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Educational Audiolog


number of babies born with significant hearing loss Everyday in the US, approximately 33 babies (1 to 3 infants per 1000) are born with significant hearing loss
most common congenital disorder in new borns hearing loss
The average age that children with hearing loss are identified in the US 12-25 months of age
number of infants born with a moderate hearing loss estimated that 3 infants per 1000
number of people is US with some form of hearing loss and what percent cannot be reversed 28 million people 80%
number of children with hearing loss Over 1 million children in the US have hearing losses
percent of children 18 years and younger that have a hearing loss 5%
number of infants born in the US with some kind of hearing problem 1 in 22 infants
number of children in the US with what is termed an educationally significant hearing loss 83 out of every 1000 children
Among every 1000 school-aged children in the US, how many have bilateral and how many have unilateral hearing losses that may significantly interfere with their education Among every 1000 school-aged children in the US, 7 have bilateral and 16-19 have unilateral hearing losses that may significantly interfere with their education
number of school-aged kids that have permanent SNHL 10 in 1000
NIH supports universal screening because... Infants who receive intervention before 6 months can maintain language development commensurate with their cognitive abilities through the age of 5
ASHA Joint Committee on Infant Hearing supports the development of screening programs based on the following: have access to screening using physiologic measure, if fail screening must be followedup before 3 mths old. If confirmed hearing loss, receive services before 6 moths old. If pass screening but has risks for audio prob or SLP delay, should be monitored
Professionals working together Pediatrician Families ENT doctors Audiologists SLPs Educators Early identification professionals
hearing loss issues in Auditory Neural Development Hear loss keeps sound from reaching the brain. If areas of brain that process audio info are not stimulated during the critical period for spch and lang, spch and lang will not develop norm. Audio stim is critical to spch perception and lang processing
Hearing loss effects relationships between parents and children A parent’s reaction to the hearing loss will have an impact on the outcome of habillitation.Particularly if the hearing loss is of severe to profound degree, it may affect the normal communicative interaction between parent and child
Acceptable ambient noise level of a class room 35 dBA
A negative acoustic classroom environment affects: Transmission of information Speech perception On-task behavior Reading Spelling Social Behavior Concentration Academic Achievement
A child with an educationally significant hearing loss should have one of the following: A bilateral hearing loss of at least 20 dB PTA in the better ear A unilateral hearing loss of at least 35 dB PTA in the affected ear A bilateral high frequency hearing loss averaging at least 35 dB at any 2 frequencies for 2k, 4k or 6k Hz.
pure-tone A pure-tone is a frequency of vibration which always has the same number of cycles per second
We test hearing by presenting stimuli through: Air conduction Bone conduction
The purpose of a hearing test To determine the type of hearing loss To determine the degree of hearing loss
To determine the type of hearing loss: You need to understand the relationship between air conducted stimuli and bone conducted stimuli
Air conduction As sound travels through the ear canal and middle ear, it is traveling through cavities that are filled with air.
Testing Air Conduction begin by presenting puretone stim through air conduction when performing audiological evaluation. The sound is presented through headphones Sound is funneled into the ear canal Sound then proceeds through the ear canal and hits the tympanic membrane
travel of sound in Air Conduction When a sound travels via air conduction, it travels throughout the entire auditory system to reach the auditory nerve. Outer Middle Inner Nerve
Bone Conduction There is a way to stimulate the cochlea directly, bypassing the outer and middle ear When we use a bone conduction oscillator anywhere on the head, it stimulates the inner ear
Frequencies at which we test for Hearing loss: Air Conduction We evaluate a person’s ability to hear at the following frequencies by air conduction: 250 Hz 500 Hz 1000 Hz 2000 Hz 4000 Hz 8000 Hz
Frequencies we use to test for Hearing Loss: Bone Conduction We test a person’s ability to hear the following frequencies by bone conduction: 250 Hz 500 Hz 1000 Hz 2000 Hz 4000 Hz
A threshold The softest level at which a signal or change in signal can be detected
Method of limits the procedure audiologists use to acquire a threshold of a patient at a particular frequency
how to test thresholds test at a reasonably high dB & descend by 10 dB to acquire threshold. Once acquired, then proceed down 10 dB more and ascend 5 dB until we receive another response, when 2 confirmed responses at the same dB that is our recorded threshold for that freq.
Degrees of hearing loss dB Normal: -10 to 15 dB Slight: 16 to 25 dB Mild: 26 to 40 dB Moderate: 41 to 55 dB Moderately Severe: 56 to 70 dB Severe: 71 to 90 dB Profound: 90+
Determining degree and type of hearing loss Always determined by the level of the air conduction threshold The type of hearing loss is always determined by the relationship between the air conduction and the bone conduction thresholds We chart the test results on an audiogram
Hearing loss degree and ability to hear speech Norm:hear soft convo.Min:have prob hearing faint speech.Mild:will miss upto 50% of a group discuss.Mod:convo +5ft may not be understood. Mod severe: miss 100% of spch info w/out amp.Severe: only hear loud noise close.Profound: depend on sight for info
Consonants Consonants are higher pitched than vowels (they lie more to the right on the chart). Consonants are spoken more softly than vowels (they lie higher on the chart, in the lower decibel ranges).
Order of Test (actual procedure) Case History Otoscopic examination Impedance and reflex testing Pure Tone Testing Air Conduction Bone Conduction Speech Reception Threshold (SRT) Speech Discrimination (WRS)
Sensorineural Hearing Loss Most common type of loss in adults; often permanent. Origin in the inner ear or along the auditory nerve. Damage occurs in the cochlea. Hair cells in the cochlea are damaged and cant transmit elec impulses to brain. loss can be congenital or acquired
Sensorineural Hearing Loss Congenital Causes Hereditary factors (Usher’s, Waardendburgs) Prematurity Birth trauma such as anoxia TORCH Toxoplasmosis Other (Hepatitis B,Syphilis,HIV) Rubella virus Cytomegalovirus Herpes simplex viruses
Sensorineural Hearing Loss Acquired Causes Ototoxic drugs Head injury Noise exposure Meningitis Encephalitis Measles
Conductive Hearing Loss Problem in the outer or middle ear preventing the sound waves from reaching the inner ear Often treated with surgery or medication
Conductive Hearing Loss Causes Injury to the outer ear Blockage of the ear canal Infections to the outer or middle ear Swimmers Ear (Outer Ear) Otitis Media (Middle Ear Infection) Perforation in the TM Congenital Malformations Atresia Microtia
Masking When significant air bone gaps are present, masking must be performed Masking occurs when noise is put into the opposite ear while testing the other ear This will prevent the better ear from picking up the test signal
Mixed Hearing Loss A mixed loss is a SN loss w/ a conduct compon. Diso in OE & ME along with diso in IE. The conduct compon may be treated, but the SN compon usually permanent both ACTs & BCTs will be abnorm. ACTs will be more abnorm b/c there is a diso in the OE, ME & IE
Mild hearing loss Soft noises are not heard. Understanding speech is difficult in a loud environment.
Moderate hearing loss Soft and moderately loud noises are not heard. Understanding speech becomes very difficult if background noise is present.
Severe hearing loss Conversations have to be conducted loudly. Group conversations are possible only with a lot of effort.
Profound hearing loss Some very loud noises are heard. Without a hearing aid, communication is no longer possible even with intense effort.
Prevalence Total number of cases of a condition in a population during a specified period of time
sensitive positive results = pathology
Specific negative results = absence of pathology
Who screens school-age kids? Health Departments and Education Departments are the primary agents responsible Personnel includes: Nurses Volunteers Students
Who do you screen in the district? kids aged 3 through 3rd grade yearly, kid needs +1 screen, have existing hearing loss, receive spe-ed services, hx colds & ear infects, have delayed spch & lang, return after major illness, sudden change in academ perform, referred by teach, new to school
Equipment for hearing screening Portable audiometer Yearly calibration Weekly check with sound level meter Biological check every day Should have a spare
Individual pure-tone screening 1000, 2000, 4000 Hz. At 20 dB. Failure at any one frequency in either ear should be rescreened, if possible, the same day
Static Admittance (Children) Mean is 0.5 cm3/ml Range 0.2-0.9 cm3/ml
Equivalent Ear Canal Volume (Children) Mean 0.7 cm3/ml Range 0.3-1.4 cm3/ml
Gradient The distance from the peak to the positive tail of the tympanogram is bisected. The width of the tympanogram at that poin is determined in daPA Gradient (children) Mean 100 daPA Range 60-150 daPa
ME Screening Primary Goal: Identify children at risk for significant outer and middle ear disorders that have been undetected or untreated
Who should be ME screened? Anyone at risk for OE or ME disorders: (Craniofacial anomalies, Native Amer heritage and Eskimo pop, Known hx of chronic Otitis Media, Exposure to excessive cigarette smoke,Learning disability, Devel delays,Spch & lang delays, SN hearing loss
Me Screening Protocol Tympanometry used for ME screenings. assesses the status of the middle ear system by measuring the mobility of the ear drum. The screening procedure takes approx 5 sec. May also be called acoustic impedance screening or acoustic immittance screening
Tympanometer An elec device used to assess ME status. Automatically varies air pressure from + to - pressure in the canal while a low frequency tone is presented to the ear. Measures the intensity of the tone as the air pressure changes and is plotted as a tympanogram
Components of a Tympanometer Air Pump/Manometer,Pure tone generator,Microphone, Probe tip, Ear tips, Printer
ME Screening Procedure 1.Use otoscope to examine ear 2.Select eartip that will seal ear canal 3.Straighten ear canal 4.Press probe firmly against ear canal creating seal 5.tymp will finish 6.Keep probe steady seal,try again 8. remove probe 9.Repeat on other ear 10.Print
Tympanogram Measurements Static Compliance Ear Canal Volume Tympanic Gradient/Tympanic Width
Static Compliance (SC) A measure of the height of the tympanogram (point of maximum mobility of the tympanic membrane) Unit of measurement is mmho, cc, cm3, or ml Also called Peak Admittance
SC will be lower than normal if ... the ME disorder makes the ME system less compliant (stiffer) than normal (OM or scarred eardrum)
SC will be higher than normal if ... the ME disorder makes the ME system more compliant (less stiff) than normal (flaccid eardrum)
Ear Canal Volume (ECV) A measure of the volume of air in the ear canal between the end of the probe tip and the eardrum Unit of measurement is mmho, cc, cm3, or ml
Smaller than normal ECV: Probe tip is occluded by wax or is against the ear canal wall
Larger than normal ECV: Perforation or PE tube is open and functioning normally
Determining Tympanic Gradient Determined where half the peak value is on both sides of the peak. The daPa values are added regardless of their sign to determine the width
tympnaograms Normal Values in Children SC = 0.2 - 0.9 mmho ECV = 0.4-1.0 cm3 TW = 60-150 daPa
ME Re-Screening Protocol Rescreen within 4-6 weeks if: At age 6 years and younger: SC < 0.3 mmho or the tympanic width is greater than 200 daPa At age 7 years and older: SC < 0.4 mmho or the tympanic width is greater than 200 daPa
ME screening Refer Fail rescreening. Ear drainage or blood. Ear canal abnorm such as obstructions,impacted cerumen, or foreign objects. Ear canal volume is greater than 1.0 cm3 & the tympanogram is flat (Possible tympanic membrane perforation, unless PE tubes are present)
To be eligible for services under IDEA the hearing loss must adversely affect educational performance
adverse effects of hearing loss on academics Poor auditory discrimination Language delay Articulation, voice or fluency problems Reading comprehension delay Poor academic achievement Social/emotional problems At least one of these must be documented
A child with an educationally significant hearing loss should have one of the following: A bilateral hearing loss of at least 20 dB PTA in the better ear A unilateral hearing loss of at least 35 dB PTA in the affected ear A bilateral high frequency hearing loss averaging at least 35 dB at any 2 frequencies for 2k, 4k or 6k Hz.
Adaptation Changes made to the environment, curriculum, instruction and or assessment practices in order to provide a student equal access to learning and equal opportunity to demonstrate what is known. These include accommodations and modifications.
Accommodations Provisions in how kid accesses info & demon learning. The accom dont change the instruct level, content or perform criteria. Include:Presentation & response format, Instructional strategies, Time & scheduling, Architect features, Envio features equipment
Modifications Substantial changes in what a student is expected to learn and demonstrate. This includes such things as: Instructional level Content Performance criteria
Minimal hearing loss Threshold greater than 16 dB Unilateral hearing loss Most minimal hearing losses are caused by otitis media
General impact of minimal hearing losses It may affect (a child’s ability to): Listen Understand auditory information Speech and language development Behavior Hear at a distance which affects incidental learning Level of fatigue
Unilateral Hearing Loss A child may have problems with: Hearing sounds directed to his poorer ear Localizing Understanding speech in noise
Mild and Unilateral Loss/ Prevalence Recent studies have indicated the following: Between 5 and 7 million school age kids have some degree of hearing loss(11-15%). Prevalence noise induced hearing loss 12.5%. 1 in 20 school aged kids have min SNHL. Unilateral SNHL is the most prevalent type of hearing loss & affects 3% school age kids
According to Dobie and Berlin, a child with a loss of 20 dB would have the following problems: Morphological markers may be lost. Very short words in connected spch will lose loudness. Inflection or markers which carry nuances such as ?s will come through inconsistently. Kid will sometimes appear to have a processing prob, rather than a hear prob
What is sound? An alteration in pressure, particle displacement or particle velocity in an elastic medium More simply put, it is vibration in an elastic medium Vibration is the rapid back & forth motion of a single object
Medium An intervening substance through which something else is transmitted or carried
Mass A unified body of matter with no specific shape
Elasticity The condition or property of being elastic; flexibility. Elasticity is the ability of a body to resist a distorting influence or stress & return to original size & shape when stress removed. Elasticity increases as distance between molecules decreases
Waves When air molecules are disturbed, they move They bounce off adjacent molecules Due to elasticity, they bounce back to the point of rest A succession of compressions and rarefactions
Compression/Condensation Molecules which are pushed close together Areas of increased density
Rarefaction Areas of decreased density Space that exists between the areas of compression
Transverse wave a transverse wave occurs when molecular motion is perpendicular to the direction of wave motion.
Longitudinal Wave Air molecules move along the axis of the wave itself. Sound propagates away from the sound source. Sound waves are longitudinal
Sine Waves A uniform wave that is generated by a single frequency. Simple harmonic motion which is sometimes defined as a projected circular motion
Cycle a compression and rarefaction as a function of time
four main parts to a sound wave: Wavelength Period Amplitude Frequency
Frequency It is the number of occurrences of any action that take place over a given time period
Pure tone A sound which is produced by an instantaneous sound pressure which is a simple sinusoidal function of time.
area of compression The part of the wave that rises above the axis
area of rarefaction The part of the wave that dips below the axis
Period The time it takes to complete one cycle is called the period If 2 cycles are completed in one second, for example, each complete cycle takes ½ second. There is a reciprocal relationship between frequency and period P=1/F
Wavelength Length is measured from any point on a sine wave, to the exact same point on the next wave Wavelength (λ) = C (velocity)/ F (frequency) C = fλ or f = c/ λ Wavelength decreases as frequency increases
Free Vibration No external force.
Forced Vibration External force`
Stiffness the resistance of an elastic body to deflection by an applied force
Resonance The ability of a mass to vibrate at a particular frequency with a minimum application of external force.
Sound Velocity The speed with which the sound wave travels from its source to another point
Average velocity distance/time
Gasses only when molecules collide with each other can the condensations and rarefactions of a sound wave move about. So, it makes sense that the speed of sound has the same order of magnitude as the average molecular speed between collisions.
Liquids Sound travels faster in liquids than in gases because molecules are more tightly packed. In fresh water, sound waves travel at 1,482 meters per second (about 3,315 mph). That's well over 4 times faster than in air!
Solids Sound travels fastest through solids. b/c molecules in a solid medium are closer together than those in a liquid or gas, allowing sound waves to travel faster through it. In fact, sound waves travel over 17 times faster through steel than through air.
Phase Any point on a sine wave (in degrees) may be compared to a standard (which is considered to be 0 degrees)
Loudness The physical correlate of loudness is intensity. It is measured in decibels.
Amplitude distance the mass moves from the point of rest. The amplitude of a sound is represented by the height of the wave. When there is a loud sound, the wave is high and the amplitude is large.
Force The greater the force, the greater the amplitude of a sound wave Dynes and Newtons are units of force
Pressure Pressure is generated whenever force is distributed over a surface area If the area remains constant, pressure increases as force increases Sound pressure is measured in dynes/cm2 or we can measure it using another unit called the microPascal: µPa
The smallest pressure to produce just audible sound to the human ear .0002 dynes/cm2 or 20 µPa
What are some problems faced by individuals with hearing loss? Decreased Audibility Decreased dynamic range Decreased frequency resolution Decreased temporal resolution An individual with hearing impairment will not just have one of these problems. They will have all of these problems in some combination.
dynamic range a range into which all sounds fit. Normal hearing people have a wide dynamic range All different levels of sound from really soft to really loud fit within this dynamic range (140 dB SPL) Hearing impaired have a reduced DR
Decreased Frequency Resolution People with hearing loss have a harder time separating these frequencies, because they can’t necessarily hear them as well
Decreased Temporal Resolution The ability to process the order in which sounds occur When one sound stops and another begins Also helps detect softer sounds in the midst of more intense sounds
Hearing Aids Help Decreased Audibility. Decreased dynamic range. Decreased frequency resolution.
Hearing Aids Cant Help Decreased Temporal resolution (No). This occurs higher up in the brainstem.
3 Basic Principles of Hearing Aids Gain Output Frequency Selectivity
Gain Weight Example: Weigh yourself = 145 lbs Weigh Dog = 30 lbs How Much did you “gain”? Another example: 40 db sound into the hearing aid The hearing aid amplifies it by 40 db “gain” is 40 db More Technical: Gain=output-input
Output Light Bulb Example - 60 Watt bulb Only put out 60 watts May put out less (dimmer switch) Can not put out more than 60 dB no matter who tries More Technical:Output=Input+Gain
What is a Hearing Aid A small electronic device worn in or behind your ear that is designed to amplify sounds so that a person with a hearing loss can listen, communicate, and participate more fully in daily activities
number of people who show benefit from a hearing aid Only about one out of five people who show benefit from a hearing aid actually use one
Analog hearing aids have a microphone that picks up sound and converts the sound into electrical signals, which are amplified and delivered to your ears
Digital hearing aids convert incoming sound waves into digital signals that are manipulated according to an individual's hearing levels and listening needs. Once the signal has been manipulated, it is amplified and delivered to your ears
benefits of Digital hearing aids More flexibility in programming Greater precision in fitting, management of loudness discomfort, control of acoustic feedback, and background noise reduction
Hearing Aid Components Microphone Amplifier Receiver Battery
Microphone The hearing aid receives sound through a microphone, which transduces the sound waves from acoustic energy to electrical energy and sends them to an amplifier Two types of microphones: Omni-directional Directional
Omni-Directional Microphone Amplifies sounds around the hearing aid user Desirable for environments where the incoming signal and noise can be heard around you `
Directional Microphones Amplify sounds coming from a specific direction (in front of you) and reduces the noise coming from behind you Directional microphones provide a better signal to noise ratio when compared to omni-directional microphones
Amplifier Increases the level of the electrical signal sent from the microphone, which is then delivered to the receiver The signal is amplified according to the user’s amplification needs and the hearing aid settings
Receiver Transduces the electrical energy from the hearing aid amplifier back into sound that is sent to the middle and inner ear
Batteries The hearing aid battery delivers power to the electronic parts of the instrument Hearing aids generally run on zinc air batteries A hearing aid battery begins to discharge as soon as the protective seal has been removed.
Replacing the battery 1. Open battery door by swinging door open with finger 2. Take out old bat 3. Peel “tab” off of new bat 4. Hold between your thumb and forefinger w/ (+) side up 5. Slide or push into bat door. Dont place battery directly inside aid itself 6. Close do
Other Aid Controls Turning the hearing aid "on" or "off" Changing the volume Switching to the telecoil Switching between omni- and directional-microphone settings Switching to different programs According to the type of environment/ listening situation
Telecoil Small magnetic coil in aid that allows users to receive sound through circuitry of aid rather than through its microphone makes it easier to hear convo over the telephone Can be used in larger settings with assistive listening devices like FM systems
Hearing Aid Styles Body Worn Behind the Ear (BTE) Receiver in the Canal (RIC)/Receiver in the Ear (RITE) In the Ear (ITE) In the Canal (ITC) Completely in Canal (CIC)
Body Worn Hearing Aids One of the first models of hearing aids Includes: Earpiece or custom earmold worn in the ear External box which contains the components of the hearing aid and is worn around the waist or in a pocket Cord that connects the earmold to the case
Behind The Ear (BTE) A small plastic case, which contains the parts of the hearing aid, sits behind the outer ear and connects to the earmold via a plastic tube Considered among the most powerful hearing aids Used by all ages for mild to profound hearing loss
Receiver in the canal/ Receiver in the Ear Similar to a BTE, however the receiver is located in the earmold or covered by a dome that goes in your ear or ear canal
In the Ear (ITE) All parts of the aid are contained in a shell/earmold that fits into outer part of ear Larger than canal aids and easier to handle Used in mild to severe hear loss Not recommended for young kids b/c their ears are growing & aid would need replacing fre
Canal Hearing Aids All parts of aid are contained in shell/earmold that fits into ear canal b/c of small size, often tough to adjust and remove Not recommended for young kids For mild to moderately severe hear loss Two styles: In the canal (ITC) Completely in canal
In the canal (ITC) Aid hearing aid is made to fit the size and shape of a person’s ear canal.
Completely in canal (CIC) Aid hearing aid is nearly hidden in the ear canal
Components of BAHA Processor: picks up sound vibrations Abutment: Connects sound processor and implant and transfers sound vibe from processor to implant Titanium Implant: Placed in temporal bone behind the ear & transfers sound vibe to functioning cochlea
Speech Processors Intenso Small, digital, head worn Cordelle Consists of an ear-level transducer and a body worn unit BP 100 First programmable sound processor Better sound quality
Criteria for a Baha Unilateral or bilateral conductive or mixed hearing loss Single Sided Deafness Receive no benefits from traditional air conduction hearing aids Not FDA approved for children younger than 5 years of age
conductive & Mixed hearing loss Criteria Bone conduction thresholds better than 45 dB Air bone gap is more than 30 dB Speech discrimination score is better than 60%
Single Sided Deafness Criteria Unilateral sensorineural deafness One ear has a profound SNHL, the other ear has thresholds less than or equal to 20 dB HL Speech recognition scores below 20% in the impaired ear and above 80% in the contralateral ear
How does BAHA work in SSD? The Baha device is placed on the deaf side behind the ear and transfers sound through bone conduction, stimulating the cochlea of the normal hearing ear
Osseointegration Occurs from the response of the bone when it is in contact with titanium The implant fuses with the bone, providing an internal anchor for the implant Takes up to 3 months in adults and 6 months in children
How to Connect/Disconnect the Sound Processor BAHA Connect: Push processer in using an angled approach Disconnect: Bend the sound processor in any direction to release it
BAHA Batteries Type 13 zinc air batteries In order to check the speech processor after the battery has been changed: Turn up volume and blow into microphone If you feel the vibrations, sound processor is on and working
Implantable Middle Ear Hearing Devices (IMEHDS) Small surgically implanted device that transduces acoustic energy to mechanical energy, which is delivered to the middle ear Works similar to a hearing aid
who uses Implantable Middle Ear Hearing Devices (IMEHDS) Used by those who do not benefit from traditional hearing aids Not satisfied with hearing aids Feedback Occlusion effect Distortion Cannot wear hearing aids or earmold Stenosis
Implantable Middle Ear Hearing Devices 2 Devices are currently approved by the FDA Med-El Vibrant Soundbridge Soundtec Direct System
Med-El Vibrant Soundbridge First middle ear implant to be approved by the FDA in 2000 Mechanical energy delivered directly to the ossicles Enhances natural vibratory motion Eliminates many of the acoustic issues associated with traditional amplification: Occlusion and feedb
Components Med-El Speech Processor Magnet Implant Conductor Link Floating Mass Transducer
Speech Processor Med-El Worn behind the ear Held in place by a magnet which connects the processor to the implant Contains a microphone that transduces acoustical energy to electrical energy and sends this energy to the implant 675 zinc air battery is needed
Implant Med-El Internal device that receives electric energy from the processor and sends the signal down the conductor link to the floating mass transducer
Floating Mass Transducer Med-El Small titanium drum wrapped with gold wire Transduces elec signals into mechanical vibe which sets the middle ear in motion conducting the signal to the inner ear Attached to incus if SNHL or Attached to stapes or round window if mixed or cond hear lo
Candidacy Criteria Med-El Adults older than 18 Bilateral moderate(in low frequencies) to severe SNHL Conductive or Mixed hearing loss Word recognition of 50% or better
Exclusion Criteria Med-El Retrocochlear Pathology Active middle ear infection Tympanic membrane perforation associated with recurrent middle ear infection Inability to follow-up Skin conditions that would be affected by the pressure from the processor
SOUNDTEC® Direct Drive Hearing System Approved by the FDA in 2001 Uses electromagnetic energy which vibrates the ossicles of the middle ear leading to the perception of sound
SOUNDTEC Components Behind the ear sound processor Earmold/Coil Assembly (ECA) Implant
Sound Processor SOUNDTEC Sits over the external ear Receives and amplifies the sound vibrations Microphone in the processor transduces the acoustic signal into electric signals which are received by the earmold/coil assembly
Earmold/Coil Assembly SOUNDTEC Earmold in the ear canal that contains the coil Transduces electrical signals from the sound processor and creates an electromagnetic field with the magnetic implant
Implant SOUNDTEC The magnetic implant directly drives the ossicles as it receives electromagnetic energy from the Earmold/Coil Assembly Attached to the middle ear ossicles at the incudo-stapedial joint
Soundtec Candidacy Criteria For ages 21 to 80 years Bilateral moderate to severe sensorineural hearing loss Normal middle ear anatomy Dissatisfied with hearing aids Score of ≥ 60% on word recognition test Hearing aid use for more than 6 months
Soundtec Exclusion Criteria Conductive hearing loss Retrocochlear pathology Ear infect Tympanic membrane perforations associated with recurrent middle ear infections Previous middle ear surgery that has destroyed the integrity of the ossicular chain Malformations of external ea
Why is a cochlear implant different than a hearing aid? A cochlear implant bypasses the absent or damaged cells and stimulates the auditory nerve directly by converting acoustic energy to electrical energy
Candidates for Cochlear Implants Adults Children 12 months or older Severe to profound SNHL Receive little or no benefit from hearing aids Healthy enough for surgery
Procedure for Cochlear Implant Surgical placement of internal component is performed under general anesthesia Typically, the surgery is done on an outpatient basis and the individual goes home on the same day. Sometimes an overnight stay is necessary
Fitting the external component of cochlear implant Following a 3-6 week recovery period, the first fitting, or “initial stimulation” takes place audiologist sets specific parameters of stimulation, setting levels that are comfortable Aural re/habilitation key for use of implant
cochlear implant Programs represents the setting that the audiologist has determined best meet the client’s needs. The sound processor can store up to 3 programs. This allows the device to be used in different listening environments.
cochlear implant Sound coding strategy method used to transcribe acoustic sound into an electrical code CIS (Continuous Interleaved Stimulation) SAS (Simultaneous Analog Stimulation) MPS (Multiple Pulsatile Sampler) HiRes (HiResolution Sound)
cochlear implant T-level threshold level which is the stimulation level that is perceived as very soft
cochlear implant M-level Most comfortable level-represents the stimulation level that is perceived as most comfortable
cochlear implant RF level radio frequency power level required to maintain the proper communication between the internal and external components during normal operation of the system
cochlear implant Lock the system is “locked” when external component is properly sending a signal to the internal component
How to put on a body worn processor cochlear implant Verify processor is off Check battery pack is in place Turn volume all down Set sensitivity to user setting Place headpiece over implant Turn on processor appropriate program LED blinks appropriately for battery charge & stops flashing confirm lock
Battery Charge Status cochlear implant 3-4 blinks of LED indicate that battery is fully charged 2 quick blinks means it is sufficiently charged 1 blink = needs replacement or re-charge
Lock Status cochlear implant After the blinking battery sequence LED will flash approximately once per second until the headpiece is properly placed over the implant and the successful communication is established The LED will stop flashing to indicate that the system is locked
check microphone cochlear implant Once you are in lock status, observe the green LED light (the other was red) as you snap your fingers or say “bah, bah, bah.” Ask child to repeat Ling 6 sounds Ah, Ooh, ee, sh, sss,mmm
Factors influencing efficacy cochlear implant Age at implantation Previous auditory experience Presence of any additional handicapping conditions Teaching emphasis on auditory learning
Auditory Milestones 0-6mo. Startles loud sound 6-8mo. Babbles 9 mo. Responds to name 12 mo. First word 15 mo. Jabbers with some real words thrown in 18 mo. 50 word vocab, start word combinations, can identify body parts 24 mo. 200+ spoken words, follows simple directio
Created by: 34802220



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