Pediatric Amplification flashcards |

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Why is Pedi Amp an issue as compared to Adult amp?

Adults don't have growing ears. Fitting will continually change for children. Kids don't also have a base for language.

Is there a minimum age for fitting HAs?

No! Youngest is 3 months, dependent on how quickly services go.

Can you base binaural HA fitting on sound field MRL?

No because it's not ear specific; only getting one ear. Could potentially get too much lows or highs.

If the child's developmental age is < 6 months, ____

Confirm behavioral responses with electrophysiology (ABR)

List the advantages of Click ABR?

-The only thing that checks for auditory neuropathy.

- Clean waveform and easy to interpret.

List disadvantages of Click ABR

- Doesn't give you any lows

- Clicks are based on the best threshold in 2000-4000 Hz.

Never EVER EVER fit based on...

Click ABR

If you fit based on Click ABR...

2000-4000 Hz



ABR clicks.


Minimum Click at 500 Hz, and then try to get 2000 and 4000 Hz to continue to work on the fitting.

ABR Tone Burst

โ€ข Confirming behavioral responses if child's developmental age is <6 months
500 Hz; more freq. specific
โ€ข Argument for slope of click-evoked wave V latency-intensity function tells configuration of the loss

Correction Factors

โ€ข 500: 15-20 dB
โ€ข All other freqs.: 10 dB
โ€ข nHL - correction factor = eHL

You should NOT fit with ABR information IF ____________ is in question.

neurologic status

Make sure you cross ABR with other _______ to ensure accuracy.

independent measures

RECD

difference in output of HA between the real ear and 2-cc coupler. Comparison of exact same signal of the 2cc coupler and the signal measured in the canal

2cc coupler is the average _____

adult size ear canal

HH 2 Coupler is used for _____

BTEs

Who do you use DSL and NAL for?

DSL: children
NAL: adults

What is the GOAL for DSL?

To provide children with amplified speech that is consistently audible, comfortable, and undistorted across the frequency spectrum. Flexible in what intensity reference is used.

What consideration factors are taken into account for DSL by AGE?

RECD and ear canal response

Speech mapping can be done through____

Test boxes

List the pros for aided sound field measures.

โ€ข More helpful for counseling

โ€ข Good cross-check

List the cons for aided sound field measures.

- The HAs will think the tones are noise.

- Never use Behavioral thresholds to fit HAs

- Not taking ear canal acoustics into account

- If testing at loud levels, compression could kick in

Probe mic measures

โ€ข Do not require behavioral (voluntary) responses

โ€ข Directly measures real-ear output levels across freqs.

โ€ข Can make predictions based on ear canal levels for amplified speech across freqs.

โ€ข Takes less time than behavioral measures

โ€ข Tests at more "real-life" intensities

โ€ข Realize the kid must still be calm; have several things to distract

True or False: AAA do NOT recommend Aided Soundfield measures as a verification measurement.

True!

If you can't get probe mic measures, use _____

RECD

AAA recommends using probe mic measures with ______

Speech stimuli

What type of HA is used most on kids?

BTE because compatibility for FM systems, they having growing ears (easier to switch out the ear molds), durable, and better retention.

What type of options would you want to include on the HA?

- FM compatible battery door (HA is FM compatible or DAI)
- Tamper proof (age dependent)
- Pedi earhook
- Water-resistant HAs
- Flexibility of having on omni/directional
- Turn off volume control buttons

List the HA characteristics for Kids.

- Binaural fittings unless contraindicated
- Programmable aids
- Minimum of 2 year warranty
- Soft ear mold materials (silicone)

Validation

Ensure meeting patient needs/targets

โ€ข Aided SII

โ€ข Functional Measurements

Validation measures can include...

-Aided SF speech
โ€ข Age-appropriate material

-Functional measurements, such as:
โ€ข SIFTER, Pre-school SIFTER
โ€ข Listening Inventory for Listening Difficulties
โ€ข Parent's APHAB
โ€ข Functional Auditory Performance Inventory
โ€ข Meaningful Auditory Performance Integration Scale; Infant-Todder Meaningful Auditory Performance Integration Scale
โ€ข PEACH, LittlEears

Aided SII (speech intelligibility index)

SII of <0.65 correlates w/ greater delays in vocabulary development for losses up to moderately severe

2cc coupler gain + head diffraction/microphone effects for instrument being fitted + RECD

REAG

RESR =

2cc coupler SSPL90 +RECD

Children <12 months show largest what?

RECD, the bigger the RECD, the greater chance of oversimplification

Differences in RECD

Ear canal length

-Ear canal occluded volume

-ME impedance

-Earmold acoustics

-Head & body diffraction effects

REDD

Real ear to dial difference

-Difference in SPL in ear vs. dial on the audiometer

Real-Ear: HL to SPL

dB eHL obtained + RETSPL + RECD = dB SPL

RETSPL

- Reference equivalent threshold sound pressure levels

- What SPL each transducer needs at each freq. to be calibrated to 0 dB HL

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