Perry C Hanavan AuD Audiologist Audiometer Earphones Ear Insert Earphones Reduce masking Reduce ear canal collapse Enhanced stability of sound delivered to ear Increase Comfort Reduce spread of bacteria ID: 662083
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Slide1
Chapters 4 & 5
Behavioral Testing
Perry C. Hanavan, Au.D.AudiologistSlide2
AudiometerSlide3
Earphones
Ear Insert Earphones
Reduce masking
Reduce ear canal collapse
Enhanced stability of sound delivered to ear
Increase Comfort
Reduce spread of bacteria
Supra-aural EarphonesSlide4
Audiogram StylesSlide5
Audiogram StylesSlide6
Recording AC ThresholdsSlide7
Degree of LossNormal 10 or betterMinimal 11-25 dB HTLMild 26-40
Moderate 41-55Moderately severe 56-70Severe 71-90Profound greater than 90Slide8
Type of LossCompare air conduction and bone conduction thresholds
Outer Ear
Middle Ear
Inner Ear
Auditory Nerve
Conductive Loss
Sensorineural Loss
Mixed LossSlide9Slide10
Audiogram 2-27
Number
Yes/NoSlide11
Air BoneSlide12
ConfigurationsSlide13
Number
Yes/NoSlide14
yes/no
numberSlide15
yes/no
numberSlide16
yes/no
numberSlide17
CROSS CHECKSRT should be within +/- 10 dB of PTASlide18
MaskingCrossoverResults when sound presented to one ear through earphones crosses to the head via bone conduction and is perceived by the opposite earSlide19
MaskingInteraural attenuation (air conduction pure tone)Reduction in sound energy of a signal as it is transmitted by bone conduction from one side to the other
Hz Supra-aural Insert Bone 250 40 75 0
500 40 75 0 1000 40 60 0 2000 45 55 0
4000 50 65 0
8000 50 65Slide20
AC MaskingSupra-aural earphonePTACTE
– PTBCNTE >= 40 dB HLInsert earphonePTAC
TE – PTBCNTE >= 70 dB HLInteraural attenuation is 40 dB HL or supra-aural phones and 70 dB HL for insert phonesSlide21
BC MaskingBone oscillatorA-B gapTE
> 10 dB HL (mask)(interaural attenuation is 0 for BC)Slide22
Speech MaskingSupra-aural phones:Speech Test LevelTE – best BC
NTE => 40 dBInsert PhonesSpeech Test LevelTE – best BCNTE => 70 dB
( Evaluate any speech test such as SRT and/or SRA and compare to the best BC of the non-test or opposite ear)Slide23
yes/no
numberSlide24
Speech AudiometryPurposeAttempt to measure the ability to understand everyday conversational communicationSlide25
Uses of Speech AudiometryMeasure of speech thresholdCross-check pure tone resultsMeasure of supra-threshold speech recognition ability
Differential diagnosisMeasure of auditory processing abilityEstimation of communication functionSlide26
SPEECH TESTINGSRT (speech recognition threshold)Measure of speech threshold
Typically use spondeesSRA (speech recognition ability)Measure of claritySupra thresholdTypically use monosyllabic or sentence materialSlide27
Speech ThresholdLowest level at which speech can be recognized or detectedSRT (could be any kind of speech material)ST (spondee threshold)
SAT (speech awareness threshold)SDT (speech detection threshold)Slide28
Spondee ThresholdST – the lowest level in decibels spondees can be recognize correctlyMeasure of threshold sensitivity for recognizing speech
Provides estimation of hearing sensitivity in the primary speech frequenciesComparable estimation of PTA (useful for cross-check)Spondee
bisyllabic word enunciated with equal stress on both syllablesSlide29
ST MaterialsBaseballCowboyHotdogSunset
Ice creamRailroadSidewalk Slide30
SRTSpeech Recognition ThresholdLowest level in decibels at which speech can be recognized correctlySentences, spondees, etc.
Typically use spondees unless otherwise indicatedSlide31
SAT/SDTSpeech awareness or detection levelLowest level in decibels at which speech is detectedUsed when patient unable to respond to spondees
Approximately 10 dB better threshold than for SRTAudiometers are calibrated to speech recognition than detection levels Slide32
Supra-threshold Speech Recognition AbilityAbility to correctly recognize speech at supra-threshold levels (reported in percentage of words correct at intensity level of presentation)100% at 80 dB HL
96% at 40 dB SLMeasured scores are generally predictable from degree, configuration and type of loss from pure tone resultsSlide33
Speech Recognition Ability MaterialsDiscourseSentences
WordssyllablesPhonemesNonsense wordsSynthetic sentences
Speech in noiseFilteredSlide34
Speech Test AdministrationMonitored Live VoiceSpeaker variationsScores affected by rate and quality of presentation
May not provide sufficient test-retest reliabilityRecordedRecommended procedureGreater test-retest reliabilityNormative data (for word recognition scores – WRS…speech recognition ability scores)Slide35
Open Vs. Closed SetClosed SetLimited set of response possibilitiesUseful for young children with limited vocabulary, patients with poor articulation, developmental delaysScores may be 10% better compared to open set scores
Open SetMore challenging as response possibilities are somewhat unlimitedSlide36
NU-6 (CNC)(Open Set)(Recorded or Live)Slide37
CID W-22 (PB Word Lists)(Open Set)(Recorded or Live)Slide38
CUNY Nonsense Syllable Test(Closed Set)(Recorded)Slide39
Minimum Age of AdministrationSlide40
WIPI (25 Word Lists)(Closed Set)(Recorded)Slide41
NU-CHIPS(Closed Set)(Recorded)Slide42
Dichotic Sentence Identification(Closed Set)(Recorded)The DSI test uses 6 of the same sentences as the SSI-ICM test but presents 1 sentence to each ear simultaneously at 50-dB SL, and the participant is asked to select from a printed list which 2 sentences were heard.
Fifer et al showed that the test is resistant to the effects of SNHL below 50 dB HL. The DSI test is administered in both a free and a directed mode. In the directed mode, only the sentence heard in test ear is noted, whereas in the free mode, the sentences heard in both ears are reported. Five presentations are used if the score is 100%; otherwise, another 5 sentences per ear are administered.
Scores are better in the directed mode than in the free mode, and the right ear scores are normally higher in adults than the left ear scores, presumably due to age related corpus callosum dysfunction.Normal scores are 80% correct and above.Slide43
Pediatric Speech Intelligibility(Closed Set)(Recorded)PSIBoth monosyllabic words
and sentences recorded in quiet and with competition.Employs color plates with pictures of animals (animals used to avoid ethnic biases) which represent either the sentences or the words.
Investigates peripheral and auditory processing disorders.Slide44
BKB-SIN (Adults)(Open Set)(Recorded)Slide45
BKB-SIN (Children)(Open Set)(Recored)Slide46
Redundancy vs. HL Sensitivity Redundancy of Informational Content
Sensitivity to Hearing Loss
Syllables
Words
Sentences
less
more
less
moreSlide47
Significant DifferenceCompare test resultsWhen is there a significant difference between test scores on speech scores?
These data permit comparison of scores to determine whether there is a significant differenceSlide48
Lower Confidence LevelsSlide49
yes/no
numberSlide50Slide51Slide52Slide53Slide54Slide55Slide56Slide57
Count the Dots
Each dot represents 1% of the information contributing to speech clarity.
The number of dots audible predict how well one understands quiet speech from a six foot distance.
The dots are unevenly distributed, with many more of them filling in the gray zone between 1000 and 3000 Hz than in the 250 to 500 Hz area.
Count the dots that are below a person’s audiometric threshold.
The more dots below threshold, the better one is able to hear normal conversational speech.
The fewer dots below threshold, the more difficulty hearing conversational speech.Slide58
SII and AI RelationshipSlide59
SII and AI Relationship of Various Speech MaterialsSlide60
Count the Dot (AI)Slide61
SNR Loss for 110 HA WearersSlide62
QuickSIN Test for SNRSlide63
26% AI Understand 90% Sentences Slide64
SNR LossSlide65
PI & Site of LesionSlide66
Pathologic PICalculate PI for SNWhen .40 or greater, suggests neural
rather than cochlearSlide67
yes/no
numberSlide68
Number of Words for SRASlide69
Speech Site of Lesion Diagnosis
A-B Gap
Excellent SRA
No Rollover
A-B Gap
Excellent SRA
No Rollover
SN Loss
XX No Significant
Rollover
SRA above
lower confidence
limits
SN Loss
Significant
Rollover
XX
SRA below
Lower confidence
Limits (scores
lower than
expected for
degree of loss)
OE
ME
IE
ANSlide70
Audigram 5-23Slide71
Audiogram 5-4Slide72
Speech MaskingSupra-aural earphoneSpeech LevelTE – BC
NTE(best tone) >= 40 dB HLInsert earphoneSpeech LevelTE – BCNTE(best tone)
>= 70 dB HLSlide73
Audiogram 2-20Slide74
Audiogram 2-25Slide75