1. HEARING LOSS & TYPES OF HEARING T
• IMRANA SHAKOOR
• MASTER IN AUDIOLOGY &SPEECH PATHO
2. THE SOUND PERCEPTION AND
UNDERSTANDING OF ENVIRONMENTAL
INTERACTION BY UTILIZING HEARING
SENSE
3. • HEARING LOSS, DEAFNESS, HARD
OF HEARING, ANACRUSIS,
OR HEARING IMPAIRMENT (A TERM
CONSIDERED DEROGATORY BY
MANY IN THE DEAF COMMUNITY),
IS A PARTIAL OR TOTAL INABILITY
TO HEAR.
6. TUNING FORK TESTS ARE SCREENING
TESTS AND DO NOT REPLACE FORMAL
AUDIOMETRY. THEY CAN BE USED WITH
PATIENTS OVER EIGHT YEARS OF AGE
TO CHECK FOR CONDUCTIVE LOSS OR
ASYMMETRIC HEARING IN THE LOW
FREQUENCIES.
WEBER
RINNER
7. • IF EXAMINER HEARS LONGER YOU
HAVE A DIMINISHED SCHWABACH
WHICH IS CONSISTENT WITH A
SENSORINEURAL LOSS.
• IF PATIENT HEARS TONE LONGER
YOU HAVE A PROLONGED
SCHWABACH CONSISTENT WITH A
CONDUCTIVE LOSS.
8. • PROCEDURE
• TF IS PLACED ON MIDLINE
(FOREHEAD OR VERTEX) OF
HEAD.
• PATIENT IS TO INDICATE
WHERE THEY HEAR THE TF THE
LOUDEST.
• INTERPRETATION
• IF IN THE GOOD EAR =
SENSORINEURAL
• IF IN THE POOR EAR =
CONDUCTIVE
9. PROCEDURE
• TF IS ALTERNATELY PLACED ON MASTOID AND ABOUT 1 TO 2
INCHES FROM PINNA.
• INTERPRETATION
• IF HEARD BETTER ON MASTOID = NEGATIVE RINNE = CONDUCTIVE
LOSS.
• IF HEARD BETTER THROUGH AIR = POSITIVE RINNE =
SENSORINEURAL LOSS.
10. • PROCEDURES
• TF IS PLACED ON MASTOID.
• FINGER IS USED TO
ALTERNATELY OPEN AND
CLOSE THE EAR CANAL
• INTERPRETATION
• IF PLACING FINGER IN EAR
CANAL MAKES SOUND
LOUDER = POSITIVE BING =
SENSORINEURAL LOSS.
• IF PATIENT DOESN‘T ‘T’
NOTICE A DIFFERENCE =
NEGATIVE BING =
CONDUCTIVE LOSS
12. • THE TECHNIQUE USED FOR MEASURING THE HEARING
ACUITY WITH THE HELP OF AN ELECTRONIC DEVICE.
Routine test used for children and adults.
Non – invasive procedure
Can be used for screening & detailed assessments
FIRST BASIC TEST IN AUDIOLOGICAL TEST BATTERY
TO MEASURE HEARING ACUITY USING PURE TONES – SINGLE
FREQUENCY, SINGLE INTENSITY
TESTING IN 2 MODES
- AIR CONDUCTION – WITH EARPHONES
- BONE CONDUCTION – BONE VIBRATOR
13. • THE USUAL PRIMARY PURPOSE OF PURE-
TONE
• TESTS IS TO DETERMINE THE
TYPE OF HEARING LOSS
DEGREE OF HEARING LOSS AND
CONFIGURATION OF HEARING LOSS
20. • AC & BC – HEARING
LOSS
• A – B GAP >/< 10 DB
HL.
21.
22. A. C. – HEARING LOSS
B. C. – NORMAL
A B GAP GREATER THAN 15
DB HL.
DOES NOT EXCEED 60 DB HL.
23. • Speech test for SRT
• Speech discrimination test
• The kindle toy test
• Reed card test
• Manchester word list
24. • IN THIS TEST, THE PATIENT’S ABILITY TO HEAR AND
UNDERSTAND SPEECH IS MEASURED. TWO PARAMETERS ARE
STUDIES:
(i) SPEECH RECEPTION THRESHOLD AND (II) DISCRIMINATION
SCORE.
• Speech reception threshold (SRT)
– The softest level (dB HL) at which a patient
can accurately repeat spondees (two-
Syllable word; i.e. baseball, hotdog, birthday)
50% of the time
– Uses the same bracketing technique ass pure
tone testing
25. • NORMALLY, SRT IS WITHIN 10 DB
OF THE AVERAGE OF PURE TONE
THRESHOLD OF THREE SPEECH
FREQUENCIES (500, 1000 AND
2000 HZ)
26. • ALSO CALLED SPEECH RECOGNITION OR WORD
RECOGNITION SCORE. IT IS A MEASURE OF PATIENT’S
ABILITY TO UNDERSTAND SPEECH. HERE, A LIST OF
PHONETICALLY BALANCED (PB) WORDS (SINGLE SYLLABLE
WORDS, E.G. PIN, SIN, DAY, BUS, ETC) IS DELIVERED TO
THE PATIENT’S EACH EAR SEPARATELY AT 30-40 DB
ABOVE HIS SRT AND THE PERCENTAGE OF WORDS
CORRECTLY HEARD BY THE PATIENT’S IS RECORDED. IN
NORMAL PERSONS AND THOSE WITH CONDUCTIVE
HEARING LOSS A HIGH SCORE OF 90-100% CAN BE
OBTAINED (TABLE 4.2).
27. SD SCORE ABILITY TO UNDERSTAND
SPEECH
90 – 100 Normal
76 – 88% Slight difficulty
60 – 74% Moderate difficulty
40 – 58% Poor
< 40 % Very poor
29. • TYMPANOMETRY IS AN ELECTRONIC
TEST AND ACOUSTIC MEASUREMENT
TECHNIQUE OF MIDDLE EAR
FUNCTION
• COMBINED WITH OTOSCOPY, ITS IS
AN OBJECTIVE FAST AND HIGHLY
ACCURATE WAY TO RULE OUTER
AND MIDDLE EAR PATHOLOGY
30. INTRODUCE A PURE TUNE INTO EAR CANAL THROUGH 3 FUNCTION
PROB TIP
• AIR PUMP TO INCREASE OR DECREASE AIR
PRESSURE IN THE EAR CANAL
• OSCILLATOR TO PRODUCE A TONE OF 220 HZ
• MICROPHONE TO PICK UP AND MEASURE SOUND
PRESSURE LEVEL REFLECTED FROM THE TM
31. • BEFORE THE TEST, YOUR HEALTH CARE PROVIDER WILL
LOOK INSIDE YOUR EAR TO MAKE SURE NOTHING IS
BLOCKING THE EARDRUM.
• NEXT, A DEVICE IS PLACED INTO YOUR EAR. THIS DEVICE
CHANGES THE AIR PRESSURE IN YOUR EAR AND MAKES THE
EARDRUM MOVE BACK AND FORTH. A MACHINE RECORDS
THE RESULTS ON GRAPHS CALLED TYMPANOGRAMS.
• YOU SHOULD NOT MOVE, SPEAK, OR SWALLOW DURING
THE TEST. SUCH MOVEMENTS CAN CHANGE THE PRESSURE
IN THE MIDDLE EAR AND GIVE INCORRECT TEST RESULTS.
• THE SOUNDS HEARD DURING THE TEST MAY BE LOUD. THIS
MAY BE STARTLING. YOU WILL NEED TO TRY VERY HARD TO
STAY CALM AND NOT GET STARTLED DURING THE TEST. IF
YOUR CHILD IS TO HAVE THIS TEST DONE, IT MAY BE
32. • A TYMPANOGRAM IS A GRAPH
PICTURE OF MIDDLE EAR FUNCTION
THAT RESULTS AS THE PRESSURE IS
VARIED AGAINST THE TM
• TYMPANOGRAM MAY BE DIVIDED
INTO 3 BASIC TYPES AND 2 SUB
TYPES, ACCORDING TO THE SHAPE
OF THE GRAPH THAT IS OBTAINED
33. CORE FEATURES OF TYMPANOGRAM:
COMPLIANCE (HIGH, INTERMEDIATE, LOW)
1) MIDDLE EAR PRESSURE (NORMAL OR HIGH
POSITIVE/ NEGATIVE)
2) SHAPE OF THE CURVE (SHARP, ROUNDED ,
FLAT)
3) EAR CANAL VOLUME (NORMAL, REDUCED,
ELEVATED)
34. TYPE A NORMAL TYMPANOGRAM
• PEAK IN TYMPANOGRAM BETWEEN + OR - 100
DAPA.
• PEAK COMPLIANCE FALLS BETWEEN 0.2 TO 1.8
• RESULTS INDICATE THE ABSENCE OF MIDDLE EAR
PATHOLOGY
• INTACT & MOBILE TM WITH NORMAL EUSTACHIAN
TUBE FUNCTIONS
• IF THERE IS A HEARING LOSS ITS LIKELY TO BE
35. TYPE AS (SHALLOW): ABNORMAL
TYMPANOGRAM
• PEAK IN TYMPANOGRAM BETWEEN + OR - 100 DAPA.
• PEAK COMPLIANCE VERY LOW BELOW 0.2 MM
• OFTEN ASSOCIATED WITH ACICULAR FIXATION
• MAY RESULT IN A FAIRLY FLAT – NON FLUCTUATING HEARING LO
• EUSTACHIAN TUBE FUNCTION IS NORMAL
