University of the Pacific Audiometric Evaluation
- Obtain Case History - See Form
- Otoscopy
- Immittance Measurements
- Audiometry
- OAEs after Audiometry
- Counseling
- Report/Chart Notes
Immittance Measurements
Audiometry
As a general rule, start with the better hearing ear, if the ears are the same, start with the right ear
SRTs/SDTs
- Familiarize with spondee word list using MLV (monitored live voice)
- start presentation at 65 db HL in binaural condition
- confirm with patient if the volume is comfortable
- use at least 9 - 12 words to familiarize
- start presentation at 65 db HL in binaural condition
- Use the bracketing method
- Threshold is defined as the lowest level at which 3 words are correctly repeated
- Spondee list of 15 of the most homogenous words
- baseball, doormat, drawbridge, eardrum, grandson, inkwell, mousetrap, northwest, padlock, playground, railroad, sidewalk, toothbrush, woodwork, workshop
- baseball, doormat, drawbridge, eardrum, grandson, inkwell, mousetrap, northwest, padlock, playground, railroad, sidewalk, toothbrush, woodwork, workshop
MCL
- Use MLV (monitored live voice); give running speech
- Use bracketing procedure, even if the patient says the first presentation volume is comfortable
UCL
- Test using MLV (monitored live voice)
- Instruct at MCL and then increase in 5dB steps until "uncomfortably loud
Air Conduction Pure Tone Thresholds
- Use insert earphones, unless contraindicated and a pulsed or warble tone
- Start at 1kHz
- begin presentation at obtained MCL for familiarization and then begin threshold searches
- Use Hughson & Westlake bracketing method
- Threshold Test order: 1k, 500, 250, 2k, 3k, 4k, 6k & 8k
- Include other inter-octaves if there is a difference of 20dB or more between thresholds
- Threshold is determined to be the level where 2 out of 3 correct responses are obtained at the lowest ascending test level
- Mask as needed
- Compare calculated PTA to the obtained SRTs to determine test reliability
- Mask as needed
- Masking criteria
- Air Bone Gap is > 40 dB (headphones)
- Air Bone Gap is > 50 dB (insert earphones)
- Applies to SRT and Pure Tones
- Air Bone Gap is > 40 dB (headphones)
- Masking criteria
Word Recognition
- Use an NU-6 word list
- If a patient scores 9/10, score 96% (Thornton & Raffin)
- For all other scores, score normally and note how many words are tested in the report
- Test presentation criteria (based on Guthrie & Mackersie recommendations)
- If word rec scores are significantly different between ears or different from a previous test, consider re-testing at +10dB HL to see if the score improves
- Report on the significance of difference between ears/previous test (using Thornton & Raffin criteria)
QuickSIN
- Test binaurally, unless there is a significant hearing loss asymmetry between ears
- Test presentation criteria:
- For PTAs </= 45 dB HL = test at 70 dB HL
- For PTAs > 45 dB HL = test at UCL - 10
- Perform a total of 3 lists; do not score the first practice list
Bone Conduction
- Using a mastoid placement with ears un-occluded, obtain bone-conduction thresholds with the bone oscillator first on the right mastoid and then repeat on the left mastoid
- Use threshold search method as described above for air conduction thresholds
- important to test below 0dB
- Mask as needed
- Masking Criteria - Mask if Air Bone Gap is > 10 dB so if there is a 15 dB gap
- Masking Criteria - Mask if Air Bone Gap is > 10 dB so if there is a 15 dB gap
OAEs
Capella System
GSI System
Capella System
- Conduct on all patients except for patients who have documented no OAEs
- Run Comprehensive protocol (currently compares to 95%tile Boys Town Research)
- Remove and replace probe with each run
GSI System
- Run the 1.5kHz - 8kHz protocol
- Run DPOAEs for two runs in each ear
- Remove and replace probe in between each run