Basic Clinical Audiometry

CSD 451
Audiology Section

Prevalence of HL in the U.S.

Hearing loss is the third most
prevalent chronic condition affecting
seniors.
1 in 3 adults over the age of 60
years, and approximately 1 in 2
adults over the age of 75 years have
a significant hearing loss.
(AAA, 2005;Gomez, 2005; Kochkin, 2010)

Prevalence of HL in the U.S.

Hearing loss is the number one birth
defect in the U.S. affecting 3 infants
per 1000 births.
In total, there are over 30 million
Americans with hearing loss,
approximately 10% of the entire U.S.
population.

Implications of Untreated HL
Untreated hearing loss has been shown to
adversely affect household income by up to
$12,000 per year.
Accounts for a loss of over $18 billion in US taxes
collected (Hearing Review, 2006).
Untreated hearing loss can cause additional
costs to Medicare and other health programs due
to loss of independence, social isolation, and
safety issues in the elderly (Gomez, 2005).

Implications of Untreated HL
Children with untreated hearing loss
cost schools an additional $420,000.
Faced with the overall lifetime costs
of $1 million in special education,
lost wages, and health complications.

Psychosocial Implications of
HL
Many hearing-impaired people:
become frustrated because of missed
communication
avoid social activities,
spend less time with friends,
have family problems
and feel isolated and depressed.
(National Council on the Aging, 1999).

Types of Hearing Loss

Types of HL
Conductive Hearing Loss
Pathology is localized to the outer
and/or the middle ear
Problem with conducting sound to the
cochlea
Usually correctable by medical
intervention
Accounts for about 10% of incidence of
all hearing loss

Problem with Conducting

Sound

https://www.youtube.com/watch?v=B6wKNEwYs4M

Types of HL
Sensorineural Hearing Loss
Pathology is localized to the inner ear or
central system
Not usually correctable by medical
intervention
Accounts for 90% of all hearing loss
Most common treatment is hearing aids

EDIT THIS SLIDE

Types of HL
Mixed Hearing Loss
Any conductive hearing loss with
an underlying sensorineural
component
Combination of conductive and
sensorineural

Types of HL
Central
Brainstem or brain
Central Auditory Processing Disorder (CAPD)

Wont get into it here, just be aware it

exists

Hearing Evaluation
Goal is to determine the:
TYPE
CONFIGURATION
SEVERITY
Basic site of lesion

Used to decide appropriate course of

action

Standard Audiometry
Basic hearing evaluation:
Case history
Otoscopy
Immitance
Audiometry
Pure tone air and bone conduction
Speech testing

Counseling

Varies based on patient characteristics

(age, compliance, physical)

Case History
What brings you in today?
Different for adults and children
Gives audiologist idea of what to expect
Starting point for testing
Which tests to perform

Make it a conversation
Try not to read off a list
Let patient lead (if possible)

Specific questions
Build patient rapport

Visual Exam./ Otoscopy

Examine
Pinna
Ear canal
Tympanic membrane

Otoscope
Battery
Lens
Light source
Specula (different
sizes)
(Gloves)

Otoscopy
Clean speculum, make
sure it locks
Turn on light
Position yourself at ear
level
Straighten ear canal
Monitor position
Bridge hand
Monitor insertion
Observe canal, scan TM
Remove speculum;
dispose/clean

Immitance
Physiologic tests based on physical properties of
the middle ear system
Looking at the conductive system
Objective (dont need patient to respond)

Usually look at admittance (Y) expressed as mmhos

How much energy is allowed to get through

Measure assumes hard walled cavity but...

Ear canal is NOT a hard walled cavity
We need to create one

Immitance
Equipment
Pressure sealing probe with three ports:
Loudspeaker
Microphone
Pressure changing pump

Probe pushes/pulls TM with ~200

daPA
Stiffens TM, cant vibrate as well, less
energy reaching inner ear hard
walled cavity (in theory)

Hearing Test
Measure
patients
audiometric
thresholds

Threshold
What we are measuring/recording with pure
tones
The least intensity required for a patient to
perceive an auditory stimulus 50% of the time
Measured at each frequency that is important
for understanding speech
How soft of a sound can the patient hear

Find for air and bone conduction

Air Conduction Testing

Pure tones presented through the
headphones
Tests the integrity of the entire
auditory system

Air Conduction Pathway

Bone Conduction Testing

Pure tones are
presented through
a bone oscillator
BC testing will
bypass outer and
middle ear and
stimulate the
inner ear directly

Bone Conduction Pathway

Finding Thresholds
Instruct Client
Response Mode
Placement of the Transducer

Ascending-Descending Threshold Search

(Modified Hughson-Westlake Procedure)
Start with air conduction, at 1000 Hz, in the BETTER HEARING EAR
Start at 40 dB, no response increase to 60 dB, no response increase
in 10 dB steps until sound is heard
Once they respond, the test has started

Every time client responds they hear a tone, decrease intensity by

10 dB, if the client does not respond the signal is increased by 5 dB
Threshold = 2/3 responses at signal level of ascending trials
Find threshold move on to next frequency
2000, 4000, 8000, RE-TEST 1000, 500, 250
Can do ascending or descending (what is patient capable of?)

Audiogram
Chart of
Hearing
Plot
Threshol
ds

Audiogram
Symbols
Uniform across facilities

Right ear information=red

Air conduction

O-unmasked

-masked

Bone conduction
< -unmasked
[ -masked

Left ear information = blue

Air conduction
X unmasked

-masked

Bone conduction
> -unmasked
] -masked

Reading the Audiogram

Unilateral vs. Bilateral
Degree of loss
Type of loss
Sensorineural
Conductive
Mixed

Configuration

Using Air & Bone Conduction

Information
If bone conduction responses are
better than air conduction responses
then the loss is due to a problem
with outer / middle ear
If bone conduction responses are
equal to air conduction responses
then the loss is due to a problem in
the inner ear

Degree of Hearing Loss

Terms used
to describe
the amount
of hearing
loss a patient
has at each
frequency

Normal Hearing
X = left ear
O = right ear

Hearing Loss Simulator

Communicating with the

Client
Ensure the Correct Patient
Building Rapport
Understand the Communicative
Partner
Uniqueness of Patients
Barriers to Communication
Special Issues
Time Constraints

Explaining the Audiogram

Speak in Lay terms
Explain slowly and clearly
Give examples of how this may be affecting
communication
BE VERY SENSITIVE TO THE FACT THAT
YOU ARE TELLING SOMEONE THAT
THEIR OR THEIR CHILDS HEALTH IS
IMPAIRED (and in most cases
permanently!)