Uncomfortable loudness levels Flashcards

1
Q

What is the aim of testing uncomfortable loudness levels?

A

-To identify the minimum level of sound that is judged to be uncomfortably loud by the subject
-This measures a person’s dynamic range
-May be helpful for hearing aid fittings to set the maximum output

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2
Q

What is meant by “dynamic range”?

A

The range of volumes between a person’s threshold of hearing and sounds that they find uncomfortably loud

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3
Q

When should we take particular care when measuring uncomfortable loudness levels?

A
  1. Tinnitus- can exacerbate it
  2. Unusual distress from particularly loud sounds- or hyperacusis
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4
Q

What is the stimulus for testing uncomfortable loudness levels?

A

Pure tone or frequency-modulated tones

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5
Q

How many frequencies should we use when testing uncomfortable loudness levels?

A

Two may be enough (e.g. a low frequency like 500 Hz and a higher frequency like 2 kHz or 4 kHz)

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6
Q

How can you minimise any distress that the test may cause?

A

-Monitor the patient’s face throughout the test and stop the test if you can spot signs of discomfort
-Present the sounds rhythmically so the patient knows when the next sound is coming and leave sufficient time between presentations for the patient to respond
-Allow the patient to see what you are doing so the sound is not a surprise to them and any flinching can be an indication that the sound was uncomfortable

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7
Q

What should be the starting presentation level and maximum presentation level for uncomfortable loudness levels?

A

-Starting presentation level: 60 dB HL or at the subject’s hearing threshold level for that ear at that frequency (whichever one is highest)
-Maximum presentation level: 110 dB HL is the maximum and levels above 100 dB HL should be used with caution

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8
Q

What is the presentation duration for uncomfortable loudness levels?

A

1 second long tone presented followed by 1 second quiet period

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9
Q

What is the increase increment for uncomfortable loudness levels?

A

5 dB

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10
Q

What is the presentation gap for uncomfortable loudness levels?

A

Leave 1 second of quiet between tones

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11
Q

What is the criteria for stopping uncomfortable loudness level testing?

A

-When the patient responds
-When the patient shows any signs of discomfort or distress e.g. the patient is flinching
-Only need one response unlike PTA

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12
Q

When should uncomfortable loudness levels be retested?

A

-If there is any reason to doubt the reliability of the uncomfortable loudness levels obtained
-If enhanced precision is required
-However consideration has to be given to the patient and their noise exposure levels

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13
Q

How are uncomfortable loudness levels recorded? What about if the maximum output of the audiometer is reached?

A

-L on the right, inverted L on the left
-If maximum output is reached this can be denoted by a downward arrow

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14
Q

What are the limitations of ULLs?

A

-The signal used may not reflect the signal which the patient finds uncomfortable (particularly in the case of hyperacusis)
-Poor test-retest relaibility
-Questionable value in hearing aid fitting
-Effectiveness of testing for tinnitus and hyperacusis (will we just be making the problem worse?)

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