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Free AIOU Solved Assignment Code 682 Spring 2021
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Course: Speech & Hearing (682)
Semester: Spring, 2021
ASSIGNMENT No. 1
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Q.1 In sound two aspects are very important compression and rarefaction, discuss it in details with the help of diagrams. Also discuss basic properties of sound waves.
The pattern of pressure changes within the sound waveform depends on what created the sound in the first place. An explosion would produce a sound pulse that begins with compression, because the expansion of the explosion compresses the air around it.
In the case of an audio speaker which was previously at rest, its output of a sound would begin with compression if the cone’s first movement is toward the listener (and away from the speaker’s frame). It could equally well begin with a rarefaction (low pressure area) if the speaker cone initially moves into the frame, away from the listener.
Sound waves start from the instantaneous condition of the medium, and are caused by some surface which is perturbed.
It might be helpful to picture a membrane, constrained at the edges and shaped to produce a perfect sine-wave sound when struck at the exact center with a perfect point-source mallet. This removes all the complexity and limits us to a sound pressure wave generator with a pre-determined starting condition.
Place this imaginary apparatus into an equally perfectly-homogenous medium which is, for purposes of this thought experiment, less massy and perfectly elastic, but with a reasonably valid inertia.
Strike the membrane on the exact center, swinging the mallet from the right of the membrane. The membrane will deflect to the left, and on the axis of motion, the initial pressure will increase in the medium to the left of the assembly. The initial pressure in the medium to the right of the membrane will decrease. The sound wave will propagate to both the left and right, expanding from the membrane. The initial pressure will be compression on one side and rarefaction on the other. If you strike the membrane from the other side, you will still get waves traveling out, with rarefraction as the initial impulse going back towards the impact side, and compression in the direction of mallet movement.
If the membrane is replaced with a large rectangular solid so the body of the solid is extending to the left and the previous medium to the right, and swing the mallet from the right, the waves will start with compression to the left and rarefraction to the right as the solid is materially compressed and the medium is rarefacted, largely by the solid retreating as a result of the impact.
There is only one case in which this is not the case: if the medium on one side of the vibrating surface is a vacuum, or a material which instantaneously dampens all vibration. In that case, vibrations reaching the interface or caused in the atmosphere by penetration or glancing blow from either side will create a sound wave in the atmosphere only. The initial compression or rarefaction will be dependent on how the interface is struck, from inside or vacuum side.
All waves have certain properties. The three most important ones for audio work are shown here:
Wavelength: The distance between any point on a wave and the equivalent point on the next phase. Literally, the length of the wave.
Amplitude: The strength or power of a wave signal. The “height” of a wave when viewed as a graph.
Higher amplitudes are interpreted as a higher volume, hence the name “amplifier” for a device that increases amplitude.
Frequency: The number of times the wavelength occurs in one second. Measured in kilohertz (Khz), or cycles per second. The faster the sound source vibrates, the higher the frequency.
Higher frequencies are interpreted as a higher pitch. For example, when you sing in a high-pitched voice you are forcing your vocal chords to vibrate quickly.
Characteristics of Sound Waves
There are five main characteristics of sound waves: wavelength, amplitude, frequency, time period, and velocity. The wavelength of a sound wave indicates the distance that wave travels before it repeats itself. The wavelength itself is a longitudinal wave that shows the compressions and rarefactions of the sound wave. The amplitude of a wave defines the maximum displacement of the particles disturbed by the sound wave as it passes through a medium. A large amplitude indicates a large sound wave. The frequency of a sound wave indicates the number of sound waves produced each second. Low-frequency sounds produce sound waves less often than high-frequency sounds. The time period of a sound wave is the amount of time required to create a complete wave cycle. Each vibration from the sound source produces a wave’s worth of sound. Each complete wave cycle begins with a trough and ends at the start of the next trough. Lastly, the velocity of a sound wave tells us how fast the wave is moving and is expressed as meters per second.
Sound wave diagram. A wave cycle occurs between two troughs.
Units of Sound
When we measure sound, there are four different measurement units available to us. The first unit is called the decibel (dB). The decibel is a logarithmic ratio of the sound pressure compared to a reference pressure. The next most frequently used unit is the hertz (Hz). The hertz is a measure of sound frequency. Hertz and decibels are widely used to describe and measure sounds, but phon and sone are also used. A sone is the perceived loudness of a sound and a phon is the unit of loudness for pure tones. Additionally, the phon refers to subjective loudness, while the sone is the perceived loudness.
Sound Wave Graphs Explained
Sound waves can be described by graphing either displacement or density. Displacement-time graphs represent how far the particles are from their original places and indicates which direction they’ve moved. Particles that show up on the zero line in a particle displacement graph didn’t move at all from their normal position. These seemingly motionless particles experience more compressions and rarefactions than other particles. Since pressure and density are related, a pressure versus time graph will display the same information as a density versus time graph. These graphs indicate where the particles are compressed and where they are very expanded. Unlike displacement graphs, particles along the zero line in a density graph are never squished or pulled apart. Instead, they are the particles that move back and forth the most.
AIOU Solved Assignment Code 682 Spring 2021
Q.2 Masking is an important technique in assessment of hearing. Discuss its need in air-conduction and bone-conduction tests. Also discuss its types.
Pure tone audiometry has been the gold standard for the measurement of hearing acuity for over 80 years.1 Despite some of its obvious limitations, pure tone audiometry remains the main diagnostic equipment for standard hearing assessment in many audiological practices.2
The American Speech-Language-Hearing Association (ASHA) first suggested the use of audiometric symbols to record results for pure tone audiometry in 1974, with the latest revised audiometric symbols adopted in 1990.3 The ISO 8253-1:2010 standard also specifies the audiometric symbols that should be used for the graphic presentation of hearing thresholds; these symbols are similar to those suggested by ASHA.3,4 Many audiology clinics use these symbols, making them universally accepted. The use of standard audiometric symbols allows for uniformity and efficiency in sharing audiometric information from one clinician to another, thus benefiting patients.
There is always a need to add to the exhaustive list of the ASHA audiometric symbols to benefit our patients, should a clinic/research discover an innovative way of recording results through audiometric symbols. In this article, we aim to start a conversation around the creation of a new audiometric symbol for audiometric findings for “minimum response levels” due to a non-patient behavior limitation, such as
- a limitation of the audiometer,
- a clinical decision to only test to a certain lower intensity,
- or as a result of excessive ambient noise not permitting the testing of lower intensities.
One clear limitation of audiometry is the minimum and maximum output limit of the equipment. The audiometric symbol to indicate a “no response” as a result of the equipment’s maximum output limitations has been established and reported by ASHA.3 In essence if the true test ear threshold cannot be established due to the maximum output limitations of the audiometer, an audiometric symbol for the specific ear with a downward arrow should be plotted on the audiogram at the last presented (highest) pure tone intensity. This practice is common and standard among audiologists. In a sense, this audiometric symbol is important in indicating that the threshold for the individual, at the specific frequency, could not be found due to the limitations of the test equipment that was used.
With the introduction of booth-less audiometry more than a decade ago, the need arose for mobile audiometers to record the minimum testable thresholds obtainable on a patient due to excessive ambient noise levels. Today, these audiometers typically measure ambient noise in real-time and have the potential to indicate when a minimum plateau was reached because of the noise levels. The first audiometer to have implemented a minimum plateau symbol was the KUDUwave in 2008. It then became apparent that there has always been a need for this annotation and that it should become standard practice in audiology.
PLATEAU-RESPONSE DUE TO AUDIOMETRIC MINIMUM OUTPUT LIMITATIONS
An issue of clinical relevance (and one that begs for a new audiometric symbol) that is not making the most amount of noise in the clinical sphere is the minimum output limitation of an audiometer.
In this article, the term minimum plateau will be used to refer to the minimum intensity that one can test down to. This is widely known as the floor effect across the field of statistics. Specific to audiology, a floor effect may arise when the measurement tool has a lower limit thus not being able to measure lower hearing thresholds.
But why does this matter? For us to be able to answer this question, we first have to define what a hearing threshold is. A hearing threshold is the softest sound one can hear 50 percent of the time, and this is generally assessed using pure tone audiometry. When a patient hears and responds 100 percent of the time to a specific intensity the clinician decreases the intensity further. But what if that is the lowest testable intensity?
The minimum intensity that clinicians test down to, or are able to test down to, is not always the testee’s hearing threshold. It is inaccurate to refer to these patient responses as their hearing thresholds. The minimum-plateau responses are of clinical relevance as they indicate that the thresholds obtained at that moment are or could be “not as accurate” due to equipment limitations or the amount of ambient noise in the environment.
To be clear, the audiometer’s minimum output levels can be influenced by a few things, namely:
- Equipment Audiometer Intensity Range
- Ambient noise levels
- Clinicians testing protocols
- Room certification limits
Equipment Intensity Range: Acoustic transducers, such as bone vibrators, insert earphones and supra-aural headphones, have their own maximum and minimum output limits. For example, some circumaural headphones have an intensity range of -20 to 100 dB HL for high frequencies, while a supra-aural headset has the intensity range of -10 to 120 dB HL in the conventional frequencies. This demonstrates the minimum output levels of the two acoustic transducers. Additionally, some audiometers have a minimum intensity of 0 dB HL.
Ambient Noise Levels: Ambient noise, whether transient or static, can affect the lowest intensity that you can present at. Various standards (i.e., ANSI S3.1, ISO 8253-1, SANS 10182) have prescribed maximum permissible ambient noise levels (MPANLs) to stipulate the acceptable noise levels in an audiometric assessment room or environment.5 For example, different levels of noise allow the audiologist to test either down to -10, 0, 10, or 25 dB HL. The lower the ambient noise levels in the environment, the lower the intensity one can test down to. As an example, many organizations have recommended that school-based hearing screening programs test down to 25 dB in developing countries (which may not have sound-treated booths) to mitigate ambient noise levels.
Clinicians Testing Protocols: The clinician’s testing protocol or procedure may also define the lowest intensity tested down to. Using the same example as above, a clinician may choose to test down to 25 dB for school-based hearing screenings, whilst on the other hand, a clinician may choose to test down to 15 dB across the frequency spectrum when testing for percentage loss of hearing (PLH) in the occupational health setting.
Room Certification Limits: Certifications of sound booths and/or test environments that allow for compliance with standardized MPANLs for audiometric testing are conducted annually. Depending on the test setting (i.e., occupational settings vs clinical settings) and the frequency range tested, certain ambient noise levels are permitted when certifying the test environment to the standards mentioned previously. With clinical settings, ambient noise levels should be low to allow for testing down to -10 dB HL. Typically a sound booth is certified to allow testing to a minimum of 10 dBHL. What this means is that, if testing in those settings that do not allow for testing lower than 0 dB HL, one would technically always have marked the “threshold” using the recommended audiometric symbol if the patient could potentially have a lower threshold than 0 dB HL.
When conducting pure tone audiometry, audiologists should note the considerable difference between “hearing threshold” and “minimal response level,” or as we refer to it here, the “minimum plateau.” Thus, it must be indicated on the audiogram whether the response is a hearing threshold or a minimum plateau. This can be represented graphically or through notes written below one’s audiogram. The symbol that we suggest is one that is almost similar to the “no response due to the maximum output of the audiometer” reported by ASHA3 and ISO. To record a minimum plateau for a specific ear, mark a threshold symbol for the ear with an upward arrow at the last presented (lowest) pure tone intensity.
AIOU Solved Assignment 1 Code 682 Spring 2021
Q.3 Differentiate between acoustic and linguistic elements of speech testing. Support your answer with examples.
Acoustic dimension of speech (ADS) is a complex neurodevelopmental condition. Based on the 5th edition of Diagnostic Statistical Manual of Mental Disorders (DSM-5), specific diagnostic criteria for childhood autism include social skills and communication deficit associated with restrictive and repetitive behaviors, interests, or activities.1 ADS is currently one of the most common childhood morbidities, presenting in various degrees of severity. The most recent global prevalence of autism was estimated at 0.62%.2
This disorder has grown into a constant challenge for many countries such as Tunisia, as it has a severe impact on both the affected individuals and their families. The financial burden, which has become more acute since the Tunisian revolution, along with the lack of scientific knowledge about the epidemiology, etiology, and natural course of this condition, have rendered the situation more complex.3–5
The spectrum of symptoms and the extreme complexity in the developmental and associated medical conditions within ADS do not necessarily mean a single etiology. Several hypotheses concerning the pathogenesis have been proposed, including the interaction of environmental factors and various genetic predispositions.5,6 Studies based on concordance rates among monozygotic twins and families suggest a possible role of both genetic and environmental factors in the etiology of ADS.7
A recent study suggests that genetic factors account for only 35-40% of the contributing elements.8,9 The remaining 60-65% are likely due to other factors, such as prenatal, perinatal, and postnatal environmental factors. Since ADSs are neurodevelopmental disorders, neonatally-observed complications that are markers of events or processes that emerge early during the perinatal period may be particularly important to consider.8
To the best of our knowledge, in Tunisia, there are no studies that have considered the relationship between prenatal, perinatal, and postnatal risk factors and ADS.
Thus, the aim of the present study was to identify the pre-, peri-, and postnatal factors associated to ADS by comparing children with ADS to their siblings who do not present any autistic disorders.
Informal consent from parents or legal guardians of participants was obtained after the nature of the procedures had been fully explained.
The interviews were conducted with mothers in 78% of the cases, with fathers in 4% of the cases, and with both parents in 18% of the cases, by a properly trained child psychiatrist.
Parents completed a medical history questionnaire with a combination of closed and open-ended questions regarding pregnancy, labor, and complications during and after birth. Additionally, data were collected with reference to medical record and medical birth book.
The studied variables were designed according to the probable risk factors of ADS from existing literature. The following variables, which were considered for both groups, were classified as parental factors, pre-, peri-, and postnatal characteristics and were codified as binary variables (yes/no).
Parental factors: Advanced maternal and paternal age at the time of childbirth (≥35 years), consanguinity.
Prenatal factors: These consisted of conditions that arose during pregnancy, such as gestational diabetes, which usually develops in the second half of pregnancy; high and low blood pressure; gestational infections; and fetal distress inducing threatened abortion conditions, such as amniotic fluid loss, bleeding during gestation, and suboptimal intrauterine conditions. Perinatal factors: delivery characteristics, such as term birth (premature or post-term birth); delivery types, including forceps or cesarean section; acute fetal distress; and birth weight (low birth weight [<2500 g] and macrosomia [>4000 g])
Postnatal factors: All conditions occurring in the first six weeks after birth, such as respiratory and urinary infections; auditory deficit (a loss of 30 dB); and blood disorders such as anemia and thrombopenia.
The diagnosis of respiratory and urinary infections was achieved during hospitalizations in pediatric services.
In the present study, the chose 35 years as the age cut-off for both parents. This choice was based the recommendations of many authors.11–13 Despite the fact that a correlation between advanced age at the moment of the conception of both parents and ADS was not observed, the frequency of parents aged over 35 years was higher in children with ADS than their siblings (respectively 24% vs. 19.6% for maternal age and two-thirds vs. almost 50% for paternal age).
Theories advocating the association between parental age and increased risk for ADSs include the potential for more genetic mutations in the gametes of older fathers and mothers, as well as a less favorable in utero environment in older mothers, with more obstetrical complications such as low birth weight, prematurity, and cerebral hypoxia.11
Moreover, according to some studies, high prevalence of chronic diseases among older women could contribute to expand the risk of adverse birth outcomes.12,14 Data from the literature trying to explain the increased risk for ADS’s among older mothers have incriminated the high risk of obstetric complications observed in these mothers.11,12,14
Furthermore, congenital anomalies are also more common in the fetuses and infants of older mothers, and these conditions contribute in increasing the risk of ADS.
In the present study, a rate of 28% of consanguinity was observed. In the literature, it is stated that consanguinity increases the chances of inheriting a bad DNA fit, which will definitely result in a birth defect. Inbred disorders may cause other abnormalities, and ADS can also be brought on by other conditions.15 Since the control group, in the present study, was represented by the siblings conceived and born from the same biological parents, consanguinity could not be evaluated as a risk factor for ADS.
Prenatal, perinatal and postnatal factors
In the present survey, no correlation was observed between the severity of ADS and prenatal, perinatal, and postnatal factors. The present results are in agreement with some recent studies.16,17 Conversely, some hypothesis have been raised, indicating that the light form of autism would show weaker or no association with obstetric risk factors.
In the present study, the occurrence of maternal infection was higher among cases when compared to controls (12% for the first group vs. 3.9% for controls).
According to many studies, adverse intrauterine environment resulting from maternal bacterial and viral infections during pregnancy is a significant risk factor for several neuropsychiatric disorders including ADS.15 The association between intrauterine inflammation, infection, and ADS is based on both epidemiological studies and case reports. This association is apparently related to maternal inflammatory process; hence, maternal immune activation may play a role in neuro-developmental perturbation.
In large population studies, researchers have not identified a specific infection, but rather an increased rate of ADS, especially when the maternal infection is rather severe and requires hospitalization.15,18
Among the prenatal factors identified in this study, exposure to cigarette tobacco (passive smoking) was noted in 22% of cases. Retrospective epidemiological studies have observed, among mothers of children with ADS, a significantly increased percentage of women who were exposed to tobacco during the conception of the child. Therefore, maternal smoking was considered as a potential maternal confounding factor, as well as other toxic chemicals.6
Some authors have demonstrated that maternal cigarette smoking during pregnancy may have a commutative impact on the lineage of her reproductive cells; it is also associated with an increased rate of spontaneous abortions, preterm delivery, reduced birth weight, among others.19 The findings regarding its relation with ADS are still controversial.20–22
The present study showed that the frequency of gestational diabetes was higher in the first group (8% vs. 2% in the second group).
According to some authors, gestational diabetes is mainly associated with disturbed fetal growth and increased rate of a variety of pregnancy complications.23 It also affects fine and gross motor development and increases the rate of learning difficulties and of attention deficit hyperactivity disorder, a common comorbid neurobehavioral problem in ADS. The negative effects of maternal diabetes on the brain may result from intrauterine increased fetal oxidative stress and epigenetic changes in the expression of several genes. The increased risk observed might be related to other pregnancy complications that are common in diabetes, or to effects on fetal growth rather than to complications of hyperglycemia. It is also unknown whether optimal control of diabetes will further decrease this association.23
Because of its rising incidence, maternal diabetes has been considered, by several studies, as an obvious candidate to be associated with ADS, whereas others have failed to demonstrate such associations.15,20,23
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In the current survey, hypertension, hypotension, and threatened abortion were more frequent in the first group (respectively 10% vs. 5.9%, 2% vs. 0%, and 10% vs. 5.9% in the second group). These conditions are generally related to fetal loss and adverse infant outcomes, such as prematurity, intrauterine growth retardation, still birth, and neonatal death indicating fetal distress. Likewise, fetal hypoxia is one of the manifestations of fetal distress and has been reported to induce conditions such as placental abruption, threatened premature delivery, emergency cesarean section, forceps delivery, spontaneous abortion, and varying degrees of cerebral damage.4,5 Accordingly, ADS was linked to fetal distress: oxygen deprivation could damage vulnerable regions in the brain, such as the basal ganglia, hippocampus, and lateral ventricles. Some neuroimaging studies have demonstrated abnormalities in these regions among patients with ADS compared with controls.5,14
In the present series, perinatal factors were very significantly associated with ADS (p = 0.03). This result is consistent with the literature.4,24 In fact, complications occurring during labor affect the neurodevelopment of the fetus and infant in later stages, and can contribute toward the risk of ADS.
The current research also suggests that obstetric factors occur more frequently in ADS children than in their unaffected siblings. The present results corroborate other studies reporting an association between perinatal factors and ADS.
Perinatal factors were represented by a long duration of delivery and prematurity in 18% of the cases each one and suffering acute fetal in 26% of the cases. Therefore, it is admitted that these conditions may lead to fetal distress and asphyxia, resulting in brain damage. Fetal oxygen deprivation has been proposed to increase the risk for ADS. Recently, research has highlighted the occurrence of ADSs in very preterm infants, in addition to already identified developmental disorders.4,14,24
The present findings are in agreement with previous studies suggesting that postnatal events may increase the risk for ADSs in some children.4 In fact, a significant association between postnatal factors and ADS (p = 0.042) has been observed.
In the present study, an association was observed between both urinary and respiratory infections and ADS. These findings could be explained by the release of cytokines as immune responses of the baby to these infections, which can affect neural cell proliferation and differentiation. These impairments are known to be associated with ADS.5,25
Hearing deficits were more common in the first group (4% vs. 0% in the second group). The present results corroborate those of Fombonne,26 who reported, in a meta-analysis, that the prevalence of sensory deficits in autism vary from 0.9% to 5.9%.
Rosenhall et al.,27 in a study conducted on 199 children and adolescents with ADS, estimated that the prevalence of hearing impairment in autism is ten times higher than in general population (11%). They also observed that 7.9% of the patients had an moderate hearing loss, 3.5% were profoundly deaf, and 18% had hyperacusis in the audiogram, even after controlling for the age factor. More recently, Kielinen et al.28 observed, in a population of children with autism, that 8.6% had a mild hearing loss, 7% a moderate deficit, and 1.6% severe deficiency (hearing loss in more than 60 dB at audiometry).
The strength of the present study lies in its precise confirmation of the ADS, the active participation of parents, and resorting to unaffected siblings as controls. This last feature may help to identify risk factors and to control for hereditary background, family environment, and maternal predisposition to complications in pregnancy or birth. Nonetheless, there are some limitations, namely the limited number of samples. Therefore, the present results should be completed by epidemiological studies with a larger scale and in larger populations. To face the issue of ADS and consanguinity, a larger population with and without consanguinity should be evaluated.
In the present study, no individual factor in the prenatal period was consistently significant as a risk factor for ADS. In the literature, some of these factors were associated with autism; therefore, they should be considered as potential risk factors, as well as perinatal and postnatal events.
Prenatal, perinatal, and postnatal factors for ADS should be considered in the broadest sense: these events of the fetal, newborn, and infant environment could interact or contribute in combination with other co-factors (environmental and genetic, among others) to characterize ADS. Scores indicate that rather than focusing on a single factor, future studies should investigate the combination of several factors.
AIOU Solved Assignment 2 Code 682 Spring 2021
Q.4 Why the knowledge, if main components of atypical hearing-aid and its functions are important for a teacher of hearing impaired children? Support your answer with suitable examples.
A hearing aid is a small electronic device that you wear in or behind your ear. It makes some sounds louder so that a person with hearing loss can listen, communicate, and participate more fully in daily activities. A hearing aid can help people hear more in both quiet and noisy situations. However, only about one out of five people who would benefit from a hearing aid actually uses one.
A hearing aid has three basic parts: a microphone, amplifier, and speaker. The hearing aid receives sound through a microphone, which converts the sound waves to electrical signals and sends them to an amplifier. The amplifier increases the power of the signals and then sends them to the ear through a speaker.
Hearing aids are primarily useful in improving the hearing and speech comprehension of people who have hearing loss that results from damage to the small sensory cells in the inner ear, called hair cells. This type of hearing loss is called sensorineural hearing loss. The damage can occur as a result of disease, aging, or injury from noise or certain medicines.
A hearing aid magnifies sound vibrations entering the ear. Surviving hair cells detect the larger vibrations and convert them into neural signals that are passed along to the brain. The greater the damage to a person’s hair cells, the more severe the hearing loss, and the greater the hearing aid amplification needed to make up the difference. However, there are practical limits to the amount of amplification a hearing aid can provide. In addition, if the inner ear is too damaged, even large vibrations will not be converted into neural signals. In this situation, a hearing aid would be ineffective.
If you think you might have hearing loss and could benefit from a hearing aid, visit your physician, who may refer you to an otolaryngologist or audiologist. An otolaryngologist is a physician who specializes in ear, nose, and throat disorders and will investigate the cause of the hearing loss. An audiologist is a hearing health professional who identifies and measures hearing loss and will perform a hearing test to assess the type and degree of loss.
Styles of hearing aids
- Behind-the-ear(BTE) hearing aids consist of a hard plastic case worn behind the ear and connected to a plastic earmold that fits inside the outer ear. The electronic parts are held in the case behind the ear. Sound travels from the hearing aid through the earmold and into the ear. BTE aids are used by people of all ages for mild to profound hearing loss.
A new kind of BTE aid is an open-fit hearing aid. Small, open-fit aids fit behind the ear completely, with only a narrow tube inserted into the ear canal, enabling the canal to remain open. For this reason, open-fit hearing aids may be a good choice for people who experience a buildup of earwax, since this type of aid is less likely to be damaged by such substances. In addition, some people may prefer the open-fit hearing aid because their perception of their voice does not sound “plugged up.”
- In-the-ear(ITE) hearing aids fit completely inside the outer ear and are used for mild to severe hearing loss. The case holding the electronic components is made of hard plastic. Some ITE aids may have certain added features installed, such as a telecoil. A telecoil is a small magnetic coil that allows users to receive sound through the circuitry of the hearing aid, rather than through its microphone. This makes it easier to hear conversations over the telephone. A telecoil also helps people hear in public facilities that have installed special sound systems, called induction loop systems. Induction loop systems can be found in many churches, schools, airports, and auditoriums. ITE aids usually are not worn by young children because the casings need to be replaced often as the ear grows.
- Canalaids fit into the ear canal and are available in two styles. The in-the-canal (ITC) hearing aid is made to fit the size and shape of a person’s ear canal. A completely-in-canal (CIC) hearing aid is nearly hidden in the ear canal. Both types are used for mild to moderately severe hearing loss.
Because they are small, canal aids may be difficult for a person to adjust and remove. In addition, canal aids have less space available for batteries and additional devices, such as a telecoil. They usually are not recommended for young children or for people with severe to profound hearing loss because their reduced size limits their power and volume.
Hearing aids work differently depending on the electronics used. The two main types of electronics are analog and digital.
Analog aids convert sound waves into electrical signals, which are amplified. Analog/adjustable hearing aids are custom built to meet the needs of each user. The aid is programmed by the manufacturer according to the specifications recommended by your audiologist. Analog/programmable hearing aids have more than one program or setting. An audiologist can program the aid using a computer, and you can change the program for different listening environments—from a small, quiet room to a crowded restaurant to large, open areas, such as a theater or stadium. Analog/programmable circuitry can be used in all types of hearing aids. Analog aids usually are less expensive than digital aids.
Digital aids convert sound waves into numerical codes, similar to the binary code of a computer, before amplifying them. Because the code also includes information about a sound’s pitch or loudness, the aid can be specially programmed to amplify some frequencies more than others. Digital circuitry gives an audiologist more flexibility in adjusting the aid to a user’s needs and to certain listening environments. These aids also can be programmed to focus on sounds coming from a specific direction. Digital circuitry can be used in all types of hearing aids.
The hearing aid that will work best for you depends on the kind and severity of your hearing loss. If you have a hearing loss in both of your ears, two hearing aids are generally recommended because two aids provide a more natural signal to the brain. Hearing in both ears also will help you understand speech and locate where the sound is coming from.
You and your audiologist should select a hearing aid that best suits your needs and lifestyle. Price is also a key consideration because hearing aids range from hundreds to several thousand dollars. Similar to other equipment purchases, style and features affect cost. However, don’t use price alone to determine the best hearing aid for you. Just because one hearing aid is more expensive than another does not necessarily mean that it will better suit your needs.
A hearing aid will not restore your normal hearing. With practice, however, a hearing aid will increase your awareness of sounds and their sources. You will want to wear your hearing aid regularly, so select one that is convenient and easy for you to use. Other features to consider include parts or services covered by the warranty, estimated schedule and costs for maintenance and repair, options and upgrade opportunities, and the hearing aid company’s reputation for quality and customer service.
Hearing aids take time and patience to use successfully. Wearing your aids regularly will help you adjust to them.
Become familiar with your hearing aid’s features. With your audiologist present, practice putting in and taking out the aid, cleaning it, identifying right and left aids, and replacing the batteries. Ask how to test it in listening environments where you have problems with hearing. Learn to adjust the aid’s volume and to program it for sounds that are too loud or too soft. Work with your audiologist until you are comfortable and satisfied.
You may experience some of the following problems as you adjust to wearing your new aid.
- My hearing aid feels uncomfortable.Some individuals may find a hearing aid to be slightly uncomfortable at first. Ask your audiologist how long you should wear your hearing aid while you are adjusting to it.
- My voice sounds too loud. The “plugged-up” sensation that causes a hearing aid user’s voice to sound louder inside the head is called the occlusion effect, and it is very common for new hearing aid users. Check with your audiologist to see if a correction is possible. Most individuals get used to this effect over time.
- I get feedback from my hearing aid.A whistling sound can be caused by a hearing aid that does not fit or work well or is clogged by earwax or fluid. See your audiologist for adjustments.
- I hear background noise. A hearing aid does not completely separate the sounds you want to hear from the ones you do not want to hear. Sometimes, however, the hearing aid may need to be adjusted. Talk with your audiologist.
- I hear a buzzing sound when I use my cell phone. Some people who wear hearing aids or have implanted hearing devices experience problems with the radio frequency interference caused by digital cell phones. Both hearing aids and cell phones are improving, however, so these problems are occurring less often. When you are being fitted for a new hearing aid, take your cell phone with you to see if it will work well with the aid.
AIOU Solved Assignment Code 682 Autumn 2021
Q.5 Discuss activity method of teaching appropriate antonyms in auditory discrimination to be late applied to voice control and speech training. Examples should be part of your answer.
Child behavior problems have been shown to negatively impact a range of developmental, social, and educational outcomes (Masten et al., 2005; Pierce, Ewing, & Campbell, 1999). There has been substantial progress in understanding the complex relationships between biological, family, and social systems that lead to behavior problems. However, some relationships still require clarification, such as the one between language and behavior problems. Previous studies have reported strong links between language and behavior problems, with children diagnosed with language disorders showing a higher incidence of behavior problems and, conversely, children diagnosed with behavior problems showing a higher incidence of language disorders. However, it is not clear whether deficits in language lead to behavior problems, result from them, or whether the two are independent manifestations of a more general developmental process (Beitchman et al., 2001; Brownlie et al., 2004). This lack of clarity results, in part, from the difficulty isolating language from behavior problems. In previous studies the etiologies of language and behavior difficulties were either not reported or unknown, making it difficult to rule out the effect of a general developmental process underlying both problems (Rescorla, Ross, & McClure, 2007).
Deaf children of hearing parents are unique because the etiology of their language difficulties is known, and results from the mismatch between the communication strategies of the child and parent. Evidence for this comes from deaf children of deaf parents who develop language similar to that of normally hearing children (Schick, de Villiers, de Villiers, & Hoffmeister, 2007). Previous studies of deaf children of hearing parents have found elevated behavior problems in this population, but the reasons for these difficulties are not known (Mitchell & Quittner, 1996). In combination, the known etiology of their language delays and elevated rates of behavior problems make this population exceptionally well suited to disentangle language from behavior problems. The purpose of this study was to examine the relationship between language and behavior problems in the largest cohort to date of young, deaf cochlear-implant candidates, and children with normal hearing.
Externalizing behavior problems in young children are fairly common, and are often dismissed as a normal developmental phase (i.e., “terrible twos”; Rubin, Burgess, Dwyer, & Hastings, 2003). However, early behavior problems are a relatively stable risk factor for future behavior problems, poor academic performance, and peer rejection. Children manifesting externalizing problems (e.g., oppositional behavior, aggression, violating societal rules) in early childhood are likely to continue having behavioral difficulties in elementary school (Campbell, Shaw, & Gilliom, 2000), early adolescence (Pierce et al., 1999) and often into adulthood (Moffitt, Caspi, Harrington, & Milne, 2001).
Children with sensorineural hearing loss, in particular, exhibit higher rates of externalizing behavior problems (30–38%; van Eldik, Trefferes, Veerman, & Verhulst, 2004; Vostanis, Hayes, Du Feu, & Warren, 1997) than children with normal hearing (3–18%; Hinshaw & Lee, 2003). Unfortunately, little is known about why prevalence rates are higher for this population. Some evidence suggests that visual attention and parent communication are related to behavior problems for older children with hearing impairments, but these findings need to be replicated and extended to younger children (Mitchell & Quittner, 1996; Smith, Quittner, Osberger, & Miyamoto, 1998; Terwogt & Rieffe, 2004). There is currently no study that directly addresses the potential link between language and behavior problems in deaf children.
In contrast to externalizing behaviors, the stability and predictive power of internalizing behavior problems (e.g., anxiety, social withdrawal, depression) for academic and social difficulties is less clear (Masten et al., 2005). This ambiguity may be, in part because of the methodological difficulties of measuring internalizing behaviors in young children. It is often difficult for young children to reliably report on their own emotional states, and furthermore, because they are not as obvious and bothersome as externalizing behaviors, internalizing behaviors tend to go unnoticed by parents and teachers (Clarke-Stewart, Allhusen, McDowell, Thelen, & Call, 2003). Despite these methodological limitations, internalizing problems have been linked to children’s future mood, learning, academic, and conduct problems (Kovacs & Devlin, 1998). Similar to externalizing problems, parents of deaf children report more internalizing problems in their children than parents of normally hearing children (25–38% vs. 2–17%; Albano, Chorpita, & Barlow, 2003; Hammen & Rudolph, 2003; van Eldik et al., 2004; Vostanis et al., 1997). Research on both internalizing and externalizing behavior problems has been limited by its reliance on parent-reported behavior problems, which may be biased by the parent’s own level of stress and emotional adjustment, potentially inflating or deflating reports of behavior problems (Sawyer, Streiner, & Baghurst, 1998). To reduce these biases, this study included both standardized parent questionnaires and a videotaped measure of negative behavior directed at the parent.
Language plays a central role in development. It is not only the medium for social exchange, but aids in internalizing social norms and the development of behavioral control (Luria, 1961; Vygotsky, 1962). Consequently, language deficits may contribute to behavior problems by interfering with the understanding and communication of requests and needs to others, and by interfering with emotional and behavioral regulation. The first process is interpersonal and the second is intrapersonal (Gallagher, 1999). Previous research has linked both of these processes to child behavior problems (Cohen et al., 1998; Gallagher, 1999; Schick et al., 2007; Terwogt & Rieffe, 2004). However, most of the work has been done with school-age children. It is currently not known when language deficits begin to interact with behavior problems, and whether they operate primarily through emotional and behavioral regulation or through parent–child communication.
Parent–child communication is essential to children’s development and socialization. Hearing-impaired children struggle to communicate with their hearing parents, resulting in frustration on the part of parent and child. Moreover, hearing parents of deaf children tend to be more directive and controlling in their interactions with their children (Vaccari & Marschark, 1997). Not being able to communicate needs and desires or understand parental and societal rules may be one reason for the clinically elevated rates of behavior problems observed in these children. Alternatively, parents who do not understand their children’s actions may interpret their behavior as problematic and report it as such on behavior checklists, highlighting the need for observational measures of child negativity.
Sustained attention is an important component of behavioral regulation. Children need to be able to attend to important social and environmental cues to successfully regulate their behavior and fulfill their needs (Murphy, Laurie-Rose, Brinkman, & McNamara, 2007). Previous studies have linked poor attention regulation to increased behavior problems and, conversely, linked language delays to poor attention regulation (Beitchman et al., 1996; Quittner et al., 1994). However, the relationships between these systems are still unclear.
In normal-hearing school-age children, the link between executive functioning (i.e., attention regulation, planning, problem solving, response inhibition) and behavior problems is strong (Morgan & Lilenfeld, 2000; Snyder, Pritchard, Schrepferman, Patrick, & Stoolbar, 2004). However, little is known about how these skills are related in younger, hearing children (Nigg & Huang-Pollock, 2003). Two recent studies focused on younger children, but found mixed results. The first study did not find a relationship between sustained attention at 15 months of age and parent-reported behavior problems at 36 months of age (Belsky, Friedman, & Hsieh, 2001). However, because attention was assessed during an unstructured, highly engaging task (i.e., free play), the measure may not have been sensitive to attentional processes. Moreover, the outcome was measured solely by parent report. The second study was cross-sectional, but used both parent report and multiple laboratory assessments to look at “effortful control,” a broader construct that subsumes sustained attention, in 3-year-old children (Olson et al., 2005). This study did find associations between parent and laboratory measures of attention and concurrent parent and teacher reports of externalizing behaviors. These conflicting results highlight the need for further investigation of the relationship between attention and behavior problems in young children, as well as the need to use a multimethod assessment approach.
In deaf children, visual attention, which is typically used to focus and sustain attention (Ruff & Rothbart, 1996), may play an even more critical role in development of behavior problems because of the loss of auditory input. If children cannot monitor their environment auditorially, they may have to rely on visual monitoring of the world, which places increased demands on visual attention and reduces children’s ability to sustain attention (Quittner et al., 2007). Previous studies have consistently found marked deficits in visual attention in this population (Mitchell & Quittner, 1996; Quittner, Smith, Osberger, Mitchell, & Katz, 1994; Smith et al., 1998), with associated elevations in behavior problems reported by teachers and parents (Mitchell & Quittner, 1996). Beyond the increased demands on visual attention, these children may also struggle because they do not have the language to help scaffold the internal regulation of attention (Bell, Wolfe, & Adkins, 2007). There is currently no study that links language and visual attention deficits in this population. To date, previous studies of visual attention in deaf children have assessed school-age children, providing little information about how early these deficits emerge. Moreover, only one study has examined the relationship between visual attention and behavior problems (Mitchell & Quittner, 1996), and none have examined the broader relations among language, attention, and behavior problems in hearing-impaired children.