Audiometry Concepts

Pure Tone Audiometry

Sound has 2
components:
Frequency (pitch) cf.
wavelength
Hz / kHz
Intensity (loudness) cf.
amplitude
dB

Decible scales

Human Speech level

Speech Freq= 300- 3500 Hz
vowels have most of their energy
lower than 1000 Hz.
Speech is mixture of pure tones
Frequency- testes PTA= 250- 8000Hz

audiometry
Subjective methods
1. PTA
2. STH /SA
. Objective methods
1. OAE
2. ABR
3. ECOG
4. Acoustic reflex

Hearing Classification

PTA
used to identifyhearingthreshold levels
determination of the degree, type and hearing
loss
AC done
1. know pt is deaf or Normal
2. Know the degree of impairmentBC done
3. To know the type of deafness
4. To know the inner ear status
A-B gap = average of all frequencies
.Usually BC curve is higher than AC

PTA
Pure tone- tone of particular single
frequnecy
Single frequency used because
Easy to generate,measure and calibrate

Noise= tone of mixed frequency

test frequency range= 125- 8000hz
Pure tone avearge= Avg of hearing
threholds of 500, 1000 and 2000 hz
X-axis- octave of frequency, Yaxisintencity in dB

Patterns of hearing loss

Masking
Done to prevent hearing from the Non
test ear while testing the deaf ear
Due to cross over of sound from test ear
to non test ear by bony vibration
cross hearing suspected best to do
masking to the non-test ear.
1. Types- complex, pink,white,speech
noise

 IA= 40-80 dB
IA= 0-10dB
i/D- cross hearing suspected
1. Mask AC :threshold (test- non test) ear
=> 40 dB
2. Mask BC: A-B gap of test ear >10dB

NORMAL
Speech fequency is 300 3000 hz
Consonants and vowel make up words
and speech
AC= 2*BC
Normal Air bone gap (A-B) - absent or
minimal.

 Vowel information is more cocncentrated in lower

Freq
Consonants centered at higher frequencies

Basic Algorithm
How to READ ?
B
C
<20d
B

A
C

NORM
AL

AbN

>20
dB

CHL

STEP
1
>20d
B
STEP
2

A-B
Gap

<20
dB
SNH
L

>20
dB
MIXE
D

Cochlear
Recruitment ++
Tone decay less 020dB
SDS- 50 to 70% max
Menieres, presbycusis

Retrocochlear

Absent
Tone decay more than 20dB
Very poorVIII and cerebellopontine
angle

Differntiated

by suprathreshold tests- differntial

liamen, SISI, ABLB test, tone decay tests

Recruitment- nonlinear growth or abnormal

growth of loudness, hallmark of cochlear disease

??????

????/

????

???

????

?????

BOILER
S
NOTCH

Up sloping- LFHL

1. Can hear consonants but not vowels

2. often can still understand human speech
well.

Downsloping-HFHL

1.
2.
3.
4.

Can hear vowels but not consonants

difficulty talking in groups
Unable to hear when background noise is present
NIHL,Ototoxicity,presbycusis, genetic,

ABLB

Speech audiometry
SRT
How much can I hear words correctly.
Lowest hearing level at which 50% of
a list of SPONDEE words are correctly
identified.
2 sylabble with equal stress,
baseball, eardrum, arm chair
Difference between PTA and SRT
should not exceed 12dBmalingering.

 SDS
I can hear but cannot understand words
clearly
the percentage of correctly idientifed
words from a list of phonetically
balanced words.
Monosyllable- man,van,tan,can
Normal-100%, CHL-= 100%, SNHLreduced
inference=- HA not useful < 50%

tympanogram

Tympanogram/ impedance
audiolmetry

Stapedial reflex

ABR

BERA

OAE

Emissions from the outer hair cellls of

cochlea

OAE

2 types- Transient and DP OAE

Used for neonnatal screening
Provides integrity of cochlea
identify in early cochlear damage

ECOG
Integrity of cochlea and VIII nerve
Cochlea is transducer, electrical activity in
response to sound stimulus is recorded
3 parameters
1. Cochlear Microphonics
2. Action Potential - AP
3. Summation Potential- SP
Used in Meneires disease. SP/AP=>0.4 (N-SP/AP=0.4)
Used in measuring hearing threshold.

WHAT U SHOULD KNOW

Causes of CHL, SNHL

Algorithm of audiometry.
identify the PTA- patterns
Identify- Impedence audiometry
pattern