AUDIOMETRY
(Neurophysiology II: PIO 307)
Dr. M. T. Bekinbo
Department of Human Physiology
FBMS, FUO.
Outline
● Definition
● Basic Techniques
● Clinical Significance, etc.
Definitions
● Audiometry refers to a painless hearing test that measures the ability
to hear sounds at different:
A. pitches (frequencies) and
B. volumes (intensities)
In order to detect hearing loss.
The types (conductive, sensorineural, mixed), and severity, with results
plotted on a graph called an audiogram to guide diagnosis and treatment.
● Audiometry consists of tests of function of the hearing mechanism
which includes the tests of :
1. mechanical sound transmission (middle ear function),
2. neural sound transmission (cochlear function), and
3. speech discrimination ability (central integration) .
A complete evaluation of a patient's hearing must be done by trained personnel using
appropriate instruments designed specifically for this purpose .
Steps for Hearing Assessment
● After preliminary interactions with the patient/client, the
steps include the following:
1. Whispering test
● Position yourself approximately 60cm from the
patient’s ear and then whisper a number or word
● Mask the ear not being tested by rubbing the tragus, it
is far nicer to occlude the ear from behind the head.
● Ask the patient to repeat the number or word back to
you.
● Assess the other ear in the same way
2. Tuning fork tests
● 512Hz tuning fork is used as it gives the best balance between time of decay
and tactile vibration.
A. Weber’s test:
i. Tap a 512Hz tuning fork and place in the midline of the forehead.
ii. Ask the patient “Where do you hear the sound?”
Normal: sound is heard equally in both ears. Sensorineural deafness: sound is
heard louder on the side of the intact ear. Conductive deafness: sound is heard
louder on the side of the affected ear.
B. Rinne’s test:
i. Place a vibrating 512 Hz tuning fork in front of the external auditory meatus to
test air conduction.
ii. Place a vibrating 512 Hz tuning fork on the mastoid bone to test bone
conduction.
If air conduction is better than bone conduction, which is what would be
expected in a healthy individual or in sensorineural hearing loss it referred to as
a (Rinne’s positive). If bone conduction > air conduction (Rinne’s negative)
which seen in conductive deafness.
c. Absolute Bone Conduction (ABC) test
● The ABC compare the bone conduction of the patient with that
of the examiner (assuming he is normal).
3. Audiometry
This is a wide-ranging hearing test that measures an individual’s ability
to hear sounds at different pitches (frequencies) and intensities
(volumes) in order to detect, diagnose, and monitor hearing loss,
involving both pure-tone tests (beeps) and speech tests, all plotted on a
graph called an audiogram to show the degree and type of hearing
impairment.
a. Subjective Audiometric Tests: such as pure tone audiometry
(PTA), speech audiometry. In children: behavioral hearing tests,
visual response audiometry, and play audiometry
b. Objective Audiometric Tests: such as: Impedance audiometry:
tympanometry and acoustic reflex (AR), oto-acoustic emissions
(OAEs), brainstem evoked response audiometry (BERA).
● The audiometer is an electric instrument consisting of
a pure tone generator, a bone conduction oscillator for
measuring cochlear function, an attenuator for varying
loudness, a microphone for speech testing, and
earphones for air conduction testing.
● Other tests include impedance audiometry, which
measures the mobility and air pressure of the middle
ear system and middle ear (stapedial) reflexes, and
auditory brainstem response (ABR), which measures
neural transmission time from the cochlea through the
brainstem .
▪ An audiologist is a healthcare professional specializing in
hearing, balance, and related disorders, diagnosing issues like
hearing loss, tinnitus, and vertigo, and providing treatments
such as fitting hearing aids, implants, offering counseling, and
managing prevention programs for all ages, from infants to the
elderly.
▪ They use specialized technology, work with other medical
professionals, and often complete doctoral-level education
(Au.D.).
AUDIOMETRY TECHNIQUES:
Pure tone audiometric air conduction testing:
● This is performed by presenting a pure tone to the ear through
an earphone and measuring the lowest intensity in decibels
(dB) at which this tone is perceived 50% of the time.
● The testing procedure is repeated at specific frequencies from
250 to 8000 hertz (Hz, or cycles per sec ond) for each ear, and
the thresholds are recorded on a graph called an audiogram.
Bone conduction testing:
● This is done by placing an oscillator on the mastoid process
and measuring threshold at the same frequencies . Masking
noise is sometimes used in the non-test ear to prevent its
participation in the test.
● The audiogram is a graph depicting hearing thresholds in
decibels on the ordinate and frequency in hertz on the abscissa.
● Speech testing is the measurement of a patient's ability to
hear and understand speech.
● The speech reception thresh old (SRT) is the lowest
decibel level at which a patient can correctly repeat 50% of
test words.
● The speech threshold should be within ± 10 dB of the pure
tone average at frequencies of 500, 1000, and 2000 Hz .
● The speech discrimination score is obtained using
phonetically balanced, one-syllable words usually
presented at 25 to 40 dB above the hearing threshold
obtained from the pure-tone audiogram .
For auditory brainstem response (ABR) audiometry,
● Here, electrodes are placed on the patient's vertex, earlobes,
and forehead .
● Clicks are delivered through earphones, and a computer sums
the time-locked responses (potentials) for the first 10 msec
after sound stimulation .
● From these responses, a dis play of five characteristic waves
is generated at predictable latencies.
● This response must be reliably repeatable for an evaluation to
be made.
Basic Science and Clinical Significance
● Conductive hearing loss may be caused by obstruction of the external ear
canal (e.g., wax) or middle ear problems such as infection, tumor, fixation of
.the ossicles (otosclerosis), and congenital diseases.
● Many conductive losses can be managed medically or surgically.
● Sensorineural hearing loss (cochlear or eighth nerve damage) may be
caused by conditions such as maternal rubella, mumps, meningitis, noise
trauma, otologic effects of aging (presbycusis), ototoxic drugs, trauma.
● Meniere's disease, hyperlipidemia, hereditary syndromes, demyelinating
diseases, and tumors affecting the eighth nerve .
● A patient with sensorineural hearing loss is usually a candidate for a hearing
aid.
● Carefully performed audiometry can make an invaluable contribution to
diagnosis and management of patients with ear problems.