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Conventional Speech Audiometry includes...

Speech Recognition Threshold
Suprathreshold speech recognition

Suprathreshold speech recognition gives you the...

Word Recognition Score; WRS

Acoustic immittance audiometry includes...

tympanometry
acoustic reflex thresholds

part of the audiological evaluation that describes the impact of hearing loss on daily function?

Functional Assessment

What is an example of a Functional Assessment?

Hearing Handicap Inventory

questionnaire completed by adult patients that assesses their perception of their level of communication difficulty related to hearing

Hearing Handicap Inventory (HHI)

Scoring for HHI

13 emotional questions and 12 social questions
0 for no
2 for sometimes
4 for yes

range of HHI score for no handicap/no hearing aid necessary

0-20

range of HHI score for mild-mod. handicap/hearing aid possibly needed

22-60

range of HHI score for severe handicap; hearing aid needed

62-100

Hearing Threshold

lowest intensity level at which the listener can detect a sound

what kind of response is required for a hearing threshold?

behavioral response

records hearing thresholds

audiogram

x-axis of audiogram

FREQUENCIES from 125 to 8000 Hz
--low to high PITCH

y-axis of audiogram

INTENSITY of sound from -10 to 120 db HL
--LOUDNESS. soft to loud

threshold unit for audiogram

dB HL

one frequency of vibration

pure tone

thresholds are measured for...

pure tones

Octave intervals

intervals of pure tones that stimulate specific places in the cochlea
-250, 500, 1000, 2000, 4000, 8000

humans are not equally sensitive to all...

frequencies (pitches of sound)

Humans are MOST sensitive to frequencies between

1000 and 4000 Hz

ANT (average normal threshold) is the reference point because...

it is in dB SPL, and is set to 0 dB HL

Threshold that reflects the integrity of the total peripheral auditory mechanism

Air conduction threshold

Air Conduction measurement

different pure-tone stimuli transmitted through earphones one ear at a time
can also be conducted in the sound field

Pure Tone Threshold Measurement Procedure

Instruct the patient
place earphones
test right ear OR better ear first
begin at 1000 Hz
present each tone for 1 second and vary timing between tones

Threshold Measurement Familiarization

finding a starting intensity level

what is the very first step of Threshold Measurement Familiarization

present the pure tone at 30 dB HL

if there is no response at 30 dB HL during Threshold Measurement Familiarization, you...

increase the level by 20 dB (to 50 dB HL)

if there is still no response at 50 dB HL, you...

increase the level by 10 dB until there is a response

if there is a response after first presenting the pure tone at 30 dB HL...

move on to threshold determination (down 10 up 5)

Threshold Determination

decrease level by 10 when there is a response; increase level by 5 when there is no response ;
until there are 2 responses in the ascending direction only.

after threshold determination...

you repeat the familiarization and threshold determination processes at different frequencies

Pure Tone Frequency Sequence:

1000, 2000, 3000, 4000, 6000, 8000, retest 1000 (first ear only), 500, and 250 Hz

Test-retest reliability for Pure Tone Frequency Sequence should be within...

+ or - 5 dB

Test interoctaves If the Test-retest reliability for Pure Tone Frequency Sequence is over...

is over 20 dB or greater difference between thresholds at adjacent octave intervals (ex: 750, 1500)

REPRESENTS SENSITIVITY OF THE SENSORINEURAL SYSTEM

bone conduction thresholds

threshold that is not ear-specific unless masking is used

Bone conduction
(b/c vibration of the skull reaches both cochleas)

Threshold determination procedures for Bone conduction the same as for air conduction except for a few differences

...

Frequencies tested for bone conduction

1000, 2000, 4000, 500, 250 Hz
(different from air conduction)

Maximum intensity limit is _____ for bone conduction

lower than air conduction

If a person's Air conduction thresholds are normal in both ears, bone conduction is usually...

not tested

Factors that Influence Threshold

calibration of the audiometer
test environment
earphone placement

The audiometer should be have Biological Calibration how often?

daily

the audiometer should have electronic calibration how often?

yearly (at least)

If the earphones are too loose...

there's an increase in low-frequency thresholds

If standing waves are present because of earphone placement...

there's an increase in high-frequency thresholds

**Pure Tone Average

Calculation of the average (mean) loss of hearing for the pure tone thresholds at 500, 1000, and 2000 Hz.

Determining Degree of hearing loss

describe as the best to worst threshold.

passes through entire auditory system

air conduction

passes through entire auditory EXCEPT for outer and middle ear

bone conduction

determines sensorineural sensitivity

bone conduction

Conductive system

outer and middle ear, determined by air conduction

Sensorineural system

inner ear, auditory nerve and auditory cortex; determined by bone conduction

TWO QUESTIONS FOR DETERMINING TYPE OF LOSS

1) Is bone conduction abnormal (>15)?
----if yes, sensorineural

2) Are there air-bone gaps present (gaps >10)?
----if yes, conductive

Air-bone gaps=

AC-BC

Conductive Loss

Bone conduction normal (under 20 dB HL)
Air-bone gaps present (greater than 10 dB HL)

Sensorineural Loss

BC abnormal; greater than 15 dB HL
no air bone-gaps; AC and BC thresholds approximately the same at all test frequencies.

Mixed Hearing Loss

Bone conduction abnormal (>15 dB HL)
Air-Bone Gaps present (>10 dB HL)

Hearing Loss Configuration

flat
sloping
rising
notched
cookie-bite
symmetrical/asymmetrical
bilateral/unilateral

SPEECH AUDIOMETRY

...

Speech Audiometry definition

a technique designed to assess a person's ability to hear and understand speech

Speech threshold measurements

Speech Detection Threshold
Speech Recognition Threshold

Speech Audiometry includes...

Threshold measurement for speech.
suprathreshold speech recognition.

minimum hearing level (dB HL) at which an individual can just detect the presence of speech material.

Speech Detection Threshold (SDT)

The SDT is used when..

when you have a client who can't perform the SRT.
-clients whose word recognition is so poor that speech is heard but not understood
-young client's who can't respond by pointing to pictures or writing a response

Material for SDT

not important because recognition is not required.

Procedure for SDT

usually presented via monitored live voice.
Use procedure similar to pure tones.
Ascending procedure may also be used.

Speech Recognition Threshold

SRT
minimum hearing level for speech at which an individual can identify simple speech materials approximately 50% of the time

recognition task where the listener selects the test item from a closed set of choices

SRT

SRT Material

spondaic words; at least 20

Spondaic Words

two-sylable words with equal emphasis on each syllable. common vocab, sound be able to understand and respond to each spondee.

Response Required for Speech Recognition Threshold

Identification of the word
repetition
pointing to picture or object,
signing or writing the response

Procedure of Speech Recognition Testing

mode of presentation (MLV v. recorded speech)

what is the mode of presentation for SRT?

usually MLV (monitored live voice)
--b/c of it's flexibility
can be recorded
--standardized speaker, material and presentation level
--recorded speech is inflexible; can't vary the rate of presentation or the test words.

Method of obtaining SRT

familiarization then threshold determination

Familiarization

testing that the vocab used is familiar to the client.
determine that client's responses are recognizable to the clinician.

SRT Familiarization Procedure

-present words at 50 dB HL (or clearly audible level)
-have client respond to every word
-eliminate problem words

SRT Threshold Determination Procedure

similar to pure-tone threshold method; down 10 up 5.
Need THREE correct responses at the same level; count both descending and ascending responses (b/c recognition required)
(for pure-tone, only need two responses in the ascending direction only)

Responses needed for pure tone threshold

two in the ascending direction

responses needed for SRT Threshold

three in either ascending or descending directions

Modifications for SRT Threshold Determination

should be noed; children's spondees, selected spondees

SRT correspondence to Pure Tone results

SRT should be within + or - 10 dB of the Pure Tone Average

if the SRT is much better than the PTA...

the listener may be exaggerating hearing loss

if the SRT is much worse than the PTA...

client may have very poor word recognition ability

The SRT can be used as...

a reference point to determine optimal presentation level for suprathreshold word recognition testing

dB SL

sensation level
40 dB ABOVE the speech threshold

for an adult with hearing loss with relatively flat configuration, what is the optimal presentation level?

40 dB
-will result in optimal word recognition performance

sloping configuration may require ____ dB SL for optimal speech recognition

higher

Word Recognition testing

suprathreshold performance

suprathreshold performance/Word recognition measures...

ability to identify speech material at intensity levels above the threshold.

maximum % score

suprathreshold performance/Word recognition

Word Recognition testing Material

list of monosyllabic words that are phonetically balanced.
Typically open set material

Open set material

no choices provided, identification required

Closed set material

multiple choice

Clinical decisions in the word recognition testing

...

What mode of presentatin is preferred for Word Recognition Testing?

Recorded speech
-greater reliablilty, standardization, comparison btwn listenrs

Response required for Word Recognition Testing?

Oral- repitition of word
can be written or point to pictures

Presentation level for Word Recognition Testing for listeners with normal or flat hearing losses?

at least 40 dB SL above the PTA or SRT

Presentation level for Word Recognition Testing for liesteners withs sloping hearing loss

Greater SL needed

youcan present the Word Recognition Testing Level at a high intensity for...

screening for retrocochlear pathology

Normal PI (performance-intensity function)

increasing performance (% correct) with increasng intensity of speech until plateau

Abnormal PI

performance decreases with increasing intensity of speech... AKA ROLLOVER**

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