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SPPA 5520 Exam 2
SPPA 5520 - Hearing Disorders Exam 2
| Question | Answer |
|---|---|
| Hearing Disability - Age of Onset | Most disabling hearing impairments are clumped into early childhood + elderly, age at which Hearing Impairment occurs will determine disabling affect of that Hearing Loss; Pre-lingual, Post-Lingual |
| Development of the Auditory System | In utero development; embryology + fetal studies; embryo (Greek for "to swell"; first 8 wks of gestation); Fetal (Latin for "offspring"; after 1st 8 weeks) |
| Origin of the Structures | Where do the structures come from? Germ layers in embryo (ectoderm, mesoderm, endoderm) |
| Germ Layers in Embryo | Ectoderm (outer skin layers, nervous system, sense organs); Mesoderm (skeletal, circulatory systems, kidneys + reproductive organs), Endoderm (digestive canal + respiratory organs) |
| Ectoderm (Germ layer in Embryo) | Outer skin layers, nervous system, sense organs |
| Mesoderm (Germ layer in Embryo) | Skeletal, circulatory systems, kidneys + reproductive organs |
| Endoderm (Germ layer in Embryo) | Digestive canal and respiratory organs |
| Primitive Gill Slits | In embryo, five Branchial Grooves or Primitive Gill Slits or pharyngeal grooves; between grooves are arches; inside grooves are pouches; arches-->mesoderm; grooves-->ectoderm; pouches-->endoderm |
| Primitive Gill Slits (continued) | Fish-ectodermal grooves meets endodermal pouch to form passageway from pharynx to outside of head; Man- 1 ectodermal groove meets an endodermal pouch to form passageway from pharynx to outside of head; Groove=EAM; pouch=middle ear + Eustachian Tube |
| Origins of the Structures of the Ear | Develop from the facing areas of teh 1st and 2nd Branchial Arches |
| External Ear, EAM, Outer Layers of TM (tympanic membrane) | Ectoderm: 1st Branchial Groove; Anterior/Superior portion: 1st Branchial Arch; Posterior/Inferior Portion: 2nd Branchial Arch |
| Ossicles | Malleus and Incus--> from mesoderm: 1st Branchial Arch; Stapes--> from mesoderm: 2nd Branchial Arch |
| Middle Ear | Middle Ear Cavity and Inner Layer of TM--> from endoderm; Eustacian Tube--> from endoderm |
| Inner Ear | Membranous Labyrinth--> from ectoderm; Bony Labyrinth --> from mesoderm |
| Diagnostic Significance | Knowledge of the development of the ear re: timing of development + origin of structures can be diagnostically significant. |
| Timing of Development | A noxious influence on the fetus during development may result in a malformation of the structures forming at that time |
| Gestational Period | 280 days or 9 months or 40 weeks; three trimesters |
| First Trimester | Early: brain + organs begin to form, heart starts to beat, fingers + toes start to take shape; Late: sex organs begin to develop, muscles contract, bones begin to harden, + baby begins to breath amniotic fluid |
| Second Trimester | Maturation of organs developed during the first trimester |
| Third Trimester | Period of rapid growth |
| Timing of Development | Knowing timing of a noxious influence on fetus could lead you to speculate malformation of structures forming at that time; Maternal Rubella during 1st trimester; 50% chance of SNHL; defective tooth enamel can be traced to neurological/hearing disorder |
| Origin of Structures | Knowing origin of structures can be diagnostically significant; e.g. anomaly of external ear, suspect anomalities of malleus/incus since both come from region of 1st BA + groove, Treacher-Collins; mandibular + malleus/incus abnormalities (1st BA) |
| Origin of Structures continued | Skin disorders present at birth, SNHL may be present since both inner ear + epithelium come from same germ layer (ectoderm); fused malleus + incus, develop from same area, no fetal development during development |
| Development of Auditory Function | Major responsibility of auditory organ is equilibrium; unchanged in phylogenetic evolution b/w man + fish; hearing important only to high life forms |
| Development of Auditory Function (Continued) | Physiologically cochlea has normal adult functioning by 20th wk of gestation (2nd trimester); fetal hearing after 20th wk gestation, by 26th wk, adult functioning for frequency decoding, 26th to 30th wk, capable of intensity coding |
| Significance of Development of Auditory Function Research | Before birth, ear can accept + process auditory information; new born child has been listening to fluid borne sound for four months; found that sound level in womb is 72 dB |
| Fetal Hearing | Fetal hearing exp. may influence some areas of speech perception; acoustic info 1000 Hz+ not available - needed for phoneme differentiation- suprasegmental info likely available to fetus + may become encoded as speech info into child's long-term memory |
| Fetal Hearing Continued | Been previously reported newborns can discriminate native language from other languages + mother's voice from other voices + familiar nursery rhymes from novel rhymes; supports supposition that newborns encode suprasegmental parts of speech |
| Prenatal Noise Exposure | American Academy of Pediatrics recommendation: exposure to excessive noise during pregnancy may result in high-frequency Hearing Loss in newborns + may be associated w/ prematurity + intrauterine growth retardation. |
| Prenatal Noise Exposure Continued | Pregnant women should avoid prolonged exposure >65 dB(A) |
| Significance | At birth, new born ready to receive info to help w/ complex process of development; auditory system has adult functioning 182 days before visual system |
| CANS (central auditory nervous system) | maturation of CANS continues until puberty; most rapid development occurs during 1st 12 months of life |
| CANS continued | Optimal period for CANS development is during 1st 3.5 yrs of life (most sensitive period); variability in data between ages of 3.5-7yrs; sensitive period ends at 7 yrs; auditory processing become difficult after sensitive period |
| CANS continued | During this period, CANS in dynamic state, needs continued auditory stimulation to mature normally; maturation + maintenence of CANS depend on "normal" activation of pathways during period; during this period, CANS vulnerable to environmental influences |
| CANS continued | some babies that fail newborn hearing screening develop normal hearing w/in 12 months; delayed development of CANS??? |
| Pre-Lingual Hearing Loss | Hearing loss that occurs before acquisition of speech and language; i.e. adults values of maturation; hearing loss that occurs before age of 3-6 yrs old |
| Pre-Lingual Hearing Loss: Problems | Most handicapping hearing losses are present at birth; pre-lingual Hearing Loss is often (33%) associated w/ other physical or mental impairments |
| Pre-Lingual Hearing Loss: Problems Continued | ? is the disability assoc w/ pre-lingual hearing loss simply the result of reduced auditory input; Theory of Critical Periods of Development |
| Theory of Critical Periods | Certain periods in dev. when an organism is programmed to receive + utilize particular stimuli for normal development.; if period is missed, + stimuli are received subsequently, stimuli will have diminished potency in affecting organism's development. |
| Application of Theory of Critical Periods to Audition | Theory suggests that at certain dev. stage, auditory stimuli will be optimally received + utilized for auditory perceptual development; once stage is missed, effective utilization of these stimuli will gradually decline |
| Application of Theory of Critical Periods to Audition Continued | Absence of normal, patterned auditory activity from the cochlea could result in changes in the anatomy and physiology of the CANS |
| Research re: Speech/Language Development | 60% of adult values of maturation have been reached by time language begins to make its appearance; language stimulation during 1st 6 months of life lays foundation for chronologically appropriate language + cognitive growth |
| Research re: Speech/Language Development Continued | Before 4 yrs, "critical" for language development; by this time, all necessary subskills for normal speech/language development have been obtained by the normal child |
| Theory of Critical Periods re: Speech/Language Development | analogous theory for speech/language development holds that language input must be experienced at a certain time or it becomes decreasingly effective for utilization in emergent language skills; if a HL is present at or shortly after birth |
| Theory of Critical Periods re: Speech/Language Development Continued | theory suggests that hearing loss will have devastating, long term effects that may not be reversible |
| Sensory Deprivation Experiments | Attempts to give credence to Theory of Critical Periods; effect of sensory deprivation on anatomy, physiology + psychology of an organism; human studies + animal studies done |
| Basic Experimental Paradigm | Deprive a new born animal of a particular stimulus, then evaluate any effects of deprivation anatomically, physiologically and/or psychologically |
| Conclusions of Sensory Deprivation (SD) experiments | appears to be critical period of development in which proper meaningful stimuli must be received for central nervous system to mature normally |
| Conclusions of Sensory Deprivation (SD) experiments Continued | sensory deprivation (either temporary or permanent) during early development can result in irreversible neurophysiological changes that result in inability to learn |
| Trends from Sensory Deprivation (SD) experiments | The earlier the deprivation, the more serious the effects; The more complete the deprivation, the more serious the effect; The higher the animal in the evolutionary scale, the more severe the effects of deprivation |
| Implications of Sensory Deprivation Experiments re: CHL (conductive Hearing Loss) | believed that small, temporary, fluctuating HL due to OM (Otitis media) were tolerable for long periods of time w/ no affect on development; Katz suggested that these losses may be detrimental to development b/c of their affect on dev + maturation of CANS |
| Implications of Sensory Deprivation Experiments re: CHL continued | If loss is present during early development, stable or fluctuating, it may interfere w/ ability to learn language; may cause a long term problem even after loss is resolved |
| Implications of Sensory Deprivation Experiments re: CHL continued | anatomical/physiological/psychological changes may occur secondary to the SD resulting in irreversible auditory processing problems |
| Implications of Sensory Deprivation Experiments re: CHL Continued | OME in the 1st yr of life may impair brainstem + cortical auditory processing; causing long-term auditory processing problems |
| Implications of Sensory Deprivation Experiments re: SNHL (sensorineural hearing loss) | Post-mortem studies revealed changes in CANS nuclei- severe SNHL, changes may disturb normal psychological processes - auditory processing; reduced capacity to learn auditorily; important when considering habilitative methods based on normal model |
| Implications re: Idenfication and Intervention | Early Identification and intervention; minimize possible effects of sensory deprivation; minimize possibility of auditory processing/learning disorders developing secondary to hearing loss |
| Summary: Pre-lingual Hearing Loss | Why is pre-lingual hearing loss so disabling? so many secondary problems (literacy, scholastic, vocational); is problem due to: rehab methods/procedures/models, timing of intervention, organic problems secondary to or concomitant w/ pre-lingual HL |
| Summary: Pre-lingual Hearing Loss | Theory of Critical Periods: attempts to understand problems, states that for emergence of a behavior to occur, stimulation at the right time during development is "critical" |
| Summary: Pre-Lingual Hearing Loss -->Sensory Deprivation (SD) experiments | To give credence/support for Theory of Critical Period; results suggest irreversible neurological changes that result in ability when deprivation occurs during early development; trends, implications |
| Summary: Pre-Lingual Hearing Loss Caveat | Caveat - can this SD research be applied to humans? Human brain plasticity, critical period in humans has not been defined, maybe just a sensitive period but not critical |
| Summary: Pre-Lingual Hearing Loss | Post-mortem studies may be reflecting something else, concomitant problem; effects may not be irreversible; delayed not disordered, appropriate intervention never too late |
| Cochlear Implants and Brain Reorganization | May restore normal auditory pathways in brain even after many years of deafness; younger subjects + those w/ shorter history of deafness showed changes that mirrored patterns in people w/ normal hearing more closely; |
| Cochlear Implants + Brain Reorganization | Implication: brain can reorganize sound processing centers or press into service latent ones based on sound stimulation |
| Post-Lingual Hearing Loss | Hearing loss after acquisition of speech and language; usually much less disabling than pre-lingual: already has speech/lang, know rules of speech/lang., experience participating in human communication; secondary problems do develop |
| Late-Onset Auditory Deprivation | systematic decrease over time in auditory performance asso w/ reduced availability of acoustic info; may/may not be reversible; does it truly exist, if so, in whom; mechanism not clear - ? changes in allocation of tonotopic presentation in auditory cortex |
| Problems: General | gradual estrangement from associates, looked upon as social outcast, develop symptoms of depression, anger, paranoia, little effort directed towards developing identification + intervention programs, ignored, minimally effective procedures |
| Problems: Early Adulthood | Vocational and social problems, can't do what they did before, emotional problems can develop |
| Problems: Progressive Hearing Loss | Give time to adjust + seek help, make plans for future, problems may still develop due to uncertainty of ultimate magnitude of HL, emotional, social, + vocational problems |
| Problems: Elderly | Social problems; family problems; poorer health; problems dealing w/ disorders typically associated with aging - either caused by hearing loss or exacerbated by the hearing loss |
| Problems: Elderly Continued | Cognitive decline; cognitive abilities (binaural processing, binaural summation, binaural squelch, spatial integration, working memory, and temporal processing) significantly impact speech perception - particularly in challenging acoustic environments |
| Problems: Elderly Continued | Hearing loss in the elderly is often accompanied by visual impairment; dual sensory impairment increases communication difficulty (lack of visual cues to help when indiv has hearing impairment) |
| Remember!!! | Vision matters more when hearing declines; hearing matters more when vision declines; Audition/Vision matters more as cognition declines; cognition matters more as audition/vision declines. |
| Remember!!! | The absence of auditory/visual stimulation can exacerbate cognitive deficits in adults; cognitive deficits can exacerbate hearing/visual problems in adults; absence of auditory stimulation can arrest cortical development in children |
| Summary | Hearing disability or the handicapping effect of a hearing loss is related to Age of Onset; pre-lingual HL more disabling than post-lingual HL |
| PSYCHOACOUSTIC PROBLEMS - Unit VIII PP Slides | |
| Assessment: Conductive Hearing Loss: Non-Audiometric Symptoms | Complains of non-audiometric symptoms or statements frequently (but not always) made by patients w/ conductive HL |
| Conductive Hearing Loss: Fluctuating Hearing Loss | Change in Hearing sensitivity over time |
| Conductive Hearing Loss: Good Word Recognition | As long as sufficient intensity is present to overcome mechanical problem |
| Conductive Hearing Loss: Hearing Well in Noise | Loss reduces perception of noise more than speech, may hear better than normal hearing individuals |
| Conductive Hearing Loss: Tinnitus | Usually low frequency, or simply more aware of head noises |
| Conductive Hearing Loss: Speaks Softly | Voice is not masked by Environmental sounds, hears self-better, reduces self-monitored speaking intensity |
| Audiometric Findings for Conductive Hearing Loss | Pure tone findings, speech audiometry, acoustic immittance testing |
| Pure-Tone Findings for Conductive Hearing Loss (Audiometric finding) | Loss by air conduction (AC) usually equal loss at all frequencies or more low frequency loss; no loss by bone conduction (BC), air/bone gap |
| Speech Audiometry for Conductive Hearing Loss (Audiometric Finding) | SRT=PTA (speech recognition scores equal to or expected based on Pure Tone averages); WRS is WNL (88 to 100%), word recognition scores are within normal limits |
| Acoustic Immittance Testing for Conductive Hearing Loss (Audiometric Finding) | Abnormal tympanometry; Middle Ear Muscle Reflex (MEMR) are absent |
| Summary of findings for Conductive Hearing Loss | No disruption of normal neural pathways, mechanical destruction or obstruction |
| PSYCHCOACOUSTIC PROBLEMS: Conductive Hearing Loss background info | CHL is simply a problem of reduced intensity entering the cochlea; magnitude of A/B gap = decrease in sound entering cochlea; ex. sound = 70 dB, A/B gap = 20 dB, sound entering cochlea = 50dB |
| PSYCHCOACOUSTIC PROBLEMS: Conductive Hearing Loss background info continued | CHL causes a reduction in acoustic redundancy, NCL-SRT=40 dB; 40dB constitutes acoustic redundancy; that part of message signal that can be eliminated w/o a loss of info; intensity redundancy |
| PSYCHCOACOUSTIC PROBLEMS: Conductive Hearing Loss background info continued | Equal loudness contours or phon lines; show how the sensitivity of the ear changes as intensity increases above threshold |
| Equal Loudness Contours or Phon Lines | As intensity increases above threshold, the sensitivity of the ear changes - the ear begins to become more equally sensitive to different frequencies of sound; equal intensity results in equal loudness |
| Equal Loudness Contours or Phon Lines | at 60 dBspl, ear is equally sensitive to the range of frequencies important for word recognition |
| Psychoacoustic Problem | Although intensity (sensitivity) is reduced equally across the frequency range, loudness is not reduced equally; loudness curves of the ear changes, affects the upper and lower ends of the speech spectrum; why speaking louder helps |
| Psychoacoustic Problem continued | CHL (conductive hearing loss) will affect the perception of some phonemes more than others (upper and lower end of the speech spectrum) |
| Effects on Speech Perception | Vowels more easily recognized than consonants; /sh/ /th/ /f/ /v/ most difficulty; morphological markers may be lost; very brief utterances may be lost; inflection information may be lost (where are Jack's gloves to be place --> where Jack glo be placed) |
| Summary | CHL results in reduction in overall redundancy of speech resulting in an adverse listening condition; problem is increased in adverse listening situations, special implication w/ young children since they need more intensity than adults |
| Assessment: Sensorineural Hearing Loss (SNHL) | SNHL - cochlear, SNHL - DAN (disorder of the Auditory Nerve); SNHL - ANSD (auditory Neuropathy spectrum disorder) |
| SNHL - Cochlear (SNHL-C) | Impairment of hearing that results when there is hair cell damage in the cochlea |
| SNHL-C: Non-Audiometric Symptoms | Speak loudly (due to reduced BC hearing), hears but doesn't understand speech; more difficulty hearing in noise than in quiet, recruitment |
| SNHL-C: Non Audiometric Symptoms: Tinnitus | Tinnitus= phantom auditory sensation; auditory sensation not related to an external sound (e.g. ringing, buzzing, hissing, roaring, crickets, water running, bacon frying) |
| Tinnitus | ~17% (40-50 million) of Americans have tinnitus; ~30% of people above 65 yrs old; 10-12 million have sought treatment; 2 million find it debilitating (significantly interferes w/ ADLs) |
| Tinnitus Continued | May be result of brain overcompensating for loss of information due to neural unit damage; plastic transformation - CANS rewires itself leading to aberrant changes; equivalent of phantom limb pain |
| Hyperacusis | Abnormally strong reaction in the auditory pathways to moderate sound; reduced tolerance levels, inordinate intolerance to sound; low UCLs (uncomfortable loudness levels); speculated same mechanism as tinnitus |
| Hyperacusis Continued | Not to be confused w/ phonophobia - emotional or learned fear of sound |
| SNHL-Cochlear (SNHL-C) Audiological Findings | WRS will be reduced from normal (i.e. less than 88%) + predictable from Pure Tone findings; MEMR present at reduced sensation levels, OAE absent or abnormal; ABR normal at high intensity levels |
| SNHL - Disorders of the Auditory Nerve (SNHL-DAN) | Impairment of hearing that results from disease, irritation or pressure on the nerve trunk of Cranial Nerve VIII (CN VIII); visible structural alteration |
| SNHL-DAN: Non-Audiometric Symptoms | Hears but doesn't understand speech; more difficulty hearing in noise than in quiet; tinnitus |
| SNHL-DAN: Audiological Findings | SNHL w/ pure tone thresholds near normal better than what you would have predicted based on patient's complaints |
| SNHL-DAN: Audiological Findings Continued | WRS will be poorer than would be predicted from pure tone thresholds w/ large difference b/w WRS in quiet vs. in noise; MEMR absent or present at elevated hearing levels w/ decay; OAE normal; ABR abnormal |
| SNHL- Auditory Neuropahty Spectrum Disorder (SNHL-ANSD) | Impairment of hearing resulting from abnormal functioning at level of CN VIII w/ no visible structural alteration in many cases. |
| Possible sites of Auditory Neuropathy | Possible sites of auditory neuropathy include inner hair cells, synaptic juncture b/w inner hair cells + CN VIII, CN VIII fibers or perhaps auditory pathways of brainstem (lateral lemniscus) |
| SNHL-Auditory Neuropathy Spectrum Disorder | Patients may or may not have any other neuropathies outside of the auditory system |
| SNHL-ANSD: Non-Audiometric Symptoms | Hears but doesn't understand speech; more difficulty hearing in noise than in quiet |
| SNHL-ANSD: Audiological Findings | Normal to severe/profound SNHL, WRS poorer than would be predicted from pure tone thresholds w/ large difference b/w WRS in quiet vs. in noise; MEMR absent or elevated; OAE normal but sometimes disappear (30% of cases); ABR absent or severely abnormal |
| SNHL: Psychoacoustic Problems | Related to: reduced auditory sensitivity, reduced dynamic range, reduced/minimal frequency resolution, reduced temporal resolution |
| Reduced Auditory Sensitivity | Effect upon word recognition in quiet depends on: frequencies involved in the HL, frequency and intensity characteristics of the different phonemes of speech; the more of the frequency spectrum that is eliminated, the more word recognition will be reduced |
| Fletcher (1953) | Filtered speech to simulate different configurations of SNHL; Freq. above 3000 Hz - reduced recognition of high freq. fricatives; Freq above 1000 Hz - reduced recognition of all consonants; freq. above 500 Hz - reduced recognition of vowels, loss of F2 |
| Effect of Speech Perception | Back vs. Front Vowels: back vowels have a lower freq + higher amplitude F2, front vowels have a higher freq + lower amplitude F2 |
| Effect of Speech Perception - Vowel Confusion | Vowel Confusion - vowels having a similar F1 but different F2, vowels having a similar F1 and F2 |
| Effect of Speech Perception - Word Recognition Problems | Word recognition problems: hear but don't understand, people sound like they are mumbling, vowels vs. consonants |
| Effect of Speech Perception - Signal to Noise (S/N) ratio for Listening | Low freq sounds masking out higher freq sounds; noise masking speech; vowels masking consonants; F1 masking F2 |
| S/N ratio for Listening | W/ high frequency hearing loss, upward spread of masking, low frequency sounds can interfere w/ the perception of higher frequency sounds |
| Reduced Dynamic Range | Elevated SRT with normal or reduced UCL (uncomfortable Loudness Level) |
| Word Recognition Ability in Noise | Higher order skill; depends on the frequency and temporal resolution of the ear |
| Reduced/Minimal Frequency Resolution | Reduced ability to resolve frequency (reduced frequency discrimination ability), (reduced "frequency tuning" of the ear) |
| Reduced Temporal Resolution | Reduced ability to resolve timing aspect of sound; disruption in temporal processing; either in the peripheral or central auditory system; loss of temporal resolution even w/ normal audiogram will cause word recognition problem |
| Temporal Resolution | e.g. VOT (voice onset time) "Did you get the bill" vs "Did you get the pill?" e.g. gap detection and phonological problems |
| Summary: SNHL Psychoacoustic Problems | Poor speech understanding in cases of SNHL can be related to: reduced auditory sensitivity; reduced dynamic range; reduced/minimal frequency resolution; reduced temporal resolution; cognitive decline |
| Summary: SNHL | Background info: hearing in quiet - simply a sensitivity problem; Hearing in noise - higher level skill, requires good sensitivity and good frequency resolution |
| Summary: SNHL | Reduced frequency resolution: loss of "spectral detail" |
| Central Auditory Disorders (CAD) | Impairment of hearing that results when there is a structural lesion in the higher auditory pathways w/in the brainstem and the brain |
| CAD: Non-Audiometric Symptoms | More difficulty hearing in noise than in quiet; difficulty w/ sound localization; Auditory Processing problems (inattention, missing some info; inconsistencies in response; figure-ground differentiation, etc.) |
| CAD: Audiological Findings | Normal to severe/profound SNHL; WRS poorer than would be predicted from pure tone thresholds w/ large difference b/w WRS in quiet vs. in noise; acoustic reflex present at normal hearing levels; OAE normal, ABR normal |
| CAD: Psychoacoustic Problems | Related more to processing than sensitivity changes; higher level hearing disorder; Auditory Processing disorder; auditory, discrimination, figure-ground, sequencing, closure, and memory |
Created by:
Apan511