PURE TONE

AUDIOMETRY
 PURE TONE SOUND
▪ An object vibrates in fixed single frequency, the
sound waves presents as a sinusoidal wave pattern
known as sine-wave.

▪ The sound sensation produced by such a

sine-wave is called as a pure tone sound.

▪ In pure tone audiometry, we test the hearing

sensitivity of a subject only for pure tone sounds.
 AIMS OF PURE TONE
AUDIOMETRY
▪ Whether the subject has any definite hearing loss.

▪ Whether the hearing loss is

conductive/sensorineural/mixed type.

▪ To note the degree of hearing

dysfunction.
 PURE TONE AUDIOMETER
▪ An electronic device used for creating pure tone audiogram.

▪ Consists of an audio-oscillator which generates pure tone

sounds of different frequencies from 125-8000 Hz

▪ Each tone can be separately amplified to a maximum of 100 to

110 dB.

▪ Audiometer is connected to standard & specified bone

conduction vibrator or earphones.
 THRESHOLD

▪ The International Standards Organisation has

defined hearing threshold as “the lowest sound
pressure level, at which under specified conditions,
a person gives a predetermined percentage of
correct responses on repeated trials”.
 HOW TO READ AN
AUDIOGRAM
▪Terminology Used

▪ Hertz (Hz) : frequency or pitch, cycles per

second

▪ Decibel (dB) : intensity, or loudness, of the

sound
AUDIOMETRIC
SYMBOLS
 MASKED AUDIOMETRIC
SYMBOLS
Masked Left Ear Masked Right Ear
Air

Bone

Masking keep one ear “busy” while testing the opposite side
 AUDIOMETRIC SYMBOLS
Key to symbols
UNMASKED MASKED

RIGHT LEFT RIGHT LEFT

AIR O X X
CONDUCTION
BONE < > [ ]
CONDUCTION
 PROCEDURE OF P.T.A.
▪ AIR CONDUCTION TESTS

▪ 1.Calibration of the instrument.

▪ 2. Insert ear-phones/ ear conduction head phone cushions
 METHOD
▪ Tones presented for 1-3 sec
▪ First given at above threshold level.
▪ Then decrease 10 dB until no response
▪ Then increase 5 dB until responds.
▪ Repeated 3 times- average taken

❑ Air conduction – checked at 1000 Hz,2000 Hz, 4000 Hz, 8000 Hz, 250
Hz then 500 Hz
❑ Bone conduction – checked at 1000 Hz,2000 Hz, 4000 Hz, 250 Hz then
500 Hz
 PROCEDURE OF P.T.A.
▪ BONE CONDUCTION TESTS

▪ 1.Calibration of the instrument

▪ 2.Reasonably noiseless test environment.
▪ 3.Placement of bone conduction vibrator-
▪ 4. The bone conduction vibrator is placed over the mastoid bone
attached to a spring metal headband.
 PROCEDURE OF P.T.A.
▪ Area over which the person can hear the sound loudest is placed.
▪ The testing ear is kept uncovered. The other ear is kept covered for
masking.
▪ The bone conduction vibrator must not touch the pinna or the earphone.
 MASKING
▪ In pure tone audiometry, the clinician must ascertain the
exact hearing threshold by air & bone conduction for the
different frequencies for each of the two ears separately &
individually.

▪ Contralateral masking means introducing a noise in non-test

ear, such that the non-test ear is acoustically blocked & can
not participate in the hearing test.
 MASKING
▪ Masking is done by:

▪ 1.White noise consists of sound of all frequencies from high to low.

▪ 2.Narrow band noise-more effective, consists of a narrow band of

noise 100-200 Hz above/below that frequency.

▪ 3.Complex noise-low frequency fundamental+multiples of

frequencies up to 4000 Hz. Least efficient for masking.
 INTERPRETETION OF P.T.A.

▪ 1.What is the AC threshold?

▪ 2.What is the BC threshold?

▪ 3.What is the A-B gap?

▪ 4.Wheather masking has been done or not?

▪ 5.Does it match with clinical findings and tuning fork tests?

 AUDIOGRAM PROVIDE SOME
INFORMATION
▪1.Provides a metric for degree of loss

▪2.Type of hearing loss

▪3.Describes the shape of loss

▪4.Differentiate each ear problems

1. DETERMINE AMOUNT OF
LOSS
▪ Hearing impairment is documented
unilateral or bilateral sensorineural,
mixed, or conductive hearing levels
greater than 20dB HL
▪ 0-20 dB – Normal hearing

▪ 20-40dB – Mild hearing loss

▪ 40-55 db – Moderate hearing loss

▪ 55- 70 dB - Moderately severe hearing loss

▪ 70-90 dB – Severe hearing loss

▪ >90 dB – Profound hearing loss

 DETERMINE AMOUNT OF
LOSS
From low to high pitch
From soft to loud
NORMAL AUDIOGRAM
 2. TYPE OF HEARING
LOSS
▪ Conductive
▪ Bone Conduction better than Air Conduction

▪ Sensorineural
▪ Bone Conduction equal to Air Conduction

▪ Mixed
▪ Some amount of Air and Bone Conduction loss
▪ Conductive HL- results from external and middle ear
problems
▪ Bone conductions was normal but air conduction was
affected.
▪ Sensorineural HL -result from disorders in the cochlea or auditory nerve
- both air conduction and bone conduction sensitivity are reduced equally (10
dB and less)
▪ Mixed HL -both a conductive and a sensorineural component affected.
▪ Gap between air and bone more than 10 dB
PTA OF CONDUCTIVE
DEAFNESS
PTA OF SENSORINEURAL
DEAFNESS
PTA OF MIXED DEAFNESS
 CONDUCTIVE DEAFNESS

▪AC threshold>30dB.
▪BC threshold<20 dB.
▪A-B gap>25 dB.
SENSORINEURAL DEAFNESS

▪AC threshold>30 dB.

▪BC threshold>20 dB.
▪A-B gap<20 dB.
 MIXED DEAFNESS

▪AC threshold>45 dB.

▪BC threshold>20 dB.
▪A-B gap>20 dB.
 3.DESCRIBES THE SHAPE OF
LOSS
▪Flat Configuration

▪Sloping

▪Rising
MIDDLE EAR EFFUSION
MENIERE’S DISEASE
NOISE INDUCED HEARING
LOSS
PREBYCUSIS
 4.DIFFERENTIATE EACH EAR
PROBLEMS
Provides a measure of inter-aural
symmetry or the extent to which hearing
sensitivity is the same in both ears or better
in one than the other.
NORMAL HEARING
LOW FREQUENCY
LOSS
CONDUCTIVE HEARING
LOSS
HIGH FREQUENCY
SENSORINEURAL
HEARING LOSS
MIXED HEARING LOSS
CONDUCTIVE DEAFNESS IN
OSSICULAR DISCONTINUITY
PRESBYACUSIS(S.N.D.)
ACOUSTIC TRAUMA
 LIMITATIONS OF P.T.A.
▪ 1.AUDIOGRAMS ARE VERY OFTEN INACCURATE.
▪ a)Improper technique- masking, placement.
▪ b)Improper test condition
▪ c)Improper test instrument- calibration.
▪ d)Improper examiner.

▪ 2.SUBJECTIVE & TIME-CONSUMING TEST.

▪ 3.DOES NOT ASSESS ALL FEATURES OF HEARING.

▪ 4.DOES NOT IDENTIFY THE NATURE OF THE PATHOLOGY.

THANK YOU