Aud 725 Pediatric Audiology Exam 2

Front 1

"Fetus may hear sound in utero." Is this a ridiculous statement?

Back 1

The cochlea has normal adult function at 20 weeks GA and reaches its final size and structure by 34 weeks. Johansson (1964): first to report testing fetal hearing. High frequency tones presented through abdomen. Fetal heart rate increased for fetuses >20 weeks GA. So babies start hearing from the 5th month of gestation.

Front 2

List responses to sound that can be observed in a neonate

Back 2

Auropalpebral Reflex (APR)
Moro Reflex
Changes in respiration, heart rate and sucking.

Front 3

APR

Back 3

Auropalpebral reflex (APR): eye blink in response to loud sound. Reliable response in neonates. Resistance to extinction (habituation). In a quiet room can reliably elicit APR reflex with broadband signals & speech signals at levels of 60-75 dB SPL (40-55 dB HL).

Front 4

Moro Reflex

Back 4

Startle response. Knees and arms drawn into body. Can elicit with speech signals above ~65 dB HL. Problem = can elicit even if handicapping high freq HL.

Front 5

4 states and infant can be in during testing

Back 5

Deep sleep, light sleep, awake & quiet, or awake & active.

Front 6

Behavioral responses you might expect in response to sound from infants 0-6 weeks

Back 6

APR & startle, change in pre-stimulus state (sucking, heart rate, respiration), eye-widening (later in this period).

Front 7

Behavioral responses you might expect in response to sound from infants 6 weeks-4 months

Back 7

Eye-widening, eye-shift, quieting, rudimentary head turn.

Front 8

Behavioral responses you might expect in response to sound from infants 4-7 months

Back 8

Head turn on lateral plane toward sound.

Front 9

Behavioral responses you might expect in response to sound from infants 7-9 months

Back 9

Direct localization to side, indirectly below.

Front 10

Behavioral responses you might expect in response to sound from infants 9-13 months

Back 10

Direct localization to side, below, indirectly above.

Front 11

Behavioral responses you might expect in response to sound from infants > 13 months

Back 11

Direct localization in all directions.

Front 12

Define auditory perception

Back 12

Interpretation of sensory evidence, produced by ears in response to sound, in terms of the objects & events that caused the sound.

Front 13

Observer-based psychoacoustic procedure (OPP)

Back 13

Observer says in s/he thinks the infant responded to sound during interval. Takes about 1 month to train (must have less than 25% false positive rate). Use in conjunction with visual reinforcement.

Front 14

Conditioned orientation reflex/response audiometry (COR)

Back 14

Based on the observation that infants will reflexively turn the head toward a novel auditory or visual stimulus. COR required accurate localization of sound source to be reinforced.

Front 15

For what age group would you use VRA?

Back 15

Infants 5 to 30 months.

Front 16

VRA Procedures

Back 16

1) Explain procedure to parent and caution about cuing.
2) Start with SF speech at low levels. Ascend and look for spontaneous response. Gives a ballpark idea of unconditioned MRL. Speech is the easiest stimulus to get a response. Can also give you an idea of the developmental level of response.
3) Speech stimuli: use earphones. Condition one-sided head turn. Need to justify using earphones because you need twice as many responses (each ear).
4) Warble tones: earphone or SF.
5) Must be speedy. Usually only have 15 min before child habituates.

Front 17

Frequencies tested for VRA

Back 17

2000, 500, 4000, 1000 Hz

Front 18

Test environment for VRA/BOA

Back 18

Simple, speakers at a minimum of 45 degrees, ideal to have a dimmer for VRA so R+ shows up more (at least have R+ behind dark plexiglass), good to have different reinforcers for variety.

Front 19

Test environment for CPA and older kids

Back 19

Need to make decision whether or not to have parent in the room. Child may "act out" instead of working if parent in room or child may be frightened. Bottom line - ask parent & child what they want.

Front 20

Responsibilities of test assistant

Back 20

Behavior management - distract without being distracting, centering, assist with conditioning procedure (VRA & CPA), management of parent, observation of behavior (BOA & VRA).

Front 21

The test behavior is ______

Back 21

Dynamic not static

Front 22

Response-ready state/window

Back 22

Not too distracted with toy, not talking or vocalizing, not interacting with parent, not looking at R+. As session progresses the periods of response-ready time decreases, it may vary with distractors depending on how much the child likes them. Stimulus presentation must be matched to response-ready window.

Front 23

At what age would you use CPA procedures? Lowest age and typical age (initial session), lowest age (multiple sessions)

Back 23

Lowest age (initial session): 2 years, 3 months
Typical age (initial session): 2 years, 8 months
Lowest age (multiple sessions): 18 months (AR kid)

Front 24

Detection

Back 24

Ability to detect the presence of a stimulus.

Front 25

Identification (recognition)

Back 25

The ability to recognize and identify a stimulus by pointing, repeating or writing (most of our word recognition tests).

Front 26

Comprehension

Back 26

The ability to understand what a stimulus means.

Front 27

Ling 6-sound test

Back 27

/a/, /u/, /i/, /s/, “sh”, /m/

Front 28

Speech discrimination tests

Back 28

Body parts, picture cards/spondees, PBK-50 word list.

Front 29

PBK-50 word list

Back 29

Developed by Hastins (1949). 3 lists of phonetically balanced words selected from spoken vocab of kindergarteners. Open-ended set of stim words. Presented MLV or tape recorded. Children < 4.5 years may not do well unless use play techniques. Tangible reinforcement is an effective method of maintaining interest. (Significant improvement found in children 4-8 years when used token reinforcement). Used to test when receptive vocab child approaches that of normal hearing kindergartener.

Front 30

WIPI

Back 30

Word intelligibility by picture identification. Developed by Ross & Lerman (1970). Developed for HI children. Evaluated test on 61 HI kids ages 5-6; should not use with children <5 yrs. 25 picture plates w/ 6 pictures/plate. Closed response set. Test has high reliability, simple & rapid to administer.

Front 31

NU-CHIPS

Back 31

Northwestern University Children’s Perception of Speech Test. Developed by Elliott & Katz (1980). 50 monosyllabic words – in vocab of children > 2.5 years. Includes 65 word pictures & interchanges 50 words as test items & foil items. Simple words (e.g. food school) represented in 4 AFC picture set. Child responds by pointing to picture.

Front 32

SERT

Back 32

Sound effects recognition test. Developed by Finitzo-Hieber et al. (1980). Developed for children w/ limited verbal abilities. 3 equivalent sets, each containing 10 familiar environmental sound (e.g. dog barking, toilet flushing, mother singing). Use as supplement to more traditional speech discrim tests – closed set, picture pointing, 10 sounds + practice sound.

Front 33

PSI

Back 33

Pediatric speech intelligibility test. Developed by S. Jerger et al. (1980, 1981). Used realistic speech materials to control receptive language factor in children incorporating actual responses of normal children between changes of 3-6 yrs. 20 monosyllabic words; 10-sentence procedures. Word lists= simple nouns, such as dog, spoon. Sentence construction Format I & Format II (nonsense “a bear is brushing his teeth.” Different sentence formats = different speech patterns of nml children betwn 3-6 yrs. Can use PSI test items in presence of competing message & defining PI functions for children of varying chronological & receptive language age groups – prior to this, only thought could do this testing in adults

Front 34

The clinical implication from the Noza et al. (1999) study

Back 34

Overall found 4 dB effect of nonsensory influences across freq, thus, there must be sensory diffs between infants & adults.
Clinical implications: average thresholds for infants 7-9 months of age at 500, 1000 & 2000 Hz differ from adult’s. These authors recommend infant nml thresholds as: 20 @ 500, 15 @ 1000, & 10 @ 2000 Hz. Variability between infants was not much greater than for adults.

Front 35

Babies middle ear vs. adults middle ear (mass & stiffness)

Back 35

Babies system is more mass dominated than stiffness dominated (adults).

Front 36

What frequency tympanometry is used for infants 7 months and younger?

Back 36

About 800 Hz

Front 37

Frequency spectra of ABR for kids vs. adults

Back 37

Adults: more energy in higher frequencies. Near threshold - concentration near 100 Hz.
Neonates: less frequency spilling. Much less high frequency info. Dominated by lower frequencies.

Front 38

How do the difference in frequency spectra for kids change your filtering characteristics for ABR testing?

Back 38

Need to open filters lower than what we would have done for adults. 100 Hz cut off for kids vs. 1500 Hz cut off for adults.
Recommendations 25 or 30 - 3000 Hz.

Front 39

What are the drawbacks to using click stimuli for ABR testing?

Back 39

Broadband signal, so we can’t determine hearing sensitivity for specific frequencies because clicks activate wide are of basilar membrane.

Front 40

Why do we use a one sided head turn?

Back 40

Initially takes more time to condition but when we switch ears the response will not extinguish. Requiring localization can be difficult near threshold or if you need to finish in the sound field and there is an asymmetrical hearing loss.

Front 41

Requirements of a pediatric audiologist

Back 41

1) Behavior management
2) Control bias
3) Recognized response ready window
4) Present tone during window
5) Switch up timing
6) Switch up types of tones
7) Flexibility
8) Patience
9) Speedy
10) Self evaluation

Front 42

Issues in pediatric assessment of speech perception

Back 42

1) The child's language
2) Cognitive and attentional capabilities
3) Articulation problems
4) MLV over recorded materials
5) A variety of tests are needed to measure speech perception
6) Children should not be trained on materials

Front 43

Two applications of ABR

Back 43

1) Estimate of hearing sensitivity
2) Identification lesions at 8th nerve and beyond

Front 44

At lower intensities there is _____ variability in latency. At higher intensities there is ____ variability.

Back 44

More, less

Front 45

Amplitude ratio V/I for adults and infants

Back 45

For adults the ratio is 2+
For kids ~1

Front 46

Infants ABRs compared to adults

Back 46

Kids ABR amplitudes are smaller, simpler waveform (only identify waves 1, 3, and 5), longer latency and we use a slower click stimulus (shouldn't go over 66)--> we need different norms for kids and adults.

Front 47

The three latencies we look at

Back 47

1) Absolute latencies of all waves
2) Inter-peak latency
3) Inter-aural differences

Front 48

Bone conducted ABRs

Back 48

Pretty rare because if it is not a kid we have other ways of getting this information. It is a way of backing up the ABR that we got. Can help us figure out if the results are sensorineural or conductive. Two-channel recordings.
Bone conduction thresholds (infants):
500 Hz: expected down to 20 dB nHL
2000 Hz: expected down to 30 dB nHL

Front 49

What things can alter TEOAE measures?

Back 49

Intensity of stimulus, status of middle and outer ear, functioning cochlea (SNHL), age (we need different norms for infants and adults, 10 dB different). (3 dB above noise floor, conservatively 6 dB).

Front 50

DPOAE measures overview

Back 50

Range between infants and adults (3-10 dB difference). The distortion is due to the non-linearity of cochlea. 1.2 ratio. Levels <70 should be 10 dB apart, at 70 dB they can be equal. L1 > L2 because we want them to arrive at the membrane at the same time. Want at least a 6 dB SNR or use template to identify a present DPOAE.

Front 51

What are the applications of OAEs in infants and children?

Back 51

Cochlear status (does not require participation of infant or child), non-invasive, easy, does not require much preparation, faster to measure than ABR, reliable within and across sessions.
Specific uses of OAEs:
1) Hearing Screening
2) Ototoxic monitoring (noise or drugs)
3) Site of lesion (differential diagnosis)
4) Middle ear status
5) Malingers (psudo-hypocusis, liars)