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Beskey: History

started in WWII

Beskey: Premise

Tax the system

Beskey: Methods

1. Press the button then release, then press and release again.

2.It gets louder, louder, louder, quieter, louder, quieter, louder

Beskey: Results

1. Type I: could be SNHL, but most likely Normal or Conductive - laying on top of each other, no diff. b/w continuous and pulsed

2. Type II: Cochlear loss (sensory) - gets a little worse as the tone keeps going

3.Type III: Retrocochlear loss - gets worse

4. Type IV: severe conductive or retrocochlear - kinda drops, but doesn't continue to drop, reflexes and audiogram can help determine type of loss

5. Type V: Pseudohypacusis - make it up it there mind, and they pick continuous as louder

Tone Decay: Premise

taxing the system, put a tone in for a long period of time, maybe they will stop hearing it over time; if they stop hearing it they most likely have a retrocochlear loss

Tone Decay: Threshold

1. Find threshold at whatever freq. they want to check

2. I'm gonna make a sound, if you hear it put your hand up, once you know longer hear it put your hand down

3. Start testing at 10 dB above their threshold

4. Time it for 30 secs or 1 min. - for 30 secs, after 15 secs if they lower there hand, turn it up

5. We are looking for how many dB do we have to turn it up in a given period of time

6. If we have to turn it up 30 dB in less than a minute โ†’ they have tone decay, which is an indicator for a retrocochlear loss

Tone Decay: Suprathresholds

1. Turn in up very loud, as loud as they can stand to tax the system

2. The "uncomfortable" level or LDL (loudness discomfort level)

3. Key issue โ†’ you have to mask the other ear!! Especially if one ear is normal

4. Figure how much is crossing over and how much masking you need to put in the NTE

5. More length and louder (doubling taxing the system) - need to make sure you say which you are using and why

Tone Decay: Giving results

-Be sure to specify: More length and louder (doubling taxing the system)

-Need to make sure you say which test you are using and why

Tone Decay: Results - Normal ears

-Amount of decay: 0 to 10 dB

-Rate of tone decay: not significant

-Frequency info: same across all frequencies

Tone Decay: Results - Cochlear loss

-Amount of decay: 10 to 15 dB

-Rate of tone decay: with each +5dB increase, tone audibility is longer and longer

-Frequency info: same amount of decay at each tested freq.

Tone Decay: Results - Retrocochlear

-Amount of decay: greater than 30 dB

-Rate of tone decay: decay is rapid and does not change significantly with increasing intensity

-Frequency info: slightly more decay noted in the higher pitches

Tone Decay: Tests

1. Carhart

2. Rosenberg

3. Green

4. Owen


6. Olsen and Noffsinger

Reflexes: Premise

If the pathway is damaged you will see absent or elevated reflexes

Reflexes: Absent and Elevated

Color in Jerger pattern

Reflexes: Jerger Patterns

Use to determine where the problem is

Reflexes: Sensitivity and Specificity

-If you have a Jerger pattern it could mean that there is a retrocochlear loss, but if there isn't that does NOT mean they do not have a retrocochlear loss.

-NOT 100%

Reflex Decay: Premise

Taxing the system over a long period of time

Reflex Decay: Method

10 dB above; If it decrease by half in less than 10 secs we need to see how long it took

Reflex Decay: Scoring

-1, 2, 3 = Retrocochlear loss

-7, 8, 9 = cochlear/sensory loss

-4, 5, and 6 sec = soft signs for retrocochlear loss, we to do more retrocochlear tests (ex: tone decay)

WRS: Premise

If there is a big enough neural problem there will be a sig. difference b/w ears, and if you crank it up really loud it may get sig. worse

WRS: Word Lists

-Depends on which word list we are use

-Need to use the same type of list on both ears, b/w it could cause a "false" difference b/w ears

WRS: Presentation Method

Use CD for diagnostic testing, b/c live-voice can vary

WRS: Presentation Level

30 or 40 dB SL above PTA/SRT

WRS: Interpretation

-With PTA: Is it consistence with PTA

-Significant Differences: B/w ears

-Roll-over: Are we going to screen for roll-over?

PI-PB: Premise

Once you get in higher intensities there scores will get worse b/w you taxed the system

PI-PB: Administration

-Screen: to see if there was a difference and we just want to confirm

-Full: 20, 30, 40, 40 SL until it's uncomfortable

PI-PB: How to Find PI-PB

1. Start at the patient's ART of the test ear and add 10 dB HL.

2. Obtain WRS at the level.

3. Continue the test by adding 10 dB each time.


best score


worse score

PI-PB: Roll-over Formula

PBmax - PBmin / PBmax

Central Auditory Tests: Premise

-Without a good neural system you can't handle listening in noise

-Looking for signals that are not completely clear

-Noise at same time that you can't filter out

Central Auditory Tests: Ear Symmetry

If one is way worse then they other, there can be a difference b/w ears

Central Auditory Tests: Staggered Spondaic Words (SSW)

1. Degraded signal are low in the brain stem

2. It will put words in both ears and play words at the same exact time

3. Measure of language dominance for kids - So they should do better in their right ear than their left ear until they are older and the ears even out

Central Auditory Tests: Pitch and/or Duration Patterns

- An adult w/ a stroke โ†’ we look at which ear is doing better, they will be able to handle pitch/ patterns better if the lesion was on a certain left

-Right side of brain handles pitch and duration, so if the lesion is on the right side, they won't be able to tell the context of the language (ex: "Look out! The window!"; they might literally look out the window)

Central Auditory Test: Population

-You do this type of test when the patient has bilaterally hearing and difficulty with speech in noise, pitch/patterns, etc.

-Kids with Autism sometimes have problems with these type of thing (ex: overly sensitive to sounds)

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