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TOPIC 4. BEHAVIORAL ASSESSMENT MEASURES. The Audiometer. Types Clinical Screening. The Audiometer. Components Pure tone oscillator Attenuator Interrupter switch Output transducer Headphones Supra-aural Insert Bone conduction vibrators Forehead Mastoid Loudspeakers.

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Topic 4 l.jpg

TOPIC 4

BEHAVIORAL ASSESSMENT MEASURES


The audiometer l.jpg
The Audiometer

  • Types

    • Clinical

    • Screening


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The Audiometer

  • Components

    • Pure tone oscillator

    • Attenuator

    • Interrupter switch

    • Output transducer

      • Headphones

        • Supra-aural

        • Insert

      • Bone conduction vibrators

        • Forehead

        • Mastoid

      • Loudspeakers



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Pure Tone Audiometry

“The aim of pure tone audiometry is to establish hearing threshold sensitivity across the range of audible frequencies important for communication”



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Air Conduction vs Bone Conduction Testing

Air conduction tests the entire auditory system. Bone conduction bypasses the conductive mechanism, so it tests only the inner ear.


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Audiometric Symbols

  • Unmasked air conduction

    • Left ear

    • Right ear

  • Unmasked bone conduction

    • Left side

    • Right side

  • Masked air conduction

    • Left ear

    • Right ear

  • Masked bone conduction

    • Left ear

    • Right ear

  • No response


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What the Audiogram Says About the Impairment

Within normal limits

  • Mild

Moderate

Severe

Profound/deaf


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What the Audiogram Says About the Impairment

The configuration of the hearing loss

  • Flat

  • Rising

  • Sloping


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What the Audiogram Says About the Impairment

  • The degree of hearing loss

  • The configuration of the hearing loss

  • The type of hearing loss

    • Conductive

    • Sensorineural

    • Mixed


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Establishing a Pure Tone Audiogram

  • Establish which is the better ear and test first

  • Start air conduction testing at 1000 Hz

  • Begin at 30 dB HL. If there is no response, increase intensity in 20 dB steps until you see a response

  • Follow the “down in 10, up in 5” rule


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ASHA Procedure

Hypothetical threshold search for a listener whose threshold is 35 dB HL. A + indicates the listener heard the presentation, and a - shows the listener didn’t hear the tone. Notice that the hearing level of a trial is raised by 5 dB following a - and is lowered by 10 dB following a +.


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Establishing a Pure Tone Audiogram

  • After several crossings of the same intensity, pick threshold as an intensity where 50% of the time the listener responds correctly

  • Move to 2000 Hz, 3000 Hz, 4000 Hz, and 8000 Hz (as a minimum)

  • Pick up the low frequency (500 and 250 Hz) tones

  • Repeat for the other ear


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Speech Audiometry

Uses:

  • Sensitivity for speech

    • Speech awareness threshold

    • Speech reception threshold

  • Pure tone cross check

  • Speech recognition

  • Differential diagnosis

  • Central auditory processing

  • Estimate of communicative function


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Speech Audiometry

Materials

  • Types

    • Nonsense syllables

    • Monosyllabic words

    • Spondaic words

    • Sentence tests


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Speech Audiometry

Relationship of redundancy of informational content and sensitivity to the effects of hearing loss on three types of speech recognition materials


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Speech Audiometry

  • Intrinsic redundancy

  • Extrinsic redundancy

    • Frequency--low pass filtering

    • Time--time compression

    • Intensity--high presentation levels

    • Competition--speech in noise

    • Binaural--dichotic measures


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Speech Audiometry

Relationship of intrinsic and extrinsic redundancy to speech recognition ability in normal listeners


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Speech AudiometryClinical Methods

  • Speech thresholds

    • Speech Reception threshold

      • Start audible

      • Present four spondees

      • Calculate percent-correct response

      • Follow down in 10, up in 5 rule

      • Stop at an intensity that provides 50%


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Speech AudiometryClinical Methods

  • Speech thresholds

    • Speech Reception threshold

    • Speech Awareness threshold

  • Word recognition testing


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Word Recognition Testing

Things to consider:

  • Materials

    • Goals?

    • Amount of extrinsic redundancy you need?

    • Language level?

    • Other special needs or considerations?


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Word Recognition Testing

Things to consider:

  • Materials

  • Presentation

    • Monaural?

    • Binaural?

    • Headphones?

    • Sound field?


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Word Recognition Testing

Things to consider:

  • Materials

  • Presentation

  • Presentation Level

    • Maximal ability

    • Normal conversational level


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Speech Audiometry

Interpreting speech discrimination results. Typical results based on disorder site


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Other Behavioral Measures

Uses:

  • To determine a functional or exaggerated hearing loss

  • To provide additional information necessary to fit amplification

  • To determine the presence of recruitment and adaptation

  • To determine some measure of binaural integrity