Download presentation
Presentation is loading. Please wait.
1
Understanding the Audiogram
Dr. Nancy Gillispie
2
Understanding the Audiogram
Introduce basic terminology & basic anatomy Introduction of various audiological tests Audiogram Type Degree Configuration Speech Audiometry
3
Nancy Gillispie Au.D. CCC-A, F.A.A.A.
(304) Dr. Nancy Gillispie has been working within the field of audiology since She received a master’s degree from West Virginia University and thereafter earned her Doctorate degree from Salus University. Dr. Gillispie is a licensed and certified clinical audiologist through WVBESLPA. She maintains national certification as a member of the American-Speech-Language-Hearing Association (ASHA) and a fellow of the American Academy of Audiology (AAA). Dr. Gillispie specializes in hearing evaluations, hearing aid technology, and FM system technology to persons of all ages. This also includes hearing technology monitoring, counseling, educational training and technical assistance, as well as direct aural (re)habilitation services.
4
Basic Terminology
5
Air Conduction Air-Bone Gap Audiogram Audiology Audiometry Auditory Nerve Auris Dextra – AD Auris Sinistra – AS Auris Utraque – AU Behavior Test Bilateral Bone Conduction Cerumen Cochlea Conditioned Play Audiometry Conductive Hearing Loss Dynamic Range External Auditory Meatus Incus Inner Ear Inner Hair Cells Internal Auditory Meatus Malleus Middle Ear Mixed Hearing Loss Most Comfortable Loudness Ossicular Chain Otoacoustic Emission Testing Otoscopy Outer Ear Physiological Test Pinna Pure Tone Sensorineural Hearing Loss Speech Awareness Threshold Speech Discrimination Score Speech Reception Threshold Spondees Stapes Threshold Tympanic Membrane Tympanometry Uncomfortable Loudness Unilateral Visual Reinforcement Audiology
6
Anatomy
8
https://youtu.be/eQEaiZ2j9oc
9
Audiological Evaluations
Physiological & Behavioral Testing
10
Otoscopy Instrumentation: Otoscope
visual examination of the auditory canal and the eardrum Results typically include “normal” and “abnormal” The goal is to identify a medical condition or best describe the health of the outer ear.
11
Tympanometry Instrumentation: Tympanometer or Acoustic Bridge
Can also be identified as Acoustic Immittance Results are reported in “types” Type A – normal middle ear functioning Type AD – Normal but highly compliant middle ear Type AS – Normal but less compliant middle ear Type B – abnormal middle ear functioning Normal ear canal volume Abnormal ear canal Type C – abnormal middle ear functioning
12
Otoacoustic Emission (OAE)
Instrumentation: Computerized Instrument Evaluation Options: Type: Distortion Product Otoacoustic Emissions (DPOAE) Transient Evoked Otoacoustic Emissions (TEOAE) Results: Screening (single intensity level over limited frequencies) Outcome: Pass or Refer Diagnostic (conducted several times at several intensity levels at a wide range of frequencies) Outcome: Normal, Abnormal, or Absent
13
Auditory Brainstem Response (ABR)
Instrumentation: Computerized Instrument Can also be identified as Brainstem Response Testing (BSER) Evaluates the response of the cochlea and the brain pathways for hearing Can be conducted sedated or non-sedated Results are frequency and intensity specific
14
Pure Tone Audiometry & Speech Audiometry
Audiogram Pure Tone Audiometry & Speech Audiometry
15
Types of Audiograms
16
Pure Tone Audiometry Instrumentation: Audiometer Tests
Air Conduction Stimuli is presented via Headphones, Inserts, or Sound-field Bone Conduction Stimuli is presented via Bone Oscillator Results identify: Type of Hearing Loss Degree of Hearing Loss Configuration of Hearing Loss Results should also include validity (acceptable/questionable) and reliability (good/fair/poor).
17
Basic Audiogram Symbols
Red = Right Ear Blue = Left Ear
18
Measures ability to hear pure tones at specific frequencies &decibels.
The Audiogram Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 PITCH Measures ability to hear pure tones at specific frequencies &decibels. LOUDNESS
19
Sounds occur at different intensity (loudness) and frequency (pitch).
Common Sounds Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 Sounds occur at different intensity (loudness) and frequency (pitch). Vowels Consonants
20
Range of Normal Hearing
Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 O Range of Normal Hearing x Hearing Threshold
21
Mild Hearing Loss x O Hearing Loss Consonants Vowels Hearing Threshold
Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 Hearing Loss x O Vowels Consonants Hearing Threshold
22
High Frequency Hearing Loss
Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 x Hearing Loss O Vowels Consonants Hearing Threshold
23
Moderate Hearing Loss O x Hearing Loss Consonants Vowels
Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 Hearing Loss x O Vowels Consonants Hearing Threshold
24
Severe Hearing Loss x O Hearing Loss Consonants Vowels
Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 Hearing Loss Vowels Consonants x O Hearing Threshold
25
Profound Hearing Loss x O Hearing Loss Consonants Vowels
Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 Hearing Loss Vowels Consonants x O
26
https://hearinghealthfoundation.org/degrees-of-hearing-loss
28
Types of Hearing Loss The type of hearing loss is determined by the agreement or difference between the air conduction thresholds and bone conduction thresholds for each ear. The difference between the thresholds are identified as an Air-Bone Gap.
29
Conductive Hearing Loss Sensorineural Hearing Loss Mixed Hearing Loss
Occurs when the outer or middle ear is not functioning optimally. Sound is unable to reach cochlea optimally. This type of loss can typically be corrected medically. Causes can include cerumen/debris blockage, outer ear infections, Eustachian tube dysfunction, perforated tympanic membrane, ossicular chain disarticulation, or atresia of the canal. Identified on the audiogram typically by an Air-Bone Gap. Occurs when there is damage to the inner ear/cochlea or neural pathways. This type of hearing loss can not medically corrected. Causes can include genetics, ototoxic medication, presbycusis, head trauma, noise exposure, and physical malformation of the structure(s). Occurs when a conductive hearing loss and a sensorineural hearing loss is present simultaneously.
30
Degrees of Hearing Loss
Audiometric thresholds or degree of hearing loss refers to the severity of the hearing loss. Percentages are given by some professionals that try to relate to a patient’s or caregiver’s curiosity. Typically percentages refer to degree of disability or compensation in which refers to monetary and/or benefit awards.
31
Degree of Hearing Loss Hearing Loss Range
(dB HL) Normal -10 to 15 Slight 16 to 25 Mild 26 to 40 Moderate 41 to 55 Moderately Severe 56 to 70 Severe 71 to 90 Profound 91+
32
Image from http://alphaonenow.com/userfiles/image/aud_audiogram.gif
34
Configuration of Hearing Loss
The configuration of a hearing loss is also the shape of the thresholds across the frequencies on the audiogram.
35
All thresholds are the same severity across the audiogram.
Flat Configuration All thresholds are the same severity across the audiogram. Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 Hearing Loss Vowels Consonants O
36
Sloping Configuration
Thresholds are increasing in severity across the audiogram. Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 Hearing Loss x O Vowels Consonants Hearing Threshold
37
Inverse Configuration
Thresholds are improving in severity across the audiogram. Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 x O Hearing Loss Vowels Consonants Hearing Threshold
38
Precipitous Configuration
Thresholds suddenly drop in severity. Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 x Hearing Loss O Vowels Consonants Hearing Threshold
39
Cookie Bite Configuration
Thresholds are best in the low and high frequencies. Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 x O Vowels Consonants Hearing Loss Hearing Threshold
40
Inverse Configuration
Thresholds are worse in the low and high pitched frequencies. Frequency (Hz) Intensity (dB HL) 20 40 60 80 100 120 x O Vowels Consonants Hearing Loss Hearing Threshold
41
Other Descriptors of Hearing Loss
Bilateral or Unilateral Symmetrical or Asymmetrical Progressive or Sudden Fluctuating or Stable
42
Speech Audiometry Instrumentation: Audiometer & Word Lists
Word Lists (W1, W2, W22, PBK50, WIPI, SPIN) are presented via headphones or sound-field by Monitored Live Voice or Recorded Speech Stimuli. may require masking Outcomes are measured in decibels or percentages depending on the type of test Purpose of testing is to identify the patient’s ability to detect/hear spoken words clearly. The goal is to identify the patient’s receptive communication abilities. Modifications can be made due to a patient’s ability to vocalize, vocabulary knowledge, cognition, and motor involvement and should be identified on the audiogram. Results also include validity (acceptable/questionable) and reliability (good/fair/poor).
43
Speech Awareness Threshold (SAT)
Also known as Speech Detection Threshold (SDT) SAT is the lowest level at which speech can be detected in quiet. This is typically a level that is below the level that one can understand speech. The test utilizes various stimuli such as numbers, body parts, spondees, or even a presentation of a pure tone that one would localize to illustrate detection. Results are reported in decibels (dB) and are typically 5dB to 10dB lower than the Speech Reception Threshold (SRT).
44
Speech Reception Threshold (SRT)
Speech stimuli (Spondees) is presented in quiet. The test identifies the lowest level at which speech can be heard and understood or how loud speech must be for the patient to hear and understand. The threshold is identified at a level when at least two different words (or 50% of the words) can be repeated correctly. Testing is typically conducted for each ear separately via headphones but may also be conducted in the sound-field. Results are reported in decibels (dB). Modifications can include the patient pointing to body parts or pictures or presentation via sound-field or bone oscillator.
45
Speech Discrimination Score (SDS)
The speech stimuli of an open set of 50 phonetically balanced monosyllabic words within connected speech (W22, Maryland CNC, NU #6) is presented suprathreshold (typically 40dB) in quiet via headphones or bone oscillator. SRT+40dB = presentation level Presentation Level may be varied by the clinician Presentation also uses a carrier phrase(i.e. “Say the word “day.”) Results are reported in percentages of words repeated correctly. Patients may repeat, write, or verbally spell responses for open set word lists Patients may point to pictures, retrieve items, or play “Simon Says” for closed set Scores can be used to determine: How clearly one hears speech when delivered under optimal settings, The site lesion along the auditory pathway, Candidacy for various aural (re)habilitation programs (hearing aids, cochlear implantation, surgical procedures, etc.
46
Speech In Noise Testing
There are various types of testing available that requires the speech stimuli to be presented in various levels of noise (narrow band noise, multi-talker, etc.) such as the Speech-Perception-In-Noise (SPIN). The test reduces the amount of speech sound redundancy. Noise is either presented to the test or non-test ear at various levels depending on the test being completed. Results are reported in the percent of words correct. Results are utilized to determine Maturation of the auditory pathway, Site of lesions along the auditory pathway, Candidacy for various aural (re)habilitation programs (hearing aids, cochlear implantation, surgical procedures, etc.
47
Functional Listening Evaluation (FLE)
Speech stimuli (typically Children's’ Nonsense Phrases or Common Children's’ Phrases) is presented in quiet and noise and while at varying presentation distances. Requires the use of a sound level meter to determine the speech-to- noise ratio. Results are reported in percent of words correct. The measures are used to illustrate the effects of noise, distance, and visual input in test conditions that can be correlated to real-life communication environments.
48
Other Speech Measures Most Comfortable Loudness Level (MCL)
Can be used as the presentation level utilized for Speech Discrimination testing rather than the +40dB Can be utilized to determine the limits of amplification Patient is instructed to signal when the speech stimuli is comfortably loud as the intensity is increased. Uncomfortable Loudness Level (UCL) or Threshold of Discomfort (TD) The level in which the loudness of speech becomes uncomfortably loud. This measure assists in determining maximum stimulus levels, establishing amplification settings, and a patient’s dynamic range. Patient is instructed to signal when the speech stimuli becomes uncomfortable loud as the intensity is increased slowly above the MCL. Dynamic Range (DR) The difference between a patient’s SRT and UCL Represents the limits of useful hearing that is used in aural (re)habilitation
49
Examples of Audiograms
66
Aural (Re)Habilitation
67
Digital Hearing Aids 10011 11011 00111 11100 11001 11000 Analog To
ADC Speaker (Receiver) Mic
68
FM Systems Personal Assistive Listening Devices/Systems
Phonak Focus, Roger TouchScreen Microphone, Roger Receivers, Table Mic & Pens, and TV Connector Soundfield Systems Phonak Roger Sound-Field System 0r Front Row Sound-field System
69
Questions? Dr. Nancy Gillispie (304) 784 – 2552
70
Thank You! Dr. Nancy Gillispie (304) 784 – 2552
71
References Katz, Jack. Handbook of Clinical Audiology. Baltimore, Maryland: Williams & Wilkins, 1994
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.