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PubMed1997

Pure tone audiometry and impedance screening of school entrant children by nurses: evaluation in a practical setting.

BACKGROUND: Screening for hearing loss in English children at entry to school (age 5-6 years) is usually by pure tone audiometry sweep undertaken by school nurses. This study aimed to compare the validity and screening rates of pure tone audiometry with impedance screening in these children. METHODS: Two stage pure tone audiometry and impedance methods of screening were compared in 610 school entry children from 19 infant schools in north east England. Both procedures were completed by school nurses. The results of screening were validated against subsequent clinical assessment, including otological examination and actions taken by an independent assessor. RESULTS: Both methods produced broadly similar validation indices after two stages of screening: sensitivity was 74.4% for both methods; specificity was 92.1% and 90.0%; and predicted values of a positive test 43.2% and 37.6% respectively for pure tone audiometry and impedance methods. Single stage screening in both methods produced higher sensitivity but lower specificity and predictive values of a positive test than two stage screening. Screening rates were appreciably higher with impedance methods than with pure tone audiometry. CONCLUSIONS: In choosing the method to be used, it must be borne in mind that the impedance method is technically more efficient but takes longer than pure tone audiometry screening. However, the latter method allows opportunity for other health inquiries in these children.

Audiometry, Pure-Tone↗
PubMed1997

Validation of play-conditioned audiometry in a clinical setting.

The aim of the present study was to investigate at what ages children were able to participate in play-conditioned audiometry in a clinical setting. Data concerning age and gender for 294 children (182 boys and 112 girls) were continuously recorded with details regarding audiometric method and number of successfully determined thresholds. Some children were tested more than once, resulting in a total of 449 examinations. The results are compared with those of other studies in which visual reinforced audiometry (VRA), condition-orientation reflex audiometry (COR) and play-conditioned audiometry are used, and show that in a clinical setting it is possible to determine at least one threshold in more than 35% of children tested at ages above 16 months. At 2 years of age, about 50% of the children are able to establish thresholds at least at three frequencies and from 3 years of age nearly 75% of the children could establish 6 thresholds or more. It is concluded that VRA, COR and play-conditioned audiometry should be considered along with objective hearing tests like brainstem audiometry (ABR) or measurement of otoacoustic emissions (OAE) when assessing hearing in infants and small children.

Audiometry, Pure-Tone↗
PubMed1976

[The actual stage of objective audiometry (ERA) (author's transl)].

Evoked Response Audiometry (ERA) comprises a few electrophysiological tests utilizing acoustic evoked potentials as a audiometric criterion. Some potentials with different latencies (early, late and very late potentials) which are mainly used in routine audiometry are reviewed, the practical procedure of the tests (Electrocochleography, Cortical Audiometry and CNV-Audiometry) as well as their results are discussed. Today objective audiometry should be a clinical routine examination which can provide additional and more information than conventional audiometry.

Audiometry↗
PubMed2004

[Characteristics and significance of 1/2 octave frequency pure-tone audiometry on 82 patients with tinnitus].

OBJECTIVE: To characterize the audiometric results of 1/2 octave frequency pure-tone audiometry in tinnitus patients with normal threshold on octave pure-tone audiometry and determine its clinical significance. METHOD: Eighty-two tinnitus patients (140 ears) with normal pure-tone threshold on octave audiometry were examined by using 1/2 octave frequency pure tone audiometry. Thirty normal subjects (60 ears) served as the control. RESULT: Fifty-two ears (37.14%) were mainly hearing loss in high frequency in the tinnitus patients, which closely coincides with the frequency of tinnitus. The hearing loss was slight in most of the tinnitus patients, and the intensity of tinnitus was not related to the degree of hearing loss. CONCLUSION: 1/2 octave frequency pure tone audiometry can offer the early and direct evidences of hearing loss for the tinnitus patients with normal threshold on octave pure tone audiometry, and it is of value for this method in detecting early cochlear lesions.

Adolescent↗
PubMed1990

[Correlation of speech audiometry with the Fowler and Sabin method of hearing loss evaluation].

Evaluation of hearing losses for the purpose of granting pensions, for forensic purposes or for claims of damages is very important and it should not be based on a single examination method i.e., sound audiometry, which does not evaluate the entire auditory analyzer and does not fully appreciate the social usability of hearing. Statistical analysis and mutual correlations between monosyllabic audiometry, mixed and 3-4 syllabic audiometry and sound audiometry revealed that evaluation of hearing losses according to Fowler and Sabine correlates least with mixed verbal audiometry, although mixed verbal set-ups are typical for the Czech language as regards the structure and frequency of words. The authors recommended therefore the use of mixed verbal audiometry for the percentage evaluation of hearing losses. The actual proposal with a table of calculated hearing losses will be in a subsequent communication.

Adult↗
PubMed1980

[The present position of the computer in audiometry (author's transl)].

Alike other fields, in the last years there was a considerable progress in the use of computers in audiology. Here the on-line-operation in the so-called subjective audiometry is dealt with. On principle we have to discriminate between different arrangements, where on the one hand the machine is merely registering and on the other hand the machine is also controlling the test. The last one has the exceeding advantage to be more flexible and also allows the use of randomization, which means a fundamental condition to statistics. In this case the machine also can check the patient's responses - according to the programmm e.g. periods of the patient's inattentiveness may be discovered and the audiometrist may be called. Further on at certain tests the computer may check the results of the investigation in respect to significance in on-line-operation; by this investigations can be shortened. Several situations of application are described; the computercontrolled automatical audiometry can be performed in accordance to Kékésy (the temporal sequence of pulses is independent on the patient's response) or - similar to conventional audiometry - the calculator will wait for patient's response after each stimulus. For scientific investigation the computer-controlled-performance has great advantages because of the machine-compatible output of the results (for further statistical evaluation). By the use of a calculator the audiometry is not at all limited by the inexactness of the patient during an investigation. In spite of this inexactness possibilities are shown to detect farmore smaller differences of the threshold. At least for the moment the use of a computer in routine audiometry seems to be of worth only at great audiometric station and means that the audiometrist has to pay special attention to the psychological state of the patient.

Audiometry↗
PubMed1999

Variable-speech-rate audiometry for hearing aid evaluation.

A new hearing aid evaluation method using variable-speech-rate audiometry (VSRA) was developed. VSRA was newly created based on the Japanese speech audiometry authorized by the Japan Audiological Society. The ordinary speech audiometry can not reveal a temporal factor in word discrimination ability of the hearing impaired. Since, with VSRA, we can compare several performance-intensity curves obtained from different speech-rate speech audiometries, the impact on the auditory system of each patient by the fast or slow speech rate could be easily determined. Taking the temporal factor of the auditory systems into consideration by using VSRA, hearing aid evaluation was performed for a master hearing aid with three types of signal processing and fitting for 36 hearing impaired subjects. Then hearing aid evaluation was performed using VSRA for a newly developed portable multi-function digital hearing aid with two types of signal processing and analog hearing aids which had been used by hearing-impaired patients. As a result, VSRA was useful for hearing aid evaluation, in particular, for cases when ordinary normal speech rate audiometry does not provide a significant difference in word discrimination scores. In addition, using VSRA revealed that amplitude compression is more effective for improvement of word discrimination than linear amplification.

Adolescent↗
PubMed1993

Adding objectivity to infant behavioral audiometry.

This article deals with the limitations of infant behavioral audiometry, which have led us to seek objective methods of audiometry for determining hearing sensitivity in infants. It describes efforts to add objectivity to (or reduce the subjectivity of) behavioral methods of infant audiometry. Several aspects of visual reinforcement audiometry (VRA), including the head turn response, the use of control trials, and adherence to the principles of operant conditioning, serve to reduce the subjectivity inherent in behavior observation audiometry. In addition, computer control of VRA procedures can relieve the examiner of potentially subjective decision-making during the course of evaluation and can facilitate testing with sophisticated algorithms that could not be done manually by a single examiner. Computer simulations to determine the best VRA test parameters are described.

Acoustic Stimulation↗
PubMed1975

Variables in objective audiometry.

Objective audiometry has a definite application in evaluating problem patients. Three basic tests, electrodermal response audiometry (EDR), evoked cortical response audiometry (ERA), and impedance audiometry, are used to evaluate pediatric and adult patients. Each measurement technic, however, has limitations of which the physician should be aware. Impedance audiometry has the greatest potential as an objective measurement of auditory function.

Audiometry↗
PubMed2005

Extended high-frequency audiometry in patients with acoustic trauma.

OBJECTIVES: The aim of this study was to examine extended high-frequency (EHF) hearing in patients with acoustic trauma. DESIGN: A prospective, case-control study in a group of soldiers with acoustic trauma caused by shooting practice during basic training. SETTING: Tertiary referral centre. PARTICIPANTS: A total of 39 young soldiers hospitalized for hearing loss and tinnitus following exposure to weapon impulse noise were studied. Conventional audiometry in the frequency range 0.25-8 kHz and EHF audiometry in the frequency range 9-20 kHz were performed, both on admittance and before discharge. Thirty healthy recruits of similar age and sex were used as controls. MAIN OUTCOME MEASURES: Pure-tone threshold changes documented by conventional and EHF audiometry. RESULTS: The most significant differences in pure-tone thresholds on initial testing were found in the frequency range 0.25-11.2 kHz, and especially in the 4-8 kHz region. Reduction in thresholds across most frequencies was observed after treatment, although recovery was partial in most cases. CONCLUSIONS: The EHF audiometry adds no significant additional information to conventional pure-tone audiometry in assessing and monitoring noise-induced hearing loss.

Acoustic Impedance Tests↗
PubMed2006

Absence of cochleotoxicity measured by standard and high-frequency pure tone audiometry in a trial of once- versus three-times-daily tobramycin in cystic fibrosis patients.

We undertook assessment of hearing in patients with cystic fibrosis who were taking part in a large randomized controlled trial of once- versus three-times-daily tobramycin for pulmonary exacerbations of cystic fibrosis (the TOPIC study). All patients were eligible to have standard pure tone audiometry performed across the frequency range of 0.25 to 8 kHz. High-frequency pure tone audiometry over 10 to 16 kHz was also performed with a subset of patients. Audiometry was undertaken at the start of tobramycin treatment, at the end of a 14-day course of treatment, and at follow-up 6 to 8 weeks later. We enrolled 244 patients, of whom 219 (125 children and 94 adults) completed treatment. Nineteen patients were excluded from analysis due to abnormal baseline audiometry. Complete pre- and posttreatment standard audiological data were obtained for 168/219 patients. We found no significant differences in hearing thresholds when they were assessed at the baseline, at the end of treatment, and at follow-up 6 to 8 weeks later were compared. In addition, no significant differences in hearing thresholds were detected between treatment regimens. Similar results were obtained for the subset of 63/168 patients who underwent high-frequency audiometry. We conclude that for a single 14-day course of tobramycin treatment in patients with cystic fibrosis with no preexisiting auditory deficit, no measurable effect on hearing was apparent with either once- or three-times-daily treatment. Estimation of the cumulative cochleotoxic risk in cystic fibrosis patients due to repeated aminoglycoside therapy, as evidenced by the patients excluded from this study due to hearing loss, also requires further characterization.

Adolescent↗
PubMed1985

Industrial audiometry and the otologist.

The Hearing Conservation Amendment published by the Occupational Safety and Health Administration (OSHA) in 1983 requires hearing conservation programs to be provided for over 5 million workers whose daily noise exposures exceed 85 dBA time-weighted average. The permissible exposure level is 90 dBA, above which the use of hearing protectors is mandatory. Current policies rely heavily on periodic audiometry to detect early threshold shifts due to inadequate use of hearing protection or to individual variation in susceptibility to noise induced hearing loss (NIHL). Studies including over 1,000 noise exposed workers have shown that audiometry in the industrial setting is less reliable than clinical audiometry. Pure tone averaging markedly reduces test-retest variability and should be incorporated into rules for decision-making based on industrial audiometry. However, at least half of observed shifts are spurious. In addition, aging is an important confounding variable; in our data, about half of the population mean threshold shift seen was attributable to aging. Thus, only a minority of threshold shifts seen in industrial audiometry are due to NIHL. The large number of "false positive" shifts will inevitably eventually have the effect of a de facto lowering of the permissible exposure level to 85 dBA. Otologic referral and major administrative action should be reserved for large or repeated threshold shifts. OSHA does not specify rules for otologic referral, but the criteria recommended by the American Academy of Otolaryngology-Head and Neck Surgery are reasonable and should be supported. The necessity for otologic evaluation in the differential diagnosis of NIHL from other entities (particularly baseline audiometric abnormalities) is not universally appreciated; otolaryngologists need to educate their medical and nonmedical colleagues about this.

Audiometry↗
PubMedDate not supplied

Conductive hearing loss evaluated by brief tone audiometry.

Bone-conduction measurements are inaccurate and often troubled by masking problems. Determination of the temporal integration of acoustic energy by Brief Tone Audiometry permits an estimate of the cochlear threshold. In 71 patients with middle ear pathology, the conductive impairment was measured using both conventional audiometry and Brief Tone Audiometry. In 85% of the patients, the estimates coincided within 15 dB. Results from pre- and post-operative measurements are given, and it is demonstrated that Brief Tone Audiometry can be used as an alternative to bone-conduction audiometry to determine the degree of conductive loss with the same accuracy, but without the latter's limitations.

Audiometry↗
PubMed1999

[Audioscan automatic audiometry: theoretical basis and normative data].

Audioscan automatic audiometry is a high resolution method to explore hearing thresholds in the 125 Hz-16 KHz range offering a resolution of 64 points per octave. This procedure makes it possible to study hearing threshold levels at intermediate frequencies which are not measured by conventional audiometry. As suggested in the literature, it is possible to identify hearing threshold notches, considered indicators of mild or subclinical cochlear pathology. In clinical practice, the use of a new audiometric technique requires affirmation of reliability, sensitivity and replicability in time. It also requires defining standard criteria for use in various otologic pathologies. The present study examined 50 normal hearing subjects with conventional audiometry and Audioscan (Essilor model) measurements. A standard acquisition protocol was followed where three Audioscan measurements were conducted per subject. Subjects with a history of acute otologic pathology and familiarity for genetic deafness were ruled out of the study. Multiple, pairwise correlation analyses of the audiometric and Audioscan responses indicate that: (1) there are no significant differences between threshold levels measured by Audioscan and conventional audiometry; (2) there are no significant variations in the hearing levels measured by three Audioscan retests. Three mean indicators of the threshold level have been defined, expressing Audioscan normality in three different frequency ranges. The data suggest that there are some difficulties in the subjectivity of the Audioscan method and some technical problems regarding the lower octave frequencies and these need to be addressed. The results obtained in this study confirmed reliability of the Audioscan in the mid and high frequencies. The definition of the standard mi criteria makes it easier to interpret the Audioscan measurements from cases presenting various otologic pathologies. Therefore, the plasticity and high detection sensitivity of hearing loss make the automatic Audioscan audiometry a useful clinical tool for diagnostic and/or preventive purposes.

Adult↗
PubMed1999

Suggestion audiometry for non-organic hearing loss (pseudohypoacusis) in children.

Pertaining to non-organic hearing loss in children, three goals should be attained: detection of this disease, determination of true hearing levels and information about the possible cause. Recently, objective tests have been used principally for children with non-organic hearing loss; however, these lack the simplicity and convenience of traditional audiometry. A new method, which is referred to as suggestion audiometry, since it is suggested to the patient that hearing will be improved as a result of the test procedure, was developed for the purpose of simultaneously achieving the above-stated three goals. The subjects were 20 patients aged 8-16 years suspected of demonstrating non-organic hearing loss and whose apparent hearing loss had been identified by school hearing examinations. Suggestion pure tone audiometry was useful for the detection of non-organic hearing loss and suggestion speech audiometry was valuable for the determination of true hearing levels. The subjects were classified into four groups according to the test results. We discuss causes of the disease based on the classification of the subjects obtained from this test procedure.

Adolescent↗
PubMed1990

Immitance audiometry.

Immitance audiometry is a safe, simple, reliable, and relatively objective method of determining middle-ear function that provides advantages for examining the difficult patient because minimal cooperation is needed. Acoustic-immitance measurements obtain sophisticated data that give us valuable information about the middle ear mechanism as a whole. It can be used in a quiet office environment. Immitance audiometry can confirm a doubtful otoscopic diagnosis and screen for ear disease. There are limitations to observer reliability with otoscopy, which has good sensitivity but poor specificity, in contrast to immitance audiometry. The tympanogram can be classified into four different patterns on the basis of its characteristics. These patterns are diagnostic, distinguishing normal function from various types of middle ear pathology. Immitance audiometry has very high sensitivity and specificity. The acoustic reflex, a contraction of the stapedius muscle following an intense auditory stimulus, can be valuable in determining a conductive hearing loss and many other otologic diagnoses. As a screening tool, immitance audiometry is most valuable in populations at risk for middle ear effusion, primarily those aged 7 months to 5 years. Significant improvements in measurements of ear function also allow us to be more precise in the diagnoses of otosclerosis, perforation of the tympanic membrane, ossicular discontinuity, facial nerve dysfunction, and brain stem disorders.

Acoustic Impedance Tests↗
PubMed1987

A longitudinal study comparing responses of hearing-impaired infants to pure tones using visual reinforcement and play audiometry.

A group of hearing-impaired infants, originally identified using visual reinforcement audiometry (VRA), were followed until they could be tested using more conventional play audiometry. Minimum response levels using VRA on this hearing-impaired population were highly consistent with measurements obtained later by play audiometry. Statistical analysis shows no significant differences between the two approaches. Test results obtained after the child's second birthday using conventional play audiometry were sufficiently similar to the earlier results obtained by VRA to validate the early test findings. VRA information can be obtained during a period of time when the child is too young to give behavioral information in another way. Use of the VRA test method can specifically define a hearing-impaired infant's minimum response levels so that definite recommendations can be made for auditory management.

Audiometry↗
PubMed1983

Reliability and validity of industrial audiometry: implications for hearing conservation program design.

Hearing conservation in industry relies heavily on monitoring audiometry to detect early noise-induced hearing loss in workers who are exposed to potentially damaging noise, with or without hearing protectors. The "real-world" reliability and validity of these measurements, as well as otoscopic observations in industry, have not been extensively investigated. In addition, there is considerable controversy over the selection of a definition of "significant threshold shift" in industrial audiometry. These and related issues were considered in a series of three studies utilizing data from an active hearing conservation program. Test-retest variability in industry is much higher than has been reported for clinical settings; this variability is reduced by pure-tone averaging. Workers referred for otologic evaluation were found to have hearing levels which were, on the average, about 5 dB better than indicated by plant audiometry, even without excluding 4% of referred workers who had unilateral deafness and showed "shadow curves" on the plant audiograms. Otoscopic data obtained by the plant audiometrists were uncorrelated with the results of otoscopy by consultant otologists. Techniques borrowed from decision theory and signal detection theory were used to evaluate possible criteria for significant threshold shift. Criteria based on pure-tone averaging were superior to those based on a certain amount of threshold shift for any frequency tested. It is proposed that a significant threshold shift be defined as a 10 dB or greater change for the worse for either the 0.5, 1, 2 kHz pure-tone average or the 3, 4, 6 kHz pure-tone average, in either ear, and that such shifts be validated by prompt retesting. Even with this criterion, a substantial number of shifts (most shifts, in some situations) will be either spurious or attributable to disorders other than noise-induced hearing loss, such as presbycusis. Otologic referral in cases of large or repeated shifts may prevent unjustified administrative actions, to the advantage of both workers and management. A practical consequence of the use of monitoring audiometry may be a de facto lowering of the permissible exposure level to 85 dBA TWA.

Adult↗