Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4612_Библиотеки_им_академика_М_И_Перельмана
.pdf
Audiology Review: Preparing for the Praxis and Comprehensive Examinations
https://t.me/medicina_free
472
difference is in the electrode array. It is often referred to as a “paddle” that contains multiple
rows of 21 total platinum electrodes. The paddle should be placed directly on the cochlear
nucleus.
MED-EL has an ABI that is used in other parts of the world.
Advanced Bionics had an ABI that is no longer available.
Post-Implantation and Device Management
Recipients typically do not achieve open-set word understanding with ABI devices. Expected performance is discussed under ABI Candidacy Evaluations, above.
Programming
n
While there is potential for nonauditory effects from a CI (i.e., facial stimulation),
nonauditory effects are much more common with an ABI due to the location of the device on
the cochlear nucleus and in close proximity to other neural structures. Common nonauditory
effects can include facial nerve stimulation, a tingling sensation, dizziness, nystagmus, or
a cardiac or respiratory response. Therefore, initial activation is completed with access to
emergency medical services or a cardiac code team.
n
During initial stimulation, the audiologist will determine which electrodes produce audition,
as not all electrodes will produce an auditory effect. Only those electrodes are utilized for
stimulation and the programming of lower and upper stimulation levels to set the electrical
dynamic range in the same manner of programming a CI.
n
A critically important feature of programming an ABI is determining pitch ordering of the
electrodes. The cochlear nucleus is not tonotopically organized like the cochlea but does
contain some degree of tonotopic organization. The audiologist will have to change the pitch
relationship of the electrodes to match the patient’s pitch identifications.
This is a difficult skill for patients to master and therefore will likely be completed over
multiple sessions and may span months to years to determine ideal pitch relationships,
if ever.
n
Loudness balancing also has more importance in ABI programming than in a traditional CI.
As with pitch order, loudness relationships at the level of the paddle electrode’s connection
with the cochlear nucleus are not 1:1. There will be more variation in the current level needed
for equal loudness across channels for ABI users.
There is potential to use EABR and ESRT with ABI recipients to set loudness levels.
Middle Ear Implants
Introduction
Each manufacturer of middle ear implants (MEIs) approaches the design and composition from a
different philosophy, but at its core, all (MEIs) have a piece that is surgically placed in the middle ear
space to optimize stimulation of the cochlea. Specifics of MEIs are outside the scope of this text, but
advantages and disadvantages are discussed.
CHAPTER 9 Treatment: Topics in Amplification
https://t.me/medicina_free
n
MEIs were initially designed as an alternative to traditional amplification due to limitations in
technology in the late 1990s and early 2000s (Wolfe, 2020). They provide:
Increases in gain compared to traditional amplification and more available gain before
feedback.
Less occlusion effect unless the MEI utilizes a microphone in the ear canal, which some
require.
Some devices are more comfortable than traditional amplification.
At the time they were designed, the sound quality was reported to be better than
amplification that was available; however, there have been significant advances in DSP with
conventional amplification.
Since most of the device is implanted, there is less or no visible component, which may be
preferable for discreet use.
If the device is one that is fully implanted, the recipient does not have to worry about not
having improved hearing while sleeping, water activities, and so on.
n
There are some reasons why a MEI is less desirable, which are listed here:
The device is placed surgically under general anesthesia.
473
Typically, 8 to 10 weeks of healing is required before the device can be used.
The devices and surgery are costly and not regularly covered by insurance.
For device placement, the ossicular chain may need to be disconnected, which can then
worsen recipient hearing during the healing process or when they are not actively using
the device.
Most devices have a magnet component, which therefore limits the recipient from
undergoing MRIs.
There is no evidence-based verification method comparable to real ear probe microphone
measures that are used with conventional amplification.
Candidacy
Due to insurance limitations and advances in traditional amplification, MEIs are much less common
in audiologic/otologic care.
FDA criteria vary by manufacturer, but general candidacy considerations are as follows:
n
Over the age of 18 with bilateral SNHL. An ideal candidate has thresholds better than 75 dB
HL and a word recognition score better than 60% in the ear to be implanted.
n
Chronic middle ear disease contraindicates use of these devices.
Surgery
The device is placed surgically in the middle ear space under general anesthesia. The exact placement
procedure varies by device. The most common placement is fixation to the incus, either at the body
or long process. Alternate placement options include the head of the stapes or round window. The
external device also varies and may be similar either to the CI or to an in-the-canal style hearing aid.
One device, the Envoy Esteem™, is totally implantable with no external component.
Audiology Review: Preparing for the Praxis and Comprehensive Examinations
https://t.me/medicina_free
474
Internal Devices
Within the middle ear space, there are three primary transduction mechanisms for middle ear implants,
dependent on manufacturer.
n
Piezoelectric
Piezoelectric materials are crystals that vibrate in response to an electric stimulus. These
materials also emit electricity when they experience movement or vibration.
These materials may be used to respond to vibrations of the tympanic membrane or the
ossicles to serve as replacement for a microphone or to mechanically deliver a converted
electrical signal to the ossicles or cochlea (Wolfe, 2020).
n
Electromagnetic
Electromagnetic systems use a magnet placed in the middle ear along with a wired coil.
The wired coil emits an electrically generated signal, causing the magnet to move, thereby
moving the ossicular chain (Wolfe, 2020).
n
Electromechanical
Electromechanical is similar to electromagnetic except that the wired coil is physically
attached to the magnet (Wolfe, 2020).
Post-Implantation and Device Management
The reader is encouraged to view resources from the individual companies as these devices and their
programming and management are evolving as their use increases.
Recommended Readings
Auditory Potential. (2011). New Minimum Speech
Test Battery (MSTB) for adult cochlear implant
users. https://www.auditorypotential.com/MSTBfiles/MSTBManual2011-06-20%20.pdf
Bentler, R., & Chiou, L. K. (2006). Digital noise
reduction: An overview. Trends in Amplification,
10(2), 67–82. https://doi.org/10.1177/108471380
6289514
Fuglholt, M. L. (2010). Electrophysiological thresh-
old estimation and infant hearing instrument fitting. Pediatric Whitepaper. Oticon Pediatrics. https://
wdh02.azureedge.net/-/media/oticon-us/main/
download-center/white-papers/20440-electrophys
iological-threshold-estimation-and-infant-hearinginstrument-fitting.pdf?rev=D917&la=en
Killion, M. C., & Mueller, H. G. (2010). Twenty years
later: A new count-the-dots method. The Hear-
ing Journal, 63(1), 10, 12–14, 16–17. https://doi
.org/10.1097/01.HJ.0000366911.63043.16
Ricketts, T. A. (2005). Directional hearing aids: Then
and now. Journal of Rehabilitation Research and
Development, 42(4, Suppl. 2), 133–144.
Zhang, X. (2020). New technologies of directional
microphones for hearing aids. Journal of Electrical
and Electronic Engineering, 8(3), 81–91. https://doi
.org/ 10.11648/j.jeee.20200803.12
References
Alexander, J. M. (2013). Individual variability in rec-
ognition of frequency-lowered speech. Seminars in
Hearing, 34, 86–109. http://doi.org/10.1055/ s-00
33-1341346
CHAPTER 9 Treatment: Topics in Amplification
https://t.me/medicina_free
475
American Academy of Audiology (AAA). (2013).
American Academy of Audiology Clinical Practice
Guidelines on pediatric amplification. http://www
.audiology.org/resources/documentlibrary/Docu
ments/PediatricAmplificationGuidelines.pdf
American National Standard Institute. (2014) Specifi-
cation of hearing aid characteristics. https://.ansi.org/
standards/asa/ansiasas3222014r2020
Anderson, K. L., & Goldstein, H. (2004). Speech per-
ception benefits of FM and infrared devices to children with hearing aids in a typical classroom.
Language, Speech, and Hearing Services in Schools,
35(2), 169–184. https://doi.org/10.1044/0161-14
61 (2004/017)
Anderson, K. L., Goldstein, H., Colodzin, L., & Igle-
hart, F. (2005). Benefit of S/N enhancing devices to
speech perception of children listening in a typical
classroom with hearing aids or a cochlear implant.
Journal of Educational Audiology, 12, 14–28.
Audioscan. (2022). Audioscan Verifit
4.30. https://docs.audioscan.com/userguides/
vf2manual.pdf
Buchman, C. A., Gifford, R. H., Haynes, D. S., Lenarz,
T., O’Donoghue, G., Adunka, O., . . . Zwolan, T.
(2020). Unilateral cochlear implants for severe, profound, or moderate sloping to profound bilateral
sensorineural hearing loss: A systematic review and
consensus statements. JAMA Otolaryngology-Head
& Neck Surgery, 146(10), 942–953. https://doi
.org/10.1001/jamaoto.2020.0998
Colletti, V., & Shannon, R. V. (2005). Open set
speech perception with auditory brainstem implant.
Laryngoscope, 115(11), 1974–1978. https://doi.org/
10.1097/01.mlg.0000178327.42926.ec
Cox, R. M., & Xu, J. (2010). Short and long compres-
sion release times: Speech understanding, real-world
preferences, and association with cognitive ability.
Journal of the American Academy of Audiology, 21(2),
121–138. https://doi.org/10.3766/jaaa.21.2.6
de Wolf, M. J., Hendrix, S., Cremers, C. W., & Snik, A.
F. (2011). Better performance with bone-anchored
HA than acoustic devices in patients with severe airbone gap. The Laryngoscope, 121(3), 613–616.
Dillon, M. T., Buss, E., O’Connell, B. P., Rooth, M.
A., King, E. R., Bucker, A. L., . . . Brown, K. D.
(2020). Low-frequency hearing preservation with
long electrode arrays: Inclusion of unaided hearing
threshold assessment in the postoperative test battery. American Journal of Audiology, 29(1), 1–5.
® User’s Guide
Finley, C. C., Holden, T. A., Holden, L. K., Whiting,
B. R., Chole, R. A., Neely, G. J., . . . Skinner, M.
W. (2008). Role of electrode placement as a contributor to variability in cochlear implant outcomes.
Otology & Neurotology, 29(7), 920–928. https://doi
.org/10.1097/MAO.0b013e318184f492
Glista, D., Scollie, S., Bagatto, M., Seewald, R., Parsa,
V., & Johnson, A. (2009). Evaluation of nonlinear
frequency compression: Clinical outcomes. Interna-
tional Journal of Audiology, 48(9), 632–644. https://
doi.org/10.1080/14992020902971349
Gordon, K. A., Wong, D. D., & Papsin, B. C. (2010).
Cortical function in children receiving bilateral cochlear implants simultaneously or after a
period of interimplant delay. Otology & Neurotol-
ogy, 31(8), 1293–1299. https://doi.org/10.1097/
MAO.0b013e3181e8f965
Hänsel, T., Gauger, U., Bernhard, N., Behzadi, N.,
Romo Ventura, M. E., Hofmann, V., . . . Coordes,
A. (2018). Meta-analysis of subjective complaints of
vertigo and vestibular tests after cochlear implantation. Laryngoscope, 128(9), 2110–2123. https://doi
.org/10.1002/lary.27071
Hornsby, B. W., & Mueller, G. (2004). The speech
intelligibility index: What is it and what’s it good
for? The Hearing Journal, 57(10), 10–17.
Koyama, H., Kashio, A., Fujimoto, C., Uranaka, T.,
Matsumoto, Y., Kamogashira, T., . . . Yamasoba,
T. (2021). Alteration of vestibular function in
pediatric cochlear implant recipients. Frontiers in
Neurology, 12, 661302. https://doi.org/10.3389/
fneur.2021.661302
Kuk, F., & Ludvigsen, C. (2003). Reconsidering the
concept of the aided threshold for nonlinear hearing
aids. Trends in Amplification, 7(3), 77–97. https://
doi.org/10.1177/108471380300700302
McCreery, R. W., Venediktov, R. A., Coleman, J. J., &
Leech, H. M. (2012). An evidence-based systematic
review of directional microphones and digital noise
reduction hearing aids in school-age children with
hearing loss. American Journal of Audiology, 21(2),
295–312. https://doi.org/10.1044/1059-0889
(2012/ 12-0014)
McCreery, R. W., Walker, E. A., Stiles, D. J., Spratford,
M., Oleson, J. J., & Lewis, D. E. (2020). Audibilitybased hearing aid fitting criteria for children with
mild bilateral hearing loss. Language, Speech, and
Hearing Services in Schools, 51(1), 55–67. https://
doi.org/10.1044/2019_LSHSS-OCHL-19-0021
Audiology Review: Preparing for the Praxis and Comprehensive Examinations
https://t.me/medicina_free
476
McKay, S., Gravel, J. S., & Tharpe, A. M. (2008).
Amplification considerations for children with
minimal or mild bilateral hearing loss and unilateral
hearing loss. Trends in Amplification, 12(1), 43–54.
https://doi.org/10.1177/1084713807313570
Messersmith, J. J., Entwisle, L., Warren, S., & Scott,
M. (2019). Clinical practice guidelines: Cochlear
implants. Journal of the American Academy of Audi-
ology, 30(10), 827–844. https://doi.org/10.3766/
jaaa.19088
Moore, B. C. (2008). The choice of compression speed
in hearing aids: Theoretical and practical considerations and the role of individual differences. Trends
in Amplification, 12(2), 103–112. https://doi.org/
10.1177/1084713808317819
Mussoi, B., & Bentler, R. (2017). Binaural interfer-
ence and the effects of age and hearing loss. Journal
of the American Academy of Audiology, 28(1), 5–13.
https://doi.org/10.3766/jaaa.15011
Park, L. R., Gagnon, E. B., & Brown, K. D. (2021).
The limitations of FDA criteria: Inconsistencies
with clinical practice, findings, and adult criteria as
a barrier to pediatric implantation. Seminars in
Hearing, 42(4), 373–380. https://doi.org/10.10
55/
s–0041–1739370
Rabelo, A. T. V., Santos, J. N., Oliveira, R. C., & Mag-
alhães, M. de C. (2014). Effect of classroom acoustics on the speech intelligibility of students. CoDAS,
26(5), 360–366. https://doi.org/10.1590/23171782/20142014026
Rasmussen, K., West, N., Tian, L., & Cayé-Thomasen,
P. (2021). Long-term vestibular outcomes in
cochlear implant recipients. Frontiers in Neurology,
12, 686–681. https://doi.org/10.3389/fneur.2021
.686681
Schafer, E. C., Kirby, B., & Miller, S. (2020). Remote
microphone technology for children with hearing
loss or auditory processing issues. Seminars in Hear-
ing, 41(4), 277–290. https://doi .org/10.10 55/s0040-1718713
Sharma, A., Dorman, M. F., & Kral, A. (2005). The
influence of a sensitive period on central auditory
development in children with unilateral and bilateral cochlear implants. Hearing Research, 203(1–2),
134–143. https://doi.org/10.1016/j.heares .2004 .12
.010
Slade, K., Plack, C. J., & Nuttall, H. E. (2020). The
effects of age-related hearing loss on the brain and
cognitive function. Trends in Neurosciences, 43(10),
810–821.
Souza, P. (2002) Effects of compression on speech
acoustics, intelligibility, and sound quality. Trends in
Amplification, 6(4),131–165. https://doi.org/10
.11
77/108471380200600402
Stelmachowicz, P. G., Pittman, A. L., Hoover, B. M.,
Lewis, D. E., & Moeller, M. P. (2004). The importance of high-frequency audibility in the speech
and language development of children with hearing
loss. Archives of Otolaryngology-Head & Neck Sur-
gery, 130(5), 556–562. https://doi.org/10.1001/
archotol.130.5.556
Stewart, E., & Woodward, J. (2021). Out of the (head)
shadow: A systematic review of CROS/BiCROS literature. The Hearing Review, 28(8), 22–25.
Stiles, D., Bentler, R., & McGregor, K. (2012). The
speech intelligibility index and the pure-tone average as predictors of lexical ability in children fit with
hearing aids. Journal of Speech, Language, and Hear-
ing Research, 55, 764–778.
Uhler, K., Warner-Czyz, A., Gifford, R., & Working
Group, P. (2017). Pediatric minimum speech test
battery. Journal of the American Academy of Audiol-
ogy, 28(3), 232–247. https://doi.org/10.3766/jaaa.
15123
Walker, E., McCreery, R., Spratford, M., & Roush, P.
(2016). Children with auditory neuropathy spectrum disorder fitted with hearing aids applying the
American Academy of Audiology pediatric amplification guideline: Current practice and outcomes.
Journal of the American Academy of Audiology, 27(3),
204–218. https://doi.org/10.3766/jaaa.15050
Walkowiak, A., Lorens, A., Polak, M., Kostek, B.,
Skarzynski, H., Szkielkowska, A., & Skarzynski, P.
H. (2011). Evoked stapedius reflex and compound
action potential thresholds versus most comfortable loudness level: Assessment of their relation
for charge-based fitting strategies in implant users.
ORL; Journal for Oto-Rhino-Laryngology and Its
Related Specialties, 73(4), 189–195. https://doi.org/
10 .1159/000326892
Wolfe, J. (2020). Cochlear implants: Audiologic man-
agement and considerations for implantable hearing
devices. Plural Publishing.
Wong, K., Kozin, E. D., Kanumuri, V. V., Vachicou-
ras, N., Miller, J., Lacour, S., . . . Lee, D. J. (2019).
Auditory brainstem implants: Recent progress and
future perspectives. Frontiers in Neuroscience, 13, 10.
https://doi.org/10.3389/fnins.2019.00010
Yeo, B. S. Y., Song, H. J. J. M. D., Toh, E. M. S., Ng,
L. S., Ho, C. S. H., Ho, R., . . . Loh, W. S. (2022).
CHAPTER 9 Treatment: Topics in Amplification
https://t.me/medicina_free
477
Association of hearing aids and cochlear implants
with cognitive decline and dementia: A systematic
review and meta-analysis. JAMA Neurology. Advance
online publication. https://doi.org/10.1001/jama
neurol.2022.4427
Yin, S., Njai, R., Barker, L., Siegel, P. Z., & Liao, Y.
(2016). Summarizing health-related quality of life
(HRQOL): Development and testing of a onefactor model. Population Health Metrics, 14, 1–9.
https://doi.org/10.31887/DCNS.2014.16.2/
drevicki
Zimmerling, M. J., & Hochmair, E. S. (2002). EAP
recordings in Ineraid patients — correlations with psychophysical measures and possible implications for
patient fitting. Ear and Hearing, 23(2), 81–91. https://
doi.org/10.1097/00003446–200204000–00001
Zwolan, T. A., Schvartz-Leyzac, K. C., & Pleas-
ant, T. (2020). Development of a 60/60 guideline for referring adults for a traditional cochlear
implant candidacy evaluation. Otology & Neurotol-
ogy, 41(7), 895–900. https://doi.org/10.1097/
MAO.0000000000002664
Audiology Review: Preparing for the Praxis and Comprehensive Examinations
https://t.me/medicina_free
478
Practice Questions
1. A patient with high-frequency SNHL related to presbycusis is fit with binaural amplification for
the first time. After a few days of wearing her devices, she returns to your office complaining of
bothersome noises including the refrigerator at home, the HVAC system at church, and her key
chain rattling in her purse as she walks. What programming strategy may best help this patient?
a. Implementing a looped system at church to pair to her T-coil
b.
Implementing expansion into her hearing aid programming
Reducing overall gain for all input levels
c.
Creating an earmold with smaller venting
d.
Explanation: The bothersome sounds this patient is reporting are soft sounds that she has not likely
heard for many years. With her aids, she now has access to these soft sounds. Expansion can be used
as a noise reduction strategy for low-level sounds. By implementing expansion into her device settings,
we can help the patient experience perceived quiet in quiet environments. Therefore, b is the correct
answer.
2. A 3-year-old with CHARGE syndrome is fit with binaural amplification in the form of
traditional BTEs coupled with half shell silicone earmolds. His parents report persistent
feedback from the devices after the first 10 to 15 minutes that the patient has them in each
morning. The feedback stops when the earmolds are pushed into the ear. His earmolds are new
and, when they are properly inserted, appear to fit appropriately. What steps can be taken to
reduce feedback for the patient?
a. Remake the earmolds with a larger vent.
b. Purchase a different hearing aid style. Instead of a BTE, the patient could try a RIC.
c. Remake the earmold to be a full shell with helix lock for better retention.
d. The patient is a better candidate for a cochlear implant due to his diagnosis of CHARGE
syndrome. He should be referred to the CI team.
Explanation: Based on the parents’ report and troubleshooting descriptions, the feedback seems to
result from a poor-fitting earmold. As the half-shell earmolds are new and look well fit when properly
inserted, the audiologist should consider switching to a different earmold style. The audiologist could
try remaking the earmold to be larger with an additional retention feature. A full-shell earmold with
a helix lock may prevent feedback by creating a more secure coupling method. Therefore, c is the
correct answer.
3. An adult patient has a moderate SNHL in her right ear and a severe SNHL in her left ear. Her
word recognition score was 100% in the right ear and 12% in the left ear. What is the most
appropriate amplification option for this patient based solely on the audiometric information
provided?
a. BICROS; CROS device on the left ear
b. CROS; CROS device on the right ear
c. BICROS; CROS device on the right ear
d. CROS; CROS device on the left ear
CHAPTER 9 Treatment: Topics in Amplification
https://t.me/medicina_free
479
Explanation: This patient may benefit from traditional amplification in their right ear. The patient
has poor word recognition and may not be a good candidate for traditional amplification in her left
ear. The patient may benefit from a BICROS system. The CROS device is worn on the poorer hearing
ear. Therefore, a is the correct answer.
4. A 4-year-old patient with moderate conductive hearing loss is seen for a hearing aid evaluation.
Which is the best air-conduction HA and coupling option based on the information provided?
a. RIC with open-dome modular fitting
b.
BTE with open-dome modular fitting
BTE with traditional tube and custom earmold
c.
d.
BTE with slim tube and custom earmold
Explanation: Based on the patient’s age and degree of hearing loss, the best HA option is a BTE
with a traditional tube coupled with a custom earmold. This provides increased durability and more
consistent access to appropriate gain. Therefore, c is the correct answer.
5. A 25-year-old patient is seen for an annual hearing aid check. She has a bilateral, mild to
moderately severe, high-frequency SNHL. She is currently fit binaurally with BTEs, slim tubes,
and custom earmolds. An electroacoustic check is completed using the Verifit2® real ear speech
mapping. Results show that her current aids are not meeting targets for high frequencies. What
change could initially be implemented to improve high-frequency audibility?
a.
Replace slim tubes with traditional diameter tubing
Switch from custom earmold to closed dome
b.
c. Change HA style to IIC
d. Change HA style to a CROS system
Explanation: Slim tubes can create significant high-frequency roll-off. Switching to regular tubing is
one way to try and better meet high-frequency targets. Therefore, a is the correct answer.
6. An adult patient with bilateral moderate sloping to severe SNHL arrives at your office with
HAs that they acquired from another audiologist’s office. The HAs are less than 1 year old.
The patient reports wearing the devices during all waking hours but still having difficulty
hearing in all situations. You evaluate the patient’s aids and find they are not adequately meeting
prescriptive targets for their hearing levels. The patient insists that hearing aids do not work for
them. What is the best next step for this patient:
a. Recommend the patient purchase new HAs from your office.
b. Recommend the patient for a cochlear implant evaluation.
c. Attempt to adjust the gain on the patient’s current devices. Charge your standard hearing aid
adjustment fee.
d. Refer the patient for a medical evaluation.
Explanation: First, you should try to meet the patient’s needs with the device they have purchased.
If you cannot adjust their devices, you could then consider counseling they return to their original
audiologist for adjustments. If you cannot adjust the devices to adequately meet their gain needs,
Audiology Review: Preparing for the Praxis and Comprehensive Examinations
https://t.me/medicina_free
480
then you may counsel them into new devices with more appropriate gain and/or coupling methods.
Therefore, c is the correct answer.
7. A cochlear implant recipient arrives for a visit with a chief complaint of increased difficulty in
background noise. They were last seen in the office 1 year ago. What is the best next step to
address the patient’s concerns?
a.
Increase the patient’s upper stimulation levels.
Activate a fixed directional program and counsel them regarding environmental
b.
modifications.
c. Recommend they utilize remote microphone technology.
d.
Reevaluate the patient’s internal dynamic range.
Explanation: The first thing you should do is reevaluate the internal dynamic range. Optimization of
mapping parameters is the key to successful performance. After these are optimized, you can talk about
directionality and remote microphone technology. Therefore, d is the correct answer.
8. A cochlear implant recipient is experiencing facial stimulation with their device. Which of these
is the best next step to eliminate their facial stimulation:
a. Globally lower their upper stimulation levels.
b. Increase the pulse width of the patient’s map.
c. Contact the manufacturer and order an integrity test.
d. Identify the electrode or region that is causing the facial stimulation.
Explanation: You should identify the electrode or region that is causing the facial stimulation and try
to correct it within that region only without making global changes to the MAP. Therefore, d is the
correct answer.
9. A 24-month-old child with auditory neuropathy has been wearing appropriately fitted HAs
since age 9 months. The child presents with a moderate SNHL when tested via behavioral
threshold measures. They are currently nonverbal with no other diagnoses or syndromes. Which
THREE options are appropriate next steps for the child (select all that apply):
a. Refer the child for a speech-language evaluation.
b.
Refer the child to an otolaryngologist for further medical evaluation.
Recommend the child undergo an audiologic cochlear implant evaluation.
c.
d. Contact the child’s pediatrician and recommend an evaluation for autism spectrum disorder.
Explanation: This child should undergo evaluation by the pediatric cochlear implant team members.
Regardless of behavioral thresholds, children with ANSD may not be able to adequately access speech
and language with HAs and should be considered for cochlear implantation. Therefore, a, b, and c are
the correct answers.
CHAPTER 9 Treatment: Topics in Amplification
https://t.me/medicina_free
481
10. Which of the following is considered current best practice for programming upper stimulation
levels that are equally loud for an adult that can participate in behavioral mapping techniques?
a. Electrically evoked compound action potential
b.
Electrically evoked stapedial reflex threshold
Psychophysical loudness scaling
c.
d.
Creating a map based on the manufacturer-specified population mean
Explanation: Even when the patient can participate in psychophysical loudness scaling, they may not
be skilled at listening to loudness differences through the electrode array, especially if they are a new
user. ESRT is the best way to ensure equal loudness regardless of the patient’s subjective scaling abilities.
Therefore, b is the correct answer.
Соседние файлы в папке Библиотека им академика М.И. Перельмана