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

2. Immittance Testing: Tympanograms

3. 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

4. Immittance: Acoustic Reflex

5. 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

6. DPOAE

7. DPOAE

8. 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.)

9. ABR

10. ABR & Physiology

11. Middle Latency Responses

12. 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

13. Speech Perception: Audibility

14. Speech Intelligibility Index

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

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

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

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

19. 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

20. 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

21. 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).

22. 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

23. 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)

24. 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

25. 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.

26. 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

27. 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

28. 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):

29. 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.