Do You Understand Audiometric Evaluations?

Here’s the lowdown on all the abbreviations and words you often hear:

ABR or auditory brainstem response

The auditory brainstem response (ABR) test gives information about the inner ear (cochlea) and brain pathways for hearing. This test is also sometimes referred to as auditory evoked potential (AEP). The test can be used with children or others who have a difficult time with conventional behavioral methods of hearing screening. The ABR is also indicated for a person with signs, symptoms, or complaints suggesting a type of hearing loss in the brain or a brain pathway.

The ABR is performed by pasting electrodes on the head—similar to electrodes placed around the heart when an electrocardiogram is run—and recording brain wave activity in response to sound. The person being tested rests quietly or sleeps while the test is performed. No response is necessary. ABR can also be used as a screening test in newborn hearing screening programs. When used as a screening test, only one intensity or loudness level is checked, and the baby either passes or fails the screen.

ASSR

Auditory Steady State Response (ASSR) is a test used to determine hearing loss in children who are either too young to respond or are unable to respond. Most children are referred for an ASSR after a newborn hearing screen in the hospital indicates the possibility of hearing loss. This test is typically performed at the same time as the ABR (Auditory Brainstem Response).

The audiologist will scrub the skin where four electrodes will be placed (forehead and behind the ears). Once your child is sleeping, the audiologist will place small ear phones into his or her ears that will play tones of varying frequency (pitch) and intensity (loudness). This sound travels from your child’s ears to the brain (through the auditory pathway) where it is recorded through the electrodes. ASSR provides an accurate, frequency-specific estimate of the behavioral pure-tone audiogram.

OAE

Otoacoustic emissions (OAEs) are sounds given off by the inner ear when the cochlea is stimulated by a sound. When sound stimulates the cochlea, the outer hair cells vibrate. The vibration produces a nearly inaudible sound that echoes back into the middle ear. The sound can be measured with a small probe inserted into the ear canal.

People with normal hearing produce emissions. Those with hearing loss greater than 25–30 decibels (dB) do not produce these very soft sounds. The OAE test is often part of a newborn hearing screening program. This test can detect blockage in the outer ear canal, as well as the presence of middle ear fluid and damage to the outer hair cells in the cochlea.

Otoscopic exam

Otoscopy is an examination that involves looking into the ear with an instrument called an otoscope (or auriscope). This is performed in order to examine the ‘external auditory canal’ – the tunnel that leads from the outer ear (pinna) to the eardrum.

Inspection of the eardrum can also provide a lot of information about what’s happening within the middle ear – the space within the skull where the hearing and balance mechanisms are situated.

The examination is performed by gently pulling the outer part of the ear upwards and backwards. This action straightens the external auditory canal, which has a natural curve, and makes it easier to see the eardrum.

The normal external auditory canal has some hair, often lined with yellow to brown wax. The total length of the ear canal in adults is approximately 2cm, which gives it a resonance frequency of approximately 3400 Hz, which is an important frequency region for understanding speech.

Abnormal findings may include:

  • a dry, flaky lining suggestive of eczema. The usual symptom is of itch.
  • an inflamed and swollen, narrowed canal, possibly with a discharge indicating infection (otitis externa). The usual symptoms include itch, local discomfort, a discharge and often an unpleasant smell from the ear.
  • wax obscuring the eardrum.
  • a foreign body in the ear, such as the rubber from the end of a pencil.

Tympanometry

Tympanometry is an examination used to test the condition of the middle ear and mobility of the eardrum (tympanic membrane) and the conduction bones by creating variations of air pressure in the ear canal.

Tympanometry is an objective test of middle-ear function. It is not a hearing test, but rather a measure of energy transmission through the middle ear. The test should not be used to assess the sensitivity of hearing and the results of this test should always be viewed in conjunction with pure tone audiometry.

Tympanometry is a valuable component of the audiometric evaluation. In evaluating hearing loss, tympanometry permits a distinction between sensorineural and conductive hearing loss, when evaluation is not apparent via Weber and Rinne testing. Furthermore, in a primary care setting, tympanometry can be helpful in making the diagnosis of otitis media by demonstrating the presence of a middle ear effusion.

Acoustic reflexes

Acoustic reflex measures add information about the possible location of the hearing problem. Everyone has an acoustic reflex to sounds. A tiny muscle in the middle ear contracts when a loud sound occurs. The loudness level at which the acoustic reflex occurs—or the absence of the acoustic reflex—gives information to the audiologist about the type of hearing loss.

BOA or Behavioral Observation Audiometry

BOA tests hearing by provoking a behavioral response to an acoustic stimulus. Used for infants from birth through seven months, the patient is observed for responses such as body movement, eye widening, eye opening or change in sucking rate after a stimulus is provided. This test is used to rule out hearing loss and related conditions

 VRA or Visual Reinforcement Audiometry

During VRA, the child uses earphones or sits between two speakers from which certain sounds are presented. A tone, speech or music may be played in order to encourage the child to respond by shifting their eyes or turning their head. When the child responds to the stimulus, they are rewarded with an interesting visual display, such as an animated toy. VRA performed with headphones can test each ear separately, while testing without headphones evaluates the child’s sound field instead. This test is ideal for children between the ages of seven and thirty months.

Play Audiometry

Conditioned play audiometry can be used as the child matures and is commonly used with toddlers and preschoolers (ages 2–5). The child is trained to perform an activity each time a sound is heard. The activity may involve putting a block in a box, placing pegs in a hole, or putting a ring on a cone.

Bone conduction testing

If there is a blockage, such as wax or fluid, in the outer or middle ears, a method called pure- tone bone conduction testing may be used. With this technique, the blockage is bypassed by sending a tone through a small vibrator placed behind the ear (or on the forehead). The signal reaches the inner ear (or cochlea) directly through gentle vibrations of the skull. This testing can measure response of the inner ear to sound independently of the outer and middle ears. In these cases, this test helps the audiologist determine the type of hearing loss being measured.

What Is…Executive Function?

cartoon-brain-1

Executive function is a set of mental processes that helps connect past experience with present action. People use it to perform activities such as:

  • planning,
  • organizing,
  • strategizing,
  • paying attention to and remembering details, and
  • managing time and space.

How Does Executive Function Affect Learning?

In school, at home or in the workplace, we’re called on all day, every day, to self-regulate behavior. Executive function allows us to:

  • Make plans
  • Keep track of time and finish work on time
  • Keep track of more than one thing at once
  • Meaningfully include past knowledge in discussions
  • Evaluate ideas and reflect on our work
  • Change our minds and make mid-course corrections while thinking, reading and writing
  • Ask for help or seek more information when we need it
  • Engage in group dynamics
  • Wait to speak until we’re called on

What Are the Warning Signs of Executive Function Problems?

A student may have problems with executive function when he or she has trouble:

  • Planning projects
  • Comprehending how much time a project will take to complete
  • Telling stories (verbally or in writing), struggling to communicate details in an organized, sequential manner
  • Memorizing and retrieving information from memory
  • Initiating activities or tasks, or generating ideas independently
  • Retaining information while doing something with it, for example, remembering a phone number while dialing

Source: http://www.ncld.org/types-learning-disabilities/executive-function-disorders/what-is-executive-function

A Day in the Life: Meet Lanie

Lanie is a year old, whose parents just found out she is deaf. They have just chosen ASL as her modality…

 

8:26 AM

Lanie is sitting in her high chair with mom, Linda, who is feeding her. Linda is doing her best to push in as much language every day as she possibly can, but she’s learning ASL along with Lanie and has become very confused and frustrated with the difference in ASL’s grammatical structure. Linda wonders, How will we learn this language at the same rate Lanie is? Have we made the right choice? 

 

Linda has been carrying a world of guilt on her shoulders. Asking herself constantly, How did I not know that my child was deaf? How did I miss this? 

Spotlight on Service: Marcus Autism Center

Marcus-Autism-Center

Below is an excerpt from the Marcus Autism Center website. For more information, visit http://www.marcus.org.


 

“Marcus Autism Center is a not-for-profit organization and subsidiary of Children’s Healthcare of Atlanta that treats more than 5,500 children with autism and related disorders a year.

 

As one of the largest autism centers in the U.S. and one of only three National Institutes of Health (NIH) Autism Centers of Excellence, Marcus Autism Center offers families access to the latest research, comprehensive evaluations and intensive behavior treatments. With the help of research grants, community support and government funding, Marcus Autism Center aims to maximize the potential of children with autism today and transform the nature of autism for future generations.

 

With a wide spectrum of services and evidence-based treatments, families can receive diagnosis, treatment and support in a single location. Treating patients across Georgia and the Southeast, Marcus Autism Center is the comprehensive resourcefor children with autism and related disorders.

 

Marcus Autism Center, in conjunction with Children’s Healthcare of Atlanta and through collaborations with premier academic institutions nationwide, is bringing groundbreaking research and clinical services to children and families affected by autism.

 

With the appointment of Ami Klin, Ph.D., Director of Marcus Autism Center, we are pursuing an overarching research strategy, with two main areas of focus—early detection and early intervention. This will be accomplished, in part, by Dr. Klin’s eye-tracking software, which has been shown to diagnose children as young as 6 months old. We hope that this will help future generations of children get the care they need.”

A Day in the Life: Meet Stephanie

Stephanie is 8 years old. She was identified at 1 ½ years old with a moderate hearing loss. She was diagnosed at 5 years old with autism. Her parents, Dan and Shelly, work full time and they just welcomed a newborn to their family. Stephanie attends school at the public school down the street from her house.

 

7:15 AM

 

Dan is out of town on business, and Shelly is scrambling to get Stephanie out the door on time. Her bus arrives at 7:30 and Stephanie is just now getting dressed. Shelly tries to get Stephanie to move more quickly, but Shelly is also holding a crying newborn. Juggling two children has proved more difficult than Shelly imagined. In the hustle and bustle of the morning, she forgets to put new batteries in Stephanie’s hearing aids.

 

Lately, with things being more hectic around their home, Stephanie’s progress has waned and Dan and Shelly are concerned. Stephanie is not reading on grade level and the other children in her class are making age-appropriate academic gains. They are on the waiting list at the Marcus Autism Center’s Language and Learning Clinic, where Stephanie will receive services to help her improve her communication and social skills.


 

What is ASL?

American Sign Language (ASL) is a visual language. With signing, the brain processes linguistic information through the eyes. The shape, placement, and movement of the hands, as well as facial expressions and body movements, all play important parts in conveying information.

Sign language is not a universal language — each country has its own sign language, and regions have dialects, much like the many languages spoken all over the world. Like any spoken language, ASL is a language with its own unique rules of grammar and syntax. Like all languages, ASL is a living language that grows and changes over time.

ASL is used predominantly in the United States and in many parts of Canada. ASL is accepted by many high schools, colleges, and universities in fulfillment of modern and “foreign” language academic degree requirements across the United States.

Reference:

National Association of the Deaf

http://nad.org/issues/american-sign-language/what-is-asl

 

What does this language look like?

Check out AMP (Accessible Materials Project), which is based in Georgia. AMP provides video for those who use ASL or who are learning ASL. One of their many videos can be found here, http://www.youtube.com/watch?v=CnQY1aKWrFE. This video presents sight words in written English and in ASL. Words are fingerspelled and signed.

Spotlight on Service: Sign Language Interpreters

Below is a list of sign language interpreter services in Georgia. 

 

Communication Access Network, Inc.

888-566-5585 (voice/TTY)

www.caninterpreters.com

Provides comprehensive communications services through a network of interpreters and independent consultants.

 

Georgia Interpreting Services Network

800-228-4992 (voice/TTY)

www.gisn.info

Contact: Marilyn Teague (Senior Assignment Coordinator), info@gisn.info

Non-profit organization providing certified sign language interpreting 24/7/365 for all of Georgia since 1987.

 

Georgia Registry of Interpreters for the Deaf, Inc.

www.garid.org

 

The Interpreting Connection, Inc.

1706 Tree Corners Parkway

Norcross, GA 30092-3129

770-613-0925 (voice/TTY)

Contact: Debbie Lesser (founder), debann@mindspring.com

 

Don Clark and Associates, Inc.

4651 Woodstock Road, Suite 208

Roswell, GA 30075

770-926-1667

Contact: Don Clark (President/CEO),  don@donclarkandassociates.com

www.DCA-GA.com

Sign language interpreting services. “Where words have meaning.”

 

Medley Interpreters, LLC

quality . communication . connections

770.978.3120

770.978.3121 fax

www.medleyinterpreters.com

 

National Alliance of Black Interpreters, Inc.

www.naobi.org

 

Sign Language Interpreting Specialists, Inc.

130C John Morrow Parkway

Gainesville, GA 30501-3569

770-531-0700 (voice), 770-287-9479 (TTY)}

www.slisinc.com

Contact: Ruth Dubin, slisinc@charter.net

Sign language interpreting services available 24 hours a day, 365 days a year for all settings (e.g. medical, legal, educational).

 

Reference: http://www.gahandsandvoices.org/Resources.html

Language Lesson: Fingerspelling

Deaf teachers use visual strategies for incorporating fingerspelling into classroom instruction. Studies on these visual strategies show that they are a natural part of classroom interaction and are used to promote greater understanding and retention of academic material.

 

Three such instructional strategies for using fingerspelling are as follows:

 

(1) Chaining, (2) Sandwiching, and (3) Lexicalized Fingerspelling.

 

Chaining

 

Chaining is used for introducing new concepts or new vocabulary terms. Chaining creates associations by connecting signs, fingerspelling, and the printed/written word in a sequence, with one format reinforcing the previous one. Through chaining, the teacher provides multiple ways for the students to learn the word and concept. In addition, teachers may use objects, pictures, or multimedia to reinforce the concepts. For example, when teaching the word, tornado, a teacher might choose one of the following sequences:

 

1) Point to the word tornado written on the board;

2) fingerspell T-O-R-N-A-D-O; and

3) sign TORNADO.

 

Or:

 

1) Fingerspell T-O-R-N-A-D-O;

2) sign TORNADO; and

3) write tornado on the board.

 

Sandwiching

The sandwiching technique alternates between fingerspelling and signing. This method also reinforces the equivalency of ASL and English.

 

1) Fingerspell T-O-R-N-A-D-O;

2) sign TORNADO; and

3) fingerspell T-O-R-N-A-D-O again.

 

Or:

 

1) Sign TORNADO;

2) fingerspell T-O-R-N-A-D-O; and

3) sign TORNADO again.

 

Lexicalized Fingerspelling

New signs are created through a process where fingerspelled words are altered or lexicalized to become more sign-like. Commonly referred to as loan signs, these signs sometimes omit letters (#JOB) while others blend the handshapes seamlessly (#BUS). Through this process, a loan sign is formed. Lexicalized fingerspelled signs include nouns, verbs, adjectives, conjunctions, interjections and wh-words. Lexicalized fingerspelling transforms the fingerspelled word into a sign-like visual image. Deaf teachers often use this technique; first, they produce a neutral version of a fingerspelled word, and then follow that with a lexicalized version. This process supports visual memory and facilitates retention.

 

Common Fingerspelled Loan Signs

#BANK #BACK #OFF #ON #IF

#SALE #EARLY #BUT #BUS #CAR

#WHAT #DO #SO #OK #JOB

#YES #NO #DOG #TOY #FIX

 

 

What does lexicalized fingerspelling look like?

http://www.youtube.com/watch?v=S8soqLZgPek


 

Reference:

Visual Language and Visual Learning Science of Learning Center. (2010, July). The Importance of Fingerspelling for Reading. (Research Brief No. 1). Washington, DC: Sharon Baker.

 


 

Research: “The Importance of Fingerspelling for Reading”

“The Importance of Fingerspelling for Reading”
Visual Language & Visual Learning (VL2)
What is fingerspelling?
On the most simplistic level, fingerspelling can be defined as the use of handshapes to represent letters of the alphabet.

Key Findings on the Importance of Fingerspelling for Reading:
• Deaf families fingerspell to their deaf children when they are very young.
• Early exposure to fingerspelling helps these children become better readers.
• Fingerspelling, reading, and writing are interrelated.
• Fingerspelling facilitates English vocabulary growth, and larger the lexicon, the faster new vocabulary is learned.
• Fingerspelling positively correlates with stronger reading skills. Deaf and hard of hearing children who are good fingerspellers are good readers, and vice versa.

Source:
Visual Language and Visual Learning Science of Learning Center. (2010, July). The Importance of Fingerspelling for Reading. (Research Brief No. 1). Washington, DC: Sharon Baker.

A Day in the Life: Meet Franklin

Meet Franklin who is 5 years old. He is profoundly deaf and was identified at 1 year old. His parents, who are hearing, have chosen ASL as his modality. He is in kindergarten in a mainstream classroom.

4:03 PM

Franklin is just arriving home after a long 7 hour school day. He is hot and sweaty after his 45 minute bus commute from school to his house. He has homework to do – read a book and draw a picture of his favorite scene in the book. He can’t read yet, so he has to wait until his parents are able to read to him and help him with his homework.

Franklin is preparing for his homework activity by setting up on the kitchen table his paper, colored pencils, and the book he’s chosen. Mom works from home but doesn’t finish work until 5 PM. Dad won’t be home until much later, usually after 9 PM. Mom is a hearing parent whose ASL has improved greatly over the past several years, but she doesn’t feel confident in her ability communicating with Franklin.