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HSL 834: Diagnostic Audiology (4 credits)


Fall Semester 2015
Course Syllabus

Class Schedule: Monday & Wednesday, 4:00-5:50 pm Room #: SLCC 2301


Instructor: Larry Medwetsky, Ph.D.
Office Location: SLCC 2220
Office Hours: Walk-in or apt.
Telephone: (202) 448.6965
Fax: (202) 651-5324
E-mail: larry.medwetsky@gallaudet.edu

Course Description
This course examines the principles of audiologic evaluation, including consideration of pure-tone and
speech audiometry, clinical masking, acoustic immittance battery, calibration and standards, behavioral
site-of-lesion testing, Otoacoustic Emissions, and various pathologies that affect auditory-vestibular
systems.

Prerequisite: Open to HSLS majors only, or permission of the instructor or department chair.
Co-requisites: HSL815, HSL817, HSL840

Student Learning Outcomes for the AuD Program*


Graduates of the AuD Program should be able to:
1. Communicate in a professional, culturally sensitive, and effective manner; via spoken, written,
and sign languages; in advocacy, consultation, education, and administration.
2. Plan, perform, and evaluate programs for prevention and identification of auditory and vestibular
disorders
3. Plan, perform, and evaluate assessment of individuals with suspected disorders of auditory,
balance, communication, and related systems.
4. Plan, perform, and evaluate intervention of individuals with suspected disorders of auditory,
balance, communication, and related systems.
5. Conduct clinically relevant research to support evidence-based audiological practice, including
evaluation and interpretation of the current literature and planning and executing a hypothesis-
driven study.

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Course Student Learning Outcomes

Upon successful completion of this course, students will be able to:

OUTCOME CORRESPONDING LEARNING ASSESSMENT


PROGRAM SLO* OPPORTUNITIES METHODS
1. Select, describe, and Lectures & Class - Exams
provide rationale for use Discussions - Case Presentation
of appropriate diagnostic 2, 3 Rubric
Case-based problem
procedures given case - Assignments
solving exercises
history and presenting
symptoms. Case presentations
2. Accurately interpret Lectures & Class - Exams
diagnostic test results and 1, 3, 4 Discussions - Case Presentation
state recommendations. Rubric
Case-based problem
- Assignments
solving exercises
Case presentations
3. Search, locate, and
retrieve text chapters and - Case Presentation
scientific journal articles 3, 4 Case presentations Rubric
that are relevant in
audiologic diagnoses.

This course meets the 2012 ASHA Standards and Implementation Procedures for the Certificate of
Clinical Competence in Audiology as listed below:

Standard IV-A: Foundations of Practice - knowledge of:


A9. Patient characteristics (e.g., age, demographics, cultural and linguistic diversity,
medical history and status, cognitive status, and physical and sensory abilities) and
how they relate to clinical services
A10. Pathologies related to hearing and balance and their medical diagnosis and
treatment
A11. Principles, methods, and applications of psychometrics
A13. Instrumentation and bioelectrical hazards
A14. Physical characteristics and measurement of electric and other nonacoustic stimuli
A23. Principles, methods, and applications of acoustics (e.g., basic parameters of sound,
principles of acoustics as related to speech sounds, sound/noise measurement and analysis,
and calibration of audiometric equipment), as applicable to:

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a. occupational and industrial environments


b. community noise
c. classroom and other educational environments
d. workplace environments

A29. Consultation with professionals in related and/or allied service areas

Standards IV-B: Prevention and Identification:


B1. Implement activities that prevent and identify dysfunction in hearing and communication,
balance, and other auditory-related systems

Standard IV-C: Assessment:


C2. Assessing individuals with suspected disorders of hearing, communication, balance, and
related systems
C3. Evaluating information from appropriate sources and obtaining a case history to facilitate
assessment planning
C4. Performing otoscopy for appropriate audiological assessment/management decisions,
determining the need for cerumen removal, and providing a basis for medical referral
C5. Conducting and interpreting behavioral and/or electrophysiologic methods to assess hearing
thresholds and auditory neural function
C7. Conducting and interpreting otoacoustic emissions and acoustic immittance (reflexes)
C10. Preparing a report, including interpreting data, summarizing findings, generating
recommendations, and developing an audiologic treatment/management plan
C11. Referring to other professions, agencies, and/or consumer organizations
Standards IV D: Intervention (Treatment):
D1. The provision of intervention services (treatment) to individuals with hearing loss, balance
disorders, and other auditory dysfunction that compromises receptive and expressive
communication
D2. Development of a culturally appropriate, audiologic rehabilitative management plan that
includes, when appropriate, the following:

b. Determination of candidacy of persons with hearing loss for cochlear implants and other
implantable sensory devices and provision of fitting, mapping, and audiologic
rehabilitation to optimize device use

c. Counseling relating to psychosocial aspects of hearing loss and other auditory dysfunction,
and processes to enhance communication competence

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University Policies: All may be found in the Graduate Catalog or the following link:
http://www.gallaudet.edu/Documents/Grad/Gallaudet-Graduate-Catalog-2012-2013.pdf

A. Academic Integrity
Academic Integrity Policy can be found in the current Graduate Catalog, and is also posted on Blackboard
under Syllabus. It can also be found at http://aaweb.gallaudet.edu/graduate-catalog.xml (Page 27). All
allegations regarding violations of the Universitys Policy on Academic Integrity will be investigated and
treated with utmost seriousness. Please read the Gallaudet University Policy on Academic Integrity, as you
will be responsible for its content. If you are unsure as to any part of the Policy, please discuss it with the
instructor or your academic advisor. Please familiarize yourself with the concept of due process. Violations
of the Academic Integrity Policy (e.g., cheating, plagiarism, abuse of computers) will result in a failing grade
for the course (i.e., grade of XF on transcript), and/or expulsion from the University.

B. Standards of Professional Behavior and Communication


Knowledge of the theories and methodologies of a profession and their application to professional
practice are major components of graduate study. In addition to academic accomplishments, which are
evidenced in a student's grades, graduate students must also demonstrate behavior and communication
skills that are consistent with professional standards. The principal elements of professional behavior
vary by discipline, but include tact; sensitivity to the needs and interests of clients, colleagues, and
supervisors; good judgment; and attention to professional responsibilities. Moreover, student conduct
must conform to the codes of ethics established by the particular professional associations that certify
practitioners and govern their professional behavior. The principal elements of required communication
skills include, but are not limited to written, oral, and signed communication.

Adherence to these professional standards of behavior and communication are essential elements of
professional competence. Failure to meet these standards reflects adversely upon the individual's
suitability for professional service and may be grounds for dismissal from the Graduate School.

C. Students with Disabilities


Students needing accommodations to succeed in class or clinic must formally request them through the
Office for Students with Disabilities (OSWD) at the beginning of the semester or as soon as the
disability is documented. Detailed information is available in the Graduate Catalog or the above link.

D. Compliance with ADA


Gallaudet University is in compliance with the Americans with Disabilities Act and this statement can
be found in the Graduate Catalog or the above link.

E. Compliance with Title IX

In compliance with Title IX, Gallaudet University prohibits discrimination in employment as well as in
all programs and activities on the basis of sex. The Title IX Coordinator monitors compliance with the
regulations of this law. Individuals with questions or concerns about Title IX, and/or those who wish to
file a complaint of non-compliance, may contact the University's Title IX Coordinator.

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Course Policies:

Attendance Policy:
On time or early attendance is expected at every scheduled class. Students may have two excused
absences during the semester. Excused indicates that arrangements were made BEFORE the scheduled
class start time. In addition, recurrent late arrivals or early departures will result in a drop of your
assignment grade.

Cellphone Usage:
Email and voice mail messages are acceptable in the case of illness or accident, but constant
texting/cell-phone usage or time devoted to social media is highly discouraged during class.

Computer Usage:
Computers can be used for note-taking and googling information related to course discussion but shall
not be used for other purposes- such as social media or YouTube.

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Grading
A. Weighting System
Final course grades will be based on a calculation of percentage correct out of a potential
100%. The following grade scale and weighting systems will be used in determining final
course grades

Exams (50%)
Mini-Quizzes- Readings (10%)
Lab Assignments (30%)
Case Presentation (5%)
Critical Thinking Assignment (5%)

Exams (50% of the grade) There will be two exams, Midterm (25%) and Final (25%). Final exam
is cumulative of material learned throughout the semester. The knowledge and skills examined include
the materials covered in class, lab and other exercises, and your readings. Your ability to synthesize
information from various sources will also be assessed. Study guides will not be provided; however,
you may refer to the unit objectives.

Mini-Quizzes (10% of the grade)- Readings are assigned prior to each class. To ensure that students
have read material prior to class, mini-quizzes consisting of a few questions will be administered prior
to the first class for that week. Each mini-quiz will be administered during the first 10-15 minutes of
class, except for the first week of the course when no mini-quizzes will be administered
(See Appendix A).

Assignments (30% of the grade) Several lab and case-based exercises will be assigned to reinforce
concepts covered in class or readings. (See Appendices B & C) All written assignments must
conform to the APA style, 6th ed. Late submissions will generally not be accepted unless it is
professor granted extension.

Case Presentation (5% of the grade) Students will be paired and present on a case, chosen from a
number of possible pathologies. Presentations are between 30 and 40 minutes (See Appendix C).

Problem-Based, Critical Thinking Assignment (5% of the grade)- Students will be paired up and
asked to answer questions based on three different cases (See Appendix D).

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Computation of Final Grade


Letter Grade Numerical Equivalent Quality Point Value Descriptor
A+ 97 100 4.0 Exemplary
A 94 96 4.0 Outstanding
A- 90 93 3.7 Commendable
B+ 87 89 3.3 Exceeds Course requirements
B 84 86 3.0 Satisfactory achievement
B- 80 83 2.7 Marginal satisfactory achievement
C+ 77 79 2.3 Unsatisfactory achievement
C 70 76 2.0 Unsatisfactory achievement
F Below 70 0.0 Failure

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CLASS SCHEDULE (SUBJECT TO CHANGE)
The schedule may change due to university closure, instructor decision, or student request. Any
changes to this schedule will be documented in writing by the instructor and will be posted to the
class site on Blackboard as well as announcements via email.

Readings will be added to the list throughout the semester. For the updated list of readings, see
Blackboard under Readings. Assignments are due Sunday night unless otherwise indicated.

WEEK DATE TOPIC READING & ASSIGNMENTS DUE OUT OF CLASS TIME
Introductions Katz-Chapter 1 Chapter Readings =
Scope of Practice 0.5 hours
Bb:
History/Overview of
Lubinski-Chapter 1 (5-7, 15-22, Bb readings = 3.0
Audiology
1 8/31 24-31)
Code of Ethics hours
Stach- Chapter 1
ASHA Code of Ethics

No class September 7 (Labor Instrumentation Chapter Readings =


Day) Gelfand- Chapter 4 4.0 hours
Hz & dB; Equipment &
Calibration Katz- Katz: Chapter 2 (9-20; 26)- Bb readings: 1.0 hour
skip multimeter, frequency
Otoscopy and Visual
counter/check, harmonic
Inspection
distortion, rise/fall time) and
2 9/7 monitoring meter
Katz: Chapter 3 (32-35)

Otoscopy
Gelfand- Chapter 2 (38-40)
Bb: reference sites for visual
inspection and otoscopy
Tuning Fork Tests Chapter Readings =
5.0 hours
Martin and Clark (21-25)
Gelfand (151-154) Bb readings: 1.0 hour
Tuning Fork tests
Pure Tone Audiometry Pure-Tone Audiometry
3 9/14 Air and Bone Bb: Medwetsky (Fundamentals
Audiogram of the Audiogram)
Interpretation- part 1
Martin & Clark (Chapter 4)
Gelfand- Chapter 5 (127- 150)
Katz- Chapter 4 (50-57)

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Audiogram Interpretation Chapter Readings = 1
No class September 23 Bb: Kramer & Guthrie hour
(Yom Kippur) Audiogram Interpretation- selected
exercises Bb readings = 4.0
hours
Audiogram Cross Hearing
Interpretation- contd Martin & Clark (131-132) Lab/Report = 6 hours
Cross Hearing/Interaural
Attenuation Gelfand-Chapter 9 (274-278)
Overview of Report
4 9/21 Format Bb: DeRuiter & Ramachandran
Chapter- 13 (97-107)

Bb: Two articles on Interaural


Attenuation (1) Blackwell et al.;
(2) Monro and Agnew

Due 9/27: Ascending vs.


Descending Methods
Assignment
Masking Readings = 7 hours
Martin & Clark (Chapter 6- 130-
145) Lab/Report = 6 hours

Gelfand: Chapter- 9 (279-297)


Masking for PT testing

Speech Audiometry: Speech Audiometry


5 9/28 - Threshold Testing Bb: Medwetsky (Audiometric Test
- Word Recognition Procedures 101)
Testing
- PIPB Functions Katz: Chapter 5
Gelfand: Chapter 8

October 4: Crossover and Cross


Hearing Assignment

Speech Audiometry- Speech Masking Chapter Readings =


contd: Martin & Clark Chapter 6 (145- 2.5 hours
Speech Masking 151)
Additional tests: Bb articles = 2 hours
- Phonetic Feature/ Gelfand: Chapter- 9 (pages 298-
6 10/05
Phoneme tests 299)
- MTS
Bb: Articles (Boothroyd, 1984;
Erber & Alencewicz, 1976: page
258)

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Mid-Term Exam Study
= @ 10 hours
Speech Audiometry
7a 10/12 contd
Review

Midterm Exam
7b 10/14
Tympanometry Chapter Readings =
1.5 hours
Bb: Hunter & Shahnaz Chapter- 4
Immittance Measures Bb chapter = 2.0 hours
8 10/19 Tympanometry Gelfand Chapter-7 (205-222)
Immittance Measures Lab/Report = 6.0 hours
Advanced Due 10/25: PIPB Functions
Multi-Frequency Chapter Readings =
Tympanometry 4.0 hours
Bb: Hunter: Chapter 5
Bb chapter = 3.0 hours
Katz: Chapter- 9 (148-161)
Immittance Measures
Advanced (contd)
Acoustic Reflexes Acoustic Reflexes
9 10/26 Bb: Hunter & Shahnaz:
Chapter 6

Katz: Chapter- 10

Non-Organic Hearing Loss Chapter readings =


Katz: Chapter 33 4.5 hours

Nonorganic Hearing Loss


Otoacoustic Emissions Otoacoustic Emissions Lab/Report = 7 hours
Bb: Kramer (pages 255-260)

Katz : Chapter- 19
10 11/2

Due 10/31: Comprehensive


Acoustic Immittance Test
Battery

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Bb Readings = 2.5
Other excellent diagnostic Bb: Moore article on TEN test hours
tools:
TEN tests Bb: (1) Overview of Quick SIN,
Quick SIN (2) Speech-in-Noise tests (Taylor); Lab/Report = 6 hours
11 11/9 (3) HINT Overview (4) HINT
HINT/CID
(Soli & Wong); (5) CID Everyday
CID Everyday Sentences test (Sims)
Sentences Test

Case History Katz: Chapter- 7 Chapter Reading = 2


hours
Case Study Presentation, Bb: Cohn and Chabon: Making the
and Case-Based Problem Case for Case-Based Learning Bb Reading = 1 hour
12 11/16
Solving Exercises
Due 11/16: Otoacoustic Case Presentation Prep:
Emissions Assignment - 6 hours reading
8 hours PP prep
Thanksgiving Break
14 11/23 No class

No class 11/30 (Case


presentation prep)
15 11/30
Case Presentations (12/2)

Case presentations- contd


16 12/7

12/14 Review Due: 12/13: Critical Thinking


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Assignment
Study = 10 hours
Finals 12/16 Final Exam

Total Student Contact Time: Total Outside


54 hours Assignments # = 116.5
hours

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Required Texts Suggested Texts


1. Katz, J., Chasin M., English K., Hood, L., 1. Publication Manual of the American
Tillery K. (2014). Handbook of Clinical Psychological Association, 6 th ed. ISBN:
Audiology, 7th ed. Baltimore, MD: 978-1-4338-0561-5
Lippincott, Williams& Wilkins. ISBN: 978-
1451191639 2. Mastering APA Style: Students Workbook
and Training Guide. ISBN: 978-1-4338-
2. Gelfand, S. (2009). Essentials of Audiology, 0557-8
3rd ed. NY, NY: Thieme. ISBN: 978-1-
60406-044-7. 3. Hunter, L.I., Shahnaz, N. (2014). Acoustic
Immittance Measures: Basic and Advanced
Practice. San Diego, CA: Plural
3. Martin, F.N., Clark, J.G. (2012). Introduction Publishing. ISBN: 978-1-59756-437-3
to Audiology. Upper Saddle, NJ: Allyn &
Bacon, pp 21-25. ISBN: 978-0132108218

Additional Readings:
In addition to chapters in texts, there will be additional required readings that will supplement
class lectures (see References); these readings will be made available on Blackboard.
The student is responsible for reading all required materials in preparation for class, with mini-
quizzes to examine understanding of read material to be administered at the start of each class.

References
Blackwell, K.L., Oyler, R.F., Seyfried, D.N. (1991). A clinical comparison of Grason Stadler insert
earphones and TDH-50P standard earphones. Ear and Hearing, 12(5): 361-362.
Boothroyd, A.
DeRuiter, M., Ramachandran, V. (2010). Basic Audiometry Learning Manual. San Diego, CA: Plural
Publishing.
Erber, N.P., Alencewicz, C.M. (1976). Audiologic evaluation of deaf children. Journal of Speech and
Hearing Disorders, (41): 256-267.
Kramer, S., Guthrie, L.A. (2014). Audiology Workbook, 2nd ed. San Diego, CA: Plural Publishing.
Lubinski, R., Golper, L.C., Fratalli, C.M. (2007). Professional Issues in Speech-Language Pathology
and Audiology, 3rd ed. Clifton Park, NJ Delmar/Cengage Learning, Chapter 1.

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Medwetsky, L. (2014). Understanding the Fundamental of the Audiogram...So What? Hearing Loss
Magazine, July/August: 36-41.
Medwetsky, L. (2014). Audiometric Test Procedures 101. Hearing Loss Magazine,
September/October: 16-19.
Moore, B.C.J. (2010). Testing for Cochlear Dead Regions: Audiometer Implementation of the TEN
(HL) Test. Hearing Review. http://www.hearingreview.com/practice-management/16935-
testing-for-cochlear-dead-regions-audiometer-implementation-of-the-tenhl-test
Munro, K.J., Agnew, N. (1999). A comparison of interaural attenuation with the Etymotic insert ER-
3A earphone and the Telephonics TDH-39 supra-aural headphone. British Journal of
Audiology, 33: 259-262.
Sims, D.G. (1975). The validation of the CID Everyday Sentences Test for use with thee severely
hearing impaired. www.audrehab.org/jara/1975/Sims,%20%20JARA,%20%201975.pdf
Shabon, S.S., Cohn, E.R. (2011). The Communication Disorders Casebook: Learning by Example.
Upper Saddle, NJ: Allyn & Bacon, pp 1-5.
Stach, B.A. (2009) Clinical Audiology: An Introduction, 2 nd ed. Clifton Park, NJ: Delmar/Cengage
Learning, Chapter 1.

Also Utilized:
Access to Otis, a virtual patient computer software, is available in the HSLS computer lab.

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APPENDIX A: ONSITE CLASS QUIZZES

Value = 10%

On-site, mini-quizzes will be administered at the onset of the first class of that particular week for
which the readings have been assigned. These quizzes will be approximately 10 minutes in duration
though if more time is needed, this will be provided. Quiz questions may take the format of multiple-
choice, fill in the blanks, true/false, logical or ordering of choices.

The goal of these quizzes is to prepare you prior to class presentation so that you will be better
prepared to (a) follow the presentation; (b) be an active participant- be it in class discussions or posing
questions based on the material that you have read/been presented, and (c) make it easier to ultimately
retain the information that you have learned in class.

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Appendix B. Overview of Lab Assignments/Reports.

Value = 30%

Labs # B1-B3 are each worth 5% toward your final lab grade, while Labs #B4 and #
B5 are worth 7.5% each toward your final lab grade.

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Overview of Lab Report/Assignment for Labs #B1 to #B3.

OVERALL OUTLINE
Cover Page: - Lab Title & Student Name
Introduction:
- Define the particular clinical aspect that will be examined and question(s) to be
answered during this lab
- Provide background evidence-based information from the literature that pertains
to this topic and provide citations
Hypothesis:
- Based on your review of the literature and assignment task, what do you expect
your results to reveal and why?- use citations as appropriate
Methods:
- Rationale for your Methods (use citations as appropriate)
- Equipment used, techniques(s) deployed, # and type of subjects, etc.
Results:
- What did you find?
- Summarize your main findings (such as group means) in either tables and/or
figures, or use EXCEL spreadsheets, whichever you feel can best describe the
results. Use APA format for Table/Figure headers
- Submit the raw data in the form of figures/tables in your appendix (please see
the Appendix section)
Discussion &
Conclusion(s):
- What are the implications of your findings?
- In the conclusion, indicate if your results confirmed your hypothesis or did they
reveal different findings? If different, what do you think may explain what may
account for this?
References:
- Any references cited in your report are noted in the References section which
follows the Discussion & Conclusion section. Please use APA format (e.g., cite
chapter authors and the text their chapter is found). Please follow APA format.

Appendices: - Appendices appear as the last component of any report, project, dissertation or
article. This is where you provide the raw data that you obtained in conducting
the experiment (please identify by labels for whom the data was obtained but no
identifying information).

Cite your sources in APA style. Also, write in an organized fashion with well-
constructed sentences using APA format, as these Lab Plans will ultimately lead you
to be better prepared when you must present papers on future assignments.

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Overview of Grading Criteria (Rubric) for Lab Assignments

The following provides the scoring rubric for Labs #B1 - # B3. Labs #B4 and #B5 have separate
scoring rubrics, which are identified when each of the latter labs are described.

Scoring Rubric: Labs #B1 - #B3


Each lab is based on a total of 30 points, which are described in detail below:
Lab Planning/Design (maximum of 10 points)
Lab Reflections (maximum of 10 points)
Data Collection (maximum of 5 points)
Written Expression- Organization, Clarity, Grammar/Spelling, Professional Language
(maximum of 5 points)

** Please see next page for the grid that delineates the scoring rubric.

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Category Superior Satisfactory Poor


(9.5 -10 points) (8.5 9.4 points) (7.0-8.4 points)
Lab Planning - In addition to all aspects - Background - Background has
(Introduction, covered under information helps many gaps and is
Hypothesis, Satisfactory, Lab reader understand the hard to follow; major
Method) Planning also topic/concepts that concepts not clearly
demonstrates your ability underlie the particular delineated; no
- 10 points to see the interactions of clinical issue the lab citations included
various elements (topic assignment examines - Hypothesis either
matter, equipment, (citations also omitted or not
environmental factors) and provided) logically flow from
how they can affect the - Hypothesis that literature research
outcome logically ensues from - Details regarding
your literature research methodology
and indicates results unclear/not
you expect to find described
- Plan demonstrates - Procedure
organized approach to administered does
methodology (e.g., not link clearly to
subjects, equipment) assignment/not
described
- Procedure that was
conducted provides
answer(s) to the lab
questions
Lab In addition to all aspects - Overall results (Tables, - Results not
Reflections covered under Figures) presented/ displayed or poorly
(Results, Satisfactory, discussed and raw data conveyed/displayed
Discussion/ - Thorough analyses of indicated in the - Results section does
Conclusions, results appendix not adequately
Appendices) - Absence of any - Described how the address questions
conceptual errors relative results answer the lab posed in the lab
to interpretation of results question(s) posed assignment
- 10 points
- Insightful ideas (such as - Addressed how results - Conclusions are
implications of the support whether poorly highlighted
findings for the clinic hypothesis was correct or no actual
setting) or not, and, if not, why conclusions
- Provision of evidence that regarding
support your conclusions assignment
(i.e., citations from the mentioned
book or articles) - No relationship
between results and
** Note a long reflection hypothesis
does not mean it is discussed or, if so,
superior. You should be discussed in
able to write up a lab confusing fashion
reflection in 1-2 pages.

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Data - Data are logically - All relevant data - Some relevant data
Collection organized and the collected and recorded, missing
results can be though their
interpreted easily representation is not
- 5 points effectively
organized/displayed
Written - Excellent organization - Fairly good - Poor organization;
Expression with answers being well organization; answers not very
formulated; - Answers are mostly clear;
- Answers are clearly clear though there are - Numerous
- 5 points articulated and well some inaccuracies in grammatical/
explained; choice of words and spelling errors;
- Minimal grammatical or some information - Language not
spelling errors; requiring speculation; appropriate for
- Language used is - Some grammatical/ professional
appropriate for spelling errors but does discourse
professional discourse not interfere with the
readability of the
paper;
- Some colloquial and/or
informal expressions
are used but largely
appropriate for
professional discourse

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LAB ASSIGNMENTS

Lab Assignment #B1: Ascending/Descending Lab Assignment


Goal of Assignment: To (a) practice Descending and Ascending techniques for seeking pure-tone
thresholds and (b) determine if one obtains different thresholds via the two techniques/equally
efficient.

Assignment Specifics: To seek thresholds for any three frequencies in the range of 250 -8,000 Hz in
either the right or left ear in two different individuals using the ascending and descending techniques.
On an EXCEL spreadsheet indicate the (a) Client #; (b) Ear chosen; (c) Air or Bone conduction;
(d) Procedure (descending/ascending) chosen, (e) Frequencies presented and (f) Levels presented and
the listeners response at each level (- heard) or (- missed) both from Insert Wingding fonts .

For the purpose of this lab, in the Descending approach commence testing at 30 dB HL. For the
Ascending approach commence at -10 dB HL.

Questions You Should Be Thinking About as You Approach this Lab:


1. How is the audibility of pure tones (i.e., thresholds) different when using an ascending method
versus descending method?
2. What did you do to ensure that there was no learning effect? Describe this in the Method Section.
3. Was one approach more efficient than the other; that is, did using one apporach result in less runs
on average than the other approach?
4. If you assessed only normal hearing individuals, what do you think would have happened had
you used the approaches as outlined in this lab if you had assessed an individual with a hearing
loss?? Would one approach result in less runs for an individual with hearing loss than the
other??
5. Based on the literature and your findings, which method (if any) do you feel should be used in
the clinic setting to evaluate most clients? Note that your conclusions could vary if you were to
test a normal hearing individual versus an individual who has a hearing loss (refer to
question # 4).

Before conducting the experiment, use the Lab Planning/Reporting document to guide your
thought process prior to commencing the lab.

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Lab Assignment #B2. Cross Over and Cross Hearing (Overmasking)
In this lab, you are asked to answer the following questions:
1. In persons with relatively normal hearing, how much noise results in over-masking, and, in turn,
the inter-aural attenuation level?
2. How are the over masking levels different if you used headphones vs. inserts?
3. Were the over masking-levels different if you tested using 250 Hz vs. 3k Hz?

Methodology
1. Three students will collaborate in this assignment (each student will test the other two students).
Please confirm that all of you participating in this project have normal hearing acuity. If your
group includes someone with hearing loss, then seek a third individual to serve as a second
subject.

2. You will assess each of your two colleagues by presenting 250 Hz and 3,000 Hz tones to one ear
via (i) supra-aural as well as (ii) insert phones.

3. Determine the threshold level at each frequency for each transducer.

4. Once thresholds have been obtained, present narrow band (NB) noise to the contralateral ear. The
initial noise level will commence at 10 dB above the threshold obtained in the test ear. For each
increase in noise level (increase in 5 dB steps), reassess if the subject can still hear the
presentation tone in the test ear. Continue to increase the noise level in the non-test ear until the
subject is no longer able to hear the tone in the test ear. Then decrease the noise once more (10
dB down steps) until the test tone once more is heard; then increase the noise once more (5 dB up
steps) until the subject no longer hears the tone. Do this until you have twice ascertained the same
noise level that just masks out the test tone.

Do this step for both 250 Hz and 3,000 Hz for both the supra-aural and insert phones for each of
your two subjects.

Results
1. For both the supra-aural and insert phone conditions for each of the two subjects you tested, in the
results section display a table that indicates (a) the thresholds for both subjects at 250 and 3K Hz,
(b) NB noise level at each frequency that results in overmasking, (c) specific noise level-threshold
differences (interaural attenuation) values.

Subject Earphone 250 Hz Noise Level Interaural 3K Hz Noise Level Interaural


# Type Threshold resulting in Attenuation Threshold resulting in Attenuation
Overmasking Value Overmasking Value
1

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2. In the appendix section, using either graphs or tables plot the raw data in (displaying each
presentation level and whether a response was obtained) for each subject for both earphones for
each of the two frequencies assessed.

3. Describe the patterns observed relative to group/individual findings as a function of frequency


assessed and transducer applied.

Discussion
Present your conclusions and implications of these findings. Relate these findings to the literature.

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Lab Assignment #B3: Performance Intensity Functions Assignment
1. Three students will collaborate in this assignment (if there is an individual with hearing loss in
your group, please seek a 3rd normal hearing individual to serve as a subject). You can use
either supra-aural or insert phones and choose an ear to present the speech stimuli.

1. Materials to be used: (a) 36 spondees used in our clinic and (b) 15 AB-Isophonemic Word
Lists (these 15 lists can be found in the Appendix B of the 1984 Boothroyd articles that are in
your references.

3. Spondees and AB- Isophonemic words will be presented via live voice with the goal of
ascertaining % correct as a function of dB presentation level. Only normal hearing individuals
(ears) will be used to obtain data in this study.

Spondees:
Prior to carrying out the actual lab, use the 36 spondees to create a total of six randomized, 10
item spondee lists (i.e., 10 spondees per list, total of six lists).

First, obtain the subjects SRT as you normally would do. Then prior to each presentation
level familiarize the subject to all of the spondees within each 10-item list. Commencing at
5 dB below the SRT, present 10 spondees and calculate # correct/10 and convert this to its
corresponding percentage. Increase in 5 dB steps and present 10 spondees at each level until
you get two ascending levels in a row where the subject gets all 10 spondees correct
(i.e., 100%).

For each dB presentation level, write down the corresponding percentage correct score. Then
plot the results on a graph (EXCEL is likely your easiest way to do so) for each of the three
subjects assessed and display this as a function of the starting level (i.e., the starting point for
each subject on the graph is each subjects SRT - 5 dB level; you can refer to this as 5 dB
SL, and then compare each subjects results relative to this level even though the actual dB HL
levels may vary between subjects) in the Appendix. Thus, the presentation percentages are at
the same corresponding sensation levels.

AB Isophonemic Word lists:


There are a total of 15 lists, each consisting of 10 words (30 phonemes). Commencing at 5 dB
below SRT, present each 10 item word list and derive:
i. % Word correct score
ii. % Total phoneme correct score
iii. % Initial consonant recognition score
iv. % Vowel recognition score
v. % Final consonant recognition score

Increase in 5 dB steps and present a new list each time. Continue to increase levels until you
get a word recognition score of at least 90 %.

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For each subject, write down both the % word correct score and the various % phoneme
recognition scores for each dB level. Then plot these results on a graph (EXCEL is likely your
easiest way to do so) for each of the three subjects assessed and show these figures in an
appendix. I would plot five separate graphs (WRS, Total PRS, Initial PRS, Vowel PRS, Final
PRS) and within each graph display the results for all three subjects as a function of their
SRT -5 level (thus, the presentation percentages are at the same corresponding sensation
levels).

To best do this exercise and avoid any learning of the lists, I am asking you to do the
following:

(a) Student #1 evaluates Student #2, while Student #3 is not in the room (note that if the
presenter has used 7 lists and the subject still has not achieved a 92% score, then the presenter
should do lists #1 and #2 again since the subject likely would have repeated very few, if any,
of the items correctly from those lists when presented at 5 dB below or at SRT); (2) Student #2
evaluates Student #3- using the same lists used when Student #2 was evaluated (follow the
same guidelines for when subject #2 was assessed); (3) Student # 3 can present the remaining
7 to 8 lists to Student #1 (i.e., lists not used in assessing subject #2 and # 3).

4. Average and plot the results in sensation level across all three subjects, commencing with the
percentage score at -5 dB sensation level (i.e., SRT -5 dB HL) and continuing to plot until a
plateau is reached.

Plot the mean results as a function of sensation dB level. You will create two graphs:
I. One graph will consist of (a) Mean % Spondee Recognition Score, (b) Mean % AB-word
recognition score, and (c) Mean % Phoneme Word recognition Score as a function of
sensation level.
II. A second graph will consist of the mean Initial Consonant, Vowel, and Final Consonant
Recognition AB scores as a function of sensation level.

Each of these two graphs are to be displayed in the Results section.

5. You will write each report individually, though obviously you will report on the same data
(but do not collaborate on how you will present the data). Using the APA lab format that you
have used in past assignments, present an:
Introduction to the topic- including what the research would suggest concerning the
slope of the PI functions for each of the different stimuli, what likely underlie these
differences, and, in turn, your hypothesis to what you expect to find
Indicate the methodology used to conduct this experiment
Go over the results, including tables/graphs that display the data (listed in the
appendix), as well as mean data (displayed in Results section) for each type of stimuli
In the discussion, summarize the findings, how they relate to your hypothesis, and the
implications of these findings for everyday clinical usage.

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Labs B4 and B5 overview.

Different grading rubrics are utilized for Labs # B4 and #B5 than for the earlier
assignments. Each lab is graded on a basis of 100 points (each lab has its own
scoring rubric) and a grading value of 7.5 % each.

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Lab Assignment B4: Acoustic Immittance Test Battery (point total =100 points)

This next assignment is somewhat different than the labs you have completed up to now. Rather than
it being an investigatory assignment, it is more of a practical experience in learning how to conduct a
full immittance test battery, and, the many ways it can assist the clinician. The value of this
assignment will be higher than the previous labs (thus, accounting for a greater weighting in
determining your final grading for the labs). I will also be using a different scoring method, whereby
I will score each of the sections- each with differing point totals, adding up to a total of 100 points.
Please see the scoring rubric on page 22.

I will first provide an overview of the assignment, then provide guidelines as to what I would like you
to include in your report.

For this assignment, you will be:


a) obtaining 226 Hz probe tympanograms as well as conducting multi-frequency tympanometry
b) obtaining acoustic reflexes (both contralateral and ipsilateral) as well as
c) examining acoustic reflex decay

I am asking that you do the above test battery on two subjects. Specifically, please obtain the
following measures from both ears of each subject:

Tympanometry
Physical Volume
Middle Ear Pressure
Static Acoustic Admittance
Tympanogram Type (A, B, C, etc.) for the 226 Hz probe tone
Middle Ear Resonance Frequency- as determined by the point which delta B crosses the X-
axis (obtained using multi-sweep tympanometry: see pages 4-75 to 4-81 of the GSI- Tympstar
manual)

Acoustic Reflexes
Contra Reflex Thresholds (.5K, 1K, 2K, and 4K Hz)
Ipsi Reflex Thresholds (.5K, 1K, and 2 KHz)

Acoustic Reflex Decay


Ipsi and Contra (.5K and 1K Hz)

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Format of the Report

Introduction:
Please indicate the importance of incorporating acoustic immittance measures into a clinical test
battery and how the various components listed above (tympanometry, acoustic reflexes and acoustic
reflex decay) can contribute to the audiological assessment (please examine the literature and cite
references). That is, what can the results from each of the various procedures help us better
understand diagnostically (please note that since this is not a research lab, you do not have to generate
a hypothesis).

Method:
Please describe the equipment used and program parameters that allowed you to derive each of the
various results (e.g., which GSI Tympstar hardware/software features did you access and the specific
methodology used- such as what range of middle ear pressure was encompassed in deriving the
tympanogram, middle ear resonance, how you went about obtaining the acoustic thresholds, what
guided you in determining the actual reflex threshold levels that you conducted acoustic reflex decay,
etc.).

Results:
For each subject, create a summary table that lists the results you obtained for each of the various test
measures. Also, please include a printout for one of the ears from one of your two subjects for each
of the following: (1) a 226 Hz tympanogram; (2) from the multifrequency sweep, the display of the
middle ear resonance based on delta B; (3) results from one acoustic reflex series (ipsilateral or
contralateral); (4) results of reflex decay for one of the frequencies assessed.

Discussion:
Please interpret each of the two subjects findings relative to normative values, and, indicate if they
were within norms, or, if any were deviant from what you would have expected relative to normative
values.

Conclusion:
Please discuss how the overall results would have assisted you relative to their diagnostic value had
they been included as part of an actual hearing assessment, such as: (a) what did the results indicate
relative to each clients middle ear status; (b) auditory nerve/lower auditory brainstem function;
(c) facial nerve status, etc.

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Grading Rubric for Lab 4 (Acoustic Immittance Audiometry)

Category Superior Satisfactory Poor


(9.4 -10 points) (8.4 9.3 points) (7.0-8.3 points)
Introduction Thoroughly discusses Discusses a # of points Omits many key points
20 points how each element of for each immittance relative to each
the acoustic procedure and their acoustic immittance
immittance battery contribution to the procedure and cites
contributes to the assessment; cites some either very few articles
audiological references but not without relating it to
assessment, citing necessarily indicating the information
supporting references how supports points presented/no articles
made cited
Method Accurately describes Accurately describes Describes immittance
15 points immittance bridge, immittance bridge, and bridge but some errors,
software features most of the software and omits many of the
accessed, and features accessed/ software features
sequential steps for sequential steps for accessed with
each procedure each procedure procedural steps
omitted or presented in
a disorganized fashion
Results Results for all Results for most Some results missing
15 points measures clearly/ measures clearly/ or erroneous
accurately indicated in accurately indicated in presentation (e.g.,
the table the table value(s) that does not
concur with printout
Discussion Accurate interpretation Accurate interpretation Misinterpretation of
20 points of each of the test of most of the test findings for at least 2
findings relative to findings relative to of the measures
norms norms, though one obtained
error present
Conclusion Thoroughly and Provides good Does not clearly
20 points logically demonstrates explanation as to how describe the diagnostic
the diagnostic value of the test results would value of including
including these test have assisted the these test measures as
measures as part of a student had the part of a hearing
hearing assessment findings been part of a assessment- leaving
hearing assessment but out many details
does leave out some and/or unclear
details/supporting response
information
Written Excellent organization Fairly good Poor organization;
Expression with answers being organization; answers answers not very clear;
well formulated; mostly clear though numerous
10 points
answers are clearly some inaccuracies in grammatical/ spelling
articulated and well choice of words and errors; language not
explained; minimal some information appropriate for
grammatical or requiring speculation; professional discourse

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spelling errors; some grammatical/
language used is spelling errors but does
appropriate for not interfere with
professional discourse readability of paper;
some colloquial and/or
informal expressions
used but largely
appropriate for
professional discourse

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Lab Assignment B5. Otoacoustic Emissions Assignment (point total =100 points)

Similar to the acoustic immittance lab, this lab is more of a practical experience in learning how to
conduct OAE and how using this technique can assist the clinician.

Using the Otoacoustic Emissions equipment available at Gallaudet University, each student will
conduct both transient and distortion OAE assessments from a normal hearing individual. Both ears
are to be assessed.

The following is an overview of the assignment. Prior to conducting OAES, please:


Conduct an otoscopic evaluation (if much cerumen, ask a clinical educator to remove the
cerumen),
Obtain the clients AC thresholds, and
Conduct tympanometry and obtain Ipsilateral acoustic reflexes at 1 KHz in each ear to ensure
that there is no conductive component present

Subsequently, you will conduct both transient and distortion product omissions on both ears of the
subject.

Information to be obtained and reported include:

Transient OAE
Please indicate:
Overall stimulus level
# Presentations in quiet versus noise
% Reproducibility (i.e., cross correlated power spectrums)
dB S/N ratio at each of the frequency bands displayed

Distortion Product OAE


General Information to be included for the assignment:
F2:F1 frequency ratio
dB SPL levels for F1 and F2
Approximate dB S/N ratio at 1KHz, 1.5Kz, 2KHz, 3KHz, 4KHz, and 6KHz

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Format of the Report


Introduction:
Briefly provide an overview of what OAE are. Then please indicate the value of incorporating
otoacoustic emissions into a clinical test battery; that is, for which populations would obtaining OAEs
be useful and what can the results from OAE help us better understand diagnostically relative to each
population (please examine the literature and cite references).

Method:
Please describe the equipment used and indicate the program parameters separately for the Transient
and Distortion Product OAEs. Please indicate:
Each of the software features accessed
Transient OAE: Overall TEOAE stimulus level and the setting of total # of sweeps to be
accepted
DPOAE: Frequency ratio of F2:F1, F1 and F2 dB SPL levels, and total # of sweeps presented
(how was this # of presentations chosen?)

Results:
For your client, create a table that lists the following results you obtained:
1. Client Related Information
Client Age
AC Thresholds
Tympanometry
Ipsilateral Acoustic Threshold 1KHz

For your client, now create a second table that lists the following results obtained for each ear
separately:

Transient OAE findings:


# acceptable presentations (i.e., # of data samples passed ; that is, noise level during presentation
that was below the reject level, as represented by NLo) versus the number of rejected responses
(# of data samples that were rejected due to the noise being above reject level, as represented by
NHi)
% Reproducibility (i.e., cross correlated power spectrums between the first and second
responses to stimulus presentation); note that the reproducibility values have to be copied
down from what is shown on the screen
TEOAE Response/Noise (i.e., S-N ratio at 1KHz, 1.4 KHz, 2K Hz, 2.8 KHz, 4 KHz)

Distortion Product OAE (Diagnostic Mode):


dB S/N ratio at 1KHz, 1.5Kz, 2KHz, 3KHz, 4KHz, and 6KHz

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Discussion:
Please interpret each of the clients OAE findings. Indicate if they were within norms or if any results
were different from what you would have expected relative to normative values (i.e., any frequency
region where the evoked response was not at a +ve S/N ratio). Please also report what the findings
indicate relative to each ears cochlear outer hair cell status.

Grading Rubric for Lab 5 (OAE)

Category Superior Satisfactory Poor


(9.4 -10 points) (8.4 9.3 points) (7.0-8.3 points)
Introduction Provides an excellent Provides good overview Minimalistic overview of
30 points overview of OAE and how of OAE and how OAE and its contribution
OAE can contribute to the contributes to diagnostic to diagnostic assessments
diagnostic test battery test battery, however, (e.g., omitting many of its
(e.g., populations served leaving out a few key applications) and either
and information that can be points; cites some cites few articles without
gained); cites references references but not relating it to information
and how they support necessarily indicating presented/no articles cited
points made how support points made
Method Accurately describes OAE Accurately describes Describes OAE
15 points equipment, software OAE equipment and equipment but some
features accessed, and most of the software description errors; omits
sequential steps for each features accessed/ many of the software
procedure sequential steps for each features accessed with
procedure procedural steps omitted
or presented in a
disorganized fashion
Results Results for all measures Results for most Some results missing or
15 points clearly/ accurately measures clearly/ erroneous presentation
indicated in the table and accurately indicated in (e.g., value(s) that does
concurs with printout the table and concurs not concur with printout
included in report with printout included in (or printout not included
report in report)
Discussion Accurate interpretation of Accurate interpretation Misinterpretation of
30 points each of the test findings of most of the test findings for at least 2 of
relative to norms findings relative to the measures obtained
norms, though one error
present

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Written Excellent organization with Fairly good Poor organization;
Expression answers being well organization; answers answers not very clear;
formulated; answers are mostly clear though numerous grammatical/
10 points
clearly articulated and well some inaccuracies in spelling errors; language
explained; minimal choice of words/some not appropriate for
grammatical or spelling information requiring professional discourse
errors; language used is speculation; some
appropriate for grammatical/spelling
professional discourse errors but not interfere
with readability; some
colloquial or informal
expressions used but
largely appropriate for
professional discourse

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Appendix C. CASE PRESENTATIONS

Value = 5%
Format
30 minute case study presentations (real or imaginary clients; if real, please do not use actual
names)
PowerPoint; may use additional visual and audio aids
In the Wednesday class on 11/11, paired groups will be chosen via randomized drawing; in
addition, the date selection (and group # for that day) for each group will also be determined via
the randomized drawing;
Presentations will be conducted on Wednesday, December 2 and the week of December 7th

Content
Each paired group will choose a pathology from the list of topics provided at the end of this
Appendix (or suggest an alternative pathology, however, this must be professor approved) and
inform this instructor at the latest by Sunday 11/15. In an effort to avoid duplication this will be
done on a first notification basis (please indicate your first and second alternatives). If a
pathology is already selected, I'll assign a topic to your group. You will be informed of your topic
as soon as possible (no later than Wednesday, 11/18) on which pathology topic you will be
presenting.
Present a case real or fictional, but with the approved pathology
o Start with Case History Info
- Primary complaint(s)
- Medical and any relevant birth history; for the purpose of your presentation, please
do not state any medical issues that would clearly give away the underlying
pathology (e.g., the client has had an ultrasound that has determined .)
- Ear/Hearing related issues
- Any relevant findings from elsewhere (such as headaches/high blood
pressure for which he takes medication).
o Present the audiometric findings (real or extracted from publications)
- Present other findings, as appropriate (such as previous audios)
o Summarize/integrate the test findings
Do not tell the class what the underlying pathology is until you have presented the background
case history information have everyone guess.

Once you have presented the case and you have informed the class of the diagnosis, please:
Present on the typical presentation of this pathology, including:
o Descriptions
o Prevalence
o Symptoms
o Audiometric presentations
Other key findings youd expect
o Typical interventions that are implemented
Dont forget citations, and refer to them as you present in this portion of the presentation (rather than
one big list at the end)

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** An example of a previous student presentation will be provided ahead of time, so that you can
better understand what is expected. This example's pathology cannot serve as your presentation
topic.

Grading Case Presentation: Rubric

Student Name(s):
Presentation Date:

CONTENT & ORGANIZATION POINT TOTAL


1. Case History Description: 1O complaint(s);
birth and/or medical history; ear/hearing
related issues; any results from elsewhere
(2 points)
2. Accuracy/Consistency of Audiometric
Findings: (2 points)
3. Typical Pathology Representation:
description, prevalence; symptoms;
audiometric pattern; other key findings;
accuracy; Thoroughness ( 1.5 pts)
4. Possible Interventions (1.5 points)
5. Overall Organization: (2.0 points)
6. Use of Appropriate References/Citations:
(1.0 point)
Section Score

Comments:

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Grading Case Presentation: Rubric
2nd Page

PRESENTATION DELIVERY POINT TOTAL


1. Clarity of Communication: pace;
presentation level; clarity of concepts
presented (3 points)
2. Quality of PowerPoint slides: font size;
readability; relevance/usefulness of visual
aids (3 points)
3. Ability to respond effectively to questions
(1.0 point)- responses are accurate/clear
4. Stayed within allotted time: (1.0 point)
5. Professionalism: (1.0 point)- faced
audience, professional language used
(avoid jargon/colloquial language)
6. Maintenance of audiences attention:
(1.0 point)
Section Score
Overall Score

Comments:

List of Possible Pathologies:


Vestibular Schwannoma
Cholesteatoma
Discontinuity of the Ossicular Chain
Facial Nerve Disorder
Functional Hearing Disorder
Glomulus Jugulare Tumor
Menieres Disease
Noise Induced Hearing Loss
Otitis Media
Ototoxicity
Sudden (Idiopathic) Sensorineural Hearing Loss
Unilateral Stapes Fixation
Auditory Neuropathy
Ushers Syndrome
*Proposed topics brought forth by student/approved by professor

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Appendix D. Problem-Based, Critical Thinking Assignment


This assignment will examine your ability to analyze the available information and to synthesize a
response that addresses the key issue(s) posed in this assignment.

On Wednesday, November 11 th (upon completion of content lectures), I will present three different
cases for students to review. Students will pair up and during the subsequent weeks will examine
these cases for:
Accuracy/congruency of test results
Completeness of testing or should any other tests be done to derive a more complete profile?
Based on what has been presented (and from all testing that might need to be done), the clients
diagnostic profile

Upon handing out this assignment, the corresponding rubric will also be disseminated.

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