Audiology Final PDF

Katelyn Marcia Introduction to Audiology Peter Adamson Final 1) What is a Baha? How does it work? Who is a candidate? Baha stands for bone anchored hearing aids; they can be surgically i...

Katelyn Marcia Introduction to Audiology Peter Adamson Final 1) What is a Baha? How does it work? Who is a candidate? Baha stands for bone anchored hearing aids; they can be surgically implanted or they can be placed externally. They are primarily used for patients that have mixed hearing loss, conductive hearing loss and those with single sided deafness. The mechanism first begins by surgically implanting, anchoring a screw into the skull behind the ear, where an external device would be connected, which then stimulates the cochlea directly via bone conduction. The system consists of three components. The first component is the implant which is fixed into the skull and takes advantage of the skull’s natural bone conduction to vibrate the head to which will trigger a response directly to the cochlea. The second component is the abutment is a piece that is connected to the implant and is able to attach to the processor. The last component is the processor, which has a microphone that picks up sound from the environment to transmit it to the implant. 2) What is a cochlear implant? How does it work? Who is a candidate? A candidate for a cochlear implant is an individual with severe to profound sensorineural hearing loss who has demonstrated poor speech recognition, as indicated by a low word recognition score. This includes individuals who wish to develop oral language, whether they are pre-lingually deafened (before language development) or post-lingually deafened (after language development). Candidates must be medically able to undergo the surgery and have access to the procedure. Additionally, they must be committed to the extensive follow-up care required, which involves working closely with a speech-language pathologist, audiologist, ENT surgeon, and primary care physician to achieve optimal outcomes. Access to insurance or a physician willing to assist regardless of insurance status is also an important factor for candidacy. A cochlear implant is a surgically implanted device that can enhance the patient’s ability to hear and speech. First, an external speech processor captures the ambient sounds from the environment and converts them into digital signals. The signals are then transmitted to an internal implant that’s under the skin and the implant converts the signals into electrical impulses which are sent to a neck electrode array, inserted into the cochlea. The electrode stimulates the auditory nerve and carries the signals into the brain. The brain then interprets these signals as sound therefore allowing the patient to perceive the sounds happening in their environment. Katelyn Marcia Introduction to Audiology Peter Adamson Final 3) What are hearing aids? How do they work? What are some styles of HAs? Who is a candidate? Hearing aids are listening devices that provide frequency based amplification to assist, manage hearing loss. Hearing aids consist of a microphone, amplifier and a receiver or speaker. First the microphone picks up the sound waves that are occurring in the patient’s environment. Then, the microphone converts the sound from acoustic energy to electric energy. The electric signal reaches the processor where it analyzes the sound and uses algorithms to potentially enhance the quality of the sound either through volume, clarity, etc. The receiver then transforms the electrical energy back to acoustic energy where amplified sounds than enters the ear. There are a couple of styles of hearing aids. One of the styles of hearing aids is behind the ear hearing aids. The hearing aids fit behind the pinna which connects to a sound tube and an earpiece that sends the amplified sound directly into the ear. Another style of hearing aid is an in the ear hearing aids. The style of hearing aid regardless of in the ear or behind the ear is highly influenced by the degree of hearing loss and the patient's cosmetic preference. There are three styles of in the ear hearing aids. The first style of in the ear hearing aids is that the device fills the entire concha portion of the outer ear and is generally referred to as a full shell in the ear hearing aid. The second kind of in the ear hearing aid is referred to as half shell so it only fills half of the concha portion of the outer ear. The third form is in the canal ear canal, which is a smaller then the half shell device, and it could only be seen in the opening of the concha. For a patient to be considered a candidate for a hearing aid they have to accept that they have some sort of hearing loss. That they have difficulty communicating in general. They have to have mild to moderately severe sensorineural hearing loss. It is crucial for the patients to be motivated and willing to seek assistance. Which that means they have to be open to what the professionals are going to say, they have to overlook cosmetic concerns, the psychosocial implications of having a hearing aid. They have to have the ability, accessibility to obtain these hearing aids whether it be through finding a location that can provide them. Or having insurance that can provide some sort of coverage. They also must have good or excellent word recognition scores generally above an 80. 4) What are some barriers to obtaining hearing aids? List/describe at least four. One barrier to obtaining hearing aids is the cost behind them. They typically cost around $3000-$10,000 a pair. For those who need two hearing aids the price will be significantly higher. They typically are not covered by many insurance plans and are not covered by Medicare. Medicare is an insurance plan that is provided to patients that are over 65. Another barrier to a patient obtaining hearing aids is the overall acceptance of a hearing issue and getting past the implications, connotations that surround that. This content influences the Katelyn Marcia Introduction to Audiology Peter Adamson Final patients preference wanting a device that is as inconspicuous as possible. Just generally finding a hearing aid that they are most willing to use more challenging. Furthermore, it can impact whether or not the patient wants to receive help which in turn can negatively impact their quality of life, safety. A potential barrier is does the patient have a support system? Do they have people in their lives that will not judge them more so help them and be willing to be supportive of their hearing conditions ? If the patient has a supportive community, influence in their lives, they are more willing to obtain the hearing aids to continue to participate in these peoples lives. Even if it’s something as simple having somebody to help them change the batteries or put the hearing aids on can greatly impact their decision on obtaining them. Lastly is does the patient have the skills to keep, maintain, use their hearing aids. For example, if the patient does not have good enough fine motor skills that could mean they could have a challenging time the battery, adjusting the volume, or even putting the hearing aids on. 5) Describe an audiogram. What is being measured? What units? What are the ranges for what is being measured? Where is normal hearing? Where is a profound hearing loss? What can you say about speech sounds above and below 1000Hz? An audiogram is a graphical representation of an individual’s ability to hear at different frequencies and intensities. It is used to asses and diagnose the degree of hearing that the individual has. The audiologist is measuring the intensity in which the patient can perceive the sound that is set to a specific frequency. Frequency is measured in Hertz (Hz) and intensity commonly referred to as volume is measured in decibels (dB). The frequencies typically assessed are 250, 500, 1000, 2000, 4000, and 8000 Hz for air conduction testing. The intensities can begin from -10dB all the way to 110 dB in an audiogram however in the case for air conduction testing they typically start the assessment at 40dB and go on from there. Normal hearing is usually located between 0-25 dB. Profound hearing loss is located at thresholds that are above 90 dB. Speech sounds that are above 1000 Hz are typically unvoiced phonemes, the air is just going through the vocal folds. These sounds at this frequency are what give speech clarity and allow you to help understand what a person is saying. Speech sounds that are below 1000 Hz are voiced sounds, the vocal folds vibrate. Therefore these sounds give speech its audibility, loudness. Katelyn Marcia Introduction to Audiology Peter Adamson Final 6) List and define at least four examinations that we can use on babies or difficult-to-test adults that provide information about a patient’s hearing. Play audiometry is a hearing test that is performed on children that are between the ages of 2 and 5. This test is treated as a game for the child. The sound is coming out of speakers in the sound treated room. Everytime the child hears, perceives the sound they are to participate in the game in particular way. For example, child is told every time the captain blows his whistle (the stimulus) drop a block into the bucket, to indicate that they can hear the sound. The reason we perform these tests is to see if the child shows any general signs that they cannot hear. Visual reinforcement audiometry is another type of hearing tests that occurs with much younger patients between six to seven months old. This test occurs in a sound treated room with speakers on either side of the patient with one audiologist interacting with the patient and the other audiologist presenting the stimulus on the other side of the booth. If the child perceives the sound, they will have to notably turn their head, which is then reinforced with the presentation of a cartoon or a toy within the box that’s on top of the speaker. If the child perceives the sound, they will have to notably turn their head, which is then reinforced with the presentation of a cartoon, a toy within the box that’s on top of the speaker. Auditory brainstem response is a form of assessing the functionality of the auditory pathway, cochlea, and cranial nerves. They place a small electrode on the scalp near the ears to record the electrical signals from the auditory nerve to the brain stem. Then clicking sounds are delivered through headphones and the auditory systems response is recorded in waveforms. The audiologist interpret the waveforms are than assessed to evaluate if there are any hearing complications. Tympanometry is another form of testing that asses the compliance of the tympanic membrane. This means that they are assessing the functionality of the middle ear, the ear drum, the ossicles. A low frequency probe tone is used at 220 Hz or 226 Hz at about 70 dB. They asses the movement of the tympanic membrane as the air pressure changes to see if there could be any issues that could negatively affect the patient’s hearing. Katelyn Marcia Introduction to Audiology Peter Adamson Final 7) List and define three ear/hearing pathologies that result in conductive hearing loss; list and define three ear/hearing pathologies that result in sensorineural hearing loss. Describe what the pathology is, how it affects the ear/hearing system, and how it can be treated. You must use pathologies discussed in class using your classmates’ presentations under Unit Four on Blackboard. Conductive Hearing Loss Pathologies: Otitis externa is an infection of the external auditory canal. It can be caused by either bacterial or fungal infection. A common cause is excessive moisture in the air that can be trapped following a bath or swimming. It could also occur if the patient has been exposed to contaminated water or if there’s damage to the skin of the ear canal. This impacts the skin integrity too much inflammation and the overproduction of earwax can hinder soundwaves from travelling to the ear drum. The most common treatment for it are antibiotic eardrops if it’s a bacterial infection, if it’s a fungal infection they use antifungals as well as corticosteroids to reduce the inflammation in the swelling. Other forms of treatments can include an ear canal cleaning, the use of warm compresses as well as pain management medications such as ibuprofen. Other forms of treatment can include an ear canal cleaning, the use of warm compresses as well. Otitis media it is an ear infection or the inflammation of the middle ear. It can affect the ear due to the accumulation of fluid. The build of fluid can potentially build up the pressure leading to eardrum rupture. If the infection spreads there can be an inflammation of the mastoid bone, the bone behind the ear. If it spreads even further it can affect the brain leading to meningitis. The buildup of fluid in the ear prevents the eardrum from being able to vibrate, therefore inhibiting the transmission process that occurs in the middle ear. To treat it, the doctors can prescribe antibiotic medications, pain relief medications, anesthetic drops, and continual monitoring to see if there’s any change. Another form of treatment, depending the severity of the infection is a tympanostomy where an incision is made on the eardrum to help drain the fluid that’s accumulated through the middle ear. Small tubes are inserted on the eardrums, which allows for air ventilation, equalizing the pressure in the middle ear cavity as well as further draining of the fluids. Cerumen impaction is the accumulation and the impaction of earwax. This could happen because some people just produce too much earwax in general, or they could be placing things down the ear canal such as cotton swabs that could be pushing the earwax further. The earwax primarily affects the ear canal, as well as the eardrum, meaning that sound is unable to pass through the ear canal and or the middle ear. Meaning that acoustic energy is not easily Katelyn Marcia Introduction to Audiology Peter Adamson Final converted into mechanical energy, which could imply conductive hearing loss. Treatments for this are the irrigation of the ear canal, use of eardrops, as well as the removal of the wax with instruments such as using a metal or plastic loop. Sensorineural Hearing Loss Pathologies: Ototoxicity it is the damage of the inner ear caused by certain medications or chemicals. The ototoxic substances can lead to the death of hair cells in the cochlear and vestibular system. The hair cells are central for our hearing and balance, and once they are damaged, they cannot regenerate. Another way it could cause harm is from oxidative stress that leads to cellular damage. Also, if there is an increased amount of inflammation that can make things worse for the hair cells and other structures within the inner ear. Which is all to say that it could negatively ones hearing as well balance. One form of treatment for this is to adjust or change the medication dosage. Another form is use of hearing aids and auditory training which are exercises designed to help listening skills. As well as balance rehab, which is vestibular rehabilitation therapy and it helps patience with balance issues to help retrain the brain to process balance signals again. Noise induced hearing loss is when an individual is generally exposed to sounds that are over 85 dB for a prolong period of time. This could be from going to work like construction or going to a concert which could expose you to upwards of 94 dB. If the sound is loud enough, it can rupture the eardrums or break the ossicles in the middle ear. Furthermore, it can cause damage to the hair cells within our inner ears which give us the ability to hear different frequencies and perceive different sounds. These cells do not regenerate and are essential to converting sound into electrical signals so our brains can understand what’s happening. One form of treatment is cochlear implants, the use of hearing aids and assistive listening devices. Yet the biggest form of treatment is also prevention by limiting the exposure to loud environments, if need be to wear earplugs or earmuffs to dampen the intensity of sound. Also to follow a rule of thumb, which is that you can be exposed to 80 to 85 dB for eight hours and for every 5 dB increase from that you have to half the amount of time of exposure. Auditory Neuropathy Spectrum Disorder(ANSD) is when the inner ear is able to detect sound, but the information cannot be sent to the brain comedy issue takes place in the inner ear and the auditory nerve. There is a poor connection between the inner hair cells and the auditory nerve. The nerve can have a lesion or it can have a defect, in all cases, the timing in the pattern of the electrical signals, and the auditory nerve is disrupted. Treatment for this includes frequency, modulation systems, hearing aids, cochlear implants, and the help of a team of specialist which would be an audiologist, a ears, nose, throat doctor, a speech language pathologist as well as an education specialist. Katelyn Marcia Introduction to Audiology Peter Adamson Final 8) What is a conductive hearing loss? A sensorineural hearing loss? A mixed hearing loss? A sensory loss? A neural loss? Sensorineural hearing loss occurs when there is damage to the inner ear, the cochlea or the neural pathway that facilitates hearing. For example, if there is a tumor on cranial nerve eight that could lead to an individual's reduction of hearing. Conductive hearing loss occurs when there is any damage, obstruction that occurs to the middle or the outer region of the ears leading to a reduction in the sensitivity of that person's hearing. Mixed hearing loss means that there is some conductive hearing loss as well as sensorineural hearing loss. In other words, there are potential issues happening in the outer ear, middle ear and/or the inner ear influencing the reduction in the person’s hearing. A sensory loss is the loss or minimization of one or more of the five senses (sight, hearing, taste, touch and smell). A neural loss is the loss of specialized cells in our nervous systems which is responsible for transmitting information to our brain, spinal cord and other parts of our bodies. 9) What are assistive listening devices and what are they for? Name three discussed in class or from the text, and how they could help. Assistive listening devices are devices that enhance the quality of desired sounds especially in environments that are too loud or with poor acoustics. - An example of an assistance hearing device is a CapTel, a captioned telephone. It is a telephone that has a screen hooked above the phone where it displays, transcribes the conversation that is happening. It allows the user to see and hear what the speaker is saying at the same time - Another example are fm wireless systems. It uses radio signals to transmit sound from a microphone to a the receiver the listener is wearing. This helpful especially in a classroom setting so it can link to the user’s ear so they can hear the lesson. Almost as if the teacher is talking right into the students ear. Katelyn Marcia Introduction to Audiology Peter Adamson Final - The last example of an assistive listening device are hearing system loops. The loops use electromagnetic signals to transmit sounds directly into hearing aids that have a telecoil. This is helpful since it does not require additional equipment since it just connects to the patient’s hearing aid. It is espcially helpful in loud environments such as a noisy resturant so the user can understand what is happening with much more clarity. 10) If a baby refers on a newborn hearing screening, what might this imply? Also, what are the next steps for the patient/parent? If a baby refers on a newborn hearing screening test this might imply that there could be some sort of hearing issues. The following steps would for the parents to come back with the patient for further testing such as tympanometry. If the testing comes out with a flat test, which could be from fluid in the middle ear or earwax impaction. If that is the case, the patient is given some sort of treatment and are told to come back in two weeks. If the results come out as mobile then they come back so that a non-sedated auditory brainstem response is performed to assess the functionality of the auditory pathway. It would be at this point that they would diagnose if there’s any hearing loss and begin early intervention, genetic testing, hearing aids, and speech language therapy.