Basic Audiology

Norberto V. Martinez, M.D.

Professor
Faculty of Medicine and Surgery
University of Santo Tomas
 Philippine Pediatric Society,
Inc.
Recommendations for Preventive
Pediatric Health Care 2002

Hearing Screening
• At birth to 3 months7
• Objective/subjective hearing screening8
7
endorsed by the Philippine Society of Otorhinolaryngology – Head and Neck Surgery
8
AAP Task Force on Newborn and Infant Hearing Loss
Hearing Impairment is the
single most common
condition affecting newborns

1-3 per 1000 in well-baby

2-4 per 100 in the NICU
 High Risk Registry

A pgar score < 5 in 5 minutes

B acterial meningitis
C ongenital infection (TORCH)
D efects of head and neck
E levated bilirubin level
 High Risk Registry

F amily history
G ram weight < 1500grams
H istory of NICU enrollment
I ntake of ototoxic drugs
 Auditory Milestones

Age Description
(in months)
0-3 -startles at a loud sound or noise
-stops moving or crying when you call

3-6 - turns head or move eyes to a

familiar sound

6 - 10 - responds to his/her own voice

 Auditory Milestones

Age Description
(in months)
10 - 15 -Repeats simple words and sounds
you make

15 - 18 - Understand simple phrases and

can point to body parts

18 - 24 - should have at least 150 spoken

vocabulary
 Behavioral Observation
Audiometry
• Used in testing children from birth to 8
months
• Requires two clinician (1 distracts and
observes; 1 present the stimulus)
• Toys, noisemakers or phonemes
represenative of different frequencies may
be used
 Behavioral Observation
Audiometry

Some expected behavioral responses

- Startle reflex
- Auropalpebral reflex/Eye-blink Reflex
-Eye movements
- Head movements
 Visual Response Orientation
Audiometry
• In the first stage the audiologist positions the
infant so that it is looking straight forward.
Next, a sound will be made to the child side,
and the audiologist checks to see if the child
turns to the direction of the noise. This
indicates that the child has heard the sound.

• This is repeated as the sound gets softer. To

ensure that the child makes the effort for the
quieter sounds, the child is rewarded with a
puppet show for each successful head turn.
 Visual Reinforcement
Observation Audiometry

Some observable responses

- head turn toward the sound
- Head turn toward visual reinforcer
- Change in facial expression
- Cry
- Vocalize response
 Play Audiometry

• Use in testing 2 to 5 years of age

• Child is conditioned to respond by

accomplishing a task which is usually in
the form of a play
 Play Audiometry
Modes of responses:
- Dropping
- Hitting
- Stacking
- Throwing
- Pushing buttons
- Building
 Degree of Hearing Loss
Normal Hearing Level
• 0-25dB

• Can hear all sounds

 Degree of Hearing Loss
Mild Hearing Loss

• 26-40dB
• Will miss consonants. At 30 dB can miss
25-40% of speech signal. Degree of
difficulty depends on noise level, distance
from speaker, and configuration of the
hearing loss. Will benefit from hearing aid
 Degree of Hearing Loss
Frequency
250Hz 500Hz 1000Hz 2000Hz 4000Hz
0
10
20
30
40
50 Right
60
Intensity

70 Left
80
90
100
110
120
 Degree of Hearing Loss
Moderate Hearing Loss

• 41- 60dB
• Can understand face-to-face
conversation at a distance of 3-5 feet is
structure and vocabulary is controlled.
May miss 50-75% of a spoken message is
the pure tone average is 40 dB. Will
benefit from hearing aid.
 Degree of Hearing Loss
Frequency
250Hz 500Hz 1000Hz 2000Hz 4000Hz
0
10
20
30
40
50 Right
60
Intensity

70 Left
80
90
100
110
120
 Degree of Hearing Loss
Severe Hearing Loss

• 61- 80dB
• May not even hear voices, unless speech
is very loud. Without amplification, the
individual will not recognize any speech
through listening. Can be a candidate for
cochlear implantation or hearing aids.
 Degree of Hearing Loss
Frequency
250Hz 500Hz 1000Hz 2000Hz 4000Hz
0
10
20
30
40
50 Right
60
Intensity

70 Left
80
90
100
110
120
 Degree of Hearing Loss
Profound Hearing Loss

• 61- 80dB
• May not even hear voices, unless speech
is very loud. Without amplification, the
individual will not recognize any speech
through listening. Can be a candidate for
cochlear implantation or hearing aids.
 Degree of Hearing Loss
Frequency
250Hz 500Hz 1000Hz 2000Hz 4000Hz
0
10
20
30
40
50 Right
60
Intensity

70 Left
80
90
100
110
120
 Interpretation
Frequency
250Hz 500Hz 1000Hz 2000Hz 4000Hz
0
10
20
30
40
Intensity

50 AIR
60
70 BONE
80
90
100
110
120

Conductive
 Interpretation
Frequency
250Hz 500Hz 1000Hz 2000Hz 4000Hz
0
10
20
30
40
Intensity

50 AIR
60
70 BONE
80
90
100
110
120
Sensorineural
 Interpretation
Frequency
250Hz 500Hz 1000Hz 2000Hz 4000Hz
0
10
20
30
40
Intensity

50 AIR
60
70 BONE
80
90
100
110
120

Mixed
 Speech Audiometry
• May be used in testing children
approximately 1 to 5 years of age

• Speech stimuli should be appropriate for

their language skills
 Examples of Speech Stimuli
• Body parts
• Naming/ pointing of pictures or objects
• Ling Six Sounds
/a/, /u/, /i/, /s/, /sh/, /m/
Spondees- to syllable words with equal
stress
Eg. Hotdog,cowboy
Asking questions
 For Children 6 months to
less than 5 years of age
Using noise makers
 For Children 6 months to
less than 5 years of age

Clapping Your
Hands
For Children 3 to 5 years old

Ask the child to

speak simple
words after you
For Children 3 to 5 years old
Pointing tasks
 Auditory Evoked Reponse
• AER - is an activity within the auditory
system produced or stimulated by sound
• Two processes essential for detecting
AER:
1. Amplify the voltage - 100,000 x
2. Signal
averaging
noise - EEG, electrical and muscle
activity movement of the
jaw or neck
 Otoacoustic Emissions
• Sounds generated by the cochlea that can
be measured in the external auditory canal
• Produced by the motile activity of the outer
hair cells
 Using signal averaging techniques, the AudioPath
separates the third tone from all other sounds within the
ear canal and displays the data on graphical display
 Acoustic Reflex
• The lowest intensity of an acoustic
stimulus at which minimal change in the
middle ear compliance can be measured
• ART for normal hearing subjects is 70dB
to 100dB
Hearing Aid Block Diagram

Volume
Control

Microphone Amplifier Receiver

Battery
Behind-the-ear Hearing Aids
• Connected via
earhook and tubing to
earmold
• Earmold easily
replaceable as
required
• More comfortable and
less cumbersome
than body aid
 How a cochlear implant works
4. Signal
transmitted
across skin to
3. Signal sent to headpiece implant
7. Brain
recognize
1. Sounds s this
TEMPO+ Processor
picked up signal as
by sound!
microphone
2. Speech 6. Auditory
processor nerve picks up
codes it into signal and
a signal of sends it to the
electrical 5. Implant brain
pulses sends signal
to electrodes
in the cochlea