Pure Tone Audiometry Flashcards
What are the six test considerations?
- Reliability
- Validity
- Sensitivity
- Specificity
- Efficiency
- Predictive
Which 4 test considerations go hand-in-hand?
Reliability & Validity
Sensitivity & Specificity
Define Reliability
The ability for test results to be repeatable
Define Validity
Does the test have variety to truly measure what it’s supposed to measure?
Define Sensitivity
The test being able to correctly identify a disorder
Define Specificity
The test being able to factor out those who do not fit the criterion
Define Efficiency
A test having a lot of false positive and false negative results
Define Predicative Value
The percentage of true positive and true negative results
What are the four test outcomes?
- True Positive
- True Negative
- False Positive
- False Negative
Define True Positive
Indicates a disorder is correctly present in patient
Define True Negative
Correctly eliminates an incorrect disorder
eg: a person w/o HL is giving an assessment and results show that their hearing is WNL
Define False Positive
Indicates that a disorder is present in a patient that doesn’t have a HL
Define False Negative
Incorrectly states that a person with a HL does not have it
What are the 4 Tuning Fork Tests?
- Schwabach Test
- Rinne Test
- Bing Test
- Weber Test
What is a Schwabach Test
It compares the patient’s hearing sensitivity to the clinicians
What is the Rinne Test?
It compares bone conduction to air conduction
What is the Bing Test?
Consists of an occlusion effect to differentiate SNHL vs CHL
What is the Weber Test?
It tests for lateralization
What is the Weber Test based on?
The Stenger Principle
List 6 reasons why tuning fork test aren’t widely used?
- Different intensity level depending on how hard you hit tuning fork
- Does not have specific intensities for diagnostic purpose
- It is not ear specific
- Totally subjective leading to poor reliability
- Relies on tester knowing their hearing level and not having a hearing loss
- It only has one frequency and is cumbersome to using vs using the audiometer
Instead of a tuning fork, what do we use instead and what does it give?
The audiometer and it gives a distinct reliable frequency that we need
What are the frequencies given from the audiometer?
- 125-12000 Hz
2. -10 ~ 110dbHL
Are testing chambers soundproof?
No, they’re sound treated which eliminates majority of sound but not entirely
For the patient, what are things an Audiologist should keep in mind?
- Their age, intelligence, education, motivation, willingness to cooperate
- Individualized approach to testing
- Before beginning, ask if they understand the instructions
- Positioning
What are the 3 components for an appropriate position during testing?
- Being at a right angle
- Back toward tester
- NO CUES
What are the 6 type of responses?
- Hand raising (one hand is fine)
- Finger raising
- Signal button
- Vocal response
- Conditioned play audiometry
- Visual reinforcement audiometry
Define Conditioned Play Audiometry
A game is used with a child to indicate when they heard a sound
Define Visual Reinforcement Audiometry?
Using a visual reinforcement to make a baby give a response by turning their heads when they hear a sound
Define False Negative for False Response
When a pt. fails to respond to tone that is heard
Define False Positive for False Response
When a pt. responds when no tone has been presented/when they do not hear the tone
What are the 2 types of false responses?
1, False Negative
2, False Positive
What’s the purpose of air conduction audiometry?
To specify patient’s hearing sensitivity at various frequencies by using either bone/air conduction
What does Air Conduction Audiometry give?
It only gives the degree or severity
What doesn’t Air Conduction Audiometry do?
It does not specify the type of loss
For ACA, what’s the procedure on deciding which ear first?
- If it’s known which ear has a HL, test the better ear
- If no difference, most starts with the right ear because one could be right eared or left eared due to brain processing
For ACA, if the difference is known, why should one test the better ear?
- They must be able to comprehend the tasks they have to do
- If clinical masking, is needed, Clinician needs to have a better idea of what the better ear is doing
For ACA, which frequency is used first?
1000Hz
What are the 3 reasons for the 1000Hz to be used first for ACA?
- Comfortable
- Easily heard
- Good test-retest reliability
For ACA, what is the second set of frequencies to test?
Above (2000-8000Hz)
For ACA, what is the third set of frequencies to test?
Below (250-500Hz)
For ACA, what is the final set of frequencies to test and why?
1000Hz as a reliability
For ACA, what’s the logic behind the sets of frequencies?
Because HL is normally in higher frequencies, audiologist should start with the higher ones first
For the ACA, what is actually being done with the tone?
A pure tone being presented for 1-2 seconds
What are the ideal tones being used for ACA & BCA
Constant and Pulsed
What are the two reasons for a Pulse Tone being used for ACA & BCA?
- Even though it has breaks in it, it does not change its amplitude or frequency
- Its normally used for patients with Tinnitus
Why is it ideal for the pure tone to be presented for 1-2 seconds?
It’s enough time for the patient to process sound and not have an advantage nor forget it.
For the threshold search, what dB # should an Audiologist start at?
30dB HL
What’s the procedure for a “No Response” threshold search?
- If at 30dB HL there’s no response, raise to 50db HL
2. If still no response, raise in 10dB steps until response/limit of audiometer
What’s the procedure for a “Response” threshold search?
- If at 30dB HL was heard, decrease 10dB steps
2. If no response, increase 5dB
What the rule for increasing and decreasing dBs for threshold search?
Down 10 when there’s a response, up 5 when there’s no response
Define threshold?
Lowest intensity level where sound is correctly identifies 50% of time
For clinical purposes, when do you finalize a dB for a client for ACA?
The same # of dB must be heard 2/3
Where are the thresholds recorded?
On an Audiogram
What octaves do we test for ACA?
250, 500, 1000, 2000, 4000, 8000
What inter-octaves do we use?
750, 1500, 3000, 6000
What are 2 reasons for using an Inter-Octave?
- MUST be used if threshold difference between octaves greater than 20dB
- For potential hearing aid patients, it provides additional information for programming
What are the ACA symbols?
Right - Red Circles
Left - Blue X’s
What is the purpose of Bone Conduction Audiometry?
- Determines sensorineural sensitivity
2. Determines TYPE of hearing loss
For BCA, what does determine sensorineural sensitivity aid in?
It allows one to determine the TYPE of hearing loss
For Air & Bone Conduction Audiometry, what can the results tell us?
It will give us the type of HL which can help an audiologist determine the cause of HL and recommend interventions
For BCA, where is the bone oscillator being placed?
Either forehead or mastoid
For BCA, what’s being stimulated?
The entire head is being stimulated
For BCA, does the location matter?
No, either placement will stimulate BOTH right & left cochlea
For BCA, what does unmasked bone conduction tells us?
Without keeping the other ear busy, it causes the BETTER ear to have threshold
Define occlusion
Something being blocked
What is an Occlusion Effect?
It’s an increase in intensity of sound/change in the quality of sound
For Bone Conduction Testing, what must be uncovered?
Both ears must remain uncovered
Define occlusion
If a blocking/covering of the ear occurs
When can an occlusion occur for Bone Conduction testing?
Occurs at less than 1000 Hz (low frequency sounds)
Which client will experience an Occlusion Effect?
Those with a SNHL/normal hearing
Which client rarely experience an Occlusion Effect?
CHL
Which transducers decrease the Occlusion Effect?
Insert Earphones
What frequencies are only tested for BCA?
500, 1000, 2000, 4000 Hz
For BCA, what is lowest maximum level of testing?
45 & 70-dB HL
For ACA, what is the lowest maximum level of testing?
90 ~ 110 dB HL
For BCA, why is there a lower maximum level of testing?
There will be more power needed to drive bone oscillator
For BCA, too much power being needed to drive bone oscillator can cause?
- Distortion
2. Vibrotactile response at higher intensity we’re inquiring about
For BCA, how can the procedure be described?
As less standardized
For BCA, how do you know which frequency to start at?
It depends on the air conduction response
For BCA, if there’s a good air conduction, which Hz can we start at?
500Hz
For BCA, what are 2 take a ways for the procedure?
- BC will be good as AC results
2. AC should not be significantly better than BC since BC bypasses the problem
For BCA, what is the unmasked symbol?
[ (turned to the right)
For BCA, why is that unmasked symbol used?
For BCA, we don’t know which ear the results are specifically pertaining to since both cochleae are being stimulated simultaneously
For BCA, what does the unmasked symbol tell us?
It informs us that we got a response for a cochlea
