Ped. Aud Flashcards

Question

Which of the following tests would you use for a 3-year-old child whose auditory language age is lower than 2 years and has severe to profound hearing loss? ANT NU-CHIP PBK-50 WIPI

Answer 1

Can be administered using MLV

Answer 2

Ear-specific thresholds cannot be obtained.

Answer 3

neg pressure

Answer 4

Because it measures different frequencies simultaneously Because we do not have to use pressure and young children really do not like that

Answer 5

DPOAEs are higher in newborns compared to adults.

Answer 6

ME can affect OAEs

Answer 7

Smaller volume, higher resonance frequency

Answer 8

normal ECV

Answer 9

Drawing a "rainbow" by showing the child the 3D graph developing on screen

Answer 10

It takes measurements at multiple frequencies, avoiding the need to choose between 226Hz and 1000Hz probe tones

Answer 11

The amount of energy that is absorbed by the middle ear

Answer 12

Increase level by 20 dB and try again

Answer 13

Measure threshold at 1000 Hz in the left ear

Answer 14

lack of aud feedback

Answer 15

Perform an audiologic assessment using OAEs and diagnostic ABR; counsel the parents that children younger than 3-months generally are unable to localize but do not minimize the parents' concerns

Answer 16

A much higher risk for educational difficulties exists for this child than for children with two normal hearing ears.

Answer 17

KJ did not start babbling until she turned 7 months old

Answer 18

eye widening

Answer 19

500 Hz; 2000 Hz

Answer 20

Introducing the infant to multiple languages early to speed up language acquisition.

Answer 21

Explain to the parents that mild hearing loss can pose substantial challenges in noisy environments, and that hearing aids can help Jamie better follow classroom discussions and alleviate his frustration.

Answer 22

wipi closed

Answer 23

Mia is a reluctant responder.

Answer 24

Observe if Mia shows any facial response when the tone is presented and assist her in completing the task with the block while watching for her reaction to the next stimulus.

Answer 25

One factor that would cause a patient to need to return to the clinic for a follow up or repeat session would be that they habituate really fast and you are not able to continue to get the information you still need from them. Another factor that would yield a repeat session with VRA is if you need to get ear specific information using headphones and despite multiple attempts and different strategies, you cannot get them on the child. It would be best then to have the parents work with the child to get headphones on them and come back at a different time to try again after the parents have gotten the child acclimated to the headphones. A third factor that may cause a patient to need to return for a repeat session is if the child has a conductive loss and we need to do repeat testing once the middle ear pathology is resolved to compare the hearing results from before and after.

Answer 26

One strategy to delay habituation during testing with VRA is to use two reinforcers as opposed to one. Even though we can get results by using one reinforcer, it keeps their attention longer if we use two. Another strategy that could be used to delay habituation during VRA testing is to switch back and forth with speech or the Ling 6 sounds to keep their attention for longer in order to test what we need to test. A third strategy could be to change the reinforcement to keep their attention or even changing the test assistant. For example, instead of using the same light up toys, use a video without the sound as a reinforcer to change it up for them and with a new assistant, it could be enough to get their attention back on the task.

Answer 27

Simultaneous stimulus response procedur - presenting both the stimulus and the reinforcer at the same time. Response observation and shaping approach - preferred approach, present stimulus and watch their reaction to that because they turn towards sounds naturally. Stimulus is not interesting enough so they are not reacting. Switch stimulus to make it more interesting like speech, NBN etc. It could also be that they cannot hear the stimulus. In this case, we need to increase the intensity and if this continues then attempt vibrotactile response. These help to rule out whether the child cannot be conditioned or because they cannot hear it so VT causes them to turn when they feel it it shows they can be conditioned and that they are not responding because they cannot hear it. How do I know that it is a true response? Control trial is what we need. Do not do anything or present anything and see if they still respond. If not, you know it is still a true response and everything done so far is reliable. If they do respond even without stimulus presentation, this is a false positive and the results obtained might not be true. You need to then recondition this child.

Answer 28

Yes, this information would change the procedure needed to test this child. His developmental age doesn't match his chronological age. Therefore. CPA would not be appropriate to choose to test this child and the results would not be indicative of his capabilities. If he just began walking not long ago, the chances of him being able to perform a motor task is very slim, which is required in CPA testing. Therefore, a different test, like VRA, is more appropiate for this child's developmental age. Your decision to switch from CPA to VRA is correct. However, you need to be more specific and explain why CPA is not appropriate to use in Juan's case based on his reported developmental milestones that include delay in both speech and motor development that might impact his ability to understand instructions and make appropriate motor reaction in r

Answer 29

medical home

Answer 30

can be either pruning or synaptic elasticity

Answer 31

3 mo old who was in neonatal intensive care unit for 7 days after birth Child with family hx of early and progressive HL

Answer 32

Children acquire language through aided sound

Answer 33

Connecting neurons that fire separately

Answer 34

Ped earhooks, tamper-resistant battery doors and a retention cord

Answer 35

click or chirp

Answer 36

Remake the earmolds to be a full shell with a helix lock for better retention.

Answer 37

use probe trial

Answer 38

Since a hearing loss was identified, early intervention services (including fitting with amplification) should have begun no later than 6 months of age.

Answer 39

Air- and bone-conduction ABR thresholds

Answer 40

BTE with traditional tube and custom earmold

Answer 41

Infant's middle ear is more mass-dominated and less compliant, making higher-frequency probe tones more sensitive to middle-ear status changes.

Answer 42

corrected age

Answer 43

compensated tynps

Answer 44

critical perod

Answer 45

cross check principle

Answer 46

One limitation to using ABR to assess hearing sensitivity is that with infants over 6 months of age it requires sedation which can be risky and parents are hesitant to have it performed. Another limitaton to using ABR is that it requires the infant to be completely still and to be asleep in order to avoid artifacts in the results. The behavioral audiometric procedure I would use to determine her hearing thresholds is VRA because she is 12 months old with no other cognitive or physical limitations inhibiting her from performing this test. She is also at the age that I could attempt to determine speech detection thresholds by saying nonsense words, her name, or using the Ling-6 sounds to verify the PTA I got from the VRA procedure. I would begin testing this child at 500 Hz because she has a sensorineural loss. In order to condition this child for the VRA procedure, I would begin presenting probe trials between 50-60 due to the severity of her loss. If she is not responding to the stimuli or stimuli and reinforcer presentations then I have to decide if she is either not entertained by the reinforcers used or if the stimuli presentation is not loud enough. If it is not loud enough, I would increase the intensity and retry the conditioning trials. If it is that the reinforcer is not entertaining enough, I would change it by either adding two reinforcers or using a mix of the light and motor function on one. I would begin the actual testing and threshold search at 50B because she has a known moderate loss so if I started at the normal 30d she most likely will not respond due to her loss and the next step would be to increase by 20dB and present again at 50 dB. By starting with 50d 1 am reducing the testing time due to the fact that with her severity of loss she will most likely not respond at 30dB. Once I present if she responds I will do the down 10, up 5 procedure to obtain her thresholds.

Answer 47

This patient's ear canal size most likely would not be able to accomodate a vent if needed. But with her severity, she most likely doesn't require a vent or the vent would be really small. Due to not having a vent if it is needed, we would usually be worried about the occlusion effect due to lack of venting. However, with infants, due to their ear canal sizes being smaller and their ear canal resonances being higher they do not experience the occlusion effect at this age, as well as their ear canals are changing and growing rapidly so in a few months we would be able to place a vent if needed because her ear canal size could accomodate it then.

Answer 48

In children with ASD, in response to auditory stimuli they can be overly sensitive to it and have a negative reaction to the stimulus being presented. They can also react by tuning it out, as seen in the case with speech stimuli the most. One modification that could be done when testing a child with autism is to minimize the distractions in the room. Another modification to take is to make sure they are seated in a way that they are not able to get up and walk away from the testing area. A third modification is to avoid as much physical touch as possible, as this usually has adverse reactions in this population, so testing in the soundfield is the best to begin with.

Answer 49

S: K is a 4 year old female being seen today for an audiological re-evaluation. Two weeks ago she was seen at this clinic for an evaluation following hospitalization for meningitis. Before contracting meningitis, K appeared to have normal hearing sensitivity with age appropriate speech and hearing milestones. The rest of her medical history was unremarkable. Currently, she is being treated by occupational therapy for diminished fine motor skills. O: The previous appointment revealed tympanometry results with normal middle ear function and acoustic reflex thresholds that were absent for ipsilateral conditions bilaterally. Pure tone air conduction performed in the soundfield with warble tones revealed hearing thresholds at a slightly sloping, moderately severe to severe hearing loss in at least the better ear from 500-4000 Hz. A: K's audiological evaluation results reveal that she has possible normal middle ear function and her ear canals are free of obstruction due to her normal tympanometric data. Her absent reflex thresholds are likely due to the severity of her hearing loss being below the expected thresholds for having present reflexes. Based on the results of the audiogram obtained in the soundfield, K has a significant hearing loss in at least the better ear. This loss could potentially begin to impact her speech and langauge development and her academic performance in the future without rehabilitation measures and early intervention. P: K needs to return for a follow-up audiological evaluation to perform ear specific air and bone conduction testing under headphones to determine the site of lesion and severity for each ear. Speech testing also needs to be conducted at this follow-up appointment to assess how her hearing loss is affecting her speech and language acquisition. She also needs to have OEs performed at this follow-up appointment to determine the integrity of her outer hair cells. A referral is being sent to the EHDI program to provide the parents with assistance in understanding K's potential hearing loss based off of the results obtained today. 2. Since there are no previous concerns for K's cognitive ability, I would perform CPA to assess her ear specific hearing thresholds under headphones at this appoinment. I would also perform speech reception testing and word recognition score testing. See below for modifications 3. At this appointment, it would be important to get ear specific thresholds for both air conduction and bone conduction if possible. It would also be important to assess K's speech understanding to see how her hearing loss is affecting her speech and language acquisition. 4. K's ipsilateral reflexes are absent for both ears due to her thresholds being at the dB level that they are. We can expect to get no reflex responses once the hearing loss exceeds around 60 dB HL. 5. For SRT, I would have her attempt to point at the picture board for spondees. For word recognition, I would perform NU-CHIPS closed set. For both SRT and NU-CHIPS picture pointing, a modification I could do is to slow down my presentation stimuli to allow her time to use the motor skills she does have to point to the pictures. I will also have to do this for air and bone conduction testing. She could also use a larger button to manipulate and the toys used for CPA will need to be toys that are more gross motor skills related as opposed to fine motor skills.

Answer 50

A pass in newborn hearing screenings according to the current JCIH guidelines is that both ears have to be within the criteria of the test for both ears simulatenously (within the same test) in order to pass. For example, if a newborn passed in the right ear but referred in the left ear, they would need to be re-screened in both ears and have passing results in both ears in order to be an overall pass. If one ear fails, they are a refer. Present normal-level acoustic reflexes rules out more severe hearing losses because in order to obtain them the hearing loss has to be better than around 60 dB HL. Normal reflexes can also rule out the possibility of a cochlear loss if the dB SL values are lower or a retrocochlear loss if the dB SL values are larger. Based on the graphs above, the DPOAE results are showing a pass result where as the TEOAE results are showing a refer. Looking at the DPOAE. the stimulus was good and ended before 3 seconds, the response wave began around 4 seconds and is repeatable becuase the waves are very similar, the rejection was really low confirming that there was minimal noise to effect the results and the graph showing the signal versus the noise also confirms this because the noise was less than -10. In the TEOAE however, the stimulus was not good because there was no ringing present or the peaks present we look for, the response wave somewhat overlaps but not as well as the DPOAE wave, and the noise is below -10 and the rejection rate was low. Due to the rejection rate being low and the noise floor being below -10 where it is supposed to be, as well as the stimulus not being good, this leads me to believe that the potential causes for the difference in results from the DPOAE and TEOAE was that in the TEOAE the probe insertion was not correct leading to a leakage and a reduction in the responses we see in the graph. It is important to include both TEOAEs and DPOAEs in a comprehensive audiologic assessment of patients because they each stimulate a different mechanism in the ear. Having both can give a better representation of what the hearing loss may look like, where the hearing loss could potentially be and maybe what caused it based on the mechanism effected and the test battery approach and cross-check principles combined.

Answer 51

crying phase

Answer 52

first understanding of language

Answer 53

first words

Answer 54

vocab spurt

Answer 55

two word sentences

Answer 56

development of gramar

Answer 57

Apgar scores below 5 at 1 min or less than 6 at 5 min Apgar scores of 0–4 at 1 minute or 0–6 at 5 minutes

Answer 58

Excellent localization. Easily distracted

Answer 59

No babbling at 12 months No gesturing (pointing, waving bye-bye) by 12 months No single words by 16 months No 2 words combination spontaneous phrases by 24 months No 3 words combination by 3 years of age Unintelligible speech at 3 years Limited number of consonants at 2 years Simplified grammar at 3 ½ years Difficulty formulating ideas and using vocab at 4 years Language not used communicatively

Answer 60

kid misses 10% of speech with distance vowels are heard clearly, voiceless consonants might be missed inaudible (voiceless stops & fricatives) inattention

Answer 61

miss most conversational speech vowels heard better than consonants word endings (-s, -ed) are difficult inattention, language delays, speech issues, and learning difficulties.

Answer 62

Language and speech do not develop spontaneously without intervention. can hear distorted self-vocalization, very loud environmental sounds, and only the most intense speech at close range. Significant language problems speech problems and associated educational problems.

Answer 63

Speech often includes issues with voice, articulation, resonance, and prosody. Vocal pitch may be higher, with a monotone quality due to lack of intonation and stress. rely on vision than hearing, aware of vibrations than tonal patters, S/L will not develop spontaneously, severe language delays, speech problems, and potential learning dysfunction without intervention

Answer 64

ped: -Emphasizes developmental milestones - motor skills, language acquisition & social development -Asking about prenatal and birth hx Provided by parents/guardians & accuracy depends on their observations and knowledge of the child’s history -Family hx looking for hereditary factors; social hx including child’s environment, school performance and interactions w/ peers -Behavioral issues and emotional development; focus on conditions like ADHD, autism, anxiety disorders etc. adult: -Focuses on PT’s medical hx, lifestyle factors, chronic conditions -PT usually provides the information directly allowing firsthand reporting of symptoms and concerns -Family hx is important; social hx includes lifestyle factors like smoking, alcohol use, occupation and living situation -Behavioral and emotional health - focus on mental health conditions like depression

Answer 65

physiological testing

Answer 66

Spend time w/ infant to make sure they can perform the task = more reliable results Gastrointestinal feeding tube Infants neurologic status Visually alert

Answer 67

determine if the child has sufficient hearing to develop S/L

Answer 68

Frequency specific Warble tones (pure tones?) Narrow band noise Non-frequency specific Music Noise Speech - used to capture their attention & determine SAT SAT - MLV w/ “ba ba ba” or “shhhhh” Frequency specific uses low mid and high stimuli corresponding to pure tone thresholds (ba, sh, s)

Answer 69

Begin at HFs because many infants respond better to these (usually 2000 Hz) (obtain one HF & one LF) If SNHL suspected start at 500 Hz If middle ear pathology/CHL , start at 2000 Hz because CHL affects LFs more After 500 and 2000 Hz, these answers determine the next most important piece of info Significant difference between 5 and 2: test 1 next & if flat loss test 4 next Ex: if thresholds are 500 and 2000 Hz are normal more useful to test 4000 Hz than 1000 Hz but if hearing at 500 Hz is 30 dB and 2000 is at 70 then testing 1000 Hz is more crucial Attention concerns, test 2-3 frequencies CHL - test 250, 500, & 2,000 SNHL - test 500, 2,000 & 4,000 If HL present, BC testing is next Alternate bw ears

Answer 70

Soundfield: Global idea about hearing Information reflects better hearing ear Natural head turn seems more intuitive in this localization task than in lateralization task. Headphones Needed for ear specific information Inserts are good options for infants Soundfield testing yields more responses than for insert earphone Using earphones first may upset the child; very little information is obtained. Infant responses are better for localization in soundfield than lateralization under earphones.

Answer 71

Suprathreshold stimuli presented at a level at which the infant previously responded Used to demonstrate understanding of the task before descending in level to determine threshold and through the test to determine if the infant is still on task

Answer 72

Observation trials in which the examiner judges whether a head turn occurs in teh absence of sound stimulation Primarily used to determine if the responses “head turn” being judged are truly responses to the test stimuli and not just random head turns

Answer 73

Inconsistent responses Inadequate cooperation: might be fussy, sleepy, uncooperative If infant is unwell (cold, flu, ear infections) Ototoxicity monitoring Ear canal/tympanic membrane abnormalities

Answer 74

Birth to 6 mos Observation - sucking response Looking for changes in sucking response to sounds (with bottle, nursing, pacifier (nonnutritive sucking); this change in sucking pattern is most likely to provide threshold responses responses need to be within 2 s of sond presentation minimum of 2 testers Conducted in soundfield, earphones, bone oscillator, HAs or CIs Enables accurate fitting of technology because minimal response levels (MRLs) can be obtained

Answer 75

Using auro-palpebral, moro reflexes, changes in limb movement or respiration are not elicited responses to threshold stimuli but suprathreshold stimuli instead

Answer 76

Infant is in a quiet, alert state Hungry enough to have a strong sucking reflex but not hungry enough to be upset to participate Ensure they are in a comfortable position

Answer 77

developmental ages 5-36 mos Involves training an infant to make a conditioned head turn response to a test stimulus Infant make a head turn in response to sounds and receives reinforcement. Reinforcers Best placed at the child’s ear level & 90 degrees to the side of the child Distractors Quiet and simple but less interesting than the reinforcer toy

Answer 78

Simultaneous stimulus-reinforcer pairing approach Response observation and shaping approach:

Answer 79

method that pairs an auditory stimulus with a visual reinforcer (toy) to teach them to turn towards the sound, they then learn to associate the sound with the toy & if they notice the sound but do not turn, audiologist/helper helps by pointing to the toy Tone and visual are presented together

Answer 80

preferred, method that the audiologist observes and reinforces a child’s natural response to sound, if they hear but do not turn, response is shaped by directing attention to the reinforcement during sound presentation, training continues until the child consistently responds to the sound without additional cues Tone is presented and the reinforced with visual when turn

Answer 81

Starting level: start close to the subjects threshold and not too loud (leads to greater false response rate) Start at 30 dB (improves probability of starting close to threshold) & increase in 20 dB if no response happens

Answer 82

Assess the stimulus: The stimulus might not be audible or engaging enough. Consider increasing the presentation level or changing the type of stimulus (e.g., NBN) or its frequency. Use a vibrotactile stimulus generated from the bone vibrator (such as ~ 40 dB HL at 250 Hz) with reconditioning using the paired presentation should show a response even in a deaf child. If the child is not responding to the stimulus/reward combination Enhance the reward: The reward may not be sufficiently visible or interesting. Try dimming the room lighting or offering more attractive rewards. Alternatively, possible the child is not developmentally ready for the test or is not motivated by the reward; consider other procedures.

Answer 83

Developmental age 2.5-3 yrs to 5 yrs Method of testing toddlers and preschoolers hearing through conditioned motor responses to sound with game activities Performance of the desired motor behavior within 3s after the stimulus onset of the signal

Answer 84

Condition around 40-50 dB if hearing is assumed to be normal First: start by showing the task (make eye contact, hold toy next to ear, say I hear that when sound is present & put toy into bucket) Hold toy next to ear do give a clear indication of the motor act of dropping the toy i the bucket in response to the test stimuli Lets you know that the child is ready to listen Second: assistant performs it with the child (hold child hand with toy next to their ear, say we hear that when sound is presented moving the child’s hand & dropping it in), after a few trials, feel for the child to move their hand first Third: child attempts alone (if they are hesitant, guide them by saying “you heard it, you can put it in”) *if successful move to threshold exploration, if not increase intensity and present additional conditioning trials, still if not consider using another method (VRA) or switch to bone vibrotactile (place on their head or in their hand or on their knee) & after conditioning go back to air conduction

Answer 85

fake responder

Answer 86

reluctant responders

Answer 87

off responders

Answer 88

Toss a ball in a basket Place puzzle piece together Put ring on the cone Place peg in pegboard Give mom/dad a high five Place block on a castle

Answer 89

What we offer has to be realistic Do not ask if they want to put on the headphones But which game do they want to play is good Dont switch test techniques Instead try Short breaks New toys Try a new assistant Like a parent New stimulus Bribe If you finish you can have ____ Allow them to sit on a parent’s lap Or indication of how long the test will last

Answer 90

Can be used in children older than 5 yrs Child raises their hand or presses the button in response to a stimuli rather than completing a play task

Answer 91

speech testin

Answer 92

Needs to match their capabilities (cognitive, motor, & attention) Has to be interesting and motivating Needs to match speech perception abilities in realistic scenarios *if a child isn’t repeating or identifying, is it because they cannot hear or because they do not understand the words or langauge

Answer 93

NH - present at 30 dB SL If HL is 20, administer speech at 50 HL - minus 40 dB SL Sloping - make sure it is audible at 2 kHz & in HFs

Answer 94

Developmental age of 5 mos to 24 mos Stimuli can be the child's name, nonsense words, or short phrases nonsense words - bababa name short phrases - hi, hey can you hear me, hi johnny vStimuli is presented typically via MLV and can be obtained in the SF (better ear response) or under headphone. SDT is always better than PTA average. ALWAYS LOWER THAN SRT Ling 6 sounds

Answer 95

Receptive language skills >/=2 yrs Around 5 yrs old - normal spondee words Below 5 yrs old - picture board pointing, body parts pointing, CRISP use carrier phrase show me _____ show me snowman present show me at 10-15 above what you ant to present the spondee

Answer 96

< 5 yrs or S/L delay - closed list >/= 5 yrs - attempt open

Answer 97

excellent 90-100 good 80-89 fair 70-79 poor <70

Answer 98

language age 3-5 yrs Closed set of picture pointing word recognition test closed set - using the booklet with pictures open set - ask the child to repeat the words without the book and pictures

Answer 99

Most common Language age bw 5-8 yrs Can be administered as an open-set measure by not using the picture book. The test can be performed in an “auditory only” or “auditory and visual” (lip reading allowed) modality.

Answer 100

language ages 5-8 yrs Cannot be used younger than kindergarten due to vocab too hard 50 phonemically balanced monosyllabic word list selected from spoken vocab of normal hearing kindergarten children Only open set (no pictures)

Answer 101

language age 5-8 yrs language age 5-8 yrs

Answer 102

normal hearing adults -2.5 5-6yrs: 3.5 7-10yrs: .8 11-14yrs: -0.9

Answer 103

older children around 12 yrs

Answer 104

primarily electrophysiological tests (ABR, ASSR, etc.)

Answer 105

used to test ages 7 mos to adulthood (226 becomes adultlike by around 6-8mos)

Answer 106

use for <7mos of age

Answer 107

Acoustic properties of the infant ear changes drastically over the first 6 mos of life Excessively compliant EAC Small ear canal Horizontal orientation of ™ Underossified ossicular chain Small ME space

Answer 108

Absolute emission > -10 dB SPL SNR (relative value) > 3-5 dB (varies) Reproducibility of 70% or greater

Answer 109

Absolute emission > -10 dB SPL SNR (relative value) >6 dB (3-5 dB some) Replicates

Answer 110

sensitivity

Answer 111

specificit

Answer 112

prevalence

Answer 113

1 month: children should be screened 3 months: receive comprehensive evaluation 6 months: receive appropriate intervention The earlier the impairment is identified & treatment started the greater the likelihood of preventing or reducing the debilitating/disabling effects that can result 1 mo: screening, 2 mo: aud diagnosis, 3 mo: early invention

Answer 114

Neural organization uses this maturation approach Meaning that the lower level maturation, stimulation and practice influences the quality of higher-level maturation starts at bottom and as it is built it goes up and develops i stages quality of the stages effects the next one so make sure quality is good to hafe this maturation

Answer 115

synaptogenesis

Answer 116

Synaptic plasticity

Answer 117

cross-modal reorganization

Answer 118

critical period

Answer 119

critical period

Answer 120

sensitive period

Answer 121

Behind-the-ear (BTE) hearing aids use earmolds, which are cheaper to replace compared to customized HAs. Earmolds still need to be replaced often but are generally more cost-effective. Earmolds are safer for active children as they are less likely to cause injury if the child falls or bumps their head. In-the-ear (ITE) hearing aids, being harder, can break and cause damage. Earmolds are softer and less likely to damage the ear. Increasing the distance between the receiver and the microphone reduces feedback. BTE hearing aids have a larger distance compared to smaller ITEs, reducing feedback issues Children’s hearing thresholds can change frequently, requiring hearing aids that can adjust to these changes. BTE hearing aids often have direct audio input features beneficial for school settings, which many ITEs do not offer. BTE hearing aids are generally more durable and can be cleaned more easily. If they need repair, loaners can be provided.

Answer 122

Growth: Frequent replacement due to growth. Safety: Potential for injury and connectivity issues. Durability: Harder to make adjustments and maintain.

Answer 123

Safety: Small pieces can be hazardous, and the receiver may get damaged. Power and Infection: Limited power and potential for more ear infections due to the design. Damage: kids explore by their hands and their mouth so the small pieces can cause a hazard for the child

Answer 124

every 3 mos for children under 1 yr Every 6-12 mos for children 1-5 yrs

Answer 125

Head shadow - intensities are different from ear to ear and helps with localization and one ear has a better SNR Binaural summation improve sound as louder by 2-3 dB Do not need to add as much gain with two HA’s as opposed to one Binaural squelch Central phenomenon in brain *huge adv with two devices Focuses on the desired sound and while suppressing the unwanted background noise

Answer 126

helps with distance helps with SNR even if parents do not want HAs for kids, recommend this helps in reverberant rooms helps rate of language acquisition