| Term | Definition |
|---|---|
normal hearing | 0-20 dB |
mild degree hearing loss | 20-40 dB |
moderate degree hearing loss | 40-70 dB |
severe degree hearing loss | 70-90 dB |
profound degree hearing loss | 90 dB or > |
monaural | testing one ear |
binaural | testing both ears |
unilateral | hearing loss in only one ear |
bilateral | hearing loss in both ears |
asymmetrical | hearing is different (not the same) when comparing the right and left ears (by more than 15 dB) |
symmetrical | the hearing loss is roughly the same (almost =0 between right and left ears (by more than 15 dB) |
conductive | bone scores good - air scored bad |
conductive | bone conduction thresholds are WITHIN normal limits |
conductive | air conduction thresholds are OUTSIDE of normal limits |
conductive | significant Air bone gap ARE present |
conductive | hearing loss that arises from problem in outer or middle ear |
sensorineural | bone scores and air scores are the same (within 10 dB of each other) |
sensorinural | bone conduction thresholds are OUTSIDE of normal limits |
sensorineural | air conduction thresholds are OUTSIDE of normal limits |
sensorineural | no air bone gaps |
sensorineural | hearing loss arises from problem in the inner ear or auditory nerve |
mixed | bone scores are bad and air scores are bad (with a 15 dB difference or more) |
mixed | bone conduction thresholds are OUTSIDE of normal limits |
mixed | air conduction thresholds are OUTSIDE of normal limits |
mixed | air bone gap is present |
mixed | hearing loss that is combination of the other types - has problems in the outer or middle ear or inner or auditory nerve |
flat | Symbols on graph go across in a pretty straight line from the lower pitches to the higher
pitches – thresholds are within 20 dB of each other across the frequency ran |
rising | Rising – Symbols start off lower on left side of graph (for lower frequencies/pitches) and rise or
improve as move across the graph (to the higher frequencies/pitches) – thresholds for low
frequencies are at least 20 dB poorer / worse than for the higher frequencies
|
sloping | Symbols start off higher on the left side of the graph for the lower frequencies and
slope (go downward) as move across the graph toward the higher frequencies – thresholds for
high frequencies are at least 20 dB poorer than for the lower frequencies |
high frequency/low frequency | used when only one frequency region is affected (has
hearing loss) and other frequency regions are within normal hearing limits |
degree of hearing loss | mild, moderate, severe, profound |
configuration of hearing loss | sloping, flat, rising, high frequency (or other frequency region
affected with otherwise normal hearing |
type of hearing loss | conductive, sensorineural, mixed |
What determines the severity of hearing loss? | air conduction thresholds |
What determines the type of hearing loss? | Bone conduction thresholds |
air conduction | degree of HL (how much hearing loss a person has) |
air conduction | presenting tones through earphones or inserts |
circle (o) | right |
x | left |
air conduction | Tones have to go through the outer, middle, and inner ears |
bone conduction | type of HL (what part of the ear is damaged or not working properly) |
bone conduction | presenting tomes through a bone oscillator |
< | right |
> | left |
bone conduction | bypasses the outer and middle ear and sends tones through the skull to the cochlea (inner ear) |
decibel | unit used to measure the loudness (or intensity) of a sou |
hertz | unit used to measure the frequency (or pitch) of a sou |
audiogram | graph showing the softest sounds a person is able to he |
threshold | the softest level at which a stimulus (such as a pure tone) is barely percept |
pta | average of the thresholds through air conduction at 500, 1000 and 2000 Hz – (take the thresholds
of these 3 frequencies – add them together – and divide them by |
air bone gap | difference between air conduction and bone conduction results – shows a conductive
component to the hearing loss – in order for an Air-Bone Gap to be present – there must be a difference
between air and bone conduction that is “greater than 10 dB” (so 15 dB or |
what is the difference between a mixed and conductive hearing loss | BC thresholds are within
normal limits with a conductive loss but not with a mixed lo |
otoscopic exam | |
PTA (Pure Tone Average) should be in agreement with the SRT (Speech Recognition Threshold) for the same ear | They should be 10 dB of each other. When a poor
agreement occurs (a difference greater than 10 dB) between the SRT and WRS - it indicates an
inconsistency in the test results and warrants immediate investigation |
patient related factors | maybe they misunderstood the instructions – maybe they are
faking a hearing loss (nonorganic or psychogenic reasons) – language or cognitive barriers
(speak another language or have cognitive impairment) – poor attention span (take a break
and reward and praise for response |
audiometric configuration | sometimes with a steeply sloping hearing loss it can cause the
PTA to be skewed. Ex. If normal hearing at 500 Hz and a profound hearing loss at 1000 Hz
and 2000 Hz – the 3 freq PTA will look quite poor – however the patient can often use low
frequency hearing to identify spondee words correctly – creating a false discrepancy where
the SRT is much better than the PT |
equipment and technical errors | technical problem with audiometer – problem with
transducer used – use of live voice (patient can’t understand accent of test |
pathological/ retro cochlear factors | In rare cases – pathologies impacting the auditory
nerve or central nervous system (acoustic neuroma or brainstem lesion) preserve basic tone
detection but severely damage the brain’s ability to process complex speech signals. This
leads to an SRT that is significantly worse than the PT |
SDT (Speech Detection threshold) | the lowest level in dB at which a patient can barely detect the
presence of sound – can hear that someone is talking – but not “understand” what they are say |
SRT (speech recognition threshold) | the lowest hearing level at which speech can barely be
understood – can understand and repeat what the person sa |
spondee (spondaic) words | these are two-syllable words pronounced with = stress on both syllables (ex. Of Spondee words – airplane –
cupcake – hotdog – baseball – icecream |
spondee words | are used for determining the softest level at which a person can repeat back
50% of spoken words because: 1. there is = stress on both syllables. This creates a steady and
predictable energy peak across both parts of the word. 2. Because of their energy distribution
spondees align closely with low-frequency hearing thresholds (around 500 Hz) serving as a
reliable benchmark to cross-check pure-tone averages (PTAs) |
High Familiarity and
Redundancy | These words are common, everyday vocabulary and inherently redundant,
meaning a listener can recognize them easily even when the volume is low or muff |
Quick
and Consistent Threshold Finding | because they are equally understandable and easy to
identify, they allow clinicians to quickly use a bracketing technique (raising or lowering the
volume in 5 dB steps) to pinpoint the exact 50% recognition mark without being skewed by
unfamiliar or complex vocabular |
SRS - Speech Recognition “Score” or “Word Recognition Score or called speech discrimination testing | tests performed to determine an individual’s understanding of speech stimuli – how well they
understand what people are saying in conversational speech (not the softest level they can hear speech
– but level at which they can hear and understand speech in normal conversation |
PB (phonetically balanced word list) | these are monosyllabic word lists – each list contains the same
distribution of phonemes that occurs in connected English discourse/ conversation (ex. Of PB words –
moon – bell – coke – corn – box – bag) – start this testing at 40 dB above the SRT (ex. If the SRT is 10 dB– start the SRS testing at 10+40dB = 50 dB) |
How to calculate the Word Recognition Score (WRS)? | ou divide the # of words repeated
correctly by the total number of words in the list – then multiply by 100 to get the percentage
Ex. Words repeated correctly=21 Total # of words on the list = 2 |
Why must presentation level and test conditions be considered when interpreting word
recognition scores? | Because a raw percentage does not tell the whole story about how well a
person’s auditory system processes speech |
Why presentation level matters | If words are presented too softly - the person may
miss them due to a lack of volume rather than neural or hair cell distortion. The test is
usually performed at a set sensation level (SL) – usually 40 dB above their SRT. If the presentation level is too low – the score drops artificially. If the score plummets when
the volume is turned up louder – it can signal a retrocochlear or auditory nerve
pathology rather than a simple inner ear issue
|
Why test conditions matter? | No visual cues or context given during testing. Allowing
the patient to read your lips will drastically improve the score – but that would not be
accurate. Using Live Voice testing can cause a problem with accent or how words are
articulated. Recorded testing can sometimes be a problem due to the speaker pace or
intensity. Using shorter lists can drastically affect the score by affection the percentage
making small samples less reliable. Using the right transducer (headphone – insert
earphone, etc) and applying appropriate masking noise can help to make sure that you
are testing the ear that you are trying to test. If the patient seems fatigued or seems to
be having a problem focusing – would probably be more reliable results if rescheduled |
Monitored live voice | quicker and more flexible – but more subject to variations in a person’s
accent – level/loudness of speech and rate/speed of speech |
Recorded | audiologist pushes a button and a set of words is presented to the patient - more
consistent (not affected by different accents or pronunciations)– takes longer (have to wait for
the slow and timed recorded presentation |
Oral response | repeat the word |
written response | write the word on a piece of paper |
identify the picture | point to the picture that represents the word (used usually for children) |
False Negative Response during speech testing | patient acts like did not hear the word or says a wrong
and totally unrelated word on purpose |
Why would an Audiologist cover their mouth when presenting the words during speech testing? | To prevent the patient from lip or speech reading – (so that the patient does not see the tester’s
mouth/lips as they are saying the words and guesses the words being said as a result of the lip
movement)
|
Carrier phrase | a phrase such as “say the word…..” or “You will say…..” that precedes the stimulus
word during speech audiometry – it is designed to prepare the patient for the test word and to assist the clinician (if monitored live voice is used) in controlling the input loudness of the test word
Ex. “Say the word bell…..say the word coke…..say the word box…. |
VU meter | stands for “volume unit” for an audiometer – any time live voice is used during testing – the
tester should monitor their speech signal using this level – both syllables of the word should peak at
zero on the VU met |
What is the value of the SRT? | To compare the SRT to the PTA to show the accuracy of both tests and To better counsel the patient regarding the degree of their hearing lo |
MCI | Most Comfortable (loudness) level |
UCI | Uncomfortable (loudness) level |
Bone Conduction Speech Audiometry | to compare a child’s hearing thresholds for speech by bone
conduction and air conduction – provides useful info regarding possible conductive component |
normal conversational speech range | 50-60 dB |
a / e / i / o / u | vowels that are low pitched sounds – left side of the audiogram / speech banana |
s / f / sh / th | treble consonants that are high pitched sounds – on the right side of the audiogram /
speech banana |