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Audiology: Testing & Interpretation

Audiology: Testing & Interpretation



Posted by Audiology Unit Cairo University

Posted by Audiology Unit Cairo University



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    Audiology: Testing & Interpretation Audiology: Testing & Interpretation Presentation Transcript

    • Audiology: Testing and Interpretation
    • Learning Objectives By the conclusion, participants should be able to: • Interpret and evaluate audiological testing results • Contrast methods for testing infants, preschoolers, and older children • Apply knowledge to the interpretation of different audiological tests
    • Conventional Audiometry • Subjects wears earphones • Pure tones played to each ear separately • Starting with high intensity (loud) and move to low intensity (soft) • Child indicates when s/he hears the sound • Some children can accomplish this at age 3 years but most do so at age 5
    • Deciphering the Audiogram Horizontal axis: Frequency information (pitch)
    • Deciphering the Audiogram Vertical axis: Sound energy (loudness)
    • Audiogram of Familiar Sounds
    • Plotting Results on an Audiogram White area is inaudible Tan area is audible
    • Types of Hearing Loss • Defined by site of problem – Conductive – Sensorineural – Mixed
    • Anatomy of Hearing Loss Site of Conductive Loss Site of Sensori-neural Loss
    • Conductive Hearing Loss (CHL) • Caused by damage, disease, or malformation of the outer or middle ear • Sound is prevented from reaching the inner ear • Sound perceived as muffled or weak
    • Conductive Hearing Loss
    • Sensorineural Hearing Loss (SNHL) • Caused by damage, disease, or malformation of the inner ear – Sensory loss associated with inner ear damage – Neural loss if hearing nerve cannot send the impulse to the brain • Sound can be perceived as distorted or weak
    • Sensorineural Hearing Loss
    • Degree of Hearing Loss 16 to 25 dB = Minimal hearing loss 26 to 40 dB = Mild hearing loss 41 to 60 dB = Moderate hearing loss 65 to 85 dB = Severe hearing loss > 90 dB = Profound hearing loss
    • Minimal Hearing Loss • Relevant category for children not adults – Difficulty discriminating a signal from background noise – Difficulty hearing distant, soft or fast-spoken speech – Difficulty hearing some consonants, such as „f‟ „p‟ „h‟ „s‟ – May miss subtle conversational cues
    • Mild Hearing Loss • May miss 25-40% of speech sounds – Consonant sounds are more likely to be missed than vowel sounds • Without amplification in school, children may miss 50% of classroom discussions • Speech of affected people may be difficult to understand
    • Moderate Hearing Loss • May miss 50-100% of speech sounds • Affected children will likely have delays in language and speech development • Affected individuals omit and distorts consonants • Their speech is difficult to understand
    • Severe Hearing Loss • Affected people hear loud voices but may not understand speech clearly • They are apt to hear loud environmental sounds though they cannot hear speech • Difficulty in both one-on-one and group situations • Typically children with severe loss do not develop speech and language skills without special training
    • Profound Hearing Loss • Affected people do not hear any speech • They are aware of vibrations as tactile sensation • They typically rely on visual means of communication and learning • Their articulation, pitch, and rhythm of speech will probably be poor • They are candidates for cochlear implants
    • Test Categories • Objective tests – Do not require child's participation • Subjective tests – Require the child to participate in evaluation
    • Types of Objective Auditory Tests • Tympanometry • Otoacoustic Emissions (OAEs) • Auditory Brainstem Response (ABR) • Behavioral Observation Audiometry (BOA)
    • Types of Subjective Auditory Tests • Visual Reinforcement Audiometry (VRA) • Play Audiometry • Conventional Audiometry • Hearing for Speech
    • Tympanometry • Special earplug placed in the ear canal produces a puff of air • The technique measures the response of the eardrum to the change in air pressure • Tympanometry evaluates only the middle ear and does not provide information about hearing • Used to determine if (temporary) middle ear abnormality contributes to hearing loss
    • Otoacoustic Emissions (OAEs) • Special earphones placed into the ear that deliver clicking sound within the ear canal • Cochlea responds by producing a sound • Probe detects this cochlear emission, which is recorded on computer • OAEs detect presence or absence of hearing loss, but cannot assess degree of hearing impairment • Method for newborn hearing screening
    • Auditory Brainstem Response (ABR) • Special earphones deliver sound to ear • Electrodes on the scalp measure brain activity in response to sound • Resulting waves provide information on the integrity of the neural pathway • ABRs can estimate degree of hearing loss at different frequencies • Used for infants and children who cannot cooperate with subjective testing
    • Behavioral Observation Audiometry (BOA) • Audiologist assess changes in child‟s behavior in response to speech and/or tones • Responses suggestive of hearing – Motor activity – Eye movement toward the source of sound – Cessation of activity – Crying – Startle
    • Visual Reinforcement Audiometry (VRA) • With child on parent‟s lap, speech or tones played through earphones • A toy lights up or moves if child looks in that direction after sound is played • Stimuli progress from high to low intensity • Technique provides estimate of hearing threshold
    • Play Audiometry • Technique is similar to VRA • Child is taught to respond to sounds – May drop block into a bucket – May place a puzzle piece into a puzzle or put a ring on a stick • Technique provides estimate of hearing threshold
    • Conventional Audiometry • Person wears earphones • Sound is presented to one ear at a time • The person indicates he or she hears the signal by raising the hand on the same side as the ear in which the sound was played • Technique provides estimate of hearing threshold • Difficult to use on children < age 3 years
    • Pure Tone Average (PTA) • Average of hearing thresholds at 3 frequencies--500, 1000, and 2000 Hz • Typically, PTA and SRT are within 7 dB of each other
    • Methods of Assessing Hearing for Speech • Speech Awareness Threshold (SAT) • Speech Recognition Threshold (SRT) • Word Recognition / Speech Discrimination (WRS)
    • Speech Awareness Threshold (SAT) • Person wears earphones • Stimuli are speech sounds • Person indicates whether he or she can hear the sound (but does not have to identify the word) • Method establishes the lowest hearing threshold at which a person can detect voice 50% of the time
    • Speech Recognition Threshold (SRT) • Lowest hearing threshold at which a person correctly recognizes the speech stimuli 50% of the time • Optional tasks – Body-part identification – Object identification – Picture identification – Spondees (2-syllable words with equal emphasis on each syllable, eg, „baseball‟
    • Word Recognition/ Speech Discrimination (WRS) • Word list presented at Most Comfortable Loudness (MCL) or at 30-40 dB greater than their SRT or PTA • Word list includes stimuli with similar sounds, eg, moon and spoon • Person demonstrates that he or she understands the words by picture identification • Technique estimates degree of communicative functioning • May be used to monitor progress with hearing aids and aural rehabilitation • Children must have sufficient language to do the task
    • Hearing Impairments in Children • Page 168 • “The criteria for hearing impairments in children take into account a lesser impairment in hearing which occurs at an early age may result in a severe speech and language disorder.”
    • Hearing Impairments in Children • Page 168 • “Improvement by a hearing aid, as predicted by the testing procedure, must be demonstrated to be feasible in that child, since younger children may be unable to use a hearing aid effectively.”
    • 102.08 • For children below 5 years of age, inability to hear air conduction thresholds at an average of 40 dB hearing level or greater in the better ear
    • 102.08 • For children 5 years of age and older: – 1. Inability to hear air conduction thresholds at an average of 70 dB or greater in the better ear or: – 2. Speech discrimination scores at 40% or less in the better ear or: – 3. Inability to hear air conduction thresholds at an average of 40 dB or greater in the better ear, and a speech and language disorder which significantly affects the clarity and content of the speech and is attributable to the hearing impairment