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Flashcards in Identification audiometry 2 Deck (14):

When should acoustic immittance screenings be conducted? What are the ASHA guidelines for immittance screening protocol?

  • Should be conducted on a routine basis, esp. for high-risk populations (examples) 
    • Pre-school, native american, eskimo, down's synrome, cleft palette
  • ASHA Guidelines (1996) procedures include a 4 part screening protocol:
    • case history, (ear pain or discharge -> referral)
    • otoscopic inspection, (abnormalities -> referral)
    • Pure tone screen, (identifies sensorineural loss)
    • Tympanometry (*note: no measure of acoustic reflexes because of high over-referral)


How is a tympanogram analyzed? What values indicate failure and require referral?

  • Peak admittance (Y)
    • Height of tympanogram relative to tail value
    • Abnormal results: <.3 mmho> referral
  • Equivalent volume (Vec)
    • Measure admittance at +200 daPa
    • Values that exceed normal range indicate t.m. perf.
    • If flat tympanogram and Vec>1.0 cm3 -> failure
  • Tympanometric width (TW)
    • Describes shape of tympanogram
    • TW that is abnormally wide (>200 daPa) -> failure


What are the failing criteria?

Look in lecture for failing tympanograms and what each is.


What is a failure? What happens if child fails?

  • Failure = results outside the normal range for Peak Y, TW, or equivalent volume with a flat tympanogram
  • If child fails, must be re-screened after an interval (4-6 weeks) to distinguish between persistent cases and transitory cases
  • Failure at re-screening -> medical referral


Describe Silman and Silverman's (1990) study on the evaluation of the ASHA screeing procedure.

  • Tested 54 S’s with middle ear effusion and 53 S’s with normal middle ears, aged 3-11 yrs
  • Used ASHA screening method, TPP, and ipsil. acoustic reflex at 1000 Hz at 100 dB HL
  • Sensitivity of measures:
    • 89% TPP
    • 92.5% for ipsi acoustic reflex
    • 81.5% for ASHA Guidelines
  • Specificity of measures
    • 83% for TPP
    • 84% for ipsi acoustic reflex
    • 79% for ASHA Guidelines


Describe Serpanos and Jarmel's (2007) study on the effectiveness of screening protocol for pre-school children.

  •  Screening program in NY assessed over 10 year period
    • Included pure-tone screen and tympanometry
    • N = 34,979 children, 3-5 years
  • Results
    • 18% children referred for further hearing and/or medical evaluation (22% of these followed up)
    • Of 1,316 children who followed up:
      • outer or middle ear disorder was medically confirmed in 37%
      • Hearing loss (unilat or bilat) was diagnosed in 18%
      • Of these, 12% were conductive, 1% sn, .4% mixed, 5% unspecified
  • Conclusion: hearing loss and/or otologic disorder confirmed in 49% of follow-up group; affirms importance of audiologic screening in pre-school population


Describe the otoacoustic emissions screen. What are OAEs? When are OAEs present and absent? When are OAEs used?

  • OAEs: a low level sound that is present in the ear canal about 5-10 ms after a signal is presented to the ear canal; generated by the cochlea
  • OAEs are present in people with normal hearing and absent with a cochlear lesion > 50 dB HL); also absent with conductive hearing loss
  • OAEs are used in newborn hearing screening: look for present OAEs – either TEOAE or DPOAE in both ears


What is the limitation of the ASHA screening procedures? What are TEOAEs sensitive to? Describe the study that compared the ASHA screening to TEOAEs.

  • Limitation of ASHA screening procedures: require two procedures
  • TEOAEs: are sensitive to both middle ear disorders and cochlear hearing loss
  • Study evaluated the sensitivity/specificity of TEOAEs for school screening
  • Tested 66 students, 5-10 years
  • Conducted ASHA screen and TEOAEs
  • 56 children were normal; 5 had hearing loss or otitis media; 5 had incomplete data
  • 2 methods: similar outcomes re specificity and sensitivity
    • ASHA: sensitivity: 1.0, specificity: .82
    • OAEs: sensitivity: .8-1.0, specificity: .86-.96


Describe hearing screening for adults. What do the ASHA guidelines recommend? What is the pure tone screen?What is the hearing disability screen? What do high scores indicate? What should occur if there is a failure on either measure?

  • ASHA Guidelines: recommend pure tone screen and hearing disability screen every 10 years up to age 50 and every 3 years thereafter.
  • Pure tone screen: at 25 dB HL at 1k, 2k, 4k
  • Hearing disability screen: self-assessment scales with known validity, reliability, and pass/fail criteria:
    • Self-Assessment for Communication (SAC) (Schow & Nerbonne, 1982)
    • Hearing Handicap Inventory for the Elderly
    • Screening Version (HHIE-S) (Ventry & Weinstein, 1983) 
  • Higher scores indicate greater disability
  • Failure on either measure -> counseling, audiologic eval


How is the HHIE-S interpreted?

  • Derive raw score (sum of responses to all 10 items)
    • 0 to 8 = 13% probability of hearing impairment (no handicap/no referral)
    • 10 to 24 = 50% probability of hearing impairment (mild-moderate handicap/refer)
    • 26 to 40 = 84% probability of hearing impairment (severe handicap/refer)


What is the prevalence of individuals in the US with hearing loss?


What does the USPS conclude about adult hearing screening? What does this affect?

  • Screening for Hearing Loss in Older Adults: USPS Task Force Recommendation Statement (2012)
  • Concludes that the current evidence is insufficient to screen for hearing loss in asymptomatic adults aged 50 years or older.
    • Screening tools can reliably and accurately identify adults with objective hearing loss
    • But – “evidence is inadequate to determine whether screening for hearing loss improves health outcome in persons who are unaware of hearing loss or have perceived hearing loss but have not sought care.”
  • Affects policy on screening by primary-care physicians


Describe telephone screening.

  • Telephone hearing screening - available for > 15 yrs - How many beeps did you hear?
    • Advantages?  Limitations?
      • Advantages: Puts it in the hands of the person
      • Dis - no control of level
  • The National Hearing Test (NHT; based on Dutch NHT) ( )
    • Developed by Communications Disorders Technology, Inc., Indiana U, and VU Univ Med Ctr of Amsterdam (support by NIH)
    • Uses sequences of digits in noise, presented with an adaptive tracking method; note that this assesses functional hearing
    • Valid and reliable method of screening (convenient, inexpensive)
    • tests both ears, 4 min./ear
    • Best if tested with a corded, landline phone in a quiet location
    • Validation (Williams-Sanchez et al., 2014): NHT correlates with speechin-noise measures; sensitivity .81, specificity .65 for 4-frequency PTA


Describe internet based hearing screening.

  • Developed a “screening test for detecting high frequency SNHL
    • Stimuli: 25 digit triplets and 25 CVCs
    • Noise: semi-steady-state noise; LP filtered 1.5kHz
    • Procedure: Speech level varied adaptively, noise constant -> SRT
      • Adaptive rule: incorrect response ↑ speech by 2 dB; correct response ↓ 2 dB
        • Initial SNR is -14 dB (about 8-10 dB higher than expected SRT for NH L’s)
      • Internet presentation: L adjusts sound level (S+N) to “comfortable” level; can use speakers or headphones; diotic presentation
    • Validation study: NH L’s (n = 24) and SNHL L’s (n = 50) 
      • Tested at home with varying transducers
      • Found high r’s between HF- PTA and HF-triplet (.79) and HF CVC (.82)
      • Some learning effects with repeated presentation; effects of transducer seen
      • Conc: HF-triplet and CVC tests – sensitive enough to identify HF hrg loss