-
What do you do in a hearing aid orientation?
- Counseling session that we do after HA fitting.
- Encourage family members to attend
- Provide written information.
-
What are the 6 parts of a hearing aid orientation?
- 1. Components
- 2. Check fit
- 3. Telephone use
- 4. Inserting the earmold or tie (canal in first, then concha rim, then helox
- 5. Basic care and maintenance
- 6. Return visit during 30 day trial period
-
What are the 6 things you check during the return visit?
- 1. too loud?
- 2. whistling (feedback)?
- 3. comfortable?
- 4. is the HA helpful?
- 5. Problem inserting?
- 6. Any other problems
-
What is APHAB?
Abbreviated proflie of hearing aid benefit.
-
Describe more basic care and maintenance?
- 1. Damage is water or mosture (even persperation)
- 2. Problem is excessive heat (no hairdryer or sound)
- 3. Dust (not usually a problem)
- 4. Don't take it apart
- 5. Don't drop it
- 6. Extreme cold will not dame it but may cause temporary quit
- 7. Battery may leak or have corosion
- 8. Carry batteries with you
- 9. Don't eat a battery
- 10. Don't spray hairspray or insecticide
- 11. don't expose to xrays or radiation
- 12. Don't clean with alcohol or cleaning solution
- 13. Don't turn volume down to save battery
- 14. Don't keep batteries near metal
- 15. Don't put batteries in fire (they explode)
- 16. Take of every night.
-
A t-coil on a HA recieves _____ energy from a telephone
electromagnetic
-
Describe phones in terms of the t-coil
- older phones naturally leaked electromagnetic energy
- new phones are designed to produce an electromagnetic signal = hearing aid compatable
- But digital cell phones often produce electromagnetic noise.
- HI consumers should try before buying a cell phone.
-
HAC
Hearing Aid Compatable
-
What are the T-coil advantages? What is on and off?
- 1. Reduces background noise
- 2. Eliminates feedback
-
In trouble shooting HAs, describe feedback
- Don't turn volume down
- Check ear mold fitting
- Tubing is old or cracked
- Impacted wax
- Internal feedback (squealing inside case)-send to factory.
-
When trouble shooting HAs, describe no sound.
- Check battery first
- cord on body aid is broken
- could be progressive HL
-
When trouble shooting HAs, describe intermittent sound.
- dirty volume wheel
- cord on body aid broken
- internal problem that is factory problem
- weak sound
-
When trouble shooting HAs, describe distorted sound.
likely internal in causing
-
You may also do trouble shooting for?
Broken HA case and internal noise
-
How often should you monitor children's hearing aid?
Daily
-
How much does a hearing aid stethoset cost?
30
-
What are the main parts of personal classroom amplificaion devices/trainers.
- Same basic components as a HA (Microphone-amplifier, receiver, power source.
- Key component is a remote microphone
- Remote microphone provides non- transmission of speech from the speaker to the hearing impaired listener
- Teacher wears remote mic and non acoustic transmission
-
What are the 3 environmental problems that the remote mic overcomes.
- 1. Distance (reduces to 3 inches and provides consistent signal level)
- 2. Noise: improves signal to noise ratio
- 3. Reverberation: virtually eliminates it.
-
What are the auditory trainer types?
- Hardwire
- Induction
- FM
- Infrared
-
Describe hardwire
Wire from mic to child. True wire connects it, Inexpensive, no interference. 40 years ago more common, used now in theaters or churches.
-
Describe Induction loop
electromagnetic energy, wire loop around room. Microphone changes to electromagnetic signal. signal is different around room (non-uniform distribution of signal) Can get spill over through walls- noisy not as clear
-
Describe FM
Non-acoustic transmission = radio waves
-
Typically the FM system was___ but now they are ____.
body type but now they are ear level
-
Describe the advantages?
- Complete mobility, good range
- No spill over if working right
- High quality (fidelity) signal.
-
Describe the advantages and disadvantages of FM
- Mor advantages or as many as other systems but less disadvantages
- No significant disadvantages.
-
What is the disadvantage for all systems?
hearing oneself or hearing others around.
-
Describe infrared
- Non-acoustic transmission: light waves
- Newer but not better
-
Describe the advantages of infrared.
- High quality signal
- no spill over
- complete mobility in classroom but not outside(light admitters in walls and ceiling)
-
Describe the disadvantages of infrared.
- Non even (uniform)distribution
- can pick up environment noise (windows)
-
Describe the ideal auditory trainer system?
- remote mic and casing mic
- mic comfortably worn
- amp/receiver unit can be fit individually to student
- electronically flexible
- the binaural (seperate circuit for two ears)
- uniform signal throughout room
- high fidelity
- complete mobility
- durable
- no spillover
- cost effective
- simple to use and care for
- trouble lights
- adaptable to use outside classroom
-
Describe the free field classroom amplification
- teacher wears microphone but signal goes to loud speakers not personal receiver
- Does not overcome distance, noise, and reverberation like personal ATs but does reduce distance, and improves SNR.
- Especially useful when student HLL is slight/ mild
- Student may wear ha in addition
- appears to benefit normal hearing students also
- teachers like them (students attend better and saves teacher voice.)
-
Describe classroom acoustics and noise?
- 1. Classrooms are notoriously noisy
- 2. Noise disproportionately reduces the skills of HI individuals
- *external noise (traffic on busy street)
- * Internal noise (ventilator in school) -greatest noise source and some teachers turn it off during teaching.
-
Describe classroom acoustics and reverberation?
- 1. Classrooms are reverberant
- 2. Reverberation disproportionately reduces the skills of HI individuals.
-
What is the Reverberation Time?
The time it takes for sound level to decrease by 60 dB
-
What are the 3 ways the issues of classroom acoustics is being addressed.
- 1. legislation- laws concerning construction of school buildings
- 2. Standards = asha and other professional organization developing standards for the classroom listening environment.
- 3. Building codes.
-
What are the assistive listening devices (ALDS)
- Telephone amplifiers
- Pocket talker
- Personal amplifiers
- Specialty Amplifiers
- Personal amplifyin systems for rooms
-
Describe telephone amplifiers. what is the symbol.
- Built into telephones (cellphones& others)
- Land-line phones without amplifiers (pocket size unit fits on handset receiver $25)
- In line amplifier ~50
- Commonly 30 dB gain
Symbol = telephone with volume control
-
Describe the Pocket talker?
- similar to HA
- Microphone, receiver, amplifier
- 150
- Useful in Dr. Office to help patient hear dr.
-
Describe the Personal amplifiers
- Could be used to watch tv
- radio frequency or infrared unit
- ~170-350
-
Describe the specialty amplifiers
Amplifier in stethoscope for nurse/md
-
Describe personal amplifying systems for rooms (w/ remote mic near speaker)
Theater, church, lecture hall, concert hall, courtroom, training areas (operating room in med school)
Distance, Noise, Reverberation
-
Know the assistive listening system symbol.
-
Describe Direct audio imput
- A HA feature to provide a remote mic - hardwire or FM (boot)
- Recommended for children's HA
-
Describe Alerting devices
- For severe HI Persons
- To signal presence of doorbell, telephone, smoke detector, wake up alarm, waking child, police siren, automobile directional signals.
- Signaling stimuli: flashing lamp, strobe light, tactile stiuli (wrist band bed shaker-fan) louder sound (or modify to frequency they can hear).
-
Describe Speech Recognition devices
- Can be very expensive
- EX: icommunicator
- Converts speech to text or to video sign language
- Converts text to computer generated voice
- requires speaker training and personal microphone (for consistency)
- Used in the classroom
- ~6500.00
-
What is a chochlear implant?
- Replaces cochlea and is as small as a penny
- An electronic device to replace to organ of hearing (needs battery)
-
How much does a cochlear implant cost?
50000
-
Cochlear implants are ______.
Children who are fit with CI ______ .
Adults who develop hearing loss
- highly successful (but not with everyone)
- early in life and who receive proper management often develop age appropriate speech and language
- after language acquisition display improved speech understanding
-
Who are the best canidates for CI?
Kids.
-
Describe why cochlear implands are unique and different then a hearing aid or other amplification device
- Bipases organ (cochlea that doesn't work.
- Hearing aid: amplifies filters and otherwise manipulates sound and sends it through to damaged organ.
- Cochlear Implant: Bypasses damaged organ and sends the signal directly to the 8th nerve
- The cI is a tiny computer and used to be pocket but are now ear level.
-
What are the outside components of the cochlear implant?
- Microphone
- Processor (computer)
- Transmitter (side of head)
-
What are the Implanted components of the cochlear implant?
- Receiver and electrode wire
- *these are simple and not usually replaced
-
Describe how the wire is placed?
- goes through the round window
- wind the electrodes in cochlea to get all frequencies ~ 1 full turn out of the 2.5 in cochlea
- Cortex is layed out like cochlea of one side has high frequency and one has low frequency.
-
Describe the Candidates for a CI- do they apply what are the primary and secondary qualifications.
- The candidates must qualify for CI (insurance pays for cochlear implants).
- Primary qualifications: 1- severe or profound hearing loss in both ears (permanent, cochlear, some auditory neuropathy patients) 2-Little or no benefit from a hearing aid.
- Other qualifications: 1- x-rays;mri 2-physical exam 3- psychological exam (family as well) 4- interview (commitment and appropriate expectations
-
Describe the degree of benefit from a cochlear implant and how long has it been in use?
- It is not predictable.
- It has been on the increase but not predictable.
- In use ~30 years.
-
Initially CI were only for _____ but now _____
- adults
- children at age 12 months (and younger)
-
Why is CI especially important for young children?
Because they aid in learning language.
-
WHen is most language learned?
first 3-5 years of life
-
Language is critical for
reading, academic performance, social emotioanl adjustment and career.
-
CI have not been well accepted wher>
In the Deaf community but things are changing
-
Describe the UW Thesis (1992)
- Survey of the Deaf community members in colorado.
- -47% of respondents indicated no desire to hear or hear better.
- -Although most felt that a cochlear implant should be an option for Deaf people, 82% said that they would not get or probably would not consider a CI
-
When we started the treatment of children with cochlear implant ________
has sparked particularly fierce controversies.
-
What is the view in favor of cochlear implants?
- typically the view of parents with normal hearing ~ 90% of deaf children are born to hearing parents.
- Children should be given every opportunity to succeed in the world
- Children should receive a CI at as young an age as possible for maximal language learning.
-
What is the view opposed to the cochlear implant?
- typically from some members of deaf community
- Deafness is not a disability. it does not need to be fixed. Deaf people are different, not impaired or inferior relative to hearing people.
- Children fit at an early age have no choice in deciding if they want to be deaf or hearing
-
If deaf children become hearing children through the cochlear implant, ..
deaf culture and the deaf community may eventually disappear.
-
What is the range of success of CI?
wide range of success: sound awateness only to relatively good speech understanding.
-
In the case of older children and adults what are the CI results?
best for individuals with previously good speech and language skills.
-
how many adults and children have been fit with a CI world wide?
120,000
-
how many people have a CI in both ears?
5,000 and increasing in most recent years.
-
Who regulates CI and who performs surgery?
- FDA
- Performed by otologist (ear or ear-nose-throat physician) with special training.
-
Who are the team members on the CI case?
- otologist
- other medical personnel (nurse etc)
- psychologist
- counselors
- audiologist
- Speech language pathologist
-
Team activities for CI team
- determine candidacy
- pre-surgical counseling
- surgery (1 night stay)
- Fit the processor (4-6 weeks after surgery)
- Ongoing processor adjustments
- long term rehabilitation program
-
Describe mapping
resetting electrical signals of the CI to produce stimulation at soft to comfortable loud levels
-
what is the cost of a CI and who pays?
- ~50,000
- Private insurance pays for most CIs.
- Also medicare, medicaid, VA, Vocational rehab services.
-
What are the risks associated with having a CI (child)
- General risks associated with surgery and anesthesia (infection)
- Slightly higher risk of meningitis
- Risk that cochlea will not be available for more advanced treatments in the future years (one or both ear)
- risk that the CI will not be effective and may delay other habilitation strategies
- Defective CI and more surgery
- related expenses.
-
What are the risks associated with NOT having a CI?
Child will not achieve his/her potential with regard to language, speech, communication, reading, academic performance, social-emotional adjustment, and career.
-
Describe the Telephone use with CI
- Telecoils are also available in the CI
- Avoids background noise
-
What is an Auditory Brainstem Implant and when is it used?
- Electronic device to replace cochlea and 8th nerve
- Used when can't use cochlea or 8th nerve
- Electrode pad inserted adjacent to the cochlear nucleus
-
How many ABI have been fit and in the US what are they approved for.
- 500
- Neurofibromatosis Type II (bilateral tumors)
- Usually placed during removal of NF2 tumors
-
What is the success of ABI? What is important?
- WIde range of success- some success equivalent to that of CI, others detect sound but cannot recognize words.
- Importance of "auditory contact" with the world.
-
What is the vestibular Implant?
-old?
-design?
-for who?
- Brand new and currently in experimental stage (one human fit as of march 2012)
- desgn and some of instrument are based on CI
- Three tiny gyroscopes in external processor
- Each of the three lines stimulates one semicircular canal
- designed especially for meniers's patients
-
Describe Tactile Aids?
- provides tactile sensation to sound (feel sound)
- tactile = vibratory or electrical (tickle on skin)
- cost $1000
- trial period
- no risk
- effectiveness: Awareness of sound only
-
What is a Telephone/communication device?
- tty or tdd
- typed message is coded into electronic pulses, sent through telephone lines, and decoded and displayed for the person receiving the message.
-
Who uses a telephone/communication device?
- used by deaf persons to communicate by phone (now texting is possible)
- Both parties need to have ttyp or use relay system
-
Know the symbol for the TTY
-
What are the features of a Telephone or communication device?
- portable
- cell phone connector
- memory
- pocket sized also available
- full size keyboard
- 80 character display
- printer
-
Previously the tty was the only method for deaf individuals to have distance communication but now....
- a revolution in communication alternatives
- relay service
- telephone text message
- web cam
- email
- telephone captioning
- video relay
-
Describe the relay system and what it is called in wyoming?
- Wyoming Relay System
- Communication between a HI person (using a TTY) & a hearing person (no tty) through a relay operator
- HI person can
- A) receive text and
- B) send text or use VCO
-
What is VCO?
- Voice Carry Over
- Means HI persons speech is intelligible.
-
Skype is/
A video relay system for computer or handheld device.
-
Describe telephone captioning service
- CapTel (captioned telephone)
- HI person has telephone with text capability
- go through relay person
- Call HI person & captel the captel person types to the HI person and speaks to the normal hearing person.
- The text display of telephone conversation on a special telephone
- Real-time captioning via captioning secive.
-
Describe the Captel audio conversation and captions
- Less time delay and more personal than relay
- special telephone with display ~495 (may be available free through wyo relay program) now available on the iphon
- Captioning service, like relay service is not charged to individual user
- English or spanish Captions.
-
Describe the Web CapTel
Text display of telephone conversation on a computer screen
-
What was the first area and in what year did they accept text messaging to their 911 call center?
2009- Waterloo, IA
-
what is closed captioning?
the process by which the audio protion of TV programs is translated with a decoder into captions.
-
Compare closed and open captioning
- Closed means that decoder is required (not there unless you select captioning)
- Open means that caption always visable
-
What is the history of closed captioning
- authorized by federal communication (FCC) in 1976
- 16 hrs/week available in 1980
- Beginning in Jan 2006 all new english programs must be captioned.
- Some expections (commercials)
-
Describe the national captioning institute
- Around for 30 years
- real time captioning
- did all captioning and is still involved
- Live events, news/sports
- Most comedy and drama tv programs are prepared ahead of time not captioned real time
-
What is real time captioning?
Accurate simultaneous with speaker
-
What it certified real time reporter
- person typing captioning
- Special keyboard, special training
- well paid
-
What are the applications that have captioning
- regular tv programming
- commercials
- movies on DVD
- how to videos
- college courses
- *expensive to caption but sponsers pay for it.
-
Who uses closed captioning and what does it require
- used by deaf and other hearing impaired individuals and requires at least english literacy (but also being used to learn english and assist in learning reading)
- May not be useful if only know asl
-
What law requires all tvs that are _____ screen or larger to contain a decoder chip
- Federal law 1990
- 13 inches
-
Captioning is _____ when the program is recorded.
retianed
-
Web only companies are subject to ______ and what is the example with netflix
American Disabilities Act (ADA) and netflix has agreed to close caption all streaming by 2014
-
What does a Hearing Dog do?
- Alerts HI person to important sounds
- Has privliges under ADA law
-
Describe the History of the education of the HI
- 400 years ago no education for HI
- Classified as mentally ill persons
- Got rid of and kept at home so not involved - no rights
- 400 years ago in Europe (wealthy) started hiring people to come in and teach their HI children (sign language, fingerspelling, other means created)
-
Describe the history of the education of the HI in the 17-18 th century
- 3 schools for Deaf (presidential)
- England - Braidwood
- Germany - Heincke
- Paris, France -eppe
- North america being sttled at this time
- Thomas Gallaudet sent over to europe to learn HI teach strategy
- England oral, france manuel, brought back manuel strategy
-
More history
- New england teach manuel from gallaudet
- sign was prominent way of teaching HI
- Some education available for deaf kids starting 200 years ago if lived in right place
- one in every state
- choose normal school or school for the deaf.
-
Describe the education for all handicapped children act 1975
- helped mild to moderate kids get in appropriate spot (didnt qualify for deaf school, had hard time in normal school)
- Least restrictive environment
- IEPs
-
Describe the individuals with disabilities education act (IDEA)
- 1986
- Included younger kids from birth
- SLP auds start seeing a lot of younger clients
- must use childs normal mode of communication in regular communication and in evaluations
- School is responsivle for proper function of hearing aids worn in school
- to the maximum extent appropriate children with disabilities should be educated with children without disabilities.
-
What is the opportunities for education after highschool
- 90% never went beyond high school
- 1850 Gallaudet University (WASH DC)
-
NTID
- National Technical Institute for the Deaf
- (alternative) Rochester NY
-
What is education now...
There are other colleges and universitities and are accesible now and have class amp and interpreters.
-
What are the educational placements for HI children?
- Alternatives and issues
- Many placement alternatives
- oral vs manual methods of education
-
Compare oral vs manual
last 30 years
- Oral: Preparing child to live in the hearing world with the English language and the children focused to learn and communicate through disordered system
- Manual: Easy language learning and communication that is not english and may result in reading and writing deficiencies in english. May have limited function in the hearing world
- Last 30 years: goes back and forth but manual has upper hand.
-
Describe the act that deals with confidentiality in the schools.
- Family educational rights and privacy act 1976
- Data transport
- data storage
- data destruction
- client access to information
- client right to challenge information
-
What must you document in the schools.
- Screening and diagnostic test results for each student
- Management program activities (AR, HA, use, etc.)
- Evidence for program modification
- Activities as evidence in disputes regarding services
-
Proper follow up care is ________
ESSENTIAL (anything after initial screening)
-
Even though hearing screening is typically accomplished in the schools,
follow up is often not accomplished
-
Follow up is the stage at which a program of hearing care often breaks down. what do we need to do>
- diagnostic testing following screening failure
- audiometric re-evaluation/ monitoring follwing medical referral to ensure that the HL is resolved
- appropriate classroom management (eg teacher notification, preferential seating, student support services, amplification for chronic HL
- some children with otitis media may experience HL for weeks or months
- Hearing aid evaluation
- ongoing hearing aid function and care
-
some babies are born listeners...
others need our help
-
Universal newborn hearing screening has significant implications for _______ of HI cildren.
habilitation
-
what is the plan for universal newborn hearing screening and how many are screened in wy
- 1-3-6
- 1 month of age screening
- 3 Diagnosed by 3 months
- 6 intervention by 6 months
- 98%
-
Describe diagnostic audiometry fro infants
- Diagnositc testing is completed as soon as possible, no later than at 3 months of age
- If child has hearing loss, management is initiated immediately
-
Nationally follow up is ....
Wyoming follow up is ...
-
What is the first step in the management program for HI infants
Immediate consideration for HAs (funding?)
-
What is the 2nd step in the management program for HI infants
- Early intervention program
- Research suggest that if HI infants are in intervention by 6 months of age, language will develop at a pace consistent with cognitive abilities, for most HI children this means a normal rate of language development.
-
What is the 3rd step in the management program for HI infants
- Parent education and counseling
- HA and other amplification
- Acceptance of HAs (both parent and adult)
- Care and maintenance of HAs.
- Device for monitoring daily provided to parent
- Parent support contacts
- Funding options
-
What is the 4th step in the management program for HI infants
- Referrrals
- Additional referrals in conjunction with referring physician (vision, ENT, possible genetic counseling, audiologic evaluation of siblings if genetic casue suspected)
-
What is the 5th step in the management program for HI infants
ongoing audiologic and hearing aid evaluation as needed.
-
What is the 1st component of the hospital program for HI patients?
- Identification of HI patients
- At admitting or sticker on file
-
What is the 2nd component of the hospital program for HI patients?
- Amplification and assistive devices
- portable amplifier (pockettalker)
- telephone amplifier
- TTY
- Sign language interpreter
- TV captioning
- Nurses have knowledge regarding services and devices.
-
What is the 3rd component of the hospital program for HI patients?
- Education
- In-service training of nurses and other hospital personel
- Information for patients (brochures, posters,direct counseling)
- Public service announcements or advertisements include notification that the hospital provides services for HI patient
-
What is the 4th component of the hospital program for HI patients?
- support group
- volunteers sharing inforamtion with patients and their families
-
what are 4 methods used to assist persons with HL in receiving sound track media.
- live interpreter
- super imposed interpreter
- captions
- scripts
-
What is iCanConnect?
- Wyoming
- new in 2013
- Founded by FCC
- Provides communication technology to low income persons with combined hearing and vision loss to allow them to make a phone call, send an email,and access the internet
- must qualify by impairment and financially.
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