CD 445 WK 1 Pure Tone Audiometry

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CD 445 Wk 1 Pure Tone Audiometry
Audiometry and Hearing Conservation (California State University Northridge)
StuDocu is not sponsored or endorsed by any college or university

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CD 445 Wk 1 Pure Tone Audiometry
What is a pure tone threshold?

the lowest sound pressure level the patient responds to at least 50% of
the time across 3 ascending runs
What was significant about the paper written by Carhart and Jerger
(1959)?
described a protocol for measuring pure tone thresholds, standardizing
the process for future Audiologists
Why is it important to standardize a testing protocol?

standardization allows comparison accross test results from one date or
clinic to the next.
List the main points of the revised Hughson-Westlake method proposed

by Carhart and Jerger (1959)
1) Tone should be clearly audible to the patient at the start of the test
2) A series of ascending runs are conducted
3) A down 10 and up 5 dB procedure is utilized
4) Level at which most of the responses appear is the threshold
5) Silent Intervals between tones to allow auditory system to regain
responsiviness
What is the "on-effect"?

the initial response of the auditory system at the onset of the stimulaiton;
the response is most vigorous at this time
What is "auditory adaptation"

the reduction in responsiveness of the auditory system following the on-

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effect when the stimulus is sustained, though the stimulus is too weak to
produce fatigue
Range of pure tone test frequencies

250 Hz to 8000 Hz
About what frequency in Hz is the middle C on the piano?

about 250 Hz
What is usually the reason for the "notch" in an audiogram of a patient

with noise-induced hearing loss.
...
For a patient with a "notch" that extends to 60 dBHL, which speech

sounds will he most likely miss?
some of the voiceless fricatives.
A profound noise-induced hearing loss acts as a _________, only

allowing the patient to hear lower frequecies (below 3000 Hz)
low pass filter
List 4 uses for pure tone thresholds by audiologists

1) describe the amount of the patient's hearing loss
2) determine which parts of the auditory system are contributing to the
hearing loss
3) determine if a medical referral is needed
4) predict how the patient's hearing loss may relate to the ability to
recognize speech

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List the 3 types of audiometers

1) diagnostic/clinical audiometer
2) screening audiometer
3) automatic audiometer
Which type of audiometer is used only in the field?

screening audiometer
Which type of audiometer is used for a variety of tests and has 2

separate channels?
diagnostic/clinical audiometer
Which type of audiometer changes the presentation level based on the

patient's response and is very common?
automatic audiometer
List the basic components of an audiometer

1) Frequency selector
2) Attenuator dial
3) Transducer selector
4) Router switch
5) Interrupter switch
6) Patient response indicator
7) VU meter
Which component of the audiometer changes the sound pressure level of

the signal?
attenuator dial
Which component of the audiometer directs the signal to the desired

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location?
router switch
Which component of the audiometer presents the signal to the patient?

interrupter switch
Which component of the audiometer monitors/calibrates the output

level?
VU (volume units) meter
List the 5 types of transducers used for audiological testing.

1) Insert earphones
2) Supra-aural earphones
3) High frequency earphones
4) Speakers
5) Bone conduction vibrator
An Ultra high-frequency earphone is also called a _____________

circum-aural earphone
Supra-aural earphones may cause ________________, therefore, insert

earphones are prefered for testing.
partial collapse of the ear canal
What are some examples of models of supra-aural earphones?

TDH-49, TDH-50P, TDH-39
What are situations in which supra-aural earphones are preferred?

when the ear canal walls are irritated or there is ear canal drainage from

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an infection.
What are the units used when calibrating a pair of supra-aural

earphones?
dB SPL
What may result if the diaphragm of the earphone is not centered on the
ear canal?
The high frequency test tones may be blocked or reduced in level to
some degree.
When might an audiologist use sound field speakers in testing?

When a patient is wearing hearing aids, has a cochlear implant, FM
system, etc., or when a child won't tolerate supra or insert earphones
What are the main disadvantages to using sound field speakers when
testing?
1) no ear specific information
2) the room acoustics can affect how the sound is delivered to the patient
Where is a Bone Conduction Vibrator placed on the patient?

on the skull behind the pinna
Test signals delivered to the patient via skull vibrations reach

_________________________
cochlea of both right and left ear
What are the typical test frequencies delivered with a bone conduction
vibrator? Why?

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250-4000 Hz; the band width is limited
a conductive hearing loss is identified in an audiogram when...

bone conduction threshold is 15 dB or higher above air conduction
threshold.
When air conduction thresholds and bone conduction thresholds are

equal and are both greater than to 25 dbHL
sensorineural hearing loss
What is indicative of a mixed hearing loss?

bone conduction thresholds are greater than 25 dbHL and an air-bone
gap is present
What symbol represents unmasked right air conduction thresholds?

a red circle
What symbol represents unmasked left air conduction thresholds?

a blue X
What symbol represents bone conduction thresholds?

red < is right, blue > is left
What are some conditions that result in the air conduction threshold
being lower than the bone conduction threshold?
The bone conduction vibrator was misplaced, or it was placed on the
sight of a past surgery, perhaps where there is a metal plate
The "down 10, up 5" technique is also called the

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____________________________
Hughson-Westlake method
What is the order of test frequencies according to ASHA, 2005?

1000, 2000, 3000, 4000, 6000, 8000, 500, and 250 Hz (retest 1000 Hz to
evaluate for a learning for practice effect)
Describe the familiarization phase of obtaining Pure Tone Thresholds

Present test frequency about 30 - 40 dB above the estimated threshold to
allow the patients to clearly hear the test tone.
Describe the threshold search phase

This begins when patient no longer hears the initial stimulus
presentation after being decreased by 10 dB increments
strict response criterion

no response until the patient is very confident that a tone is heard
a strict response criterion may result in _______________ thresholds

elevated; due to false negatives
lax response criterion

response even when the tone is not heard
a lax response criterion may result in

______________________________ results
inconsistent or unreliable results, such as a false positive
Weber Tuning Fork Test

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tuning fork is placed at the midline of the head or upper forhead; patient
is asked to report whether the sound is heard in the middle of the head or
which side of the head.
The Weber Tuning Fork Test is used to detect a

____________________ hearing impairment
unilateral
Rinne Tuning Fork Test

Tuning fork is placed in two positions: near ear canal and on mastoid,
and patient is asked which is louder
Rinne Tuning Fork Test is used to detect ____________ vs.

_______________
sensorineural loss vs. conduction loss

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lOMoARcPSD|7193771

CD 445 Wk 1 Pure Tone Audiometry

Audiometry and Hearing Conservation (California State University Northridge)

StuDocu is not sponsored or endorsed by any college or university

CD 445 Wk 1 Pure Tone Audiometry

What is a pure tone threshold?

Why is it important to standardize a testing protocol?

List the main points of the revised Hughson-Westlake method proposed

What is the "on-effect"?

What is "auditory adaptation"

Downloaded by candy wong ([email protected])

Range of pure tone test frequencies

About what frequency in Hz is the middle C on the piano?

What is usually the reason for the "notch" in an audiogram of a patient

For a patient with a "notch" that extends to 60 dBHL, which speech

A profound noise-induced hearing loss acts as a _________, only

List 4 uses for pure tone thresholds by audiologists

Downloaded by candy wong ([email protected])

List the 3 types of audiometers

Which type of audiometer is used only in the field?

Which type of audiometer is used for a variety of tests and has 2

Which type of audiometer changes the presentation level based on the

List the basic components of an audiometer

Which component of the audiometer changes the sound pressure level of

Which component of the audiometer directs the signal to the desired

Downloaded by candy wong ([email protected])

Which component of the audiometer presents the signal to the patient?

Which component of the audiometer monitors/calibrates the output

List the 5 types of transducers used for audiological testing.

An Ultra high-frequency earphone is also called a _____________

Supra-aural earphones may cause ________________, therefore, insert

What are some examples of models of supra-aural earphones?

What are situations in which supra-aural earphones are preferred?

Downloaded by candy wong ([email protected])

What are the units used when calibrating a pair of supra-aural

When might an audiologist use sound field speakers in testing?

Where is a Bone Conduction Vibrator placed on the patient?

Test signals delivered to the patient via skull vibrations reach

Downloaded by candy wong ([email protected])

250-4000 Hz; the band width is limited

a conductive hearing loss is identified in an audiogram when...

When air conduction thresholds and bone conduction thresholds are

What is indicative of a mixed hearing loss?

What symbol represents unmasked right air conduction thresholds?

What symbol represents unmasked left air conduction thresholds?

What symbol represents bone conduction thresholds?

The "down 10, up 5" technique is also called the

Downloaded by candy wong ([email protected])

What is the order of test frequencies according to ASHA, 2005?

Describe the familiarization phase of obtaining Pure Tone Thresholds

Describe the threshold search phase

strict response criterion

a strict response criterion may result in _______________ thresholds

lax response criterion

a lax response criterion may result in

Weber Tuning Fork Test

Downloaded by candy wong ([email protected])

The Weber Tuning Fork Test is used to detect a

Rinne Tuning Fork Test