1. Pure tone audiometry is an objective test that measures air and bone conduction thresholds to evaluate the type and severity of hearing loss. It is helpful for documentation and diagnosis. 2. Impedance audiometry objectively measures middle ear function through tympanometry and acoustic reflex testing. It can detect middle ear pathologies and is a fast screening test. 3. Otoacoustic emissions are sounds originating from the cochlea that can help diagnose cochlear hearing loss through an objective, noninvasive test done in both children and adults.

1. Dr kavitha ashok kumar

2.  FINGER FRICTION TEST
 WATCH TEST
 SPEECH /VOICE TESTS
 Normal person hears a conversation at
12m/40ft
Hears whisper at 6m/20ft in quiet
surroundings
(disadv:lack of stardardisation of pitch,intensity)
 TUNING FORK TESTS

3.  It is the study of hearing disorders through
hearing evaluation and rehabilitation
 Acoustics:refers to hearing and perception of
sound
 Sound:is a form of energy,which is produced
by any vibrating object.
 Velocity of sound in air is 344m/sec
 Sound travels faster in solids >liquids>gas

4.  Frequency:is the number of cycles /sec. Its unit is Hertz
(Heinrich Rudolf Hertz).
Ear is sensitive—20-20000Hz,
speech frequency-500-3000Hz,
audiometric testing-125-8000Hz
 Pitch is the subjective sensation produced by frequency.
 Intensity is the strength of sound and determines the
loudness of sound. Its unit is decibel (dB) (Alexander
Graham Bell)
whisper----30dB
conversation---60dB
shouting-----90dB
Pain in the ear---130dB

5.  Pure tone: a single frequency sound
 Complex sound: more than one frequency
 Music : is a peroidic complex sound
 Noise: is a aperoidic complex sound
1. White noise-all frequencies of sound
Narrow band noise – certain frequencies of sound
Speech noise-speech frequency sounds(300-3000Hz)

6.  Loudness discomfort level:90-150dB.It is
important while prescribing a hearing aid.
 Dynamic range :is the difference between the
most comfortable level and the loudness
discomfort level
Masking: is a phenomenon to produce inaudibility
of one sound by the presentation of another
Essential for bone conduction tests and air conduction tests when
the difference in hearing between the ears is>40dB

7.  Measurement of hearing acuity
 Types:
Pure tone audiometry (PTA)
Impedence audiometry
Speech audiometry
Otoacoustic emissions(OAE)
Brain stem evoked response audiometry (BERA)

8. Other audiological tests
 Tests for recruitment
◦ ABLB(alternate binaural loudness balance test)
◦ , SISI(short increment sensitivity index)
 Tone decay test
 Eustachian tube function tests

10.  Measurement of hearing acuity by
estimation of air conduction and bone
conduction thresholds of hearing for
various frequencies using pure tones
 Pure tone- 125-8000Hz(AC)
250-4000Hz(BC)
 Threshold of hearing: Minimum
perceivable intensity of sound

11.  Is an electronic device that generates pure
tones.The intensity of these tones can be
increased or decreased in 5dB steps

15.  Air conduction- sound is presented adjacent
to pinna- conduction through external and
middle ear.
 Bone conduction- sound presented on the
mastoid process- directly stimulates the
inner ear.

17.  The threshold for air and bone conduction
for each frequency is noted .
 Bone conduction is a measure of the cochlear
function
 The difference in the thresholds of air and
bone conduction(A-B gap)is a measure of
degree of conductive deafness.
 In a normal person,both air and bone
conduction is at 0dB and A-Bgap is absent

18.  Pure tone average :is an average of the air
conduction thresholds at 500,1000 and
2000Hz (speech frequencies)
 Masking :air conduction sounds cross over
when >40dB difference exists between the
AC thresholds of the two ears whereas BC
sounds may crossover at even 0dB
difference.A narrow band noise is given to
the non test ear (better ear).This is called
masking.

21. Normal

22.  Normal BC
thresholds
 Increased AC
thresholds
 AB gap
 Usually lower
tones affected
 Loss usually
<60dB

23.  Both air and bone
conduction
thresholds are
raised- No AB gap
 Bilateral sloping
(decending) curve
in presbyacusis

24. OTOSCLEROSIS

25. Noise induced hearing loss

28.  Tests various frequencies
 Both qualitative and quantitative (type and
severity of hearing loss)
 Documentation
 Compare serial audiograms/ pre and post
treatment audiograms
 May give clue to diagnosis

29.  Subjective test
 Patient should understand instructions-
cannot be done in children and psychiatric
patients
 Not accurate for medico-legal purposes if
malingering suspected
 Masking to be done to avoid involvement of
non-test ear in the test

30.  Impedance = resistance
 Impedance X compliance
 Measurement of the compliance of the middle
ear structures to the sound impulse
 More compliance= middle ear structures
vibrate more freely
 Less compliance= middle ear structures
vibrate less freely (more stiff)

32.  Tympanometry: measurement of compliance
of middle ear structures to sound impulse at
varying external ear pressures
 Stapedial reflex/ Acoustic reflex :can be
documented as there is reduced compliance
during contraction of stapedius muscle
(normal stapedial reflex threshold: 90dB)

36.  Objective test
 Easy to perform even in children
 Fast results- best screening test
 Diagnose various middle ear diseases
 Stapedial reflex studies help in
◦ Facial nerve lesions
◦ Auditory acuity in children
◦ Recruitment
◦ Malingering

37.  Speech reception threshold(SRT)
◦ Minimum intensity at which 50% of spondee words
(bisyllables with equal stress on each syllable )are
repeated correctly
◦ Normal:10dB of PTA
 Speech discrimination score(SDS)
◦ Percentage of correctly repeated phonetically
balanced words(single syllable words)given at an
intensity 30-40dB above the SRT.
◦ Normal: 95-100%
◦ Conductive hearing loss:90-100%
◦ Sensorineural hearing loss: is poor

39.  Are sounds
 Originate from cochlea
 Two types
1. Spontaneous
2. Evoked
- Transient
- Distortion

40.  Done in quite room
 No patient preparation
 Requires 10 -15 minutes
 Probe placed in the ear canal
 Not painful
 Non-invasive

41.  Uses:
 Screening test in neonates,uncooperative and
mentally challenged patients
 Helps to distinguish between cochlear and
retrocochlear hearing loss

42.  Recording of the electrical activity of the
auditory pathway till the brain stem evoked
by a sound stimulus
1 2 3 4
5

43. .
Brain stem evoked response
audiometry (BERA)
• Objective way of eliciting brain stem
potentials in response to audiological click
stimuli
• Waves are recorded by electrodes
placed over the scalp
• BERA is resistant to the effects of
sleep, sedation and anesthesia

45.  Objective measure auditory acuity
 Can be done even in new born children
 Authentic for medico-legal purposes-
malingering
 Site of the lesion in auditory pathway can be
detected depending on the latency of
individual waves

48.  What is Bing’s test?
 What is Gelle’s test?
 Why do we use 512Hz tuning fork for
TuningFork Tests?
 What is roll over phenomenon?
 What is the significance of acoustic reflex?
 What is carhart’s notch?
 Which frequency is most affected in noise
induced hearing loss?

49. 1)In impedence audiometry:
1. “A” wave denotes otosclerosis
2. Patient’s cooperation is essential
3. A 220Hz frequency probe is used
4. “C” wave denotes ossicular discontinuity
5. “B” Wave is seen in serous otitis media

50. 2) Tuning fork tests:
1. Is a subjective test
2. Quantifies the hearing loss
3. Can detect maligering
4. Are clinical tests
5. Detects the type of hearing loss

51. 3) Rinnes test is
1. Negative in acoustic neuroma
2. Positive in Meniere’s disease
3. Negative if minimum deafness is 15-20dB
4. Positive in normal individual
5. Done with 512Hz tuning fork

52. 4)Pure tone audimetry is:
1. Objective test
2. Helps in documentation
3. Ideally performed in a sound proof room
4. “X” symbol is used to mark air conduction in
left ear
5. Can differentiate between cochlear and
retrocochlear hearing loss

53. 5)Otoacoustic emissions is:
1. invasive
2. an objective test
3. Done in only adults
4. Used to screen for hearing loss
5. Helpful to diagnose cochlear deafness