Pure Tone Audiometry Flashcards by Cosette Gurule

The quietest level the pt can hear tone 50% of the time

Threshold

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How do you find the Sensation Level

Presentation Level- PT’s Threshold= Sensation Level

Presented at 40dB- Pt’s TH is 20dB= 20dB SL

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Both of these decibels compare the hearing of the patient to normal ears at audiometric zero. ANSI Standards

HTL- Hearing Threshold Level

HL- Hearing Level

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Compares this level to where the best human ears can hear

Sound Pressure Level SPL

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The amount of sound above the threshold of the pt. The sound the pt hears

Sensation Level

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The loss of acoustic energy of a sound as it travels from the test ear, across the head, to the opposite ear

IA- Interaural Attenuation

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Occurs when you present a sound to the test ear but the non test ear hears the sound first

Cross- over or IA

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Interaural Attenuation for pure tone air conduction testing is____

40dB

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The natural increase in the loudness of a tone by bone conduction when a blockage is present. It is greatest at 250Hz, about 20dB

The Occlusion Effect

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Designed to measure the auditory fatigue of the VIII Nerve

Tone Decay Tests

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3 Hearing Loss Characteristics

Type of Hearing Loss (Sensorineural, Conductive, Mixed)
Degree of HL (mild, Moderate, Severe)
Configuration of HL ( reverse slope, cookie-bite, flat)

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Always presents with better hearing from by BC, indicates a blockage or impairment to the conductive portion of the hearing mechanism, if 15dB or more at all frequencies there is a conductive loss/component. What do all these traits identify?

Air- Bone Gap/ Conductive HL

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When the AC thresholds and BC thresholds are the same (right on top of each other)

Sensorineural HL

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When there is a separation between the AC thresholds and the BC thresholds in addition to abnormal BC thresholds (worse than 20dB on Audio)

Mixed HL

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The 5 degrees of HL

Normal- 0-20dB
Mild- 21-40dB
Moderate 41-70dB
Severe 71-90dB
Profound 91+

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A configuration of HL that Generally varies within 10-15dB at all frequencies

Flat Loss

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A configuration of HL that has a gradual reduction from lower to higher Frequencies

Gently Sloping or gradual slope

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A configuration of HL that has a greater HL in the LF’s better hearing in the HF’s

Reverse or Rising slope

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Severe to profound loss in the LF’s and no response in the mid or HF’s

Corner Audiogram

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Better Hearing in the LF range to a severe drop in the highs

Ski-Slope or HF, or precipitous Loss

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A Hearing loss due to noise exposure and illustrates a V notch between 3k-6kHz and a sensorineural HL

Noise induced HL

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All Bone conduction thresholds are in normal range while AC have a reverse slope and type B Tymp…what HL would this indicate?

Otitis Media

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Early stages will exhibit that of otitis media on the audiogram but with this the BC thresholds drop at 2k (carhart notch) Tymps are type As

Otosclerosis- with surgery BC and AC will return to normal (stapedectomy) W/O surgery loss gets worse

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Produces a purely conductive loss with up to 60dB air bone gap.

Missing Drum or Ossicular Chain

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Occurs when a lower frequency sound masks out a higher frequency stimulus

Upward spread of masking

A masking noise that can be used for both pure tone and speech

White Noise

More effective masking noise and easily tolerated than white noise for pure tones but not speech tests

Narrow Band Noise

Interaural Attenuation for Bone Conduction is ___ for the sound to be audible in the opposite ear

0dB

Eliminates cross over from occurring. Determines the appropriate noise needed to cover up or keep the non test ear busy.

Effective Masking

occurs when an effective masking noise in the non-test ear isolates the test from cross over or IA and the Central Nervous system causes the test ear threshold to be 5dB lower without masking.

Central Masking

When is masking required

1. Required in the better ear when the difference in air conduction thresholds between ears is 40dB or more. 2. Whenever the masked or unmasked BC threshold of the better ear is 40dB better than AC threshold of the poorer ear, mask the poorer ear thresholds by AC

How to determine the proper amount of masking noise and the starting level for the test tone

Start masking noise in the better ear at AC threshold plus 10

When to mask for BC

When a 15dB or more difference occurs between the BC and the better ear and AC of the poorer ear

In pure tone testing, threshold means

The lowest intensity the client hears 50% of the time

What is the meaning of 40dB threshold re: audiometric zero, at 500 Hz

Subject could barely hear a 500Hz tone at 40dB about 50% of the time

The problems produced by excessive ambient noise are

Greater for the lower frequencies than the higher frequencies

What should be done before testing is performed

The Pt’s ears should be carefully examined using an otoscope

The descending technique in pure tone Audiometry is preformed because it:

It’s easier to hear when a sound stops than when it begins

Why is beginning testing with the 1000Hz tone conducted

It is the center of frequency of those most important to understanding speech Has good test, re-test reliability Provides the pt to become accustomed to the procedure

Individuals with a noise induced hearing impairment can have a V notch at which frequencies

3000, 4000, 6000Hz

The loss of acoustic energy as it travels from the test ear in the non-test ear is a definition of:

Interaural attenuation

To begin testing for air or bone conduction thresholds, test should begin at which frequency

1000 Hz

If the outer and middle ear parts are normal

Air thresholds will equal the bone thresholds

In bone conduction testing the receiver should be

Placed at the most sensitive spot on the mastoid of the test ear

Sound from the bone conduction receiver may stimulate the non-test ear at

10dB or less

A source of information that helps to identify which ear is responding in bone conduction stimuli is

Tympanometry Acoustic reflex testing Bone conduction with masking

Bone conduction testing directly stimulates the:

Cochlea

Ambient noise in the environment during bone conduction testing will

Affect the test results in the lower frequencies

During the testing process it is best to test bone conduction

After air conduction testing

A conductive loss may be caused by

Perforation of TM Immobile Middel ear ossicles Otitis media

Bone condition thresholds worse than Air conduction thresholds may be caused by

Poor placement of the vibrator Skull fracture Thickness of the skull

Sound being presented to one ear and then routed to the opposite ear is known as

Cross hearing Trans cranial hearing Shadow hearing

When the better ear answers for the poorer ear what occurs

Shadow curve

Which noise is best for masking during pure tone air and bone conduction testing

Narrow band noise

Effective masking may be described as

An increased masking noise that does not shift the threshold tone A formula method to determine how much masking noise is appropriate A psychoacoustic method like the one proposed by hood

Masking is performed during air conduction testing when

Masking is performed during bone conduction testing whenever

A 15dB or more difference occurs between the obtained bone conduction threshold of the better ear and the obtained air conduction threshold of the poorer ear

The occlusion effect occurs during

Bone conduction testing causing thresholds to shift due to headphones being placed over the ear

A masking dilemma occurs when

It is impossible to mask The patient displays a bilateral conductive loss Masking can not be completed due to over masking

Under masking is defined as

Occurring more often during air conduction testing

Central masking can effect a threshold by

5dB