Audiology Essay
3/18/2012
Learning Outcomes
Procedures in audiology
GTP103/2 Introduction to Clinical Audiology and
Speech-Language Pathology
Cheu Lih AW/ March 2012
MClinAud (Melb, Aus), B.Aud (Hons.) (UKM)
Lecturer/ Clinical Audiologist
School of Health Sciences USM awcheulih@kck.usm.my At the end of the session, students should be able to :
• understand procedures in audiolog
describe, in general, methods of assessment in audiology i.e.,
–
–
–
–
–
tympanometry visual reinforcement audiometry conditioned play audiometry speech audiometry auditory evoked response
explain the principle of amplification that involves prescription of ,
– hearing aids
– cochlear implant
– assistive listening devices
Audiologic Screening …show more content…
• includes
HEARING SCREENING
– concern on the part of an individual and/or caregiver – consent of patient or family/caregiver
– case history
– note of problems with hearing, balance, tinnitus, and speech-language
– otoscopic examination
Audiologic screening procedures:
neonates & young infants
(birth through 6 months)
children & adults
appropriate (electro)physiological measures developmentally appropriate assessment procedures & stimuli & response methods
AUDIOLOGIC EVALUATIONS
for patients who fail the audiologic screening, referral to an audiologist for further audiologic assessment/evaluation 1
3/18/2012
Basic Audiologic Evaluation
Acoustic Immittance/ Tympanometry
• Assessments for children & adults include the following: – case history
– otoscopic examination
– acoustic immittance procedures (tympanometry, static immittance, & acoustic reflex measures)
– Pure tone audiometry (PTA)
• air-conduction and bone-conduction pure-tone threshold measures with appropriate masking
– Speech test
Tympanometry
Tympanogram
Pure tone audiometry (PTA)
Transducers
• Supra-aural earphones /
Audiometer
headphones
• Insert earphones / Insertphones / Tubephones
• Bone conduction vibrator / oscillator • Speakers
2
3/18/2012
Frequencies
• Pitch perception
L
O
W
H
I
G
H
• Octave & Mid octave frequencies • Unit: Hertz (Hz)
• Range of young persons with normal hearing :
20- 20,000Hz.
• PTA typically assesses thresholds for frequencies
250 and 8000Hz
(important for speech understanding). Intensities
Normal
• Loudness perception
• Unit: dB Hearing Level
(dBHL)
• Categories of hearing loss
Mild
Moderate
Severe
Profound
Degree
Normal
Mild
Moderate
Severe
Profound
Hearing Loss
(dBHL)
≤20dB
25-40
45-65
70-90
≥95
Speech Audiometry
• Key component of audiologic assessment
• Various speech materials are presented to the patient and the responses are scored
• More realistic manner than with pure tones
3
3/18/2012
Speech Audiometry
…cont.
• Information about the impact of the auditory disorder on the communicative problems of daily living
• Can also detect speech processing problem
• Predictable relation between a person’s hearing for pure tones and speech
– use as cross check on the validity of the pure tone audiogram Otoacoustic Emissions (OAEs)
Other procedures may be completed to supplement the basic audiologic assessment:
• otoacoustic emissions (OAEs) screening
• communication inventories & needs assessment inventories
• screening for central auditory processing disorders or other auditory disorders
Interpretation of the assessment may indicate one or more of the following:
• hearing within normal limits (WNL)
• identification & quantification of hearing loss
• hearing loss identified but further testing required • patient could not be tested (CNT) using procedures Evaluation may result in one of the following:
• discharge &/or recommendations for routine follow-up Pediatric Audiological Testing
• case history
• otoscopic examination
• referral for audiologic rehabilitation evaluation • referral for further audiologic evaluation and/or other services
• acoustic immittance procedures
(tympanometry, static immittance, and acoustic reflex measures)
• otoacoustic emissions testing
4
3/18/2012
Behavioral Observation Audiometry (BOA)/
Distraction Test (DT)
developmentally appropriate behavioral procedures to obtain frequency-specific & earspecific information regarding auditory status
– Behavioral Observation Audiometry (BOA)
• < 6 months old
– Visual Reinforcement Audiometry (VRA)
• > 6 months old with good head & neck control
– Play Audiometry
• 2 years old or more
Visual Reinforcement Audiometry (VRA)
Play Audiometry
• ..\..\..\Teaching Materials\Pediatric audiology Diagnosis, technology, & management\VIDEO_TS\VTS_04_0.IFO
Other tests
• developmentally appropriate behavioral procedures to obtain speech detection/awareness/reception thresholds with appropriate masking
• word recognition measures with appropriate masking • auditory evoked potentials
Interpretation of the assessment may indicate one or more of the following:
• hearing within normal limits (WNL)
• identification & quantification of hearing loss • hearing loss identified but further testing required • speech-language screening
• patient could not be tested (CNT) using
procedures
5
3/18/2012
Evaluation may result in one or more of the following: Auditory Evoked Response (AER)
Evaluation
• discharge and/or recommendations for routine follow-up • ongoing audiologic evaluation and monitoring
• parental counseling
• determines the status of the peripheral & central auditory system
• audiologic habilitation evaluation
• referral to or collaboration with other professionals
(e.g., physician, speech-language pathologist, early intervention program, genetic counselor, educator)
AER evaluation
• provides one or more of the following: ABR
Waveforms
– an estimation of auditory sensitivity – a determination of neural pathway integrity – a determination of probable site of lesion • may include a recommendation for a referral for specialized medical evaluation and/or audiologic rehabilitative
Clinical Indications for AER Evaluations
• objective evaluation of auditory sensitivity and neural pathway status
• patients who are difficult to test by conventional behavioral methods and/or to supplement behavioral information
• to determine site of lesion or resolve conflicting information.
6
3/18/2012
Assessment may include the following:
•
•
•
•
•
•
•
Electrocochleography (ECoG) auditory brainstem response (ABR) auditory steady state response (ASSR) auditory middle latency response (MLR) auditory late (long latency) response (LLR)
P300 response mismatch negativity response (MMR)
Evaluation may result in one or more of the following:
• discharge and/or recommendations for routine follow-up
• recommendation for further testing
Interpretation of the assessment may indicate one or more of the following:
• normal auditory system function including status of the peripheral & ascending neural auditory pathways and hearing sensitivity
• identification & quantification of hearing loss
• abnormal sensory system function and/or abnormal neural pathway function
• determination of site of lesion
• inconclusive test results
Others Who May Perform the Procedure(s)
• Support personnel (technologists/ audiometrician/ technician)
– may conduct selected assessment procedures under the supervision of a certified audiologist but may not interpret the clinical results or provide referrals or recommendations.
• referral for audiologic rehabilitation evaluation • referral to other professionals
Management & Recommendations
• Referral to other professionals
– Speech-language therapist
– Medical doctor/ ENT specialist
– Paediatrician
– Psychologist’
• Prescribe hearing aids
References
• http://www.asha.org/docs/html/SP200400192.html
• http://www.asha.org/docs/html/PP200600274.html#sec1.4.5
• Katz, J. (2009). Handbook of clinical audiology,
6th ed. Philadelphia: Lippincott Williams &
Wilkins
• Identify cochlear implant candidates
7
3/18/2012
Picture References
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
http://www.leightonshearingcare.co.uk/our-services/free-hearing-test-andhearing-assessment http://www.hearingpocket.com/babyonesies.shtml http://www.hearingpocket.com/babyonesies.shtml http://www.dshs.state.tx.us/audio/reimbursement.shtm http://www.hearinglife.com.au/hearing-tests http://www.aafp.org/afp/2004/1101/p1713.html http://familydoctor.co.uk/deafness04 http://www.jish.org/Electrophysiological.html http://www.med.umich.edu/childhearinginfo/pv/vratest.htm http://polishadoptionstory.com/AdoptionImplant.htm http://www.medoto.unimelb.edu.au/images/892?size=preview http://shs.asu.edu/clinic-h-assess http://jnnp.bmj.com/content/66/5/591/F2.large.jpg http://ivertigo.net/hearing/hrfig7.html http://www.otometrics.com/hearing-assessment/immittance/OTOflex.aspx http://www.courses.audiospeech.ubc.ca/haplab/aep.htm 8
Learning Outcomes
Procedures in audiology
GTP103/2 Introduction to Clinical Audiology and
Speech-Language Pathology
Cheu Lih AW/ March 2012
MClinAud (Melb, Aus), B.Aud (Hons.) (UKM)
Lecturer/ Clinical Audiologist
School of Health Sciences USM awcheulih@kck.usm.my At the end of the session, students should be able to :
• understand procedures in audiolog
describe, in general, methods of assessment in audiology i.e.,
–
–
–
–
–
tympanometry visual reinforcement audiometry conditioned play audiometry speech audiometry auditory evoked response
explain the principle of amplification that involves prescription of ,
– hearing aids
– cochlear implant
– assistive listening devices
Audiologic Screening …show more content…
• includes
HEARING SCREENING
– concern on the part of an individual and/or caregiver – consent of patient or family/caregiver
– case history
– note of problems with hearing, balance, tinnitus, and speech-language
– otoscopic examination
Audiologic screening procedures:
neonates & young infants
(birth through 6 months)
children & adults
appropriate (electro)physiological measures developmentally appropriate assessment procedures & stimuli & response methods
AUDIOLOGIC EVALUATIONS
for patients who fail the audiologic screening, referral to an audiologist for further audiologic assessment/evaluation 1
3/18/2012
Basic Audiologic Evaluation
Acoustic Immittance/ Tympanometry
• Assessments for children & adults include the following: – case history
– otoscopic examination
– acoustic immittance procedures (tympanometry, static immittance, & acoustic reflex measures)
– Pure tone audiometry (PTA)
• air-conduction and bone-conduction pure-tone threshold measures with appropriate masking
– Speech test
Tympanometry
Tympanogram
Pure tone audiometry (PTA)
Transducers
• Supra-aural earphones /
Audiometer
headphones
• Insert earphones / Insertphones / Tubephones
• Bone conduction vibrator / oscillator • Speakers
2
3/18/2012
Frequencies
• Pitch perception
L
O
W
H
I
G
H
• Octave & Mid octave frequencies • Unit: Hertz (Hz)
• Range of young persons with normal hearing :
20- 20,000Hz.
• PTA typically assesses thresholds for frequencies
250 and 8000Hz
(important for speech understanding). Intensities
Normal
• Loudness perception
• Unit: dB Hearing Level
(dBHL)
• Categories of hearing loss
Mild
Moderate
Severe
Profound
Degree
Normal
Mild
Moderate
Severe
Profound
Hearing Loss
(dBHL)
≤20dB
25-40
45-65
70-90
≥95
Speech Audiometry
• Key component of audiologic assessment
• Various speech materials are presented to the patient and the responses are scored
• More realistic manner than with pure tones
3
3/18/2012
Speech Audiometry
…cont.
• Information about the impact of the auditory disorder on the communicative problems of daily living
• Can also detect speech processing problem
• Predictable relation between a person’s hearing for pure tones and speech
– use as cross check on the validity of the pure tone audiogram Otoacoustic Emissions (OAEs)
Other procedures may be completed to supplement the basic audiologic assessment:
• otoacoustic emissions (OAEs) screening
• communication inventories & needs assessment inventories
• screening for central auditory processing disorders or other auditory disorders
Interpretation of the assessment may indicate one or more of the following:
• hearing within normal limits (WNL)
• identification & quantification of hearing loss
• hearing loss identified but further testing required • patient could not be tested (CNT) using procedures Evaluation may result in one of the following:
• discharge &/or recommendations for routine follow-up Pediatric Audiological Testing
• case history
• otoscopic examination
• referral for audiologic rehabilitation evaluation • referral for further audiologic evaluation and/or other services
• acoustic immittance procedures
(tympanometry, static immittance, and acoustic reflex measures)
• otoacoustic emissions testing
4
3/18/2012
Behavioral Observation Audiometry (BOA)/
Distraction Test (DT)
developmentally appropriate behavioral procedures to obtain frequency-specific & earspecific information regarding auditory status
– Behavioral Observation Audiometry (BOA)
• < 6 months old
– Visual Reinforcement Audiometry (VRA)
• > 6 months old with good head & neck control
– Play Audiometry
• 2 years old or more
Visual Reinforcement Audiometry (VRA)
Play Audiometry
• ..\..\..\Teaching Materials\Pediatric audiology Diagnosis, technology, & management\VIDEO_TS\VTS_04_0.IFO
Other tests
• developmentally appropriate behavioral procedures to obtain speech detection/awareness/reception thresholds with appropriate masking
• word recognition measures with appropriate masking • auditory evoked potentials
Interpretation of the assessment may indicate one or more of the following:
• hearing within normal limits (WNL)
• identification & quantification of hearing loss • hearing loss identified but further testing required • speech-language screening
• patient could not be tested (CNT) using
procedures
5
3/18/2012
Evaluation may result in one or more of the following: Auditory Evoked Response (AER)
Evaluation
• discharge and/or recommendations for routine follow-up • ongoing audiologic evaluation and monitoring
• parental counseling
• determines the status of the peripheral & central auditory system
• audiologic habilitation evaluation
• referral to or collaboration with other professionals
(e.g., physician, speech-language pathologist, early intervention program, genetic counselor, educator)
AER evaluation
• provides one or more of the following: ABR
Waveforms
– an estimation of auditory sensitivity – a determination of neural pathway integrity – a determination of probable site of lesion • may include a recommendation for a referral for specialized medical evaluation and/or audiologic rehabilitative
Clinical Indications for AER Evaluations
• objective evaluation of auditory sensitivity and neural pathway status
• patients who are difficult to test by conventional behavioral methods and/or to supplement behavioral information
• to determine site of lesion or resolve conflicting information.
6
3/18/2012
Assessment may include the following:
•
•
•
•
•
•
•
Electrocochleography (ECoG) auditory brainstem response (ABR) auditory steady state response (ASSR) auditory middle latency response (MLR) auditory late (long latency) response (LLR)
P300 response mismatch negativity response (MMR)
Evaluation may result in one or more of the following:
• discharge and/or recommendations for routine follow-up
• recommendation for further testing
Interpretation of the assessment may indicate one or more of the following:
• normal auditory system function including status of the peripheral & ascending neural auditory pathways and hearing sensitivity
• identification & quantification of hearing loss
• abnormal sensory system function and/or abnormal neural pathway function
• determination of site of lesion
• inconclusive test results
Others Who May Perform the Procedure(s)
• Support personnel (technologists/ audiometrician/ technician)
– may conduct selected assessment procedures under the supervision of a certified audiologist but may not interpret the clinical results or provide referrals or recommendations.
• referral for audiologic rehabilitation evaluation • referral to other professionals
Management & Recommendations
• Referral to other professionals
– Speech-language therapist
– Medical doctor/ ENT specialist
– Paediatrician
– Psychologist’
• Prescribe hearing aids
References
• http://www.asha.org/docs/html/SP200400192.html
• http://www.asha.org/docs/html/PP200600274.html#sec1.4.5
• Katz, J. (2009). Handbook of clinical audiology,
6th ed. Philadelphia: Lippincott Williams &
Wilkins
• Identify cochlear implant candidates
7
3/18/2012
Picture References
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
http://www.leightonshearingcare.co.uk/our-services/free-hearing-test-andhearing-assessment http://www.hearingpocket.com/babyonesies.shtml http://www.hearingpocket.com/babyonesies.shtml http://www.dshs.state.tx.us/audio/reimbursement.shtm http://www.hearinglife.com.au/hearing-tests http://www.aafp.org/afp/2004/1101/p1713.html http://familydoctor.co.uk/deafness04 http://www.jish.org/Electrophysiological.html http://www.med.umich.edu/childhearinginfo/pv/vratest.htm http://polishadoptionstory.com/AdoptionImplant.htm http://www.medoto.unimelb.edu.au/images/892?size=preview http://shs.asu.edu/clinic-h-assess http://jnnp.bmj.com/content/66/5/591/F2.large.jpg http://ivertigo.net/hearing/hrfig7.html http://www.otometrics.com/hearing-assessment/immittance/OTOflex.aspx http://www.courses.audiospeech.ubc.ca/haplab/aep.htm 8