Introduction to

Audiologic Assessment
What is the purpose of the audiologic
evaluation?
A. Measure degree of loss
B. Define type of loss
C. Determine the medical etiology
D. All the above
E. A and B
Purpose of Audiologic Evaluation
• Define extent of the loss (degree of loss)
– normal, minimal, mild, moderate, moderate
severe, severe, or profound
• Define type of loss
– conductive, sensorineural, mixed, auditory
processing, or functional
Additional Purposes

Audiologic
assessment is
first step in
audiologic
rehabilitation
General Questions
• Why is the person being evaluated
• Should person be referred
• What is the person’s audibility
• What is the etiology
• What is the extent of the handicap from the
hearing loss
Is the referral source important?
A. Yes
B. No
C. Maybe

Senteo Question
To set the properties right click and select
Senteo Question Object->Properties...
Referral-Source Reasons

• Patient self-referral
• Physician referral
• Family member referral
• Psychologist referral
• Other (OSHA, FAA, military, etc.)
• Insurance, compensation
Adult Case History
• provides critical identifying information of person,
contact information, etc.
• shed light on etiology, time of onset, etc.
• prepares audiologist for degree and type of hearing
loss
• may suggest progressive, temporary, fluctuating,
permanent, etc., of hearing loss
• suggest whether referral to others is necessary
Child Case History

• Speech and language

development
• physical
development
• psychosocial
development
• academic
achievement
Other Factors in Case History
• Tinnitus
• Balance
• Medications
• Employment
Lets Play Audiologist
• Observations
• Case History
• Questionnaires (self-
assessments)
• Otoscope exam
• Video otoscopy
• Behavioral
• Pure tone
• Speech
• Immittance
• OAE
• Evoked potentials
Audiometry
• The audiogram is a graph showing the results of the
pure-tone hearing tests. It illustrates the type,
degree, and configuration of hearing loss.

• The frequency or pitch of the sound is referred to in

Hertz (Hz). The intensity or loudness of the sound is
measured in decibels (dB). The responses are
recorded on a chart called an audiogram that shows
intensity levels for each frequency tested.
Normal audiogram
Conductive hearing loss
Sensorineural hearing loss
Mixed hearing loss
Degree of Loss
• Pure tone thresholds
• Speech thresholds
• Evoked potential threshold estimation
Type of Hearing Loss

• Conductive
• Sensorineural
• Mixed
• Auditory processing
disorder
• Functional/organic
Speech Audiometry
• Speech audiometry has become a
fundamental tool in hearing-loss assessment.
In conjunction with pure-tone audiometry, it
can aid in determining the degree and type of
hearing loss. Speech audiometry also provides
information regarding discomfort or tolerance
to speech stimuli and information on word
recognition abilities.
• Speech-detection threshold (SDT): objective
of this measurement is to obtain the lowest
level at which speech can be detected at least
half the time.
• Speech-reception threshold (SRT): objective
of this measure is to obtain the lowest level at
which speech can be identified at least half
the time.
Tympanometry
• Immittance/impedance measurements provide
information about how the middle ear is functioning.
These include tympanometry, acoustic reflex
measures, and static acoustic measures.
• This type of testing is particularly important in
preschool children (ages 3–5), for whom hearing loss
is more often associated with middle ear disease.
• Tympanometry : to detect of fluid in the middle ear,
perforation of the eardrum, or wax blocking the ear
canal.
• It pushes air pressure into the ear canal, making the
eardrum move back and forth. The test measures the
mobility of the eardrum. Graphs are created, called
tympanograms.
• These can reveal a stiff eardrum, fluid in the middle
ear or an eardrum that moves too much.
 OAE
Otoacoustic Emissions
• Low-level sounds produced by the cochlea and
recordable in the external ear canal.
• ie, sounds given off by the inner ear when the cochlea is
stimulated by a sound. When sound stimulates the cochlea,
outer hair cells vibrate. The vibration produces a nearly
inaudible sound that echoes back into the middle ear. The
sound can be measured with a small probe inserted into the
ear canal.

• Spontaneous
• Click-evoked
• Distortion Product
• Stimulus Frequency
• Normal hearing persons produce emissions. Those
with hearing loss greater than 25–30 decibels (dB) do
not produce these very soft sounds.
• The OAE test is often part of a newborn hearing
screening program. This test can detect blockage in
the outer ear canal, as well as the presence of middle
ear fluid and damage to the outer hair cells in the
cochlea.
Clinical Use
• Screening for hearing loss
– Transient and Distortion-Product OAEs
– Rationale: quick, relatively inexpensive, possibly catching
losses in a broader frequency range than ABR
– NIH (1994) recommended two-stage protocol combining
OAEs and ABR
• Role in Audiologic Battery
– Assessment of cochlear health in site-of lesion testing
– Objective info on peripheral auditory functioning
– Correlation to audiogram
– Assessment of Auditory Efferents through Contralateral
Suppression
 ABR
Auditory Brainstem Response
• ABR test gives information about the inner ear
(cochlea) and brain pathways for hearing.
• The test can be used with children or others who
have a difficult time with conventional behavioural
methods of hearing screening.
• The ABR is also indicated for a person with signs,
symptoms, or complaints suggesting a type of
hearing loss in the brain or a brain pathway.
• ABR is performed by pasting electrodes on the
head—similar to electrodes placed around the heart
when an electrocardiogram is run—and recording
brain wave activity in response to sound.
• The person being tested rests quietly or sleeps while
the test is performed. No response is necessary. ABR
can also be used as a screening test in newborn
hearing screening programs
• Instrumentation
• Applications
– differential diagnosis
– auditory threshold testing
– neonatal hearing screening
– neurosurgical intraoperative monitoring
• Interpretation
– latency
– amplitude
– morphology
Handicap Vs. Disability

• Disability
– the functional limitation
imposed by an impairment
• Handicap
– refers to the obstacles to
psychosocial function
resulting from a disability
Screening Hearing Function
• Evoked potentials
• OAE
• Immittance/impedance
• Pure tone air
• Speech
– Whisper Test
– Phonak online speech test
• Questionnaire
– Self-survey
• BHI Quick Hearing Check
– Risk factors
Observations
Observations
Observations
Observations
Observations
Amy Tan Syndrome