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8/3/2019 PP CH 14 Counseling, Professionalism
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Audiology and Hearing Loss
Chapter 14
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How Widespread isHearing Loss?
US: 28.6 milliono 1 in 1000 infants
o 83 in 1000 children: educationally significant 95% newborns now being screened in US
o 50% baby boomers
iPod generation.???
new data
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Parts of Ear
1. Outer ear
Pinna
External auditory
meatus
2. Middle ear
Tympani membrane
Ossicles
Eustachian tube
3. Inner ear Cochlea
Vestibular system
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INNER EAR
MIDDLE EAR
TYMPANICMEMBRANE
EAR CANAL
PINNA
OUTER EAR
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THE OUTER EAR
Pinnao Amplifies soundo Localizes sound
External auditory meatus (ear canal)o leads to tympanic membrane (eardrum)
Transmits sound waveo ACOUSTIC ENERGY
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THE TYMPANIC MEMBRANE
Between outer & middle earo Thin, strong, flexible
Sound waves cause it to vibrateo ACOUSTIC ENERGY of sound way toMECHANICAL ENERGY
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THE MIDDLE EAR
Air-filled Eustachian tube:
o middle ear tothroato Equalizes air pressure
Ossicles (ear bones)o Malleus (hammer)o Incus (anvil)o Stapes (stirrup)
Pushed by the eardrum
Stapes pushes on openingto inner ear
ossicular chainacts likea lever
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Size of the OssiclesCompared to a Dime
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INNER EAR Cochleavery
complexo Curled tubeo Fluid-filled
Sends signal:
auditory nerve tobraino Push from ear bones
vibrates fluid
o Hair cells trigger nervesignals
Vestibular systemo balance & spatial
orientation
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Hearing Loss
2. Sensorineural
hearing loss
Disorder of inner ear
Usually permanent
Causes loss of loudnessand clearness
3. Mixed hearing loss
Conductive andsensorineural
1. Conductivehearing loss
Disorder of outer or
middle ear Can often be treated
medically
Causes loss of
loudness
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Hearing Loss
4. Central Auditory Processing Disorders(CAPD)
Children or elderly Trouble with:o Localizationo Lateralizationo
Discriminationo Processingo Speech in noise
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Hearing Evaluation
Audiologic testingmeasures how intensesound has to be at low tohigh frequencies for the
client to hear it
Test results are recordedon an audiogram
The range of normal
hearing is from -10 dB HLthrough 25 dB HL
F i d I t iti f
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Frequencies and Intensities ofSpeech and Noise (pg. 442)
THE SPEECHBANANA
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Audiological AssessmentProcedures
Screeningo Pure tones at 20-25 dBo Key frequencieso
Pass/fail
Assessmento Full audiogram (thresholds)
air conduction vs bone conductiono Speech detectiono Speech discriminationo Other testing
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Behavioral Testing
Pure Tone Audiometer Typical Audiometry raise your hand
Infants/toddlerso Visual reinforcement or play audiometry
Speech Audiometryo Detection
o Discrimination
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Examples of hearing test results
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Tympanometry:Test of middle ear function
Ear drum (tympanicmembrane) moves bestwhen air is equal on bothsides
If Eustachian tubedysfunction occurs Air pressure is not equal on
both sides of TM
TM movement is reduced
If an obstructive conditionsuch as earwax or middleear fluid is present TM cannot move
Probe is placed in clientsear canal Creates air tight seal
Air pressure sweep
ranging from positive tonegative is introducedinto ear canal along withtone
Equipment measures TM
movement as airpressure changes andgraphs results
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Types of tympanograms
Type A
Peak near 0 mm/H2O
Normal
Type C
Peak greater than -250mm/H2O
Eustachian tubedysfunction
Type B Flat
Impacted ear wax ormiddle ear fluid
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Persons with hearing loss
Hearing impaired: person with any type ordegree of hearing loss
Hard of hearing: person with sufficient
residual hearing, often through use ofhearing aids, to use audition as primarychannel for communication
Deaf: person with hearing impairment sosevere that audition is not primary channelfor communication
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Hard of Hearing
Speech is not always normal
Speech-language intervention is oftennecessary
HOH individual might function as deafwithout early identification, consistent useof amplification, and appropriate
intervention Benefit from visual cues to supplement
audition
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Deaf
Vision rather than audition is primary channel forcommunication and learning
Might have some intelligible speech but oftenuse signs as primary mode of communication
Usually benefit from hearing aids but aidedsignal is limited and often inadequate foraudition to be primary channel forcommunication
Often candidates for cochlear implant Some deaf individuals can function as hard of
hearing with right intervention, hearing aidsand/or cochlear implant
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Hearing Impaired Listeners
HI listeners have more difficultyunderstanding soft or distant speech
HI listeners have more difficulty
understanding speech in poor listeningconditions
HI listeners sometimes hear speech but do
not understand it HI listeners do not hear equally well in all
circumstances
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Hearing Aids
Amplify frequencies where hearing lossoccurs
Ideally
Makes soft sounds audible
Makes average sounds comfortable
Makes loud sound tolerable
Output can never exceed loudnessdiscomfort level
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Behind-the-Ear Hearing Aid
Hearing aid fitsbehind the ear andattaches to an ear
mold custom made tofit the persons ear
Used for severe toprofound hearing loss
and for children
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Completely-in-the-Canal: CIC
Smallest hearing aid
Fits deep into earcanal
Used for mild tomoderately-severehearing loss
Most expensive
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In-the-canal: ITC
Larger than CIC
Less expensive thanCIC
Fits mild to severehearing loss
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Open-Ear
Does not completelyfill up ear canal
Small case fits behind
the ear Least visible
Has most natural
sound quality
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Cochlear Implant Surgically implanted
electronic device
Stimulates undamagedfibers of CN VIII,auditory nerve
Multichannel electrodeis threaded throughcochlea and stimulatesnerve
Provides a sense of
sound to individualswho do not receivesignificant benefit fromhearing aids
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Mode of Communication
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Communication Options
Spoken vs. Manual communication
Spoken optionso Auditory-Verbal -hearing skills & amplificationo Auditory-Oral -also includes using speech reading
Manual communication typeso Sign Language -communication system which uses hand
signal to represent word or concept
o Fingerspelling -hand signal to represents each letter ofalphabet; words are spelled out
o Cued Speech -manual supplement to lip readingo Total Communication -combination of auditory-verbal and
manual communication
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Family Issues
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Issues for the Family
90% of deaf children are born into hearingfamilies
Divorce rate is higher than the national averagefor families with special needs children
Insurance does not cover all expenses incurredin raising a special needs child
Child care can be hard to find
Numerous appointments can interfere with work,or might even make it impossible for bothparents to work
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Parent Comments Feeling of powerlessness
They feel they are no longer in charge of their child Overwhelmed by the amount of information they are given and
responsibilities associated with managing hearing loss
They receive an abundance of conflicting advice and opinions
Feeling of uncertainty
They need to make important decisions about issues they arejust beginning to learn about
They question whether or not they can parent a hearing impairedchild
Worries about the future
Finances Finding good services and education
Timetable for raising a special needs child; will the child be self-supporting and independent adult
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Parent Counseling
When parents are told they have a deaf child,they begin a grief process
Disbelief
Denial of diagnosis Denial of implications
Anxiety: unmanaged confusion
Anger Guilt
Acceptance
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