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.

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How To: Add Language To Your Daily Routines

Sara spends hours on the bus with Harry every week, to and from services, work, and daycare. Here is a language lesson that any parent like Sara could use to incorporate language into their daily bus ride.


HOW TO: Add language to a bus or train ride

https://www.atlantaspeechschool.org/TALK

  1. Using the TALK strategy: Become a narrator of your child’s world by using the TALK strategy and Tune In, Ask Questions, Lift the Language, and Keep it Going to what your child is looking at and naming it or describing what’s happening.
  2. Vocabulary: Tier 1 words (basic words) for younger children or children with 1-2 spoken/signed words (i.e. trees, cars, bus, train, people, eating, running, jumping, let’s hurry, uh oh!) and Tier 2 words for older children (3 years and up) or children with 3 or more words spoken or signed

101 Tier 2 Words:

1. Abundance- more than enough of something

2. Admire- to like the way something looks

3. Advice- what you think someone should do

4. Annoy- to bother

5. Appear-to show up

6. Arrange- to put something in order

7. Arrive- to get somewhere

8. Assist- to help

9. Astonished- very surprised

10. Attentive- pay attention

11. Available- ready to be used

12. Avoid- stay away from

13. Brief- a short time

14. Cautious- careful

15. Collect- to get things together; to pick up things that belong together

16. Combine- to mix or put together

17. Comfort- to make feel better

18. Comfortable- to feel good

19. Communicate- to let someone know what you think or feel

20. Compare- to see how things are alike and different

21. Complete- finish

22. Concentrate- to think about something really hard

23. Concerned- worried

24. Confused- when you don’t understand

25. Contain- to have or hold something inside

26. Corner- the point where 2 sides come together

27. Correct- right

28. Create- to make

29. Curious- want to know

30. Dangerous- not safe

31. Delighted- happy

32. Demonstrate- to show how to do something

33. Describe- to tell about something

34. Destroy- to tear up; to ruin

35. Determined- to keep working at something until you get what you want; to not give up

36. Difficult -hard to do

37. Disappear- to go away

38. Disappointed- upset because things did not work out the way you wanted them to

39. Discover- to find out about something

40. Dispose- to throw away; get rid of

41. Eager- really ready for something to happen

42. Edible- you can eat it

43. Enormous- really big

44. Entire- the whole thing; all of something

45. Envy- want what somebody else has

46. Equal- the same as

47. Event- something that happens

48. Except- all but

49. Excited- really happy about something; having a lot of energy

50. Expect- to think something will happen

51. Expensive- cost a lot of money

52. Extraordinary- really special; very different and wonderful

53. Familiar- you’ve seen it before or you already know it

54. Famous- known by a lot of people

55. Fancy- really special

56. Favorite- the one you like best

57. Fewer- not as many

58. Fragile- breaks or gets hurt easily; not strong

59. Frustrated- feeling upset when you keep trying to do something but it doesn’t work

60. Identical – the same in every way; exactly the same

61. Ignore- not pay attention to

62. Imitate- do the same thing somebody else does

63. Immense- really big; huge

64. Impossible- can’t be done

65. Introduce- to show for the first time; to meet for the first time

66. Invisible- you can’t see it

67. Locate- to find

68. Marvelous- wonderful

69. Observe- to watch carefully

70. Occupied- being used by someone else

71. Ordinary- plain; regular; not special

72. Organize- to put in good order

73. Patient- to wait nicely

74. Peculiar- strange

75. Pleased- happy with something

76. Plenty- a large amount; a lot

77. Popular- liked by a lot of people

78. Predict-to say or to guess what is going to happen

79. Problem- when something goes wrong

80. Protect- to keep safe

81. Protect- to keep safe

82. Proud- to feel good about yourself; to feel good about something you did

83. Purchase- to buy

84. Recall- to remember

85. Remain- to stay

86. Remove- take away

87. Repair- to fix

88. Repeat- to do again

89. Ridiculous- very silly

90. Select- to choose

91. Separate- take apart

92. Similar- the same in some ways but not all

93. Simple- easy to do

94. Solution- a way to fix something that went wrong

95. Supplies- things you need

96. Transfer- to move from one place to another

97. Unusual- different; really special; not familiar

98. Useful- can be used a lot

99. Vanish- to go away fast

100. Variety- different kinds of one thing

101. Visible- you can see it

Monday: A Day in the Life

Meet Harry, who is 24 months old. He was identified at 8 months old with a profound hearing loss. He now has bilateral cochlear implants. His mom, Sara, has chosen Listening & Spoken Language as his modality. They receive services at the Auditory Verbal Center.

8:03 AM
Sara has slept through her alarm and baby Harry’s auditory-verbal therapy is at 10 AM on the other side of town. When Sara realizes this, she rushes to get Harry up and ready to go. Their bus picks them up at 8:25, so they don’t have even a second to lose. If they miss this bus, they will miss their therapy appointment, which will take another four weeks to reschedule. At 8:24, they make it to their bus stop, which is, luckily, right outside their apartment. They hop on the bus and head off to the Auditory Verbal Center.

Sara has been tossing and turning for the past six months, ever since her pediatrician told her that if Harry doesn’t receive the proper early intervention services, he will not have the language he needs to learn how to read. Sara’s a single mother whose worries range from How will I make rent this month? to Will my baby ever talk?
She wonders if she’s reading to him enough, talking to him enough, interacting with him enough.
Harry is a happy baby, interested in the world around him and the new sounds he hears every day. He enjoys reading books with his mommy and he has just started saying “mama.” Sara was overjoyed to hear her baby boy speak her name…

The 100 Babies Project

100BabiesInfographic

More about the 100 Babies Project, in the words of former Project Manager, Dr. Jessica Bergeron:

“Georgia Pathway started off as a community of practice for teachers, teachers who serve children who are deaf and hard of hearing. It started in June of 2011 in an effort to provide online support for teachers and improve their practices around literacy. We are the only group to combine LSL (Listening & Spoken Language), state-run ASL (American Sign Language)/bilingual programs, with county comprehensive programs with the common goal of grade level reading. We are the only group of our kind. Our 3rd grade goal is the same as our governor’s, which is that all children will be on a path to 3rd grade reading by 2020. Once we became a coalition in 2012-2013, we were working together to examine research-based practices that promote literacy development. Then, we recognized that we couldn’t be successful if we didn’t also target the system from birth to three. We then had a coalition meeting in June 2013. At that meeting, we made an effort to target the system, all of the people within the system instead of just teachers. This included policymakers, pediatricians, Department of Public Health, et al. Many great things happened at that meeting, but one of the best things that happened at that meeting was the creation of action teams. The Funding and Policy Action Team included Dr. Brenda Fitzgerald who is the Commissioner of the Department of Public Health in Georgia. She declared at that meeting that the next 100 babies who are diagnosed with hearing loss in Georgia would be on a path to grade level reading. She committed herself to making the changes that were needed to make it happen.

The mission of the 100 babies project is to create an efficient system that ensures that all children will be on a path to grade level reading. At the beginning of the project, the coalition started at the beginning of the literacy process, from pre-birth medical visits to 3rd grade reading, examining all interactions that would promote language growth, which is the foundation for literacy. It was an investigation of all parties that contribute to a child’s birth to literacy plan. It helped the coalition identify gaps and system failures. The gaps were places where issues arose that weren’t owned by any particular agency. The agencies have taken responsibility for their part. We are committed to staying six months ahead of the process. The 100 Babies is a first-run, testing the working system in place in Georgia for babies birth to 3rd grade. The breakdown of the project begins with investigation, then helping agencies problem solve and trouble shoot, and finally filling in the gaps. For each transaction, the focus is twofold. What capacity are we building in parents to empower their children? And how is this step building that child’s language?”

Stay tuned for more information about how you can get involved in this groundbreaking work!

 

A Baby’s Language Development: Motor Imitation

image_preview

One of the most important early steps in [language and] speech development is to copy or imitate movements.

Helping your child learn to imitate movements will improve eye contact and interaction. Set aside one or two periods a day to focus on movement imitation. Establish a time and place that eliminates distracting noises and reduces visual distractions. No specific time period is recommended. You know your child best. Remember these sessions should be enjoyable for you and your child.

To begin, sit at your child’s eye level in a face to face position. This will assist eye contact and help direct attention. Children may be in a high chair during these play sessions to focus attention and reduce the tendency to roam the house. The following activities are perfect for beginning to learn to imitate.

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Make a box of functional objects that can be used for imitation. Your box may include: cups, blocks, cars, spoons, balls, hats, small boxes to open and close, toy hammer, toy vehicles, etc.

There is no specific number of skills that your child must learn. The above activities are suggestions. Use your imagination!

The above article was written by Linda Mawhinney & Mary Scott McTeague, which can be found in their book, Early Language Development. You can find their book online.

For a helpful chart that outlines imitation and child development, visit http://www.cde.ca.gov/sp/cd/re/itf09cogdevfdimit.asp from the California Department of Education.

A Baby’s Language Development: Joint Attention

kid boy and mother playing together with cup toys

What is Joint Attention?

From birth, parents respond to their infant’s coos, smiles, and movements as though they are meaningful communicative acts, and may smile, vocalize, or otherwise imitate their infant’s actions. These types of exchanges, sometimes called “proto-conversations,” are important for the infant’s developing emotional and social competence, including bonding and attachment, as well as early understanding of turn-taking and meaningful communication.

Beginning around six months, as infants become more mobile and start to explore the world around them, the focus of their attention shifts to the objects in their environment. Soon after that, they begin to coordinate attention between caregivers and objects in a meaningful way by looking, for example, back and forth between the caregiver and the object. This kind of shared focus between a child, a caregiver, and an object or event is known as joint attention. ¹

The Importance of Joint Attention

Infants’ ability to engage in joint attention is an important developmental milestone. Joint attention serves as a foundation for developing communicative competence and is one basis for the development of early social and cognitive skills.
For both hearing and deaf children, joint attention interactions are also crucial for language development. Specifically, the language children hear and see during this particular type of interaction with their caregivers is strongly linked to early vocabulary development. When caregivers share attention with their infants, and comment on the object or event on which the infant is focusing, infants acquire new words more easily and efficiently than if the caregiver simply attempts to redirect the child’s attention. Joint attention interactions that focus specifically on shared book reading have also been linked to later language development and reading ability.¹

How to Develop This Skill (Listening & Spoken Language)

  • Tell your child, “Look at me,” then tap his/her face and then your face. After you have given this verbal cue, give your child time to respond.
  • Point to a toy that your child likes and say, “look.” Gently turn his/her head toward the toy. When he/she looks at it, play with the toy or give it to him/her.
  • Hold up a toy or favorite item and say, “look.” Your child should look at you and then the object. Reward by giving the toy to your child.
  • Blow bubbles and say, “look.” Point as your child traces the bubbles. Blow more bubbles when he/she looks at you, repeat the word “look,” and point.
  • Blow up a balloon, but don’t tie it or let it go. Say, “look,” and release it when your child looks.
  • When your child becomes interested in books, point to a picture and say, “look.” Help your child point to pictures. The goal is for your child to look at you and then the picture. By sharing awareness and interest in the same picture or book you are achieving joint attention.
  • When another family member comes into the room, point and say, “look.” Reward your child for looking with a physical activity, such as tickling or patting.

Your child may need more time to understand what turning his/her head means, so don’t be discouraged if this skill is slow for him/her to learn.²

How to Develop This Skill (ASL)

  • Placing signs into the child’s current focus of attention;
  • Using attention-getting signals (tapping the child, waving towards the child) to establish eye contact before signing;
  • Physically setting up the interaction so that both the parent and the objects can be seen with minimal shifting (for example, sitting across from the child);
  • Waiting for spontaneous looks from the child before signing;
  • Providing relevant signs when the child spontaneously looks up;
  • Giving the child time to explore objects before eliciting attention; and
  • Using specific signs such as LOOK, along with a pleasant, positive manner, to prompt the child that linguistic input is forthcoming.¹


¹Visual Language and Visual Learning Science of Learning Center. (2012, June). Eye Gaze and Joint Attention (Research Brief No. 5). Washington, DC: Amy M. Lieberman

²Mawhinney, L. & McTeague, M.S. (2004). Joint Attention. Early Language Development. Super Duper Publications.

A Baby’s Language Development: The Importance of Eye Contact

Did you know that babies’ eye contact is linked to language development?

surprised-baby

Here are a few things you can do at home to develop eye contact with your baby:

According to Linda Mawhinney and Mary Scott McTeague,

  • “Sit face to face with your child. Attempt to place your child higher than you. Examples of possible positions: sit your child on your lap; sit in a chair and place your child in a high chair or booster seat; place your child on the couch or chair and sit on the floor in front of him/her.”
  • “To draw your child’s attention, hold objects near your face to help guide your child without verbalizing. Often words do not have meaning and for other children, a verbal cue could cause him/her to tune you out.”
  • “Tap your child’s nose and then your own nose. After the child looks, even for a brief second, reward him/her by signing/saying ‘Good looking!'”
  • “Put your child’s hand on your face to gain attention before giving him/her a direction to follow or a choice.”
  • “Eliminate or reduce auditory and visual distractions, like the television, radio, etc. This helps your child focus on you.”
  • “As your child increases eye contact with you, give him/her the verbal cue, ‘Look.’ When your child looks at you, respond.”
  • “Play ‘funny face’ games in the mirror. Your child can establish eye contact with you in the mirror.”

NPR also did a piece highlighting the link between babies’ eye contact and language development, which you can read or listen to by clicking here. The transcript from the radio show can be found below.

RENEE MONTAGNE, host:

Next, we hear about research that links babies’ early eye contact with their later language development. Reporter Michelle Trudeau tells us that a study appearing in the current issue of Developmental Studies pinpoints how this connection emerges.

MICHELLE TRUDEAU reporting:

Researchers at the University of Washington videotaped babies to try and capture an important transition in infants’ social development. When is it that babies begin to follow the direction of another person’s gaze? Psychologist Rechele Brooks and Andrew Meltzoff studied about a hundred babies, nine-month-olds, 10-month-olds and 11-month-olds. In a quiet room at the university’s Institute for Learning and Brain Sciences, Brooks would sit at a table across from a baby who’d be on Mom’s lap. Down at each end of the table, there was a bright plastic toy.

Ms. RECHELE BROOKS (Researcher, University of Washington): So I would look at the baby. The baby would be looking at me. And once I had established eye contact, that’s when I took that moment to turn to the side.

TRUDEAU: Turning her head to the left or right, looking at one of the toys on the table. When Brooks did this, she sometimes had her eyes open but sometimes she shut her eyes just before she turned her head in the direction of the toy.

Ms. BROOKS: Nine-month-olds were consistently looking at the toy whether my eyes were open or closed. They did not really care. They seemed to be following my head motion rather than whether I can make eye contact with the toy or not.

TRUDEAU: Now bring in the 10-month-olds, same test, very different results.

Ms. BROOKS: Ten-month-olds, they’re going to look at the toy with me much more often when my eyes are open than when my eyes are closed.

TRUDEAU: So just 30 days later and babies will typically start to lock on to your eyes to discover an object. Now Brooks also recorded if the babies made any vocal sounds at the moment they looked at the toy with her. She and the moms were completely quiet. Here again the nine-month-olds didn’t vocalize but the 10- and 11-month-old babies did.

(Soundbite of baby)

Ms. BROOKS: It’s as if the baby goes, `Uh-huh, we’re looking at the same thing,’ and they seem to be making an extra connection.

(Soundbite of baby)

TRUDEAU: And that extra connection pays off later on. These little vocalizations made specifically when looking at the toy with Brooks are linked to later language development.

Ms. BROOKS: When children make that extra connection, when they’re looking at the same toy as the adult but they also go, `Hmm,’ that little extra vocalization, those kids are the ones that end up being more advanced with their language development.

TRUDEAU: Understanding twice as many words at 18 months as the babies who did not make those little sounds eight months earlier. So it’s the two behaviors coupled together at 10 and 11 months, first following a person’s eyes and then vocalizing upon seeing the toy that powerfully predicts later language comprehension. Developmental researcher Peter Mundy from the University of Miami calls this important milestone joint attention.

Mr. PETER MUNDY (Developmental Researcher, University of Miami): Watch how your baby begins to follow your gaze, and when they do follow, pay attention to that and respond to that because that’s a fundamental building block for language and social relatedness. And the more you can encourage it, the more fun you’re going to have with your infant and it may also have a benefit for their early development, as well.

TRUDEAU: Because it indicates, says Mundy, that your baby is beginning to understand your point of view and your intentions, essential early ingredients for a baby in becoming socially aware of other people.

You can learn more about language development in Linda Mawhinney and Mary Scott McTeague’s activity book, Early Language Development, published by Super Duper Publications.