pp ch 14 counseling, professionalism

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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