Audiometric Interpretation

Question 1

Pure tone audiometry

Answer 1

Hearing thresholds – softest sound subject can hear
Pure tone results determine subject’s ability to hear sounds in the frequency range most important for speech understanding.
Pure tone testing is performed through air conduction and bone conduction
Pure tone test results are recorded on an audiogram
Pure tone findings contribute to diagnosis of hearing impairment and to recommendations regarding patient management.

Question 2

Interpreting the Pure Tone Audiogram

Answer 2

Graph indicating softest level in each ear at which
the frequencies important for comprehension of
speech are heard.
Compare test results to a graph of normal hearing
◦ Quantitative measure of hearing
Determines:
◦ Presence of absence of HL
◦ Degree of HL
◦ Type of HL
◦ Configuration of HL
◦ Difference between the ears

Question 3

Pure Tones and Hearing Loss
Frequencies that are affected by

Answer 3

Not all frequencies are affected
*High frequency hearing loss
➢Normal ___low___frequency hearing
*Low frequeny hearing loss
➢Normal __high____ frequency hearing
Can complex tones reliably measure hearing
loss?

Question 4

A&P Review

Answer 4

Auditory Encoding of Pure Tones
High frequency tones stimulate ___base___ turn of the cochlea
Low frequency tones stimulate __apex_____ turn of the cochlea
Hearing loss at 250 and 500 Hz would have the greatest hair
cell damage in which area of the basilar membrane?
Hearing loss at 25000 and 5000 Hz would have the greatest hair
cell damage in which area of the basilar membrane?

Question 5

Audiogram of Familiar Sounds and the
Speech Banana

Answer 5

Audiogram of familiar sounds provides
visual picture of the frequency and
intensity of familiar sounds
Speech banana represents frequency and
intensity range of average conversational
speech
There is a 30dB range from the softest to
the loudest speech sound

Question 6

Audiogram, Pure Tones and Speech
Perception

Answer 6

Superimposing the speech banana
on the audiogram provides
information regarding the listener’s
ability to hear the speech phonemes.
Information about access to speech
sounds provides a foundation for SLP
to work from

Question 7

Speech Acoustics - Low Frequency Information

Answer 7

▪Speech audibility
▪90% of speech energy
▪10% of intelligibility
▪Vowels – first formant and some F2
▪Consonant manner
▪ Nasals and Semi-vowels
▪Consonant voicing
▪Non(Supra)segmentals:
▪DIP-duration, intensity, pitch

Question 8

Low frequency Hearing Loss
Speech and Language Features

Answer 8

Speech
▪Poor prosody
▪Nasalization or denasalization
▪Confusion of nasals and plosives (m vs b)
▪Confusion of voiced and unvoiced consonants

Language
▪Verbs ‘ing’
▪Irregular past tense (run,ran)
▪Prepositions (found all over the frequency range)

Question 9

High Frequency Information

Answer 9

Speech intelligibility
▪ 10% of speech energy
▪ 90% of meaning
▪ Consonants:
▪ place cues
▪ fricative manner of production
▪ Vowels – remaining F2
▪ Morphological markers
▪ Verb tense (talks,talked)
▪ Possession(John’s,yours)
▪ Pluralization (book vs.books)
▪ Contractions (he’s,what’s,it’s)

Question 10

High Frequency Hearing Loss
Speech and Language Features

Answer 10

Speech
▪Omission and/or distortion of fricatives
▪Omissions of final consonants
▪Distortion or substitutions of stops

Language
▪Verbs – [t] past tense “ed”
▪Verbs – [s] marker
▪Irregular past tense
▪S morphemic functions
▪Prepositions

Question 11

Degree of Hearing Loss

Answer 11

◦Amount of hearing loss by
◦___air condition_____ pathway.

Question 12

Classification of Hearing Loss and the
Pure tone Average - PTA

Answer 12

Based on 3 - frequency PTA of
500, 1000, & 2000 Hz
PTA contains 70% of vowel and
consonant energy
Predicts estimate of HL handicap

Question 13

Degrees of Hearing Loss

Answer 13

Normal Hearing Adult -10 to 25dB
Normal Hearing Child -10 to 15dB
Slight Child 16 to 25dB
Mild 26 to 40 dB
Moderate 41 to 55 dB
Moderately –Severe 56 to 70 dB
Severe 71 to 90 dB
Profound > 90 dB

Question 14

SLIGHT HEARING LOSS: _16__ - _25__ DBHL
Child

Answer 14

Miss hearing the endings of words
◦ possession, tense, plurality
Difficulty with soft, distant speech and
understanding in noise
Can affect speech & language
development. academic achievement
and social interaction

Question 15

MILD HEARING LOSS: 26__ - __40 DBHL

Answer 15

Reduced ability to hear conversational
speech at a distance beyond 3 – 6 feet.
Difficulty hearing faint speech.
Difficulty hearing and understanding in the
presence of BGN (e.g.TV, group conversation
or traffic noise)
Amplification may be helpful
Use of Hearing Assistive Technology (HAT)

Question 16

EFFECTS OF A MILD HL FOR CHILDREN

Answer 16

1/3 of children have delayed language, academic and socialemotional development.
May miss 25 – 40% of speech signal.
Reading delays (difficulty associating sound with
corresponding letter.
Social and emotional impact
◦ Child appears off in own world, hears what he/she wants
to hear, daydreaming.
Fatigue, headaches from increased amount of energy
expended in listening.

Question 17

MODERATE HL : __41_ - __55___ DBHL
MODERATELY – SEVERE HL: ___56_ - __70__DBHL

Answer 17

• Difficulty hearing average conversational speech beyond
  3 – 6 ft away.
• Difficulty hearing and understanding in the presence of
  competing signals such as BGN, playground, traffic
  noise, or cross conversation.
• Difficulty hearing if speaker’s voice is faint or if speaker’s
  face is not visible.
• Difficulty identifying ambient sounds such as
  approaching car, person, doorbell or telephone.
• Possible limited tolerance for loud sounds.

Question 18

EFFECTS OF MODERATE / MODERATELY – SEVERE HL FOR
CHILDREN

Answer 18

• May miss 50 – 80% of speech signal.
• Delayed or distorted syntax, limited vocabulary, imperfect
  speech production and flat voice quality.
• Delayed communication, cognition, reading, and social
  emotional development.
• Amplification and Hearing Assistive Technology (HAT) to
  overcome poor acoustic environment.
• Adults – decreased social interaction, depression

Question 19

Hearing Loss Configuration

Answer 19

Always describes AC thresholds
◦ Flat
◦ Sloping (High frequency)
◦ Gradually sloping
◦ Sharply sloping
◦ Ski slope / precipitiously sloping
◦ Corner Audiogram
◦ Rising (Low frequency)
◦ Cookie bite
◦ Notched

Question 20

Reading the Bone Line

Answer 20

Based on presence of
____Air Bone Gap__,
the relationship between
AC and BC thresholds

Question 21

Type of Hearing Loss

Answer 21

Air Conduction
◦ Tests the entire auditory pathway
◦ What is the subject hearing
Bone Conduction
◦ Tests the inner ear
◦ What is the subject capable of
hearing

Question 22

SNHL – Sensorineural Hearing Loss

Answer 22

Due to damage in the___cochlea_____________
Air conduction thresholds are normal / abnormal
Bone conduction thresholds are normal / abnormal
ABG?
Is the subject hearing what they are capable of
hearing?

Question 23

CHL – Conductive Hearing Loss

Answer 23

Due to damage in the _outer or middle ___________
Air conduction thresholds are normal /
abnormal
Bone conduction thresholds are normal /
abnormal
ABG of >15 dB
Is the subject hearing as well as they
are capable of hearing?

Question 24

CHL – Conductive Hearing Loss
Due to damage i

Answer 24

Due to damage in the outer and/ or
middle ear
(conductive mechanism)
Air conduction thresholds are
abnormal
Bone conduction thresholds are
normal
ABG of 15 dB
Subject is not hearing as well as they
are capable of hearing.

Question 25

MHL - Mixed Hearing Loss

Answer 25

Due to damage in the _sensorineural mechanism __________ and ___conductive mechanism_______
Air conduction thresholds are normal / abnormal
Bone conduction thresholds are normal / abnormal
ABG?

Question 26

Sound Field Testing

Answer 26

Transducer – speakers in sound treated booth
Not ear specific
◦ Tests better ear
Babies or patients with dev. delay
Aided functional benefit
◦ Hearing aids, Cochlear Implants