Chapters 4 & 5 Behavioral Testing

1. Chapters 4 & 5Behavioral Testing Perry C. Hanavan, Au.D. Audiologist

2. Audiometer

3. 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 Earphones

4. Audiogram Styles

5. Audiogram Styles

6. Recording AC Thresholds

7. Degree of Loss • Normal 10 or better • Minimal 11-25 dB HTL • Mild 26-40 • Moderate 41-55 • Moderately severe 56-70 • Severe 71-90 • Profound greater than 90

8. Type of Loss • Compare air conduction and bone conduction thresholds Outer Ear Conductive Loss Middle Ear Inner Ear Sensorineural Loss Auditory Nerve Mixed Loss

10. Audiogram 2-27 Number Yes/No

11. Air Bone

12. Configurations

13. Symptoms - Dysfunction Symptoms/Complaints • Tinnitus • Dizziness • Ear pain • Ear fullness/pressure • Communication difficulty Potential Dysfunction • Non (Normal or Functional • Ear canal obstruction • Middle ear disorder • Inner ear disorder • Auditory nerve disorder • Auditory processing disorder

14. Potential Site of Lesion • Symptoms • Referral source info • Rule out system • Audiologic tests • Normal • Functional • Outer ear • Middle ear • Inner ear • Auditory nerve • Central auditory system

15. Audiology Test Battery • Case History • Otoscopic exam • Immitance battery • SRT • Pure tone AC and BC • Speech recognition tests • Otoacoustic emissions (OAE) • ABR and/or CAEP (Evoked Potentials)

16. Normal • Functional • Outer ear • Middle ear • Inner ear • Auditory nerve • Central auditory system

17. Functional • Outer ear • Middle ear • Inner ear • Auditory nerve • Central auditory system

18. Normal • Functional • Outer ear • Middle ear • Inner ear • Auditory nerve • Central auditory system

19. Normal • Functional • Outer ear • Middle ear • Inner ear • Auditory nerve • Central auditory system

20. CROSS CHECK • SRT should be within +/- 10 dB of PTA

21. Masking • Crossover • Results when sound presented to one ear through earphones crosses to the head via bone conduction and is perceived by the opposite ear

22. Masking • Interaural 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 65

23. AC Masking • Supra-aural earphone PTACTE – PTBCNTE >= 40 dB HL then mask • Insert earphone PTACTE – PTBCNTE >= 70 dB HL then mask Interaural attenuation is 40 dB HL or supra-aural phones and 70 dB HL for insert phones

24. BC Masking • Bone oscillator • A-B gapTE > 10 dB HL (mask) (interaural attenuation is 0 dB for BC)

25. Speech Masking Supra-aural phones: • Speech Test LevelTE – best BCNTE => 40 dB Insert Phones • Speech 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)

26. Normal • Functional • Outer ear • Middle ear • Inner ear • Auditory nerve • Central auditory system

27. Speech Audiometry • Purpose • Attempt to measure the ability to understand everyday conversational communication

28. Uses of Speech Audiometry • Measure of speech threshold • Cross-check pure tone results • Measure of supra-threshold speech recognition ability • Differential diagnosis • Measure of auditory processing ability • Estimation of communication function

29. SPEECH TESTING • SRT (speech recognition threshold) • Measure of speech threshold • Typically use spondees • SRA (speech recognition ability) • Measure of clarity • Supra threshold • Typically use monosyllabic or sentence material

30. Speech Threshold • Lowest level at which speech can be recognized or detected • SRT (could be any kind of speech material) • ST (spondee threshold) • SAT (speech awareness threshold) • SDT (speech detection threshold)

31. Spondee Threshold • ST – the lowest level in decibels spondees can be recognize correctly • Measure of threshold sensitivity for recognizing speech • Provides estimation of hearing sensitivity in the primary speech frequencies • Comparable estimation of PTA (useful for cross-check) • Spondee • bisyllabic word enunciated with equal stress on both syllables • Trochees (not used for assessing SRT) • bisyllabic word with unequal stress on both syllables

32. ST Materials • Baseball • Cowboy • Hotdog • Sunset • Ice cream • Railroad • Sidewalk

33. SRT • Speech Recognition Threshold • Lowest level in decibels at which speech can be recognized correctly with at lease 50% criterion • Sentences, spondees, etc. • Typically use spondees unless otherwise indicated

34. SAT/SDT • Speech awareness or detection level • Lowest level in decibels at which speech is detected • Used when patient unable to respond to spondees (infants, developmental delays, etc.) • Approximately 10 dB better threshold than SRT threshold • Audiometers calibrated to speech recognition level than detection levels

35. Ling 6 Sounds

36. Supra-threshold Speech Recognition Ability • Ability 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 SL • Measured scores are generally predictable from degree, configuration and type of loss from pure tone results

37. Speech Recognition Ability Materials • Discourse • Sentences • Words • syllables • Phonemes • Nonsense words • Synthetic sentences • Speech in noise • Filtered speech

38. Speech Test Administration • Monitored Live Voice • Speaker variations • Scores affected by rate and quality of presentation • May not provide sufficient test-retest reliability • Recorded • Recommended procedure • Greater test-retest reliability • Normative data (for word recognition scores – WRS…speech recognition ability scores)

39. Open Vs. Closed Set • Closed Set • Limited set of response possibilities • Useful for young children with limited vocabulary, patients with poor articulation, developmental delays • Scores may be 10% better compared to open set scores • Open Set • More challenging as response possibilities are somewhat unlimited

40. NU-6 (CNC)(Open Set)(Recorded or Live)

41. CID W-22 (PB Word Lists)(Open Set)(Recorded or Live)

42. CUNY Nonsense Syllable Test(Closed Set)(Recorded)

43. Minimum Age of Administration

44. WIPI (25 Word Lists)(Closed Set)(Recorded)

45. NU-CHIPS(Closed Set)(Recorded)

46. 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.

47. Pediatric Speech Intelligibility(Closed Set)(Recorded) • PSI • Both 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.

48. BKB-SIN (Adults)(Open Set)(Recorded)

49. BKB-SIN (Children)(Open Set)(Recored)

50. Quick-SIN for AdultsOpen Set-Recorded