Aural Rehab

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Aural Rehab
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2011-09-20 16:51:35
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Aural Rehab
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  1. Contraction of the middle ear muscles in response to intense sounds, which has the effect of stiffening the middle ear system and decreasing its static acoustic compliance.
    Acoustic Reflex
  2. Measures the effect of middle ear muscle contraction on the TM stiffening.
    - Stimulation intensities vary from 70-100dB HL.
    - Tested freq. 500, 1000, 2000,4000
    - normally occurs in both ears
    provides useful diagnostic tool in measuring middle ear neuro functioning and audiotory sensitivity.
    Acoustic Reflex
  3. reflex is stimulated and measured in the same ear.
    Ipsilateral
  4. when the stimulus is in the tested ear and the probe is in the opposite
    • Contralateral
    • - ex. right contralateral= right ear stimulus and probe tip in the left ear.
  5. the measurement of middle ear pressure determined by the mobility of the membrane as a function of various amounts of positive and negative pressure in the external ear canal.
    Tympanometry
  6. 3 types of tymps
    • Tymp (A) As and Ad
    • Tymp B
    • Tymp C
  7. synonymous with normal middle ear function.
    - peak within normal limits and pressure within normal limits
    Type: Tymp A
  8. abnormal stiffness in the middle ear system
    - peak within normal limits but compliance is abnormally low
    Tymp As
  9. a flaccid TM with high amplitude
    - may indicate excessive scar tissue or disarticulation of the middle ear bones.
    Tymp Ad
  10. restricted TM mobility, possibly fluid or some pathological condition. Cerumen can also be the cause due to a plugged probe tip or comlete blockage.
    -compliance is abnormally low
    Tymp B
  11. abnormally negative pressure in the middle ear cavity.
    - usually indicative of upcoming or resoloving otitis media
    - compliance usually normal
    Tymp C
  12. PTA
    Pure tone average
  13. MCL
    Most confortable level
  14. UCL
    Uncomfortable level
  15. SDT
    Speech Detection Threshold
  16. SRT
    Speech Reception Threshold
  17. WRS
    Word Recognition Score
  18. OAE
    Otoacoustic Emission
  19. AABR
    Automated Auditory Brainstem Response
  20. ABR
    Auditory Brainstem Response
  21. one ear
    unilateral
  22. both ears
    bilateral
  23. one ear is aided
    • monaural
    • - hearing aid or cochlear implant
  24. both ears aided
    binaural
  25. Efforts designed to restore a lost state or function.
    - includes educators, psychologists, social workers and rehabilitaion counselors.
    - Process to help the patient
    Aural Rehab
  26. First known deaf educator
    Pedro Ponce De Leon
  27. learned finger spelling and sign language with speechreading
    - opened a school for the deaf
    Thomas Gallaudet
  28. promoted more oral methods speechreading - electrical
    Amplification
    Alexander Graham Bell and Horace Mann
  29. Pioneer of audiology
    Raymond Carhart
  30. HIS stands for
    • Hearing instrument specialist
    • - dispensed hearing aids in the 1940's and 50's
    • - audiologist just tested and recommended
  31. It is estimated that ______ percent of Americans who could benefit from hearing aids are not using amplification.
    80%
  32. What is the reason 80% of people need HA and don't get them?
    • -lack of early identification/ intervention
    • - working order of personal amplification
    • - access to resources
    • - vanity issues
    • - life experiences
    • - improper fitting of instruments
  33. charateristics of Hearing loss
    • Degree and configuration
    • time of onset
    • type of loss
    • auditory speech recognition ability
  34. impairment present at birth or prior to the development of speech and language
    • Prelingual Deafness
    • - before age 5
    • - importance of early intervention
  35. the loss occurs after about age 5
    • Postlingual Deafness
    • -speech and education possibly affected
  36. those who lose hearing after their schooling is complete.
    • Deafened
    • - unable to comprehend speech with hearing alone
    • - social and emotional effected (profound or worse)
  37. outer or middle ear damage
    conductive
  38. impairment of inner ear or nerve
    Sensorineural
  39. combination of SNHL and CHL
    Mixed
  40. level at which the patient can detect a sound is present
    • Speech Detection Threshold
    • (they have awareness of sound)
  41. Level at which the patient can repeat or identify the stimulus
    • Speech Reception Threshold
    • - more freq. specific they can repeat it back
  42. WHO
    World Health Organization
  43. CORE
    • Communication status
    • Overall participation variables
    • Related Personal Factors
    • Enviromental Factors
  44. Assessment Procedures
    C - in core
    • communication skill
    • - impairment and activity
    • - audiometric tests and questionaires used to assess awareness of hearing loss
    • - Evaluate communication and language
  45. Assessment Procedures
    O - in CORE
    • Overall Participation Variables
    • - participation aspects of hearing loss
    • - Psychological
    • - social - family, spouse, social class and lifestyles
    • - vocational - position, responsibility and compentence
    • - educational
  46. Assessment Procedures
    R - CORE
    • Related Personal Factors
    • - personal attitude
    • - personalities- Type I, II, III, IV
    • - must modigy attitude to continue in rehab process
    • - also include age, race, gender, habit, coping style, upbringing
  47. strong positive attitude
    Type I personality
  48. essentially positive, hard to fit hearing loss- hard to configure
    Type II personality
  49. negative attitude, but will cooperate at times
    Type III personality
  50. reject hearing aids and rehab process
    type IV personality
  51. Assessment Procedures
    E - CORE
    • Enviromental Factors
    • - indv. aspects - physical features of enviroment as well as personal contacts
    • - services - social structure, work, transportation
    • - systems- laws regulation and rules
    • - Acoustical environment they encounter
  52. Things to take into consideration in regards to psychosocial aspects of hearing impairment with the patient.
    • - adjustment period
    • - acceptance
    • - Lifestyles
    • - Unseen varibles
    • - Expectations
  53. deaf with a little d means
    bilateral profound SNHL
  54. Deaf with capital D means
    cultural identification with the Deaf community.
  55. learned behavior from input, feedback and peer reactions
    • Self-concept
    • - need approval from those around them
    • - kids w/hl may have poor self concept-due to communication difficulties and decreased interaction with peers
    • - Cosmetic issues may begin to appear
  56. Purpose of amplification
    • - to make speech and enviromental sounds audible to the hearing impaired person
    • -Optimize intelligibility and sound quality
    • - Ensure loud inputs are not uncomfortable or distorted
  57. Responsibility of Fitting
    • - cost effective fitting and appropriate fitting
    • - adjust the HA to the patients specific type and HL
    • - Adjust the hearing aids precisley for the patients specific listening needs.
    • - Provide follow up
    • - Facilitate other aspects of aural rehab
  58. Hearing aids need a __________ electroacoustic analysis from the manufacturer.
    yearly
  59. Hearing aid companies provide _________ that vary in length and time.
    • warranties
    • - renewal of warranty after expired for a fee.
  60. Turning off the hearing aid prevents __________ for removal or insertion?
    feedback
  61. T or F
    Its ok to use alcohol or oil to clean aids?
    False
  62. T or F
    During the first few week, use the hearing aids in a normal, quiet, everyday environment?
    True
  63. If you didn't want to turn the hearing aid off to put in someone's ear, what else could you do to prevent feedback?
    Open the battery door then insert into ear
  64. T or F
    Hearing aids are regulated by the FDA and are medical prostheic appliances.
    True
  65. Circut design in Hearing aid technology offers what? 2 things
    • 1. New signal processing algorithms
    • 2. Multiple channels of signal processing
  66. Digital/programmable hearing aids offers what? 3 things
    • 1. All current technology is programmable
    • 2. Use digital processing of the signal
    • 3. Programmed by using a computer
  67. What are Probe-microphone measures used for?
    • - used to measure the reliablity of the output of hearing aids at the level up to the tympanic membrane
    • - allows for a precise, freq. specific fitting of the hearing aids
    • - Provide a verifiable measurement for evaluation.
  68. What is computerization?
    • -Allows the hearing instrument to be programmed through specific fitting software for patient verification.
    • - Allows the audiologist to see adjustments made to the hearing aid in real time
    • -Freq. specific adjustment capabilites
  69. Waht is the AudioScan Verifit used for?
    • It is for the hearing aid itself.
    • -for checking the hearing aid
    • -scans and verifies
    • - checks acoustic info
  70. What role does the internet play in hearing aid technology?
    • - provides the consumer/patient access to current technology trends
    • - created tech savvy patients of all ages
    • - Increased patient expectations of technology.
  71. What is the initial Hearing aid process?
    • 1. Audiological examination
    • 2. Counsel regarding results
    • 3. Discuss the types of hearing aids
    • 4. Discuss the types of hearing aids
    • - make and model are important, but more important to find one that fits their lifestyle
    • 5. Take an ear mold impression
  72. What do you go over with the patient when discussing proper maintenance and care of the hearing aid?
    • 1. how it works
    • 2. replacing batteries
    • 3. cleaning instrument
    • 4. check thier dexterity
    • - remember there will always be an adjustment period
    • - warn them about loudness levels and enviromental sound they were missing
  73. What do you do in a hearing Evaluation??????? Not sure about this question>
    • 1. Program to the patient's hearing loss
    • 2. Electroacoustic analysis and probe microphone measures
    • 3. "Aided" sound field testing
    • - recorded with an "A" on audiogrm.
    • 4. Provide the patient with a before and after view of their test results
  74. Patients have a _____ day refund policy required by federal law.
    60
  75. You are allowed to return your hearing aids for a full refund before how many days?
    • 30
    • - minus exam and fitting fees
  76. BTE
    • behind the ear
    • - most powerful ha you can get
  77. OTE
    • over the ear
    • - no ear impression needed
    • - mostly for mild hearing loss
    • - cannot be used on profound patients
  78. ITE
    • in the ear
    • -fills up concha
    • - largest one for in the ear
    • - not as powerful but more cosmetically appealing
  79. ITC
    • in the canal
    • - middle sized (in the ear) hearing aid
  80. CIC
    • completely in the canal
    • - hard to see
    • - convenient but not a lot of power
  81. Basic components of a hearing aid. (4)
    • 1. Microphone
    • 2. Amplifier
    • 3. Reciever
    • 4. Battery
  82. Sound waves enter here and converts the acoustic signal(sound waves) into electrical signal?
    Microphone
  83. What increases the strength of the electrical signal (makes it louder)
    Amplifier
  84. What converts the amplified electrical signal back into amplified acoustical signal (sound waves)?
    Receiver
  85. What provides electrical energy to power the hearing aid?
    Battery
  86. What do the following control features stand for?

    M
    O
    T
    • M- microphone
    • O - turns the ha off
    • T - if present activates the telecoil
  87. What enhances use of hearing aid on the telephone? Also picks up "leaks" electromagnetic signals and converts them into acoustic energy.
    Telecoil
  88. What are the features for the volume control?
    • - Controls the loudness
    • - toggle switch, rotating wheel or remote control.
    • - some devices automatically adjust volume.
    • - So patients may prefer a volume control, even if its disabled.
  89. What is the purpose of amplification?
    • 1. to make speech and environmental sounds audible to the hearing impaired
    • 2. Optimize intelligibility and sound quality
    • 3. Ensure loud inputs are not uncomfortable or distorted
  90. What is the difference in dB between input and output of the hearing aid?
    • Gain
    • - remember the input signal plus the aid gain equals the total output

    • input signal
    • + aid gain
    • = total output
  91. What is the response or gain at the frequencies it amplifies?
    Frequency Response
  92. Information about the frequency range of the frequencies the aid effectively amplifies is called ___________.
    Bandwidth
  93. Controls and Features
    - Frequency Specific Gain
    • 1. Control the amount of amplification in specific frequencies
    • 2. Frequency band control
  94. MPO stands for what?
    Define MPO
    • Maximum Pressure/Power Output
    • - the maximum output that the hearing aid will ampligy up to its "upper limit"
  95. Compression is also known as?
    Automatic Gain Control (AGC)
  96. ______________ limits the amount of maximum power output (MPO)?
    Compression
  97. (Compression)

    AGCo happens _________ the amplifier?
    After
  98. (Compression)

    AGCi monitors input, the signal ________ before its amplified?
    Before
  99. An old form of compressing the signal by essentially cutting off the peaks of the signal is called what?
    Peak Clipping
  100. Distortion is not present with AGC?
    T or F
    • False
    • It is still present with AGC.
  101. The most expensive hearing aids can reproduce an exact amplified reproduction of the orginal signal?

    T or F
    False
  102. Directional Mic Technology does what?
    • 1. allows for better signal to noise ration (SNR)
    • 2. Can be single directional or omnidirectional
    • 3. May have a button to change between the 2 or aid may do this automatically
    • 4. Circuitry is dependant on the degree of loss and the size of hearing aid.
  103. CROS stands for?
    • Contralateral Routing of the Signal
    • - for patients with an unaidable hearing loss in one ear(mic) and normal to near normal hearing in the opposite ear (receiver)
  104. BICROS stands for?
    • bilateral Contralateral Routing of the signal
    • - for an unaidable ear, to an aided ear on the oppisite side.
    • - single amplifier and receiver to better ear.
  105. BAHA stands for?
    • Bone Anchored Hearing Aid
    • - Surgically implanted behind the ear into the mastoid area
    • - for conductive hearing loss
  106. Ideal patients for the BAHA?
    • - congiential atresia or longstanding middle ear disfunction.
    • - also for single sided deafness, but not so much for these patients.
  107. How does the BAHA tranfer sound?
    Takes sound from the direct BC from the BAHA sends it to the cochlea of the good ear.
  108. A biomedical device that is surgically implanted to bypass the middle ear and stimulate the 8th nerve directly?
    Cochlear Implant
  109. What type of hearing loss would a patient with a cochlear implant have?
    • sensorineural- hair cells not working properly.
    • - cochlear implants- very invasive surgery
  110. Steps for taking an ear impression:
    • 1. perform otoscopy
    • 2. use otolight to place eardam just beyond the second bend of the ear canal
    • 3. mix base and catalyst together
    • 4. use a syringe and inject material in the ear canal until the concha and helix are filled up.
    • 5. Lift the pinna up and back to remove hardened impression material
  111. You create an ear mold from an ear impression?

    T or F
    True
  112. What is the process for ear molds?
    • 1. impressions are sent to a company and the ear molds are made
    • 2. Couples the hearing aid to the patients ear using a specific type of tubing
    • 3. Provides support and stability for BTE's, OTE's and CI's
    • - for CI's used for retention purposes only
    • 4. Directs and modifies the sound depending on the style and features that are chosen.
  113. What are some examples of Assistive Listening Devices?
    • alarm clocks
    • tv headsets
    • telephones
    • personal communicators
    • door bell alarms
    • some dectector aids
    • (some visual aids to get their attention.)
  114. What may be the most important aspect of successful use of hearing aids?
    A tight fit
  115. A small hole drilled into the canal portion of the shell/earmold?
    vent
  116. What are the 3 primary reasons for a vent?
    • 1. Allows for low frequencies to escape from the ear canal.
    • - larger vent= more low frequency attenuation- (larger- less amplification)
    • 2. Release pressure to decrease "plugged up" feeling
    • 3. Allows for normal input of unamplified sounds.
  117. What is the purpose of Hearing Aid Dampers?
    Muffles (dampens) the peaks
  118. What are hearing aid dampers made from?
    Mesh screens, cotton, lambs wool
  119. Where are the hearing aid dampers placed?
    In the receiver of a custom insturment.
  120. What do hearing aid acoustic horns do?
    • Enhances high frequency gain especially in the 3000 to 4000 Hz range (increases amplification)
    • - progressively increase the internal diameter of the earmold tubing or custom shell sound bore
    • - size of the horn is limited to the size of the earmold/shell
  121. What are the 5 common sizes of batteries?
    5, 10, 13, 312, 675

    • - smaller batteries don't last as long and are not as powerful
    • - small # of the battery smaller size of the battery
  122. All hearing aids must operate under this standard?
    American National Standards Institute
  123. Selecting the HA Candidate
    3 things you need to know:
    • 1. Degree of loss - depending on the severity of the hl and their pure-tone threshold
    • 2. Degree of Communication Disability- How the patient percieves their communication difficulties
    • 3. Motivation- is the patient will to wear aids and accept aural rehab process.
  124. Preselection Measurements

    What is used to predict how much gain is needed in the prescriptive fitting formula?
    Pure-tone threshold
  125. Preselection Measurements

    Use of pure-tones or Narrow Band Noise to obtain how loud of a sound can be tolerated by the patient at various frequencies is called _________?
    Loudness discomfort levels
  126. What is the ability to understand speech in the presence of background noise?
    Speech-in-noise
  127. Hearing aid style depends on:
    the patients dexterity, canal size, medical conditions, cosmetic appeal, degrees and configuration of hearing loss.
  128. What is meant by gain and frequency response?
    • power of the hearing aid
    • - gain and output are manipulatied by prescriptive formulas
  129. T or F

    You should trust the manufactures fitting formulas because that are validated by NAL and DSL research?
    False
  130. What do multiple channels do?
    • allows the signal to be broken down into separtate catergories by frequency range for processing.
    • - provies a more appropriate adjustment of gain and compression
    • - helps modify for a patients specific hearing loss.
  131. What does multiple memories(programs) mean?
    • they are specific memories(programs) that can be tuned with differnet fitting parameters for varying environmental situations.
    • - ex. restaurant, music, crowd noise etc.
  132. The difference between the patient's LDL and threshold for that signal (pure-tone or speech)
    • Dynamic Range
    • - provids a guide to fitting range
    • - helps determine limiting of MPO
  133. Most effective in improving SNR based on spatial location.
    • Directional Technology
    • - works best when the desired sound input is directly in front of the patient
    • -
    • Directional provides better SNR than omnidirectional
  134. When hearing aid channels analyze the sound input and when its determined to be noise, the aid automatically decreases the gain to that channel, this is called what?
    Automatic digital noise reduction
  135. Provides the patient ability to increase the gain to make soft sounds more audible?
    • Adaptive Feedback Reduction
    • - allows for more open fitting
    • - hearing aid identifies the frequency of feedback and applies gain reduction
  136. Besides improper fit of a hearing aid, what is another major cause of hearing aid rejection?
    Feedback
  137. What are the advantages of binaural fittings?
    • Two is better than one
    • - increased gain
    • - improved localization
    • - sound quality
    • - better speech understanding in the presence of noise.
    • -
  138. When listening with 2 ears we are able to hear sound at a lower level compared to one ear, this is called what?
    Binaural Summation
  139. What are the advantages of binaural summation?
    • - advantages for low level sounds is 3 dB better
    • - Suprathreshold advantage is as much as 10-12dB better (high frequencies)
    • - helps you localize better
  140. More advantanges of Binaural Hearing
    • 1. Binaural summation
    • 2. Intensity/Frequency- can hear smaller changes in both.
    • 3. Sound localization- localize sound better
    • 4. Time difference- timing in localization
    • 5. Speech discrimination- better in the presence of background noise.
  141. Who are Probe Mic Measures used on?
    • babies
    • - most reliable method in assessing realtime hearing aid adjustments and performance.
  142. H- stands for
    hearing expectations
  143. I - stands for
    Instrument operation
  144. O - stands for
    occulsion effect
  145. B - stands for
    batteries
  146. A - stands for
    acoustic feedback
  147. S - stands for
    System troubleshooting
  148. I - stands for
    insertion and removal
  149. C- stands for
    Cleaning and maintenance
  150. S - stand for
    Service, warranty and repair
  151. HIO basics hearing expectations
    adjustment periods and realistic expectations.
  152. HIO instrument operations
    ability to turn the aid on/off, change programs, adjust volume, activate telecoil, and use telephone
  153. HIO basics
    what is it called when you have a plugged up feeling/ head in a barrel?
    occlusion effect
  154. HIO basics
    Batteries
    • types, sizes, where to buy, battery life.
    • Ability to insert/remove battery
  155. HIO Basics
    Acoustic Feedback
    Demonstrate when feedback is appropriate
  156. HIO Basics
    System Troubleshooting
    review hearing aid manual
  157. HIO Basics

    Insertion and removal
    Properly insert and remove hearing aid
  158. HIO Basics

    Cleaning and maintenance
    cleaning tools, wax removal, no fluids allowed, not to drop the hearing aid.
  159. HIO Basics

    Service, warranty and repairs
    • warranty explanation of coverage, repair policies, when to service the aid and the process of repairs.
    • - refer to booklet or audiologist
  160. Purpose of follow ups
    • 1. Measure functional gain
    • 2. Measure LDL with patients normal setting
    • 3. Repeat self assessment questionaires
    • 4. Check general care and maintenance of hearing aid
    • 5. Check data logging
  161. What do you need to remind the patient about acclimatization?
    that it takes several weeks to months for the brain to adjust to new sounds
  162. For pediatric patients when prefitting use _________ results to plot audiogram for fitting?
    ABR
  163. What does RECD stand for?
    • Real ear to copuler difference.
    • - very important - metal coupler
    • - re-evaluate often
    • - obtain behavioral measurements as soon as possible- aided and unaided

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