younger children as they grow the ear molds will create feedback so it could be altering the signals that they are getting that are important for speech -we should not use FC as a way to prolong the life of an earmold

Question 88

given what we know about earmolds and feedback, when there is any feedback within children that is typically a sign of what

Answer 88

the child needs a new ear mold -with the feedback they are losing the higher frequencies

Question 89

selection of digital noise reduction in infants and children

Answer 89

anything that has noise associated with it will be reduced so this does not improve the SNR but it is expected to reduce the cognitive load of the patient -should increase listening comfort, listening effort and speech intelligibility should left unchanged

Question 90

selection of frequency lowering in infants and children

Answer 90

sending the HF signals into an area where there is no HL to become audible and to be perceived -if children have HF loss we need to think about this to help with speech recognition and phonological development

Question 91

what are some candidacy factors for frequency lowering

Answer 91

hearing instrument details, does the child have access to the female /s/, depending on the developmental status do they response to the /s/ -FL is more likely with a HF or severe to profound loss

Question 92

what are some topics that need to be covered during counseling with parents

Answer 92

hearing milestones, care/use of HAs, troubleshooting, safety issues, help parents understand that the more consistent they are the better outcomes there are and ensure that parents are aware of the milestones that they can expect from their child

Question 93

what are some care and use of the HA that needs to be covered

Answer 93

cleaning the earmold/HA, changing batteries or charging schedule's, performing listening checks, putting the HAs on, setting controls and avoiding hazards such as moistures

Question 94

hearing should be re-evaluated ....

Answer 94

-1 month following the fitting -2 to 3 month intervals for the first year of amplification -every 4 to 6 months until age 5 -yearly for children over the age of 5

Question 95

what is the importance of early intervention

Answer 95

early diagnosis of a HL is vital to help promote brain development -the failure to detect congenital or acquired HL in children may result in lifelong deficits

Question 96

cross check principle

Answer 96

achieved through a test battery approach, where multiple tests can check each other to ensure accuracy -behavioral and electrophysiological tests must be used to determine the extent of a child's auditory function

Question 97

3 stages for selecting a test protocol

Answer 97

determine the child's cognitive age, evaluate the child's physical status and then choose the test room setup

Question 98

closed vs. open set

Answer 98

want to attempt an open set by the age of 5 years old -if child is developmentally delayed, you may want to use closed set -if child has a speech or language delay would not want to attempt an open list

Question 99

how does a tymp become compensated

Answer 99

the volume and the effect of the ear canal from the whole value

Question 100

typically we will want to accomplish a full audio by the age of _______

Answer 100

5 -at this time they should be able to be tested through conventional audiometry

Question 101

what testing requires cooperation? what testing does not require cooperation?

Answer 101

behavioral testing ; electrophysiological testing

Question 102

between 6 months and 5 years, what is important to do for testing?

Answer 102

needing to select a developmentally appropriate assessment -selecting between VRA and CPA based on the child's cognitive age

Question 103

ABR testing is indicated when ______________

Answer 103

behavioral responses are not reliable enough to provide ear specific information and if there is any evidence of HL

Question 104

6 months to 24 months with speech testing

Answer 104

can so SDT/SAT with MLV including their name or other phrases to get them to turn OR if the older children do know some body parts you can do body part pointing for SRT

Question 105

2 to 5 years with speech testing

Answer 105

should do SRT based on age accordance, is younger children known body parts do this, otherwise you can do SAT/SDT