40 dB supraaural

70 dB insert

(Remember for bone conduction it is 0dB)

When to mask for AC:

the least level of intensity needed to obtain threshold shift in the non-test ear...

Just enough to shift AC & BC ofthe non-test ear by 5 dB

-used when a tone is presented and it is thought to be heard in the non-test ear

-masking noise is introduced to the non-test ear & intensity increased in 5 dB steps until tone is no longer perceived

-the threshold for the test ear is measured again 

-the tone has reached threshold of the test ear

-further increases in noise does not shift the threshold of the tone

-the masking level is so intense that it crosses to the test ear resulting in continuous increased shifts of threshold & continuous increased shifts in the masking noise

-maintenance & calibration

-test environment

-earphone placement

-bone vibrator placement

Behavior procedures for young children:

soundfield testing

VRA- visual reinforcement audiometry

-thresholds for each ear seperately

-bone conduction thresholds

-responses from children with severe profound hearing loss, due to limitations of equipment 

Speech recognition threshold

identify simple speech materials approximately 50% of the time

1. excellent check on the validity of pure-tone threshold

2. provides basis for selecting the sound level at which a patient's speech recognition abilities should be tested 

 electrical potentials recorded from remote locations using surface electrodes placed on head

-stimulate ear with a brief stimulus

-Decrease stimulus in 10-20dB steps until response disappears and increas in 5db steps until it reappears

-play audiometric techniques

-Tangible reinforcement operant conditioning (TROCA)

-Visual reinforcement operant conditioning

- other types of responses

-false negative responses suggest that hearing sensitivity is pooer than it actually is.

-seen in people who deliberately exaggerate of feign hearing loss. 

when response is given even if no stimulus is presented

sometimes a patient may be highly motivated to respond

tinnitus somtimes invites false responses

this can almost be more aggravating than false negatives

resistance

mass

stiffness

generic terminology

evolved b/c of the difference between Impedance and Admittance.

No dedicated unit of measurement

force causing the movement of air particles through the ear canal.

Force/volume velocity

Dependent

more specifically, dependent on the frequency being measured

As objects are forced to vibrate, and causes a system to respond at frequencies other than its resident frequency opposition will begin.

Mass & stiffness oppose directions because… Mass is proportional to acceleration. Stiffness is proportional to acceleration.Mass & stiffness oppose directions because… Mass is proportional to acceleration. Stiffness is proportional to acceleration.

 Mass & stiffness oppose directions because… Mass is proportional to acceleration. Stiffness is proportional to acceleration.

 Mass & stiffness oppose directions because… Mass is proportional to acceleration. Stiffness is proportional to acceleration.

 Mass is 

-various middle ear pathologies

-eustachian tube dysfunction

-facial nerve dysfunction

-acoustic nerve pathology

-tympanometry

-static acoustiv immitance

-tympanometric width

-acoustic reflex thresholds

the measurement of acoustic immitance w/i the ear canal as the AIR PRESSURE is VARIED w/i the ear canal

ABOVE & BELOW ambient pressure

Obtaining Immitance:

Probe is placed into the ear & creates a __________

226 Hz -low freq

660 Hz- High freq

Speech threshold materials:

ASHA uses most of the 36 spondiac words from the CID W-1

30-40 dB

or at 50 dB HL if an estimate cannot be obtained

phonetically balanced word lists

multiple choice tests

sentence tests

phonetically balanced

performance in percentage-correct recognition of the test items as a function of the intensity of the speech signal.

intensity usually specified in dB above SRT (in dB SL)

age

significant differences until about 2 yrs -11 months

narrower with age

significant differences until about 2 yrs -11 months

reducing peak admittance (immittance) by 50%,

drawing a line to intersect both sides of the tympanogram at that reduced value

and measuring the width of the tympanogram in da Pa between the points of intersection.

SPL result 20 dB higher than the dial setting with Speech. So 0 dB HL is equivalent to 20 dB SPL through a supraural headphone.

SRT serves as a reference for selecting the level of presentation of other speech stimuli at supra-threshold levels

speech threshold measurement:

If no response or incorrect response is given: 

speech threshold measurement:

if a correct response is given:

appear as speech discrimination, speech recognition scres 

preferred term is WR

monosyllabic words,

nonsense syllables

digits

sentences

suprathreshold speech measurements:

materials are offered either in __________ or ___________

closedset paradigm

openset paradigm

MRHT: 

CCT:

NST: 

multiple choice test: MRHT

modified rhyme hearing test

1968

choices differ by one speech sound

eliminates the need to familiarize subject with vocab, reducing potential for practice effect

elimation of examiner bias, ease of administration, simplified scoring

multiple choice test: CCT

California consonant test: developed for & standardized by pop. w/ hearing loss

2 different scramblings of 100 test items

consonant-vowel-consonant monosyllabic word. 36 initial, 64 final consonant words

max. intelligibilty @ 50 dB SL. Slope finction 1.6% per dB

Multiple choice test: NST

Nonsense syllable test

consonant-vowel and vowel-consonant

11 subtests of 7 to 9 syllables each

syllables differ in voicing, positioning (init. or final), voel context (/a,u,i/)

type of errors as well as number of errors

sentence tests:

(4)

CID

SSI

SPIN

connected speech test

sentence test: CID

central institute for the deaf everyday sentence test

first sentence test developed 

no commercial recordings of this material

clinical application somewhat limited

synthetic sentence identification

each word is meaningful, grouping however is not.

grouped with competiting speech. message to competition ratio of 0 dB (meaning presented at same intensity)

similar results to PB materials in a quiet environment

speech perception to noise

8 lists: 50 sentences, each 5 tp 8 words length. 25 sentences w/ high predictability, 25 w/ low. 

HIGH: "The boat sailed across the bay"

LOW: "John talked about the bay"

connected speech test

passages on a central topic, 25 total 'key words.' Pause after each sentence, asked to repeat.

percent correct score & back ground of competing speech

Pediatric population:

PBK

WIPI

NU-CHIPS

phonetically balanced kindergarten test (PBK-50s)

open response, most suitable for 6-9 years

children sometimes lose interest in this tedious test 

word intelligibilty by picture identification test

multiple choice (closed), most widely used in children with hearing loss

4, 25-word lists of monosyllabic words within the vocab of preschool aged children

3.5-6 years old 

Childrens perception of speech

under 3 years

4 lists of 50 items, monosyllabic

word picture identification test

two purposes of carrier phrases:

alerts listener

helps examiner control intensity level during MLV (monitored live voice)

stiff or immobile

(otosclerosis)

supra threshold speech measurements...

Start at __ dB for maximum results…

air pressure measured in dekaPascal (daPa) international systems unit for air pressure...

which axis?

when using an immitance tool:

a low frequency tone is used because...

this is the frequency most affected by changes in stiffness.

pressure is decreased slowly, membrane becomes increasingly compliant, more sound allowed to pass through...

Static Acoustic Immittance is on _______ vaxis.

(unless we are using an Admittance meter then it would be admittance)

When the air pressure within the canal is the same as the space, you will get the maximum transfer of energy. System will be at its most compliant position.

arch peaking at 0 daPa

normal static acoustic admittance & normal mid ear pressure measurements

No peak. Flat tympanogram.

abnormally low static scoustic admittance. 

Excessive negative pressure within the middle ear.

Just acting a little abnormally. Normal acoustic admittance but middle ear pressure is abnormal. Negative pressure within the ear canal.

Peak is smaller and on the negative side of 0 daPa

Pressure is normal, tubes are working fine.

Peak is in expected range but acoustic admittance is abnormally low.

Less compliant than it should be (otosclerosis)

-s is for shallow

pressure is normal, tubes are working fine.

ossicle chain broken, more compliant than it should be.

curve is where we would expect it but admittance is abnormally HIGH 

-d for deep

We are only looking at the acoustic admittance of air between the probe tip and the tympanic membrane.  Because supposedly everything is being reflected of the membrane. When we get to the tympanigram, we stop and measure the acoustic immitance again. Ear canal immitance + middle ear (y-axis 0, .5, 1.5ml of air). You have to subtract if you only want to know the middle ear. EX: 1.0- .3 = .7= middle ear measurement. 

: done when nothing is moving. Done through indirect measurements. Equivalent volume of air in cubic cm.

tells us about the height of the tympanogram

obtained by subtracting the acoustic immittance of the ear canal from the acoustic immittance obtained at the peak of the tympanogram (sometimes referred to as peak compensated static acoustic immittance

the combination of Xm, Xe, and R

a quantity with both magnitude and direction

range of noise levels that fail to shift the tone is the plateau 

level of the tone during the plateau is the true threshold