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81 Cards in this Set
- Front
- Back
Why do we mask? |
1. when you need ear specific info 2. when there is possible crossover [inter-aural attenuation] |
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WHAT IS HEARING AND WHERE DOES IT OCCUR? |
HEARING IS A PERCEPTUAL EVENT WHIC HAPPENS IN THE BRAIN |
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Narrow Band Noise |
used for tones to put noise into non-test ear via air conduction |
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WHY CROSS HEARING? |
INTERAURAL ATTENUATION; THE AMOUNT OF SOUND REQUIRED TO BRIDGE ACROSS THE HEAD AND STIMULATE THE OPPOSITE COCHLEA VIA BC |
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SHADOW CURVE |
UNMASKED THRESHOLDS TRACE THIS OUT FROM THE NON-TEST EAR BY THE SIZE/AMOUNT OF IA. SIMILARITY IN CONFIGURATION. |
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AT WHAT LEVELS DO INTERAURAL ATTENUATION OCCUR FOR TDH, BONE VIBRATOR, AND INSERT? |
TDH: APPROX 40 DB BONE VIBRATOR: APPROX 0 DB INSERT: APPROX 60-70DB |
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WHEN DO YOU MASK AIR CONDUCTION? |
WHEN THE UNMASKED THRESHOLD IN TE IS >BC THRSHOLD IN NTE BY THE MINIMUM IA VALUE OR MORE |
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WHEN TO MASK BONE CONDUCTION? |
1.MASK ANY SIGNIFICANT AIR BONE GAP 2.MOST OFTEN CALCULATED AT > 10DB 3. AIR BONE GAP= ACte - BCte |
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WHEN IS MASKING NOT NEEDED? |
WHEN TEST RESULTS 1. ARE ALL SYMMETRICAL 2. THERE IS NO SIGNIFICANT AIR-BONE GAP. |
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TIME WHEN YOU CAN'T MASK |
1. CHILDREN 2. COGNITIVE DELAY |
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MASKING |
INSURING THAT THE NON-TEST COCHLEA IS NOT HELPING OUT. MAKING SURE THAT THE EAR YOU WANT TO TEST IS THE ONE THAT IS RESPONDING. |
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EFFECTIVE MASKING |
CONDITION WHEN THE NOISE PRESENTED TO THE NON-TEST-EAR IS SUFFICIENT TO KEEP IT FROM CONTRIBUTING TO THE RESPONSE AND IS NOT INTENSE ENOUGH TO INFLUENCE THE ABILITY OF THE TEST EAR TO RESPOND. [PUTTING IN ENOUGH NOISE IN THE NON-TEST EAR TO KEEP IT FROM HEARING THE NOISE] |
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UNDERMASKING |
CONDITION WHEN NOISE PRESENTED TO THE NON-TEST EAR IS NOT SUFFICIENT TO KEEP IT FROM CONTRIBUTING TO THE RESPONSE. [NOT USING ENOUGH NOISE DURING MASKING] |
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OVERMASKING |
CONDITION WHEN THE NOISE PRESENTED TO THE NON-TEST EAR IS INTENSE ENOUGH TO CROSS OVER TO THE TEST EAR AND MASK IT. [USING TOO MUCH SOUND] |
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THE OCCLUSION EFFECT |
ENHANCEMENT OF BONE CONDUCTION PRODUCED BY COVERING OR CLOSING OFF THE EXTERNAL EAR CANAL. |
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TWO TYPES OF EVALUATIONS |
BEHAVIORAL AND PSYCHOLOGIC |
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CROSS-CHECK CONCEPT |
IF YOU LOOK AT THE BEHAVIOR AND PHYSIOLOGICAL RESULTS YOU WANT THEM TO AGREE. CHECKS FOR ACCURACY AND PATHOLOGIES. SIMPLY SAID OFTEN A SINGLE TEST IS NOT GOOD ENOUGH TO ANSWER ALL OF THE QUESTIONS |
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BEHAVIORAL TESTS/ESTIMATES |
1. MEASURE AN OBSERVABLE BEHAVIOR [ASSOCIATED WITH HEARING PERCEPTION] 2. UTILIZE;STIMULUS-RESPONSE CONSEQUENCE 3. MOST COMMON TEST USED TO ESTIMATE HEARING [PURE TONE AUDIOMETRY] PROVIDES A BEHAVIORAL ESTIMATE OF HEARING |
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PHYSIOLOGIC TEST |
1. TONE IS BEING PRESENTED BUT NOT ASKING FOR BEHAVIORAL RESPONSE [JUST READING THE RESULTS ON A GRAPH] 2. TEST THE FUNCTION/STATUS OF THE SYSTEM |
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PURE TONE AVERAGE |
1. PART OF THE MOST COMMON INTER-TEST RELIABILITY STATEMENT SPECIFICALLY 2. IT'S COMPARED TO THE SPEECH THRESHOLD VALUE [SRT] 3. ACCEPTABLE RELATIONSHIP BETWEEN PTA AND SRT |
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SPEECH THRESHOLD TEST |
PURPOSE IS TO COMPARE TO PURE-TONE AUDIOMETRIC RESULTS. SHOULD AGREE WITH PTA +/- 10 DB. |
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WHAT HAPPENS WHEN THERE IS A GREATER THAN 10 DB VARIATION BETWEEN TEST? |
YOU HAVE A VALIDITY ISSUE. YOU WOULD EITHER RETEST OR LOOK AT NON-BEHAVIORAL TEST RESULTS. |
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PHYSIOLOGIC TEST |
AUDITORY BRAIN STEM RESPONSE TESTS [ABR], OTO-ACOUSTIC EMISSIONS [NEWBORN] IMMITTANCE TESTS [TYMPANOMETRY; ACOUSTIC REFLEX TESTING] |
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FUNDAMENTAL POINT OF THE CROSS-CHECK PRINCIPLE |
ORIGINAL APPLICATION WAS IN PEDIATRIC ASSESSMENT. |
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CO-EXISTING LESIONS |
THE POSSIBILITY THAT THE LISTENER COULD HAVE MULTIPLE PROBLEMS WITHIN THEIR AUDITORY SYSTEM[S] |
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WHAT ARE THE MEDICAL APPLICATIONS OF AUDIOLOGY? |
1. DETECT PRESENCE OF DISEASE 2. TRACK PROGRESS OF DISEASE [TRIGGER FOR TREATMENT] 3. AS OUTCOME MEASURE OF EFFECTS OF TREATMENT [PRE-OP/POST-OP,POST MECD] 4. TRACK PROGRESS OF TREATMENT 5. TRACK UNDESIRED EFFECTS OF TREATMENT |
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WHAT ARE THE NON-MEDICAL APPLICATIONS OF AUDIOLOGY? |
1.TO DETECT A SIGNIFICANT HEARING CONDITION 2. TO DETERMINE NEED FOR NON-MEDICAL INTERVENTION |
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INTRA VS INTER |
INTRA: WITHIN THE SAME TEST INTER: MULTIPLE TESTS |
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WHY DO WE USE SPEECH AUDIOMETRY? |
1. FOR COMPREHENSIVE TESTING 2. WE INCORPORATE SPEECH ASSESSMENT 3. SPEECH THE MOST IMPORTANT AUDITORY STIMULUS BECAUSE SPEECH IS BASIS FOR SPOKEN LANGUAGE |
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PRINCIPLE OF THE LEVEL OF COMPLEXITY OF MATERIAL |
SPEECH MATERIAL FORMS A CONTINUUM FROM WHAT IS CONSIDERED. ANALYTIC-LEVEL TO SYNTHETIC-LEVEL MATERIALS DEPENDING ON THE POSITION ALONG THIS CONTINUUM, DIFFERENT SOURCES OF INFORMATION ARE AVAILABLE |
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ANALYTIC |
PHONE SOUNDS IN SPEECH PHONEMES [SMALLEST UNIT OF MEANINGFUL SOUND] BASIC |
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SYNTHETIC |
MULTI-SYLLABIC WORDS, PHRASES, SENTENCES, CONVERSATIONS |
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SPEECH AUDIOMETRY |
TRADE OFF IN ASSESSMENT OF A PERSON'S ABILITY TO PROCESS SPEECH. AUDIBILITY VS. UNDERSTANDING/DETECTION VS. FAMILIARITY. |
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DETECTION |
IS THE SOUND THERE?/ HEARING |
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DISCRIMINATION |
IS IT THE SAME OR DIFFERENT?/UNDERSTANDING |
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RECOGNITION |
REPEAT THE WORD OR IDENTIFICATION [POINT TO] |
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COMPREHENSION |
MEANING [DEPENDENT ON MEMORY, ATTENTION, CLOSURE] MORE CENTRAL AUDITORY PROCESSING |
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SPEECH RESPONSE THRESHOLD |
SOFTEST VOICE TONE THAT IS AUDIBLE TO THE LISTENER 50% OF THE TIME. LISTENER HAS TO BE FAMILIAR OR UNDERSTAND THE WORDS |
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SPEECH DISCRIMINATION SCORE |
MEASURED IN PERCENTAGE/AMOUNT OF CORRECT RESULTS. WHEN MEASURING IT HAS TO BE AUDIBLE [NO LONGER TESTING THE DB OF HEARING RATHER IF THE LISTENER HEARS THE WORDS] |
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GROWTH OF UNDERSTANDING |
ONCE SOMETHING IS AUDIBLE/LOUD ENOUGH IT SHOULD BE AUDIBLE/LOUD ENOUGH. AS THE INTENSITY INCREASES SO DOES THE ACCURACY. ONCE YOU CAN HEAR IT'S GOING TO PLATEAU |
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TWO BASIC TESTS IN SPEECH AUDIOMETRY |
1. SPEECH THRESHOLD TEST 2. WORD RECOGNITION TEST |
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PRIMARY PURPOSE OF A SPEECH THRESHOLD TEST |
TO COMPARE TO PURE TONE AUDIOMETRIC RESULTS. SHOULD AGREE WITH PURE TONE AVERAGE +/- 10 DB. |
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SRT |
SPEECH RESPONSE THRESHOLD |
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SPONDEE |
2 SYLLABLE WORD THAT CAN BE SEPARATED INTO TWO DIFFERENT WORDS |
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IF THE LISTENER CAN'T PERFORM SRT WHAT TEST DO YOU USE? |
SAT-SPEECH AWARENESS THRESHOLD SDT-SPEECH DETECTION THRESHOLD |
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WHY DO WE USE MONOSYLLABIC WORDS IN SRT? |
BECAUSE MONOSYLLABIC WORDS HAVE A GRADUAL GROWTH THEY HAVE A STRONGER INDICATION OF WHERE THE LOSS MIGHT BE. IE. IF PTA AND SRT SHOW SYMMETRY BUT SPEECH DISCRIM SHOWS ASYMMETRICAL RESULTS CAN INDICATE A PATHOLOGY MEASURED IN PERCENTAGE CORRECT |
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WHAT FACTOR HEAVILY IMPACTS WORD RECOGNITION SCORE? |
PRESENTATION LEVEL OUTCOME/AUDIBILITY OF MATERIAL. |
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THRESHOLD |
USED TO DETERMINE IF THE PATIENT'S PERFORMANCE AGREES WITH HIS OR HER PURE TONE HEARING LOSS |
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DISCRIMINATION |
TO IDENTIFY UNUSUAL ASYMMETRY THAT IS NOT PREDICTED BY THE HEARING LOSS. TO MONITOR PERFORMANCE OVER TIME, THROUGH SEQUENTIAL TESTING. TO ASSIST IN MAKING AMPLIFICATION DECISIONS. |
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TYPICAL RANGE OF HEARING IN A HEALTHY ADULT |
20-20K HZ |
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PEDIATRIC HEARING LOSS |
A CONDITION IN WHICH A CHILD OR ADOLESCENT IS UNABLE TO DETECT OR DISTINGUISH THE RANGE OF SOUNDS AT THE LEVEL NORMALLY POSSIBLE BY THE HUMAN EAR. |
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PEDIATRIC AUDIOMETRY |
IMPORTANCE OF HEARING. RECOGNIZE FAMILIAR VOICES, DIFFERENTIATE AMONG WIDE RANGE OF SOUNDS [IE. FAMILIAR VOICES]. THIS IS WHY IT IS SO IMPORTANT TO IDENTIFY COMMUNICATION DISORDERS ASAP. |
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PEDIATRIC TESTING |
1. STAKES ARE MUCH HIGHER THAN ADULT 2. HISTORY VERY IMPORTANT AND MORE EXTENSIVE 3. USE FAMILY-CENTERED APPROACH IN BOTH DIAGNOSTIC AND INTERVENTION |
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HEARING LOSS AND COMMUNICATION |
-IT VARIES IN THE EXTENT THAT IT AFFECTS SPEECH, LANGUAGE, AND COMMUNICATION. -AFFECTS ABILITY TO DEVELOP RELATIONSHIPS, SUCCEED ACADEMICALLY AND BE INVOLVED |
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VARIETIES OF HEARING LOSS |
LOCATION, SYMMETRY, EXTENT OF IMPACT ON COMMUNICATION, PERSISTENCY, TIMING, LATERALIZATION |
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location |
peripheral:damage to the outer, middle, or inner ear, or the auditory nerve central: hearing loss due to problems after the auditory nerve hits the brain stem |
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auditory processing disorder |
hearing loss resulting from damage to the processing centers of the brain. can be present without peripheral hearing loss |
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edhi |
early hearing detection and intervention programs are present in most states, with the goal to detect hearing loss while the infant is still in hospital at birth. |
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early identification |
family needs to respond early, proactively, and responsively. newborn hearing screenings increase likelihood of early identification. parental decision: communication mode. BEST AGE FOR IDENTIFICATION AND INITIATION OF INTERVENTION PRIOR TO 6 MONTHS. |
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When are toddlers and preschoolers referred? |
1. if they show signs of developmental delay 2. have hereditary disposition for hearing loss 3. develop disease or disorder that affects that auditory mechanism |
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pediatric audiology screening and evaluation steps |
1. screening 2.pediatric techniques used in diagnostic testing |
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who is typically screened in schools? |
k,2,5,8,10 special eduction teacher/parent referrals new students |
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procedure for hearing screening in schools |
screening levels: 500, 1k, 2k, 4k all at 20 or 25 dbhl pass=child heard all 8 tones fail=child did not hear any single 1 or more |
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when do we need more extensive evaluations? |
the younger the child the more dependent of physiologic test; however comprehensive assessment is not complete until behavioral assessment is also done. [always with children] |
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behavioral observation [boa] |
age: birth to 6 mos. outcome: yields a minimal response level not threshold stimuli: noisemakers, speech, warble tones, narrow bands of noise typically in sound field unconditioned response |
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limitations of a boa |
1. if done in a sound field not ear specific 2. will miss mild to moderate hl 3. cant get a lot of data 4. judgement of whether child responded to stimuli is highly subjective |
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visual reinforcement audiometry [vra] |
age: 6 mos to 2 years [some suggest 3 yrs] outcome: yields a minimal response level not threshold stimuli: speech, warble tones, narrow bands of noise typically in sound field conditioned/trained response |
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limitations of vra |
1. if done in sound field not ear specific 2. need special equipment 3. best done with assistant 4. children get bored with procedure 5. judgement of whether child responded to stimulus is still an issue however response if more obvious |
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conditioned play audiometry [cpa] |
age: 2.5 to 4/5 years outcome: should be closer to threshold stimuli: using earphones and/or bone vibrator, can deliever speech, pure/pulsed/warble tones; conditioned/trained response using a play response |
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limitations of cpa |
1. cognitive level of child and behavior are critical 2. needs appropriate toys/tasks 3. best done with assistant 4. children get bored with procedure |
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modified conventional audiometry |
age: 5 years and older outcome: should be a threshold stimuli: using earphones and/or bone vibrator, can deliver speech, pure/pulsed/warble tones response: more like adult; verbal reinforcement |
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how is pediatric hearing loss treated? |
communication choices, amplification and listening devices, aural habiliation |
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hearing aid evaluation |
if family decides on this option, it requires fitting and monitoring use of hearing aids. hearing aids in children usually have behind the ear hearing aids [btes] |
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probe microphone measurement |
computerized method of measuring hearing aid function in a child's ear |
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electroacoustic evaluaiton |
electronic verification of sound properties of hearing aid [gain, output, frequency response] |
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cochlear implants |
provides direct electrical stimulation to the auditory nerve, for children with severe to profound sensorineural loss |
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additionally assistive listening devices |
improve a person's ability to hear in difficult listening situations [eg. fm system, soundfield system] |
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aural habilitation |
individualized intervention to achieve fluent communication in manual and/or oral modality. involves activities such as tactile training, auditory, training, speech reading and visual cues, and education and counseling. |
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three principles of aural habilitation |
1. ensure an appropriate listening environment 2. maximize audition 3. support the continuum of listening development |
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intervention principles: infants, toddler, and preschoolers |
1. early intervention 2. parental involvement 3. naturalistic environments 4. social interaction 5. functional outcomes |
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intervention principles: school aged children |
1. effective means of communication 2. self-advocacy 3. literacy |