Pure-tone audiometry is a behavioral test used to measure hearing sensitivity. This measure involves the peripheral and central auditory systems. Pure-tone threshold (PTTs) indicate the softest sound audible to an individual of the time. Hearing sensitivity is plotted on an audiogram, which is a graph displaying intensity as a function of frequency.
A tympanogram is a graphic representation of the relationship between the air pressure in the ear canal and the movement of the eardrum, or tympanic membrane, and the tiny bones in the air-filled middle ear space. When the eardrum is disturbed by a sound, part of the sound is absorbed and sent through the middle ear while the other part of the sound is reflected. The information derived from tympanometry provides additional information regarding middle ear function, especially Eustachian tube function.
The otoscopic exam is performed by gently pulling the auricle upward and backward. In children, the auricle should be pulled downward and backward. This process will move the acoustic meatus in line with the canal. Hold the otoscope like a pen/pencil and use the little finger area as a fulcrum. This prevents injury should the patient turn suddenly.
Brainstem Evoked Response Audiometry (BERA)
BERA is an objective way of eliciting brain stem potentials in response to audiological click stimuli. These waves are recorded by electrodes placed over the scalp. Thisinvestigation was first described by Jewett and Williston in 1971.
Even though BERA provides information regarding auditory function and sensitivity, it is not a substitute for other methods of audiological evaluation. It should be always viewed in conjunction with other audiological investigations.
Auditory Steady State Response (ASSR)
Auditory Steady State Response (ASSR) is an objective test used for evaluation of hearing ability in children too young for traditional audiometric testing. Most children are referred for ASSR after a newborn hearing screen in the hospital indicates the possibility of hearing loss. Early intervention strategies, such as hearing devices 0r cochlear implantation, are necessary for development of speech and language skills in a child with hearing impairment. The results obtained from ASSR testing can be used to estimate the behavioral pure-tone audiogram. This information is essential in the management of children with hearing loss.
✡ASSR compared To ABR✡
ASSR is similar to the ABR in some respects.For example, ASSR and ABR record bioelectric activity from electrodes arranged in similar recording arrays .ASSR and ABR auditory evoked potentials.ASSR and ABR use acoustic stimuli delivered through inserts
ASSR and ABR have important differences ,too.Rather than depending on ampiltude and latency , ASSR uses amplitudes and phases in the spectral domain. ASSR depends on peak detection across a spectrum ,rather than peak detection accros a time versus amplitude waveform .ASSR is evoked using brief sounds presented at a relatively low repetition rate.
ABR recordings are most often dependent on the examiner subjectively reviewing the waveform and deciding whether a response is present. Determining the response becomes increasingly difficult as the ABR approaches true threshold —which is when the decision is more important. ASSR uses an objective , sophisticated , statistics–based mathematical detection algorithm to detect and define hearing thresholds .
ABR protocols typically use clicks or tone-bursts in one 👂 at a time .
ASSR cab be used binaurlly ,while evaluating broad bands or four frequencies (500Hz,1000 Hz, 2000Hz, and 4000Hz) simultaneously.
ABR is useful in estimating hearing thresholds essentially from 1,000 Hz to 4,000 Hz in typical mild -moderate-severe hearing losses. ASSR can also estimate hearing thresholds across the same range as the ABR ,but ASSR offers more spectral information more quickly,and can estimate and differentiate hearing within the severe to profound hearing loss ranges.
The ability to detect difference in these significant hearing loss categories is very important. For example , differentiating a 75 dB versus 95 dB hearing loss may impact decisions such as fitting traditional hearing aids on a child with a 75 dB SNHL.
Play Way Audiometry
Conditioned play audiometry (CPA), sometimes called play audiometry, is a method of testing the hearing ability of a child of toddler or preschool age.
CPA is a fun and interactive game. It involves conditioning the child to listen to sounds and indicate a response when the sound is heard through a playful activity. The response is elicited by making it interesting to the child, such as throwing a ball in a bucket, adding a block to the castle, putting a piece into a puzzle, or pretty much any playful activity that the child may enjoy.
Free Field Testing
It is just a hearing test where they have you leave your hearing aids on and they do the test through a speaker that is in the booth with you. They want to see how much help your hearing aids are to you
Speech therapy is an intervention service that focuses on improving a child’s speech and abilities to understand and express language, including nonverbal language. Speech therapists, or speech and language pathologists (SLPs), are the professionals who provide these services.
. 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.