Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Audiology
Dr. the who/December 9, 2010
WEBER’S Test
the stem of the vibrating TF is held in the midline of the
forehead, vertex of the skull, or best the incisors
The pt. Is asked to which ear it is best heard or midline
results:
lateralization:
a) to the poorer ear – hearing loss is conductive
reasons:
1) attenuation of air conducted
background noise
2) prevention of loss of acoustic
energy from the EAC
b) to the better ear – hearing loss is SN
c) midline – 1) = SN hearing loss
2) normal hearing AU
3) equal conductive hearing loss
RINNE’S Test
E V A L U A T IO N Compares the pts. Hearing by bone conduction against air
1. Etiology – diagnosis conduction
2. Tools for hearing evaluation the hilt of the vibrating TF is held against the pt’s mastoid
a) TUNING FORK TEST process until no longer heard and the tines placed close tothe
b) PURE TONE AUDIOMETRY orifice of the EAC, same ear, until no longer heard
c) SPEECH AUDIOMETRY normally AC>BC by a ratio of 2:1
d) TYMPANOMETRY
e) BERA Reason: the intrinsic impedance mismatch in the fork skull
3. Degree of Hearing Loss relationship
a) mild
b) moderate results hearing status locus
c) severe a)positive AC>BC normal or SN none or cochlear,
impairmentretrocochlear
TUNING FORK TEST b)negative AC<BC conductive EAC/ME
Reference Comparison
a.) Examiner – standard or golden ear
b.) Patient’s own normal ear – for unilateral hearing loss
c.) Third person with normal hearing acuity
Otorhinolaryngology - AUDIOLOGY
Page 3 of 9
3 ESSENTIAL PARTS (PTA)
1. Variable frequency oscillator to produce sounds
2. Attenuator to permit variations in intensity
3. Transducer, either an earphone, bone vibrator or a loud
speaker to convert electrical to acoustic energy
AUDIOGRAM
• a graph of the patient’s hearing sensitivity for various
frequencies
• measures are recorded for each ear separately with frequency
on the abscissa & intensity on the ordinate
THRESHOLD
• the lowest intensity level in db that can be heard for each
SCHWABACH’S Test frequency
compares the pt’s bone conduction against a normalreference
the stem of the vibrating TF is held against the mastoidprocess AUDIOMETRIC ZERO (ANSI)
of the pt until inaudible, then applied to the sameagainst a • the median average threshold of a large sample of young
normal reference& the time measured until no longer adults with no hearing complaints, no history of ear disease &
perceived no recent colds
• each frequency has its separate zero with zero calibrated
results hearing status locus values built into the audiometer
equal normal none
prolonged conductive EAC/ME INTERPRETATION
diminished sensorineural coclear/retrococlear 1. Degree of hearing loss
a.) Mild
BING’S Test b.) Moderate
application of the so-called occlusion effect c.) Severe
while the stem of the vibrating TF is held against the pt’s d.) Profound
mastoid process, the EAC is alternately occluded 2. Configuration or pattern of loss
- certain disorders or diseases seem to have associated
results hearing status locus audiometric signature
positive increase/decrease normal/SN none/coclear/ 3. Air conduction – Bone conduction Relationship
in loudness retrocochlear a) when BC thresholds are better than air conduction by 10 db or
negative none conductive EAC/ME more & are normal, the loss is conductive
b) when bone conduction thresholds are the same as air
Reliability: conduction& neither is normal, the loss is sensorineural
- problems of reliability ensue from judgment errors of both the c) when bone conduction thresholds are reduced but are still
patient & the examiner as to the moment of inaudibility as the tonal better than air conduction by 10 db or more, the loss is mixed
experience decays into silence or combined
- the 256 TF is the most accurate in determining slight conductive
hearing loss but requires control of background noise
- the 512 TF is better able to provide useful Bing’s test
- the incidence of false negative rinne and false increased
schwabach arises from the nature of bone conduction:
a) the vibrating TF applied to the skull will vibrate the entire
head, thus both ears stimulated. The result will therefore reflect the
ear with better bone conduction.
Phonetically Balanced (PB) Word List for CID Auditory Test W-22,
List A
Clinical uses
1. Threshold testing in infants, young
children and malingerers
2. Diagnosis of acoustic neurinomas
3. Diagnosis of brainstem lesions
Otorhinolaryngology - AUDIOLOGY
Page 7 of 9
Sample case:
Mr. Juan dela Cruz 23 y/o
CC: hearing loss
Otoscopy: AD-intact TM AS-perforated TM
TFT: 512
Weber: lateralize to the left Bing’s test : AD- positive
Rinne: AD- AC>BC AS- negative
AS- BC>AC Schwabach’s test: AU- diminished
Pre OP
250 500 750 1000 1500 2000 3000 4000 6000 8000
Post Op
250 500 750 1000 1500 2000 3000 4000 6000 8000