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Audiology Review: Preparing for the Praxis and Comprehensive Examinations
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n
ToM is often assessed using a false-belief task where the child is presented with a specific
situation. Then, something changes in the situation that would be known to only one of
the individuals from the example situation (thus creating conflict between what the two
individuals from the story would be thinking). The person in the situation now has a false
belief that the situation is still the same as when they left it. An example of a false-belief task is
provided in the upcoming Audiology Nugget.
Example false-belief tasks: Sally-Anne Story, Mark Story, Theory of Mind Test (Anderson
& Arnoldi, 2014)
AUDIOLOGY NUGGET: SALLY-ANNE STORY
The child is presented with a puppet show or toys to act out the situation. You
will need two characters, a small ball, a yellow box, and a green box.
Story:
This is Sally. Sally places a ball into the yellow box. Then she leaves to
go to ballet class. This is Anne, Sally’s friend. While Sally is gone at ballet, Anne
takes the ball from the yellow box and places it in the green box. Then Anne
goes outside to play. Sally comes home from ballet class. She wants to play with
her ball.
Question for the child:
Where will Sally look for her ball first? The answer should be the
yellow box.
The second two questions are to help problem-solve if the child misses the first
question and reports the green box.
Where was the ball when Sally went out?
Where is the ball now?
A child should be able to correctly answer the first question at approximately 4
years of age (Anderson & Arnoldi, 2014). If the child reports the ball to be in
the yellow box because Sally was not there when the ball was moved to the green
box by Anne, this demonstrates that the child understands that Sally and Anne
have two different perspectives of where the ball should be located.
Recommended Readings
Anderson, K. L., & Arnoldi, K. A. (2011). Building
skills for success in the fast-paced classroom: Optimizing achievement for students with hearing loss. Butte
Publications.
Bagatto, M. P., Moodie, S. T., Seewald, R. C., Bartlett,
D. J., & Scollie, S. D. (2011). A critical review of
audiological outcome measures for infants and
children. Trends in Amplification, 15(1–2), 23–33.
http://doi.org/10.1177/1084713811412056
Chermak, G. D., & Musiek, F. E. (2014). Handbook of
central auditory processing: Comprehensive intervention (Vol. 2). Plural Publishing.
Deconde Johnson, C., & Seaton, J. B. (2021). Educa-
tional audiology handbook (3rd ed.). Plural Publishing.
CHAPTER 6 Pediatric Assessment and Differential Diagnosis
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Diefendorf, A. O., & Tharpe, A. M. (2017). Behav-
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Tharpe & R. C. Seewald (Eds.), Comprehensive
handbook of pediatric audiology (2nd ed., pp. 591–
607). Plural Publishing.
Hill, M. (2017). Hearing development: Embryology
of the ear. In A. M. Tharpe & R. C. Seewald (Eds.),
Comprehensive handbook of pediatric audiology (2nd
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Interacoustics Academy. (n.d.). https://www.intera
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Korczak, P., Smart, J., Delgado, R., Strobel, T. M., &
Bradford, C. (2012). Tutorial: Auditory steady-state
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Peck, J. E. (2017). Pseudohypacusis: False and exagger-
ated hearing loss. In A. M. Tharpe & R. C. Seewald
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Practice Questions
1. Jason is having difficulty in Spanish class perceiving the rolled or trilled “r” but does not have
any difficulty with the single “r.” The audiologist called and spoke to the Spanish teacher, who
indicated that the only difference between the two speech sounds is the speed at which they are
produced. If auditory processing difficulties are the reason for his issue correctly perceiving the
rolled “r,” which area of auditory processing is most likely affected?
a.
Auditory figure-ground
Temporal processing
b.
c.
Discrimination
Dichotic listening
d.
Explanation: The correct answer is temporal processing as it refers to the effectiveness of processing
auditory information over time, and the Spanish instructor indicated that the difference between
the two sounds is a difference in production speed. Figure-ground is related to hearing in noise.
Discrimination is related to a person knowing two sounds are different from one another. Dichotic
listening applies when there are two different signals presented, one to each ear. Therefore, the correct
answer is b.
2. Which anatomical location is attributed to the initial stage for processing of the natural speech
signal?
a. Medial geniculate body
b. Dorsal cochlear nucleus
c. Lateral superior olivary complex
d. Auditory cortex
Explanation: The medial geniculate body, which is located within the thalamus (a site known for integration of multiple neural pathways), is the site believed to be responsible for the initial processing of
speech. The perception of speech requires the integration of several spectral and temporal cues provided
by various lower auditory regions and integrated in the MGB of the thalamus. The cochlear nucleus
has the role of transmitting precise timing patterns, whereas the superior olivary complex relates to
interaural timing and regulates the efferent systems. The auditory cortex is responsible for processing
the suprasegmental cues and then transferring the information to the left side to assign meaning to the
signal via the corpus callosum. Thus, the answer is a.
3. Jillian has a mild to moderate hearing loss, bilaterally. The audiologist wishes to examine her
performance in an academic setting. Which of the following is/are teacher checklist(s)/rating
scales that can be used to determine how a student with hearing loss is functioning in the
classroom:
a. Functional Listening Evaluation
b. Categorical Individual Performance Profile
c. Screening Instrument for Targeting Educational Risk
d. Beliefs About Deafness Scale
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Explanation: The SIFTER is a checklist that examines a child’s performance on different functional
aspects needed for educational success (e.g., academics, participation). A functional listening evaluation examines a child’s performance in various listening conditions to determine the impact of noise,
distance, and visual cues on sentence repetition. It is used to measure amplification and HATS benefits.
The BADS is a scale to examine how the patient versus other significant people in the life feel about
hearing loss. It is more often used for adults. Therefore, the answer is c.
4. Johnny is experiencing difficulty hearing at school, and he failed his hearing screening at
4000 Hz. His pure-tone audiogram indicated a high-frequency conductive loss; however, his
tympanogram was a typical Type A tympanogram. You performed the G tympanogram below
at resonant frequency and obtained these results.
How would you interpret these findings?
a. This is a normal pattern for a G tympanogram, suggesting that there is no explanation for
the conductive component.
b. There are too few peaks to be on a G tympanogram, and explains the conductive
component.
c. There are too many peaks for the G tympanogram, and explains the conductive component.
Abnormal G tympanograms have no bearing on the function of the middle ear system.
d.
Explanation: The G is representative of the conduction of the middle ear system. This pattern is
abnormal because there should never be more than three extrema on a G tympanogram. This suggests
a middle ear problem that has changed the friction of the middle ear. Therefore, the answer is c.
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5. Sylvia, a 5-year-old, is being evaluated. By case history report, Sylvia started kindergarten this year.
She is in the process of having her speech and language evaluated by the school speech-language
pathologist. According to her parent, they can understand approximately half of Sylvia’s speech. The
parents feel she understands them when they talk to her. You find a mild bilateral sensorineural hearing
loss. You now want to test word recognition for Sylvia. Which of the following is the best option:
a.
PBK words
NU-6 words
b.
c.
Spondee words
WIPI words
d.
Explanation: Given the difficulties in understanding Sylvia’s speech, a picture-pointing task such as the
WIPI would be appropriate. The PBK words would be appropriate age-wise, but interpretation/scoring
would be impacted by Sylvia’s articulation difficulties. The NU-6 words are an adult word list; spondee
words are typically used for speech threshold testing, not word recognition. Therefore, the answer is d.
Example Case (Questions 6‒10)
A 5-month-old (George) is scheduled for a hearing evaluation. His mother noted that she was sick in
the first trimester of her pregnancy with a fever, sore throat, and fatigue, but she did not seek medical
care at that time. The mother reports that George was born at 27 weeks gestational age and was in
the NICU for 8 weeks. During that time, George received oxygen due to underdeveloped lungs. His
mother also noted that George did not show any other symptoms of sickness at birth and that George
passed his ABR newborn hearing screening in the NICU. George has had approximately four ear
infections in the past 3 months, which have been treated with antibiotics. His most recent ear infection
was last week. At this time, George’s pediatrician is talking to his family about getting PE tubes for
George. On the test date, George showed normal movement of the tympanic membranes and absent
otoacoustic emissions. You are scheduling additional testing for this child to estimate hearing ability.
6. How would you estimate hearing ability in this patient?
a. Soundfield VRA thresholds
b. BO results
c. Air- and bone-conduction ABR thresholds
d. VRA thresholds under headphones
Explanation: This child was born 13 weeks prematurely; even though the child is 5 months chronological age, he is approximately 2 to 3 months developmentally. You must base the choice of behavioral
testing on developmental age rather than chronological age. Because the child is developmentally 2 to 3
months of age, VRA is not appropriate. Responses to sound could be seen via BO, but such responses
cannot be used to estimate hearing sensitivity. As such, air- and bone-conduction ABR should be
utilized to estimate hearing sensitivity of this child. Thus, the answer is c.
7. Related to embryological development of the ear, which risk factor is of most significant concern?
a. Mother’s sickness in first trimester
b. George’s premature birth
c. Oxygen given to George after birth
d. George’s history of ear infections
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Explanation: The largest risk for the ear development is in the first trimester, which is when the mom’s
sickness occurred. This is the time when the major portions of the ear are developing. While there is
maturation in the third trimester, it would not be the biggest concern (ruling out the premature birth).
The oxygen after birth and the ear infections are not in utero, and as such would not constitute an
embryologic concern. Therefore, the answer is a.
8. Your additional test results indicate a moderately severe sensorineural hearing loss of a progressive
nature. Based on case history, what would be the most likely cause of the hearing loss?
a. Loss due to ear infections
Common cavity deformity
b.
c.
Cytomegalovirus
Michel’s aplasia
d.
Explanation: Cytomegalovirus impacts the ear during development and is associated with a progressive hearing loss. This is why the child may have passed the hearing screening at birth. A loss due to ear
infections is typically associated with a temporary conductive hearing loss. Both the common cavity
deformity and Michel’s aplasia would be associated with significant hearing loss at birth (leading to a
failed newborn hearing screening). Thus, the answer is c.
9. If you could obtain only one piece of information, which of the following would be best for
fitting amplification on this child?
a. Behavioral results
Click-evoked ABR
b.
c. Tone-burst ABR
d. OAEs
Explanation: Tone-burst ABR results would provide frequency and ear-specific results that can be
used to fit amplification. With the infant being too young developmentally for VRA, you would
only be able to see behavioral responses to sound using BO, which is not appropriate for diagnosing
a hearing loss or programming hearing aids. The OAEs do not provide threshold estimates, and the
click-evoked ABR results are not frequency specific. Thus, the answer is c.
10. Because of the history of possible middle ear dysfunction, you want to perform immittance
testing. How would you perform immittance testing on this child?
a. Utilize a lower-frequency probe Hz for tympanometry and acoustic reflexes
b. Utilize a higher-frequency probe Hz for tympanometry and acoustic reflexes
c. Perform tympanometry and reflexes in same manner as for older children/adults
d. You cannot perform tympanometry or acoustic reflexes on children of this age
Explanation: Higher-frequency probe frequency, such as 1000 Hz, is recommended for children
under 6 to 9 months of age. The lower-frequency probe tone does not provide reliable results in young
infants/toddlers, and the older children/adults are tested typically with the lower-frequency probe tone.
Therefore, the answer is b.
CHAPTER 6 Pediatric Assessment and Differential Diagnosis
https://t.me/medicina_free
Appendix 6–A
Abnormal Auditory Electrophysiological Findings
ELECTROPHYSIOLOGIC
MEASURE DIAGNOSTIC OUTCOME AUDITORY STATUS
ABR Absent waveforms Presentation level below auditory
threshold
Alternating polarity: possible ANSD
Delayed wave V Presentation level close to auditory
threshold
Brainstem lesion depending on other
findings
311
ABR Latency/Intensity
Functions
“Kissing” or reversing waveforms with
condensing and rarefacting polarities
Present wave I, absent or delayed waves
III and V
Normal latency I, delayed III with
normal III-V interpeak
Normal latency waves I & III with
normal I-III interpeak, delayed wave V
Abnormal prolongations to high
repetition rates (>0.1 ms shift per
decade (10) increase in stimulus rate)
Delayed wave V at all intensities;
higher threshold than normal
Normal wave V latency at high
intensities, delayed at lower intensities
with higher threshold than normal
Delayed wave V with any pattern of
latency shift; higher threshold than
normal
ANSD
Vestibular schwannoma/acoustic
neuroma; pontine lesions
Lesion at the CN/SOC
Lesion at the LL/IC
Demyelinating disease (e.g., multiple
sclerosis)
Conductive hearing loss
Cochlear hearing loss
Neural hearing loss
MLR Absent waveforms
Abnormal amplitude differences
between ears
Abnormal amplitude differences
between electrodes
Abnormal transmission of neural
signals through the thalamocortical
tract
continues
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