University of the Pacific Audiometric Evaluation

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
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

MCL

Use MLV (monitored live voice); give running speech
Use bracketing procedure, even if the patient says the first presentation volume is comfortable

UCL

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

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

OAEs

Capella System

GSI System