Clinical Application: Auditory Chapter 10 Perry C. Hanavan, AuD

Immittance Testing: Tympanograms

Immittance: Static Compliance Acceptable Range by Age Flaccid: disarticulation, flaccid TM, etc. 0.9 1.8 Normal mobility 0.2 0.3 Stiff: otosclerosis, fluid, tympanosclerosis, etc. Child Adult

Immittance: Acoustic Reflex

Otoacoustic Emissions David Kemp disovered OAEs Acoustic energy produced by the cochlea and recorded in the external auditory canal Most likely energy produced by outer hair motility and possibly outer hair cell cilia Objective test DPOAE TEOAE

DPOAE

DPOAE

Auditory Evoked Potentials Auditory evoked potential analyzed on logarithmic time-base to reveal the component potentials with approximately equal weighting and categorized in arbitrary but commonly used time windows of short- (SLR), middle- (MLR), and long- (LLR) latency responses. (Figure modified and redrawn from Michelini et al., 1982.)

ABR

ABR & Physiology

Middle Latency Responses

Frequency-Following Response (FFR) Speech-evoked frequency-following response (FFR): Noninvasive snapshot of sound processing in CNS Same equipment used for ABRs Replace click or chirp stimuli for complex sound such as speech

Speech Perception: Audibility

Speech Intelligibility Index

Prosthetic Devices Hearing Aids (HA) Cochlear Implants (CI) Hearing Assistive Technologies (HAT)

Cochlear Implants (CI) How A Cochlear Implant Works by Advanced Bionics Elsie's Cochlear Implant Switch On! Today Tonight

Hearing Aids (HA) Oticon Opn™ - Craft Your Own Connections Introducing Oticon Opn - a true paradigm shift in hearing care

Hearing Assistive Technologies (HAT) Roger Voice Kickstarter campaign AVA Communicate Beyond Barriers Jacoti Lola Classroom - student tutorial - join a session 2/2

Otitis Media Prevalent among children birth to 6. At-risk children for OM: Down Syndrome Cleft Palate (cranial facial) Treacher-Collins (cranial facial) 2nd-hand smoke Day-care Low income (Inner city, Native Americans, etc.) Bottle fed rather than breast fed Allergies Other infections (upper respiratory) Immune suppression (HIV, AIDS, etc.) Family history

OME Tendencies Language impairments Poor phonetic processing At-risk for developmental delays in perceptual and phonemic awareness, thus leading to difficulties with higher level language functioning and reading

Specific Language Impairment Characterized by difficulty with language not caused by: known neurological, sensory, intellectual, or emotional deficit. Can affect the development of: vocabulary, grammar, and discourse skills, with evidence that certain morphemes may be especially difficult to acquire (including past tense, copula be, third person singular).

SLI (cont.) Children with SLI may be intelligent and healthy in all regards except difficulty with language May in fact be extraordinarily bright and have high nonverbal IQs Children with SLI usually learn to talk late child 3 or 4 years of age with limited vocabulary and short utterances Likely to be kids told by parents and teachers they are smart but unmotivated and just need to try harder

SLI (cont.) Difficulty processing rapid acoustic speech cues (temporal processing problem) Difficulty identifying formant transitions, thus difficulty identifying phonemes Children of the Code Paula Tallal (Temporal spectral deficits)

Dyslexia Categorical perception difficulty Reading ability is significantly lower Difficulty perceiving consonant contrasts Confuse sounds phonetically similar May have deficits in processing the temporal order of acoustic information (difficulty identifying phonemes and judging the order in which the phonemes are heard) Difficulty segmenting, discriminating and identifying speech sounds

Types of Dyslexia Developmental phonological dyslexia - difficulty with nonword reading. Changing the initial and middle letters of a word. Examples are mana (mama) and aufo (auto). Developmental surface dyslexia - difficulty in reading irregular words. 25% English words are irregular, which means that they violate English spelling-to-sound word rule. Examples: pretty, bowl, and sew.

Etiology of Dyslexia Heredity: Family gene carries the disorder Studies have shown that males are four times more likely to have a reading disorder than a female; However, perhaps a male’s behavior contributes to this as it brings forth the disorder to a teacher’s attention more easily. Perhaps females can more readily compensate

Etiology of Dyslexia Environment: Limited English vocabulary English as second language students. Difficulty understanding phonemics. Children of poverty Children with parents with low reading levels Students with speech or hearing impairments

Articulatory Problems Categorized into subgroups: 1. Those with speech perception difficulties 2. Those with normal speech perception Subjects asked to identify words that contrasted phonemes /s/ and /S/. In this test, a subgroup of articulation-disordered children were unable to identify the test stimuli appropriately (seat vs. sheet). Subjects asked to identify words that contrasted the phonemes /s/ and /theta/, In words sick and thick, and none of the articulation-disordered children were able to identify these words appropriately whereas children without disorder could. Important to assess speech perception abilities prior to initiating articulation therapy Rvachew S & Jamieson DG. (1989). Perception of voiceless fricatives by children with a functional articulation disorder. J Speech Hear Disord.; 54(2):193-208.

Reading Disorders Difficultly reading or understanding material within a reading. Most have problems with their phonemic (sound/symbol relationships) awareness development. Have difficult time putting together letters to make a sound.