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The Word of Jones
LDL can also be called...
Acceptable noise level (ANL) is the...
The Word of Jones
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1
Acceptable noise level (ANL) is the...
Difference between the loudest and quietest sounds a person hears
Intensity of a sound stimulus above a person's hearing threshold
Acceptability of the level of background noise while listening to speech
Detection of dead zones in the cochlea
2
LDL can also be called...
Threshold of discomfort
Uncomfortable loudness
Highest comfortable level
Upper level of comfort
3
All of these are contraindications of HA fitting/when to refer EXCEPT
Deformity of normal ear
Family hx of presbycusis
Tinnitus
Vertigo
4
HAs will be more useful if you need to listen in ____ places
quiet
loud
5
What is the TEN test?
Threshold equalizing noise test
detects regions of the cochlea where IHCs no longer function
Counting to ten
Tinnitus education network
6
What does the SNR-50 score specifically indicate in the context of speech perception?
The speech-to-noise ratio at which a listener can get 50% of speech
The effectiveness of HAs in quiet environments
The minimal level of background noise tolerated by a listener
The overall loudness discomfort level for HA users
7
RECD = ???
Real-ear value minus coupler value
Coupler value minus real-ear value
8
What adjustments does NAL-NL2 incorporate for hearing aid fitting?
Eliminates the need for adjustments after the initial fitting
It uses the same settings for all users regardless of experience
Adjustments based on hearing loss, experience level, and user feedback
It prioritizes high-frequency amplification only for new users
9
Speech in Noise: fixed testing
difficulty level of speech stimulus or background noise adjusts
Level of speech and background noise remains constant throughout the test.
10
Otitis media, headaches, and asymmetric HL are other possible contraindications of a HA fitting/when to refer
True
False
11
Automatic gain control-input typically has a ___ activation kneepoint
Low
High
12
Reference Equivalent Threshold in SPL (RETSPL) is the difference in dB between...
HL and the output in SPL in the ear canal
HL and the reference coupler
The reference coupler and the real ear
13
Dynamic Range
Difference between the loudest and quietest sounds a person hears
Difference between the high and low frequencies a person can hear
14
According to Lybarger’s proposal, what should the gain be set to in relation to hearing loss? (half gain)
One half of the hearing loss
Equal to the hearing loss
Twice the hearing loss
10-15 dB above the hearing loss
15
How does LTASS help in evaluating hearing aids?
It measures the size of the hearing aid.
It compares audibility with and without a hearing aid.
It assesses the battery life of hearing aids.
It determines the style of hearing aid preferred by the user.
16
The presence of an auditory processing disorder may prevent fitting HAs on a patient. Try to see what else can be done.
True
False
17
What if LDL implications are too high?
Music may sound dull
Speech may become distorted
Range of loudness perceptions will be limited
Turn down gain and not have appropriate audibility for soft and avg noises
18
A big part of the success of the overall HA fitting relates to making ____
A trusting relationship with the patient
The patient wear hearing aids all the time
Speech audible
19
The Speech Banana is in reference to what?
A graphic representation of LTASS
The admittance of sound into the middle ear
A method for measuring speech clarity
20
Speech in Noise Testing: Sentence Cons
Hard to relate to everyday life
Basic auditory function is difficult to determine
Requires more complex cognitive skills
Syntactic and semantic structures can influence performance
21
What if LDL implications are too low?
Initial negative experiences with HAs
May miss out on appropriate amplification for the majority of situations
Speech may not have necessary amplitude dynamics
Unnecessary MPO limiting could make the SNR more harmful
22
DSL v5.0 targets for speech are increased by 3 dB across input levels for bilateral fittings
True
False
23
DSL 5 does not include an anything for gender, while NAL-NL2 includes a 1 dB increase/decrease
False
True
24
ANL high score
8 - 12 dB
>13 dB
<7 dB
25
What is the primary benefit of using adaptive speech in noise testing over fixed testing methods prior to HA fitting?
Fixed testing methods are more time-efficient than adaptive methods
Can adjust to pt performance, reducing chance of floor and ceiling effects
Provides a consistent measure of speech perception across all patients
Requires less technical knowledge to administer than fixed testing
26
What is a recommended practice when establishing full-on gain in a hearing device?
Use the maximum gain setting
Decrease the gain by 5 dB
Add 10-15 dB of reserve gain
Set the gain to zero
27
Why would you choose to do TEN test before HA fitting?
Confuse the patient on the treatment they're getting
To show the patient how to adjust volume
Might help eliminate feedback
28
LTASS is a reference signal used to achieve a comfortable and intelligible ______
Listening level for speech
Compression level
Understanding of speech sounds
29
Excessive amplification of background noise is a major complaint for pts
False
True
30
What is loudness normalization?
Attempt to give pts the same amount of loudness that a normal person has
Attempt to take all key freq. of speech and make them the same loudness
31
For SPL-O-GRAM testing, what is ______ falls below the patient's thresholds
Not audible
Audible
32
NAL-NL2 first applies gain for the sensorineural component of the HL, then adds ___ of the air-bone gap to this value
25%
75%
50%
30%
33
What is the primary use of LTASS in audiology?
To determine the clarity of speech in noisy environments
To quantify the relationship between speech levels and hearing thresholds
To analyze the emotional content of speech
To measure the speed of speech
34
REDD can be calculated by adding RECD and RETSPL
False
True
35
RETSPL is usually equipment specific, not earphone specific
True
False
36
NAL-NL2 has a bilateral gain correction that increases with input level
True
False
37
What is loudness equalization?
Attempt to give pts the same amount of loudness that a normal person has
Attempt to take all key freq. of speech and make them the same loudness
38
NAL helps with loudness ___
Normalization
Equalization
39
What is the primary goal of the desired sensation level (DSL) method in pediatric hearing instrument fitting?
To focus exclusively on improving low-frequency sound perception
Ensure audibility of amplified speech young children with HL
To amplify all sounds equally without regard to speech recognition.
To create a one-size-fits-all solution for all age groups
40
Personalities that work well with HA satisfaction will have this quality
External locus of control
Internal locus of control
"glass half-empty" view
Introverts
41
Why would you choose speech in noise testing before a HA fitting?
Don't have to put gain in dead zones
Monitor performance over time
Establish a baseline
Better speech understanding
42
Self reported disabilities do not help aid a hearing loss journey
True
False
43
Which best describes the impact of CAPD on individuals with HAs?
Solely a result of age-related HL and does not influence fitting
CAPD enhances the effectiveness of HAs by improving localization
CAPD primarily affects the outer ear, leading to CHL
Those with CAPD may struggle to process auditory info
44
ANL low score
>13 dB
<7 dB
8 - 12 dB
45
Which of these factors is most likely to influence a user's ability to effectively manage and manipulate their HAs?
Type of battery
Hearing aid brand
User's age and dexterity
Color of the aid
46
Speech in Noise Testing: Sentence Pros
Less cognitive skill needed
Basic auditory function can be tested
Better approximation of how individuals understand conversation
More like everyday life
47
Speech in noise: Adaptive testing
difficulty level of speech stimulus or background noise adjusts
Level of speech and background noise remains constant throughout the test
48
What is a key characteristic of the NAL-NL1 fitting approach?
Focuses on overall loudness normalization rather than frequency-specific
Prioritizes low-frequency sounds to improve listening comfort
Aims to amplify all frequencies equally for balance
It normalizes the relative loudness of each frequency to enhance clarity
49
Manipulation difficulties can preclude HA use
True
False
50
Most commonly, a dynamic range of ___ dB is advocated for making predictions of speech recognition
30 dB
20-25 dB
10 dB
40 dB
51
If at 70 dB HL at 2000 Hz equals 73 dB SPL in the 2 cc coupler, the RETSPL would be...
76 dB
3 dB
70 dB
6 dB
52
The NAL-NL2 does not have corrections for listening in noise
True
False
53
What is needed for Articulation/Audibility Index? (AI)
Maxima and minima of the exact speech signal of interest
Frequency-specific hearing thresholds
Thresholds of discomfort
Background noise levels
54
____ is directly related to dynamic range of speech
NAL-NL2
Compression
LTASS
Speech intelligibility
55
RECD is normally a negative number due to real-ear output
False
True
56
Automatic gain control-output typically has a ___ activation kneepoint
Low
High
57
DSL attempts to...
To prioritize high-frequency sounds over low-frequency sounds for comfort
Make sounds comfortably loud across all hearing levels and all frequencies
To amplify all sounds to the same level regardless of hearing ability
To eliminate background noise completely for enhanced clarity
58
What does the long-term average speech spectrum (LTASS) represent?
The emotional tone of speech
The distribution of frequencies in a speech sample over time
The volume of speech over time
The speed of speech production
59
OSPL90 is used synonymously with ___
Maximum power output
Compression
RETSPL
60
What factors affect aidable hearing loss?
Pure tone loss
Joe mama
Speech identification ability
Attitude and motivation
61
Satisfaction with HAs ____ as age ____
stays the same, increases
decreases, increases
increases, increases
decreases, stays the same
62
ANL = ???
Background noise level - most comfort level
Most comfort level - background noise level
63
What is the goal of NAL?
To completely eliminate background noise for the user
Maximize speech intelligibility but keeping gain from being too loud
To amplify all sounds equally, regardless of frequency
To increase the overall loudness of sound for users with hearing loss
64
Not taking RECD into account could lead to over-amplification for children
False
True
65
Why do ANL testing before HA fitting?
Customized fit
Better speech understanding
Help eliminate acoustic feedback issues
Personal comfort
66
When should additional gain be considered according to the half-gain rule?
High-frequency losses only
For all types of hearing losses equally
Sensorineural losses only
Mixed or conductive losses
67
Disadvantage of fixed speech in noise testing
Hard to explain test results
Difficult to relate findings to third parties
Difficult to relate results to the real world
68
Real Ear Coupler Difference (RECD) is the difference in dB between...
HL and the reference coupler
HL and the output in SPL in the ear canal
The reference coupler and the real ear
69
Loudness discomfort level ensures ____ and ___ are adjusted correctly
Gain, MPO
SNR, Speech in noise
SITU, RECD
Compression, dynamic range
70
Real Ear Dial Difference (REDD) is the difference in dB between...
HL and the reference coupler
The reference coupler and the real ear
HL and the output in SPL in the ear canal
71
What is OSPL90?
Maximum compression - minimum compression
Maximum output of the HA when specific settings have been made
Compares the output of a HA in the real ear vs a 2 cc coupler
The broadest and powerful potential output of a HA with gain "full-on"
