| Question | Answer |
| conducive hearing loss | -outer/middle ear
-otitiis media
-TM perforation
-tympanosclerosis
-foreign bodies |
| SNHL | -inner ear
-meniere's disease
-presbycusis
-ototoxicity |
| mixed hearing loss | both conductive and sensory |
| degrees of hearing loss | -mild
-moderate
-moderately severe
-severe
-profound |
| high frequency slope | hearing loss increases as frequency gets louder |
| low frequency slope | loss in low frequencies |
| flat | loss in both frequencies |
| aural rehabilitation | those efforts designed to help a deaf or hard-of-hearing person adjust to the hearing loss (SNHL), or to alleviate the effects of the hearing loss. |
| habilitation (children) | -acquisition of communication skills
-Pre-lingual loss |
| rehabilitation (adults) | restoration of communication abilities |
| life expectancy | -In 1900 the average life expectancy was 47 years of age with 4 % of the population being over the age of 65
-In 2019, the average life expectancy in the USA was 78.87 years of age with 15.6% of the population being over the age of 65 years. |
| americans with disabilities act (ADA) | Says that if someone has a hearing loss they must be accommodated in whatever place they are working at or attending - free of charge |
| places that provide aural rehabilitation | -private practice audiologists
-schools
-early intervention
-hospitals
-skilled nursing facilities |
| main effects of hearing loss | -Reduction in absolute sensitivity: audibility - Threshold is higher, sensitivity is lower
-Reduction in differential sensitivity: difficulty discriminating in frequency, temporal and intensity domains from one sound to another |
| secondary effects of hearing loss | -Emotional withdrawal/depression
-Transportation/safety
-Education/Employment
-Loss of Independence |
| Factors Which Influence The Degree to Which Secondary Effects of HL are Experienced | -age
-onset of HL
-progression of HL
personality
-symmetry of HL
support system |
| Relationship between degree of hearing loss and effect of hearing loss on receptive communication (audibility) | -0-15 dB normal hearing
-16-25 almost normal
-15-25 =little difficulty w/ soft speech
-25-40 mild difficulty w/ soft speech
-40-55 moderate difficulty w/ normal speech
-56-70 moderate-severe
-71-90 severe
->91 profound |
| effects of hearing loss on communication | -degree of loss
-ability to understand speech
-demands on the person’s hearing |
| formants | harmonics in the glottal wave that are amplified as they travel through the vocal tract |
| frequency | -Most important info for speech found between 400-3000 Hz
-Speech frequencies (in audiogram) = 500-2000 Hz |
| consonants: place of articulation | -Labiodental
-Bilabial
-Linguadental
-Alveolar
-Palatal
-Glottal |
| consonants: manner of articulation | -stop/plosive
-Fricative
-Affricate
-Nasal
-liquids/glides (semivowels) |
| components of auditory perception | -Detection
-Discrimination
-Identification
-Recognition
-Attention
-Memory
-Closure
-Comprehension |
| What we know about listeners with hearing loss and speech perception | -Listeners with HL have minimal difficulty with vowels
-Listeners with HL have much more trouble with consonants, especially /s/, /p/, /k/, /d/, and / θ /
-Listeners with HL make more perception errors when phonemes are in the word final position |
| the importance of slope of HL | -As steepness of audiogram slope increased, listeners with HFSNHL had increasing difficulty perceiving /s/, /ʃ/, /θ/, /t/, and /ch/
-Audibility above 2000 Hz is crucial for perception of /s/, /ʃ/, and / θ/ |
| speechreading | Process of using cues such as observing speaker’s mouth, facial expressions, and gestures to supplement audition and accurately perceive speaker’s message |
| factors affecting speechreading | -Speaker = Familiarity, Use of appropriate facial expressions/gestures
-rate
-gender
-signal/code = visual phonemes
-environment = distance, visibility, angle
-speechreader = age, gender, visual skills, perception, hearing |
| analytic approach to speech reading | -Visually learn and identify phonemes
-Training = recognition of phonemes, words, phrases, etc
-Time consuming |
| synthetic approach to speechreading | -Vision is only one communication modality
-Training = incorporation of auditory-visual info, use of repair strategies and environmental cues, counseling
-Preparation for “real-world communication” |
| ASL | -Independant language
-Uses visual-manual mode
-Has its own grammar, syntax, dialects, vocabulary, slang, puns, etc
-Signs are meaning-based (Many express a concept rather than just a singular word)
-Official language of the deaf community |
| signed english | -Follows english grammar and syntax
-Uses markers to denote word affixes and suffixes, such as -ing, -ed, -s
-Widely used in education |
| Seeing essential english (SEE 1) | -Signs are based on morphemes
-Extreme form of word-based signs
-Never gained wide-scale popularity in the US |
| Signing exact english (SEE 2) | -Signs are word based
-All affixes in english are signed
-Signed in strict accordance with english word order
-Widely used in education |
| pidgin sign language | -Combines elements of ASL and other sign systems
-Used in conjunction with speech in interpreting
-Frequently uses english finger-spelled words
-Signs are meaning based |
| cued speech | -Aid to oral communication (used in conjunction with lip movements)
-Clarifies ambiguous visual information that arises from visemes
-Uses 8 handshapes in 4 positions on the face (Goal is to tell you what that sound is by using these cues) |
| fingerspelling | -Different hand shape for each letter of the alphabet
-Used to borrow english words in ASL
-Called rochester method when used with speech and speechreading |
| auditory training (AT) | -Teaching a child or adult with hearing loss to maximize auditory information
-Acquisition/development of auditory perception abilities |
| auditory training goals | -Development of the ability to recognize speech using audition and interpret auditory experiences
-The listener maximizes residual hearing and the auditory signal |
| who is a candidate for AT | -Children with prelingual SNHL, usually moderate-profound range with congenital onset
-Children with postlingual SNHL
-Select groups of hard-of-hearing adults
-New cochlear implant users, both adults and children |
| objectives for AT for children | -Development of sound awareness
-Development of gross discriminations
-Development of broad discriminations among simple speech patterns (syllables)
-Development of finer discriminations for speech |
| 4 levels of auditory skill development | -easier to more difficult
-Awareness
-Discrimination
-Identification
-Comprehension |
| AT for children: assessment of auditory skills | -WIPI
-NU-CHIPS
-six sound test
-IT-MAIS |
| AT for adults: assessment of auditory skills | -NU-6
-CCT
-SPIN |
| AT activities for children: in the clinic | -sound awareness
-sound discrimination
-sound identification
-sound comprehension |
| Auditory Training Activities for Children: Technology | -AB Listening Adventures (iPhone and iPad)
-VocAB Scenes (iPhone and iPad)
-Hear Coach |
| Auditory Training Activities for Adults | -Audition Alone Computer Auditory Training Programs
-Audition+Vision Computer Auditory Training Programs
-SmartPhone Apps |
| Hearing loss in adults: impact of Self concept | -difficulty adjusting to a self-concept as someone with a hearing loss
-Cost + Cosmetic concerns of hearing aids
-signs of self-stigma: stress, shame, lower self-esteem
-denial of the hearing loss, a barrier to someone seeking treatment |
| Hearing loss in adults: impact of emotional development | -Anger
-Denial
-Anxiety
-Stress
-Grief
-Depression
-Isolation
-Adults often feel left out; ignored
-Fear |
| Hearing loss in adults: impact of family and social concerns | -Family members may feel stressed or burdened
-Family members may take blame for communication breakdown
-Family members may feel frustrated or disappointed
-Beware of “downward spiral” |
| hearing loss in adults: quality of life | -older adults with hearing loss who did not use hearing aids demonstrated a significantly poorer quality of life score on formal measures
-people with untreated loss experienced more distress and thus a lower quality of life |
| Hearing loss in children: impact of self concept | -Children are in the process of developing their self-concept
-Children with HL at risk for developing poor self-concept
-Cosmetic concerns: “hearing aid effect”
-Preschoolers shown to have fewer negative images (Riensche, et.al, 1990) |
| Hearing loss in children: impact of emotional development | -Difficulties with language sometimes = difficulty with self-expression, understanding of emotions
-Miss opportunities to overhear and learn about strategies to deal with emotions
-Importance of understanding “emotion” vocabulary |
| Hearing loss in children: impact of family concerns | -Families frequently grieve when learning their child has a hearing loss (Mode of communication, Amplification)
-There is a range of emotions (Inadequacy, Guilt, Anger, Confusion, Vulnerability, Fear
-Effects on other family members |
| Hearing loss in children: impact of social competence | -Language difficulties = difficulties with peer interactions, relationships
-more isolated, without friends, and unhappy in school
-Preadolescent children are more fearful of being teased and spend more time alone |
| Language acquisition in children with hearing loss | -Language: A system of communication used by a community
-Hearing loss means the child receives reduced information regarding: Phonology, Syntax, Morphology, Semantics, Pragmatics
-Language Delay = primary consequence of hearing loss for children |
| Factors affecting language acquisition | -Child’s Age
-Age of Amplification
-Early Intervention
-Child’s Cognitive Status
-Presence of other disabilities |
| Does early detection and intervention work? | -EHDI (Early Hearing Detection and Intervention): practice of screening every newborn for hearing loss prior for discharge from the hospital
-Benefits seen in areas of: (Vocabulary development, Syntax and morphology, Phonology, Pragmatics |
| early detection/intervention focuses on | -Receptive and expressive language skills
-Vocabulary
-Pragmatics
-Syntax/Morphology
-Phonology |
| pre-verbal/early communication | -3-4 months old: nonverbal communication; gesture, move, cry, vocalize
-6-12 months old: intentional communication; gesture/cry repeatedly until goal is reached
-Around 12 months old: 1-word stage |
| Language interactions between caregivers and the deaf or hard of hearing child | -“Motherese” used when communicating with young child
-Hearing parent/deaf child: communication is shorter and less complex than when hearing status is the same |
| Language interactions of preschoolers with hearing loss: schema | -Have limited linguistic and world knowledge
-Have limited access to language used in daily routines
-Miss incidental language learning opportunities
-Have limited practice using language |
| Language interactions of preschoolers with hearing loss: semantics and pragmatics | -Have similar semantic and pragmatic functions as younger children with normal hearing
-Use conversational devices (um, oh, etc.) to hold a speaking turn or to find time to search for what to say
-Use fewer “Wh” questions |
| Vocabulary skills of deaf or hard of hearing preschool children | -4-year-old children with normal hearing had an approx. 2000 word expressive vocabulary
-4-year-old children who are deaf had an approximately 158 word vocabulary |
| Language characteristics of school-aged children with hearing loss: lexical/semantic | -Vocabulary delay when compared to their normally hearing age-matched peers
-Degree of delay is often proportional to degree of loss |
| Language characteristics of school-aged children with hearing loss: phonological skills | -Phonological errors similar to those seen in younger children with normal hearing
-Acquisition of speech sounds in the same order as children with normal hearing (Oller and Kelly, 1974) |
| Language characteristics of school-aged children with hearing loss: syntactic skills | -Overuse of nouns and verbs, specifically subject-verb-object sentence
-Omission of function words
-profound hearing loss: use of asequential word order (“saw dog brown”), Misuse of morphological markers, especially for plurality and past tense |
| Language characteristics of school-aged children with hearing loss: pragmatic skills | Difficulty with conversational turn taking, topic initiation, topic maintenance (missing parts of the convo), use of repair strategies (ask to repeat) |
| Speech intelligibility of deaf and hard of hearing children | -Segmental errors
-Suprasegmental errors
-influences = aided thresholds, intervention strategies, age of amplification, consistency of amplification, and frequency of use of speech in environment |
| Speech characteristics of children with mild-moderately severe SNHL | -Final Consonant Omissions: “dog” to “do_”
-Omission/distortion of blends: “black” to “back”
-Omission of voiced consonants: “over” to “oer” |
| Speech characteristics of children with severe-profound SNHL: respiration | -Difficulties in speech breathing
-produces only a few syllables per exhalation
- has a lower than normal lung volume at the initiation of and during speech
-Air is lost during the pre-phonatory period due to inadequate valving |
| Speech characteristics of children with severe-profound SNHL: resonance | -Many deaf talkers have difficulty with nasality; speech is either hypernasal or hyponasal
-Nasal cues tend to be primarily auditory (nasal formant and antiformants) and therefore it can be difficult for deaf talkers to make use of these cues |
| Speech characteristics of children with severe-profound SNHL: phonation | -inadequate vocal fold adduction due to not taking in enough air at inhalation to support phonation
-deaf talkers having “breathy” voices
-It also leads to substitution of voiceless consonants for voiced consonants |
| Speech characteristics of children with severe-profound SNHL: articulation | -Vowel errors: (Substitutions, Neutralizations, Dipthongization, Nasalization
-Consonant errors: (Voiced/voiceless confusions, Substitutions, Omissions; especially in the word final position, Distortions, Consonant cluster errors |
| Speech characteristics of children with severe-profound SNHL: suprasegmentals | -Abnormal stress and rate of speech
-Excessive breathiness
-Difficulty regulating vocal intensity
-Intonation fluctuations over the course of an utterance |
| hearing aids | -Assistive listening devices that are used primarily to hear and understand conversation
-Amplifies the acoustic signal but the device can’t decide what to amplify or not to amplify |
| Goals of amplification | -increase the strength of the auditory signal so it's audible
-provide a clean, clear signal
-shape the signal in order to meet the needs of the HL
-protect the ear from uncomfortable loudness
-meet the expectations of the wearer |
| role of audiologist | -Ensure amplification is appropriate
-Quantitative evaluation of hearing aid function
-Technical monitoring of hearing aid performance
-Counseling |
| parts of hearing aids | -Power Supply: Battery
-Microphone (acoustic --> electric)
-Amplifier (Makes sound louder, goes to receiver)
-Receiver (Sends signal to ear canal)
-Earmold (Individually customized)
-Telecoil (transfers signal from telephone to hearing aid) |
| types of hearing aids: body-worn and eyeglass hearing aids | -Not seen often anymore
-Can sometimes see body aids for infants because they are too small for earmolds and of the uncertainty of hearing status (lots of flexibility)
-Body aids very powerful
-Usually worn in a harness on the body |
| types of hearing aids: BTE (post auricular) | -With BTE aids, all components are contained within the case: microphone, receiver, amplifier and battery
-Worn most frequently by children
-Can provide significant amount of amplification; for people with severe/profound degree of loss |
| types of hearing aids: ITE (custom fit) | -All components encased in custom shell made from ear impression
-school-age children with mild/moderately-severe hearing loss
-pinna enhancements
-No possibility for a “loaner” hearing aid when the custom-fit aid is being repaired and size limitations |
| types of hearing aids: canal/completely in canal | -Very small; hard to visualize
-Can be worn by older adults and teens with mild-moderate hearing loss
-Can use natural enhancements of the pinna and canal but trade off with size limitations
-The smaller the hearing aid the less power it has |
| basic hearing aid schematic | -The mic of the HA picks up the analog sound wave
-Sound wave is changed into a voltage wave, amplified and processed
-Sound is sent to the receiver to be changed back to analog sound wave
-Receiver delivers amplified sound wave to ear |
| analog hearing aid | -Sound wave is represented as a continuous voltage change over time
-Most common type of hearing aid for many years
-Allow for representation of a continuously changing signal (sound) by electrical current |
| digital hearing aid | -Sound wave is changed into bits (0s and 1s) and mathematically manipulated
-The changed back into an analog signal as leaves the hearing aid
-tailor the response of this device to closely meet the needs of the individual wearer
-Clean, clear sound |
| features of digital signal processing (DSP) | -separates incoming sounds into different frequency regions, called channels
-Two directional microphones
-Multiple memory/program capability
-Digital noise reduction
-Data logging
-Bluetooth connectivity
-Smart Phone Apps |
| why are Binaural Hearing Aids are always preferable when audiologically appropriate | -Elimination of head shadow
-Loudness summation
-Localization
-Improved SNR and improved speech perception (especially in noise!) |
