This module will cover basic outlines of Audiology.

1. Introduction of
Audiological/Balance
Assesments
Module # 01
8th semester Audiology
M. Farhan Siddiqi
Lecturer, PIRS
siddiqif911@gmail.com

2. Contents
Prescription reading
Patient Complaint
Information regarding test
History taking
Otoscopy
Introduction of Audiological and Balance assessments
Quiz

3. Prescription reading
 Abbreviated as ℞ or Rx,
 Prescription / report is a medical document which gives
the information about patient problem.
 Must includes name, age, complaint, sign & symptoms,
history, disease-disorder, different diagnostic tests and
registered health care provider sign/stamp.
 A formal communication between a physician or other
registered health-care professional to a pharmacist,
laboratory and authorizing clinic to dispense a specific
prescribed medicine, test and management for a
specific patient.
 Piece of paper on which doctor writes an order for
medicine and tests.

4. Patient complaint
Patient comes to your Audiology
clinic because of several reasons:
1. ENT referral
2. Otalgia
3. Ear itching
4. Discharge from ear
5. Foreign body in ear
6. Audiological assesments
7. Vestibular assesments
8. Hearing loss management
9. Hearing aids knowledge/trial
10. Earmolds fabrication
11. Hearing aids
service/repair/programming/
Accessories
12. To sale their hearing aids

5. Information regarding test
Patient should be acknowledged
and instructed about what is going
to happen with himself. As
audiological and balance
assessments are painless,
noninvasive but time consuming.
The diagnostic hearing tests takes
approximately 30 to 60 minutes to
complete.

6. Audiologica
l
Assessment
s
01 Otoacoustic emissions OAEs
02 Tuning fork test
03 Distraction test
04 Tympanometry
05 Loudness Balance Test –ABLB, MLB
06 Acoustic reflex
07 Eustachian tube test
08 Pure Tone Audiometry
09 Play/Magic Audiometry
10 Bekesy Audiometry
11 Speech Audiometry
12 Free Field Audiometry
13 Aided Audiometry
14 Brainstem Evoked Response Audiometry
15 Auditory Steady State Response
16 Behavioral Observational Audiometry
17 Stenger Test
18 Short Increment Sensitivity Index
19 Visual reinforcement Audiometry
01 Caloric test
02 Electro/Video NystagmoGraphy
03 Single-Leg Stance Test (SLS)
04 Rotatory Chair / Rotation Test
05 Video head impulse test
06 Vestibular Evoked Myogentic Potentials
07 Computerized Dynamic Visual Activity
08 Computerized Dynamic Posturography
09 Fistula test
10 Romberg test
11 GAIT
12 Past pointing and falling
13 Dix-Hallpike Manoeuvr (positional test)
14 Cerebellar Dysfunction Test
15 Kobrak test
16 Optokinetic test
17 Galvanic Test
Balance
Assessments

7. History-taking skills
1. In audiology, a patient's history is the first key to unlocking diagnosis.
2. Effective audiological and balance assessments begin with the map of a patient's
history.
3. It includes relevant symptom and medical history, helps in understanding the
possible impact of lifestyle, environmental factors, and genetics on hearing and
balance.
 Prenatal (before birth)
 Perinatal (during birth)
 Postnatal (after birth)
 Adult case history

8. Infants' history Format (taken from mother)
1. Name: ______________ Age: _______ Date: _________________
2. Presenting Complain: _________________________________________________________________
3. Family history / Consanguine marriages: __________________________________________________
4. How you feel your child have hearing issues? (Behavioral Observations)
5. Any history of ear infection: __________________________________________________________
6. Any trauma in 1st trimester of pregnancy: ___________________________________________________
7. Is baby abruptly crying during/after birth: _______________________________________________
8. Birth normal or premature:______________________________________________________________
9. Birth weight: (normal between 5.5 pounds (about 2.5 kilograms) and 8.8 pounds (about 4 kilograms)
10. Ototoxic medication intake during pregnancy:
11. Developmental milestone normal or delayed?

9. Why an Audiologist ask about Family history?
• aids in identifying genetic hearing loss
• enables early detection and effective treatment
How Cousin marriage causes hearing loss?
• Hearing loss often autosomal recessive; needs two gene copies.
• Cousin marriages raise homozygosity, heightening inherited hearing loss risk in offspring.
Behavioral Observations:
• Does the infant startle to loud noises? Do they turn their head in response to sounds or shows interest, enjoys music, engages
vocally?
• Does the infant seem to recognize familiar voices, especially those of the parents, and calm down when they hear them?
• Is the infant's babbling varied or limited? Delays in expected communication?
• Does the infant show any signs of discomfort or pain in the ears, like pulling at them?
• Does the infant meet age-appropriate motor milestones (e.g., holding head up,
rolling over, sitting up)?
• Infant may favor visual over auditory cues, indicating potential hearing issues.

10. Pregnancy and Birth History:
• Was the baby exposed to any infections in uterus (e.g.,
rubella, cytomegalovirus, toxoplasmosis)?
• Was there any use of ototoxic medications during
pregnancy?
Neonatal History:
• Did the infant pass the newborn hearing screening?
• Were there any neonatal illnesses or conditions requiring
ICU admission?
• Is the infant currently experiencing any health issues,
including those not directly related to hearing or balance?
• Are there any difficulties with feeding (e.g., sucking,
swallowing)?
• Have there been any interventions already (e.g., hearing
aids, cochlear implants, speech therapy)?

11. How LBW causes hearing loss?
• Premature and LBW infants face risks like auditory
neuropathy and hearing loss due to organ underdevelopment
and potential damage from necessary oxygen therapy.
• Jaundice, often seen in LBW and premature babies, can
progress to kernicterus if bilirubin enters the brain,
potentially causing sensorineural hearing loss by damaging
the auditory nerve.
• Necrotizing Enterocolitis a serious gastrointestinal issue
common in LBW babies, can indirectly harm their hearing
development via infection and inflammation.
• LBW infants may need intensive care involving ototoxic
medications, which can harm their hearing system.

12. Miscellaneous factors
1.Noise Exposure: Constant exposure to high noise levels can damage an infant's
sensitive hearing mechanism, leading to noise-induced hearing loss. Infants are
more vulnerable because their auditory systems are still developing.
2.Ototoxic Substances: Exposure to ototoxic chemicals in the environment, such as
heavy metals (lead, mercury) or certain pesticides, can adversely affect hearing.
3.Infections: Living in environments with poor hygiene or crowded conditions can
increase the risk of infections like otitis media (middle ear infections), which, if
recurrent or chronic, can impact hearing ability.
4.Access to Healthcare: Environments with limited access to healthcare can delay
the diagnosis and treatment of hearing loss, affecting language and cognitive
development.
5.Nutritional Deficiencies: Environments where malnutrition is prevalent can lead
to deficiencies in essential nutrients necessary for hearing health, such as vitamin
A, omega-3 fatty acids, and zinc.

13. Adult history (taken from patient)
• Name: ______________________ Age: _______ Date: _________________ Occupation:_________________
• Chief Complain: _________________________________ Family history / Parent consanguine marriages: _______________________________
• Living environment: ______________________________ Travelling history: ____________________________________
• Loud Noise exposure: __________________________________ Use of headphones: ___________________________________________
• What issues you experiencing with your hearing or balance? When did you first notice these problems?
• Do you have trouble understanding speech, especially in noisy environments?
• Have you noticed any ringing, buzzing, or other noises in your ears?
• Do you experience pain, discomfort, or a feeling of fullness in your ears?
• Have you had any ear discharge, infections, surgeries, or trauma to your ears or head?
• Have you experienced any episodes of dizziness, vertigo, or imbalance when standing up quickly or walking in the dark?
• Do these episodes seem to have any triggers, such as changes in position or movement?
• Have you had any falls or near to falls recently?
• Are you currently taking any medications,

14. How Systemic diseases affects hearing?
diabetes, hypertension (high blood pressure), and thyroid disorders can all be linked to an
increased risk of hearing loss.
• Diabetes
High blood sugar levels associated with diabetes can damage the small blood vessels and
nerves in the inner ear, like how diabetes affects the eyes and kidneys. This damage can
impair the ear's ability to process sound. Research has shown that people with diabetes are at
a higher risk of developing hearing impairment compared to others.
• Hypertension
High blood pressure can damage the blood vessels in the body, including those in the inner
ear, leading to reduced blood flow. The inner ear relies on a delicate blood supply to function
properly, and any disruption in this supply can lead to hearing problems. Studies have
suggested a link between hypertension and hearing loss, although the exact mechanisms are
not fully understood yet.
• Thyroid Disorders
Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid), can
have an impact on hearing. Thyroid hormone plays role in the development of ear, any
imbalances can affect auditory function. Hypothyroidism can lead to fluid retention and
thickening of tissues, which can affect the middle ear and auditory processing pathways.

15. Is drugs affects hearing?
use of tobacco, excessive alcohol consumption, and certain recreational drugs have linked to an increased risk of hearing
loss.
• Tobacco Smoke
Smoking tobacco can harm hearing by reducing blood flow to the cochlea. Nicotine and carbon monoxide in tobacco
smoke also interfere with the oxygen supply to the inner ear, potentially damaging its delicate cells. Smoking can worsen
the impact of noise exposure on hearing. Studies have shown that smokers are at a higher risk for hearing loss compared
to non-smokers.
• Alcohol Consumption
It can impair the auditory cortex in the brain, affecting the brain's ability to process sound. It can also be toxic to the hair
cells in the cochlea. Chronic heavy drinking may result in a reduction in hearing sensitivity.
• Opiates (like heroin and certain prescription painkillers) can lead to auditory processing issues, where the ear may hear
sounds, but the brain has difficulty interpreting them.
• MDMA (Ecstasy) is associated with tinnitus and, in some cases, sudden hearing loss.
• Cocaine can affect the neurotransmitters in the brain, potentially leading to auditory damage.

16. Otoscopy
• Abbreviated as O/E
• Examination of external ear
• Examines Wax / foreign object in
EAC, Color/position of tympanic
membrane, Cone of light , Handle of
malleus, Umbo, Discharge in ears,
Infection in ears, furuncles, polyp,
perforation, atresia and stenosis

18. Tuning fork test
• Rinne
• Weber
• Absolute bone conduction
• Schwabach’s
• Bing
• Gelle’s

19. Quiz
Q#1: Why patients comes to you.
Q#2: Who will refer patient to your clinic.
Q#3: What important questions you asked from mother while taking history of infants?
Q#4: How Occupation and systemic diseases associates with hearing loss?
Q#5: What is myringosclerosis ?
a) Bony growth on stapes footplate
b) Scarred/thickened TM
c) Infection of meninges
d) Perforation of TM
Q#6: MEI stands for……….?

20. Thanks