The most commonly used test for evaluating auditory sensitivity among people of almost all-ages is pure tone audiometry. This method has been proven to be reliable in measuring hearing, especially in adults. While pure tone audiometry can be used in very young children and in adults, it is unreliable when used to test children or adults who may not understand instructions.
Regulations and standards that cover the use of audiometers exist globally. While some differ, most, if not all, require that the equipment is calibrated and maintained regularly and records are kept for auditing.
Despite overwhelming evidence in support of extended high-frequency testing, many clinicians remain limited to conventional tonal audiometry (125 - 8000 Hz). Normal hearing in the extended high-frequency range is what enables us to hear conversation in loud environments. Without it, communication in these environments becomes very troublesome.
Ensuring accurate and reliable results isn’t always a walk in the park and we all know that the quality of your test results has a direct impact on diagnosis, management and patient outcomes. It’s a multifaceted concept that requires participation from both the patient and the health care practitioner. Tools and methods that help increase your test results fidelity are worth looking into.
You may be an audiologist considering providing screening services to bring more patients into your practice. You may be a doctor interested in adding hearing testing to your service, or branching out into occupational health. Whichever the case, a common consideration is options that either screening or diagnostic options may offer. In order to make the right decision it is important to know the difference between the two.
At first glance, this title may seem like a redundant statement, but, in reality, these are vastly different concepts and the sooner we address them the better. Let us first remind ourselves of what a soundbooth is actually for.
There is little consensus among standards for sound booths globally, there are also many countries where standards don't exist and where they do, they can differ from state to state and may never actually be enforced at all. With that said, there is one overarching concept that I am sure we can all agree on.
Tinnitus can make it difficult for a patient to distinguish between test tones (pure tones) being presented and those generated by their tinnitus. As a result false-positive responses will occur. In effect, the tones presented are masked when the tinnitus is of the same pitch but of a higher intensity than the presented tone. As an unfortunate result, a patient may be misdiagnosed and mismanaged.
Over the years, there's been an increase in the use of insert earphones (IE) in audiometry. Although previously supra-aural headphones were part of standard practice, insert earphones perform the same function. Furthermore, various clinical studies have shown that both transducers yield thresholds within 5dB of each other, validating the use of IE. Inserts are simply a foam earplug with tubing that carries the test signal into the ear.
“Millions saw the apple fall, but Newton asked why.’’ - Bernard Baruch. As clinicians, we often follow the same protocols and procedures we learned in university. These procedures become a habit, we are so used to them that we don’t even think about them anymore. It’s just the way we do it, the way we have always done it.
This reminds me of a story a colleague shared with me a while ago.
Every clinician has experienced a patient feigning illness and the field of audiology is no exception. Whether physical or psychological, it only takes one telenovela style impersonation of a factitious disorder to see why many get caught out.
"Fakers" usually don't have a complete grasp of the illness or disability they are trying to mimic and end up giving themselves away all too easily. But, there are the rare few who are a lot more convincing which is where science steps in.
Most clinicians break out in a cold sweat when it comes to masking in audiology. “Am I doing this correctly, is it effective?”. Take a deep breath and look no further.
To understand it, we must first understand the science and reasoning behind masking in audiology. We must also cover some of the related concepts such as interaural attenuation (IA) and the occlusion effect (OE). You may already know these terms, but let’s see if we can shed a little light on how they all work together.
Just over 70 years ago, Georg von Békésy’s experiments laid the foundation for bone conduction (BC) testing. Over 50 years ago, Raymond Carhart researched and wrote about the clinical applications of BC assessment. Ever since the earliest testing using tuning forks, the assessment of bone-conducted hearing sensitivity has been an essential part of audiological assessments and remains so today.
You just performed a pure tone audiometry test and your audiogram is in front of you - what now
Now, its time to
understand how to read an audiogram.
Audiometry is a key tool in uncovering, preventing or treating hearing loss . Let's get back to basics with an indepth look at the audiogram, audiogram examples and some more information on how to read the results of a hearing test.