Uncomfortable loudness levels Flashcards
What is the aim of testing uncomfortable loudness levels?
-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
What is meant by “dynamic range”?
The range of volumes between a person’s threshold of hearing and sounds that they find uncomfortably loud
When should we take particular care when measuring uncomfortable loudness levels?
- Tinnitus- can exacerbate it
- Unusual distress from particularly loud sounds- or hyperacusis
What is the stimulus for testing uncomfortable loudness levels?
Pure tone or frequency-modulated tones
How many frequencies should we use when testing uncomfortable loudness levels?
Two may be enough (e.g. a low frequency like 500 Hz and a higher frequency like 2 kHz or 4 kHz)
How can you minimise any distress that the test may cause?
-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
What should be the starting presentation level and maximum presentation level for uncomfortable loudness levels?
-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
What is the presentation duration for uncomfortable loudness levels?
1 second long tone presented followed by 1 second quiet period
What is the increase increment for uncomfortable loudness levels?
5 dB
What is the presentation gap for uncomfortable loudness levels?
Leave 1 second of quiet between tones
What is the criteria for stopping uncomfortable loudness level testing?
-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
When should uncomfortable loudness levels be retested?
-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
How are uncomfortable loudness levels recorded? What about if the maximum output of the audiometer is reached?
-L on the right, inverted L on the left
-If maximum output is reached this can be denoted by a downward arrow
What are the limitations of ULLs?
-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?)