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Flashcards in Pediatric's 2nd Exam Deck (173)
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1

What are the four main purposes for a pediatric audiologic assessment?

- to obtain a measure of peripheral hearing sensitivity that rules out or confirms hearing loss as a cause of the baby's or child's problem
- to confirm the status of the baby's or child's middle ear
- to assess auditory functioning using speech perception measures when possible
- to observe and interpret the baby's or child's auditory behaviors

2

Why is using a test battery approach so important?

- furnishes detailed information
- avoids drawing conclusions from a single test
- allows for the identification of multiple pathologies
- provides a comprehensive foundation for observing a child's auditory behaviors

3

ASHA recommendation for test protocols birth - (4ish) months of age

- adjusted for prematurity
- primarily physiologic measures of auditory function like ABR
- frequency-specific stimuli to estimate the audiogram
- OAEs and acoustic immittance measures should be used to supplement ABR results
- also perform: case history, parent/caregiver report, behavioral observation of the infant's responses to a variety of sounds, developmental screening, and functional auditory assessments

4

ASHA recommendation for test protocols 5-24 months of age

- behavioral assessments should be performed first
- CRA being the behavioral test of choice
- OAEs and ABRs should be assess only when behavioral audiometric tests are unreliable, ear-specific thresholds cannot be obtained, behavioral results are inconclusive or auditory neuropathy is suspected

5

ASHA recommendation for test protocols 25-60 months of age

- suggests that behavioral tests (VRA or CPA) and acoustic immittance tests are usually sufficient
- speech perception tests should also be performed in combination with developmental screening and functional auditory assessments

6

The expected outcomes of pediatric audiologic protocols are extensive and include:

- identification of hearing loss
- identification of auditory neuropathy, if present, or of a potential central auditory processing/language disorder
- quantification of hearing status based on behavioral and electrophysiologic tests
- development of a comprehensive report of historical, physical, and audiologic findings, and recommendations for treatment and management
- implementation of a plan for monitoring, surveillance, and habilitation of hearing loss
- provision of family-centered counseling and education

7

Why is behavioral testing not the preferred method for evaluating hearing & selecting hearing aids in infants birth to 4 months old?

- the prolonged cooperation required from the child
- excessive test time needed
- poor frequency resolution
- poor test-retest reliability

8

What are some tests used for pediatric assessments?

- Behavioral Observation Audiometry (BOA)
- Visual Reinforcement Audiometry (VRA)
- Conditioned Play Audiometry (CPA)
- Immitance
- Transient Otoacoustic Emissions (TOAE)
- Distortion product OAEs (DPOAE)
- Auditory Brainstem Response (ABR)`

9

What is the cognitive age range of BOA?

birth - 6 months

10

What is the cognitive age range of VRA?

5-36 months

11

What is the cognitive age range of CPA?

30 months to 5 years

12

Which pediatric assessments can be conducted for any cognitive age?

- immitance
- TOAEs
- DPOAEs
- ABR

13

What are some benefits of BOA?

- enables the audiologist to obtain valuable behavioral responses in infants, part of the cross-check principle
- testing can be conducted in sound-field, with earphones, with bone oscillator, hearing aids, or cochlear implants
- enables accurate fitting of technology because minimal response levels (MRLS) can be obtained

14

What are some challenges of BOA?

- requires careful observation of infant sucking on the part of the audiologist
- cannot be used with infants who do not suck (e.g. infants with feeding tubes)
- testing can be performed only when the infant is in a calm awake, or light sleep state
- BOA has t been generally accepting int he audiology community because audiologists typically have no been trained to use a sucking response paradigm

15

What are some benefits of VRA?

- enables the audiologist to obtain valuable behavioral responses in infants and young children, park of the cross-check principle
- because responses are conditioned, more responses can be obtained in one test session
- testing can be conducted in soundfield, with earphones, with bone oscillator, hearing aids, or cochlear implants
- enables accurate fitting of technology because MRL can be obtained
- the state of the infant or child is less problematic because the child can be more easily be involved in the task

16

What are some challenges of VRA?

- some children will not accept earphones so obtaining individual ear information can be challenging

17

What are some benefits of CPA?

- accurate reponses can be obtained at threshold level
- testing can be conducted in sound field, with earphones, with bone oscillator, hearing aids, or cochlear implants

18

What are some challenges of CPA?

- keeping the child entertained and involved long enough to obtain all the necessary information can be challenging

19

What are some benefits of immittance?

- provides information about middle ear functioning and about intactness of the auditory system reflex arc

20

What are some challenges with immittance?

the child must sit still, not speaking or moving during the test battery

21

What are some benefits of TOAE?

- measures outer hair cell function
- presence of emissions indicates no greater than a mild hearing loss
- contributes to evaluation of the overall function of the auditory system

22

What are some challenges of the TOAE?

- the infant or child must sit still, not speaking or moving during test battery
- cannot rule out mild hearing loss

23

What are some benefits of DPOAE?

- measures outer hair cell function
- presence of emissions indicates no greater than a moderate hearing loss
- contributes to evaluation of the overall function of the auditory system

24

What are some challenges of DPOAE?

- the infant or child must sit still, not speaking during testing
- cannot rule out moderate hearing loss

25

What are some benefits of ABR?

- tonal ABR provides frequency specific threshold information
- click ABR provides information about the intactness of the auditory pathways, including measures contributing to the diagnosis of auditory neuropathy

26

What are some challenges of ABR?

- the infant or chid must be asleep, sedated or very still for the duration of testing
- ABR testing is not a direct measure of hearing and is not substitute for behavioral audiologic testing

27

What are some areas in which information should be obtained in case history?

- birth and prenatal history
- health history
- developmental history
- communication history
- hearing history
- amplification history
- communication history: speech and language
- social history
- educational history
- special services
- other evaluations

28

What is the expected infant/child response of a BOA?

- change in sucking in response to auditory stimulus; other behavioral changes are not accepted because they usually indicate supra-threshold responses

29

What is the expected infant/child response to VRA?

- conditioned head turn to a visual reinforcer; usually a lighted animated toy

30

What is the expected infant/child response to CPA?

- Child performs a motor act in response to hearing a sound (e.g. listen and drop task)