1. Chapters 4 & 5 Behavioral Testing
Perry C. Hanavan, Au.D.
Audiologist

2. Audiometer

3. Earphones Ear Insert Earphones Reduce masking
Reduce ear canal collapse
Enhanced stability of sound delivered to ear
Increase Comfort
Reduce spread of bacteria
Supra-aural Earphones

4. Audiogram Styles

5. Audiogram Styles

6. Recording AC Thresholds

7. Degree of Loss Normal 10 or better Minimal 11-25 dB HTL Mild 26-40
Moderate
Moderately severe 56-70
Severe
Profound greater than 90

8. Type of Loss Compare air conduction and bone conduction thresholds
Outer Ear
Conductive Loss
Middle Ear
Sensorineural Loss
Inner Ear
Auditory Nerve
Mixed Loss

10. Audiogram 2-27
Number
Yes/No

11. Air Bone

12. Configurations

13. Symptoms - Dysfunction
Symptoms/Complaints
Tinnitus
Dizziness
Ear pain
Ear fullness/pressure
Communication difficulty
Potential Dysfunction
Non (Normal or Functional
Ear canal obstruction
Middle ear disorder
Inner ear disorder
Auditory nerve disorder
Auditory processing disorder

14. Potential Site of Lesion
Symptoms
Referral source info
Rule out system
Audiologic tests
Normal
Functional
Outer ear
Middle ear
Inner ear
Auditory nerve
Central auditory system

15. Audiology Test Battery
Case History
Otoscopic exam
Immitance battery
SRT
Pure tone AC and BC
Speech recognition tests
Otoacoustic emissions (OAE)
ABR and/or CAEP (Evoked Potentials)

16. Central auditory system
Normal
Functional
Outer ear
Middle ear
Inner ear
Auditory nerve
Central auditory system
33 year old male.
Otoscope exam: Normal
Physician report indicated symptoms included hearing loss, vertigo, pulsatile tinnitus, autophony, and oscillopsia. 

17. Diagnosis of 33 year old male
Temporal bone CT in the Posterior Semicircular Canal (A)

18. Normal
Functional
Outer ear
Middle ear
Inner ear
Auditory nerve
Central auditory system

19. Functional
Outer ear
Middle ear
Inner ear
Auditory nerve
Central auditory system

20. Normal
Functional
Outer ear
Middle ear
Inner ear
Auditory nerve
Central auditory system

21. Normal
Functional
Outer ear
Middle ear
Inner ear
Auditory nerve
Central auditory system

22. CROSS CHECK
SRT should be within +/- 10 dB of PTA

23. Purpose of Masking
A procedure audiologists use while testing to separate the two ears, acoustically Noise is introduced to one ear while the other ear is tested with a pure tone (or speech signal) To indicate that the hearing thresholds were obtained using masking, masked threshold symbols are used on the audiogram

24. Masking
Crossover
Results when sound presented to one ear through earphones crosses to the head via bone conduction and is perceived by the opposite ear

25. Masking Interaural attenuation (air conduction pure tone)
Reduction in sound energy of a signal as it is transmitted by bone conduction from one side to the other
Hz Supra-aural Insert Bone

26. Masking Types Narrowband Broadband (White Noise or Pink Noise
Pure tone testing
Broadband (White Noise or Pink Noise
Speech Testing

27. AC Masking Supra-aural earphone Insert earphone
PTACTE – PTBCNTE >= 40 dB HL then mask
Insert earphone
PTACTE – PTBCNTE >= 70 dB HL then mask
Interaural attenuation is 40 dB HL or supra-aural phones and 70 dB HL for insert phones

28. BC Masking Bone oscillator A-B gapTE > 10 dB HL (mask)
(interaural attenuation is 0 dB for BC)

29. Speech Masking Supra-aural phones:
Speech Test LevelTE – best BCNTE => 40 dB
Insert Phones
Speech Test LevelTE – best BCNTE => 70 dB
( Evaluate any speech test such as SRT and/or SRA and compare to the best BC of the non-test or opposite ear)

30. Normal
Functional
Outer ear
Middle ear
Inner ear
Auditory nerve
Central auditory system

31. Speech Audiometry Purpose
Attempt to measure the ability to understand everyday conversational communication

32. Uses of Speech Audiometry
Measure of speech threshold
Cross-check pure tone results
Measure of supra-threshold speech recognition ability
Differential diagnosis
Measure of auditory processing ability
Estimation of communication function

33. SPEECH TESTING SRT (speech recognition threshold)
Measure of speech threshold
Typically use spondees
SRA (speech recognition ability)
Measure of clarity
Supra threshold
Typically use monosyllabic or sentence material

34. Speech Threshold
Lowest level at which speech can be recognized or detected
SRT (could be any kind of speech material)
ST (spondee threshold)
SAT (speech awareness threshold)
SDT (speech detection threshold)

35. Spondee Threshold Trochees (not used for assessing SRT)
ST – the lowest level in decibels spondees can be recognize correctly
Measure of threshold sensitivity for recognizing speech
Provides estimation of hearing sensitivity in the primary speech frequencies
Comparable estimation of PTA (useful for cross-check)
Spondee
bisyllabic word enunciated with equal stress on both syllables
Trochees (not used for assessing SRT)
bisyllabic word with unequal stress on both syllables

36. ST Materials
Baseball
Cowboy
Hotdog
Sunset
Ice cream
Railroad
Sidewalk

37. SRT Speech Recognition Threshold
Lowest level in decibels at which speech can be recognized correctly with at lease 50% criterion
Sentences, spondees, etc.
Typically use spondees unless otherwise indicated

38. SAT/SDT Speech awareness or detection level
Lowest level in decibels at which speech is detected
Used when patient unable to respond to spondees (infants, developmental delays, etc.)
Approximately 10 dB better threshold than SRT threshold
Audiometers calibrated to speech recognition level than detection levels

39. Ling 6 Sounds

40. Supra-threshold Speech Recognition Ability
Ability to correctly recognize speech at supra-threshold levels (reported in percentage of words correct at intensity level of presentation)
100% at 80 dB HL
96% at 40 dB SL
Measured scores are generally predictable from degree, configuration and type of loss from pure tone results

41. Speech Recognition Ability Materials
Discourse
Sentences
Words
syllables
Phonemes
Nonsense words
Synthetic sentences
Speech in noise
Filtered speech

42. Speech Test Administration
Monitored Live Voice
Speaker variations
Scores affected by rate and quality of presentation
May not provide sufficient test-retest reliability
Recorded
Recommended procedure
Greater test-retest reliability
Normative data (for word recognition scores – WRS…speech recognition ability scores)

43. Open Vs. Closed Set Closed Set Open Set
Limited set of response possibilities
Useful for young children with limited vocabulary, patients with poor articulation, developmental delays
Scores may be 10% better compared to open set scores
Open Set
More challenging as response possibilities are somewhat unlimited

44. NU-6 (CNC) (Open Set)(Recorded or Live)

45. CID W-22 (PB Word Lists) (Open Set)(Recorded or Live)

46. CUNY Nonsense Syllable Test (Closed Set)(Recorded)

47. Minimum Age of Administration

48. WIPI (25 Word Lists) (Closed Set)(Recorded)

49. NU-CHIPS (Closed Set)(Recorded)

50. Dichotic Sentence Identification (Closed Set)(Recorded)
The DSI test uses 6 of the same sentences as the SSI-ICM test but presents 1 sentence to each ear simultaneously at 50-dB SL, and the participant is asked to select from a printed list which 2 sentences were heard.
Fifer et al showed that the test is resistant to the effects of SNHL below 50 dB HL.
The DSI test is administered in both a free and a directed mode.
In the directed mode, only the sentence heard in test ear is noted, whereas in the free mode, the sentences heard in both ears are reported.
Five presentations are used if the score is 100%; otherwise, another 5 sentences per ear are administered.
Scores are better in the directed mode than in the free mode, and the right ear scores are normally higher in adults than the left ear scores, presumably due to age related corpus callosum dysfunction.
Normal scores are 80% correct and above.

51. Pediatric Speech Intelligibility (Closed Set)(Recorded)
PSI
Both monosyllabic words and sentences recorded in quiet and with competition.
Employs color plates with pictures of animals (animals used to avoid ethnic biases) which represent either the sentences or the words.
Investigates peripheral and auditory processing disorders.

52. BKB-SIN (Adults) (Open Set)(Recorded)

53. BKB-SIN (Children) (Open Set)(Recored)

54. Quick-SIN for Adults Open Set-Recorded

55. QuickSIN Test for SNR

56. Redundancy vs. HL Sensitivity
less
more
Syllables
Words
Sentences
Redundancy of Informational Content
Sensitivity to Hearing Loss
less
more

57. Significant Difference
Compare test results
When is there a significant difference between test scores on speech scores?
These data permit comparison of scores to determine whether there is a significant difference

58. Lower Confidence Levels

59. yes/no
number

67. Count the Dots
Each dot represents 1% of the information contributing to speech clarity.
The number of dots audible predict how well one understands quiet speech from a six foot distance.
The dots are unevenly distributed, with many more of them filling in the gray zone between 1000 and 3000 Hz than in the 250 to 500 Hz area.
Count the dots that are below a person’s audiometric threshold.
The more dots below threshold, the better one is able to hear normal conversational speech.
The fewer dots below threshold, the more difficulty hearing conversational speech.

68. SII and AI Relationship

69. SII and AI Relationship of Various Speech Materials

70. Count the Dot (AI)

71. SNR Loss for 110 HA Wearers

72. 26% AI Understand 90% Sentences

73. SNR Loss

74. PI & Site of Lesion

75. Pathologic PI Calculate PI for SN
When .40 or greater, suggests neural rather than cochlear

76. yes/no
number

77. Number of Words for SRA

78. Speech Site of Lesion DiagnosisME OE IE AN
A-B Gap
Excellent SRA
No Rollover
A-B Gap
Excellent SRA
No Rollover
SN Loss
XX No Significant
Rollover
SRA above
lower confidence
limits
SN Loss
Significant
Rollover
XX SRA below
Lower confidence
Limits (scores
lower than
expected for
degree of loss)

79. Audigram 5-23

80. Audiogram 5-4

81. Speech Masking Supra-aural earphone Insert earphone
Speech LevelTE – BCNTE(best tone) >= 40 dB HL
Insert earphone
Speech LevelTE – BCNTE(best tone) >= 70 dB HL

82. Audiogram 2-20

83. Audiogram 2-25