Muhammad Ahmed
Assistant Professor DRS
(FAHS)
MS-SLP (RIU)
BS-SLP (UHS)
Certified Audio verbal Therapist
Board Certified Aphasia Therapist
PURE TONE AUDIOMETRY
• It is a subjective test.
PURE TONE AUDIOMETRY
PURE TONE
A single frequency sound is called Pure
tone e.g. a sound of 250, 500, 1000Hz.
Audio means “to hear” & Metria means “to
measure”, now the definition of “PURE
TONE AUDIOMETRY”
PURE TONE AUDIOMETRY is a hearing
test in which we measure the hearing
threshold levels of an individual in decibels
for various pure tones from 125 to 8000Hz.
In PTA we find out the type & degree of
patient’s Hearing levels .
AUDIOGRAM
A graphic record produced by audiometry.
An audiogram shows a quietest sounds
you can just hear.
In audiogram, red circles shows right ear
& blue crosses shows left ear.
On the top of the graph there is frequency
range from left to right.
On the side of the graph there is intensity
range from top to bottom.
TERMS USED IN PTA
FREQUENCY:
Is the number of sounds per second.
It is measured in Hertz (Hz).
INTENSITY:
Is the strength of sound which determines
its loudness.
It is measured in decibels (dB).
AIR CONDUCTION:
When sound is given through the external
ear. e.g. headphones , insert ear phones.
BONE CONDUCTION:
When sound is given through mastoid
process. e.g. bone vibrator.
TYPES OF HEARING LOSS
CONDUCTIVE HEARING LOSS:
When there is problem in EAC, tympanic
membrane & in ossicles.
SENSINEURAL HEARING LOSS:
When there is problem in cochlea & in 8th
nerve.
MIXED HEARING LOSS:
When there is problem in external ear, middle
ear & in inner ear.
DEGREE’S OF HEARING LOSS
• -10 – 25 dB HL = Normal range
• 26 – 40 dB HL = Mild hearing loss
• 41 – 55 dB HL = Moderate
• 56 – 70 dB HL = Moderately Severe
• 71 – 90 dB HL= Severe
• Greater than 90 dB HL = Profound
AUDIOMETER
AUDIOMETER is an electronic device used
to measure hearing threshold level of an
individual.
It can measure Air-Conduction thresholds
between 125-8000Hz & Bone-Conduction
thresholds between 250-6000Hz.
Max intensity level for air conduction is
120dB &
Max intensity level for bone conduction is 50
dB.
COMPONENTS OF AUDIOMETER
Oscillator
Interrupter switch
Amplifier
Hearing level attenuator
Equalization circuit
Output power amplifier
OSCILLATOR
This generates pure tones
Frequencies generated include 125, 250, 500,
750, 1000, 1500, 2000, 3000, 4000, 6000, and
8000 Hz.
These sounds are electronically generated
INTERRUPTER SWITCH
It controls the duration of signal
presented to the patient
Amplifier
It increase the intensity of signals
EQUALIZATION CIRCUIT
This contains resistors which help in
equalization of sound generated
Human ear is highly sensitive to 2khz
frequency
OUTPUT POWER AMPLIFIER
Signals produced by oscillator needs to
be amplified
This amplifier produces very little
distortion
It has a good signal to noise ratio
HEARING LEVEL ATTENUATOR
It controls the level of signal from the
audiometer within 110-120 dB
The intensity can be varied in steps of 5
dB
INSTRUMENTS USED IN AUDIOMETER
There are some instruments that is used in
audiometry.
They are as following:
HEADPHONES
INSERT EAR PHONES
BONE VIBRATOR
LOUD SPEAKERS
HEADPHONES:
Used for air conduction. Placed properly
on the opening of the EAC & sound is
presented to patient through it.
INSERT EAR PHONES:
Also used for air conduction. In this, there
is probe which is inserted into the ear canal. It
is used if there is a problem in sound
presented to patient by headphones.
BONE VIBRATOR:
Used for bone conduction. Placed on the
mastoid process & gives direct signal to cochlea.
LOUD SPEAKERS:
In this sound is presented to patient through loud
speakers in a sound proof or noise free room from
various directions.
THE LEGENDS
HUGHSON – WESTLAKE TECHNIQUE
Up 5 and down 10 method.
Tones of short duration is used(1-3 seconds).
Better ear is tested first to decided whether
masking is necessary.
Started at 1000 Hz at a level above threshold.
In pts with profound hearing loss the test
should be started with 250 Hz because
these patients have residual hearing only
in low frequencies.
On positive response the volume is decreased
by 10 dB. If the pt responds it is decreased by
10 dB and repeated till he does not respond
On no response the intensity is increased by 5
dB till the pt confirms hearing the tone
This should be repeated till the pt gives
positive response in two out of three
attempts at the same dB level
Tone presented should last between 1-3
seconds
Why we start PTA from 1kHz ?
1 kHz: Standard Starting Frequency in Pure
Tone Audiometry
Optimal sensitivity range for human hearing
Familiar frequency for easy patient response
Less impacted by ambient noise (minimal
masking)
Standardized for consistency in testing and
comparison
MEASURING A THRESHOLD
First the tone is presented to patient of 40dB at
1000Hz.
If no response occurs, the tone is increased to
60dB at same Hz.
If response occurs, then 10dB is decreased.
Now the tone is 50dB. If no response occurs ,
add 5dB in it. Now the tone is 55dB. This is
the threshold of a patient.
THRESHOLD:
The lowest level at which the patient
can correctly identify the tone
presentation at least 50% of the time,
with a minimum of 3 responses at a
given level.