Pure-Tone Audiometery flashcards |

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-We perform hearing tests to assess a person's hearing status or sensitivity.

-Pure tone testing is an audiological assessment that allow us to determine hearing status and often used as diagnostic information to determine if someone is a candidate for amplification or cochlear implant. We can also infer if there are auditory processing problems or receptive language problems

-To test the two pathways of sound and determine the nature of a hearing loss (if any)

Pure-tone test environment:
Max. Ambient Noise Level

-Make sure noise is NOT too loud; it will not be too loud if you close both sets of doors
-If there is no noise outside the booth you can leave one or both doors open depending on the situation.
-Parent can sit in booth with child IF they are quite
-We must keep it at a standard loudness level in the booth.

Pure-tone test environment:

-it's easier if they can't see your face, if they are facing you, so have it darker on your side vs. their side.
-If they can see you they can get clues from you or read your lips

Pure-tone test environment:

-It's best to seat them where you can still see their face, but not straight on, so that they can't see you and get hints
-We want to see them, but we don't want to too really see us
-45 degrees is good for children b/c we can see their face
-Has to be under the x or dot (in the center) to be in the correct spot in the sound booth if doing sound field
-If the parent is in there, they have to sit away from the speakers, so they don't block them

Pure-tone test environment:
Placement of Transducers

-Earphones- Put them on from the back, extend all the way up, push hair back, then place them on directly over the ear canal opening, (right side in right hand and vice versa)
-Inserts- clip on the back (so no one messes with them), still from behind them, (right side in right hand and vice versa)
-Supraral Headphones- make sure the entire ear is covered
-Soundfeild- be under calibrated spot
-BC- place on the mastoid where there is no hair, the box needs to be flat, and the other side is on the other side towards the front of the head so that the band is flat.

Pure-tone testing:

-What mode we are using: raise hand, push button, toys for kids, ect.

Pure-tone testing:
False Negative Response

-They DO NOT raise their hand when they actually heard it

-Due to: faking, yawning, falling asleep, don't want to be there, don't understand the instruction that to respond way they barely hear it
-Not good if you have a lot- we need to readjust and check everything

Pure-tone testing:
False Positive Response

-When they raise their hand, but there was nothing there. No signal was present when they pressed their hand.

-Due to- Most of the time the presenter (make sure you vary your presentation so it's not predictable, b/c they have most likely gotten a cueing); when they are trying really hard sometimes they raise their hand a few times when nothings there b/c they think they might have heard something.

Pure-tone testing:

-Keep in mind case history (don't ask someone to raise their hand if they can't physically move)
-In person before transducer is on or after if they can hear it.
-For kids you can use toys

Can vary,"when you hear the sound, you need to... (what they need to do)", "it's okay to respond if you think you heard it, if you aren't sure go ahead and respond!" So MAKE SURE YOU TELL THEM:
-What the are listening for
-What they need to do
-It's okay to guess!

-FOR BC- tell them in need to stay right there and you'll go fast b/c its uncomfortable

Pure-tone testing:
Test Frequencies

AC- you will start at 1000 Hz, do the octaves for sure
•1000, 2000, 4000, 8000 Hz then go back and recheck 1000, then 500, and 250
•For HA testing/fitting add 3000 & 6000 b/c you can fine tune the frequencies better)

BC- you will not do anything above 4000 HZ b/c it will be vibrotactile
•Only do 3000 Hz when you make sure the audiometer is calibrated for 3000 Hz
•1000, 2000, 500, 250 Hz

Pure-tone testing:
Signal detection theory

you are more accurate in testing if you know what you are listening for. So you start with something that you think that can for sure hear.

Pure-tone testing:
Find Initial Phase

-Typically we start at 40 dB HL, unless they cannot hear you can jump up by 10 dB or 20 dB (If 40 go 10 dB higher for the next freq.) If you aren't sure where to start, start at 30 dB- this is not set it stone, it just needs to be audible

-If they do NOT respond, increase by 10 dB or 20 dB until you get to where they can hear.
-If they respond you start to drop by 10 dB, until you get to where they can not hear, which is known as the initial phase.

Pure-tone testing:
Test Phase

Use either the Hughson-Westlake method, ascending method, or descending method

*We use the Hughson-Westlake the most*

Pure-tone testing:
Hughson-Westlake Method

-If they hear it go down 10 dB until they don't
-If they don't then up 5 dB

-We are looking for criteria of 50% off the time (we typically look for 3 out of 6 times, can be more or less, just whenever you got 50%)

**We use this the most**

Pure-tone testing:
Ascending Method

-Starts at 0 dB and goes up 5 dB until you get a response, then go down 20 dB and try again
-This is what we do when we recheck 1000 Hz and correct is +/- 5 dB, you might get a little higher dB b/c they aren't getting that signal detection.
-If they are faking, it will help to do this b/c they will guess lower

Pure-tone testing:
Descending Method

-Start at 60 dB, go down then back up, then down then back up;
-Used for degenerative diseases b/c they can't keep in their brain what they are listening for so this is the easiest method.

Pure-tone testing:
Pure-Tone Average (PTA)

-Average 500, 1000, 2000 Hz, this checks reliability, do this before you make a report
-If steeply sloping or steeply rise you will preform a two-tone PTA (Fletcher Avg.) you avg the best two of the three!

Pure-tone testing:

-Test 500, 1K, 2K, and 4K Hz
-we don't test 6000 or 8000, we can't go as loud due to the vibrotactile response
-We usually start 10 dB above their AC threshold.
-We use signal detection, so they can hear it
-If conduction HL- start below threshold
-If SNHL- start 10 dB above threshold.
-Do the Hughson-Westlake

Pure-tone testing:
Describing a HL

•Degree- AC
•Configuration - AC
•Nature - AC & BC

Pure-tone testing:

-At least: if we don't have a masked score for AC or in sound field b/c we don't know which ear; At least a moderate, but it could be worse...

-Unable to mask: the degree and configuration become unclear; At least a moderate, but it could be worse b/c I was unable mask

-Maximum bone: either SNHL or mixed loss, we do not know which one b/c we reached max. limit for BC (for nature)

-In at least one ear:

Hearing Screenings

•For ASHA- 20 dB for 500, 1000, 2000, 4000 (do they hear it?)
•For Texas- 25 dB for 1000, 2000, 4000 Hz (test odd school yrs.)

•Familiarization - so they know they know what to look for
•Testing- Do they hear it?
•Recording- pass or fail

Why would it be important for a patient to get a hearing screening before getting a speech screening?

We need to be able to determine if there is a receptive language problem due to a potential HL before we assume there is a speech or expressive language problem.

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