Aural Rehab #2
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What are the two visual properties of speech?
What is a viseme?
What can you compare it too?
- The visual unit of speech
- Phoneme- the acoustic unit of speech
How many visemes are there for English speech.
10. All english phonemes fall into 1 of 10 discrete visual categories.
What are homophenes?
- Speech sounds within the same visual category (homophenous)
- *look but don't sound the same.
What are the 3 more recognizable visemes?
2) f, v
3) w, hw, r
What are the 5 less recognizable visemes?
- 1) Th and th (voiced and unvoiced th)
- 2) Sh, ch, j, ig (beige)
- 3) s, z
- 4) j (yellow)
- 5) t, d, n, l
What are the 2 visemes with very little visual information?
Vowels are ___ in acoustics but ___ in visual.
____ of words and phonemes are homophenous.
How many phonemes are heard and seen per second?
- Speech - 15 phonemes/sec
- Eye- 12 phonemes/sec
What are limiting factors in lipreading?
- 50% of words and phonemes are homophenous
- Speech-15 phonemes/sec Eye- 12 phonemes/sec
- Running speech
- Different speakers ( artic movements, familiarity, rate, oral prosthetic, disordered artic, whisper)
- Visual Noise (poor lighting, glare, hand in front of face, food chewing, cigarette, pipe, truning away, gum chewing, mustache beard.
When you whisper...
Articulation is different.
Define speech reading
the process of decoding the visual cues of speech.
WHat are the two speech reading methods and describe each. Also give examples of each
- Analytic method: breaking message down in little parts. Drill on sounds. mueller-walle, jena
- Synthetic method: pull everything together from all info w/o focusing on little parts. nitchie, and kinzie
Who is the father of lipreading?
What is the more popular method of speech reading today?
What is the classic test of speechreading?
- The Utley test,
- Not sure of validity due to lack of science.
There are a variety of other tests for speech reading assessment, and some are designed to evaluate _____ rather than ___ skills.
What things must you specify for testing conditions of speech reading?
- who is the speaker
- acoutsic cues (signal level, noise level, SNR.)
- Speaker position
- gestures, facial expression
- speaker distance
- rate of speech
- lighting (make sure its good)
what should test administration always include?
Who is a candidate for speechreading instruction?
those persons with substantial disability whom other AR techniques have not been effective.
What are the factors that mean S/R is usually not a priority in an AR program?
- limitation of S/R
- difficulty learning s/r in a training program
- availability of more effective AR techniques.
What are two perceptual strategies in understanding speech? Describe each and give an example.
- Figure-ground patterning: Recognizing a stimulus pattern in a background of noise. (focusing in on what you want to focus on in the midst of noise). EX- word search
- Closure: Perception of an incomplete stimulus as being complete. Ex- A win__r _orm warn_ng is in e_e_t
____ is important in communication and quality of life.
_____ are often present in clinical populations. Which one?
- Visual disorders.
- multiply disordered individuals.
What is acuity?
Ability to resolve visual stimuli.
20/20 vision is a term used to express normal visual acuity (the clarity or sharpness of vision) measured at a distance of 20 ft. if you have 20/20 vision you can see clearly at 20 feet what should normally be seen at that distance.
What does it mean to have 20/100 vision?
it means that you must be as close as 20 ft to see what a person with normal vision can see at 100 feet.
What is adaptation?
Ability to adjust sensitivity to light.
Describe Retinitis pigmentosa?
Genetic. Occurs in usher syndrome.
What is the most common disorder causing loss of both hearing and vision (may also affect balance)?
With usher syndrom, hl is often _____ and vision loss occurs in ___ to ___.
- childhood, late teens
With Usher syndrome, there is a decrease in _____ a loss of ___ and _____.Usually not ______.
- night vision
- peripheral and central vision (in advanced cases)
- complete blindness.
what is in the future for usher syndrome?
promising research (nature medicine 2013) treating HL in Ushers with RNA injection.
What are the 4 most common age related visual disorders?
- macular degeneration
- diabetic retinopathy
Clouding of lens.
- usually excessive pressure in eye
- group of diseases that cause optic nerve damage
- second leading cause of blindness
- early treatment can prevent damage
Describe macular degeneration.
- Affects central part of retina
- Central vision may blur and eventually advance to a central blindspot.
Describe diabetic retinopathy
Damaged blood vessels on retina.
What is the retina?
The light sensitive tissue at back of eye.
In children, visual disorders may be related to ____.
In children, following diagnosis of sensorineural HL (and some conductive HL e.g. craniofacial), what must occur?
Referral to vision specialist
What is deafblindness?
combined hearing loss and visual impairment
Describe the range of impairment, prevalence, etiologies and key qualities of deafblindness.
- range of impairment ranges for both hearing and vision.
- estimated present in 3/100,000 newborns
- rubella, usher's syndrom and other genetic disorders, illness, trauma
- often severe communication, learning and mobility problems.
Compare and contrast vision care providers and hearing care providers.
- Vision Care Providers:
- *Opthalmologist (m.d., surgery)
- *Optometrist (O.D., Doctor of optometry, 4 year grad program, some diagnosis and treatment, prescribe some meds)
- * Optician (fills lens perscriptions)
- Hearing Care:
- * Otologist or otolaryngologist (M.D)
- *Aduiologist (AUD)
- * Hearing and dispenser
What are three types of cues to speech perception?
- Acoustic cues
- visual cues
- linguistic cues
What are three linguistic constraints?
What are lexical constraints?
Closed set of phonemes and words
What are structural constraints?
rules for stringing together words and phonemes
what are contextual constraints
Topic of conversation, speaker-listener relationship setting.
What is redundancy?
The part of the message that can be lost without significant loss of information *both auditory and visually*
What is the communication model
- Speaker ----- encoding and monitoring speech-----message
Research studies provide...
selected pieces of information regarding paterns of language performance.
HI persons are a very __________ and any individual may fit the _____.
- Heterogenous group
language is extremely ___
Normal acquisition is through_____
everyday exposure 24/7
HL prevents or reduces?
Earlier onset & more sever HL =
HL can cause both ___ and ____
language disorder and delay
HL can produce profound _____
Profound language deficit can result in profound impact on:
- Social and emotional relationships
- academic performance
Describe the 7 characteristics of vocabulary related to hl.
- related to age of onset of HL
- Related to degree of HL
- Significantly smaller vocabulary
- Gap between HL and normals widens as age increases
- Islands of deficit (certain situations kids w/ HL are not exposed to)
- Poor understanding of idioms, puns, multiple meanings and subtle differences
- Poor understanding of function words (conjunctions, prepositions, compared to semantic words (nouns))
Describe syntax as it relates to hl
- Related to degree of HL
- Use shorter sentences
- Use simpler sentences
- Poor understanding of complex sentences
- poor understanding of passive voice
- errors difficult to overcome
Describe morphology as it is related to hl
certain morphemes are in audible (especially s and z)
What percentage of deaf children are of normal hearing parents ?
_____ have better language skills than_____ due to ______.
- Deaf kids from deaf parents
- those with normal hearing parents
- consistent language exposure.
- *before cochlear implants.
Describe the speech characteristics of the HI?
- Acoustic input is critical for development of speech.
- -hearing others
- -hearing self (cannot self monitor)
Describe the babble behavior in deaf infants.
- Start to babble like normal (throws parents off)
- Difference is that babble does not progress and may regress.
Describe the speech characteristics of mile/moderate HL
- Normal voice quality
- Normal vowel articulation
- Some consonant misarticulating (final consonants and fricatives
- *Speech is pretty normal*
Describe the speech characteristics of profound HL
- Deaf speech
- poor coordination of breathing and speech
- flat intonation contour --- monotone
- high pitch voice (putting in more effort)
- hypernasal (they can hear nasals better)
- articulation errors for both vowels and consonants
- poor control of pitch and loudness
- poor differentiation of vowels
- omission of consonants
- poor rhythm of speech
The first management procedure is ? Describe the process of the first class
- Speech reading instruction:
- Be creative
- make session interesting
- group is hard to facilitate
- introduce clients to each other
- determine client occupations, interests
- explain the audiogram and typical high-freq. hearing loss
- Talk briefly about hearing aid
- discuss the communication model (don't get to academic)
- Prepare and distribute handouts
- Administer a hearing handicap scale; situational, psychosocial
- Briefly demonstrate the process of speech reading
- Give homework: over the time period until the next session, list situations in which it is especially difficult for you to hear clearly.
Describe the second class
- Class two:
- Discuss hw
- s/r pre test
- discuss pretest results
- briefly discuss visibility of speech sounds
- present most recognizable visemes
- S/R exercises -- for example, QRE (quick recognition exercise)
- Homework: watch and analyze three different news casters without sound.
Describe the 3rd class of speech reading
- discuss homework
- more visemes
- more exercises
- S/R post tests.
Describe the QRE
- Write 3 words up on board (pitch, fish, rich) that look different
- 1) Say words and they listen
- 2) Say it and point
- 3) Say them with you
- 4) you say it and they repeat it.
What is meant by environmental control?
- -A management procedure
- Manipulate environment to perceive better cues
- get in position for auditor and visual cues
- avoid noise
- avoid reverberation
- *Don't talk down to them*
- achieve proper lighting
- assert yourself (not aggressive)
Sign language is used for what type of hearing loss?
what are the 3 components of manual communication
gestures, fingerspelling, signs
what is iconic?
look like what they signify
What are the sign features?
Know the sign language interpretation symbol.
Describe american sign language
- asl or ameslan
- a non-English lanuage
- The language of the deaf community
- No written form (ie text for everyday reading)
Describe manual english
- english language in signs
- a sign for every pronoun, prefix, suffix, etc.
- english order
- many signs the same as asl
- used predominantly only in educational setting (used in schools to teach english)
Compare SEE I, SEE II, signed english
- SEE I: seeing essential english (early 1970's)
- SEE II: Signing exact english
- Signed english: developed at gallaudet university
What is LOVE
Linguistics of visual english
used to fascilitate communication between haring ad hearing impaired individuals.
registry of interpreters for the deaf
certificate of interpretation
between asl and spoken english
Certificate of transliteration?
between signed english and spoken english
What are the rules for hearing people using an interpretor
- Talk directly to HI person
- Short breaks
- Don't ask for interpretation of just part of message
- Furnish interpretor with technical vocabulary ahead of time
- Be prepared to slow speech
- only one person should talk at a time.
Describe the interpreter position.
- 1:1 conversation behind HI person
- Classroom - near instructor
- good lighting
- slide/video presentation near presenter
- Group meeting
- stage presentation.
What is the association connected with tinnitus
american tinitus association
When a client has tinnitus you should...
referral to ENT physician or an audiologist who specialized in tinnitus.
what are the common treatments for tinnitus
- Hearing aids (won't hear tinnitus)
- Tinnitus masker
- simple maskers (radio)
- Tinnitus retraining therapy
- Support group
- Diet (less caffine)
What is residual inhibition?
- goes with tinnitus masker
- absence of tinnitus for a short time after masking is removed (in HA too)
Describe tinnitus retraining therapy?
- long term
- good and bad reports
relaxation tech using electrodes
Amplification is the _______.
Best treatment for hearing loss
What are the amplification and other electronc devices
- Hearing aids
- auditory trainers
- assistive listening devices
- cochlear implants
- tactile aids
What is the goal of amplification?
intensify speech sounds that are inaudible.
Who is responsible for ensuring safety and effectiveness of hearing aids?
The food and drug administration
what are the 4 basic components of a hearing aid?
- 1) Microphone(changes sound to electricity)
- 2) Amplifier (increases magnitude of electrical signal)
- 3) receiver (changes electrical signal back to sound)
- 4) Power supply ( battery or plugged in)
What is the order of using a hearing aid.
1) Sound---->2 Microphone------> 3) Amplifier --->4) Receiver ----> 5) ear mold ----> 6) ear
List devices that have essentially the same components for any audio amplification
- Cell phone
- amplification system in church or lecture hall
- home stereo system
- classroom amplification
- mega phone
What are the three electroacoustic characteristics f hearing aids?
- Gain (volume)
- Frequency Response
- OSPL (output sound pressure level)
- The amount o amplification by the HA (input sound and gain = output sound)
- gain= use gain and reserve gain (amount you use and amount available)
Describe frequency response
- relative gain across frequencies
- tailored to compensate for the HL
- typically, increase high-frequency, sound and reduce low frequency sound.
- Programmable on a HA
- Treble and bass controls on a radio or other music playing device.
Study the graph
The maximum output of the HA in dB SPL
Reduced visability and acoustic advantages have produced a resurgence in BTE popularity
What is the most common hearing aid now?
What is meant by reduced visability?
- small size of HA
- clear smooth triming
- absence of ear mold in many cases.
Describe the BTE characteristics?
- most commonly fit
- typically best acoustic benefit
- engneered to reduce feedback
- multiple channels:program multiple settings
- ear level is better for localization and head shadow effects
- suitable for directional feature
- sufficient power.
Describe the characteristics of the Body aid?
- rarely fit (young children still use)
- aesthetic (not attractive)
- body baffle
- clothing noise
- poor localization cues
- commonly worn in harness (front or back)
when was the body aid most popular
Describe the characteristics of the ITE
- commonly fit
- good benefit for some
- custom fit to patient
- not available for comparison (cant try on before buying)
- difficult to modify shell if poor or sore fit- may need to remake
- more feedback
- earwax issues
- battery controls smaller and harder to handle
- safely (breakage in ear--children)
- less adaptable to remote mic and other features.
How old is the ITE?
40 years old
similar advantages and disadvantages re: the ITE, sometimes more pronounced.
Describe the CIC
- Similar to ITE
- Stem or string to remove
- resonance advantage of concha
- close to eardrum, requires less power
- aesthetically preferred
Describe the Deep and Fit
- Worn up to 4 months w/o removing
- must be professionally placed
- battery lasts 4 months
- soft seal- breathable, water resistant
- consumer can remove if necessary (so, not considered implantable) hook loops to remove
- consumer buys a years worth of the service (receives new units as needed within that year.)
There is not compelling evidence for use of the ______ over a standard HA
implantable ha for s/n hl
Implantable HA for S/N HL uses a ___. Costs ____ and DR. Primus does not know why__
- Transducer (changing energy to electricity) lightly touches ossicles
- why people get them.
Describe Eyeglass HA (historic)
- Rarely fit, mostly historical
- more expensive
- fit problems for the glasses
- problems with bifocals, trifocals (problems)
- Limited selection
- replacement dilema (HA and Glasses)
- Repair (lose both vision and hearing)
- Advantage for CROS
What is CROS?
one ear is not working so you could put wire through frames.
Describe bone conduction HA
- metal head band
- elastic head band - more for kids who will probably get BAHA after 5 yrs
- Usually good outcome
- Primary uses
- Bone anchored HA
- Very stable signal into skull
- no headband or other accessory
- 1. bilateral conductiveHL (permanent or long term Ex: bilateral atresia
- 2. Persons with one aidable ear.
When did hearing screening start?
What is the first screening and how many will pass the second screening after failing the first?
How many of wyoming infants with HL are diagnosed with HL under the age of 3 months
___ have hearing loss @ birht in wyoming.
Are hearing and understading the same?
How loud can you listen to an ipod and for how long, without damage?
60% volume for 2 hours
Some BTEs are receiver _________ units
in the canal
What are the identifying components of hearing aids?
- Make (name)
- Model (combination of letters and numbers)
- Serial number (different for left and right)
- Year of manufacturer.
- Microphone port (opening to microphone
- Battery Compartment (usually on end)
- Elbow (ear hook)
What are the controls on older hearing aids?
- gain (volume) wheel (not linear- not even in between levels)
- OTM (on back side. Off, telephone, microphone)
- H or HF switch (high frequency- good in noisy situation)
- Additional controls
What are the controls on newer HA?
- Controls may or may not be present
- *programming determines if they will be active or automatic
- *many users prefer totally automatic function.
What are the 11 HA features?
- Volume control
- Directional microphone
- Environmental noise reduction
- Impulse noise reduction
- Wind noise reduction
- Feedback reduction
- Digital technology
Describe Volume Control.
- One manual-control option
- *Touch control (like an iphone)
- *Touch to change program
- *Sweep to change program
- Receives signals from telephone--electromagnetic.
Recieves external signals from telephone, ipod, tv--RADIO WAVES
Listening programs that are designed for specific listening environments
People tend to use how many listening programs?
Describe directional microphones vs omnidirectional
- omnidirectional = equally sensitive to 360 degrees
- Improves SNR in typical communication situations
- Most newer HA have microphones that switch automatically into directional mode under certain conditions.
Describe how directional microphones came about and the idea of rear view mirror directionality
Designed for new york city taxi drivers - sensitivity to rear not front
Are directional microphones typically appropriate for young children? Why?
- Children often don't look at person they are talking to
- Incidental listening
- saftey (hearing everything around.
Describe Environmental noise reduction
HA attempts to automatically sense the presence of non-speech sounds (background noise) and attempts to filter-out the noise
Describe Impulse noise reduction
HA automatically senses the presence of very brief, impact sounds and attempts to suppress them
Describe WInd noise reduction
HA automatically senses wind turbulence across the mic and suppresses the noise produced
Describe Feedback reduction
- HA automatically senses feedback occuring and electronically suppresses it (improved in last several years)
- Allows open ear canal in many cases because of improvements
What is WDRC
- Wide Dynamic Range Compression
- Relates to OSPL output SPL = maximum level hearing aid can amplify.
Loud sounds are just as loud for ______ as for _____
- sensorineural HL as for normals (Recruitment)
- = Reduced dynamic range
A WDRC would squeeze 0-80 dB sounds into what range
WDRC allows soft sounds to be processed with______
Medium sounds are processed with ________
Loud sounds receive ________
- little or no compression
- moderate compression
- substantial compression
Describe Digital technology
- Most new HA are digital
- Greater Resolution (clearer) and control of digital (vs. Analog) signals.
What is the average cost of a newer pair of HAs?
MOst people wear ______ HA
HA technology developed at the same time as ____
The development and reduction in size of HA is in part dependent on ______
development of batteries
How many volts do HA batteries usually produce?
Describe battery sizes
- 675 (bigger
- 13 (thicker with smaller diameter
- 312 (flatter and most common)
What element is most commonly found in batteries?
- Zinc Air
- -Remove sticker to activate
- - Shelf life up to 3 years if battery remains sealed
Do we use rechargable batteries for HA?
Some rechargable available, but problems with initial cost and replacement
How much does a HA battery cost?
What is the battery life of HA?
- Varies with HA type and user
- ~ 10 days
What is meant by shelf life? what is recommended
How long they last on the shelf. Purchase fresh batteries.
How can batteries be inserted?
What organization deals with battery ingestion and who is likely to ingest batteries
- National button battery Ingestion Hotline
- (202) 625 -3333
- 8-16 months most common
- competent adults
What is a battery caddy?
Carry extra batteries with you
What is the discharge pattern of HA?
Flat- stay at stable level but quit all at once
Many people use ____ to check the level of volts the battery is producing
What volts do hearing aids put out
Size determines _____ not ______.
How long it lasts not VOLTAGE
At what voltage should you throw your hearing aid away.
Who should wear hearing aids
A person who needs them, benefits from them, wants them
Need of HA increases with what?
Benefit is greatest for who?
- degree of HL
- Persons with moderate to severe hearing loss.
What are the two ways to evaluate hearing aids, and describe first?
- Real ear measurements
- - measure HA output with mic in ear canal, match output to HL (audiogram).
- -during clinical evaluation, 30 day trial *can return it if you dont like it*
Earmolds can be ___ or ____
custom or general
when you have more severe feedback you should have what size ear mold?
The earmold helps to
Hold the hearing aid in place.
Many hearing aids are ____ but others are connected to ____/
- Open fit with no ear mold
- to a earmold
How do you make a hearing aid?
- Audiologist makes an impression of the ear
- -cotton damn past second turn in canal
- -use syringe to push putty into ear
- -wait 10 minutes
Who produces the final product and how much does it cost
What are the functions of an earmold?
- to hold the HA securely on the ear
- to modify acoustics
- =higher frequencies= more open
- Also made for custom earplugs to protect ears from (water, noise)
What are the 5 parts of a hearing aid? Label on work sheet.
- Sound bore :inside of canal portion
- Snap ring:receives button receiver (body HA)
- Helix: Slips in helix flap of concha, last in holds mold, causes most soreness and can be cut off.
- Concha rim: fits in concha
What are the two materials used for earmolds? Who usually gets which
- Hard lucite: hard, clear, smooth plastic. Easy to clean--ADULTS
- Soft: rubbery, sillacone, snug fit ---KIDS
Modifications on earmolds can be performed to...
enhance high frequencies and reduce low frequencies
earmolds supplement ____
electronic modification of the HA
- allow low frequency sound to escape
- allows natural sounds to enter
- allows ventilation
What is the overall effect of venting and one potential problem
- Improved speech understanding
- natural sound quality
- decreased loudness
- PROBLEM= FEEDBACK
When fitting an earmold, what are you concerned with
- Feedback (snug fit = less feedback)
- Securing the HA on the ear (disfigured pinna, huggie aid, toupee tape (double sided tape.))
What is one way to prevent loss of the earmold and HA on kids?
What are the two ways of doing earmold impression?
- Impression material that sets up in ~10 min
- New way of digital imaging
Where does earmold tubing attach to HA.
tubing glues to earmold and attaches to the elbow on the HA
Earmold tubing can get old which may allow what? Also it is______
- feedback or HA not being secure
- easy inexpensive to replace.
How do you clean an earmold?
- Remove HA
- Warm soapy water (do not use alcohol or cleaning fluid)
- Clear all water from tubing (squeeze bulb)
you should NEVER expose hearing aids to ___-
How do you manage feedback?
- Consult audiologist
- Snug earmold fit
- eliminate or reduce vent size
- soft earmold material (clings to ear)
- Seperate microphone from sound output (body HA)
- Do not reduce gain except as a temporary solution
What would you like to do?
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